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PubMed1995

Influences on breast-feeding by lower-income women: an incentive-based, partner-supported educational program.

OBJECTIVE: To determine the effects of a partner-supported, incentive-based educational program on rates and duration of breast-feeding among low-income women. DESIGN: Women who expressed a willingness to participate in the breast-feeding educational program were randomly assigned to one of two groups: an intervention group and a control group who received usual breast-feeding education. SETTING: Clinics of the Special Supplemental Food Program for Women, Infants, and Children in Flagstaff, Ariz. SUBJECTS: Sixty-eight primiparous pregnant women with expected due dates between May 1992 and December 1992 were willing to participate in the study. Of these, 34 were randomly assigned to the intervention group and 34 to the control group. Approximately 81% of the women completed the study: 29 in the control group and 26 in the intervention group. INTERVENTION: The intervention consisted of special incentives (prizes) for women and their partners to participate in a breast-feeding class for expectant couples and an educational series on childbirth. Women were also encouraged to use a breast-feeding support program in which peers serve as role models. MAIN OUTCOME MEASURES: The primary outcome measure was infant feeding method. Data were collected from mothers in both groups at the time of discharge from the hospital and at 2 weeks, 6 weeks, and 3 months postpartum. STATISTICAL ANALYSES PERFORMED: Binomial proportional analyses of the feeding data were performed. RESULTS: Women in the intervention group reported a higher percentage of breast-feeding at all measurement times. APPLICATIONS: These findings suggest that incentives, such as donated prizes, can be used to attract primiparous women from lower socioeconomic groups, along with their partners, to participate in educational interventions designed to promote breast-feeding. Participation by couples in breast-feeding promotion activities can dramatically increase the rate and duration of breast-feeding.

Adolescent↗
PubMed1978

A comparative study of IPPB, the incentive spirometer, and blow bottles: the prevention of atelectasis following cardiac surgery.

Following cardiac operations, 145 patients were treated with either intermittent positive-pressure breathing (IPPB), blod bottles, or an incentive spirometer in an attempt to alter the incidence of atelectasis. Pulmonary complications occurred in 30% of the patients receiving IPPB, 15% of those using an incentive spirometer, and 8% of those using blow bottles. Gastrointestinal side-effects occurred in 20% of the IPPB group and were rare in other groups. The cost of IPPB is also considerably greater than either incentive spirometry or blow bottles. IPPB is not essential to prevention of atelectasis in postoperative cardiac surgical patients and may be inferior to other methods.

Cardiac Surgical Procedures↗
PubMed1997

The effect of incentive spirometry and inspiratory muscle training on pulmonary function after lung resection.

BACKGROUND: A predicted postoperative forced expiratory volume in 1 second (FEV1) of less than 800 ml or 40% of predicted is a common criterion for exclusion of patients from lung resection for cancer. Usually, the predicted postoperative lung function is calculated according to a formula based on the number of lung segments that will be resected. Incentive spirometry and specific inspiratory muscle training are two maneuvers that have been used to enhance lung expansion and inspiratory muscle strength in patients with chronic obstructive pulmonary disease and after lung operation. METHODS: Thirty-two patients with chronic obstructive pulmonary disease who were candidates for lung resection were randomized into two groups: 17 patients received specific inspiratory muscle training and incentive spirometry, 1 hour per day, six times a week, for 2 weeks before and 3 months after lung resection (group A) and 15 patients were assigned to the control group and received no training (group B). RESULTS: Inspiratory muscle strength increased significantly in the training group, both before and 3 months after the operation. In group B, the predicted postoperative FEV1 value consistently underestimated the actual postoperative FEV1 by approximately 70 ml in the lobectomy subgroup and by 110 ml in the pneumonectomy subgroup. In group A, the actual postoperative FEV1 was higher than the predicted postoperative FEV1 by 570 ml in the lobectomy subgroup and by 680 ml in the pneumonectomy subgroup of patients. CONCLUSIONS: In patients undergoing lung resection the simple calculation of predicted postoperative FEV1 underestimates the actual postoperative FEV1 by a small fraction. Lung functions can be increased significantly when incentive spirometry and specific inspiratory muscle training are used before and after operation.

