Associations of self-forgiveness processes with distress and well-being outcomes: Evidence from a longitudinal study of Indonesian adults.

To date, few empirical studies have examined the benefits of the processes involved in self-forgiveness-value reorientation and esteem restoration-for individual well-being using longitudinal data from non-Western samples. In this study, we take a step toward addressing this gap by analysing three waves of data collected among 595 Indonesians (Mage = 21.95, SD = 4.39). Applying the analytic templates for lagged exposure-wide and outcome-wide longitudinal designs, we performed a series of linear regressions to estimate associations of value reorientation and esteem restoration in Wave 2 with three indicators of distress and 10 indicators of well-being in Wave 3, adjusting for Wave 1 covariates. Value reorientation and esteem restoration were each associated with improvements in several well-being outcomes (six for value reorientation and three for esteem restoration), but both showed little evidence of associations with the distress outcomes. In a secondary analysis, those who scored higher on both value reorientation and esteem restoration (i.e., self-forgiveness group) in Wave 2 reported higher well-being on five outcomes in Wave 3 compared to those who scored lower on value reorientation, esteem restoration, or both (i.e., no or partial self-forgiveness group). We discuss some implications of the findings for conceptualising self-forgiveness and promoting well-being.

Differential effects of decisional and emotional forgiveness on distress and well-being: A three-wave study of Indonesian adults.

Research suggests that interpersonal forgiveness is beneficial to individual functioning, but few longitudinal studies have explored the independent contributions of decisional and emotional forgiveness to reducing different forms of distress and improving multidimensional well-being. In this three-wave (T1: December 2020; T2: January 2021; T3: February 2021) prospective study of predominantly young Indonesian adults (n = 595), we examined the associations of decisional and emotional forgiveness with three indicators of distress and 10 components of well-being. Applying the outcome-wide analytic template for longitudinal designs, our primary analysis involved estimating two sets of linear regression models (one set for decisional forgiveness and one set for emotional forgiveness) in which the outcomes were regressed on each interpersonal forgiveness process (one outcome at a time). Adjusting for a range of covariates (including prior values of decisional forgiveness, emotional forgiveness, and all 13 outcomes) assessed at T1, decisional forgiveness assessed at T2 was associated with an increase in seven components of well-being (i.e., life satisfaction, physical health, sense of purpose, promote good, delayed gratification, content with relationships, satisfying relationships) approximately 1 month later at T3. In contrast, emotional forgiveness assessed at T2 was associated with an increase in a single component of well-being (i.e., satisfying relationships) assessed at T3. Neither decisional nor emotional forgiveness assessed at T2 showed evidence of associations with any of the subsequent indicators of distress assessed at T3. Our findings suggest that, at least within a principally collectivistic cultural context such as Indonesia, decisional forgiveness in the aftermath of a transgression may have greater short-term benefits for well-being compared to emotional forgiveness. Implications of the findings for research and interventions are discussed.

Suffering, psychological distress, and well-being in Indonesia: A prospective cohort study.

Research on the subjective experience of suffering has typically focussed on older clinical samples living in Western, educated, industrialised, rich, and democratic (WEIRD) countries. To further extend the existing body of empirical research on suffering to less WEIRD contexts, we use three waves of data (Wave 1: December 2020; Wave 2: January 2021; Wave 3: February 2021) from a sample of nonclinical Indonesian adults (n = 594) to examine associations between suffering, two indices of psychological distress, and 10 facets of well-being. In our primary analysis, we estimated a series of multiple regression models that adjusted for a range of sociodemographic characteristics, financial and material stability, religious/spiritual factors, prior values of overall suffering, and prior values of each outcome assessed in Wave 1. Results indicated that overall suffering assessed in Wave 2 was associated with an increase in both indices of psychological distress and a decrease in eight facets of well-being assessed in Wave 3. Using a similar analytic approach, results from a secondary analysis indicated that higher scores on both indices of psychological distress and lower scores on seven of the well-being facets assessed in Wave 2 were associated with worse subsequent overall suffering assessed in Wave 3. These findings contribute to empirical literature on the implications of suffering for well-being.

