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At least 127 records · Page 7Linked to original sources
PubMed1988

Daily decision-making in community residences: a social comparison of adults with and without mental retardation.

In addition to physical placement in the community, the extent to which individuals experience personal autonomy may provide a crucial measure of the attainment of a more normalized lifestyle. Everyday choices and choice-making opportunities of 24 persons with mental retardation living in community group homes were compared to choices of 42 nonretarded adults. The adults with mental retardation had significantly fewer opportunities to make decisions on such matters as what to eat or wear, how to spend free time, and with whom to live. Results were discussed in terms of the need to operationalize meaningful improvements in the lives of persons with mental retardation that go beyond the appearance of the physical environment.

Activities of Daily Living↗
PubMed1996

The times, they are a changin'.

Significant changes are taking place and will continue to take place in U.S. health care and medicine. Many of these changes are not, and will not be, to the benefit of physicians. Reduced personal autonomy, probably lower compensation than expected, fewer and less adequate resources, and overall significantly reduced power are some of the likely outcomes of the changes underway. Perhaps of greatest personal interest is the high likelihood of lack of employment in medicine for upwards of 200,000 physicians over the next 20 years.

Adaptation, Psychological↗
PubMedDate not supplied

Perceived coercion among clients entering substance abuse treatment: structural and psychological determinants.

Little is known about the extent to which admission to alcohol and other drug treatment programs is perceived as a coercive imposition. This is because coercion is typically inferred from referral source rather than measured. In this study, clients (N = 300) entering substance abuse treatment were assessed on structural variables (sociodemographic background, criminal history, current legal status, referral source), psychological variables (personal beliefs about substance abuse, perceived interpersonal pressures), alcohol/drug use, and perceived coercion. Mandated treatment status predicted perceived coercion; however, many mandated clients did not, and many self-referrals did, report being coerced into treatment. Psychological factors accounted for additional variance in perceived coercion, controlling for referral source. Substance dependence did not add to the predictability of perceived coercion beyond structural and psychological variables. These findings are inconsistent with the notion that coercion can be inferred from referral source. Instead, results support self-determination theory (Deci & Ryan, 1985), which proposes that multiple social and psychological events promote perceived coercion by undermining personal autonomy.

Adult↗
PubMed1995

[Social rehabilitation through sports].

The contribution community disabled sports is making towards comprehensive rehabilitation of people with disabilities is interpreted much too narrowly by the statutory definition of rehabilitation sports. In the member clubs of Deutscher Behinderten-Sportverband, the German disabled sports association, severely disabled individuals rediscover their potential and self-worth, which may entail self-determination, solidarity with others, and genuine social integration. Renewed awareness of the traditional values of German disabled sports as a self-help movement of those concerned, and characterization of rehabilitation as a complex learning process towards regaining personal autonomy--both call for a thorough reconsideration of ambulatory disabled sports in organizational and funding respects.

Adaptation, Psychological↗
PubMed1980

The wit: a personality analysis.

Fifty-eight undergraduate psychology students were group tested on 12 variables thought to be related to the successful prediction of wit. In addition to a score on wit, scores on creativity, verbal fluency, need for play, need for impulsivity, self-confidence, dominance, exhibition, change, autonomy, personal adjustment, authoritarianism, and sex group were obtained. The results were analyzed in a stepwise multiple regression analysis. A significant Pearson product-moment correlation was obtained between wit and creativity (p < .01) and between wit and personal adjustment (p < .05). The multiple regression analysis indicated that creativity was the best single significant predictor of wit. Personal adjustment, in combination with creativity, provided the next highest significant contribution. The results are discussed and suggestions for further research are posited.

Journal Article↗
PubMed1998

Determinants of the treatment climate in psychiatric and substance abuse programs: implications for improving patient outcomes.

This study examined determinants of the treatment climate in 89 psychiatric and substance abuse programs. Clearer policies giving patients more control, and more health and treatment services, were related to more supportive, autonomous, expressive, and practically oriented milieus. In contrast, more policy choice and daily living assistance were associated with less support, personal expression, and practical orientation. Programs in which staff had more paraprofessionals and better team functioning, and in which patients had more social resources and better mental functioning, tended to be more supportive and to have more emphasis on autonomy, personal expression, and practical orientation. Based on these results, we suggest some guidelines on how to change the treatment milieu to benefit patients' adjustment.

Activities of Daily Living↗
PubMed2000

Perceived worker autonomy: the foundation for shared governance.

