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PubMedDate not supplied

The paraphilia-related disorders: an empirical investigation of nonparaphilic hypersexuality disorders in outpatient males.

The frequency distribution of nonparaphilic hypersexual behaviors was investigated in an outpatient sample of 206 consecutively evaluated males seeking help for sexual impulsivity disorders (SIDs), either paraphilia-related disorders (PRD; n = 63) or paraphilias (PA; n = 143). Paraphilia-related disorders associated with help-seeking behaviors included compulsive masturbation (sample prevalence, 69%), protracted heterosexual or homosexual promiscuity (51%), pornography dependence (50%), telephone-sex dependence (24%), and severe sexual desire incompatibility (12%). Eighty-six percent of the PA sample reported at least one lifetime PRD. The subgroup of males with both PAs and lifetime PRDs (n = 123) self-reported the greatest number of lifetime SIDs, the highest incidence of physical and sexual abuse, the fewest years of completed education, and the highest likelihood of current unemployment or disability. As well, the subgroup of males with PAs but no lifetime PRDs (n = 20) self-reported the fewest lifetime SIDs; this subgroup was not statistically different from the PRD group on these aforementioned variables. These data suggest that social disadvantage, as assessed in this sample, is associated with the cumulative incidence of SIDs but not necessarily with the diathesis to develop paraphilic disorders.

Adult↗
PubMed2002

Noncardiac chest pain.

GOALS: Review of research directions in the etiology, evaluation, and treatment of patients with noncardiac chest pain. The author proposes a combined practical approach to noncardiac chest pain that incorporates these findings, which is useful in a clinical practice setting. BACKGROUND: Several major schools of thought have emerged in the etiology of noncardiac chest pain: acid reflux, motor disorder, altered pain threshold/hypersensitivity, and association with psychiatric dysfunction. There is significant overlap among these. Occult gastroesophageal reflux disease (GERD) is more common than motor disorders and is found in 30% to 40% of these patients; a subset has hypersensitivity, with a normal pH profile. Esophageal motility testing and endoscopy have a more limited role than 24-hour pH testing. Impedance planimetry and balloon sensory provocative testing remain research tools. Provocative testing with hydrochloric acid or edrophonium is less helpful than pH monitoring. Gastroesophageal reflux disease-induced chest pain requires high-dose long-term proton pump inhibitors (PPIs): at least 4 to 8 weeks. Psychotropics are superior to placebo, both in patients with and without psychiatric dysfunction. RESULTS: The author found combined PPIs and psychotropics helpful in patients with esophageal hypersensitivity and GERD, although supporting data is scant. CONCLUSIONS: A brief 1-week high-dose PPI challenge, i.e., omeprazole test, may be cost-effective in a primary care setting. However, this approach may not be useful in a referral setting, where pH data and diary assessment of associated symptoms provide useful management help. A behavioral model approach, with early emphasis on patient education, integrated with physiologic data helps the most.

Algorithms↗
PubMed1985

Career management: an ongoing process.

This article is the last in a three-part series on career management. Reasons to pursue and ways to choose a suitable second career are discussed. A stalled career, a lack of achievement, or a wrong job choice are three reasons why people pursue new jobs or careers. To ensure satisfaction in a second career, individuals must examine an ego ideal--an idealized image of what they would like to be in the future. When a pharmacist's career stalls, introspection can help reveal behavior that interferes with career success. Periodic introspection and self-assessment can help an individual adapt to changes in a career and in the profession throughout the various life stages. For the pharmacist who chooses the wrong job, self-assessment and research of alternative opportunities will increase the likelihood that a second career will be satisfactory. The traditional hospital pharmacy career is linear; the pharmacist starts at the bottom of the organization and rises to the top. A nonlinear career strategy is now suggested because of limited positions at the top and an abundance of well-trained individuals. The nonlinear strategy moves a person indirectly in a career; short-term career moves are designed to meet long-term goals. Pharmacists can grow in a current or second career by using introspection and self-assessment and by adapting to changes that occur in the profession.

