A qualitative analysis of psychosocial needs and support impacts in families affected by young sudden cardiac death: The role of community and peer support

BACKGROUND

Young sudden cardiac death (YSCD), often occurring in previously healthy individuals, is a tragic event with devastating impact on affected families, who are at heightened risk of posttraumatic stress and prolonged grief and may themselves be at risk of YSCD. Previous research suggests that surviving family members' psychosocial support needs are often unmet.

PURPOSE

This study sought to identify how YSCD-affected families experience dedicated community and peer support in light of their psychosocial support needs.

METHODS

The study used a qualitative design, employing a thematic analysis of focus group and interview data. Three focus groups and five individual interviews were conducted with affected family members (N = 19). The sample was drawn from a UK-based charity, Cardiac Risk in the Young. Audio-recordings of the focus groups and interviews were transcribed and subjected to thematic analysis.

RESULTS

Three super-ordinate themes were identified: 1. YSCD community support as offering a place of safety, 2. YSCD community support as fostering sense-making, 3. YSCD community support as facilitating finding new meaning.

CONCLUSIONS

YSCD-affected families can benefit from access to dedicated community and peer support that offers a safe environment, provides affiliation, understanding and normalisation and enables sense-making and the rebuilding of a sense of self. Dedicated community support can facilitate meaningful re-engagement with life through helping prevent YSCD and through memorialisation and legacy-building to maintain a continuing bond with the deceased. Clinicians need to be aware of the need to incorporate available community and peer support into patient pathways.

Calretinin positive neurons form an excitatory amplifier network in the spinal cord dorsal horn

Nociceptive information is relayed through the spinal cord dorsal horn, a critical area in sensory processing. The neuronal circuits in this region that underpin sensory perception must be clarified to better understand how dysfunction can lead to pathological pain. This study used an optogenetic approach to selectively activate spinal interneurons that express the calcium-binding protein calretinin (CR). We show that these interneurons form an interconnected network that can initiate and sustain enhanced excitatory signaling, and directly relay signals to lamina I projection neurons. Photoactivation of CR interneurons in vivo resulted in a significant nocifensive behavior that was morphine sensitive, caused a conditioned place aversion, and was enhanced by spared nerve injury. Furthermore, halorhodopsin-mediated inhibition of these interneurons elevated sensory thresholds. Our results suggest that dorsal horn circuits that involve excitatory CR neurons are important for the generation and amplification of pain and identify these interneurons as a future analgesic target.

Toward a Framework for Islamic Psychology and Psychotherapy: An Islamic Model of the Soul

A uniquely Islamic theoretical framework for an Islamic psychology has yet to be established. To do so requires that we understand how human beings are conceptualized within the cosmology that characterizes the Islamic tradition. This paper presents a model of the soul from within an Islamic paradigm, generated through a grounded theory analysis of interviews with 18 key informants with relevant academic or religious expertise. The model elaborates aspects of a mechanism for the development of the soul that constitutes a potential foundation for an Islamic theory of human psychology and has particular relevance for Islamic approaches to psychotherapy.

Time, space, power, and the liminal transformation of the psychologised “self ”

Drawing on the concept of liminality, we provide an alternative language for understanding how time, space, and power intersect to impact upon the relationship that individuals hold with themselves as “self.” A historical (re)contextualisation is presented that traces the genesis of a notable development in British war-time psychiatry, the “Northfield experiments,” to its contemporary parallels in the democratic therapeutic community in prisons and Psychologically Informed Planned Environments. Links are made between the development of these “liminal events” and aspects of Foucault’s works on the technologies/techniques of objectification and subjectification/self, his critique of the object of painting and his critical analytics of “other” spaces. It is argued that the therapeutic community can be (re)contextualised as a highly functional liminal event that held/holds significant implications for how patients subjectively experience(d) “self” as certain forms of psychological power and knowledge were/are given (material) effect within this point in time and space.

"I thought they should know… that daddy is not completely gone"

This study aimed to explore the experiences, responses, and conceptualizations of sense of presence experiences in bereavement in terms of family meaning-making. A case study framework was chosen, using group and individual interviews and ethnographically derived observations in a father-bereaved family in the south of England. Interview data were analyzed by applying both phenomenological and social constructionist perspectives to the same data set. It was observed that there was a division between the mother, who had derived much personal benefit from sense of presence experiences, and the children, who dismissed the experiences as incompatible with their own worldviews and how they made sense of their father's death.

