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BACKGROUND: Insecticide-treated nets (ITNs) are pivotal tools for malaria prevention in endemic regions like Ghana. Understanding the protective factors and barriers influencing ITN ownership and usage is crucial for designing effective interventions. A scoping review was conducted to identify studies exploring protective factors and barriers related to ITN ownership and usage. METHODS: This review followed the guidelines by Askey and O'Malley. Search was done in four major databases including PubMed, Science Direct, PubMed CENTRAL, and JSTOR. Additional searches were done in Google Scholar and Google. Peer-reviewed and grey literature were included. RESULTS: A total of 24 papers met the eligibility criteria and were included in the review. Included studies found regional disparities in ITN ownership and usage. Furthermore, included studies reported ownership rates between 97.8 and 28% and usage rates between 94 and 20%. Protective factors facilitating ITN ownership were marital status, higher educational attainment, higher income levels, and being aged 25 years or older. In contrast, the factors for its use included community-level campaigns advocating for ITN use and awareness, individuals with secondary education or higher and those residing in urban areas. Missed opportunities in free distribution exercises and the unavailability of subsidized ITNs at health facilities were barriers to ownership. CONCLUSION: Understanding and addressing protective factors and barriers influencing ITN ownership and usage are crucial for enhancing malaria prevention strategies and achieving sustainable progress in combating malaria in endemic areas. Collaborative and evidence-based interventions are essential for addressing these challenges effectively.
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Mosquiteiros Tratados com Inseticida , Malária , Controle de Mosquitos , Propriedade , Gana , Mosquiteiros Tratados com Inseticida/estatística & dados numéricos , Propriedade/estatística & dados numéricos , Malária/prevenção & controle , Controle de Mosquitos/estatística & dados numéricos , Controle de Mosquitos/métodos , HumanosRESUMO
BACKGROUND: Therapeutic communication (TC) promotes effective patient care, emotional wellbeing, and improves patient outcomes. The purpose of this review was to synthesise evidence on barriers and outcomes of TC between nurses and patients in Africa and to inform future studies and systematic reviews. METHODS: Search for the records was done in four major databases including PubMed, Science Direct, PubMed CENTRAL, and JSTOR. Additional searches were done in Google Scholar and Google. Results and findings from published studies and grey literature were included. A total of 16 articles met the eligibility criteria and were included in the review. This scoping review followed the guidelines by Askey and O'Malley. RESULTS: Barriers associated with TC were grouped under five main themes: sociodemographic factors, patient-related factors, nurse-related factors, environmental and health service-related. Age, and religious beliefs were the main sociodemographic factors that hindered TC while stress and inadequate knowledge and skills were identified among the nurse-related barriers to TC. Extreme weather conditions and mosquito infestation were environmental factors while lack of access to TC educational programmes on TC was a health service-related factor that interfered with TC. Both positive and negative outcomes of TC were also identified. CONCLUSION: Continuous professional development on TC is necessary to improve nurses' attitudes and update their skills to enable them to render culturally competent nursing care to patients.
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In the area of addiction, Canada has been in a public health crisis since 2016. Addiction takes a toll on an individual's self-worth and identity. In this narrative literature review, the distinct nature of spirituality was addressed. Next, individualized conceptualizations of spirituality were outlined. Subsequently, the importance of fellowship in addiction recovery was detailed. Next, the significance of being of service was presented. Meaningful and authentic spirituality were discussed in the context of recovery identity. Lastly, spirituality as a personal journey is described. A narrative literature review of 70 manuscripts published between 1999 and 2021 was undertaken to determine multiple approaches to treating addiction recovery in the context of spiritual development. An understanding of spirituality can inform counsellors regarding spiritual development in addiction recovery. Implications for counselling include a roadmap to support clients developing an individualized spiritual connection and operating as a functional system.