Adult↗
PubMedDate not supplied

Goal-directed instrumental action: contingency and incentive learning and their cortical substrates.

Instrumental behaviour is controlled by two systems: a stimulus-response habit mechanism and a goal-directed process that involves two forms of learning. The first is learning about the instrumental contingency between the response and reward, whereas the second consists of the acquisition of incentive value by the reward. Evidence for contingency learning comes from studies of reward devaluation and from demonstrations that instrumental performance is sensitive not only the probability of contiguous reward but also to the probability of unpaired rewards. The process of incentive learning is evident in the acquisition of control over performance by primary motivational states. Preliminary lesion studies of the rat suggest that the prelimbic area of prefrontal cortex plays a role in the contingency learning, whereas the incentive learning for food rewards involves the insular cortex.

Adaptation, Psychological↗
PubMed2001

Dopamine antagonism attenuates the unconditioned incentive value of estrous female cues.

The role of dopaminergic transmission in the incentive-motivational processes involved in the generation of male sexual behavior was examined. Three groups of sexually naïve Long-Evans male rats traversed a straight alley for one of three goalbox targets: an empty goalbox, a nonestrous female, or an estrous female. A Plexiglas partition within the goalbox allowed for the perception of visual, auditory, and olfactory cues, but prevented physical contact. Baseline run times revealed that subjects returned to the goalbox significantly faster for an estrous female than for a nonestrous female, replicating our earlier work on the inherent incentive value of primary female cues. When subjects were then pretreated with the dopamine receptor antagonist, haloperidol (0.0, 0.075, or 0.15 mg/kg), they expressed decreased sexual motivation as reflected by increased run times for estrous female targets. Subjects' run times for the empty goalbox condition were unaffected by haloperidol, suggesting that the drug did not reliably impair motoric capacity. Results support the contention that central dopaminergic systems are involved in the regulation of the positive, unconditioned incentive value of estrous female cues.

Animals↗
PubMed2002

Dopamine gating of glutamatergic sensorimotor and incentive motivational input signals to the striatum.

Dopamine (DA) neurons of the substantia nigra (SN) and ventral tegmental area (VTA) respond to a wide category of salient stimuli. Activation of SN and VTA DA neurons, and consequent release of nigrostriatal and mesolimbic DA, modulates the processing of concurrent glutamate inputs to dorsal and ventral striatal target regions. According to the view described here, this occurs under conditions of unexpected environmental change regardless of whether that change is rewarding or aversive. Nigrostriatal and mesolimbic DA activity gates the input of sensory, motor, and incentive motivational (e.g. reward) signals to the striatum. In light of recent single-unit and brain imaging data, it is suggested that the striatal reward signals originate in the orbitofrontal cortex and basolateral amygdala (BLA), regions that project strongly to the striatum. A DA signal of salient unexpected event occurrence, from this framework, gates the throughput of the orbitofrontal glutamate reward input to the striatum just as it gates the throughput of corticostriatal sensory and motor signals needed for normal response execution. Processing of these incoming signals is enhanced when synaptic DA levels are high, because DA enhances the synaptic efficacy of strong concurrent glutamate inputs while reducing the efficacy of weak glutamate inputs. The impairments in motor performance and incentive motivational processes that follow from nigrostriatal and mesolimbic DA loss can be understood in terms of a single mechanism: abnormal processing of sensorimotor and incentive motivation-related glutamate input signals to the striatum.

Amygdala↗
PubMed2002

Brain reward circuitry: insights from unsensed incentives.

The natural incentives that shape behavior reach the central circuitry of motivation trans-synaptically, via the five senses, whereas the laboratory rewards of intracranial stimulation or drug injections activate reward circuitry directly, bypassing peripheral sensory pathways. The unsensed incentives of brain stimulation and intracranial drug injections thus give us tools to identify reward circuit elements within the associational portions of the CNS. Such studies have implicated the mesolimbic dopamine system and several of its afferents and efferents in motivational function. Comparisons of natural and laboratory incentives suggest hypotheses as to why some habits become compulsive and give insights into the roles of reinforcement and of prediction of reinforcement in habit formation.

Animals↗
PubMedDate not supplied

Frequency and characteristics of cognitive services provided in response to a financial incentive.

