The bereavement experiences of families of potential organ donors: a qualitative longitudinal case study illuminating opportunities for family care

OBJECTIVES

To illuminate opportunities for care in the context of deceased organ donation by exploring pre-existing family and healthcare professional characteristics, in-hospital experiences, and ongoing adjustment through the lenses of grief theory, systems theory, meaning-making, narrative, and organ donation literature.

METHOD

Qualitative longitudinal case studies explored individual and family change in five Australian families who had consented to Donation after Circulatory Determination of Death at a single centre. Participants attended semi-structured interviews at four, eight, and twelve months after the death.

FINDINGS

Family values, pre-existing relationships, and in-hospital experiences influenced first responses to their changed lives, understanding of the patient's death, and ongoing family adjustment. Novel behaviour that was conguent with family values was required at the hospital, especially if the patient had previously played a key role in family decision-making. This behaviour and emerging interactional patterns were drawn into family life over the first year of their bereavement.

RECOMMENDATIONS

Training that includes lenses introduced in this study will enable healthcare professionals to confidently respond to individual and family psychosocial needs.

CONCLUSION

The lenses of grief theory and systems thinking highlight opportunities for care tailored to the unique in-hospital context and needs that emerge in the months that follow.

What role do early life experiences play in eating disorders? The impact of parenting style, temperament and early maladaptive schemas

OBJECTIVE

Given that most eating disorders develop in adolescence and early adulthood, early life experiences are said to play a key role in the aetiology of eating disorders. There are well-documented relationships between early maladaptive schemas and eating disorders, early maladaptive schemas and temperament and temperament and perceived parenting style. The present study aimed to test a hypothesis that perceived parenting style predicts temperament, which predicts early maladaptive schemas, which predict eating disorder symptoms in young people.

METHOD

An online survey measured perceived parenting style, temperament, early maladaptive schemas and eating disorder symptoms in 397 people with disordered eating between the ages of 18 and 29. Path analysis was used to investigate the relationship between these elements.

RESULTS

The results found support for this hypothesis. Perceived maladaptive parenting ratings for mothers were a stronger predictor of temperament, and only two temperament factors were adequate predictors of early maladaptive schemas.

CONCLUSIONS

Overall, the present study found preliminary support for a linear relationship where perceived parenting style predicts temperament, which predicts early maladaptive schema levels, which predicts eating disorder symptoms. The present study was the first to propose and test this model; however, further research is required to confirm the nature and extent of this relationship.

Is schema therapy effective for adults with eating disorders? A systematic review into the evidence

Commonly developing in adolescence and following a chronic course, eating disorders are life-threatening psychological disorders and typically very difficult to treat despite the body of research exploring treatment options. Due to the high levels of severity and the enduring nature of eating disorders, schema therapy has been proposed as a more effective treatment than cognitive behaviour therapy. To assess the effectiveness of schema therapy in adults with eating disorders, the present systematic review was designed in accordance with PRISMA guidelines. A structured search of electronic databases and grey literature was conducted, and the Mixed Methods Assessment Tool was used to assess the quality of each article. Four articles including 151 participants were found which demonstrated that schema therapy is effective at reducing eating disorder symptoms and behaviour and general psychopathology. Despite the limitations of this study, including the scarcity of research available and varying methodologies used, the present systematic review found evidence supporting the use of schema therapy in patients with eating disorders, particularly those experiencing severe and enduring forms.

Variables influencing the case prioritisation of men convicted of internet child abuse material offences