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Comportamento Aditivo , Terapias Espirituais , Humanos , Espiritualidade , Alcoólicos Anônimos , CanadáRESUMO
BACKGROUND: Challenges such as stigma and loneliness may increase vulnerability to Human Immunodeficiency Virus (HIV) infection and negatively affect the quality of life of people living with HIV (PLHIV) despite the massive investment in access to antiretroviral therapy. This study aims to determine the level of loneliness and stigma and explore the coping resources employed by PLHIV in a resource-constrained setting. METHODS: This was a sequential mixed methods study conducted at the Cape Coast Teaching Hospital (CCTH) in Ghana between May and December 2021. A total of 395 adults were selected using a simple random sampling technique. HIV Stigma Scale and UCLA Loneliness Scale were used to collect quantitative data. A purposive sampling technique was applied to recruit 18 participants to saturation using a semi-structured interview guide. SPSS version 21 was used for the statistical analysis of the quantitative data. HIV-related loneliness and stigma levels were estimated, and bivariate and multivariable logistic regression were used to evaluate associated factors using a statistical significance of p-value (p < .05). In general, the thematic analysis approach by Braun and Clark was employed to analyse the qualitative data. Findings were then triangulated. RESULTS: The mean age was 46.79 years (± 12.53), 75.4% of the participants were female, with a prevalence of stigma of 99.0% (95%CI = 97.4-99.7) and loneliness of 30.1% (95%CI = 25.6-34.9). Tertiary-level education and instrumental support were associated with lower levels of loneliness. In contrast, comorbidity, personalised stigma, negative self-image, and self-blame were positively related to loneliness. Thematic analyses of the qualitative data produced a range of themes that showed that people living with HIV rely on personal resources, social support networks, and behaviour modification strategies to manage their condition. In particular, some of these strategies include; religiosity and spirituality, family and friends, medication and professional support systems. CONCLUSION: The results suggest that PLHIV in the developing world face enormous challenges, socially, psychologically and financially. Although there have been global efforts to make HIV services accessible, the findings suggest a need for integrating mental health services contextually to reduce loneliness and HIV-related stigma to improve quality of life.
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Infecções por HIV , Saúde Mental , Adulto , Humanos , Feminino , Pessoa de Meia-Idade , Masculino , Qualidade de Vida/psicologia , Solidão , Região de Recursos Limitados , Estigma Social , Infecções por HIV/psicologia , Adaptação PsicológicaRESUMO
BACKGROUND: Diagnosing a life-threatening disease like the human immunodeficiency virus (HIV) can be unbearable to the individual, which has implications for their subsequent care-seeking decision-making. However, an essential element of HIV testing is identifying infected individuals and linking them with adequate care services, thus contributing to the UNAIDS 95-95-95 targets. The attainment of these targets has been particularly challenging for lower and middle-income countries (LMIC). This study explored the psychological reactions to a positive HIV status in a hospital treatment centre to provide insight into mental health interventions' role in improving HIV screening and early antiretroviral therapy (ART) initiation to enhance the quality of life. METHODS: An exploratory qualitative study was investigated among adults who were diagnosed as HIV positive. Participants were purposively recruited from an HIV Treatment Centre. Data were collected with semi-structured interviews that explored the interpretations and psychological reactions to their positive HIV status. Overall, 18 participants were interviewed to reach saturation. Data were transcribed verbatim and analysed thematically to produce findings that address the study's objective. RESULTS: Following analysis of participants' interpretations, understanding and implications of their HIV-positive diagnosis, two major themes emerged: (1) anxiety regarding the impact of the disease on self, family and society was overwhelming. Participants were anxious because of the stigma, fear, worry, shock, and shame they faced. (2) Participants expressed hopelessness and could not see meaning or purpose in life. Suicidal ideation, suicide plans and self-harm characterised hopelessness. CONCLUSIONS: The initial reaction to the diagnosis of HIV in this LMIC context has the potential to impact linkage to care negatively and, thus, the attainment of the global 95-95-95 targets. It is, therefore, essential that mental health and psychological support services are integrated with testing services to manage the initial reactions and support individuals to improve early linkage to care and thus improve overall outcomes for the infected individual and society.
