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PubMed2005

Impact of a common CV evaluation scheme on overall laboratory performance: 8-year experience of a large national proficiency testing program in Japan.

In proficiency testing (PT), it is difficult to set rational criteria for determining target values and allowable limits. In Japan, the largest national PT program has for the past 8 years used an evaluation scheme based on a "common coefficient of variation" (cCV) to overcome this difficulty. The cCV, the average within-method variation, is derived by one-way analysis of variance from data of peer groups after excluding those with large variations. A unit interval used for grading participants is obtained by multiplying the cCV by the peer-group mean which is computed using an iterative method featuring repeated removal of a large portion of the tails of the distribution and reinflation of the standard deviation (SD) to compensate for the trimming. The evaluation scheme gives a relatively better grade to those participants in peer groups with small CVs, compared to use of individual peer-group CVs. The scheme has expedited the transition to more reproducible methods, resulting in a notable overall improvement in laboratory performance. The cCV evaluation scheme is uniformly applicable to any analyte measured quantitatively. The iterative method, an integral part of the scheme, effectively precludes bias in the evaluation.

Amylases↗
PubMed1992

Removal from natal social group to peer housing affects cortisol levels and absolute numbers of T cell subsets in juvenile rhesus monkeys.

Psychosocial stress associated with the removal of six naive juvenile rhesus monkeys from their natal social group to peer housing resulted in increased basal cortisol secretion and significant decrements in the absolute numbers of the T lymphocyte subsets in the peripheral blood. Six subjects matched for age and social rank remained in the group of 80 animals serving as controls. Baseline immune and cortisol measurements were obtained before the six test subjects were removed from the group and housed together in an outdoor circular enclosure. Blood samples were taken 24 h following removal of the test subjects from the group and at intervals thereafter through 11 weeks. Compared to controls, test subjects showed a significant decrease in the absolute numbers of CD4+ (-56.9%) and CD8+ T cells (-57.6%) and a significant increase in basal cortisol levels (+43.9%) 24 h following removal to peer housing. Group difference in the absolute numbers of most immune cells persisted through 11 weeks, whereas cortisol differences lasted only through 2 weeks. These data, when compared to an earlier study employing an identical protocol, with the exception that subjects were housed in indoor individual cages following separation, fail to demonstrate a modulating effect of randomly chosen peer-mates on the stress effects produced by social separation.

Animals↗
PubMed2007

Controlled trial of dementia training with a peer support group for aged care staff.

OBJECTIVE: This study evaluated the impact of an eight-session training program for aged care staff in managing dementia-related challenging behaviours. Participation in the training program with an additional five-session peer support group was compared with both participation in training only and a wait-list control condition. METHODS: Outcomes were evaluated for 90 participating staff members and 113 residents with challenging behaviours from six aged care facilities. Measures of staff attitudes and the behaviours of staff and residents were collected pre- and post-intervention, and at six month follow-up. RESULTS: Staff members in both dementia training groups reported improved attitudes regarding their knowledge and skills in managing residents with challenging behaviours, immediately after the training and six months later. Facility supervisors rated the nursing performance of trained staff more positively, particularly those who participated in a peer support group. The dementia training programs, whether with or without the inclusion of peer support, did not impact on levels of staff burnout or substantially reduce the level of challenging behaviours among aged care residents. CONCLUSIONS: While training programs may impact positively on staff performance, organisational characteristics of aged care facilities, including low levels of management support for staff training initiatives, limit the potential outcomes. Methodological limitations are discussed.

Adult↗
PubMed1998

Effectiveness of one-year participation in school-based volunteer-facilitated peer support groups.

This study evaluated the effectiveness of one-year participation in a program of volunteer-facilitated peer support groups conducted in a southeast Texas high school. One hundred eighteen students who experienced emotional distress or behavioral problems voluntarily participated in weekly groups facilitated by adult volunteers who were not mental health professionals. Seventy-six participants anonymously assessed the program using an instrument developed to evaluate the group experience. Results indicated that the program was highly accepted by the students even though two-thirds had initially felt uncomfortable in the groups. There was significant improvement in the interpersonal, internal, and school domains. Two-thirds of the alcohol and substance users reported reducing their intake or abstaining. The beneficial effects reported by a majority of the participants indicate that schools opting to implement this early intervention program can look forward to encouraging results within one year.

