Parental confidence in managing food allergy: development and validation of the Food Allergy Self-Efficacy Scale for Parents (FASE-P).

BACKGROUND: Food allergy is often a life-long condition that requires constant vigilance to prevent accidental exposure and avoid potentially life-threatening symptoms. Parents' confidence in managing their child's food allergy may relate to the poor quality of life anxiety and worry reported by parents of food-allergic children. OBJECTIVE: The aim of this study was to develop and validate the first scale to measure parental confidence (self-efficacy) in managing food allergy in their child. METHODS: The Food Allergy Self-Efficacy Scale for Parents (FASE-P) was developed through interviews with 53 parents, consultation of the literature and experts in the area. The FASE-P was then completed by 434 parents of food-allergic children from a general population sample in addition to the General Self-Efficacy Scale (GSES), the Food Allergy Quality of Life Parental Burden Scale (FAQL-PB), the General Health Questionnaire-12 (GHQ-12) and the Food Allergy Impact Measure (FAIM). A total of 250 parents completed the retest of the FASE-P. RESULTS: Factor and reliability analysis resulted in a 21-item scale with five subscales. The overall scale and subscales have good to excellent internal consistency (Cronbach's α of 0.63-0.89), and the scale is stable over time. There were low to moderate significant correlations with the GSES, FAIM and GHQ-12 and strong correlations with the FAQL-PB, with better parental confidence relating to better general self-efficacy, better quality of life and better mental health in the parent. Poorer self-efficacy was related to egg and milk allergy; self-efficacy was not related to severity of allergy. CONCLUSIONS AND CLINICAL RELEVANCE: The FASE-P is a reliable and valid scale for use with parents from a general population. Its application within clinical settings could aid provision of advice and improve targeted interventions by identifying areas where parents have less confidence in managing their child's food allergy.

Chronic pain and health care utilization in women with a history of childhood sexual abuse.

OBJECTIVE: This cross-sectional controlled study investigated the association between chronic pain, health care utilization and a history of childhood sexual abuse. SUBJECTS: Three groups, constituting 80 women in total, were studied (1) attendees at group therapy for individuals who had experienced childhood sexual abuse (n = 26); (2) Two control groups consisting of nonabused (a) psychiatric outpatients (n = 33); and (b) nurses (n = 21). SETTING: The setting was a university affiliated community and tertiary care hospital in London. Ontario. OUTCOME MEASURES: Each subject voluntarily completed questionnaires documenting history of childhood abuse, pain, psychological symptomatology and medical and surgical history. RESULTS: Sixty-nine percent of the women who had experienced childhood sexual abuse reported a chronic painful condition lasting more than three months, compared to 43% of the combined control groups (p = .026). Women who had experienced childhood sexual abuse reported a greater number of painful body areas (p = .003), more diffuse pain and more diagnoses of fibromyalgia (p = .013). They had more surgeries (p = .037), hospitalizations (p = .0004) and family physician visits (p = .046). CONCLUSIONS: Women with a history of childhood sexual abuse reported more chronic pain symptoms and utilized more health care resources compared to nonabused control subjects. Identification of such a history in the patient experiencing persisting pain may be the first step toward a successful combination of medical and psychosocial interventions.

A comparison of short-term group and individual therapy for sexually abused women.

OBJECTIVE: To compare the effectiveness of 10 sessions of group therapy with that of 10 sessions of individual therapy in a sample of 86 adult women seeking treatment for the effects of childhood sexual abuse. METHOD: Participants were randomly assigned to the 2 treatment modalities and tested at assessment, pretherapy following a 10-week wait condition, posttherapy, and 6-month and 12-month follow-up. RESULTS: Participants had fewer symptoms and better psychosocial functioning posttherapy and were further improved at the 6- and 12-month follow-up. Neither treatment modality was superior to the other. Approximately one-half of the sample sought further treatment during the follow-up periods. CONCLUSIONS: Improvement in symptoms and functioning was associated with short-term treatment in both modalities, but many patients remained distressed and required further treatment. Future research should investigate whether sexually abused women who meet criteria for specific diagnoses require more focused and/or longer-term therapy.

