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PubMed1986

The use of telemarketing in the community-wide prevention of heart disease: the Pawtucket Heart Health Program.

The marketing of preventive health behaviors is typically accomplished through various broadcast, print, and other mass media channels. By making randomly-dialed telephone calls to 4,000 residents of Pawtucket, RI, volunteers of the Pawtucket Heart Health Program succeeded in registering nearly 400 individuals for risk factor reduction groups or self-help behavior change kits. Additionally, community awareness of the program was an indirect benefit of this "telemarketing." Telemarketing is an interactive and inexpensive approach to marketing preventive health behaviors.

Heart Diseases↗
PubMed1985

Social networks and social support: an overview of research, practice, and policy implications.

Following a brief overview of the stressful life events-illness model and its implications for intervention, this article highlights the role of social support as a resource for resisting stress-induced illness and disability. It identifies three different connotative meanings that have been assigned to the social support construct, and describes their empirical operationalizations in several recent studies. Specifically, the social integration/participation formulation, the social network approach, and the social intimacy measurement strategy are described and contrasted. Within the latter approach, one study that illuminated types of informal helping behaviors is discussed in greater detail. A review of possible mechanisms whereby social support accomplishes its health-protective impact is also offered, and two types of planned interventions involving the mobilization or optimization of social support are spotlighted. The article concludes with ideas about ways that professionals can safeguard the natural helping skills of citizens and achieve an appropriate balance between formal and informal systems of service delivery in the health and human services fields.

Adaptation, Psychological↗
PubMed1993

Teaching and social support: effects on knowledge, attitudes, and behaviors to prevent low back injuries in industry.

An educational program designed to reduce low back injuries was modeled after several well-known back schools and taught to postal workers in a randomized trial of about 4,000 workers. Physical therapists taught 3 hours of class sessions, including knowledge, skills, and individual work station assessment, to small groups of workers and supervisors, with reinforcement every 6 months afterward. At 2 1/2 years, a random sample of 209 workers was surveyed for program impact on intermediate outcomes. We observed increased knowledge among experimental unit workers, but no significant improvements in behaviors associated with back health or in proportion of workers with tired backs. Experimental unit workers who had received training by the time of the survey were less likely to report helping/reinforcement for healthy behaviors than controls or untrained experimental unit workers. The program might have led trained workers to perceive a lack of support and reinforcement for back safety among coworkers and supervisors by sensitizing them to what is possible and raising expectations. There appeared to be group social effects in the dissemination of knowledge and perhaps of helpful behaviors; however, it is apparent that worker social support for change in health behaviors is a complex phenomenon that cannot always be relied upon to enhance program goals.

Back↗
PubMed2005

Empathy scores in medical school and ratings of empathic behavior in residency training 3 years later.

The authors designed the present study to examine the association between individuals' scores on the Jefferson Scale of Physician Empathy (JSPE; M. Hojat, J. S. Gonnella, S. Mangione, T. J. Nasca, & M. Magee, 2003; M. Hojat, J. S. Gonnella, T. J. Nasca, S. Mangione, M. Vergare, & M. Magee, 2002; M. Hojat, S. Mangione, T. J. Nasca, M. J. M. Cohen, J. S. Gonnella, J. B. Erdmann, J. J. Veloski, & M. Magee, 2001), a self-report empathy scale, during medical school and ratings of their empathic behavior made by directors of their residency training programs 3 years later. Participants were 106 physicians. The authors examined the relationships between scores on the JSPE (with 20 Likert-type items) at the beginning of the students' 3rd year of medical school and ratings of their empathic behavior made by directors of their residency training programs. Top scorers on the JSPE in medical school, compared to Bottom scorers, obtained a significantly higher average rating of empathic behavior in residency 3 years later (p < .05, effect size = 0.50). The findings support the long-term predictive validity of the self-report empathy scale, JSPE, despite different methods of evaluations (self-report and supervisors' ratings) and despite a time interval between evaluations (3 years). Because empathy is relevant to prosocial and helping behavior, it is important for investigators to further enhance our understanding of its correlates and outcomes among health professionals.

Adult↗
PubMed1997

Giving and getting: altruism and exchange in transplantation.