The popular notion that worker autonomy is an outcome of shared governance is challenged in this critical analysis of the author's research and selected literature. Growing evidence is presented that environment, expectations, and clarity of meaning play important roles in fostering and supporting personal autonomy. Staff and administrators can use this valuable information about autonomy to refocus partnership models and team-based strategies for enhanced team effectiveness.

Communication↗
PubMed1989

Addictive eating disorders.

Addictive eating disorders have been a part of history and have only recently been recognized as psychiatric disorders. Increased publicity has enabled family and friends of eating disordered individuals to recognize the disease and seek help for them from trained medical professionals. Everyone is "at risk," but certain subpopulations have been "coming out of the closet" in epidemic proportions. An ever-increasing number of high school-aged and college-aged females have developed some form of eating disorder, from fad diets to self-induced vomiting. In these individuals, the obsession with thinness takes priority over family, friends, schoolwork, or career. Strangely enough, the eating disordered person's addiction is not to food but to the feeling of numbness her behavior brings. Over time, the need to control is desperately sought and many patients transfer their obsession to other patterns of self-abuse. Nursing intervention should include setting the appropriate example in terms of the professional's relationship with food, while providing much needed emotional support. An innovative method of intervention available to nursing professionals includes the use of creative, visual imagery to repeatedly diffuse fear and anxiety about food until a level of personal autonomy over the disorder and other emotional concerns is achieved. Therefore, a system of recovery can be designed for the anorectic or bulimic patient and the experience of recovery from the eating disorder can be a lifelong process of personal growth.

Feeding and Eating Disorders↗
PubMed2005

Measuring the values and preferences for everyday care of persons with cognitive impairment and their family caregivers.

PURPOSE: This study describes the development and psychometric properties of a 24-item scale to be used in both research and practice settings that assesses the everyday care values and preferences of individuals with cognitive impairment and the perceptions of family caregivers about their relative's values and preferences for care. DESIGN AND METHODS: The Values and Preferences Scale was developed on the basis of previous measures used with cognitively intact samples with additional items generated by the authors in consultation with an advisory committee of practitioners, researchers, family caregivers, and persons with cognitive impairment. Individuals with mild to moderate cognitive impairment and their family caregivers (n = 111) were interviewed for the study. RESULTS: Results of a factor analysis determined that the Values and Preferences Scale can be divided into two domains or subscales for persons with cognitive impairment and their family caregivers (i.e., Environment-Social Network and Personal Autonomy). These domains were found to have good internal consistency for both the individuals and their caregivers (Cronbach's alphas ranged from.70 to.82). Evidence of their psychometric properties compared with measures of depression, quality of life, and involvement in decision making was also found. IMPLICATIONS: These findings suggest that persons with cognitive impairment are able to express values and preferences about care they currently receive or will need in the future. Further application and testing of the Values and Preferences Scale should prove useful to practitioners who assist those with cognitive impairment and their caregivers with daily care decisions and the development of care plans.

Adult↗
PubMed1990

[A study of mental distress in old age].

Sociocultural and economic features of elderly individuals have important effects on their mental health. We evaluated the influence of those factors in 135 elderly individuals distributed in four groups depending on their personal relation setting: 39 were inmates of a closed institution, 40 lived by themselves, 43 lived with their families and 13 were displaced. The evaluation was carried out with a social questionnaire and the General Health Questionnaire (GHQ--28 items). The overall prevalence of psychological distress (positive GHQ) in the study sample was 51.1%, with a significant relation between distress and the following variables: personal relation setting (p less than 0.001), rural or urban origin (p less than 0.05), satisfaction with personal relation (p less than 0.01) and degree of personal autonomy (p less than 0.0001). No significant relation was found between psychological distress and age, sex, marital status, amount of the pension or educational level. It was concluded that there is a high prevalence of psychological distress in the population over 65 years. There is a remarkable influence of the personal relation setting and family milieu on the preservation of psychological well being in the elderly and the prevention of feelings of misery and loneliness.

Activities of Daily Living↗
PubMed1996

[Psychomotor treatment of cranial injuries in childhood. Two cases of apallic syndrome].