The differentiation between men convicted of child abuse material offences, known as Internet Child Abuse Material (I/CAM), and Contact (CO) child sex offenders is an ongoing area of research. Current research indicates there are differences between men convicted of I/CAM and CO offences. This article highlights key variables that may indicate clinically and/or statistically significant differences between I/CAM and CO populations, as identified in current published research. Identified key variables may contribute to the case prioritisation of men under investigation for I/CAM offences to assist timely investigation. Post conviction, key variables may contribute to targeted treatment, reducing recidivism and protecting the global community. Articles containing variables differentiating I/CAM and CO populations were reviewed; articles that did not include any comparative analysis were excluded. The final sample of articles (n = 10) was reviewed using a literature review methodology to collate trend variables and directionality between the two populations. Demographic variables with critical differences between men convicted of I/CAM offences when compared to CO offences are younger age, White ethnic background, employed, lower use of alcohol and drugs, and less or no recorded criminal history but higher self-reported history of offending. Key psychological variables identified are lower impression management, lower demonstrations of antisociality, higher sexual deviancy and higher levels of victim empathy when compared to men convicted of CO offences. The findings will be considered in line with existing risk assessment and case prioritisation tools. This research can contribute to community safety through a specific focus on prioritising the investigation, case management, and treatment of men convicted of I/CAM offences and signals future pathways for targeted risk assessment.

Grief, Stress, Trauma, and Support During the Organ Donation Process

The organ donation process is complex and stressful for the family of the potential donor and members of the multidisciplinary team who may experience grief, ethical dilemmas, vicarious trauma, or compassion fatigue. Several studies each explore the role of a specific healthcare group and the impact of inhospital processes on group members. We conducted a systematic literature search to identify such studies and a qualitative synthesis to consolidate findings and highlight features of the interaction and relationships between role players. Our results suggest that, while healthcare professionals have different roles, attitudes, and views, the experience of stressors and interdisciplinary tension is common. Nevertheless, staff are united by the goal of caring for the patient and family. We therefore propose that, while focusing on bereavement care and other aspects of the family's experience, staff can find other shared goals and develop understanding, trust, empathy, and respect for each other's positions, thereby improving functioning in the complex adaptive system that forms at this time. Education and training can equip staff to facilitate anticipatory mourning, family-led activities, and a meaningful parting from their relative, assisting families with their grief and increasing staff members' efficacy, confidence, and interdisciplinary teamwork. Knowledge of systems thinking and opportunities to share ideas and experiences will enable staff to appreciate each other's roles, while supportive mentors, self-care strategies, and meaningful feedback between role players will foster healthy adjustment and shared learning. A focus on psychosocial outcomes such as family satisfaction with the process, collaboration within the multidisciplinary team, and reduction in the role stress of healthcare professionals will contribute to family well-being as well as personal and professional growth for staff.

Fantasy-Driven Versus Contact-Driven Users of Child Sexual Exploitation Material: Offender Classification and Implications for Their Risk Assessment

Since the advent of the Internet, convictions for the possession, display, trading, and distribution of child sexual exploitation material (CSEM) have risen steadily, but little is known about their appropriate assessment and treatment, especially concerning their risk of reoffending. It has been suggested that a conceptual distinction of fantasy- versus contact-driven CSEM users might be of merit. Sixty-eight offenders recruited from sex offender treatment providers were assessed via an anonymous computer survey including a variety of clinical and risk-related variables; the findings showed differences in the psychological profiles between CSEM users and contact child sex offenders. Numerical and spatial methods of data analysis were used to identify subgroups of CSEM users; these confirmed the twofold distinction of fantasy- versus contact-driven offending. The spatial representation of participants identified three dimensions as crucial in the classification of these subgroups: direct sexual contact with a minor, possession of fantasy-generating material, and social contact with other users with a sexual interest in minors; potentially differentiating distinct offender subgroups with different risks and needs. The current study informed the development of an empirical model of CSEM users that could aid in the assessment of risk of reoffending and cross-over to contact sex offending.

A novel approach to studying co-evolution of understanding and research: Family bereavement and the potential for organ donation as a case study

A novel approach to data extraction and synthesis was used to explore the connections between research priorities, understanding and practice improvement associated with family bereavement in the context of the potential for organ donation. Conducting the review as a qualitative longitudinal study highlighted changes over time, and extraction of citation-related data facilitated an analysis of the interaction in this field. It was found that lack of ‘communication’ between researchers contributes to information being ‘lost’ and then later ‘rediscovered’. It is recommended that researchers should plan early for dissemination and practice improvement to ensure that research contributes to change.