Career Choice↗
PubMed2005

Instructional design strategies for health behavior change.

To help health educators build upon the best of different health behavior change theories, this paper offers a unified set of instructional design strategies for health education interventions. This set draws upon the recommendations of Rosenstock (Health Belief Model), Bandura (Social Cognitive Theory), and Dearing (Diffusion Theory), and uses a modified Events of Instruction framework (adapted from Robert Gagne): gain attention (convey health threats and benefits), present stimulus material (tailor message to audience knowledge and values, demonstrate observable effectiveness, make behaviors easy-to-understand and do), provide guidance (use trustworthy models to demonstrate), elicit performance and provide feedback (to enhance trialability, develop proficiency and self-efficacy), enhance retention and transfer (provide social supports and deliver behavioral cues). Sample applications of these strategies are provided. A brief review of research on adolescent smoking prevention enables consideration of the frequency with which these strategies are used, and possible patterns between strategy use and behavioral outcomes.

Adolescent↗
PubMed2005

Cognitive behavioral therapy guided self-help and orlistat for the treatment of binge eating disorder: a randomized, double-blind, placebo-controlled trial.

BACKGROUND: Cognitive behavioral therapy (CBT) has efficacy for binge eating disorder (BED) but not obesity. No controlled studies have tested whether adding obesity medication to CBT facilitates weight loss. We performed a randomized, placebo-controlled study of orlistat administered with guided self-help CBT (CBTgsh). METHODS: Fifty obese BED patients were randomly assigned to 12-week treatments of either orlistat plus CBTgsh (120 mg three times a day [t.i.d.]) or placebo plus CBTgsh and were followed in double-blind fashion for 3 months after treatment. RESULTS: Seventy-eight percent of patients completed treatments without differential dropout between orlistat+CBTgsh and placebo+CBTgsh. Intent-to-treat remission rates (zero binges for past 28 days on Eating Disorder Examination Interview) were significantly higher for orlistat+CBTgsh than placebo+CBTgsh (64% versus 36%) at posttreatment but not at 3-month follow-up (52% in both). Intent-to-treat rates for achieving 5% weight loss were significantly higher for orlistat+CBTgsh than placebo+CBTgsh at posttreatment (36% versus 8%) and 3-month follow-up (32% versus 8%). Significant and comparable improvements in eating disorder psychopathology and psychological distress occurred in both treatments. CONCLUSIONS: The addition of orlistat to CBTgsh was associated with greater weight loss than the addition of placebo to CBTgsh. Clinical improvements were generally maintained at 3-month follow-up after treatment discontinuation.

Adult↗
PubMed2003

Self-help for bulimia nervosa: a randomized controlled trial.

OBJECTIVE: The authors examined the effectiveness of unguided self-help as a first step in the treatment of bulimia nervosa. METHOD: A total of 85 women with bulimia nervosa who were on a waiting list for treatment at a hospital-based clinic participated. The patients were randomly assigned to receive one of two self-help manuals or to a waiting list control condition for 8 weeks. One of the self-help manuals addressed the specific symptoms of bulimia nervosa (cognitive behavior self-help), while the other focused on self-assertion skills (nonspecific self-help). RESULTS: Twenty patients (23.5%) dropped out of the study. The data were analyzed with intention-to-treat analysis. Although the group-by-time interaction for binge eating and purging was not statistically significant, simple effects showed that there was a significant reduction in symptom frequency in both self-help conditions at posttreatment but not in the waiting list condition. There were no statistically significant changes in levels of dietary restraint, eating concerns, concerns about shape and weight, or general psychopathology. A greater proportion of patients in the cognitive behavior self-help (53.6%) and nonspecific self-help (50.0%) conditions reported at least a 50% reduction in binge eating or purging at posttreatment, compared with the waiting list condition (31.0%). A lower baseline knowledge about eating disorders, more problems with intimacy, and higher compulsivity scores predicted a better response. CONCLUSIONS: The findings suggest that a subgroup of patients with bulimia nervosa may benefit from unguided self-help as a first step in their treatment. Cognitive behavior self-help and nonspecific self-help had equivalent effects.