'A good method of quitting smoking' or 'just an alternative to smoking'? Comparative evaluations of e-cigarette and traditional cigarette usage by dual users

The development of e-cigarettes was initially hailed as a resource in facilitating a reduction in or cessation of cigarette smoking. Many users of e-cigarettes are ‘dual users’, smoking traditional cigarettes and e-cigarettes. The present qualitative study examines the factors that a group of 20 dual users considered to have been influential in their decisions to use e-cigarettes and their comparative evaluations of e-cigarettes and traditional cigarettes. Health concerns were not found to be sole motivators. Participants pointed to financial and contextual considerations, particularly peer influence on uptake and continued usage of e-cigarettes. E-cigarettes were evaluated as comparable to cigarettes in some ways but not in other important respects such as sensation and satisfaction. Different social evaluations of cigarette and e-cigarette usage were discerned which influenced how participants identified as smokers, ‘vapers’ or neither. Findings are discussed in relation to social representations, identity and implications for continued e-cigarette usage among dual users.

Troubled Men and Threatening Women: The Construction of `Crisis' in Male Mental Health

In recent years, the development of an apparent `crisis' in male well-being (and, more specifically, in male mental health) has become a focus of media and academic interest. This crisis has been linked to disruptions in the traditional system of gender relations, with men being problematically positioned within a changed social context, especially in relation to issues of emotion. In this study, articles on men's health in a British broadsheet newspaper are subjected to discourse analysis to examine the ways in which the crisis in male mental health has been rhetorically constructed. The analysis suggests that it is constructed as arising from the enactment of a traditional, hegemonic masculinity (seen as militating against emotional expression), gender role changes in the employment and sexual domains and the advance of women. Despite an apparent acknowledgement of a need for change, alternative enactments of masculinity are undermined. The implications of these analyses are explored.

Using the Counselling Interview To Collect Research Data on Sensitive Topics

In interview-based research on sensitive health-related topics, the interview may restimulate painful memories among respondents who may become distressed. It is ethically questionable for researchers to address sensitive issues without being equipped to deal with resultant distress. An effective way of addressing this problem is for interviewers to foster counselling attributes and use counselling skills within research interviews. This fulfils various therapeutic and supportive functions for the interviewees, such as helping them to understand their experiences and engage in cathartic disclosure. It also serves research functions in that it can foster good rapport, encourage interviewees to elaborate their experiences and help establish potential lines of association and causation in the research data. The use of the counselling interview as a data collection tool is illustrated with examples drawn from a study of AIDS-related bereavement among gay men.

Perceived influences on post-diagnostic dietary change among a group of men with prostate cancer

A cancer diagnosis is often associated with loss of agency and control that can adversely affect well-being. Patients may try to regain control through dietary change aimed at preventing progression and/or recurrence. Evidence for the effectiveness of post-diagnostic dietary change in prostate cancer is not conclusive, which can cause uncertainty among patients and health professionals. This qualitative study explored how eight men in the U.K., who had been diagnosed with prostate cancer in the previous 5 years, accounted for any post-diagnostic changes they made to their diet. Data were generated through semi-structured telephone interviews and were subjected to thematic analysis. This yielded two themes concerning the perceived nature and importance of dietary change and the perceived determinants of dietary change. The latter focused on internal dimensions such as agency and external dimensions such as the perceived role of relationships with health professionals, the availability of credible dietary information and family influences. The study points to the importance of the family context in enabling the men to implement dietary change. It is suggested that, even if health professionals can only offer qualified, general advice about diet, this may provide men with a focus for action and a means of regaining control.