An exploration of the relationship between families of deceased organ donors and transplant recipients: A systematic review and qualitative synthesis

Following deceased organ donation and transplantation, the narratives of families of donors and organ recipients become connected. This is acknowledged when parties receive anonymous information from donation agencies and transplant centres, when they exchange correspondence or when they meet in person. This article reviews literature describing the experience from the points of view of donor families, recipients, and other stakeholders to explore the dynamic system that evolves around this relationship. Findings highlight a link between identity development and ongoing adjustment and will assist those supporting donor families and recipients to make decisions that fit meaningfully.

The development of a narrative describing the bereavement of families of potential organ donors: A systematic review

Families of potential post-mortem organ donors face various challenges in the unfamiliar hospital context and after returning home. This review of sources published between 1968 and 2017 seeks to understand their journey as a bereavement experience with a number of unique features. Grief theory was used to identify ways that staff can assist family members to tolerate ambiguities and vulnerabilities while contributing to an environment characterised by compassion and social inclusion. Staff can guide families and create opportunities for meaningful participation, building resilience and developing bereavement-related skills that could assist them in the months that follow.

In-hospital experiences of families of potential organ donors: A systematic review and qualitative synthesis

Information and compassion assist families of potential organ donors to make informed decisions. However, psychological implications of the in-hospital process are not well described with past research focusing on decision-making. To enhance understanding and improve service delivery, a systematic review was conducted. Inductive analysis and synthesis utilised Grounded Theory Methodology within a systems theory framework and contributed to a model proposing that family and staff form a System of Systems with shared responsibility for process outcomes. This model can guide evaluation and improvement of care and will be tested by means of a longitudinal study of family experiences.

An Examination of Culturally Appropriate Items for the WAIS-R Information Subtest with Canadian Subjects

Ten questions with culturally specific American content from the WAIS-R Information subtest were examined empirically for level of difficulty for Canadian subjects. Rank order and chi square analyses showed that accuracy scores (p-values) for these questions differed significantly from the p-values of the WAIS-R (Wechsler, 1981) normative sample for the majority of these items for this sample (N = 95). Nine of 10 Canadian substitutes were found to reflect more accurately the difficulty level of the original standardization data.

Two clusters of child molesters based on impulsiveness

OBJECTIVE

High impulsiveness is a general problem that affects most criminal offenders and is associated with greater recidivism risk. A cluster analysis of impulsiveness measured by the Barratt Impulsiveness Scale - Version 11 (BIS-11) was performed on a sample of hands-on child molesters.

METHODS

The sample consisted of 208 child molesters enrolled in two different sectional studies carried out in São Paulo, Brazil. Using three factors from the BIS-11, a k-means cluster analysis was performed using the average silhouette width to determine cluster number. Direct logistic regression was performed to analyze the association of criminological and clinical features with the resulting clusters.

RESULTS

Two clusters were delineated. The cluster characterized by higher impulsiveness showed higher scores on the Sexual Screening for Pedophilic Interests (SSPI), Static-99, and Sexual Addiction Screening Test.

CONCLUSIONS

Given that child molesters are an extremely heterogeneous population, the "number of victims" item of the SSPI should call attention to those offenders with the highest motor, attentional, and non-planning impulsiveness. Our findings could have implications in terms of differences in therapeutic management for these two groups, with the most impulsive cluster benefitting from psychosocial strategies combined with pharmacological interventions.

Psychosocial pathways to inconsistent condom use among male sex workers: personality, drug misuse and criminality

BACKGROUND

This research compared street male sex workers in Santo André, Brazil, that reported consistent condom use with those that revealed inconsistent condom use with their clients, concerning personality aspects, impulsiveness, alcohol and drug consumption, depressive symptoms, sociodemographic data and criminal involvement.

METHODS

Eighty-six male sex workers were evaluated in face-to-face interviews at their place of work. A 'snowball' sampling procedure was used to access this hard-to-reach population.