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Infecções por HIV , HIV , Adulto , Humanos , Saúde Mental , Qualidade de Vida , Aceitação pelo Paciente de Cuidados de Saúde , Infecções por HIV/diagnóstico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/psicologia , Pesquisa QualitativaRESUMO
BACKGROUND: In Ghana, prostate cancer is more prevalent than all other cancers, with a mortality rate of 75% partly due to late presentation to the health care facilities. Limited health services provision across the country and shortages of skilled nurses place a significant demand on family caregivers who are often ill-equipped for the caring role, resulting in many challenges. As they are expected to provide complex care at home with little resources, information, and support, the healthcare system rarely addresses the challenging needs of these family caregivers. This study explored the challenges encountered by family caregivers of people with prostate cancer. METHODS: We conducted interviews using a descriptive phenomenological approach. Twelve family caregivers of prostate cancer patients were selected through a purposive sampling technique at the Cape Coast Teaching Hospital. All interviews were recorded, transcribed, and analysed using Colaizzi's (1978) data analysis approach. RESULTS: Three main themes were identified as critical challenges: education and training needs, resources and caregiver-nurse relationship issues. Under the three main themes emerged seven sub-themes that collectively hindered the family caregiver's ability to meet the care demands. Sub-themes that emerged were; lack of preparedness towards the caring role, lack of knowledge about condition/ treatment, misconception about the condition, lack of accommodation facilities, financial constraints, poor communication, and poor staff attitude. CONCLUSION: Caregiving is associated with significant challenges that hinder the family caregiver's ability to care for the patient effectively, further diminishing the caregiver's quality of life and patient care. Therefore, healthcare professionals, especially nurses, should consider these challenges family caregivers face and take measures to obviate them through education, preparation and support.
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Cuidadores , Neoplasias da Próstata , Atitude do Pessoal de Saúde , Cuidadores/psicologia , Comunicação , Família , Gana , Humanos , Masculino , Neoplasias da Próstata/psicologia , Qualidade de Vida , Estresse PsicológicoRESUMO
BACKGROUND: The job demand and stress associated with the nursing profession expose nurses to an increased risk of psychiatric morbidities such as anxiety and depression. This study assessed the prevalence of depression, anxiety and stress among psychiatric nurses in Ghana. METHODS: A cross-sectional survey was conducted in three psychiatric hospitals in Ghana between March 2020 and May 2021. Simple random sampling technique were used to select 311 psychiatric nurses. Beck's Depression Inventory, Beck's Anxiety Inventory and Perceived Stress Scale were used to assess depression, anxiety and stress, respectively. Data were analysed using SPSS version 23.0. RESULTS: The results showed that 19.6% of psychiatric nurses experienced mild to severe depression, 27% mild to severe anxiety and 42% mild to high stress. Regression analysis showed that participants with a diploma qualification had higher odds of having moderate depression compared to those with a master's degree. In terms of stress, participants with a diploma qualification were 29.6% less likely to have moderate stress compared to those with a master's degree. Those with a bachelor's degree were 7.1% less likely to have moderate stress compared to those with a master's degree. CONCLUSION: Psychiatric nurses experience depression, anxiety and stress to varying degrees. Education level was identified as a determinant of depression, anxiety and stress. Therefore, preventive strategies should be designed to reduce the risk of these conditions.
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Living with a chronic mental condition such as schizophrenia impacts significantly on the individual's social functioning and activities of daily living. However, there is little data on the experiences of people living with schizophrenia, especially in Ghana regarding personal care and stigma. This study explored qualitatively the experiences of people living with schizophrenia in Southern Ghana. Nine people with schizophrenia were purposively recruited for this study. Data were collected using semi-structured interviews and analysed thematically following a descriptive phenomenological data analysis framework. The study revealed that people with schizophrenia are capable of performing some activities of daily living, such as maintenance of personal and environmental hygiene and medication management. However, some participants narrated their experiences of stigma and thus, resorted to certain strategies such as spirituality, medication adherence and mental fortitude to cope with schizophrenia. In conclusion, it was evident that people with schizophrenia, in their lucid intervals, can undertake various activities of daily living, including personal care, however, living with schizophrenia impacts on psychological well-being enormously, and thus, education, counselling, and client adherence to the treatment may improve quality of life.
