Hopelessness and Social Support among Cancer Patients in Saudi Arabia.

BACKGROUND: Receiving a cancer diagnosis can be extremely stressful for patients, as it is a life-threatening disease. However, when this topic is discussed or researched, the psychological state of cancer patients is often ignored or forgotten. The study aimed to measure the levels of hopelessness and social support among cancer patients. It also aimed to assess the relationship between different demographic variables, hopelessness, and social support of these patients. METHODS: The study followed a cross-sectional quantitative design. The setting included Princess Norah Oncology Center, at King Abdul-Aziz Medical City, Jeddah.   A convenience sampling technique including 300 cancer patients was followed. Data collection included a demographic questionnaire, the Beck Hopelessness Scale (BHS), and the Multidimensional Scale of Perceived Social Support (MSPSS).  Ethical principles of anonymity and confidentiality were followed. RESULTS: The total number of respondents was 300, with 50% being male and 50% being female. The mean age of patients was 52.6±14.83 years. The most prevalent types of cancer were breast cancer (21.4%), colorectal (15.2%), and lymphoma (12.1%) respectively. Most of the patients were married (71.3%). The mean value of the BHS was 4.5, whereas the mean value of the MSPSS was 67.7. Moreover, the type of cancer showed a significant association between family support and total social support. In colorectal cancer patients, the total social support (71.2 ± 20.1) and family support (26.2 ± 5.0) provided was the highest followed by leukemia (70.3 ± 15.5 and 25.2 ± 5.1) and breast cancer (68.3-± 20.3. and 24.3 ± 6.8). CONCLUSION: The findings of the present study suggest that the levels of hopelessness in cancer patients are moderate, and the levels of social support received by participants are high. In addition, the relationship between the levels of hopelessness and the levels of social support received is inversely proportional.

Intensive care nurse-family engagement from a global perspective: A qualitative multi-site exploration.

BACKGROUND: Critical illness is distressing for families, and often results in negative effects on family health that influence a family's ability to support their critically ill family member. Although recent attention has been directed at improving care and outcomes for families of critically ill patients, the manner in which nurses engage with families is not fully understood. OBJECTIVES: To describe nurses' perceptions and practices of family engagement in adult intensive care units from a global perspective. DESIGN: A qualitative-descriptive multi-site design using content analysis. SETTINGS: The study was conducted in 26 intensive care units of 12 urban, metropolitan, academic medical centers in ten countries, spanning five continents. PARTICIPANTS: A total of 65 registered nurses (77% women, age of M = 39.5, SD = 11.4 years) participated. Most held intensive care certification (72%) and had worked on average 10 (SD = 9.6) years in the ICU. METHODS: Semi-structured, individual interviews (M = 38.4 min, SD = 12.0) were held with ICU nurses at the hospital (94%) or their home using an interview guide. Qualitative interview data were analysed using inductive content analysis. RESULTS: We found that nurse-family engagement was an ebb and flow of relational power that needed to be carefully negotiated and balanced, with nurses holding and often exerting more power than families. Constant fluctuations in nurses' practices of engagement occurred in day-to-day practice from shift-to-shift and from nurse-to-nurse. Family engagement was dependent on individual nurses' attitudes and perceptions of family, the patient's condition, and workload. Lastly, family engagement was shaped by the ICU context, with team culture, collaborative relationships, unit structures and organizational resources either enabling or limiting nurses' ability to engage with families. CONCLUSIONS: This global study provides an in-depth understanding of the way nurses engage with families in ICU and reflects many different cultures and health systems. We found that nurse-family engagement was marked by a shifting, yet often unequal power distribution in the nurse-family relationship, inconsistent nurse engagement practices, both of which resulted in variable family engagement in intensive care. Our research contributes a detailed description of engagement as practiced in the everyday delivery of health care. A more concentrated team effort, based on a shared culture and defined framework of family care is needed to ensure that families of critically ill persons are fully engaged in all aspects of intensive care.

