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PubMed1990

[Possibilities of cognitive behavior therapy in general practice].

Cognitive behavior therapy has achieved an important standing among the various approaches in psychotherapy. The article gives a short overview over the history of cognitive behavior therapy and delineates its applications in psychotherapy, especially in the treatment of mild to moderate depressions. Further indications include the treatment of anxiety disorders, as well as in the skills training and self-management of schizophrenic patients. Therapeutic experience underscores the importance of a multimodal concept, embedded in a trusting therapeutic relationship. Cognitive behavior therapy must not be viewed as mere therapeutic technique but rather as a therapeutic attitude with the goal of helping the patient achieve better self-efficacy.

Cognitive Behavioral Therapy↗

PubMed1990

Promoting adherence to low-fat, low-cholesterol diets: review and recommendations.

Evidence that lowering blood cholesterol levels reduces risk of coronary heart disease has prompted widespread recommendations that hyperlipidemic individuals undergo dietary therapy. However, the extent to which people can adopt and maintain diets to lower lipids is unclear. In our article, we review what is currently known regarding adherence to low-fat diets and present an approach to dietary counseling for lowering cholesterol that incorporates elements of behavioral self-management and social learning theory. We discuss specific recommendations for counseling hyperlipidemic patients based on the Dietary Alternatives Study. Recommendations include providing patients with an adequate knowledge base to make dietary changes, using goal setting and self-monitoring to help patients initiate dietary changes, enlisting support from the patient's family, and enhancing self-efficacy to promote long-term dietary maintenance.

Cholesterol, Dietary↗

PubMed1990

[Teaching and education of diabetic patients].

The instruction of the patient with diabetes mellitus, aimed at the mastery of technical elements in self-management, as well as his/her education to a coherent behavior respecting both the quality of metabolic control and the quality of life, are basic elements of diabetes treatment. To neglect them would be a professional error. The physician in charge of a diabetic patient must take into account the knowledge and the capabilities that have been acquired by the patient before, as well as his/her actual demand for information and instruction. Concepts and methods of learning and teaching for diabetic patients that have been developed and applied over the last decade may serve as reference for all levels of health education.

Diabetes Mellitus↗

PubMed1990

[Anterior cerebral artery occlusion clinical analysis of 27 self-experienced cases].

From the years 1977 through 1989, the author experienced 27 cases with only anterior cerebral artery (ACA) occlusion but without any other main cerebral arterial occlusions. These were proven by cerebral angiographies and verified by CT. Two patients showing large infarction in the left frontal lobe on CT but showing no evidence of arterial occlusion by cerebral angiography were also registered in this study because these patients were thought to have recanalized ACA. There were 15 males and 12 females with an age of 61.5 +/- 7.98 (mean +/- SD) and 66.1 +/- 6.45, respectively. Twenty two cases had cerebral thrombosis and 5 had cerebral embolism. There were 4 cases with bilateral ACA occlusions, 8 with right ACA occlusion and 15 with left ACA occlusion. Twenty two patients (81%) were alert on admission and this fact might explain their excellent ADL on discharge: full recovery in 9 patients (33%) and self-management in 12 patients (44%). Seventeen patients (63%) had a CT-proven infarcted area with a correlation to ACA occlusion (s), while 9 patients (33%) showed no correlation between an infarction on CT and an ACA occlusion. One patient showed no abnormal findings on CT. Four patients with right ACA occlusion were incidentally observed, even though their mode of onset was strokes. The symptoms of the other 23 patients were those of anterior cerebral artery syndromes: hemiparesis (74%), urinary incontinence (39%), forced grasping (39%), mutism (30%), indifference (26%) and apraxia (22%) etc.

Aged↗

PubMedDate not supplied

[Strategies to reduce morbidity and mortality caused by acute diarrhea in Latin America].