OBJECTIVE: To determine the effects of a financial incentive on the number and types of cognitive services (CS) provided by community pharmacies to Medicaid recipients in the State of Washington. DESIGN: Prospective randomized trial. CS were reported using a problem-intervention-result coding system over a 20-month period. SETTING AND SUBJECTS: Pharmacists practicing in 110 study (financial incentive) and 90 control community pharmacies. RESULTS: Study pharmacists documented an average of 1.59 CS interventions per 100 prescriptions over a 20-month period, significantly more than controls, who documented an average of 0.67 interventions (P < .05) per 100 prescriptions. One-half (48.4%) of all CS were for patient-related problems, 32.6% were for drug-related problems, 17.6% were for prescription-related problems, and 1.4% were for other problems that did not involve drug therapy. A change in drug therapy occurred as a result of 28% of all CS documented in this demonstration. Changes were rarely (2.4%) due to generic or therapeutic substitution and almost always (90%) followed communication with the prescriber. The average self-reported time to perform CS was 7.5 minutes; 75% of interventions were < or = 6 minutes. Considerable differences existed between study and control groups in the types of problems identified, intervention activities performed, and results of interventions. CONCLUSION: A financial incentive was associated with significantly more, and different types of, CS performed by pharmacists.

Cognition Disorders↗
PubMed2000

Ignoring small predictable profits and losses: a new approach for measuring incentives for cream skimming.

Under inadequate capitation formulae competing health insurers have an incentive for cream skimming, i.e., the selection of enrollees whom the insurer expects to be profitable. When evaluating different capitation formulae, previous studies used various indicators of incentives for cream skimming. These conventional indicators are based on all actual profits and losses or on all predictable profits and losses. For the latter type of indicators, this paper proposes, as a new approach, to ignore the small predictable profits and losses. We assume that this new approach provides a better indication of the size of the cream skimming problem than the conventional one, because an insurer has to take into account its costs of cream skimming and the (statistical) uncertainties about the net benefits of cream skimming. Both approaches are applied in theoretical and empirical analyses. The results show that, if our assumption is right, the problem of cream skimming is overestimated by the conventional ways of measuring incentives for cream skimming, especially in the case of relatively good capitation formulae.

Adult↗
PubMed2000

Adding voucher-based incentives to coping skills and motivational enhancement improves outcomes during treatment for marijuana dependence.

Sixty individuals seeking outpatient treatment for marijuana dependence were randomly assigned to 1 of 3 treatments: motivational enhancement (M), M plus behavioral coping skills therapy (MBT), or MBT plus voucher-based incentives (MBTV). In the voucher-based incentive program, participants earned vouchers exchangeable for retail items contingent on them submitting cannabinoid-negative urine specimens. MBTV engendered significantly greater durations of documented marijuana abstinence during treatment compared with MBT and M, and a greater percentage of participants in the MBTV group compared with the MBT or M groups were abstinent at the end of treatment. No significant differences in marijuana abstinence were observed between the MBT and M groups. The positive effects of the voucher program in this study support the utility of incentive-based interventions for the treatment of substance dependence disorders including marijuana dependence.

Adaptation, Psychological↗
PubMed2003

Instrumental and Pavlovian incentive processes have dissociable effects on components of a heterogeneous instrumental chain.

Two experiments compared the effects of Pavlovian stimuli and incentive learning on the performance of a heterogeneous chain of instrumental actions. Using a Pavlovian-instrumental transfer design, the authors found that only a stimulus paired with the same outcome as that earned by performance of the chain produced positive transfer, an effect that was restricted to the action in the chain most proximal to reward delivery. In contrast, after a shift to a nondeprived state, only animals that had previously consumed the instrumental outcome when they were nondeprived decreased instrumental performance. Furthermore, this effect of the incentive learning treatment was limited to performance of the distal action. Together these data suggest that Pavlovian and instrumental incentive manipulations have dissociable effects on instrumental performance.

Animals↗
PubMed2005

Alcohol, intentional control, and inappropriate behavior: regulation by caffeine or an incentive.