Prosocial and Aggressive Behavior: A Longitudinal Study.

Developmental theorists have made strong claims about the fundamental prosocial or aggressive nature of the human infant. However, only rarely have prosocial behavior and aggression been studied together in the same sample. We charted the parallel development of both behaviors from infancy to childhood in a British community sample, using a two-construct, multimethod longitudinal design. Data were drawn from the Cardiff Child Development Study (CCDS), a prospective longitudinal study of a volunteer sample of parents and their firstborn children. A sample of 332 mothers was recruited from National Health Service (NHS) prenatal clinics and general practice clinics in Wales, UK, between Fall of 2005 and Summer of 2007. Potential participants represented the full range of sociodemographic classifications of neighborhoods. Participating families were divided about equally between middle- and working-class families, were somewhat more likely to have sons than daughters, and the majority (90%) were in a stable partnership. In response to standard categories recommended for use in Wales at the time, the majority (93%) of mothers reported themselves as Welsh, Scottish, English, or Irish; most others named a European or South Asian nationality. Of the 332 families agreeing to participate, 321 mothers (Mage = 28 years) and 285 partners (Mage = 31 years) were interviewed during the pregnancy and 321 of the families contributed data at least once after the child's birth. After an initial home visit at 6 months, data collection occurred in four additional waves of testing when children's mean ages were approximately 1, 1.5, 2.5, and 7 years. Data collection alternated between family homes and Cardiff University. Of those families seen after the child's birth, 89% were assessed at the final wave of testing. Data collection ended in 2015. Methods included direct observation, experimental tasks, and collection of reports from mothers, fathers, other relatives or family friends, and classroom teachers. Interactions with a familiar peer were observed at 1.5 years. Interactions with unfamiliar peers took place during experimental birthday parties at 1 and 2.5 years. At 7 years, parents were interviewed, parents and teachers completed questionnaires, and the children engaged in cognitive and social decision-making tasks. Based on reports from parents and other informants who knew the children well, individual differences in both prosocial behavior and aggression were evident in children. Both types of behavior showed stability across the second and third years. The association between prosocial behavior and aggression changed over time: at 1.5 years, they were not significantly related (the association approached zero), but they became negatively correlated by 3 years. Different patterns were seen when children played with familiar versus unfamiliar peers. At 1.5 years, when children were observed at home with a familiar peer, prosocial behavior and aggression were unrelated, thus showing a pattern of results like that seen in the analysis of informants' reports. However, a different pattern emerged during the experimental birthday parties with unfamiliar peers: prosocial behavior and aggression were positively correlated at both 1 and 2.5 years, contributing to a general sociability factor at both ages. Gender differences in prosocial behavior were evident in informants' reports and were also evident at the 1-year (though not the 2.5-year) birthday parties. In contrast, gender differences in both prosocial behavior and aggression were evident by 7 years, both in children's aggressive decision-making and in their parents' and teachers' reports of children's aggressive behavior at home and school. By age 7, children's aggressive decision-making and behavior were inversely associated with their verbal skills, working memory, and emotional understanding. Some children had developed aggressive behavioral problems and callous-unemotional traits. A few (12%) met diagnostic criteria for conduct disorder or oppositional-defiant disorders, which had been predicted by early angry aggressiveness and lack of empathy for other people. Taken together, the findings revealed a gradual disaggregation of two ways in which children interact with other people. Individual differences in both prosocial behavior and aggression revealed continuity over time, with gender differences emerging first in prosocial behavior, then in aggression. Restrictions in the participant sample and the catchment area (e.g., all were first-time parents; all were drawn from a single region in the United Kingdom) mean that it is not possible to generalize findings broadly. It will be important to expand the study of prosocial behavior and aggression in other family and environmental contexts in future work. Learning more about early appearing individual differences in children's approaches to the social world may be useful for both educational and clinical practice.

