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HIV seroprevalence surveys in drug treatment centers.

Sharing of equipment used to inject illicit drugs intravenously is a risk factor for human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS). Systematic surveillance of HIV infection among intravenous drug users (IVDUs) in the United States is essential to monitor the HIV epidemic and to target and evaluate prevention programs for IVDUs and their partners. The most accessible segment of the largely covert population of IVDUs are those in drug treatment programs. In collaboration with State and local health departments and drug abuse treatment agencies, the Centers for Disease Control is conducting blinded (serologic test results not linked to identifiable persons) and nonblinded (in which clients voluntarily agree to participate) surveys of IVDUs entering drug treatment in 39 U.S. metropolitan areas. The same protocol is used in all participating drug treatment centers. Blinded surveys will be carried out annually to determine HIV seroprevalence rates in eligible IVDUs entering drug treatment and to monitor trends over time. Each year, nonblinded surveys of IVDUs entering drug treatment will assess self-reported drug use and sexual behaviors to help design educational interventions and to detect changes in behavior over time. This sentinel surveillance system, using a standardized methodology, will provide the best national and regional data available on the seroprevalence of HIV among IVDUs and the relationships of drug use, sexual behaviors, and HIV serologic status of IVDUs.

AIDS Serodiagnosis↗

Behavior therapy for obsessive compulsive disorder.

Exposure in vivo and ritual or response prevention are the essential elements of behavior therapy for obsessive compulsive disorder. Naturalistic behavior therapy helped a fortunate few before the effective elements of behavior therapy were identified and systematically applied. Homework exposure and response prevention are essential and therapist accompaniment is seldom necessary. Homework sessions are planned by patient and clinician and written records facilitate treatment modifications during homework sessions. About a quarter of patients refuse behavior therapy, but 90% of the remainder achieve worthwhile gains with exposure and response prevention. Limited availability of behavior therapy is a substantial public health problem.

Behavior Therapy↗

Prosocial behavior and perspective-taking of mentally retarded and nonretarded children.

Fourteen nonretarded second-grade children, 14 EMR elementary-aged children, and 14 TMR adolescents, all of preoperational cognitive level on Piagetian tasks, were compared on measures of perceptual perspective-taking, empathy (affective perspective-taking), and helping (prosocial behavior). In their performance on a simple task, subjects did not vary on any of these measures. Successful perspective-taking was found to be task specific. The expected association between ability to empathize and helping was found only for nonretarded children. Results were discussed in terms of both cognitive and social factors affecting behavior.

Adolescent↗

A framework for modeling health behavior protocols and their linkage to behavioral theory.

With the rise in chronic, behavior-related disease, computerized behavioral protocols (CBPs) that help individuals improve behaviors have the potential to play an increasing role in the future health of society. To be effective and widely used CBPs should be based on accepted behavioral theory. However, designing CBPs while at the same time specifying their linkages to behavioral theory and developing reusable CBP components (interventions) are challenges to developers of CBPs. Having an ontology with which to describe CBPs could help with these issues. As a first step towards creating such an ontology, we modeled PACE-Adolescent, a theory-based behavioral protocol that uses the Stages of Change Model and Social Cognitive Theory, using PROTEGE-2000, an ontology editor and knowledge acquisition system. We created a three-part knowledge model. Two sub-ontologies described behavioral interventions and psychological theories. The third component, implemented using Guideline Interchange Format (GLIF3), provided a way to describe the structure of a protocol and to link intervention resources and groups of actions to elements of psychological theory. Using this framework, we formally described the PACE-Adolescent protocol. Creating knowledge models such as this may lead to improvements in the design and evaluation of computerized health behavior protocols.

Adolescent↗

The preliminary effectiveness of migraine lay trainers in a home-based behavioural management training.

OBJECTIVES: This pilot study examined the effectiveness and trainer skills of the first migraine lay trainers (MLTs). METHODS: In a stepwise training program eight MLTs participated in a behavioural management training (BMT) aimed at the prevention of migraine attacks by proactive relaxation and trigger management. After successful reduction of their migraine attacks, three MLTs provided BMT under supervision at home to one fellow patient and subsequently to a small group. RESULTS: Migraine frequency was significantly reduced in five out of eight patients trained by MLTs (mean 48%) and medication use decreased substantially in four patients (mean 47%). Qualities of MLTs concerned their motivational assistance, knowledge of premonitory symptoms and exchange of disease specific problems. Pitfalls were that migraine symptoms hampered an active guidance of the sessions and providing tailored feedback was difficult. CONCLUSION: The first MLTs were successful in training fellow patients in behavioural prevention of migraine attacks. PRACTICE IMPLICATIONS: Continuous supervision of MLTs health and trainer skills is recommended but is likely to have implications for cost-effectiveness.

Adaptation, Psychological↗

A Systematic Review of Help-Seeking Barriers for Racial-Ethnic Minority Caregivers Accessing Autism Diagnostic and Intervention Services.