This study shows that reduced intentional control under alcohol can be counteracted by caffeine or an environmental incentive. Four groups of social drinkers (n = 11) received 1 of the following: 0.62 g/kg alcohol (A), alcohol with 4.4 mg/kg caffeine (AC), alcohol with a rewarding monetary incentive (AR), or a placebo (P). They then performed a word stem completion task that provided separate measures of the influence of controlled and automatic processes governing responses. Controlled processes were depressed in Group A compared with Group P, whereas Groups AR and AC did not differ from Group P. Most inappropriate responses were displayed under alcohol alone, fewer with caffeine, and least with incentive. No treatment significantly affected automatic processes.

Adult↗
PubMed2001

The potential impact of incentives on future blood donation behavior.

BACKGROUND: It is important to assess the potential efficacy and safety of offering donation incentives as part of recruitment and retention programs. STUDY DESIGN AND METHODS: In 1995, 7489 allogeneic donors responded to an anonymous mail survey that inquired about demographics, donation history, infectious disease risks, and the potential appeal of incentives. RESULTS: The projected net effect of offering blood credits and medical testing would be to motivate, respectively, 58 percent and 46 percent of donors to return, whereas offering an item of limited value would motivate 20 percent to do so. First-time and younger donors reported more frequently than repeat or older donors that incentives would appeal to them. Donors attracted by cash were 60 percent more likely to have a risk for transfusion-transmissible infections (p = 0.03). Although not statistically significant, the odds of being an at-risk donor were higher among individuals attracted by tickets to events (OR 1.5) and extra time off work (OR 1.2). CONCLUSION: These findings suggest that offering blood credits and (though to a lesser extent) items of limited value could be safe and effective strategies for retaining donors. Although medical tests were found to have broad appeal, studies are needed to identify tests in which donors would be most interested.

Behavior↗
PubMed1995

Incentive spirometry to prevent acute pulmonary complications in sickle cell diseases.

BACKGROUND: This study was designed to determine the incidence of thoracic bone infarction in patients with sickle cell diseases who were hospitalized with acute chest or back pain above the diaphragm and to test the hypothesis that incentive spirometry can decrease the incidence of atelectasis and pulmonary infiltrates. METHODS: We conducted a prospective, randomized trial in 29 patients between 8 and 21 years of age with sickle cell diseases who had 38 episodes of acute chest or back pain above the diaphragm and were hospitalized. Each episode of pain was considered to be an independent event. At each hospitalization, patients with normal or unchanged chest radiographs on admission were randomly assigned to treatment with spirometry or to a control nonspirometry group. Each patient in the spirometry group took 10 maximal inspirations using an incentive spirometer every two hours between 8 a.m. and 10 p.m. and while awake during the night until the chest pain subsided. A second radiograph was obtained three or more days after admission, or sooner if clinically necessary, to determine the incidence of pulmonary complications. Bone scanning was performed no sooner than two days after hospital admission to determine the incidence of thoracic bone infarction. RESULTS: The incidence of thoracic bone infarction was 39.5 percent (15 of 38 hospitalizations). Pulmonary complications (atelectasis or infiltrates) developed during only 1 of 19 hospitalizations of patients assigned to the spirometry group, as compared with 8 of 19 hospitalizations of patients in the nonspirometry group (P = 0.019). Among patients with thoracic bone infarction, no pulmonary complications developed in those assigned to the spirometry group during a total of seven hospitalizations, whereas they developed during five of eight hospitalizations in the nonspirometry group (P = 0.025). CONCLUSIONS: Thoracic bone infarction is common in patients with sickle cell diseases who are hospitalized with acute chest pain. Incentive spirometry can prevent the pulmonary complications (atelectasis and infiltrates) associated with the acute chest syndrome in patients with sickle cell diseases who are hospitalized with chest or back pain above the diaphragm.

Acute Disease↗
PubMed1990

Prospects for faking believable memory deficits on neuropsychological tests and the use of incentives in simulation research.

The vulnerability of several neuropsychological memory tests--the Wechsler Memory Scale--Revised, Complex Figure Test, Auditory Verbal Learning Test, and Rey Memory Test--to faked deficits was evaluated. Subjects were randomly assigned to one of three conditions: Control (n = 28), Malingering with a financial incentive (n = 30), and Malingering without a financial incentive (n = 28). Overall, the performance of the Malingering Groups was not significantly different from one another, but both groups were significantly poorer than Controls. Discriminant functions with a reduced set of predictors correctly classified about 75% of cases in both the Control and the combined Malingering Groups on cross-validation. The results suggest that neuropsychological memory tests are vulnerable to faked deficits, and that recognition tasks are disproportionately affected. The use of incentives in simulation research is also discussed.