Investigating staff knowledge of safeguarding and pressure ulcers in care homes.

OBJECTIVE: To investigate whether nursing/care home staff regard pressure ulceration as a safeguarding issue; and to explore reporting mechanisms for pressure ulcers (PUs) in nursing/care homes. METHOD: Within one clinical commissioning group, 65 staff members from 50 homes completed a questionnaire assessing their experiences of avoidable and unavoidable PUs, grading systems, and systems in place for referral to safeguarding teams. Understanding of safeguarding was assessed in depth by interviews with 11 staff members. RESULTS: Staff observed an average of 2.72 PUs in their workplaces over the previous 12 months, judging 45.6% to be avoidable. Only a minority of respondents reported knowledge of a grading system (mostly the EPUAP/NPUAP system). Most respondents would refer PUs to the safeguarding team: the existence of a grading system, or guidance, appeared to increase that likelihood. Safeguarding was considered a priority in most homes; interviewees were familiar with the term safeguarding, but some confusion over its meaning was apparent. Quality of written documentation and verbal communication received before residents returned from hospital was highlighted. However, respondents expressed concern over lack of information regarding skin integrity. Most staff had received education regarding ulcer prevention or wound management during training, but none reported post-registration training or formal education programmes; reliance was placed on advice of district nurses or tissue viability specialists. CONCLUSION: Staff within nursing/care homes understand the fundamentals of managing skin integrity and the importance of reporting skin damage; however, national education programmes are needed to develop knowledge and skills to promote patient health-related quality of life, and to reduce the health-care costs of pressure damage. Further research to investigate understanding, knowledge and skills of nursing/care home staff concerning pressure ulcer development and safeguarding will become increasingly necessary, as levels of the older population who may require assisted living continue to rise.

Efficacy of gaseous chlorine dioxide as a sanitizer for killing Salmonella, yeasts, and molds on blueberries, strawberries, and raspberries.

Gaseous chlorine dioxide (ClO2) was tested for its effectiveness in killing Salmonella, yeasts, and molds on blueberries, strawberries, and red raspberries. An inoculum (100 microl, 6.0 to 6.8 log CFU/g of fruit) that contained five serotypes of Salmonella enterica was deposited on the skin, calyx tissue, or stem scar tissue of blueberries, skin or stem scar tissue of strawberries, and skin of red raspberries, dried for 2 h at 22 degrees C, then held for 20 h at 4 degrees C and 2 h at 22 degrees C before treatment. Sachets that contained reactant chemicals were formulated to release gaseous ClO2 at concentrations of 4.1, 6.2, and 8.0 mg/ liter of air within treatment times of 30, 60, and 120 min, respectively, at 23 +/- 1 degrees C. Lethality of ClO2 to Salmonella, yeasts, and molds was measured when fruits were in an atmosphere that contained 75 to 90% relative humidity. Treatment with 8.0 mg/liter of ClO2 significantly (alpha = 0.05) reduced the population of Salmonella on blueberries by 2.4 to 3.7 log CFU/g. Lethality was higher to cells in inoculum placed on the skin compared with the stem scar tissue. Populations of Salmonella on strawberries treated with 8.0 mg/liter of ClO2 were reduced by 3.8 to 4.4 log CFU/g; a significant reduction of 1.5 log CFU/g of raspberries was achieved. Treatment with 4.1 to 8.0 mg/liter of ClO2 caused reductions in populations of yeast and molds on blueberries, strawberries, and raspberries of 1.4 to 2.5, 1.4 to 4.2, and 2.6 to 3.0 log CFU/g, respectively. Treatment with 4.1 mg/liter of ClO2 did not markedly affect the sensory quality of fruits stored for up to 10 days at 8 degrees C. Results indicate that gaseous ClO2 has promise as a sanitizer for small fruits.