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BACKGROUND: To obviate malaria and other healthcare costs and enhance healthcare utilization, the government of Ghana introduced the National Health Insurance Scheme (NHIS) in 2005. Nonetheless, there is dearth of empirical evidence on Ghanaian women's knowledge about whether malaria treatment is covered by the NHIS or not. The current study, therefore, investigated factors associated with knowledge of malaria treatment with the NHIS among women aged 15-49 in Ghana. METHODS: The study is a secondary analysis of data from women respondents in the 2014 Ghana Demographic and Health Survey. A total of 2,560 women participated in this study. Descriptive computation of the weighted proportion of women who knew that malaria is covered by NHIS was conducted at 95% confidence interval (CI). A multilevel logistic regression analyses was carried out with Stata's MLwinN package version 3.05. We declared significance at 5% alpha. Findings from the models were reported as adjusted odds ratios (aOR) and credible intervals (CrIs). RESULTS: In all, 81.0% of Ghanaian women included in the study knew that NHIS covers malaria treatment. Women aged 45-49 had higher odds of knowing that NHIS covers malaria relative to those aged 15-19 age category [aOR=1.5;95%crl=1.2-2.1]. Women with higher education (post-secondary) had higher odds of knowing that NHIS covers malaria treatment compared with women who had no formal education [aOR=1.6;95%Crl=1.2-2.0]. Richest women were more likely to know that NHIS covers malaria treatment compared to the poorest women [aOR=1.3;95%Crl=1.2-1.7]. Women who had subscribed to the NHIS were more likely to report that NHIS covers malaria treatment [aOR=1.5;95%Crl=1.2-1.8]. The study revealed that the variance in the tendency for a woman to be aware that NHIS covers malaria treatment is attributable to 10.8% community level factors. CONCLUSION: This study has shown that individual, community and regional level factors affect women's knowledge on whether NHIS covers malaria treatment or not. As knowledge that malaria treatment is covered by NHIS may increase use of malaria prevention and treatment services in health facilities, we recommend that the Ghana Health Service intensifies community level education and awareness creation efforts, targeted at women among whom awareness levels are currently low.
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Malária , Programas Nacionais de Saúde , Adolescente , Adulto , Feminino , Gana , Humanos , Malária/prevenção & controle , Pessoa de Meia-Idade , Análise Multinível , Análise de Regressão , Adulto JovemRESUMO
BACKGROUND: Living with a chronic condition such as epilepsy can have a debilitating effect on the individual and their carers. Managing epilepsy among people with learning disabilities may present a challenge because of limited communication and may require a multidisciplinary approach. The study investigated the communication and information needs of people with learning disabilities with epilepsy and their physicians, nurses and carers. METHODS: Qualitative designed was adopted to collect data from 15 community-based people with mild learning disabilities with epilepsy and 13 carers. Recorded data were transcribed verbatim and analysed thematically. RESULTS: A range of findings emerged related to patient communication and information needs. These included: Knowledge regarding epilepsy; involvement; honesty and openness when giving information and consistency in provision of information. CONCLUSION: People with learning disabilities with epilepsy and their carers would like to know more about epilepsy, to be more involved decision makings through communication in the management of epilepsy to enable them feedback information regarding their health.
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Comunicação , Epilepsia , Necessidades e Demandas de Serviços de Saúde , Deficiências da Aprendizagem , Relações Profissional-Paciente , Cuidadores , Tomada de Decisões , Feminino , Humanos , Masculino , Médicos , Pesquisa QualitativaRESUMO
Substance use disorder is a global mental health issue. Purpose in life, Loneliness and depression are key indicators of poor mental health, and people with substance use disorder are more likely to experience low purpose in life, depression, and loneliness. This study aims to further the understanding of purpose in life, depression and loneliness among substance use disorders (SUD) patients in three hospitals in Ghana. It uses a cross-sectional survey design. A total of 425 SUD inpatients were screened. Beck Depression Inventory-II, the revised UCLA Loneliness Scale, and the Purpose in Life Test were utilised to measure depression, loneliness, and purpose in life respectively. Data were analysed using the SPSS version 23 for Windows. Data from 378 participants were collected for this study using a cross sectional survey design; after data cleaning, frequency tables (for categorical variables) and descriptive statistics (for continuous variables) were used to summarise the demographics and the three outcome variables depression, purpose in life, and loneliness. Our findings indicate that overall, participants are more likely to experience low sense of purpose in life, depression, and loneliness compared to the general population. There was no statistically significant relationship between depression and loneliness (r = 0.030, p = 0.567). There was a statistically significant negative relationship between depression and purpose in life (r = -0.514, p < 0.001). There was a statistically significant positive relationship between purpose in life and loneliness (r = 0.147, p = 0.004). There was no gender difference in depression, purpose in life, and loneliness among SUDs patients in psychiatric hospitals. There were no significant differences in purpose in life, depression and loneliness based on marital status. It is anticipated that the findings of this study will inform policies and clinical practice regarding service provision for patients with SUDs.