Toward sensitive practice: issues for physical therapists working with survivors of childhood sexual abuse.

BACKGROUND AND PURPOSE: The high rates of prevalence of childhood sexual abuse in the United States and Canada suggest that physical therapists work, often unknowingly, with adult survivors of childhood sexual abuse. The purposes of this qualitative study were to explore the reactions of adult female survivors of childhood sexual abuse to physical therapy and to listen to their ideas about how practitioners could be more sensitive to their needs. The dynamics and long-term sequelae of childhood sexual abuse, as currently understood by mental health researchers and as described by the participants, are summarized to provide a context for the findings of this study. SUBJECTS AND METHODS: Twenty-seven female survivors (aged 19-62 years) participated in semistructured interviews in which they described their reactions to physical therapy. RESULTS: Survivors' reactions to physical therapy, termed "long-term sequelae of abuse that detract from feeling safe in physical therapy," are reported. Participant-identified suggestions that could contribute to the sense of safety are shared. CONCLUSIONS AND DISCUSSION: Although the physical therapist cannot change the survivor's history, an appreciation of issues associated with child sexual abuse theoretically can increase clinicians' understanding of survivors' reactions during treatment. We believe that attention by the physical therapist to the client's sense of safety throughout treatment can maximize the benefits of the physical therapy experience for the client who is a survivor.

Working models of attachment and representations of the object in a clinical sample of sexually abused women.

This study examined internal working models of attachment as assessed by the Adult Attachment Interview (AAI; George, Kaplan, & Main, 1984) and self-other differentiation as assessed by the Description of Significant Other (Marziali & Oleniuk, 1990) in a clinical sample of 40 women reporting a history of childhood sexual abuse. Although there was some relationship between the two measures, the association was not strong. The Cannot Classify category of the AAI, which is increasingly being assigned in clinical samples, needs refinement to increase the usefulness of the AAI for clinical purposes. Integration of concepts from objects relations theory may also enhance the value of the AAI in studies of clinical samples.

Attachment organization and adaptation in sexually-abused women.

OBJECTIVE: To explore the possible associations among attachment organization, current functioning and Axis II personality disorder. METHOD: Attachment organization was assessed using the Adult Attachment Interview in a clinical sample of 40 women with a history of childhood sexual abuse. The Global Assessment Scale yielded measures of current psychosocial functioning and the Structured Clinical Interview for Diagnosis on DSM-III-R was used to assess presence of personality disorder. RESULTS: Preoccupation with attachment issues was evident in 68% of the subjects; 60% of the subjects were unresolved in respect to loss and/or trauma; and 88% of the subjects met criteria for one or more Axis II disorders. A relationship between Borderline Personality Disorder and the Unresolved attachment classification is suggested. CONCLUSIONS: Women who have experienced childhood sexual abuse require intervention that focuses on resolution of trauma and loss and responds to individual differences in attitudes toward attachment issues.

A randomized clinical trial of cognitive marital therapy.

Thirty-three couples with severe marital discord referred to a psychiatric outpatient department were randomly assigned to Cognitive Marital Therapy or a control group. Cognitive Marital Therapy is a brief, structured couple therapy, which involves spouses in reciprocal self-disclosure of personal constructs. The control group received the same number of sessions of self-disclosure from a programmed marital enhancement text. Personal distress, marital adjustment, marital quality, and aspects of self-disclosure were measured before and after treatment. Symptoms of depression as well as somatic and compulsive complaints showed significant improvement in both groups. The wives exhibited a trend suggesting that they were making more self-disclosures to their spouses after counseling. No discernable differences in outcome were found between the marital therapy group and the control group. Marital intimacy and marital satisfaction did not improve significantly over the course of 10 therapy sessions. This study suggests that the role of self-disclosure in marital therapy needs further clarification.

Association between risk factors for coronary heart disease in schoolboys and adult mortality rates in the same localities.