Evaluation of gaseous chlorine dioxide as a sanitizer for killing Salmonella, Escherichia coli O157:H7, Listeria monocytogenes, and yeasts and molds on fresh and fresh-cut produce.

Gaseous chlorine dioxide (ClO2) was evaluated for effectiveness in killing Salmonella, Escherichia coli O157:H7, and Listeria monocytogenes on fresh-cut lettuce, cabbage, and carrot and Salmonella, yeasts, and molds on apples, peaches. tomatoes, and onions. Inoculum (100 microl, ca. 6.8 log CFU) containing five serotypes of Salmonella enterica, five strains of E. coli O157:H7, or five strains of L. monocytogenes was deposited on the skin and cut surfaces of fresh-cut vegetables, dried for 30 min at 22 degrees C, held for 20 h at 4 degrees C, and then incubated for 30 min at 22 degrees C before treatment. The skin surfaces of apples, peaches, tomatoes, and onions were inoculated with 100 microl of a cell suspension (ca. 8.0 log CFU) containing five serotypes of Salmonella, and inoculated produce was allowed to dry for 20 to 22 h at 22 degrees C before treatment. Treatment with ClO2 at 4.1 mg/liter significantly (alpha = 0.05) reduced the population of foodborne pathogens on all produce. Reductions resulting from this treatment were 3.13 to 4.42 log CFU/g for fresh-cut cabbage, 5.15 to 5.88 log CFU/g for fresh-cut carrots, 1.53 to 1.58 log CFU/g for fresh-cut lettuce, 4.21 log CFU per apple, 4.33 log CFU per tomato, 1.94 log CFU per onion, and 3.23 log CFU per peach. The highest reductions in yeast and mold populations resulting from the same treatment were 1.68 log CFU per apple and 2.65 log CFU per peach. Populations of yeasts and molds on tomatoes and onions were not significantly reduced by treatment with 4.1 mg/liter ClO2. Substantial reductions in populations of pathogens on apples, tomatoes, and onions but not peaches or fresh-cut cabbage, carrot, and lettuce were achieved by treatment with gaseous ClO2 without markedly adverse effects on sensory qualities.

Experimental rationale for treatment of high-risk human melanoma with zinc chloride fixative paste. Increased resistance to tumor challenge in murine melanoma model.

BACKGROUND: Fixed-tissue micrographic surgery (Mohs) of melanoma has been shown by retrospective analysis to improve 5-year survival. OBJECTIVES: To determine whether zinc chloride fixative paste acts as an immune adjuvant to increase host resistance to melanoma. METHODS: We performed a murine study using the poorly immunogenic B16 melanoma of C57Bl6J mice, and the more immunogenic K1735p melanoma of C3H/HeN mice. Tumors were treated with zinc chloride paste and excised 24 hours later (Group 1), or simply excised (Group 2). Mice were challenged 7 days later with injection of melanoma cells at a distant site, and tumor growth in this second site was followed. RESULTS: K1735p melanomas developed at the challenge site in 69% of mice treated with excision versus 32% of mice treated with zinc chloride fixation (P < 0.025). Development of B16 melanoma was not altered by zinc chloride fixation. CONCLUSION: Zinc chloride fixation of the more immunogenic K1735p melanoma increased resistance to subsequent tumor challenge, suggesting that zinc chloride fixative paste acts as an immune adjuvant.

A reevaluation of the effect of occlusion on the trichloroacetic acid peel.