Following the World Health Organization guidelines, the Latin American Diarrheal Disease Control Programs have directed its efforts towards the promotion of Oral Hydration Therapy (OHT) and appropriate dietary management during the diarrheal episode and convalescent period, aimed at diminishing the mortality secondary to diarrhea. In developing countries, OHT is preventing, annually, one million of childhood deaths due to dehydration. Yet, only one fourth of the total population of children suffering diarrhea are being treated with this therapy. Among the strategies to decrease diarrhea morbidity, breast-feeding and hand washing are top priorities. The fundamental strategy has been to promote educational programs to train health personnel and community members. To continue these actions, we suggested the creation of more secondary and tertiary level hospitals and the installation of community units of OHT. They should become self-sufficient and self-manageable and include other programs of primary health care, such as immunization, growth and development surveillance, family planning and pregnancy control.

Acute Disease↗

PubMed1990

[Anxiety and illness behavior in bronchial asthma].

In 82 patients attending a one-week asthma self-management education program, asthma symptom anxiety, personality trait anxiety, and attack-related coping styles were correlated with attack frequency, medication regimen and pulmonary function parameters. In 21 patients, asthma symptoms anxiety was shown to influence illness behaviour at follow-up one year later: in patients with severe asthma, greater symptom anxiety was associated with more suitable illness behaviour. Moreover, suitable illness behaviour appears to be related to cognitive coping styles that take into account the asthmatic's feeling of dependency in attacks without denying them.

Adaptation, Psychological↗

PubMed1990

The nursing shortage: dynamics and solutions. A new decade of leadership. From vision to reality.

New leadership must move our health delivery system from one that is too costly and declining in quality to one that is less bureaucratic and less procedurally and hierarchically dominant. Changing demographics, with increasing needs of the elderly, disabled, and chronically ill, will require a delivery system focused on the community. Emerging models of leadership will require more collaboration and coalitions, more cooperation and shared resources, and creative incentives for highly motivated self-management at decentralized levels.

Delivery of Health Care↗

PubMed1990

A skills-training group intervention model to assist persons in reducing risk behaviors for HIV infection.

Fifteen gay men with a history of recent high-risk sexual activities attended seven group sessions that provided risk education, training in self-management skills pertinent to risk reduction, sexual assertiveness training, and problem solving with respect to health consciousness, social supports, and efficacy of risk-reduction change. Before and after intervention, subjects completed measures of AIDS risk knowledge, sexual practices occurring over 4-month retrospective periods, and self-monitored records of ongoing sexual activities and participated in role plays assessing behavioral assertiveness skill for resisting high-risk coercions. Eight-month follow-up data were also collected. Subjects exhibited substantial and well-maintained change following intervention in behaviors relevant to HIV infection risk, including frequency of unprotected anal intercourse (which decreased to near-zero levels), condom use (which increased to almost 90% of intercourse occasions), and in an index that reflects the multiplicative function of risk behaviors frequency by the number of partners with whom high-risk behaviors occurs. This demonstration provides further evidence that skills-training approaches can assist individuals in implementing behavior changes to reduce risk for AIDS and identifies a model relevant to counseling efforts in AIDS prevention programs, HIV counseling and testing programs, drug abuse and STD clinics, and other applied settings.

Adolescent↗

PubMed1989

Shared governance.

1. Shared governance allows the individual to assume more authority and responsibility and be a part of an overall structure of self-management. 2. Major categories which need to be assessed in such a proposal include: budget, staffing, communications, quality assurance, education, statistics, and supplies, maintenance requirements. 3. Nurses involved with the proposal stated an increased sense of professionalism, increased job satisfaction and a greater understanding of hospital financing, legal and professional demands made upon the hospital by government, professional organizations and the community.

Humans↗

PubMed1989

Therapy of asthma in children.

The principal goal in the management of childhood asthma is to allow patients to lead a normal life and, when possible, to achieve an almost complete freedom from symptoms. To successfully treat a child with asthma, first it is necessary to gain the confidence of the child and his family, next to allay the anxieties of the family and finally to make quite sure that the parents understand the instructions regarding their child's treatment. For these reasons it is plausible to suggest that health education and self-management programs will improve adherence to the therapeutic regimen and will facilitate asthma treatment. The therapy of asthma in children consists of three major modalities: a) environmental control (avoidance of known precipitating factors), b) pharmacologic management and c) specific immunotherapy.