The governing of the self/the self-governing self: Multi-rater/source feedback and practices 1940–2011

This article argues for a more critical contextualisation of multi-rater/source feedback mechanisms applying Foucault’s conceptual template of technologies of objectification and subjectivity/self, as they relate to a mode of “self” government that is intricately entwined with psychological knowledge and expertise. An in-depth genealogical analysis is presented that traces the genesis of two prominent forms of multi-rater/source feedback mechanisms between 1940 and 2011: the educational innovation of the T-Group and the contemporary human resource practice of 360-degree feedback. We conclude that such practices have functioned to enfold individuals within relations of power and signification that impact upon individual self-governance, subjectivity, and identity. As such, the application of 360-degree feedback within contemporary organisational models is emblematic of a programme of government that relies for its effectiveness on the self-regulatory and self-developing capacities of the individual at work.

The cigarette box as an advertising vehicle in the United Kingdom: A case for plain packaging

This research aimed to study tobacco advertising between 1950-2003 and to evaluate the role of the cigarette box in advertising. Tobacco company advertisements (n = 204) were coded for content and meanings used to promote their product. There was a significant shift from cigarettes being displayed to the cigarette box only. Changes in advertising and the meanings evoked were unrelated to changes in smoking behaviour. It is argued that the cigarette box has absorbed the meanings associated with smoking and has become an effective vehicle for advertising. It is also argued that this can only be minimised with plain packaging.

Sense of presence experiences and meaning-making in bereavement: a qualitative analysis

This qualitative study aimed to explore the potential role that might be played by the reported experience of "sensing the presence of the deceased" in meaning-making processes in bereavement. Semistructured interviews were conducted with 12 participants who reported having had such an experience and the transcripts were subjected to thematic analysis. Seven overarching themes were identified, 3 of which were considered central: finding benefit in the continuation of the deceased, finding benefit in the continued relationship, and finding meaning through existential, spiritual, and religious sense-making. While participants found many benefits in what they experienced, finding meaning beyond immediate coping seemed to require the availability of spiritual/religious frameworks that could be adopted or, if available but discrepant, could meaningfully accommodate the experience.

Death and football: An analysis of men's talk about emotions

This study is concerned with men's talk about emotions and with how emotion discourses function in the construction and negotiation of masculine ways of doing emotions and of consonant masculine subject positions. A sample group of 16 men, who were recruited from two social contexts in England, participated in focus groups on 'men and emotions'. Group discussions were transcribed and analysed using discourse analysis. Participants drew upon a range of discursive resources in constructing masculine emotional behaviour and negotiating masculine subject positions. They constructed men as emotional beings, but only within specific, rule-governed contexts, and cited death, a football match and a nightclub scenario as prototypical contexts for the permissible/understandable expression of grief, joy and anger, respectively. However, in the nightclub scenario, the men distanced themselves from the expression of anger as violence, whilst maintaining a masculine subject position. These discursive practices are discussed in terms of the possibilities for effecting change in men's emotional lives.

Discourses of Friendship between Heterosexual Women and Gay Men: Mythical Norms and an Absence of Desire

Gay men and heterosexual women may share some common interests in critiquing hetero-patriarchy. However feminism and gay liberationist politics do not always coincide and the role of individual subjectivities in recognising oppressive discourses of normativity remains debated. Interviews were conducted with seven friendship dyads of heterosexual women and gay men. Transcripts were subjected to discourse analysis, which suggested extensive management of heterosexist norms in the friends’ accounts of friendship. The analysis highlighted ambiguity over the ‘male’ status of gay men, a concern with constructing the friendships as legitimately asexual, and the use of parody in the face of homophobia to disrupt normative assumptions. Although we primarily considered the role of heterosexist discourses, there is also evidence that other dimensions of non-normativity (for example, gender and ethnicity) are implicated in friendships constructed around shared otherness and mutual non-normativity.

The rhetoric of acculturation: when integration means assimilation

Viewing traditional acculturation literature through a social constructionist lens, the present paper identifies a number of limitations with this research. A discourse analytic approach to acculturation is offered as a means of addressing some of these issues. Drawing on examples taken from British print media debate surrounding the issue of faith schooling in the UK, an analysis is presented which illustrates the manner in which, though optimally positioned within acculturative moral hierarchies directed towards the legitimization of both pro- and anti-faith schooling debates, integration rhetoric often conceals the (re-)production of a more implicit assimilationism. Findings are discussed in terms of their implications for hegemonically structured acculturative power relations. This exploratory analysis provides the basis for reflection on the benefits of a discursive approach to acculturation. Moreover, the dependence of integrationist discourse on a series of socio-spatial resources is considered and, following on from Dixon and Durrheim's (2000) discursive re-conceptualization of place-identity, is taken to signify the need for a more environmentally 'grounded' approach to acculturation.