Adolescent↗
PubMed1980

Recognizing the teen-ager who needs to be pregnant: a clinical perspective.

Based on the last three years' clinical experience with 600 inpatient adolescents at the Adolescent Center of Houston International Hospital, this paper reviews the pregnancy issue in terms of primary, secondary, and tertiary prevention. The majority of the patients were white middle-class girls ranging in age from 12 to 17. The clinical symptoms which especially identified at-risk patients were (1) failure experiences, (2) stymied aggression, (3) rights of passage proclamation, (4) parental complicity, (5) the guaranteed spouse, (6) perceived love deprivation, (7) contrived need for parental acceptance, and (8) pseudoknowledge. Secondary prevention is described in terms of (1) parents' group for the parents of the young parents, (2) use of peer group psychotherapy, and (3) parents' groups as a means for dealing with "pregnancy substitutes." Tertiary prevention is depicted in terms of (1) peer group psychotherapy in the postabortion phase, (2) use of peer groups and parents' groups to avoid further pregnancies, and (3) peer/parents' group psychotherapy as a source of contraceptive information. Illustrative vignettes are included for each category. Follow-up at six months after hospitalization has supported the effectiveness of the methods of intervention described.

Adolescent↗
PubMed2004

A 3-year follow-up of participation in peer support groups after a cardiac event.

Secondary prevention is an important component of a structured rehabilitation programme following a cardiac event. Comprehensive programmes have been developed in many European countries, the vast majority of which are hospital based. In Sweden, all patients with cardiac disease are also given the opportunity to participate in secondary prevention activities arranged by the National Association for Heart and Lung Patients [The Heart & Lung School (HL)]. The aim of this 3-year longitudinal study was to compare persons who attended the HL after a cardiac event and those who declined participation, with regard to health aspects, life situation, social network and support, clinical data, rehospitalisation and mortality. Totally 220 patients were included in the study. The patients were asked to fill in a questionnaire on four occasions, in addition to visiting a health care center for physical examination. After 3 years, 160 persons were still participating, 35 of whom attended the HL. The results show that persons who participated in the HL exercised more regularly, smoked less and had a denser network as well as more social support from nonfamily members than the comparison groups. This study contributes to increased knowledge among healthcare professionals, politicians and decision makers about peer support groups as a support strategy after a cardiac event.

Adult↗
PubMed2006

The impact of stigma, experience, and group referent on HIV risk assessments and HIV testing intentions in Namibia.

People often perceive risks for others and themselves differently. This study examines whether personal beliefs about HIV and experience with those living with HIV influence personal risk assessments of contracting HIV in an interview sample of northern Namibians (N=400), but not others' assessments as explained by singular-distribution theory [Klar, Medding, & Sarel (1996). Nonunique invulnerability: Singular versus distributional probabilities and unrealistic optimism in comparative risk judgments. Organizational Behavior and Human Decision Processes, 67, 229-245]. Findings indicate that personal risk perceptions decrease with more HIV stigmatizing beliefs and increase with greater experience, but that those characteristics had no impact on assessments for others' risk. The study also examines whether the size and characteristics of the referent group, peers and the general Namibian population, influence others' risk assessments. Optimistic biases for personal risk versus others' risk appear with the highest discrepancy emerging between personal and general population risk assessments. Further, we found that personal risk perceptions did not mediate the relationship between personal characteristics, beliefs and experiences, and intentions to seek HIV testing.

AIDS Serodiagnosis↗
PubMed1982

Imitation by institutionalized and noninstitutionalized mentally retarded and nonretarded children.

Institutionalized and noninstitutionalized mentally retarded children and noninstitutionalized nonretarded children matched for MA performed on two imitation tasks. The institutionalized retarded group was found to be more imitative on the first task. For all groups, peers as opposed to adults were found to be the more salient model on the second task. Performance across the two imitation tasks was not correlated; however, within each of the tasks, amount of imitation of peers was related to amount of imitation of adults. These findings were interpreted within the framework of Zigler's outerdirectedness formulation.

