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Physician and consumer attitudes and behaviors regarding self-help health support groups as an adjunct to traditional medical care.
This study assessed the creditability of self-help health support groups as an adjunct to traditional medical care among a sampling of physicians (N = 120) and group members (N = 73) located in the Dallas/Ft. Worth Metropolitan area. Findings suggest a general lack of awareness of local groups among physicians, referral to only a few select groups, as well as little communication between health care professionals and their patients. Physicians in group practice, surgical specialties, and having never referred patients to support groups responded less favorably. Several benefits were reported by the group members, although for a majority their patient-physician relationship remained relatively unchanged.
A practice-sponsored Web site to help patients pursue healthy behaviors: an ACORN study.
PURPOSE: We tested whether patients are more likely to pursue healthy behaviors (eg, physical activity, smoking cessation) if referred to a tailored Web site that provides valuable information for behavior change. METHODS: In a 9-month pre-post comparison with nonrandomized control practices, 6 family practices (4 intervention, 2 control) encouraged adults with unhealthy behaviors to visit the Web site. For patients from intervention practices, the Web site offered tailored health advice, a library of national and local resources, and printouts for clinicians. For patients from control practices, the Web site offered static information pages. Patient surveys assessed stage of change and health behaviors at baseline and follow-up (at 1 and 4 months), Web site use, and satisfaction. RESULTS: During the 9 months, 932 patients (4% of adults attending the practice) visited the Web site, and 273 completed the questionnaires. More than 50% wanted physician assistance with health behaviors. Stage of change advanced and health behaviors improved in both intervention and control groups. Intervention patients reported greater net improvements at 1 month, although the differences approached significance only for physical activity and readiness to change dietary fat intake. Patients expressed satisfaction with the Web site but wished it provided more detailed information and greater interactivity with clinicians. CONCLUSIONS: Clinicians face growing pressure to offer patients good information on health promotion and other health care topics. Referring patients to a well-designed Web site that offers access to the world's best information is an appealing alternative to offering handouts or impromptu advice. Interactive Web sites can facilitate behavior change and can interface with electronic health records. Determining whether referral to an informative Web site improves health outcomes is a methodological challenge, but the larger question is whether information alone is sufficient to promote behavior change. Web sites are more likely to be effective as part of a suite of tools that incorporate personal assistance.
Teaching youths with autism to offer assistance.
Three adolescent boys with autism were taught to offer assistance to a person stating inability to complete a task. The study used a multiple baseline across the 3 youths and a multiple baseline across three tasks for each student. Both designs provided clear support for the ability of the youths to discriminate those settings in which offers of assistance were desired. All 3 participants showed relatively rapid acquisition of responding. Generalization was assessed to a new person in the training setting, to a familiar person in a new room at the center, to the mother in the youth's home, and to three novel tasks. Generalization to a new person in the familiar setting was most likely to occur, with very high levels of responding for all 3 youths. Generalization to the other conditions varied across youths, although all 3 boys showed some transfer of skills to all conditions.
Pathologic gambling disorder. How to help patients curb risky behavior when the future is at stake.
Pathologic gambling disorder and problem gambling are becoming increasingly common in the United States as more states legalize gambling. Although gambling-related disorders can cause devastating consequences, well-studied treatments are few. Fortunately, clinical experience suggests that pathologic gambling disorder is highly treatable. In this article, Drs Sumitra and Miller briefly summarize gambling-related disorders and discuss available, effective treatments.
Destroyers. Written treatment contracts can help cure self destructive behaviors of the borderline patient.
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Intervention can help reduce risky sexual behavior.
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Missed treatments: how to help patients change problem behavior.
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A view from the field: phone help line in India helps indentify HIV risk behaviors.
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JCAHO standards help address disruptive physician behavior.
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The effects of cooperatively and competitively structured learning enironments on inter- and intrapersonal behavior.
This study examines the effects of cooperative versus competitive goal structures on the subsequent intra- and interpersonal behavior of fourth-grade children. 2 situational variables were operating in each situation: first, the variable of working on a project as a group versus as an individual; and second, the variable of public reward. Results indicate that the effects of competitively structured environments differ for winners and nonwinners and for boys and girls. Girls, both winners and nonwinners, adopt the evaluations of the experimenter and generalize worthiness or deservedness to other situations as evidenced by their prize giving to self and others. After failure to win, girls also refrain from taking a toy away from the winner. After failure to win, boys behave competitively by taking a toy away from the winner and rewarding self more relative to others. The data also suggest that boys may not have experienced cooperative winning as success.
New dental modality to help patients modify eating behavior and slow the rate of food ingestion.
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[Behavior therapy in alcoholism--does it help?].
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Trichotillomania in adults.
The cause of hair plucking is purely psychological. The extent of the hair plucking and the area from which the hair is plucked seem to have no direct correlation with the patient's underlying psychopathologic behavior. Hair plucking that begins in childhood and extends into adolescence and adulthood may represent a more complex psychopathologic condition. Therapy can consist of confronting the patient with his behavior and helping him cope with the triggering stressful external causes. Psychiatric consultation is suggested if this is not helpful. Trichotillomania by definition implies psychosis. Since this behavior is seldom associated with psychosis, we suggest the term hair plucking be used to describe this syndrome. Herein, we present two cases of trichotillomania (hair plucking), review of the relevant literature dealing with the psychopathologic nature of this disorder, and suggest methods for managing these patients.