FINDINGS

Male sex workers with inconsistent condom use showed greater involvement with criminal activities, higher reward dependence level and more frequent self-report of being HIV-positive.

CONCLUSIONS

Conceptualisation of male sex workers' psychological characteristics may be required where HIV risk is not only attributed to sex work per se, but to other aspects such as personality-related factors and negative identity.

Deprivation and satiation: The interrelations between food and wheel running

Two experiments were designed to assess whether depriving rats of food would increase the reinforcement effectiveness of wheel running (Experiment 1) and whether satiation for wheel running would decrease the reinforcement effectiveness of food (Experiment 2). In Experiment 1, a progressive-ratio schedule was used to measure the reinforcement effectiveness of wheel running when rats were deprived or not deprived of food. Completion of a fixed number of lever presses released a brake on a running wheel for 60 s, and the response requirement was systematically increased until the rat stopped pressing or until 8 hr had elapsed. The ratio value reached (and the total number of lever presses) was an inverted-U function of food deprivation (percentage body weight). In Experiment 2, when wheel running preceded test sessions, fewer food-reinforced lever presses were maintained by the progressive-ratio schedule, and responding occurred at a lower rate on a variable-interval schedule. An interpretation of these results is that deprivation or satiation with respect to one event (such as food) alters the reinforcement effectiveness of a different event (such as access to wheel running).

Prospective actuarial risk assessment: a comparison of five risk assessment instruments in different sexual offender subtypes

This study examines the predictive validity of the most commonly used risk assessment instruments for sexual offenders: Static-99, Rapid Risk Assessment for Sexual Offense Recidivism, Sex Offender Risk Appraisal Guide, Sexual Violence Risk-20, and Psychopathy Checklist-Revised in a prospective research design. Although risk assessment is part of a regime leading to various efforts to reduce risk by treatment and aftercare, all instruments show good predictive validity. However, depending on the instrument, recidivism category, and subgroup, the predictive accuracy varies markedly. Furthermore, the authors fail to demonstrate predictive validity for sexual violent reoffences-for the whole sample and for all subgroups. The results, nevertheless, support the utility and predictive validity of actuarial risk assessment complementary to treatment efforts to reduce risk. On the other hand, forensic practitioners have to be aware of the limitations of actuarial risk assessment methods, in particular as regards to variable predictive accuracy for different sexual offender subgroups and reoffence categories.

Questões éticas referentes à avaliação de risco e ao tratamento de autores de ofensas sexuais no Brasil

<p>Neste artigo discutimos questões éticas associadas ao uso de testes estatísticos desenvolvidos em outros países ou em populações únicas para avaliar autores de abuso sexual no Brasil, que são diferentes das amostras utilizadas no desenvolvimento dos testes. Esta prática é problemática por poder resultar no prolongamento da detenção ou na prematura liberação de um indivíduo perigoso. Outras medidas, tais como diretrizes clínicas estruturadas, podem prover uma solução a curto prazo para o julgamento profissional realizado sem diretrizes, amplamente aplicado, e para a falta de testes baseados e validados na população. Na medida em que medições correntes podem indicar alguma idéia a respeito da necessidade de tratamento, o Brasil está ficando atrasado no que se refere à aplicação do “estado da arte” ao tratamento de autores de abuso sexual, tanto farmacologicamente e psicologicamente. Nós discutimos como estas questões se relacionam e sugerimos alguns meios para solucioná-las.</p>

The Personality Assessment Inventory as a proxy for the Psychopathy Checklist Revised: testing the incremental validity and cross-sample robustness of the Antisocial Features Scale

The Personality Assessment Inventory's (PAI's) ability to predict psychopathic personality features, as assessed by the Psychopathy Checklist-Revised (PCL-R), was examined. To investigate whether the PAI Antisocial Features (ANT) Scale and subscales possessed incremental validity beyond other theoretically relevant PAI scales, optimized regression equations were derived in a sample of 281 Canadian federal offenders. ANT, or ANT-Antisocial Behavior (ANT-A), demonstrated unique variance in regression analyses predicting PCL-R total and Factor 2 (Lifestyle Impulsivity and Social Deviance) scores, but only the Dominance (DOM) Scale was retained in models predicting Factor 1 (Interpersonal and Affective Deficits). Attempts to cross-validate the regression equations derived from the first sample on a sample of 85 U.S. sex offenders resulted in considerable validity shrinkage, with the ANT Scale in isolation performing comparably to or better than the statistical models for PCL-R total and Factor 2 scores. Results offer limited evidence of convergent validity between the PAI and the PCL-R.