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Solidão , Transtornos Relacionados ao Uso de Substâncias , Humanos , Solidão/psicologia , Estudos Transversais , Depressão/epidemiologia , Depressão/psicologia , Hospitais Psiquiátricos , Gana/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologiaRESUMO
AIM: This study explored the psychosocial experience of caregiving on the family caregiver of patients with prostate cancer in the Cape Coast metropolis of Ghana. DESIGN: A descriptive phenomenological study was conducted through in-depth face-to-face semi-structured interviews. Twelve family caregivers of prostate cancer patients were selected through purposive sampling. Interviews were conducted until data saturation. All interviews were taped, transcribed verbatim and analysed thematically. RESULTS: The family caregiver's psychosocial experience associated with caregiving uncovered two significant themes with 13 sub-themes. 'Psychological impact' emerged as the first central theme, with anxiety, care as an obligation and feelings of inadequacy, hopelessness, uncertainty, denial and concealment as the sub-themes. The second central theme was 'Social impact' with sexual concerns, role adjustment, loss of livelihood, turmoil and reduced leisure activities emerging as sub-themes. CONCLUSION: The findings demonstrated that caring significantly impacts the psychological and social well-being of the caregivers of prostate cancer patients. Therefore, there is a need for holistic assessment to include the psychosocial well-being of family caregivers to improve quality of life. Therefore, psychiatric nurses support family caregivers through education and psychosocial interventions to improve their quality of life and enable them to care for their loved ones more effectively.
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Cuidadores , Neoplasias da Próstata , Masculino , Humanos , Cuidadores/psicologia , Qualidade de Vida , Estresse Psicológico , Hospitais de EnsinoRESUMO
PURPOSE: The purpose of this qualitative research study is to explore health-care providers' perspectives and experiences with a specific focus on supports reported to be effective during the COVID-19 pandemic. The overarching goal of this study is to inform leaders and leadership regarding provision of supports that could be implemented during times of crisis and in the future beyond the pandemic. DESIGN/METHODOLOGY/APPROACH: Data were collected by semi-structured, conversational interviews with a sample of 33 health-care professionals, including Registered Nurses, Nurse Practitioners, Registered Psychologists, Registered Dieticians and an Occupational Therapist. FINDINGS: Three major themes emerged from the interview data: (1) professional and personal challenges for health-care providers, (2) physical and mental health impacts on health-care providers and (3) providing supports for health-care providers. The third theme was further delineated into three sub-theses: formal resources and supports, informal resources and supports and leadership strategies. ORIGINALITY/VALUE: Health-care leaders are advised to pay attention to the voices of the people they are leading. It is important to know what supports health-care providers need in times of crisis. Situating the needs of health-care providers in the Carter and Bogue Model of Leadership Influence for Health Professional Wellbeing (2022) can assist leaders to deliberately focus on aspects of providers' wellbeing and remain cognizant of the supports needed both during a crisis and when circumstances are unremarkable.