Adolescent↗
PubMed2005

Does infertility cause marital benefit? An epidemiological study of 2250 women and men in fertility treatment.

OBJECTIVE: To investigate (i) marital benefit, e.g., that infertility has strengthen the marriage and brought the partners closer together among people beginning fertility treatment and (ii) communication and coping strategies as predictors of marital benefit 12 months later. METHODS: A prospective cohort design including 2250 people beginning fertility treatment and a 12-month follow-up. Data were based on self-administered questionnaires measuring marital benefit, communication, and coping strategies. The analyses of predictors were based on the sub-cohort (n=816) who had not achieved a delivery after fertility treatment. RESULTS: 25.9% of women and 21.1% of men reported high marital benefit. Among men medium use of active-confronting coping (e.g., letting feelings out, asking others for advice) and use of meaning-based coping were significant predictors for high marital benefit. Having the infertility as a secret, difficult marital communication, and using active-avoidance coping (e.g., avoid being with pregnant women or children, turning to work to take mind off things) were among men significant predictors for low marital benefit. No significant predictors were identified among women. CONCLUSION: Fertility patients frequently experience marital benefit. PRACTICE IMPLICATIONS: The study provides information about where to intervene with male fertility patients in order to increase their marital benefit after medically unsuccessful treatment.

Adaptation, Psychological↗
PubMed2005

Stigma and safe havens: a medical sociological perspective on African-American female epilepsy patients.

PURPOSE: Very little is known about the attitudes and behaviors of minorities with epilepsy. This pilot study explored access to health care, help-seeking behaviors, and adherence to treatment among African-American females with epilepsy. METHODS: Ethnographic interviews were conducted with 10 African-American female adults. RESULTS: Findings indicate four major obstacles to care: limited financial resources, lack of knowledge about epilepsy among African-Americans, poor patient-provider communication, and lack of social support. Social support impacted individuals seeking surgery, and also affected purchasing medication, adherence to medical treatment, and needed transportation. Lack of knowledge and misinformation about epilepsy in the African-American community and poor communication with physicians contribute to the social stigma felt by these patients. CONCLUSIONS: The behavioral epidemiology of epilepsy among African-Americans is lacking. This disease exacerbates health disparities for this population. These findings point to a need for a safe haven for these individuals.

Adult↗
PubMed2004

Motivational interviewing in health settings: a review.

There is evidence that patient-centred approaches to health care consultations may have better outcomes than traditional advice giving, especially when lifestyle change is involved. Motivational interviewing (MI) is a patient-centred approach that is gathering increased interest in health settings. It provides a way of working with patients who may not seem ready to make the behaviour changes that are considered necessary by the health practitioner. The current paper provides an overview of MI, with particular reference to its application to health problems.

Cognitive Dissonance↗
PubMedDate not supplied

Mind-body and mind-gut connection in inflammatory bowel disease.

A bidirectional pathway between the brain and immune system known as psychoneuroimmunology has been the basis of much research and discussion within this interdisciplinary field over the past 25 years. An overly aggressive immune response in inflammatory bowel disease makes the psychoneuroimmunology framework applicable in establishing evidence-based outcomes. Mind-body and mind-gut connections and behavioral interventions can influence outcomes for patients with inflammatory bowel disease. Professional nurses can help develop behavioral interventions to improve quality of life with symptom management for this patient population. Healthcare providers and patients through partnerships should consider the effects of psychosocial factors in manifestations of health and illness.

Humans↗
PubMed1995

Help seeking in high risk pregnancy: the role of the CNS.