In this paper the authors aim to assess the results of psychomotor treatment of 5 patients with cranial injuries admitted to the Division of Infantile Neuropsychiatry at Gaslini Hospital from 1983 to 1985 and to evaluate the role of this treatment in a pathology with multiple, complex functional disorders. Evolution was excellent in 3 out of 5 patients who presented level 1-3 coma with limited post-traumatic sequelae (epilepsy and dysfunction of the left side in A.D., epilepsy and learning disorders in C.F., motor impairment and learning disorders in V.D.) Effective control was achieved in epileptic patients together with a good recovery in those with learning handicaps. Only slight fine motor disorders remained in the case (A.D.) with left hemiparesis. The two cases with level 5 coma that developed into apallic syndrome both attained full postural and motor autonomy, although a slight paretic deficit remained in the left side in one case (V.A.) and vague cerebellar signs in the other (G.D.). Moreover, despite continuing residual difficulties involving concentration and instability of attention, together with slight affective and emotional problems, both girls acquired satisfactory knowledge and responsibility regarding their own psychomotor status and achieved good personal autonomy and a stable ego structure. These results appear to confirm the hypothesis that psychomotor treatment is an effective method of achieving an adequate recomposition of the psychophysical and functional unit of body, damaged by injury.

Brain Injuries↗
PubMedDate not supplied

[Neurologic diseases, mental retardation and reduction in work capacity].

The reduction of working ability, because of disease, was considered in 1,053 subjects. 21 groups of maladies were found; the neurological disease and mental retardation (MR) caused various degrees of working inability in 416 subjects, i.e. in the 39.51% of the examined population; orthopaedic changes affected the 15.57% of the patients; psychic disorders determined some inability in 8.93% of the persons. The subjects unable to work receive, by Law, an economic help. This study was limited to neurological patients and to subjects mentally retarded. The working ability was reduced by 5 types of disturbances: neuromotor pathology, mental retardation, mental deterioration and dementia, epilepsy, other neurological diseases. The neuromotor pathology affected 163 subjects; the types of symptomatology: hemiplegia; it was found in 71 patients; 62 times it was the result of cerebrovascular disease; in 4 patients it was caused by a hypoxic-ischaemic pre-perinatal encephalopathy. 43 patients affected by cerebrovascular disease lost their personal autonomy, i.e. they could no longer do the activities of daily living (ADL); 7 patients lost their working ability; 12 subjects kept some ability to work. The hemiplegias which struck after 50 years of age were caused by cerebrovascular disease; paraplegia: 28 paraplegic patients have been seen; the aetiology was: poliomyelitis in 8 subjects; MS in 5 patients; ALS in 2 patients; in 13 patients the aetiology was unknown. 6 patients resulted unable to work; 8 persons kept some working ability; 14 patients lost the ability to do the ADL; tetraplegia, or double/bilateral hemiplegia, was found in 20 patients; the aetiology: poliomyelitis in 4 patients; pre-perinatal hypoxic ischaemic encephalopathy in 4 patients; 3 patients of MS; lesion of the cervical spinal cord because of breech delivery in 2 patients; the aetiology was not known in 7 persons. The ability to do the ADL was lost in 17 patients; 3 subjects kept some working ability. Double or bilateral hemiplegia (Little disease) was the model of neuromotor deficit subsequent natal encephalopathy (Infantile Cerebral Palsy, PCI); brachial plexus paralysis was only found from obstetrical (i.e. natal) origin; poliomyelitis and PKU resulted prevented as of 10 years. Mental Retardation (MR) was considered a borderline pathology between neurology and psychiatry; it included 162 subjects: in patients with severe MR a pre-perinatal hypoxic-ischaemic encephalopathy was found in 40.4% of the cases; in patients affected by moderate or light MR the same encephalopathy was found in the 11.3% of the subjects.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1997

[Therapy studies in dermatologic oncology. Recommendations for patient education].

Guidelines of good clinical practice regulate controlled clinical studies. Goal of the study, type of treatment and possible side effects have to be explained. The physician faces problems, if the study includes a "no treatment group". Referring to the literature and based on our own experience with tumor patients, several criteria are proposed to optimize the recruitment of patients. Important points are: Explanations should be given by an experienced doctor. He must be informed about the study and therapeutic alternative treatments. The atmosphere for the talk must be quiet. The participation of a person whom the patient trusts is desirable. The necessity of the study must be explained. Randomization in different study groups should be discussed without any preference. Prognosis should be explained without any detailed statistical data. Form of treatment, possible side effects and control examinations have to be discussed. The family physician's cooperation should be stressed. Personal autonomy in the patient's decision to participate in the study must be emphasized. Enough time for reflection must be granted before the final decision. It must be assured that the patient receives the same medical attention even after rejecting the study. These recommendations might help to avoid major mistakes which are harmful for the doctor-patient-relationship and further tumor therapy. A good initial discussion forms the basis for effective cooperation during tumor treatment. It may counteract the personal fear and negative reports in media of being "a guinea pig". The patient will appreciate the efforts of the doctor to provide optimal therapy. Furthermore, he will realize that such studies are necessary to improve future therapies.