In the study of organ and tissue transplantation, the focus tends to be on donation. But where there is "giving," there is also "getting:" receiving help. Altruism, helping behavior, and the exchange of benefits have received extensive attention from social psychological researchers. The gift exchange described by anthropologist Marcel Mauss provides a framework for reviewing this social psychological research on altruism and exchange and applying it to transplantation. An overall conclusion is that altruistic donation is not so ethically or clinically problematic, while receiving help has a complex psychosocial context that needs to be acknowledged and given more attention.

Altruism↗
PubMed1998

Cognitive-behavioral self-help for binge eating disorder: a controlled effectiveness study.

The aim of this study was to evaluate the effectiveness of 2 methods of administering a cognitive-behavioral self-help program for binge eating disorder. The study was designed to reproduce many of the conditions that apply in settings in which self-help interventions are most relevant. Seventy-two women with binge eating disorder were randomly assigned to 1 of 3 conditions for 12 weeks: pure self-help (PSH), guided self-help (GSH), or a waiting list (WL) control condition (followed by PSH or GSH). They were then followed up for 6 months. Both PSH and GSH had a substantial and sustained impact with almost half the participants ceasing to binge eat. There was little change in the WL condition. Cognitive-behavioral self-help may be of value both as an initial treatment for binge eating disorder and as a form of secondary prevention.

Adult↗
PubMed1981

The effects of family constellation and child gender on parental use of evaluative feedback.

Mothers and fathers of 43 middle-class families were observed individually interacting during a paper-folding task with either their only or middle child in order to assess parental use of evaluation and task-facilitative behaviors with preschoolers. Middle children were from 3-child families in which the older sibling was the same sex as the target child. Sibling spacing was greater than 36 months in 12 families and less than 36 months in 11 families. With total interaction, parental income, education, and age as control variables, analyses indicated that parental approvals, disapprovals, task facilitative feedback, and helping behaviors varied with parent gender, child gender, and family constellation. Children's task performance did not differ significantly among groups. It was concluded that gender effects on parental use of evaluation feedback in parent-child teaching interactions may be different for families with different types of family structure.

Adult↗
PubMedDate not supplied

Computer-based patient records: challenges to implementation.

In summary, behavioral healthcare organizations are faced with an environment which is demanding that cost and quality decisions be made based upon the information gleaned from patient records. The challenge before the industry is how best to collect, store, retrieve and disseminate this information to key decision makers. The CPR has been identified as one means of addressing this challenge. Hopefully, the results of this study will help behavioral healthcare organizations in developing a CPR system to meet this challenge.

Attitude of Health Personnel↗
PubMed2006

The hypothalamus, hormones, and hunger: alterations in human obesity and illness.

Obesity is a major global epidemic, with over 300 million obese people worldwide, and nearly 1 billion overweight adults. Being overweight carries significant health risks, reduced quality of life, and impaired socioeconomic success, with profound consequences for health expenditure. The most successful treatment for obesity is gastric bypass surgery, which acts in part by reducing appetite through alterations in gut hormones. Circulating gut hormones, secreted or suppressed after eating food, act in the brain, particularly the hypothalamus, to alter hunger and fullness. Stomach-derived ghrelin increases food intake even in those with anorexia from chronic illness, while pancreatic polypeptide (PP), intestinal peptide YY 3-36 (PYY), oxyntomodulin, and other hormones reduce food intake and appetite. While obese subjects have appropriate reductions in orexigenic ghrelin, other gut-hormone disturbances may contribute to obesity such as reduced anorexigenic PYY and PP. Prader-Willi syndrome (PWS) arises from the loss of paternally inherited genes on chromosome 15q11-13, leading to life-threatening insatiable hunger and obesity from early childhood, through developmental brain, particularly hypothalamic defects. The study of genetically homogenous causes of abnormal-feeding behavior helps our understanding of appetite regulation. PWS subjects have inappropriately elevated plasma ghrelin for their obesity, at least partly explained by preserved insulin sensitivity. It remains unproven if their hyperghrelinemia or other gut-hormone abnormalities contribute to the hyperphagia in PWS, in addition to brain defects. Postmortem human hypothalamic studies and generation of animal models of PWS can also provide insight into the pathophysiology of abnormal-feeding behavior. Changes in orexigenic NPY and AGRP hypothalamic neurons, or anorexigenic oxytocin neurons have been found in illness and PWS. Functional neuroimaging studies, using PET and fMRI, will also allow us to tease apart the hormonal and brain pathways responsible for controlling human appetite, and their defects in obesity.