Buoyancy and diving behavior in mosquito pupae.
Mosquito pupal diving behavior has been studied mostly in Aedes aegypti and in this species pupal buoyancy varies relative to several factors. The research reported herein addresses the 2 following questions. Does diving behavior vary among different mosquito genera and species? How is diving behavior influenced by variation in buoyancy? Depth and duration of dive, and dive pattern, were compared among Ae. aegypti, Culex pipiens, Anopheles stephensi, Aedes albopictus, and Aedes triseriatus. In response to the stimulation associated with transferring pupae between containers, diving behavior varied dramatically among the different genera studied. Culex pipiens and An. stephensi make short-duration, shallow dives and remain positively buoyant. The 3 aedine species studied make longer-duration dives, typically to a depth at which they become neutrally or negatively buoyant. Buoyancy reduction effects were studied in the 3 aedine species. Normally buoyant pupae tend to dive to greater depths and for longer periods of time than reduced-buoyancy pupae. Aedine pupal diving behavior clearly is closely regulated relative to buoyancy variation. To the earlier hypotheses that pupal behavior may help avoid predation and be energy-conserving, we add the suggestion that the diving behavior displayed by the container-breeding aedine pupae we studied represents an adaptation that helps keep them from being washed from their container habitat by overflowing water during rainfall. We also suggest that the diving behavior of all the species studied may help pupae survive heavy, pelting rainfall by enabling them to avoid the mechanical shock of a direct hit by a raindrop, which could cause disruption of the gas in the ventral air space, thereby causing the loss of hydrostatic balance and drowning.
Managing problem behaviors associated with dementia.
The older adult with dementia who exhibits problem behaviors is likely to be experiencing physical or psychological distress. Both can negatively affect the health, rehabilitation, and quality of life for the older adult. Managing problem behaviors can challenge the skills of the most experienced nurse. Being able to identify the origins of these behaviors can help caregivers respond in a way that will achieve behavioral management and preserve the dignity of the older adult. This article presents some practical measures to assist nurses with minimizing the negative effects of dementia-associated problem behaviors in older adults.
Microwaves: effect on thermoregulatory behavior in rats.
Rats, with their fur clipped, pressed a lever to turn on an infrared lamp while in a cold chamber. When they were exposed to continuous-wave microwaves at 2450 megahertz for 15-minute periods, the rate at which they turned on the infrared lamp decreased as a function of the microwave power density, which ranged between 5 and 20 milliwatts per square centimeter. This result indicates that behaviorally significant levels of heating may occur at an exposure duration and intensities that do not produce measurable changes in many other behavioral measures or in colonic temperature. Further study of how microwaves affect thermoregulatory behavior may help us understand such phenomena as the reported "nonthermal" behavioral effects of microwaves.
The associations of suicide attempts in adolescents.
OBJECTIVE: Suicide completion has increased in the United States among 15- to 24-year-olds from 4.5 per 100 000 (1950) to 13.2 per 100 000 (1990). Suicide attempts have been found to be associated with depression, substance use, overall number of life stressors, gender, and impulsive behaviors. We hypothesized that suicide attempt is associated with many other health risk behaviors. DESIGN: To evaluate this hypothesis, we analyzed the data from the 1993 Massachusetts Youth Risk Behavior Survey from a representative sample of students in grades 9 through 12 in public and private high schools. We examined the relationships between ever attempting suicide and engaging in other health risk or problem behaviors (eg, sexual activity, substance use, violence, and seat belt nonuse). RESULTS: The 3054 students were distributed among the 9th to 12th grades; 50.7% were female, 77.7% white, 6.7% black, 5.9% Hispanic, 4. 6% Asian, .8% Native American, and 4.4% other; and the mean age was 16 +/- 1.2 years. Based on logistic regression analysis, ever attempting suicide was associated with physical fights in the past 12 months (odds ratio [OR] = 1.3[95% confidence interval (CI), 1. 22-1.44]), regular cigarette use in the past 30 days (2.0[1.41-2. 97]), female gender (3.2[2.21-4.71]), lack of seat belt use (1.3[1. 21-1.34]), gun carrying in the past 30 days (1.4[1.12-1.70]), substance use before last sexual activity (1.4[1.09-1.84]), Native American or other (2.4[1.21-4.71]), and lifetime use of other drugs (1.2[1.04-1.40]). The full model correctly assigned 92% of the youth. There were small differences in models for males, females, and sexually active youth. Same gender sexual experiences for sexually active youth did not significantly improve the model (partial r = .0, OR = .87 [95% CI, .33-2.30]) and fewer (88%) of the youth were correctly assigned by the model. CONCLUSIONS: Ever attempting suicide is associated with other problem behaviors. This research proposes an empirical model of the relationship between suicide attempts and other health risk behaviors. Identifying which adolescents are at risk for suicide attempts from the presence of accompanying risk behaviors will help clinicians to evaluate suicide risk when other problem behaviors are identified, thus enabling the design of possible prevention strategies.