Effects of nomophobia on anxiety, stress and depression among Saudi medical students in Jeddah, Saudi Arabia.

OBJECTIVE: To assess the prevalence of depression, anxiety and stress in medical students, and to analyse effects of demographics and nomophobia on depression, anxiety and stress. METHOD: The descriptive cross-sectional study was conducted at the College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia, from April 1 to May 23, 2019, and comprised male and female medical students aged 19-25 years. Data was collected using a demographic information form, the 21-item depression, anxiety and stress scale and the 20-item nomophobia questionnaire. Data was analysed using SPSS 20. RESULTS: Of the 230 students, 108(47%) were boys and 122 (53%) were girls. The overall mean age was 21.93±1.80 years. Anxiety, depression and stress was reported in 168 (74.6%), 158 (70.2%) and 127 (55.9%) of the students. Extremely severe anxiety, depression and stress were self-reported by 92 (40.9%), 38 (16.8%) and 16 (7.04%) students. There was a significant difference in the distribution of subjects within different levels of anxiety across gender (p<0.05). Higher anxiety and stress scores were observed in 78 (33.9%) students with severe nomophobia. Differences in the levels of anxiety and stress with regards to type of residence and nomophobia levels were significant (p<0.05). CONCLUSIONS: There was high prevalence of depression, anxiety and stress associated with gender, nomophobia levels and residence type.

Reconsidering longstanding assumptions about the role of medial prefrontal cortex (MPFC) in social evaluation.

The psychological nature of the association between MPFC modulation and social evaluation remains poorly understood. Despite confounds, small samples, and mixed results in existing research, MPFC activation is often interpreted as a reflection of socioemotional association and/or perceived similarity between the self and an evaluation target. The present research addressed issues from the existing literature by examining whether MPFC is modulated by (a) socioemotional associations unconfounded by previous knowledge (memory effects (Study 1, N = 48), repetition suppression (Study 2, N = 43), multi-voxel pattern analysis (Study 1 & 2)) and (b) perceived similarity to self (Study 2). MPFC was modulated by self-reference and trait-relevance, but there was not significant empirical support for the interpretation that MPFC modulation reflects socioemotional association or perceived similarity. These findings highlight the weak basis for prevailing assumptions about the psychological significance of MPFC in social evaluation and the need for studies which test multiple mechanisms.

How Does Motivation Modulate the Operation of the Mentalizing Network in Person Evaluation?

The mentalizing network is theorized to play a central role in making sense of people (compared with nonsocial targets), but is its involvement affected when we make sense of people in a nondispassionate manner (e.g., favoritism toward others on the basis of group membership)? First, mixed findings and small samples have prevented strong conclusions about whether intergroup evaluation increases or decreases activation regions associated with the mentalizing network. Second, little is known about the psychological mechanism underlying mentalizing network activation shaped by ingroup versus outgroup evaluations. Psychological models suggest two hypotheses that can be challenging to disentangle with self-report: Ingroup trait evaluations may benefit from a priori expectations and/or preferential evidence accumulation. Therefore, the current study (n = 50) drew on a combination of drift diffusion modeling and fMRI to examine how group membership affects the engagement of the mentalizing network for trait evaluation and whether group-differentiated activation is associated with a priori expectations and/or preferential evidence accumulation. Outgroup trait evaluations engaged dorsomedial pFC activation, whereas ingroup trait evaluations engaged ventromedial pFC activation as well as other regions associated with mentalizing such as precuneus, posterior cingulate cortex, and right TPJ. Furthermore, the ventromedial pFC and posterior cingulate cortex activation was associated with differential expectations applied to ingroup trait evaluation. The current findings demonstrate the importance of combining motivational factors, computational modeling, and fMRI to deepen our understanding of the neural basis of person evaluation.

Engaging in social rejection may be riskier for women.