Caregivers play an essential role in early help-seeking and intervention for children with Autism Spectrum Disorder (ASD). Caregivers, therefore, provide a crucial role in helping to address the racial and ethnic disparity identified in accessing ASD intervention and diagnostic services (Bejarano-Martín et al., Journal of Autism and Developmental Disorders 50(9), 3380-3394, 2020). Unfortunately, racial-ethnic minority caregivers of children with autism (CCA) are less likely to contact a physician or healthcare professionals about their concerns and more likely to delay their contact to have their child evaluated (Zeleke et al., Journal of Autism and Developmental Disorders 49(10), 4320-4331, 2019). However, little evidence exists to explain why such a gap exists in the help-seeking behaviors between White and racial-ethnic minority CCA. To address this knowledge gap, we conducted a systematic literature review to identify articles that have studied barriers in help-seeking for racial-ethnic minority CCA. A broad literature search across four databases was conducted (i.e., PubMed, PsycINFO, Education Resources Information Center, and Child Development and Adolescent Studies). The coding team identified 17 articles on help-seeking barriers for racial-ethnic minority CCA. A thematic analysis was used to narratively synthesize the help-seeking barriers identified across these 17 studies. Four themes emerged from our findings: logistical barriers, provider competence, ASD literacy, and cultural stigma. We also provided clinical recommendations for healthcare providers working with families with racial-ethnic minority CCA.

Humans↗

Adolescents' smoking behavior and its relationships with psychological constructs based on transtheoretical model: a cross-sectional survey.

BACKGROUND: Korean adolescents' smoking is currently being considered as a crucial factor determining the health status of adolescents and an important public health and social issue. OBJECTIVES: The purpose of the study was to test the applicability of the Transtheoretical model to gain an understanding of smoking behavior change. METHODS: A total of 706 adolescents who participated in the smoking cessation programs administered by the Korea Quit Smoking Association or Korean Association of Smoking & Health in 2003 were recruited. Four Korean-version questionnaires were used to identify the stages of smoking behavior and psychological attributes: Stage of Smoking Behavior Change Scale, Processes of Change Scale for Smoking, Decision Balance Scale for Smoking, and Self-efficacy Scale to avoid smoking. RESULTS: Korean adolescents' smoking behavior was differed according to gender. In addition, the findings revealed that behavioral and cognitive processes of change, self-efficacy, and positives differed across the stages of smoking behavior, and that psychological constructs of the transtheoretical model had a statistically significant impact on smoking behavior change. CONCLUSIONS: This research could spawn the development of theory-based and empirically supported smoking cessation intervention strategies and programs directed toward adolescents in the health care and nursing areas.

Adolescent↗

Physicians' opening questions and patients' satisfaction.

OBJECTIVE: To determine the association between the format of physicians' opening questions that solicit patients' presenting concerns and patients' post-visit evaluations of (i.e., satisfaction with) the affective-relational dimension of physicians' communication. METHODS: Videotape and questionnaire data were collected from visits between 28 primary-care physicians and 142 adult patients with acute problems. Factor analysis resulted in three dependent variables derived from the 9-item Socioemotional Behavior subscale of the Medical Interview Satisfaction Scale. RESULTS: Question format was significantly, positively associated with patients' evaluations of physicians' listening (p=.028) and positive affective-relational communication (p=.046). CONCLUSION: Patients desire opportunities to present concerns in their own time and terms regardless of how extensively they act on this opportunity. PRACTICE IMPLICATIONS: Visits should be opened with general inquiries (e.g., What can I do for you today?) versus closed-ended requests for confirmation (e.g., Sore throat, huh?).

Adult↗

Prolactin and paternal care: comparison of three species of monogamous new world monkeys (Callicebus cupreus, Callithrix jacchus, and Callimico goeldii).

The authors explored whether prolactin is associated with paternal care in 3 monkey species: titi monkey (Callicebus cupreus), common marmoset (Callithrix jacchus), and Goeldi's monkey (Callimico goeldii). They compared prolactin levels in fathers before and after infant birth as well as between fathers and nonfathers. C. cupreus fathers carry infants almost exclusively, have higher prolactin levels than nonfathers, but show no prolactin increase after infant birth. C. goeldii fathers carry infants only after 3 weeks, show an increase in prolactin levels during the precarrying period, but do not have higher levels than nonfathers. C jacchus fathers are the primary carriers, have higher prolactin levels than nonfathers, and show a trend for a prolactin increase after the birth of infants. In conclusion, species differences in the patterns of prolactin secretion were evident and reflect the different paternal roles.

Animals↗

Dialysis: prolonging life or prolonging dying? Ethical, legal and professional considerations for end of life decision making.