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COVID-19 , Humanos , Pandemias , Liderança , Pessoal de Saúde/psicologia , Pesquisa QualitativaRESUMO
Introduction: Before 2020 and the advent of the COVID-19 pandemic, mental disorders, including anxiety and mood disorders, were considered the leading causes of the global disease burden. There is evidence from multiple countries and social contexts that suggest the high risk of anxiety and mood disorders among students. Yet, there is a knowledge gap concerning understanding the association between the experience of discrimination and the risk of anxiety and mood disorders. We examined the association between the experience of discrimination and the risk of anxiety and mood disorders among university students. Methods: This study is a cross-sectional survey among university students in Ghana. A quota sampling technique was used to recruit 1,601 students. Data were collected using structured questionnaires. All data were analyzed using Stata. Binary logistic regression model was used to examine the significant association between the outcome variable and the explanatory variables. Results: The prevalence of anxiety disorder among the respondents was 67 per cent. Students who had experienced discrimination or had any member of their family experienced discrimination had higher odds (OR = 4.59, Cl = 2.64, 7.96) of anxiety and mood disorder compared to those who had not experienced any form of discrimination. Respondents aged 20-24 years had higher odds (OR = 1.47, Cl = 1.16, 1.85) of anxiety and mood disorder than those aged 15-19. Students with a high perceived risk of contracting COVID-19 had a higher odd (OR = 1.52, CI = 1.10, 2.10) compared to those with a low perceived risk. Conclusion: The findings underscore a need for university authorities to lay out clear initiatives that will reinforce and meet the mental health needs of university students during and after periods of crisis, such as returning from COVID-19 lockdown. There must be a conscious effort to advocate and raise students' awareness of anxiety disorders. Also, it is imperative to create support groups within the university set up to address the mental health needs of all students. Younger students should be the primary focus of these interventions.
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INTRODUCTION: Prostate cancer is a significant public health burden and a significant cause of morbidity and mortality among men worldwide. This study, therefore, explored how caring affects the physical health of family caregivers of prostate cancer patients. METHOD: The study adopted a descriptive phenomenological method. Twelve participants were recruited using the purposive sampling technique. A semi-structured face to face, in-depth interviews were conducted with family caregivers of patients living with prostate cancer. The interviews were transcribed verbatim, and the data were analysed using Colaizzi's phenomenological approach. FINDINGS: The family caregiver's experience with the physical impact associated with caregiving uncovered two significant themes with six sub-themes. "Rest and Sleep" emerged as the first central theme, with sleeplessness, fatigue, pain, and worsening pre-existing conditions as the sub-themes. The second main theme was 'Nutrition' with altered eating patterns and weight loss emerging as sub-themes. CONCLUSION: The study suggests that family caregivers of patients treated for prostate cancer may struggle with physical consequences associated with the caregiving role, which impacts their physical health. It is of great importance, especially for nurses, to come up with measures to minimise these adverse physical effects on the family caregivers through formal education programmes and training on how to care for these patients at home.
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Cuidadores , Neoplasias da Próstata , Família , Fadiga , Gana , Humanos , Masculino , Pesquisa QualitativaRESUMO
INTRODUCTION: COVID-19 pandemic has had a greater psychological impact on patients with chronic ailments such as diabetes mellitus, tuberculosis, and HIV/AIDS compared to those without chronic conditions. We explored the psychological impacts of COVID-19 among people living with diabetes mellitus in Ghana. METHODS: this study employed a hospital-based cross-sectional design involving 157 diabetes mellitus patients aged 20 years and above. We assessed diabetes distress by the seventeen-item diabetes stress (DDS17) scale and COVID-19 worries by 3 specific benchmarks: "worry about overly affected due to diabetes if infected with COVID-19", "worry about people with diabetes characterized as a risk group" and "worry about not able to manage diabetes if infected with COVID-19". A close-ended questionnaire was used in data collection. RESULTS: of 157 diabetic patients interviewed, the majority had type 2 diabetes mellitus with known complications and only 42.7% were managing COVID-19 symptoms. The participants showed moderate to high level of COVID-19 specific worry, moderate fear of isolation, and low level of diabetes-associated distress. About 33.8% of the study population expressed a sense of worry towards the pandemic. The logistic regression showed that age, employment status, and presence of other chronic diseases were significantly associated with worries about being overly affected if infected with COVID-19 due to their diabetes status. Age and sex were associated with worries about people with diabetes being characterized as a risk group and age, sex and employment status were associated with participants who were worried about not being able to manage diabetes if infected with COVID-19. CONCLUSION: the general trend indicates a sense of worry among diabetes patients during the COVID-19 pandemic which is associated with poorer psychological health. Clients' education and counseling on COVID-19 are necessary to address some of their concerns to minimize the level of anxiety and emotional stress in these individuals.