Asthma↗

PubMed1989

[Patient education in the treatment of bronchial asthma. Goals, content, pedagogic technics and evaluation of a structured program].

Despite the advances in the understanding of the pathogenic mechanisms, clinical assessment and medical treatment of asthma, an increase of mortality and morbidity has been observed. It is clear from several studies, however, that this discrepancy may be at least partly due to serious short-comings, amongst asthmatic patients, in their ability to judge the severity of their asthma, and their knowledge of medication and correct dosaging, in the event of deterioration. Therefore, to effectively manage asthma structured education programs for adult asthmatics appear to be useful including information about the disease and the medication as well as training of self-management of airflow limitation by the patients. The evaluation of the course of the disease before and after this education revealed a reduction in severe attacks, hospitalization and days lost from work in trained asthmatics.

Adult↗

PubMed1989

Helping adolescents in crisis: a case study.

Suicide among adolescents is a major mental health problem in the United States. The most recent data on adolescent suicide indicate that approximately 5,170 of those between the ages of 15 and 20 took their lives. Several researchers asserted that in most cases something could have been done to prevent the actual suicide. The author developed five stages (suicidal signs, establishing rapport, making referral, constructive actions, and self-management) that may be used to help adolescents in distress. The five stages were used in a case study to demonstrate the roles played by teacher, friend, and parents in helping an adolescent through a crisis.

Adult↗

PubMed1989

Freedom from fat: a contemporary multi-component weight loss program for the general population of obese adults.

This report summarizes results for the first 2,037 participants in the Freedom from Fat (FFF) weight loss program. FFF combined nutrition education, a low-fat dietary pattern, exercise, behavioral self-management, and social support in a program designed to serve the general population of overweight and obese adults. Participants ranged in age from 18 to 84 and from ideal weight to massively obese. After enrolling, program participants attended professionally led weekly meetings as long as they wished. Participants were encouraged to keep daily food diaries, to reduce the proportion of calories from fat to 30% or less, to exercise at moderate intensity for 30 minutes a day 5 days a week, to keep graphic records of weight change and exercise, and to display their graphs at each weekly group meeting. Attrition rates were comparatively low for a large-scale program, with half of the participants still active in the fifth month and 22% still active after 1 year. Mean weight loss for obese participants (BMI 30 or greater) at 6 months was 7.3 kg (16.2 lb) for men and 5.3 kg (11.6 lb) for women. The best predictors of weight loss at 6 months were number of days per week in which food diaries were kept, baseline body mass index, number of minutes of exercise per week, and age.

Adult↗

PubMed1989

Informational needs of patients who undergo excision of an acoustic neuroma.

Individuals who undergo removal of an acoustic neuroma are usually apprehensive in spite of the intrinsically benign nature of the disease. Fears surrounding the experience are related to the real risks involved in surgery near the brain and the complications which can ensue. The intensity of the patients' feelings of anxiety and uncertainty might be decreased if nurses were aware of and attended to the informational needs of these patients. In order to describe the informational needs of acoustic neuroma patients, a retrospective survey of 21 subjects who had had removal of such a tumor six to eighteen months previously was carried out. The survey determined: (1) the type of information patients received preoperatively and postoperatively (2) the type of information patients wanted (3) the type of problems experienced postoperatively and (4) the length and severity of the problems if they occurred. Content analysis indicated that the majority of subjects experienced tiredness, depression, headache, and dryness of eyes and mouth in the postoperative and convalescent phases. The actual illness experience persisted much longer than the subjects had expected. Subjects expressed explicit informational needs related to self-management after the surgery. The implications for nursing care will be discussed and the recommendations for an interdisciplinary patient education programme will be outlined.

Female↗

PubMed1989

Halo-body jacket immobilization in rheumatoid arthritis patients with cervical myelopathy.

The rehabilitation nurse may care for patients with arthritis in a variety of settings. When the patient has advanced RA, the problem of cervical myelopathy may require surgical intervention and use of the halo-body jacket immobilization orthosis. Expert pre- and postoperative management requires a knowledge of surgical nursing as well as rehabilitation nursing, in the traditional sense, to prevent complications and promote optimum recovery. When dealing with people who have lived with RA for many years, the rehabilitation nurse must continue to assess the patient's knowledge of the disease and use of self-management strategies and community resources.