Expression of the Th1 chemokine IFN-gamma-inducible protein 10 in the airway alters mucosal allergic sensitization in mice

Although the preliminary characterization of chemokines and their receptors has been prolific, comparatively little is known about the role of chemokines in the evolution of immune responses. We speculate that the preferential recruitment of a particular immune cell population has implications for the short- and long-term features of an adaptive response. To test this hypothesis, we employed adenovirus-mediated gene transfer to express the Th1-affiliated, CXC chemokine IFN-gamma-inducible protein (IP) 10 in the airways of mice undergoing a mucosal sensitization regimen known to result in a Th2-polarized allergic response. This resulted in a approximately 60-75% inhibition of eosinophils in the bronchoalveolar lavage (BAL); these inflammatory changes were accompanied by enhanced IFN-gamma, ablated IL-4, and, peculiarly, unaltered IL-5 and eotaxin levels in the BAL. The effect of IP-10 expression was shown to be dependent on IFN-gamma, as there was no statistically significant reduction in BAL eosinophilia in IFN-gamma knockout mice subjected to the IP-10 intervention. Flow cytometric analysis of mononuclear cells in the lung revealed a approximately 60% reduction in the fraction of CD4(+) cells expressing T1/ST2, a putative Th2 marker, and a parallel increase in the proportion expressing intracellular IFN-gamma following IP-10 treatment. The effect of IP-10 expression at the time of initial Ag encounter is persistent, as mice rechallenged with OVA following the resolution of acute inflammation exhibited reduced eosinophilia and IL-4 in the BAL. Collectively, these data illustrate that local expression of the chemokine IP-10 can introduce Th1 phenomena to a Th2-predisposed context and subvert the development of a Th2 response.

IL-15 and IL-2: a matter of life and death for T cells in vivo

Interleukin (IL)-2 and IL-15 are redundant in stimulating T-cell proliferation in vitro. Their precise role in vivo in governing T-cell expansion and T-cell homeostasis is less clear. Each may have distinct functions and regulate distinct aspects of T-cell activation. The functional receptors for IL-2 and IL-15 consist of a private alpha-chain, which defines the binding specificity for IL-2 or IL-15, and shared IL-2 receptor beta- and gamma-chains. The gamma-chain is also a critical signaling component of IL-4, IL-7 and IL-9 receptors. Thus, the gamma-chain is called the common gamma or gamma-c. As these receptor subunits can be expressed individually or in various combinations resulting in the formation of receptors with different affinities, distinct signaling capabilities or both, we hypothesized that differential expression of IL-2 and IL-15 receptor subunits on cycling T cells in vivo may direct activated T cells to respond to IL-2 or IL-15, thereby regulating the homeostasis of T-cell response in vivo. By observing in vivo T-cell divisions and expression of IL-2 and IL-15 receptor subunits, we demonstrate that IL-15 is a critical growth factor in initiating T cell divisions in vivo, whereas IL-2 limits continued T-cell expansion via downregulation of the gamma-c expression. Decreased gamma-c expression on cycling T cells reduced sustained Bcl-2 expression and rendered cells susceptible to apoptotic cell death. Our study provides data that IL-2 and IL-15 regulate distinct aspects of primary T-cell expansion in vivo.

What does it mean to be a donor offspring? The identity experiences of adults conceived by donor insemination and the implications for counselling and therapy

In the absence of research with adult donor offspring, this study begins to bridge that gap by asking individuals about their experiences as donor offspring and considering the implications for psychotherapeutic and counselling practice. Sixteen participants (13 male, three female, age range 26-55 years) recruited through donor insemination support networks in the UK, USA, Canada and Australia, were sent semi-structured questionnaires by E-mail and post. Using identity process theory as a framework for understanding participants' accounts, the data were qualitatively analysed using interpretative phenomenological analysis. Participants consistently reported mistrust within the family, negative distinctiveness, lack of genetic continuity, frustration in being thwarted in the search for their biological fathers and a need to talk to a significant other (i.e. someone who would understand). These experiences could be postulated as being indicative of a struggle to assimilate, accommodate and evaluate information about their new identities as donor offspring. Psychotherapists and counsellors need to be aware of these identity issues if they are to meet the needs of donor offspring within therapeutic practice.