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COVID-19/psicologia , Diabetes Mellitus Tipo 1/psicologia , Diabetes Mellitus Tipo 2/psicologia , Adulto , Fatores Etários , Ansiedade/epidemiologia , Estudos Transversais , Medo , Feminino , Gana , Humanos , Masculino , Saúde Mental , Pessoa de Meia-Idade , Fatores de Risco , Fatores Sexuais , Estresse Psicológico/epidemiologia , Inquéritos e Questionários , Adulto JovemRESUMO
This paper examines attachment theory in the context of the biology of affect regulation and the convergence of these in psychotherapeutic processes. Because of recent advances in understanding how the infant brain/mind/body is shaped by the infant's first social experiences, the purpose of this investigation is to extract those underlying mechanisms that expand adaptive and regulatory capacities and to review their application within the therapeutic relationship. Interdisciplinary advances are indicating that just as the infant-mother relationship is fundamentally a psychobiological dyadic system of emotional communication and affect regulation, this same system underlies the essential mechanisms that adaptively sustain subsequent relationships-including the therapeutic alliance. This review highlights the importance of right-hemisphere-to-right-hemisphere emotional and relational processes-moving away from the traditional emphasis on "left-brain" verbal and cognitive processes-thereby underscoring the necessity for therapist understanding of implicit, nonverbal communication as well as self-integration and awareness in order to help increase their client's capacity for the same. We propose a model of therapeutic communication that takes these factors into account for the therapist, the client and the relationship.
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Adaptação Psicológica , Afeto , Apego ao Objeto , Psicoterapia , Adulto , Comunicação , Contratransferência , Humanos , Terapia Psicanalítica , Transferência Psicológica , ConfiançaRESUMO
Introducción: Las lesiones atípicas de la glándula mamaria afectan a un total de 20 000 mujeres en el mundo. La categorización BI-RADS 4 se considera indefinida y tiene variación considerable a malignidad hasta con cinco años de seguimiento. Objetivo: Establecer la correlación entre los informes BI-RADS 4 y hallazgos histopatológicos en mujeres con diagnóstico de patología atípica de mama que aceden a la consulta de Ginecología y Obstetricia del Hospital Provincial General Docente de Riobamba, Ecuador. Método: Se realizó un estudio de tipo analítico correlacional, retrospectivo, no experimental, de corte transversal en el periodo enero-diciembre de 2021, en 78 pacientes de 20 a 70 años. Los datos fueron tomados de las historias clínicas. Para la validez de pruebas se usó pruebas estadísticas tipo Ji cuadrado de correlación con intervalos de confianza del 95 % e índice de error del 5 %. Resultados: El principal factor de riesgo observado fue la edad ≥40 años (26,92 %), seguido de: deformidad mamaria (20,51 %), y recurrencia de nódulos (15,38 %). En relación a las subcategorías del informe BI-RADS 4, se observó que el tipo C fue la de mayor prevalencia con 39 casos (50 %). Predominó la hiperplasia ductal con el 44,87 % y la fue de un 95,83 % con una especificidad del 70 %. Hubo una significación asintónica de 0,001 entre BI-RADS 4 y resultados histopatológicos. Conclusiones: Las lesiones subcategorizadas como BI-RADS 4C tienen mayor probabilidad de malignizar debido a que se asocian principalmente a hiperplasia ductal, siendo esta el principal cáncer mamario en mujeres mayores de 40 años.
Introduction: Atypical lesions of the mammary gland affect a total of 20,000 women worldwide. The BI-RADS 4 categorization is considered indefinite and has considerable variation to malignancy with up to five years of follow-up. Objective: To establish the correlation between BI-RADS 4 reports and histopathological findings in women with a diagnosis of atypical breast pathology who attend the Gynecology and Obstetrics consultation of the Hospital Provincial General Docente de Riobamba, Ecuador. Method: A correlational, retrospective, non-experimental, cross-sectional analytical study was carried out in the period January-December 2021, in 78 patients aged 20 to 70 years. The data were taken from the medical records. For the validity of the tests, Chi-square correlation statistical tests were used with 95% confidence intervals and an error rate of 5%. Results: The main risk factor observed was age ≥40 years (26.92%), followed by: breast deformity (20.51%), and recurrence of nodules (15.38%). In relation to the subcategories of the BI-RADS 4 report, it was observed that type C was the most prevalent with 39 cases (50%). Ductal hyperplasia predominated with 44.87% and was 95.83% with a specificity of 70%. There was an asymptomatic significance of 0.001 between BI-RADS 4 and histopathological results. Conclusions: Lesions subcategorized as BI-RADS 4C are more likely to become malignant because they are mainly associated with ductal hyperplasia, this being the main breast cancer in women over 40 years of age.