Adolescent↗
PubMed2001

[Standardization of statistical procedures and evaluation scheme in external quality-control survey].

Numerous external quality assessment surveys are being conducted by variety of organizations throughout Japan, but the statistical processing and evaluation scheme are not compatible. Standardization of the procedures is essential to make comparison of results among surveys possible. A coding system is available only for names of analytes and analytical equipments. Systematic coding for analytical principles, manufacturers and standard materials is necessary. Regarding computation of peer-group statistics, the mean and SD are often biased when there are many, or wildly, outlying values. Therefore it is recommended to use an iterative method. The methodology removes a relatively large proportion of the population in the tails of the distribution and re-inflates the SD to compensate for the trimming, thus reaching an unbiased mean and SD by iteration. It is also useful to compute between-method CV and within method-CV by one-way analysis of variance. They represent overall levels of standardization and reproducibility of the analyte, respectively. The evaluation of results is usually based on the peer-group mean and SD. The scheme is unfair for those belonging to a peer-group with a narrow SD. It is recommended to use so-called "common CV evaluation scheme", which is based on a within-method CV computed from overall test results after excluding those peer-groups with large CVs. The common CV is applied to the unbiased peer-group mean to get the evaluation SD. For standardized data processing and statistical analysis, it is crucial to develop a unified, generalized soft ware. We developed its prototype named SurveyMaster I & II and herein introduce their potentials.

Clinical Laboratory Techniques↗
PubMed2001

A randomized, controlled trial of interventions to improve adherence to isoniazid therapy to prevent tuberculosis in injection drug users.

PURPOSE: To determine the effect of several interventions on adherence to tuberculosis preventive therapy. METHODS: We conducted a randomized trial with a factorial design comparing strategies for improving adherence to isoniazid preventive therapy in 300 injection drug users with reactive tuberculin tests and no evidence of active tuberculosis. Patients were assigned to receive directly observed isoniazid preventive therapy twice weekly (Supervised group, n = 99), daily self-administered isoniazid with peer counseling and education (Peer group, n = 101), or routine care (Routine group, n = 100). Patients within each arm were also randomly assigned to receive an immediate or deferred monthly $10 stipend for maintaining adherence. The endpoints of the trial were completing 6 months of treatment, pill-taking as measured by self-report or observation, isoniazid metabolites present in urine, and bottle opening as determined by electronic monitors in a subset of patients. RESULTS: Completion of therapy was 80% for patients in the Supervised group, 78% in the Peer group, and 79% in the Routine group (P = 0.70). Completion was 83% (125 of 150) among patients receiving immediate incentives versus 75% (112 of 150) among patients with deferred incentives (P = 0.09). The proportion of patients who were observed or reported taking at least 80% of their doses was 82% for the Supervised arm of the study, compared with 71% for the Peer arm and 90% for the Routine arm. The proportion of patients who took 100% of doses was 77% for the Supervised arm (by observation), 6% for the Peer arm (by report), and 10% for the Routine arm (by report; P <0.001). Direct observation showed the median proportion of doses taken by the Supervised group was 100%, while electronic monitoring in a subset of patients showed the Peer group (n = 27) took 57% of prescribed doses and the Routine group (n = 32) took 49% (P <0.001). Patients in the Routine arm overreported adherence by twofold when data from electronic monitoring were used as a gold standard. There were no significant differences in electronically monitored adherence by type of incentive. CONCLUSION: Adherence to isoniazid preventive therapy by injection drug users is best with supervised care. Peer counseling improves adherence over routine care, as measured by electronic monitoring of pill caps, and patients receiving peer counseling more accurately reported their adherence. More widespread use of supervised care could contribute to reductions in tuberculosis rates among drug users and possibly other high-risk groups.

Adult↗
PubMed2003

School-based peer support groups: a new approach to the prevention of disordered eating.