People often worry how others will perceive them if they socially reject others, but do women have more to fear than men? Although previous research has shown that women are perceived negatively for behaving in counter-stereotypical ways, research on backlash has focused on business settings. The present research applies backlash theory to examine how women are perceived for engaging in social rejection. The findings suggest that backlash may operate differently in social rejection because only men punish women for rejecting. Across four studies, the present research found that (1) women felt they were more likely to be penalized for engaging in social rejection than men, (2) women were less willing to endorse social rejection than men, and (3) men, but not women, viewed female rejectors in a more negative manner than male rejectors.

The functional role of ventral anterior cingulate cortex in social evaluation: disentangling valence from subjectively rewarding opportunities.

Despite robust associations between the ventral anterior cingulate cortex (vACC) and social evaluation, the role of vACC in social evaluation remains poorly understood. Two hypotheses have emerged from existing research: detection of positive valence and detection of opportunities for subjective reward. It has been difficult to understand whether one or both hypotheses are supported because previous research conflated positive valence with subjective reward. Therefore, the current functional magnetic resonance imaging study drew on a social evaluation paradigm that disentangled positive valence and subjective reward. Participants evaluated in-group and out-group politicians in a social evaluation paradigm that crossed trait valence with opportunity for subjectively rewarding affirmation (i.e. a chance to affirm positive traits about in-group politicians and affirm negative traits about out-group politicians). Participants rated in-group politicians more positively and out-group politicians more negatively. One subregion of vACC was modulated by positive valence and another relatively posterior region of vACC was modulated by opportunity for subjective reward (i.e. a politician × valence interaction). The current findings demonstrate the importance of incorporating vACC function into models of social cognition and provide new avenues for sharpening our understanding of the psychological significance of vACC function in social evaluation and related domains such as reward and affect.

Exploring the cultural competence of undergraduate nursing students in Saudi Arabia.

PURPOSE: To explore the cultural competence of undergraduate nursing students at a college of nursing, Saudi Arabia. DESIGN: A descriptive exploratory design was used to explore the Saudi undergraduate nursing students' level of cultural competency. METHOD: The convenience sample included 205 nursing students affiliated with a college of nursing at a health science university in Jeddah, Saudi Arabia. Data was collected using the Inventory for Assessing the Process of Cultural Competence-Revised (IAPCC-R) consisting of 25 items. The tool reported acceptable reliability of Cronbach alpha 0.89. RESULTS: The majority of students were culturally aware and dealt with people from different cultures. One-third preferred to have training on culture over a period of time. Half the students preferred studying a special course related to working with people from different cultures. Cultural desire reported the highest mean while cultural knowledge scored the lowest among the cultural competence subscales despite students being exposed to some cultural knowledge content in their training. CONCLUSIONS: Implementing the guidelines for culturally competent care assure covering all aspects of care with consideration of cultural heritage as a main concept. Comparative study of nurses' and students' perception is further recommended.

Clinical Outcomes of Total Disc Replacement Versus Anterior Lumbar Interbody Fusion for Surgical Treatment of Lumbar Degenerative Disc Disease.

STUDY DESIGN: The authors performed a retrospective controlled study of patients diagnosed with lumbar degenerative disc disease who received surgical intervention (either total disc replacement [TDR]/Activ-L or anterior lumbar interbody fusion [ALIF]) at a single tertiary-care hospital from 2007-2010. OBJECTIVES: To investigate the clinical outcomes after TDR in comparison with ALIF for surgical treatment of lumbar degenerative disc disease (DDD). METHODS: Analyzed data included intra-operative blood loss, time to return to work, and clinical outcomes as evaluated through the Oswestry Disability Index (ODI) and the Visual Analog Scale (VAS) pain questionnaires pre-operatively and at 6 weeks, 3 months, 6 months, and 1 year postoperative follow-up. RESULTS: At the univariate analysis, patients submitted to TDR presented significantly lower VAS pain scores than patients who received ALIF starting at 6 weeks (P < .001) and continuing through one year postoperatively (P = .007). Patients submitted to TDR also presented significantly lower ODI disability scores at all time points. There was a significant difference in the number of days to return to work, with TDR patients returning to work on average 65 days sooner than ALIF patients (P = .011). There was no significant difference in the total blood loss between both groups. CONCLUSIONS: The results of this retrospective controlled study suggest that, in comparison with patients submitted to ALIF, patients submitted to TDR present quicker return to work, less back pain, and lower disability scores at 1 year follow-up.