Arthritis, Rheumatoid↗

PubMed1988

[The status of managing the type I diabetic patient in Austria. Organization].

During the Annual Meeting of the Austrian Diabetes Association various diabetic centres presented their success and failure rates with respect to metabolic control and prevention of late complications in diabetic patients on a country-wide basis. The analysis revealed that only 30% of all type I diabetic patients are adequately controlled. Intensive education in diabetes self-management, capable of leading to optimal metabolic control in up to 50% of the instructed patients, is however available only to a small minority of the diabetic patients to date. Despite the enormous improvement which has been achieved in the management of pregnant diabetic women, intensive specialized care is often commenced far too late. In rural areas, in particular, even conventional therapy is not fully implemented and late complications are, thus, inevitable.

Austria↗

PubMed1988

The role of emotions in the development and organization of personality.

In this chapter I have attempted to introduce a model of personality development that emphasizes the important contribution of emotional experiences, specifically differential emotional experiences. I have suggested that in the course of development children acquire affect-specific emotional organizations that then influence the way they subsequently engage the world. The attachment literature has led in establishing that early, formative social interactions with caregivers affect, in consequential ways, the nature of the subsequent parent-child bond and the child's social competence and cognitive skills. The discrete-emotions analysis undertaken here suggests it may be informative to learn more about the specific types of emotional exchanges that go on between infants and their caregivers. From this we may be able to understand more about differential personality development. In this chapter I also attempted to establish the case for the existence of emotional biases in adults and to show that these emotional biases appear to have rudimentary counterparts in infants and young children. I suggested that differential emotional biases are acquired developmentally in the context of differential social ecologies that elicit and emphasize certain emotions over others. Several mechanisms were proposed to account for the consolidation of emotional biases over time, including social learning principles, contagion and self-regulation, language, and the formation of cognitively mediated emotion loops. Once these kinds of ideoaffective organizations (Tomkins, 1963) or affective-cognitive structures (Izard, 1977) that are embodied in emotional organizations have taken shape, they tend to be self-sustaining without further "emotion socialization" from caregivers and other family members, although the wider social environment may continue to reinforce emotional biases, as is evident in the Dodge et al. (1986) study. Does this mean that emotional organizations established early in life will resist subsequent change? I suggest that cognition and feeling experience are capable of contributing to either further consolidation of emotional organizations and their dominance in personality and behavior or the forging of a new developmental path. Although emotion and cognition tend to sustain one another within emotion organizations, experience teaches that one can discover one's own "modes of states of mind" and deploy this information in the service of enlightened self-management (although there may be limitations on this ability, especially if the organization is of the more inflexible form found in psychopathology [Malatesta & Wilson, 1988]).(ABSTRACT TRUNCATED AT 400 WORDS)

Child↗

PubMed1988

Assessment of the effects of cost-sharing in Yugoslavia.

In this study the existing forms and amounts of cost-sharing in the Republic of Serbia (Yugoslavia) are analyzed. The level of cost-sharing is ranked according to the number and type of services involved and the relative importance with which they are viewed within the overall health-care policy of Yugoslavia. The "self-managing community of interest of health care," administratively coincident with the district, is taken as the unit of observation. Until recently, these bodies independently decided whether to introduce cost-sharing as well as the rate of cost-sharing. Therefore, the implementation of this health-policy measure differed among the districts generating inequality within health-care system. The results of simple and multiple correlation indicate that poorer districts with fewer health resources and lower levels of consumption introduced cost-sharing for more services, attempting to provide additional resources for financing of the health-care system. The multiple linear-regression model shows that population/physician ratio and the use of primary care physicians' services are the significant indicators of health-care expenditures in this territory. Considering the current economic situation in Yugoslavia and the level of development of the health-care system, the results of this cross-sectional study imply that cost-containment in health care can be achieved in a more equitable and effective manner by controlling supply of health services than by limiting demands.

Cost Allocation↗