Did Freud mislead patients to confabulate memories of abuse? A reply to Gleaves and Hernandez (1999)

Gleaves and Hernandez have argued that skepticism about the validity of Freud's seduction theory, including by Powell and Boer, is largely unjustified. This paper contends that their analysis is in many ways both inaccurate and misleading. For example, we did not, as they implied, reject the possibility that some of Freud's early patients were victims of childhood sexual abuse. We also maintain that the weight of the available evidence indicates that false memories of traumatic events probably can be implanted, and that Freud's (1896/1962a) original evidence for the validity of his patients' recovered memories remains lacking in several respects-particularly in view of the extremely suggestive procedures he often used to elicit such memories.

Investigation of the criminal and conditional release profiles of Canadian federal offenders as a function of psychopathy and age

Using the Psychopathy Checklist-Revised (PCL-R; R. D. Hare, 1991) diagnostic cut-off score of 30, the complete criminal career and community release profiles of 317 Canadian federal offenders (224 low scorers and 93 scoring within the psychopathic range) were investigated. Adult crimes were coded according to age at commission as well as either violent, nonviolent, or nonsexually violent. Changes in performance following release into the community also were examined. Results indicated that offenders scoring within the psychopathic range consistently committed more violent and nonviolent crimes than their counterparts for about three decades, spanning their late adolescence to their late 40s. Numbers of nonviolent criminal offenses committed by high PCL-R scorers declined considerably after age 30 relative to violent offenses, which declined and then rebounded in the late 30s before a major reduction was evidenced. Throughout adulthood, high PCL-R scorers failed during community release significantly faster than did low scorers. Importantly, from a risk management perspective, the release performance of low PCL-R scorers improved with age, whereas the opposite was seen for high scorers. Further, offenders scoring high on the PCL-R did not show a lower charge to conviction ratio with age, suggesting that they may not have been getting better at manipulating the legal system.

A revision of the Abel and Becker Cognition Scale for intellectually disabled sexual offenders

The Abel and Becker Cognition Scale (ABCS) measures cognitive distortions supportive of sexually assaultive behavior by child molesters. Research has shown that ABCS items may be too complex to be comprehended by offenders with intellectual disabilities. A modification of the ABCS to increase its readability may be one way to facilitate the valid assessment of the cognitive distortions of intellectually disabled offenders. In addition, a dichotomous scoring system was found to be helpful in the reduction of extremity bias by such offenders. The revised items, explanation of the scoring system, and supporting data are available from the first author.

Did Freud misinterpret reported memories of sexual abuse as fantasies?

While serious questions have arisen concerning the validity of Freud's seduction theory of neurosis, a related issue concerns the extent to which Freud, following the abandonment of the seduction theory, may have misinterpreted real memories of sexual abuse as imaginary. Certain theoretical statements by Freud as well as his advice to Jung concerning a 6-yr.-old patient who had accused her foster-father of sexual abuse indicate that he may have been significantly biased toward interpreting certain types of incest allegations as fantasies. Increased awareness of Freud's biases, both in his early tendency to pressure patients into believing that they were victims of abuse and in his later tendency to regard certain types of incest allegations as unreal, may contribute to a more objective approach to the diagnosis and treatment of sexual abuse in the future.

Did Freud mislead patients to confabulate memories of abuse?