When Saying Sorry May Not Help: The Impact of Apologies on Social Rejections.

If you have to socially reject someone, will it help to apologize? Social rejection is a painful emotional experience for targets, yet research has been silent on recommendations for rejectors. Across three sets of studies, apologies increased hurt feelings and the need to express forgiveness but did not increase feelings of forgiveness. The investigation of hurt feelings arising from a social rejection is challenging because previous research has shown that participants are reluctant to admit they felt hurt by the rejection. The present research addressed the self-report issue in two ways. First, participants rated how much social rejections would hurt someone's feelings as a function of whether an apology was included across various social rejection scenarios (Studies 1a-e). Second, aggressive behavior was measured in response to face-to-face social rejections that were manipulated to include or exclude apologies (Studies 2a-c). More specifically, Studies 1a-e (N = 1096) found that although individuals sometimes use apologies in social rejections, social rejections with apologies are associated with higher levels of explicit hurt feelings. Studies 2a-c (N = 355) manipulated the presence of an apology in face-to-face social rejections and found that social rejections with apologies cause more aggressive behavior. As in previous research, participants are reluctant to admit to feeling hurt. Finally, Study 3 (N = 426) found that in response to social rejections with apologies, individuals feel more compelled to express forgiveness despite not actually feeling more forgiveness. Implications for the role of language in social rejections are discussed.

How Do You See Me? The Neural Basis of Motivated Meta-perception.

We cannot see the minds of others, yet people often spontaneously interpret how they are viewed by other people (i.e., meta-perceptions) and often in a self-flattering manner. Very little is known about the neural associations of meta-perceptions, but a likely candidate is the ventromedial pFC (VMPFC). VMPFC has been associated with both self- and other-perception as well as motivated self-perception. Does this function extend to meta-perceptions? The current study examined neural activity while participants made meta-perceptive interpretations in various social scenarios. A drift-diffusion model was used to test whether the VMPFC is associated with two processes involved in interpreting meta-perceptions in a self-flattering manner: the extent to which the interpretation process involves the preferential accumulation of evidence in favor of a self-flattering interpretation versus the extent to which the interpretation process begins with an expectation that favors a self-flattering outcome. Increased VMPFC activity was associated with the extent to which people preferentially accumulate information when interpreting meta-perceptions under ambiguous conditions and marginally associated with self-flattering meta-perceptions. Together, the present findings illuminate the neural underpinnings of a social cognitive process that has received little attention to date: how we make meaning of others' minds when we think those minds are pointed at us.

What makes moral dilemma judgments "utilitarian" or "deontological"?

The distinction between utilitarianism and deontology has become a prevailing framework for conceptualizing moral judgment. According to the principle of utilitarianism, the morality of an action depends on its outcomes. In contrast, the principle of deontology states that the morality of an action depends on its consistency with moral norms. To identify the processes underlying utilitarian and deontological judgments, research in psychology and neuroscience has investigated responses to moral dilemmas that pit one principle against the other (e.g., trolley dilemma). However, the interpretation of responses in this paradigm is ambiguous, because the defining aspects of utilitarianism and deontology, outcomes and norms, are not manipulated. We illustrate how this shortcoming distorts interpretations of empirical findings and describe an alternative approach that overcomes the limitations of the traditional paradigm.

Softening the Blow of Social Exclusion: The Responsive Theory of Social Exclusion.