Humans↗
PubMed1986

Human autonomy and the frontal lobes. Part II: Patient behavior in complex and social situations: the "environmental dependency syndrome".

Imitation and utilization behavior have previously been described in terms of a simple interaction between an examiner and a patient, and were interpreted as an excessive dependence on environmental cues. In this study, patient dependence was observed in complex situations of everyday life. Two patients with focal unilateral frontal lobe lesions were observed while in a doctor's office, a lecture room, a car, and a garden, while visiting an apartment where various activities were possible, and while in a gift shop. The patients' behavior was striking, as though implicit in the environment was an order to respond to the situation in which they found themselves. The term environmental dependency syndrome is proposed for this condition. It implies a disorder in personal autonomy. Individual psychological traits influenced the way in which loss of autonomy was manifested. This study does not offer a physiological model of autonomy, but it does provide clinical and behavioral observations on the loss of autonomy secondary to unilateral lesions of the frontal lobe.

Brain Diseases↗
PubMed1992

[Social medicine aspects in expert assessment according to the new long-term care legislation].

According to the new German 'Betreuungsgesetz' (BtG) legislation concerning care for the mentally and or physically disabled, instituting a "case of care" requires an expert opinion on the patient's mental and physical impairments as well as on the question as to what degree the patient lacks the ability to manage his or her own affairs. The respect for the personal autonomy has to be weighed against the need to take action for the patient's benefit. The concept of 'neglect' ('Verwahrlosung') plays an important role in judging a patient's situation. Criteria for the use of this term are derived from a study carried out by the author, and lead to a questionnaire designed for preparatory investigations. As to the question of who should act as an expert in BtG cases, the author argues that the public health offices qualify best for this task.

Disability Evaluation↗
PubMed2001

Repeated use of the emergency department: qualitative study of the patient's perspective.

OBJECTIVE: To explore what lies behind repeated emergency department (ED) use, from the patients' own perspectives. METHODS: Qualitative study based on in depth interviews with frequent users of the ED at the Huddinge University Hospital, Sweden. Ten adult patients having visited the ED 6-17 times in the previous 12 months were interviewed. The personal meaning they attached to the symptoms and their encounters at the ED were inductively analysed, thereby relating patient behaviour to life conditions. RESULTS: The frequent ED visitors perceive pain or other symptoms as a threat to life or to personal autonomy. Irrespective of whether or not the patients relate their health problems to a traumatic event, overwhelming anxiety compels them to seek urgent help. Clear cut diagnoses are seldom mentioned. Although none of the patients is homeless or totally lacking in means, the narratives reveal struggles with adverse life circumstances and medical, psychological and/or social problems, including alcohol or other substance misuse. Occasional referrals from the ED to a psychiatrist seem not to lead to any continuous treatment or to a change in the patients' health seeking behaviour. Satisfaction with care becomes adversely affected when the patients perceive that the ED staff classifies their use of the ED as inappropriate or when their symptoms are belittled. CONCLUSIONS: From their own perspectives, frequent ED visitors are in need of urgent care. It is particularly important to these patients that the personal meaning they attach to their symptoms is attended to and respected by the ED staff.

Adult↗
PubMed1992

[Ethical and social issues on the human genome analysis].

The modern technologies for human genome analysis raise a variety of ethical and social questions. The pre-symptomatic diagnostic of diseases of late expression is becoming possible for a rapidly increasing number of situations. The use of that knowledge by employers, insurance companies, schools, and society in general, could lead to discriminations and stigmatizations, in addition to adverse psychological reactions. DNA fingerprinting raises questions of privacy and personal autonomy in its applications to paternity proof, criminal proceedings, and establishment of data banks. The project of the immediate and complete sequencing of the human genome will lead to questions of economical ethics, as well as of access, commercialization and property rights of scientific information and materials obtained. It also favours a reducionistic mentality and international unbalances. The molecular biology of humans, which will follow the complete sequencing of the genome, may foster a rethinking of the concepts of freedom of self-determination (basic for moral responsibility) and of equality. The gene therapy and its possible extension to the betterment of the human species, pose questions of ethical limits to this technology. All these problems will have to be answered in terms of the application of the principle of ethical freedom for self-fulfillment, as a right of the human person, as well as of science and society. Scientific, economic and social interests have to be subordinated to the dignity of the human person.

DNA Fingerprinting↗