Brain Mapping↗
PubMed1989

Support behaviors identified as helpful and desired by second-time parents over the perinatal period.

The initial transition to parenthood is well represented in theory and research, but little exists related to the addition of subsequent children to the family. In order to provide for the caring needs of expanding families, nurses need to better understand the experiences of repeat parents, their needs, and the supportive behaviors these parents find helpful in the process of adding another child to their families. The purpose of this secondary analysis was to describe the types of social support and the specific behaviors identified as helpful or desired by mothers and fathers having a second child. Consistently, over the perinatal period, both mothers and fathers found behaviors which provided material support helpful and desired more of them. Emotional support was also helpful, particularly during pregnancy. In addition, information and comparison support were helpful during the antepartum period. Clinical application of findings is discussed.

Clinical Nursing Research↗
PubMedDate not supplied

A randomized controlled trial of the effects of group psychological therapy on survival in women with metastatic breast cancer.

In order to test the effect of a psychological intervention on survival from cancer, 66 women with metastatic breast cancer, all receiving standard medical care, were randomly assigned into two groups; one group (n = 30) attended the psychological intervention, consisting of 35 weekly, 2 h sessions of supportive plus cognitive behavioral therapy; the control group (n = 36) received only a home study cognitive behavioral package. No significant difference was found in survival post-randomization between the groups as assessed by a log rank test 5 years after the commencement of the study. As expected, several prognostic factors were significant predictors of survival: metastatic site, hormonal receptor status, and chemotherapy prior to randomization. While many personal and demographic variables did not influence survival, there was a significant effect of self-reported exercise (possibly due to better health). A small subgroup of intervention subjects who attended outside support groups also survived significantly longer than those who did not. The strengths and limitations of the present study are discussed, and the results contrasted with those of a well known study by Spiegel et al. (Spiegel, D., Bloom, J.R., Kraemer, H.C. and Gottheil, E. (1989) Lancet ii, 888-891). We propose that a different experimental design (correlative) may be needed to show any effect of self-help behaviors and psychological attributes in a small minority of patients.

Adult↗
PubMed2004

How regular blood donors explain their behavior.

BACKGROUND: To understand repeated donation, it is crucial to know its meaning. This issue was explored by asking a sample of regular donors to explain why they maintain this behavior. STUDY DESIGN AND METHODS: Discourse analysis was conducted in five groups of regular donors, selected according to the setting and number of their donations (from 1990 to 2001), on their motivation, attitudes, commitment to donation, personality, and self-concept. RESULTS: Three discursive positions were distinguished in relation to the different cultural meanings attributed to blood donation. Blood donation was understood in a rational and evaluative manner by the majority but in an emotional, personalized, and stereotyped manner by a minority. Continual donation as a form of help was rationalized as a function of internal and external factors, notably personal convenience in comparison to other helping behaviors and ease of access to collection points. CONCLUSIONS: The discourse referents offered to the donor greatly influence the meanings they attribute to their behavior. Some promotional materials should be revised because they may not connect with the reasons for donating that people find most comprehensible.

Adult↗
PubMed2006

Physicians' counseling of patients when prescribing nicotine replacement therapy.

AIMS: Nicotine patches and gum are now available without a prescription in many countries. Some have expressed concern that allowing access to these medications without a prescription may deprive smokers of the instruction and support they would otherwise have received from their physician. We assessed the value of physician involvement in NRT prescription. DESIGN AND PARTICIPANTS: We analyzed data interviews from 993 subjects who had filled prescriptions for patch (n=669) or gum (n=324) about physician behavior when prescribing patch and gum when these were available only by prescription. FINDINGS: 82% of smokers actually met with the physician; however, only 67% received some instruction in using the medication; only 50% were told about potential side effects; and substantial fractions were prescribed a dose that differed from that recommended on the usage instructions (patch: 24%; gum: 33%). Participants who received no intervention from their physicians were significantly more likely to be abstinent than those participants who received smoking cessation advice and support, likely because physicians offered help to those who most needed it, biasing the association. CONCLUSIONS: These findings suggest that physicians did not typically perform the helpful behaviors often expected of them or attributed to them.