BACKGROUND: Prior studies have demonstrated reduced wounding with trichloracetic acid (TCA) peels after tape occlusion. It is therefore reasonable to question whether or not other types of occlusion may have similar effects, particularly those used in routine postoperative care. OBJECTIVE: To reevaluate the effect of occlusion after TCA peels in multiple human models using various forms of dressings, at various times postoperatively, and to make recommendations regarding wound care that will not adversely affect the efficacy of the peel. METHODS: Equal-sized sections of anterior alopecic scalps of four patients were peeled with 50% TCA, occluded with bacitracin, Vigilon, or Tegaderm at various times postoperatively, and biopsied 1 day later. Depths of necrosis were measured and compared with nonoccluded controls. RESULTS: Bacitracin ointment and Vigilon did not lessen TCA wounding, and sometimes actually enhanced it. Conversely, Tegaderm lessened the degree of the TCA wound. Timing of application played a role in the case of occlusion with Vigilon. CONCLUSION: Occlusives used in conjunction with TCA peels do not have a uniform effect on depth of necrosis. Ointments and Vigilon can be used without reducing the efficacy of the TCA peel. Multiple subjects and rigid control of variables are necessary in studies of TCA-induced necrosis.

Unilateral linear lichenoid eruption after bone marrow transplantation: an unmasking of tolerance to an abnormal keratinocyte clone?

Chronic cutaneous graft-versus-host disease may appear clinically as a lichenoid eruption. We describe a 26-year-old man who developed a unilateral linear lichenoid eruption 7 months after allogeneic bone marrow transplantation. We believe this represents an unusual form of localized, chronic graft-versus-host disease. The possible relationship to viral infection or cellular mosaicism and the clinical, histologic, and immunologic similarities to idiopathic lichen planus are discussed.

Papillary adenoma of the nipple.

Papillary adenoma of the nipple is a benign condition of the nipple that can be confused clinically with adenocarcinoma metastatic to the skin or Paget's disease. Deep biopsy of the nipple is necessary to make a histologic diagnosis. Complete excision of the nipple and the subareolar tissue is sufficient to effect a cure.

Malignant melanoma with evidence of maturation arising from a giant congenital nevocellular nevus.

The association between melanoma and giant congenital nevocellular nevus has been well documented, although controversy still exists regarding the precise incidence. The following patient report illustrates the excision of malignant melanoma arising from a giant congenital nevocellular nevus in a 4-month-old infant. The child had malignant melanoma with deep dermal involvement diagnosed by incisional biopsy with positive margins. She underwent subsequent en bloc resection of the original biopsy site and nevus. The reexcision specimen showed no evidence of malignancy. No adjuvant chemotherapy was used. The child is disease free at 5 years. It is possible that very young children (infants) with melanoma arising in a giant congenital nevocellular nevus may have a good prognosis.

Evaluation of spindle cell tumors.

The most important aspect of any evaluation of spindle cell tumors in the skin or superficial soft tissues is the clinical examination, as a great deal can be learned from the location, appearance, and size of the tumor in question. As recounted in this chapter, the histologic features of these tumors may also be distinctive; however, in some instances, histologic examination alone is insufficient for diagnosis. In such cases, electron microscopy holds considerable promise, but the technique is too dependent upon both the availability of adequately preserved tissues and access to the technique itself. As a result, immunohistochemistry remains the favored approach to most problematic lesions. In our experience, at least 90% of histologically enigmatic tumors will exhibit a characteristic immunophenotype, the remainder usually being indeterminant for a specific pattern of differentiation. The latter outcome is often the result of improper tissue preservation, but may also reflect the primitive nature of some neoplasms. Fortunately, the least common outcome is an ambiguous or "mixed-lineage" phenotype, in which neither one of two or more patterns of differentiation is resolved with certainty. The most common settings in which these problems arise are the separation of MPNST from LMS, and the recognition of melanocytic lesions as distinct from tumors of peripheral nerve sheath. The latter is clearly of greatest clinical concern, and should be the focus of additional study.

Acoustic stimulation-induced fetal response compared to traditional nonstress testing.

Eighty-eight nonstress tests (NSTs) were obtained on gravid women between 27 and 44 weeks' gestation to compare the results of a three-second acoustic stimulus with a traditional NST. Length of testing time was significantly decreased with the use of acoustic stimulation. Consequently, nursing time and equipment use were also considerably lessened per test. Previous studies indicated that the predictive value of the acoustic stimulation test is comparable or better than the traditional NST.