Risk factors for coronary heart disease were compared in fifth year boys (15-16 years old) from two schools that were chosen from localities with a fourfold difference in adult mortality from coronary heart disease. One school was in an underprivileged urban locality in the area of increased incidence of heart disease ('high risk') and the other in a semi-rural affluent locality with an incidence of heart disease similar to the national average ('low risk'). Smoking, hypertension, hypercholesterolaemia, obesity, physical fitness, and inactivity were evaluated as risk factors for coronary heart disease. Smoking, increased body fat, poor diet, and physical inactivity were found increased among pupils from the school in the high risk area compared with those in the low risk area. Lipids, maximum oxygen uptake, and hypertension were similar in both schools. The risk of coronary heart disease seems to reflect the adult mortality rates in the area. To reduce the overall incidence of coronary heart disease, health education should be directed towards prevention of smoking, improving diets, and increasing amounts of activity among school children, with special attention directed toward children in regions where there is a high mortality from coronary heart disease among adults.

The impact of group therapy for adult survivors of childhood sexual abuse.

This article reports on 95 women who were referred to an outpatient psychiatry clinic for group therapy for adult survivors of childhood sexual abuse. Criteria for exclusion in group therapy are outlined and the format of the group therapy is described. Those who completed the groups are compared to dropouts. The group's effectiveness was evaluated using measures of psychiatric symptomatology (SCL 90), depression (Zung Self-Report Depression Scale), and self-esteem (Texas Social Behaviour Inventory) with a pre/post test design. Clients' evaluation questionnaires were also used. Group therapy was found to be effective in reducing symptomatology and change was in the expected direction in terms of depression and self-esteem.

Dysthymia: a randomized study of cognitive marital therapy and antidepressants.

Preliminary data from a randomized study of the effectiveness of combined marital therapy and antidepressant medication in the treatment of dysthymic married women is presented. The study compares doxepin with placebo, and a marital therapy designed to enhance intimacy through facilitating self-disclosure between spouses with a more supportive and educational therapeutic approach. After ten weeks of combined treatment, the dysthymic women show statistically significant improvement on all the depression measures as well as on the intimacy scale. A trend is developing for greater reduction of depressive symptomatology in the group treated with self-disclosure. The evidence appears to suggest the possibility that the presence of a patient's husband as a supportive figure may of itself be a potent therapeutic manoeuvre in the treatment of dysthymic women.

A hypothesis-testing approach to treatment of a child with an idiosyncratic (morpho)phonological system.

Evaluation of a 6-year-old language-impaired girl's phonological and morphophonological systems revealed several idiosyncratic characteristics. Three hypotheses regarding the nature of this child's impairment were developed and then tested by monitoring the child's progress in therapy. The results of the intervention program supported all three hypotheses in principle. It is concluded that phonologically impaired children must learn to communicate facing articulatory and linguistic constraints similar to but often greater than those influencing the performance of younger normally developing children. It can be expected, then, that these children often will use phonological rules commonly found among normal children. It should also be expected that they occasionally will be led to phonological and morphological solutions to their communication problems that are unusual, if not idiosyncratic. The hypothesis-testing approach used in this investigation is advocated as a useful step in the development of an efficient intervention program and as a means of gaining insight into the nature of children's phonological and morphological impairments.

Surgical treatment of kinked internal carotid arteries.

Carotid artery insufficiency is caused by an abnormal kinked or coiled internal carotid artery in 15-20 per cent of symptomatic patients. Surgical correction should be considered if other causes for the neurological signs are excluded, a pronounced kinked or coiled area is demonstrated and if there is not a severe neurological deficit. As well as eliminating the elongation, surgical correction should include intraluminal inspection of the artery as, in 38-5 per cent of cases, a concomitant arteriosclerotic stenosis requires simultaneous correction.

Foot skin ischaemia in atherosclerotic peripheral vascular disease.

Hyperbaric oxygen and the vasodilating effect of tolazoline hydrochloride were used to investigate atherosclerotic ischaemia of the skin of the foot. Ischaemic feet were divided into two subgroups each with a foot blood flow significantly higher than normal and significantly different from each other. The high blood flow in the ischaemic feet appears to have been an attempt to meet a tissue oxygen need. In some instances this need seems to have been satisfied but without obvious benefit to the ischaemic or anoxic skin. It is suggested that a local rather than a regional blood flow insufficiency is the cause of skin lesions in peripheral vascular disease.