There are over 7,000 people on dialysis in Australia and this is predicted to increase due to the ageing population and the high incidence of diabetes mellitus. Discontinuation of dialysis is the second most frequent cause of death in dialysis patients in Australia. Risk factors for the discontinuation of dialysis include: co-morbidities (especially diabetes mellitus) and being older. Because the decision to discontinue dialysis is a major life choice, collaborative decision making should be encouraged, and the patient needs assurances of the continuation of care and kindness, a palliative care plan, and the alleviation of suffering. Patients decide to discontinue dialysis because of an unacceptable quality of life, depression and a chronic failure to thrive. Health professionals need to support end of life decision making using an ethical decision framework. A review of current literature was undertaken and revealed a paucity of information in regard to palliation in those with end stage renal disease who had discontinued dialysis. The fear of dying, pain, suffering, and abandonment that a patient and/or their family may perceive as being associated with death may create barriers to decisions to discontinue with dialysis treatments. Therefore health care personnel should provide information with honesty to allow patients to predict their quality of life and death. Support for the patient and family during the dying period should be multi-disciplinary, with clear and timely communication between all members of the team.

Advance Care Planning↗

Maternal sensitivity to children in problem situations.

Sixty mothers and their preschool children were placed in interactions structured to involve a problem situation for the child, the mother, or both. Maternal sensitivity and insensitivity were measured to test a number of parent effectiveness constructs. Results indicate that mothers were more insensitive than sensitive to their children, and that some major assumptions of the parent effectiveness model lack sufficient support to justify its training procedures.

Authoritarianism↗

The importance of being there: perspectives of social support by adolescents with cancer.

Adolescents with cancer are confronted with many challenges. The extent to which they are able to deal with such challenges appears to be partly contingent on a positive strong social support system. In this article, the author describes findings specific to the sources of social support that 15 adolescents with cancer found to be most important in getting them through the cancer experience. Data were collected as part of a longitudinal qualitative interpretive study and involved individual interviews, focus group interviews, and participant observation as the main sources of data. The relationships that adolescents maintained with their nuclear families, health care team members, and special friends were the 3 main supportive relationships in the adolescents'lives. The act of others "being there" was seen by the adolescents as the key element of a supportive relationship and involved 6 main behaviors. Although the 3 key supportive relationships were essential in helping adolescents get through cancer, these relationships were at times a source of stress for adolescents.

Adaptation, Psychological↗

Are there demonstrable effects of distant intercessory prayer? A meta-analytic review.

BACKGROUND: The use of alternative treatments for illness is common in the United States. Practitioners of these interventions find them compatible with personal philosophies. Consequently, distant intercessory prayer (IP) for healing is one of the most commonly practiced alternative interventions and has recently become the topic of scientific scrutiny. PURPOSE: This study was designed to provide a current meta-analytic review of the effects of IP and to assess the impact of potential moderator variables. METHODS: A random effects model was adopted. Outcomes across dependent measures within each study were pooled to arrive at one omnibus effect size. These were combined to generate the overall effect size. A test of homogeneity and examination of several potential moderator variables was conducted. RESULTS: Fourteen studies were included in the meta-analysis yielding an overall effect size of g = .100 that did not differ from zero. When one controversial study was removed, the effect size reduced to g = .012. No moderator variables significantly influenced results. CONCLUSIONS: There is no scientifically discernable effect for IP as assessed in controlled studies. Given that the IP literature lacks a theoretical or theological base and has failed to produce significant findings in controlled trials, we recommend that further resources not be allocated to this line of research.

Behavioral Medicine↗

Perceptions of women living with coronary heart disease: a pilot investigation.

This qualitative study describes how forty-one perimenopausal and postmenopausal women with coronary heart disease (CHD) perceive their illness experience. Five focus groups were conducted by a professional facilitator at two community hospitals in New Jersey. All data were collected and analyzed based on the grounded theory approach. Findings indicate that participants often failed to recognize the significance of risk factors and symptoms, and even denied the presence of disease following diagnosis and treatment. Consequences of illness centered on women's efforts to maintain control over their health and their lives. Findings also indicate that there is a gap between the desire for knowledge and the ability to access and assimilate information in key areas regarding CHD and personal health behaviors. The insights provided by these women have several implications for future research and contribute valuable information related to the needs of this population.

Adaptation, Psychological↗

Mutual-help groups: members' views of their benefits and of roles for professionals.

Members of 18 self-help groups in Canada were surveyed as to the benefits of participation in mutual help groups and the roles for professionals in such groups. Three distinctions are made among mutual help groups: (1) those dealing with loss-transition (L-T), (2) those with members one step removed (OSR) from the problem, and (3) groups for stress, coping and support (SC&S). Members in OSR groups feel they benefit significantly more from participation than SC&S group members, while many L-T members feel they could get along well without the group if they had to. Members of SC&S groups tend to favor indirect involvement of professionals and see professional help and mutual help as complementary, more than do members of L-T and OSR groups. The traditional health care system is found to ignore the needs of L-T and OSR group members; mutual help thus provides a critical source of support and education for these people.

Canada↗