Cutaneous glomus tumor. A comparative immunohistochemical study with pseudoangiomatous intradermal melanocytic nevi.

Glomus tumor of the skin and subcutis is an uncommon neoplasm in which the histologic features can be mimicked by other dermal lesions of diverse types. The cell of origin is thought by most to be the pericyte, which has some of the ultrastructural features of smooth muscle. We examined six glomus tumors with a panel of antibodies including the myogenic markers, muscle-specific actin (HHF-35), and desmin; all tumors were immunoreactive for muscle-specific actin, but only two expressed desmin. Half of these tumors expressed the endothelial determinant, factor VIII-related antigen. Pseudoangiomatous melanocytic nevi stimulating glomus tumors were consistently immunoreactive for S-100 protein, which was not expressed by glomus tumors.

Spindle and epithelioid cell nevus (Spitz nevus). Natural history following biopsy.

A clinical follow-up study of 49 cases of spindle and epithelioid cell nevus is presented to address the question about the potential for local recurrence. Only 19 (39%) of the 49 lesions were initially excised en toto, and the remainder (30 cases) had positive margins; six of the latter spindle and epithelioid cell nevi were reexcised, and no evidence of a residual nevus was found in five of the six cases. There were no recurrences in the 49 patients during an average follow-up period of 5.0 years (range, 1 to 10 years). The rarity of recurrent spindle and epithelioid cell nevus would justify a conservative approach to management, with clinical follow-up alone recommended after a subtotal excision, when the pathologic diagnosis is unequivocal.

The use of fundal pressure during the second stage of labor.

The intensity of the legal climate and the focus on standards of practice in the obstetric setting have forced nurses to carefully scrutinize clinical techniques. The use of fundal pressure during the second stage of labor is a cause of great concern for many obstetric nurses. A nationwide pilot study was conducted to determine whether fundal pressure application is an accepted part of nursing practice in contemporary obstetrics. Sixty-two of the respondents (84%) used fundal pressure during the second stage of labor in their institutions.

Geriatric urologic dermatology.

Most diseases involving the skin affect all age groups; however, some are more common in old age. The skin of the genital area may be involved as an isolated process or as part of more generalized disease. Clinical features and management of some of the more common dermatologic conditions affecting the genital area in the elderly are discussed.

Microcystic adnexal carcinoma. An immunohistochemical comparison with other cutaneous appendage tumors.

Since its initial description, microcystic adnexal carcinoma (MAC) of the skin has been controversial. In particular, it features keratin production of the type seen in some pilar neoplasms , and has been thought to pursue partial follicular differentiation. Diagnostically, MAC may be difficult to separate from desmoplastic trichoepithelioma (DTE) in superficial biopsy specimens. We studied 12 MACs, 22 malignant eccrine acrospiromas, 7 sudoriferous syringometaplasias, 6 syringomas, 5 DTEs, and 40 other benign pilar neoplasms immunohistochemically. Paraffin sections and antibodies to "hard" (pilar) keratins. epithelial membrane antigen (EMA), carcinoembryonic antigen (CEA), Leu-M1, and S100 protein were employed. The MACs exhibited reactivity for hard keratin subclasses AE 13 and AE 14, EMA, CEA, and Leu-M1. Desmoplastic trichoepitheliomas expressed positivity for AE 14, EMA, and Leu-M1 focally, but lacked the other specified markers. Syringomas and malignant acrospiromas displayed EMA, CEA, and AE 14 reactivity, and 5 syringometaplastic lesions were AE 14-reactive. Benign pilar tumors aside from DTEs were reactive only for AE 13, AE 14, or both. These data indicate that MAC exhibits an immunophenotype that is a "hybrid" of those seen in pure sweat glandular and follicular neoplasms, and suggest that it may indeed show combined pilar and sudoriferous differentiation. Based on these results, it also appears that immunohistochemical analysis may be useful in the diagnostic separation of MAC and DTE.