Positive Experiences of Patient-Centred Care Are Associated With Intentions to Comply With Fertility Treatment: Findings From the Validation of the Portuguese Version of the PCQ-Infertility Tool.

Positive experiences of patient-centred care are associated with intentions to comply with fertility treatment: findings from the validation of the Portuguese version of the PCQ-Infertility tool.

Hum Reprod. 2013 Jul 2;
Pedro J, Canavarro MC, Boivin J, Gameiro S

Are positive experiences of different aspects of patient-centred care (PCC) associated with higher intentions to comply with fertility treatment?Positive experiences regarding information received, respect from staff about values and preferences, continuity in treatment and competence of staff are directly associated with higher compliance intentions, while positive experiences regarding accessibility to and involvement in the treatment and communication with staff are indirectly associated, via associations with less concerns about treatment.The quality of infertility services can influence patients’ intentions to comply with treatment. Patients cite negative care experiences as one of the main reasons why they discontinue treatment prematurely. Delivering PCC in routine infertility care is associated with higher quality of life and lower distress during treatment.In this cross-sectional study of 265 women and 83 men, we investigated first, the psychometric properties of the Portuguese version of the Patient-Centredness Questionnaire (PCQ)-Infertility tool, which assesses infertility PCC, and secondly, the associations between PCC and intentions to comply with treatment.Men and women undergoing fertility diagnostic investigation or treatment at Portuguese fertility clinics were recruited online and in clinical setting. Participants filled out a socio-demographic and fertility data file and other questionnaires to assess PCC (PCQ-Infertility), intentions to comply with treatment (FertiQoL Persistence Scale), wellbeing (Anxiety and Depression subscales of the BSI and FertiQoL), concerns about treatment (CART Scale) and treatment tolerability (FertiQoL Tolerability Domain).There were 265 women and 83 men who completed the questionnaires. The confirmatory factor analysis for the PCQ-Infertility indicated a good fit [X(2) = 479.097; P < 0.001; comparative fit index = 0.929; root mean square error of approximation = 0.058 (0.051-0.065)]. All PCQ-Infertility dimensions showed good internal consistency (? ? 0.70, excepting for organization: ? = 0.57). Information provision, respect for patients' values, continuity of care and competence of the team were directly associated with higher intentions to comply with treatment (r from 0.13 to 0.23). Greater accessibility, patient involvement and good communication were negatively associated with concerns about treatment (r from -0.14 to -0.16) and less concerns were associated with higher intentions to comply with treatment (r from -0.14 to -0.15).Of the sample, 49% were recruited online. Patients recruited online had higher education and were more likely to be undergoing assisted reproduction treatment and this could have influenced the ratings of PCC reported. We did not account for treatment prognosis factors and/or doctor censuring and this may have resulted in underestimation of the strength of associations reported involving compliance intentions. The cross-sectional design of the study does not allow for cause and effect analysis between the study variables.To promote treatment compliance, clinics should allow patients to establish stable relationships with a reference doctor who is competent and respectful of their interests and values and who provides them with the information they need. Clinics can also alleviate their patients' concerns regarding medical procedures by ensuring that these professionals are easily accessible, have good communication skills, and involve patients in the treatment process and associated decision-making. The Portuguese version of the PCQ-Infertility tool is valid and reliable.No external funding was either sought or obtained for this study and no competing interests are declared. TRIAL REGISTRATION NUMBER: NA. HubMed – depression

Physiological, Biochemical, and Psychological Responses to Environmental Survival Training in the Royal Australian Air Force.

Mil Med. 2013 Jul; 178(7): e829-e835
Chester AL, Edwards AM, Crowe M, Quirk F

Military environmental survival training (EST) is designed and considered to evoke significant stressors to military personnel in preparation for combat-like scenarios. The aim of this study was to observe and report selected physiological, biochemical, psychological, and performance responses to this intense 15-day program of Royal Australian Air Force (RAAF) EST. Fourteen RAAF participants undertook the EST course. Physiological and psychological responses were collected across the 15 days across outcomes: (1) biochemical markers (blood lactate, interlukin-6, and creatine kinase), (2) performance and anthropometric indices (vertical jump, body mass), and (3) psychological questionnaires profile of mood states, depression anxiety stress scale, Kessler-10 etc.). Creatine kinase concentration increased significantly from baseline to day 5 (p < 0.05) and thereafter remained elevated for the remaining 10 days of EST (128%; p < 0.01). Vertical jump (-10%; p < 0.01) and body mass (-8%; p < 0.01) both decreased across 15 days of EST, while there were no significant change in interlukin-6. Negative psychological responses were observed for mood (p < 0.01), depression (p < 0.05), anxiety (p < 0.01), and stress (p < 0.01) following the EST course. This case study showed the RAAF EST course imposed significant physiological and psychological stress as observed from markers of muscle damage, deterioration in physical performance, substantial weight loss, negative mood, and psychological distress. HubMed – depression

Impaired inhibition of prepotent motor actions in patients with Tourette syndrome.

J Psychiatry Neurosci. 2013 Jul 2; 38(4): 120138
Wylie SA, Claassen DO, Kanoff KE, Ridderinkhof KR, van den Wildenberg WP

Background: Evidence that tic behaviour in individuals with Tourette syndrome reflects difficulties inhibiting prepotent motor actions is mixed. Response conflict tasks produce sensitive measures of response interference from prepotent motor impulses and the proficiency of inhibiting these impulses as an act of cognitive control. We tested the hypothesis that individuals with Tourette syndrome show a deficit in inhibiting prepotent motor actions. Methods: Healthy controls and older adolescents/adults with persistent Tourette syndrome without a history of obsessive-compulsive disorder or attention-deficit/hyperactivity disorder and presenting with stable mood functioning (i.e., no history of well-treated anxiety or depression) participated in this study. They performed a Simon task that induced conflict between prepotent actions and goal-directed actions. A novel theoretical framework distinguished group differences in acting impulsively (i.e., fast motor errors) from the proficiency of inhibiting interference by prepotent actions (i.e., slope of interference reduction). Results: We included 27 controls and 28 individuals with Tourette syndrome in our study. Both groups showed similar susceptibility to making fast, impulsive motor errors (Tourette syndrome 26% v. control 23%; p = 0.10). The slope (m) reduction of the interference effect was significantly less pronounced among participants with Tourette syndrome than controls (Tourette syndrome: m = -0.07 v. control: m = -0.23; p = 0.022), consistent with deficient inhibitory control over prepotent actions in Tourette syndrome. Limitations: This study does not address directly the role of psychiatric comorbidities and medication effects on inhibitory control over impulsive actions in individuals with Tourette syndrome. Conclusion: The results offer empirical evidence for deficient inhibitory control over prepotent motor actions in individuals with persistent Tourette syndrome with minimal to absent psychiatric comorbidities. These findings also suggest that the frontal-basal ganglia circuits involved in suppressing unwanted motor actions may underlie deficient inhibitory control abilities in individuals with Tourette syndrome. HubMed – depression