This study was designed to examine the type and amount of help sought from CNSs in a population of women who were experiencing a high risk pregnancy (specifically, gestational diabetes mellitus). The amount of subjective distress (perceived impact) experienced by the women was also explored as a predictor of help seeking behavior. Through the use of logs kept of each contact with subjects, episodes of help seeking were identified and classified. A total of 290 episodes of help seeking were identified in the logs of 10 subjects representing 199 contacts with subjects over 567 days of follow-up. The majority of help seeking episodes were classified as seeking knowledge (45.9%). Significant positive correlation was noted between the perceived impact of gestational diabetes mellitus and help seeking. Strong positive correlations were noted between help sought in the psychological, social, and economic categories and perceived impact. This data provide support for a CNS to care for this high risk population of women. Nurses in advanced practice have the ability to analyze clinical situations as well as to assess and address nonclinical variables that influence health.

Adult↗
PubMed2005

Analysis of integration in nursing science and practice.

PURPOSE: To clarify the definition of integration and to identify universal aspects of the experience of integration related to healing, health, and nursing care. DESIGN: An integrative review concept analysis method was used. Relevant reports were identified by a computer-assisted search using the keyword integration in CINAHL from 1966 to 2004 and by reviewing the reference lists of retrieved reports. The final sample included 56 reports; 36 were empirical and 20 were theoretical. METHODS: Data were extracted from primary sources on the definition of integration, aspects of the process, antecedents, consequences, and facilitators. Data display matrices were used and were iteratively compared to derive a process model of integration related to health. FINDINGS: A wide range of primary sources indicated that integration is an important aspect of healing or recovery from illness. Integration is defined as a complex person-environment interaction whereby new life experiences (i.e., illness) are assimilated into the self and activities of daily living, thereby contributing to overall life balance. CONCLUSIONS: Results of this analysis indicate the importance of the concept of integration to the science and practice of nursing. The process of integration appears to be a significant phase that occurs between a diagnosis of illness and subsequent physical and emotional healing.

Activities of Daily Living↗
PubMed2007

The transtheoretical model and primary care: "The Times They Are A Changin'".

PURPOSE: To identify the transtheoretical model and the five stages of change that assist to bring about behavioral change. A case study is presented to illustrate how the model can be applied by primary care nurse practitioners (NPs) to assist patients toward a healthier lifestyle. DATA SOURCES: Scientific literature, theoretical framework, and case study. CONCLUSIONS: The transtheoretical model has implications in primary care to assist NPs in assessing what stage a patient may be in, offering encouragement to promote a healthier lifestyle change, and reassessing the patient to maintain the desired healthy behavior. IMPLICATIONS FOR PRACTICE: Primary care NPs can use the transtheoretical model to better advance patients into a healthy behavioral change. Documentation of the current stage a patient is in can promote continuity of care among providers, outline specific health promotion initiatives to enhance patient care, and provide documentation during regulatory inspections.

Attitude to Health↗
PubMed2005

Development and validation of the Emotional Intimacy Scale.

Although many measures have been developed to capture elements of social support, only a few include an assessment of emotional intimacy. Emotional intimacy involves a perception of closeness to another that allows sharing of personal feelings, accompanied by expectations of understanding, affirmation, and demonstrations of caring. The 5-item Emotional Intimacy Scale (EIS) was developed to assess the emotional intimacy component in one close relationship. A sample of 90 women with rheumatoid arthritis was used to assess the reliability and validity of the scale. Internal consistency and test-retest reliability for a 6-week period were .88 and .85, respectively. To assess construct validity, significant, positive correlations were obtained between the EIS and measures of social support, self-efficacy, perceived health competence, reappraisal coping behaviors, life satisfaction, and positive affect. Significant negative correlations were obtained between the EIS and perceived stress levels, helplessness, negative pain coping behaviors, pain, and fatigue. In support of criterion-related validity, the EIS predicted outcomes from an intervention program. To further assess criterion-related validity, scores on the EIS and helplessness predicted scores on two indicators of psychological well-being that measured positive affect and life satisfaction. The EIS is a brief measure of emotional intimacy with good psychometric properties.

Adaptation, Psychological↗