The goal of the present study was to evaluate the effectiveness of a school-based peer support group designed to improve body esteem and global self-esteem and to reduce negative eating attitudes and behaviors. A total of 214 girls in grades 7 and 8, 115 of whom were in the control group, completed self-report questionnaires immediately before and following the intervention, and three months later. The findings revealed that participation in the 10-session group, facilitated by public health nurses, led to increases in weight-related esteem and decreases in dieting. The role of peer support groups in the prevention of disordered eating is discussed.

Journal Article↗
PubMed1985

The consequences of child abuse for the formation of relationships with peers.

The peer interaction of 26 physically abused children was observed and compared to the peer interaction of normal children (n = 26), neglected children (n = 4) and children referred to a child guidance clinic (n = 21). The children were either enrolled in a day-care intervention program and observed in well-established peer groups or not enrolled in peer-based intervention and observed in newly formed peer groups. The hypothesis that abused children who were enrolled in day-care intervention programs would be more competent in peer interaction than abused children who were observed in newly formed groups and not enrolled in peer-based intervention programs was supported. The peer interaction of abused children in well-established groups was similar to that of normal children and more skillful than that of abused and clinic children in newly formed groups. Normal children engaged in similar peer interaction in newly formed and well-established groups. The results are discussed in terms of the social support network provided by the day-care intervention and missing in the family environment of abused children.

Child Abuse↗
PubMed2006

One-to-one or group-based peer support for breastfeeding? Women's perceptions of a breastfeeding peer coaching intervention.

BACKGROUND: Studies reporting one-to-one peer support interventions have been successful in some countries with high breastfeeding initiation rates, but less so in Great Britain, where low uptake of peer support has occurred. We conducted a peer coaching intervention study in rural Scotland that improved breastfeeding initiation and duration. This study reports qualitative data about participants' perceptions of the coaching intervention. The aim was to investigate why group-based peer support was more popular than one-to-one peer support. METHODS: Qualitative data were collected and analyzed from an initial focus group; 21 semi-structured interviews; and 31 coaching group observations and respondents (n = 105/192) in response to an open question about reasons for not choosing a personal coach in a survey of breastfeeding experiences. We developed a coding frame, identified themes, and constructed charts for analysis and interpretation of data. RESULTS: Analysis revealed that groups were more popular because they normalized breastfeeding in a social environment with refreshments, which improved participants' sense of well-being. Groups provided flexibility, a sense of control, and a diversity of visual images and experiences, which assisted women to make feeding-related decisions for themselves, and they offered a safe place to rehearse and perform breastfeeding in front of others, in a culture where breastfeeding is seldom seen in public. Women often felt initial anxiety when attending a group for the first time, and they expressed doubt that one set of "breastfeeding rules" would suit everyone. CONCLUSIONS: Pregnant women and breastfeeding mothers will voluntarily engage in an activity to support breastfeeding if there is a net interactional (verbal, visual, emotional and gustatory) gain and a minimum risk of a negative experience. One-to-one peer coaching was perceived as a greater risk to confidence and empowerment than group- based peer coaching.

Adaptation, Psychological↗
PubMed2004

Impact of the choice of benchmark on the conclusions of hospital report cards.

BACKGROUND: Hospital report cards for outcomes following acute myocardial infarction (AMI) are being produced with increasing frequency. Implicit in the statistical methods used is the fact that hospitals are being compared with an average hospital. Prior research has demonstrated that institutional characteristics such as a high annual volume of AMI patients and academic status are associated with improved outcomes. This raises the important issue of what is an appropriate benchmark against which hospitals should be compared. The objective of the current study was to determine whether the number of hospitals identified as mortality outliers depended upon the benchmark against which hospitals are compared. METHODS: We examined all patients discharged with a diagnosis of AMI from 163 Ontario hospitals between April 1, 2000, and March 30, 2001. Logistic regression models that incorporated random provider effects were used to identify hospitals with a mortality rate significantly higher than average. The initial model included only patient characteristics, whereas additional models incorporated both patient and hospital characteristics. RESULTS: After adjusting for patient characteristics only, 3 hospitals had significantly higher mortality compared to an average-mortality hospital, while 4 hospitals had significantly lower mortality than an average-mortality hospital. However, after further adjusting for peer group, only 1 hospital was identified as having significantly lower mortality than an average-mortality institution in its peer group. CONCLUSIONS: The use of peer-group-defined rather than overall benchmarks has a substantial impact on the identification of mortality outliers. The choice of the appropriate benchmark is related to the underlying purpose of the comparison.