Attitude of Health Personnel↗
PubMed2004

Therapy for neurobehavioral disorders in epilepsy.

Neurobehavioral disorders commonly affect patients with epilepsy. In addition to the behavioral changes during and immediately after seizures, the epileptogenic disorder of function often extends further into the postictal and interictal period. Cognitive impairments commonly affect attention, memory, mental speed, and language, as well as executive and social functions. Reducing seizure frequency and the antiepileptic drug burden can reduce these problems. Attentional deficits may respond to therapies for attention-deficit/hyperactivity disorder, but apart from patients with this comorbid disorder, their efficacy is unproven in other epilepsy patients. No effective therapies are established for other cognitive problems, but pragmatic, compensatory strategies can be helpful. Behavioral disorders include fatigue, depression, anxiety, and psychosis. Many of these disorders usually respond well to pharmacotherapy, which can be supplemented by psychotherapy. Cognitive and behavioral disorders can be the greatest cause of morbidity and impaired quality of life, often overshadowing seizures. Yet these problems often go unrecognized and, even when identified, are often undertreated or untreated.

Anticonvulsants↗
PubMed2007

The neural substrate of human empathy: effects of perspective-taking and cognitive appraisal.

Whether observation of distress in others leads to empathic concern and altruistic motivation, or to personal distress and egoistic motivation, seems to depend upon the capacity for self-other differentiation and cognitive appraisal. In this experiment, behavioral measures and event-related functional magnetic resonance imaging were used to investigate the effects of perspective-taking and cognitive appraisal while participants observed the facial expression of pain resulting from medical treatment. Video clips showing the faces of patients were presented either with the instruction to imagine the feelings of the patient ("imagine other") or to imagine oneself to be in the patient's situation ("imagine self"). Cognitive appraisal was manipulated by providing information that the medical treatment had or had not been successful. Behavioral measures demonstrated that perspective-taking and treatment effectiveness instructions affected participants' affective responses to the observed pain. Hemodynamic changes were detected in the insular cortices, anterior medial cingulate cortex (aMCC), amygdala, and in visual areas including the fusiform gyrus. Graded responses related to the perspective-taking instructions were observed in middle insula, aMCC, medial and lateral premotor areas, and selectively in left and right parietal cortices. Treatment effectiveness resulted in signal changes in the perigenual anterior cingulate cortex, in the ventromedial orbito-frontal cortex, in the right lateral middle frontal gyrus, and in the cerebellum. These findings support the view that humans' responses to the pain of others can be modulated by cognitive and motivational processes, which influence whether observing a conspecific in need of help will result in empathic concern, an important instigator for helping behavior.

Adolescent↗
PubMed1999

American and Korean adolescents' physical and mental health self-efficacy.

Self-efficacy beliefs are thought to have causal influence on behavior, helping to explain what tasks people approach, persevere at, or abandon. Few cross-cultural studies of adolescents' self-efficacy beliefs have been conducted or reported. We compared physical and mental health self-efficacy beliefs of Korean and American high school students. A Korean translation of the English language School Health Efficacy Questionnaire (SHEQ) was used in data collection. The translated version of the SHEQ showed psychometric estimates similar to the original English language version. Sizable age and culturally related differences were found on both physical and emotional health self-efficacy perceptions between the two groups of adolescents.

Adolescent↗
PubMed2005

Altruistic punishment and the origin of cooperation.

How did human cooperation evolve? Recent evidence shows that many people are willing to engage in altruistic punishment, voluntarily paying a cost to punish noncooperators. Although this behavior helps to explain how cooperation can persist, it creates an important puzzle. If altruistic punishment provides benefits to nonpunishers and is costly to punishers, then how could it evolve? Drawing on recent insights from voluntary public goods games, I present a simple evolutionary model in which altruistic punishers can enter and will always come to dominate a population of contributors, defectors, and nonparticipants. The model suggests that the cycle of strategies in voluntary public goods games does not persist in the presence of punishment strategies. It also suggests that punishment can only enforce payoff-improving strategies, contrary to a widely cited "folk theorem" result that suggests that punishment can allow the evolution of any strategy.

Altruism↗