Introdução: Lesões atípicas da glândula mamária afetam um total de 20.000 mulheres em todo o mundo. A categorização BI-RADS 4 é considerada indefinida e apresenta variação considerável para malignidade com até cinco anos de acompanhamento. Objetivo: Estabelecer a correlação entre os laudos BI-RADS 4 e os achados histopatológicos em mulheres com diagnóstico de patologia mamária atípica que atendem na consulta de Ginecologia e Obstetrícia do Hospital Provincial General Docente de Riobamba, Equador. Método: Estudo correlacional, retrospectivo, não experimental, transversal, analítico, foi realizado no período de janeiro a dezembro de 2021, em 78 pacientes com idade entre 20 e 70 anos. Os dados foram retirados dos prontuários médicos. Para a validade dos testes foram utilizados testes estatísticos de correlação qui-quadrado com intervalos de confiança de 95% e taxa de erro de 5%. Resultados: O principal fator de risco observado foi idade ≥40 anos (26,92%), seguido de: deformidade mamária (20,51%) e recorrência de nódulos (15,38%). Em relação às subcategorias do relatório BI-RADS 4, observou-se que o tipo C foi o mais prevalente com 39 casos (50%). A hiperplasia ductal predominou com 44,87% e foi de 95,83% com especificidade de 70%. Houve significância assintomática de 0,001 entre o BI-RADS 4 e os resultados histopatológicos. Conclusões: Lesões subcategorizadas como BI-RADS 4C têm maior probabilidade de se tornarem malignas porque estão associadas principalmente à hiperplasia ductal, sendo este o principal câncer de mama em mulheres com mais de 40 anos.
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Registered General Nurses (RGNs) play crucial roles in emergency departments (EDs). EDs in Ghana are primarily staffed by RGNs who have had no additional formal education in emergency care. Additionally, basic, master's, or doctoral level nursing education programs provide limited content on the complexities of emergency nursing. Nurses in EDs are affected by many challenges such as growing patient population, financial pressures, physical violence, verbal abuse, operational inefficiencies, overcrowding, and work overload. There is a paucity of research on challenges experienced by RGNs in EDs in the Volta Region of Ghana. In this qualitative study, twenty RGNs in EDs from three selected hospitals in the Volta Region of Ghana were interviewed. All recorded interviews were transcribed, reviewed several times by researchers and supervisors, and analyzed using content analysis. Five thematic categories were identified. These thematic categories of challenges were lack of preparation for ED role, verbal abuse from patients relatives, lack of resources in ED, stressful and time consuming nature of ED, and overcrowding in ED. Formal education of RGNs in the advanced role of emergency care, adequate supply of resources, increased hospital management support, and motivations for RGNs working in ED are necessary to improve the practice of emergency care.
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BACKGROUND: We recently described a novel autosomal recessive neurodevelopmental disorder with intellectual disability in four patients from two related Hutterite families. Identity-by-descent mapping localized the gene to a 5.1 Mb region at chromosome 16p13.3 containing more than 170 known or predicted genes. The objective of this study was to identify the causative gene for this rare disorder. METHODS AND RESULTS: Candidate gene sequencing followed by exome sequencing identified a homozygous missense mutation p.Gly46Arg, in THOC6. No other potentially causative coding variants were present within the critical region on chromosome 16. THOC6 is a member of the THO/TREX complex which is involved in coordinating mRNA processing with mRNA export from the nucleus. In situ hybridization showed that thoc6 is highly expressed in the midbrain and eyes. Cellular localization studies demonstrated that wild-type THOC6 is present within the nucleus as is the case for other THO complex proteins. However, mutant THOC6 was predominantly localized to the cytoplasm, suggesting that the mutant protein is unable to carry out its normal function. siRNA knockdown of THOC6 revealed increased apoptosis in cultured cells. CONCLUSION: Our findings associate a missense mutation in THOC6 with intellectual disability, suggesting the THO/TREX complex plays an important role in neurodevelopment.