No abstract

The population in Canada and other developing countries is aging, increasing the need for palliative care services. In rural communities, care of dying people is normally provided by health care professionals as part of a generalist practice, not by palliative care specialists. Despite a lack of specialists and resources, some rural communities have developed local palliative care programs. The goal of this research was to conceptualize rural communities’ process of developing palliative care programs using a theoretical perspective of community capacity development. Data were from nine focus groups of interdisciplinary rural health care providers who provided palliative care in seven provinces/territories of Canada. The outcome is a theoretical model that conceptualizes the process of developing palliative care programs in four sequential phases: antecedent community conditions, a catalyst, creating the team, and growing the program. The activities of each phase are outlined. This research offers practical and theoretical knowledge to guide practitioners and planners seeking to develop palliative care programs in other rural communities.

Forty-five women (15 bulimic, 15 obese, and 15 normal) served as subjects. All were matched on age and height. Normal and bulimic subjects also were matched on weight. Each subject was administered the Minnesota Multiphasic Personality Inventory, the Symptom Checklist-90, the Beck Depression Inventory, and a body image assessment. Results showed that bulimics evidenced significantly more psychopathology than did the normal and obese subjects. In particular, bulimics were found to be more depressed, more anxious, and generally more neurotic and impulsive. Bulimics also evidenced a distorted body image in that they perceived themselves as significantly larger and desired to be significantly smaller than did their matched controls. Bulimic and obese subjects showed some similarities in eating habits and psychopathology, especially regarding obsessiveness, impulsivity, and guilt.

Although volunteers are widely acknowledged as important members of the palliative care team, their unique contribution to whole-person care has not been well documented or theorized, especially in rural communities. We conducted a focused ethnography in a small rural community, asking key community informants about their understanding of the role of hospice volunteers with dying people and their families. Our results show that these volunteers inhabit a unique third culture of care that fuses elements of formal care with the informal visiting of friends and neighbours. Their role is shaped to a community context where dying is not a private medical event, but rather a whole-person-in-community event, and where care is offered as a natural expression of the interdependence and reciprocity that characterizes rural community life. Our results are a reminder that it takes an entire community to care for the dying, and that hospice volunteers are a crucial link in the network of care that allows people to die with dignity and quality of life.

This study investigated the role of maternal psychopathology in predicting children's psychological distress in a disaster-exposed sample. Participants consisted of 260 children (ages 8-16) recruited from public schools and their mothers. These families were displaced from New Orleans because of Hurricane Katrina in 2005. Assessment took place 3 to 7 months postdisaster. Hierarchical regression analyses revealed that global maternal psychological distress and maternal posttraumatic stress disorder moderated the relation between child hurricane exposure and mother-reported child internalizing and externalizing symptoms.

Objective This study examined trajectories of posttraumatic stress disorder symptoms in Hurricane Katrina affected youth. Method A total of 426 youth (51% female; 8–16 years old; mean age=11 years; 75% minorities) completed assessments at 4 time points post-disaster. Measures included Hurricane impact variables (initial loss/disruption and perceived life threat); history of family and community violence exposure, parent and peer social support, and post-disaster posttraumatic stress symptoms. Results Latent class growth analysis demonstrated that there were three distinct trajectories of posttraumatic stress disorder symptoms identified for this sample of youth (resilient, recovering, and chronic, respectively). Youth trajectories were associated with Hurricane-related initial loss/disruption, community violence, and peer social support. Conclusions The results suggest that youth exposed to Hurricane Katrina have variable posttraumatic stress disorder symptom trajectories. Significant risk and protective factors were identified. Specifically, youth Hurricane and community violence exposure increased risk for a more problematic posttraumatic stress disorder symptom trajectory, while peer social support served as a protective factor for these youth. Identification of these factors suggests directions for future research as well as potential target areas for screening and intervention with disaster exposed youth. Limitations The convenience sample limits the external validity of the findings to other disaster exposed youth, and the self-report data is susceptible to response bias.

We used the high‐probability (high‐p) instructional sequence with and without escape extinction in the treatment of food refusal. Acceptance increased and refusal decreased only with the introduction of escape extinction. These results raise important questions about the high‐p sequence in the treatment of food refusal.

Whether adolescent suicide attempters would have deficits in interpersonal problem solving and the relation between social problem solving, suicide intent, and medical lethality were evaluated. Compared with psychiatric and normal controls, adolescents who attempted suicide exhibited poorer social problem-solving abilities, particularly in terms of problem orientation. Specifically, suicide attempters brought more maladaptive cognitive-emotional-behavioral response sets to problematic situations than did psychiatric and normal controls. Both suicide attempters and psychiatric controls had similar deficits in problem-solving skills (e.g., generation of alternatives, decision making, and solution implementation) compared with nonhospitalized peers. Social problem solving was not found to be correlated with suicide lethality or intent.