Benchmarking↗
PubMedDate not supplied

Sibling Peer Support Group for young people with a sibling using drugs: a pilot study.

Siblings of young people abusing drugs are at particular risk for drug abuse and other health compromising behaviors. A Sibling Peer Support Group was developed by the Centre for Adolescent Health (Melbourne, Australia) for young people aged 13 to 18 years with a problematic drug user in their family. Groups aimed to provide support and information, promote harm minimization, and reduce the sense of isolation. The project emanated from the recognized need for specific support for adolescent siblings of problematic drug users. Evaluation of two pilot groups indicated positive benefits for group members, who reported feeling better informed, more supported, and having a reduced sense of isolation. Parents reported that their adolescent attending the group demonstrated improved communication with, and greater understanding and tolerance of, the family member using drugs. Promising indicators at a community level were manifested in enthusiastic collaboration among schools, police and local service agencies, and the organization of a local drug forum. There appeared to be little evidence that the groups inadvertently encouraged drug use. Recruitment of young people into groups was the major challenge for the project, but among drug and alcohol and family organizations there was support for the concept of a Sibling Peer Support Group. A new model to overcome the challenge of recruitment is proposed.

Adolescent↗
PubMedDate not supplied

Participation in peer support groups after a cardiac event: a 12-month follow-up.

All cardiac patients in Sweden are given the opportunity to participate in group activities that are arranged by the Swedish National Association for Heart and Lung Patients through a program called The Heart School. In this study, we compared persons who participated in the Heart School activities (n = 59, intervention group) with persons who declined to participate (n = 125, comparison group) with regard to their: self-rated health, life situation, social support, clinical data, rehospitalization, and mortality. Participants completed a questionnaire at 2 weeks, 3 months, and 12 months after discharge from a hospital. They also visited a healthcare center for physical examinations. The intervention group reported more physical symptoms and a higher degree of social support. No other differences were found between the groups. Differences within groups were that the intervention group had increased their physical activities and had eventually stopped smoking. This study adds to the knowledge about the use of peer support groups as a support strategy and supports their use in long-term rehabilitation after a cardiac event.

Aged↗
PubMed2000

Mediating effects of an indicated prevention program for reducing youth depression and suicide risk behaviors.

This study explored the intervention processes of an indicated prevention program for high-risk youth. It was hypothesized that intervention effects would be influenced by the direct and mediating effects of teacher social support on both peer group support and perceived personal control. In turn, personal control was hypothesized to mediate between teacher and peer group support, contributing to reductions in depression and suicide risk behaviors. The hypotheses were tested using a three-wave, longitudinal design incorporating data from preintervention, 5-month follow-up, and 10-month follow-up assessments of 106 high-risk youth divided into three comparison groups: two experimental, one control. For the two intervention groups, there were direct and/or indirect effects of teacher and peer group support on personal control, depression, and suicide risk behaviors. The general hypothesis that personal control mediates between support resources and reductions in depression and suicide risk behaviors received partial support across the study groups.

Adolescent↗
PubMed2004

Peer support groups in multiple sclerosis: current effectiveness and future directions.

Peer support programs have become a common method of providing support for patients with chronic illness. Utilizing peers as resources has been proposed as an effective means for coping with a stressful life experience and for gaining support from others who share a common factor, although data are somewhat mixed on the efficacy of peer support. The aim of the present study was to evaluate the effectiveness of eight weeks of a standard form of peer support in improving quality of life and reducing depressive symptoms in 44 patients with multiple sclerosis (MS). One person from each of six groups participated in a training course in order to learn basic principles of peer support. Eight weekly sessions were held and patients completed self-administered questionnaires pre- and post-treatment assessing quality of life and depression. Results showed that support groups do not provide consistent improvement in quality of life or depression in patients with MS and suggest that patients who have better mental health functioning could be at risk for deterioration in support groups.

Depression↗