Genomic organization and characterization of mouse SAP, the gene that is altered in X-linked lymphoproliferative disease

X-linked lymphoproliferative (XLP) disease is a fatal immunological disorder that renders the immune system unable to respond effectively to Epstein-Barr virus (EBV) infection. The gene that encodes a protein termed SAP or SH2D1A is either deleted or mutated in XLP patients, resulting in uncontrolled B- and T-cell proliferation upon EBV infection. Here, we report the cloning and characterization of the mouse SAP gene. It is localized on the mouse X chromosome and comprises four exons spanning approximately 25 kb. Its expression appears to be restricted to T lymphocytes. Whereas a high level of SAP expression is observed in Thl cells, only small amounts are detectable in Th2 cells. Moreover, SAP expression is down-regulated upon in vitro activation of T cells, including CD4+, CD8+ single-positive T cells, and Thl and Th2 cells. This study provides valuable information for in-depth genetic and biochemical analysis of the function of SAP in the immune system.

How counselling psychologists view their personal therapy

A survey of UK chartered counselling psychologists (N = 192) was carried out to investigate how they viewed their personal therapy. Eighty-four respondents completed questionnaires about their reasons and motivations for therapy, as well as its outcome and process. The results indicated that the majority (88%) were in favour of personal therapy as a training requirement. Most respondents rated the outcome and process of their personal therapy as positive, however 27% also reported some negative effects. A factor analysis of various components of personal therapy indicated that counselling psychologists made a distinction between three factors, i.e. learning about therapy itself, issues arising out of training and dealing with personal issues. Analyses of the data suggested that aims and motivation for therapy were related to dealing with personal issues, whereas these were not important for the other factors. Learning about therapy itself was related to the number of sessions: more specifically, those who had more than the mandatory 40 sessions rated contributions of their personal therapy to understanding therapeutic relationships and processes more highly than those who had less. Initial sessions may be used by trainees to explore personal issues, leading to a preoccupation with the self, and learning about therapy per se may only occur once this has been dealt with.

Demonstration of the therapeutic potential of non-anaphylactogenic anti-IgE antibodies in murine models of skin reaction, lung function and inflammation

BACKGROUND

Allergies and allergic asthma are believed to be mediated by allergen-specific IgE antibodies. We have investigated the therapeutic potential of inhibiting endogenous IgE by a non-anaphylactogenic anti-mouse IgE antibody 1-5 with respect to its effects on antigen-induced skin reaction, lung function changes and lung inflammation in mice.

METHODS

Mice were immunized with benzylpenicillinoyl-KLH or ovalbumin, and antigen-mediated skin reaction, bronchoconstriction, bronchopulmonary hyperresponsiveness (BHR) and lung eosinophilic inflammation determined in anti-IgE 1-5-treated versus untreated animals.

RESULTS

Application of anti-IgE 1-5 inhibited (by 90%) the serum IgE and, 3-4 days after onset of treatment, blocked the antigen-induced skin reaction. Furthermore, the antibody also inhibited (by 90%) the antigen-induced infiltration of eosinophils into the lung. This latter effect seems to be mediated by blocking the IgE-CD23 interaction and indicates that lung eosinophilic inflammation also depends on IgE. Moreover, when applied to rats passively sensitized with mouse IgE, antibody 1-5 inhibited the antigen-induced bronchoconstriction. A similar effect could be seen in actively immunized mice, where antibody 1-5 was able to inhibit (by 70%) the ovalbumin-induced bronchoconstriction as well as BHR.

CONCLUSIONS

In summary, non-anaphylactogenic anti-IgE antibodies can markedly inhibit IgE levels and IgE-mediated allergic reactions. Since bronchoconstriction, BHR and lung eosinophilic inflammation can be suppressed, such antibodies may be attractive principles for the treatment of allergic asthma.