Social exclusion is an interactive process between multiple people, yet previous research has focused almost solely on the negative impacts on targets. What advice is there for people on the other side (i.e., sources) who want to minimize its negative impact and preserve their own reputation? To provide an impetus for research on the interactive nature of exclusion, we propose the Responsive Theory of Social Exclusion. Our theory postulates that targets and sources' needs are better maintained if sources use clear, explicit verbal communication. We propose that sources have three options: explicit rejection (clearly stating no), ostracism (ignoring), and ambiguous rejection (being unclear). Drawing on psychology, sociology, communications, and business research, we propose that when sources use explicit rejection, targets' feelings will be less hurt, their needs will be better protected, and sources will experience less backlash and emotional toil than if sources use ambiguous rejection or ostracism. Finally, we propose how the language of rejections may impact both parties.

What do we know about positive appraisals? Low cognitive cost, orbitofrontal-striatal connectivity, and only short-term bolstering of resilience.

The PASTOR framework needs to be reconciled with existing research on positive illusions, which finds that positive appraisals of stressors have a short shelf life as a mechanism of resilience, do not draw on costly executive functioning, and rely on neural networks that are distinct from those found in studies of experimentally instructed reappraisal or value.

Lyn deficiency leads to increased microbiota-dependent intestinal inflammation and susceptibility to enteric pathogens.

The Lyn tyrosine kinase governs the development and function of various immune cells, and its dysregulation has been linked to malignancy and autoimmunity. Using models of chemically induced colitis and enteric infection, we show that Lyn plays a critical role in regulating the intestinal microbiota and inflammatory responses as well as protection from enteric pathogens. Lyn(-/-) mice were highly susceptible to dextran sulfate sodium (DSS) colitis, characterized by significant wasting, rectal bleeding, colonic pathology, and enhanced barrier permeability. Increased DSS susceptibility in Lyn(-/-) mice required the presence of T but not B cells and correlated with dysbiosis and increased IFN-γ(+) and/or IL-17(+) colonic T cells. This dysbiosis was characterized by an expansion of segmented filamentous bacteria, associated with altered intestinal production of IL-22 and IgA, and was transmissible to wild-type mice, resulting in increased susceptibility to DSS. Lyn deficiency also resulted in an inability to control infection by the enteric pathogens Salmonella enterica serovar Typhimurium and Citrobacter rodentium. Lyn(-/-) mice exhibited profound cecal inflammation, bacterial dissemination, and morbidity following S. Typhimurium challenge and greater colonic inflammation throughout the course of C. rodentium infection. These results identify Lyn as a key regulator of the mucosal immune system, governing pathophysiology in multiple models of intestinal disease.

Three ways in which midline regions contribute to self-evaluation.

An integration of existing research and newly conducted psychophysiological interaction (PPI) connectivity analyses suggest a new framework for understanding the contribution of midline regions to social cognition. Recent meta-analyses suggest that there are no midline regions that are exclusively associated with self-processing. Whereas medial prefrontal cortex (MPFC) is broadly modulated by self-processing, subdivisions within MPFC are differentially modulated by the evaluation of close others (ventral MPFC: BA 10/32) and the evaluation of other social targets (dorsal MPFC: BA 9/32). The role of DMPFC in social cognition may also be less uniquely social than previously thought; it may be better characterized as a region that indexes certainty about evaluation rather than previously considered social mechanisms (i.e., correction of self-projection). VMPFC, a region often described as an important mediator of socioemotional significance, may instead perform a more cognitive role by reflecting the type of information brought to bear on evaluations of people we know well. Furthermore, the new framework moves beyond MPFC and hypothesizes that two other midline regions, ventral anterior cingulate cortex (VACC: BA 25) and medial orbitofrontal cortex (MOFC: BA 11), aid motivational influences on social cognition. Despite the central role of motivation in psychological models of self-perception, neural models have largely ignored the topic. Positive connectivity between VACC and MOFC may mediate bottom-up sensitivity to information based on its potential for helping us evaluate ourselves or others the way we want. As connectivity becomes more positive with striatum and less positive with middle frontal gyrus (BA 9/44), MOFC mediates top-down motivational influences by adjusting the standards we bring to bear on evaluations of ourselves and other people.