Freud's abandonment of the seduction theory within a year of first proposing it has been the subject of considerable recent debate and speculation. Closer examination of Freud's writings, however, shows that he had often used highly suggestive procedures to elicit the memories of childhood "seductions" from his patients. Moreover, he had not considered alternative explanations for the evidence he presented when first claiming that these recovered memories of sexual abuse were real. Nevertheless, some present-day authors have argued for the validity of recovered memories by presenting much the same type of evidence that Freud once did. Research is needed to assess the extent to which recovered memories can be clearly corroborated and to establish rules for distinguishing between real and false memories of abuse.

Suppression of food deprivation-induced high-rate wheel running in rats

To test for involvement of endogenous opioids in the maintenance of high-rate running we have administered naloxone, a specific opioid antagonist, to rats. The animals were stabilized voluntarily running 6000 to 8000 m/day through a standard protocol and maintained in this state on approximately 18 g of food per day. Naloxone (50 mg/kg in saline) or saline alone was injected intraperitoneally on alternate days for 20 days. All rats ran less on days when naloxone was administered. The mean distance run for the group (N = 6, mean +/- SE) was: saline: 6401 +/- 985; naloxone: 5344 +/- 805 m/day. This difference was highly significant (p less than 0.001). In the 4-hour period immediately following the naloxone injection there was no inhibition of running. The second four-hour period showed a nonsignificant (p greater than 0.05) decrease in running. Inhibition of running was highly significant after eight hours (30%, p less than 0.001). The results demonstrate a clear inhibition of the high-rate running by naloxone and imply a significant role by endogenous opioids in the maintenance of running. The time course of the inhibition is consistent with the relatively high initial concentrations of naloxone exerting an agonist action and the subsequent lower levels having an antagonist effect.

Prevention of myocardial disease in JCR:LA-corpulent rats by running

The JCR:LA-corpulent rat is a congenic strain that, if homozygous for the cp gene, is obese with a very low-density lipoprotein hyperlipidemia and is insulin resistant. The male corpulent rats develop atherosclerotic lesions of the major arteries and myocardial lesions. Corpulent and lean male rats were induced through mild food restriction to run intensively (approximately 6,000 m/day) from 6 wk to 6 mo of age. Food restriction, especially when coupled with running, lowered all classes of lipids in the whole serum of corpulent rats. The principal changes in lipid concentrations were in the very low-density lipoprotein fraction. Food restriction caused a significant drop in fasting insulin levels of corpulent rats and decreased beta-cell hyperplasia. Both effects were more marked in the running animals. There was a significant decrease in myocardial lesion frequency in the food-restricted corpulent rats and an absence of lesions in the running rats. The results indicate that intensive physical activity can largely correct the lipid abnormalities and insulin resistance of this atherosclerosis-prone strain, and these changes are associated with inhibition of the disease process. However, moderate food restriction has similar effects, and the greater effects seen with intensive running may simply reflect an effectively more severe metabolic restriction in the presence of the exercise.

Induction of voluntary prolonged running by rats

The rat is widely used in studies of the metabolic and physiological effects of physical exercise. The most commonly used form of exercise is running on treadmills or mechanically driven running wheels. Rats will not voluntarily run significant distances, under normal circumstances. If rats are exposed to running wheels with food freely available, only very limited activity normally occurs. When rats with access to a running wheel are restricted to a fixed amount of food, presented once per day, consistent running occurs. The running is spontaneous and very sensitive to the amount of food provided. Six 6-wk-old rats of 197 g mean body wt were induced to run for 139 days. The distance run increased rapidly over a 20-day initial period on a food supply of 15 g/day (vs. 19.5 g/day consumption by sedentary controls). From day 20 to day 139 the mean distance run was described by the regression equation distance (m/day) = 10,410 - 37.9 X days. Food provided was varied according to distance run, ranging from 15 to 18 g/day, and was normally 17.5 g/day. Thus a food deprivation of 10% of normal consumption will result in mean distances run of approximately 8,000 m/day. The use of pair-fed control animals without access to a wheel allows the conduct of experiments to test the effects of chronic long-distance running. The running is spontaneous; thus the technique avoids the complications accompanying techniques that force running.