Adult↗
PubMed1976

Monetary incentive, age, and cognition.

Results from studies of cohort differences suggest that older and younger volunteers may differ in aspects other than age. In this study subjects, who had or had not been promised $10.00 payment for their participation, were compared on certain personality and intelligence factors. No differences between incentive conditions were observed for 2466 potential subjects on willingness to participate, nor for 591 subjects eventually tested on their scores on the Primary Mental Abilities Test, the Test of Behavioral Rigidity and Cattell's 16 PF. However, differences by incentive condition were observed on the intercorrelation matrices for women on Form B of the 16 PF. Results of these analyses suggest that, with few exceptions, supplying a monetary incentive to induce subjects to participate in a study does not significantly alter the characteristics of a volunteer sample with regard to age or sex.

Adult↗
PubMed1998

Controlled trial of the effect of length, incentives, and follow-up techniques on response to a mailed questionnaire.

Mailed questionnaires are an economical method of data collection for epidemiologic studies, but response tends to be lower than for telephone or personal interviews. As part of a follow-up study of volunteers who provided a brief health history and blood sample for a blood specimen bank in 1989, the authors conducted a controlled trial of the effect of length, incentives, and follow-up techniques on response to a mailed questionnaire. Interventions tested included variations on length of the questionnaire, effect of a monetary incentive, and effect of a postcard reminder versus a letter accompanied by a second questionnaire. Response was similar for the short (16-item, 4-page) and long (76-item, 16-page) questionnaire groups. The non-monetary [corrected] incentive did not improve the frequency of response. The second mailing of a questionnaire was significantly better than a postcard reminder in improving responses (23% vs. 10%). It is important to systematically test marketing principles to determine which techniques are effective in increasing response to mailed questionnaires for epidemiologic studies.

Adolescent↗
PubMed1994

Are incentive spirometry, intermittent positive pressure breathing, and deep breathing exercises effective in the prevention of postoperative pulmonary complications after upper abdominal surgery? A systematic overview and meta-analysis.

BACKGROUND AND PURPOSE: The purpose of this meta-analysis was to quantitatively assess the conflicting body of literature concerning the efficacy of incentive spirometry (IS), intermittent positive pressure breathing (IPPB), and deep breathing exercises (DBEX) in the prevention of postoperative pulmonary complications in patients undergoing upper abdominal surgery. METHODS: Computerized searches of MEDLINE and the Cumulative Index to Nursing and Allied Health databases were performed for the years 1966 through 1992. Citations were selected based on the following relevance criteria: (1) patients undergoing any type of upper abdominal surgery; (2) any combination of IS, IPPB, and DBEX; (3) an outcome of pulmonary complications; and (4) randomized trials. Review of 116 citations yielded 55 potential trials and 10 review articles. Of these, 14 citations were included in the overview based on relevance criteria requirements. Study validity was assessed by two independent observers, and data were extracted. RESULTS: The common odds ratio (COR) for the occurrence of pulmonary complications for IS versus no physical therapy was 0.44 in favor of IS. The COR for DBEX versus no physical therapy was 0.43 in favor of DBEX. Both findings were statistically significant. The CORs for IS versus IPPB, IS versus DBEX, and IPPB versus DBEX were 0.76 (95% confidence interval [CI] = 0.39-1.4), 0.91 (95% CI = 0.57-1.4), and 0.94 (95% CI = 0.28-3.17), respectively. None of these comparisons reached statistical significance. CONCLUSION AND DISCUSSION: Incentive spirometry and DBEX appear to be more effective than no physical therapy intervention in the prevention of postoperative pulmonary complications. There is no evidence to support a significant difference between any of the three modalities. [Thomas JA, McIntosh JM. Are incentive spirometry, intermittent positive pressure breathing, and deep breathing exercises effective in the prevention of postoperative pulmonary complications after upper abdominal surgery? a systematic overview and meta-analysis.

Abdomen↗