Dissociable neural modulation underlying lasting first impressions, changing your mind for the better, and changing it for the worse.

Unattractive job candidates face a disadvantage when interviewing for a job. Employers' evaluations are colored by the candidate's physical attractiveness even when they take job interview performance into account. This example illustrates unexplored questions about the neural basis of social evaluation in humans. What neural regions support the lasting effects of initial impressions (even after getting to know someone)? How does the brain process information that changes our minds about someone? Job candidates' competence was evaluated from photographs and again after seeing snippets of job interviews. Left lateral orbitofrontal cortex modulation serves as a warning signal for initial reactions that ultimately undermine evaluations even when additional information is taken into account. The neural basis of changing one's mind about a candidate is not a simple matter of computing the amount of competence-affirming information in their job interview. Instead, seeing a candidate for the better is somewhat distinguishable at the neural level from seeing a candidate for the worse. Whereas amygdala modulation marks the extremity of evaluation change, favorable impression change additionally draws on parametric modulation of lateral prefrontal cortex and unfavorable impression change additionally draws on parametric modulation of medial prefrontal cortex, temporal cortex, and striatum. Investigating social evaluation as a dynamic process (rather than a one-time impression) paints a new picture of its neural basis and highlights the partially dissociable processes that contribute to changing your mind about someone for the better or the worse.

Protecting the self: the effect of social-evaluative threat on neural representations of self.

One of the most robust ways that people protect themselves from social-evaluative threat is by emphasizing the desirability of their personal characteristics, yet the neural underpinnings of this fundamental process are unknown. The current fMRI study addresses this question by examining self-evaluations of desirability (in comparison with other people) as a response to threat. Participants judged how much personality traits described themselves in comparison with their average peer. These judgments were preceded by threatening or nonthreatening social-evaluative feedback. Self-evaluations made in response to threat significantly increased activation in a number of regions including the OFC, medial pFC, lateral pFC, amygdala, and insula. Individual differences in the extent to which threat increased desirability were significantly correlated with medial OFC activity. This is the first study to examine the neural associations of a fundamental self-protection strategy: responding to threat by emphasizing the self's desirability. Although neural research has separately examined self-evaluation processes from the regulation of social-evaluative threat, little is known about the interplay between the two. The findings build on this previous research by showing that regions, often associated with self-evaluation, are modulated by the degree to which people respond to threat by emphasizing their own desirability.

Macrophage heterogeneity and cholesterol homeostasis: classically-activated macrophages are associated with reduced cholesterol accumulation following treatment with oxidized LDL.

Macrophages are centrally involved during atherosclerosis development and are the predominant cell type that accumulates cholesterol in the plaque. Macrophages however, are heterogeneous in nature reflecting a variety of microenvironments and different phenotypes may be more prone to contribute towards atherosclerosis progression. Using primary human monocyte-derived macrophages, we sought to evaluate one aspect of atherogenic potential of different macrophage phenotypes by determining their propensity to associate with and accumulate oxidized low density lipoprotein (oxLDL). Classically-activated macrophages treated simultaneously with interferon γ (IFNγ) and tumor necrosis factor α (TNFα) associated with less oxLDL and accumulated less cholesterol compared to untreated controls. The combined treatment of IFNγ and TNFα reduced the mRNA expression of CD36 and the expression of both cell surface CD36 and macrophage scavenger receptor 1 (MSR1) protein. Under oxLDL loaded conditions, IFNγ and TNFα did not reduce macrophage protein expression of the transcription factor peroxisome proliferator-actived receptor γ (PPARγ) which is known to positively regulate CD36 expression. However, macrophages treated with IFNγ attenuated the ability of the PPARγ-specific agonist rosiglitazone from upregulating cell surface CD36 protein expression. Our results demonstrate that the observed reduction of cholesterol accumulation in macrophages treated with IFNγ and TNFα following oxLDL treatment was due at least in part to reduced cell surface CD36 and MSR1 protein expression.