Stress management in men with solvent-induced chronic toxic encephalopathy

Assessments of coping after acquired brain injury: a systematic review of instrument conceptualization, feasibility, and psychometric properties

OBJECTIVE

To identify measures of coping styles used by patients with acquired brain injury; to evaluate the conceptualization, feasibility, and psychometric properties of the instruments; and to provide guidance for researchers and clinicians in the choice of a suitable instrument.

DESIGN

Systematic review.

RESULTS

The search identified 47 instruments, of which 14 were selected. The instruments focused on dispositional coping, situation-specific coping, or domain-specific coping. Psychometric properties were scarcely investigated. The COPE stood out in terms of psychometric properties but had low feasibility. The brief COPE, Coping Scale for Adults-short form, and Utrecht Coping List stood out in terms of feasibility, and the available psychometric properties of these instruments were good. Only the Coping With Health Injuries and Problems was used as other report.

CONCLUSION

Information on psychometric properties of coping instruments in acquired brain injury is scarcely available and limits the strength of our recommendations. For patients with mild injuries, we cautiously recommend the COPE and for patients with more severe injuries the brief COPE, Coping Scale for Adults-short form, Utrecht Coping List, and Coping With Health Injuries and Problems-other-report. Other instruments may be used to address particular issues such as coping with a specific stressful situation or illness.

Optimising pharmacological maintenance treatment for COPD in primary care

Chronic obstructive pulmonary disease (COPD) is a multi-faceted disease that is a major cause of morbidity and mortality worldwide, and is a significant burden in terms of healthcare resource utilisation and cost. Despite the availability of national and international guidelines, and effective, well-tolerated pharmacological treatments, COPD remains substantially under-diagnosed and under-treated within primary care. As COPD is both preventable and treatable there is an urgent need to raise the awareness and profile of the disease among primary care physicians and patients. Increasing evidence suggests that initiation of long-acting bronchodilator treatment at an early stage can significantly improve the patient's long-term health and quality of life (QoL). Recent large-scale trials in COPD have confirmed the longterm benefits of maintenance treatment with long-acting bronchodilators. A wide range of benefits have been shown in selected patient groups including improved lung function and QoL, reduced exacerbations and, in some studies, delayed disease progression and improved survival. In this review, we consider recent developments in our understanding of COPD, including current and emerging pharmacological treatment options, and identify steps for optimising early diagnosis and pharmacological treatment of COPD within the primary care environment.

The psychometric relationship between career thinking and salutogenic functioning amongst unemployed adults

Orientation: Corporate survival mechanisms, like mergers, downsizing, restructuring and outsourcing, contribute to unemployment levels amongst adults. Psychological maturity seems to influence the quality of the career decisions that people make in these difficult circumstances. However, we do not know what their behavioural strengths are.Research objectives: The objective of this study was to investigate the psychometric relationship between career thinking (negative and positive career thoughts) and salutogenic functioning (locus of control and sense of coherence) amongst unemployed adults.Motivation for study: Career decision research has consistently surveyed students to understand career indecision. Adults are not a homogenous group. Therefore, this trend may not reflect throughout the larger adult population. For this reason, the researchers conducted exploratory research into the nature of career indecision amongst non-student adults.Research design, approach and method: The researchers used a quantitative design that included a four-instrument survey on a purposive sample of 225 Canadian unemployed and non-student adults who had not decided on a career. They calculated correlations and regressions.Main findings: The researchers reported significant relationships between the four constructs. They found that a sense of coherence predicted career thinking.Contribution/value-add: A sense of coherence, which includes comprehension, meaningfulness and manageability, acts as a facilitator of effective career thinking.Practical/managerial implications: During career assessment and guidance, the role of sense of coherence as a strength factor will indicate the person’s readiness to make important career decisions.

Cognitive functioning in patients with suspected chronic toxic encephalopathy: evidence for neuropsychological disturbances after controlling for insufficient effort

OBJECTIVES

Chronic toxic encephalopathy (CTE) caused by long term occupational exposure to organic solvents is still a controversial disorder. Neuropsychological testing is the cornerstone for diagnosing the syndrome, but can be negatively influenced by motivational problems. In this nationwide study, we investigated the neuropsychological functioning and psychological symptoms of a large group of patients with suspected CTE, and ruled out alternative explanations for their complaints, including suboptimal performance due to insufficient effort.

METHODS

We studied participants with suspected CTE (n = 386) who were referred for further diagnosis to the Netherlands Centre of Occupational Diseases in the period 1998-2003 and who had completed the entire diagnostic protocol. Patients were excluded if there was the slightest suspicion that test performance had been negatively influenced by insufficient effort (n = 221), or if comprehensive assessment identified an alternative diagnosis (n = 80). Insufficient effort was defined by a combination of three indices. The neuropsychological test scores of the patient group (n = 85) were compared with those of a control group of building trade workers matched for sex, age, and educational level (n = 35).

RESULTS

The patient group had significantly more psychological complaints and performed significantly worse than the control group on tests of speed of information processing and memory and learning. However, only a small percentage of the patients had clearly abnormal scores for cognitive speed (9%) or memory (8%). Attention, verbal abilities, and constructional functions were not disturbed. Exposure duration and cognitive complaints were significantly correlated, whereas the correlation between exposure duration and neuropsychological domain scores was not significant.

CONCLUSIONS

Insufficient effort was present in a substantial part of the patient group. After minimising the likelihood that insufficient effort negatively influenced neuropsychological scores, we still found neuropsychological deficits in speed of cognitive processing and memory; however, these scores were clearly abnormal only in a minority of patients with suspected CTE. Screening instruments should focus on these domains.