Decision making in HIV testing among a group with low HIV risk

Relatively little is known about how individuals (apart from gay and bisexual men) decide to have an HIV test and how, once they have presented for testing, they make decisions about proceeding through the testing trajectory. This paper reports on a qualitative study in which 55 mainly heterosexual respondents with low HIV risk were interviewed about their experiences of decision making around HIV testing. Reasons for deciding to be tested centred on a desire for reassurance and the circumstances of the respondents' current relationship. The most common relationship reason focused on a desire to confirm HIV status before beginning sexual relations or engaging in unprotected sex with a partner. Although some respondents recognized that other individuals had influenced their decision to be tested, few said that pre-test counselling had been influential in this respect. Instead, it was said to have promoted feelings of 'ownership' of a decision which had already been taken prior to counselling. The potential effects of HIV testing on HIV risk behaviour were also examined and a non-significant increase in unprotected sex was reported between the month before the test and the month after. The implications of these findings for the provision of HIV testing services are explored.

A review of research on the nature and quality of HIV testing services: a proposal for process-based studies

Considerable research has been conducted on various issues associated with HIV testing. However, rather than conceptualizing HIV testing as a dynamic process which consists of interrelated elements, this body of work has focused on discrete aspects of the HIV testing process. As an example of such research, studies which have examined HIV testing in terms of various behavioural and psychological outcomes are critically reviewed. Their limitations are attributed to their failure to account for all the elements involved in the HIV testing process that-singly and in dynamic combination-could have produced the measured outcomes. It is contended that if research on HIV testing is to be of use in the development and improvement of HIV testing services, it should be able to identify and describe in detail the factors that might lead to various outcomes of testing. This requires an in-depth examination of all aspects of the HIV testing process and their interrelationships from the perspectives of those undergoing testing and those providing testing services. The principal process elements in HIV testing are described; existing research on these topics is critically reviewed; and recommendations are made for future research. The process elements of HIV testing are identified as making a decision to be tested; accessing testing services; test counseling; and waiting for the test result. Of these, most consideration is accorded to the HIV test counselling process. It is contended that research is needed which examines both clients' and counsellors' expectations, experiences of and satisfaction with HIV test counselling. Specific issues that could usefully be addressed by future research include the process of obtaining clients' informed consent for testing; the ways in which test results are conveyed to clients; the strategies used in HIV counselling to help clients avoid or reduce behaviours in the future; partner notification; and which professional groups are best placed to conduct HIV test counselling. Finally, the question of which research methods might be suitable for process-based studies is considered. It is concluded that qualitative methods could be particularly appropriate as they are well-placed to chart in detail the varied aspects of the HIV testing process and their interrelationships.

Blood-flow augmentation of intermittent pneumatic compression systems used for prevention of deep vein thrombosis prior to surgery

PURPOSE

To compare, using Duplex ultrasonography, different intermittent pneumatic compression (IPC) systems to augment venous blood flow for deep venous thrombosis (DVT) prevention during and after surgery and during periods of immobility.

METHODS

This cross-over study randomly assigned 26 young, healthy, adult subjects, without history of DVT, hypertension, diabetes, stroke. vascular or cardiac pathologies, to an order of knee-high, foam, single-pulse IPC device and thigh-high, vinyl, sequential-pulse pneumatic compression systems. Prior to making the flow measurement, the girth of the calf and thigh and length of the leg of each subject were determined. The right leg was used in this evaluation.

RESULTS

The average flow augmentation, which is a direct measure of the amount of femoral vein blood flow velocity increase over the base, was 107%+/-49% with the knee-high system, and 77%+/-35% with the thigh-high IPC system (P<0.002). Augmentation was higher for 62% of the subjects with knee-high IPC, and for 23% of the subjects with the thigh-high system. Overall, the blood was actively moving through the vein during the decompression phase. On occasion, the velocity during the decompression phase would fall to zero for short intervals with both systems, indicating complete emptying of the vessel. Variation in limb anatomy did not significantly affect blood-flow augmentation with the knee-high IPC, but augmentation decreased with increase in girth with the thigh-high IPC.

CONCLUSIONS

The study indicates that the knee-high, foam, single-pulse IPC device produces a significantly higher venous blood-flow augmentation than the thigh-high, vinyl, sequential-pulse system.