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PubMed2002

The third person in the room: frequency, role, and influence of companions during primary care medical encounters.

OBJECTIVE: We wanted to characterize patient accompaniment to medical encounters and to explore the rationale and influence of the companion on the primary care medical encounter. STUDY DESIGN: This was a descriptive study. POPULATION: Academic general internal medicine physicians, patients, and patient companions participated. OUTCOMES MEASURED: We measured the frequency of waiting and examination room companions, the reasons for accompaniment, the influence on the encounter, and the overall helpfulness of the companion as assessed by patients and companions. We also determined the physicianamprsquos assessment of the companionamprsquos influence, helpfulness, and behavior during the encounter. RESULTS: Companions were in the examination room for 16% of visits; 93% were family members. The rationales for waiting and examination room companions were to help with transportation, provide emotional support, and provide company. Examination room companions helped communicate concerns to the physician, remember the physicianamprsquos advice, make decisions, and communicate their own concerns to the physician. Patients believed that examination room companions influenced 75% of medical encounters, mainly by improving communication between physician and patient. Physicians agreed that examination room companions favorably influenced physician and patient understanding (60% and 46% of encounters, respectively). Patients indicated that waiting and examination room companions were very helpful for 71% and 83% of visits, respectively. CONCLUSIONS: Companions frequently accompany patients to their primary care medical encounters. They are often family members, and they assume important roles in enhancing patient and physician understanding.

Adolescent↗
PubMed2002

Help-seeking and risk-taking behavior among Black street youth: implications for HIV/AIDS prevention and social policy.

This article explores and analyzes the help-seeking and risk-taking behavior of Black urban street youth in Washington, DC, USA and Cape Town, South Africa. The target population of 100 youths came from the streets of Washington, DC and Cape Town, South Africa. Structured face-to-face interviews and direct observation of informal and formal settings where youths congregated were used to gather data. Major findings indicate that the majority received high levels of support from families and friends. In terms of formal systems, social and mental health services are viewed as much less accessible or useful. Youths were knowledgeable about HIV/AIDS but did not translate this into safer sexual practices. Implications for health and social policy are outlined.

Adolescent↗
PubMed2003

Exercise plus behavioral management in patients with Alzheimer disease: a randomized controlled trial.

CONTEXT: Exercise training for patients with Alzheimer disease combined with teaching caregivers how to manage behavioral problems may help decrease the frailty and behavioral impairment that are often prevalent in patients with Alzheimer disease. OBJECTIVE: To determine whether a home-based exercise program combined with caregiver training in behavioral management techniques would reduce functional dependence and delay institutionalization among patients with Alzheimer disease. DESIGN, SETTING, AND PATIENTS: Randomized controlled trial of 153 community-dwelling patients meeting National Institute of Neurological and Communicative Diseases and Stroke/Alzheimer Disease and Related Disorders Association criteria for Alzheimer disease, conducted between June 1994 and April 1999. INTERVENTIONS: Patient-caregiver dyads were randomly assigned to the combined exercise and caregiver training program, Reducing Disability in Alzheimer Disease (RDAD), or to routine medical care (RMC). The RDAD program was conducted in the patients' home over 3 months. MAIN OUTCOME MEASURES: Physical health and function (36-item Short-Form Health Survey's [SF-36] physical functioning and physical role functioning subscales and Sickness Impact Profile's Mobility subscale), and affective status (Hamilton Depression Rating Scale and Cornell Depression Scale for Depression in Dementia). RESULTS: At 3 months, in comparison with the routine care patients, more patients in the RDAD group exercised at least 60 min/wk (odds ratio [OR], 2.82; 95% confidence interval [CI], 1.25-6.39; P =.01) and had fewer days of restricted activity (OR, 3.10; 95% CI, 1.08-8.95; P<.001). Patients in the RDAD group also had improved scores for physical role functioning compared with worse scores for patients in the RMC group (mean difference, 19.29; 95% CI, 8.75-29.83; P<.001). Patients in the RDAD group had improved Cornell Depression Scale for Depression in Dementia scores while the patients in the RMC group had worse scores (mean difference, -1.03; 95% CI, -0.17 to -1.91; P =.02). At 2 years, the RDAD patients continued to have better physical role functioning scores than the RMC patients (mean difference, 10.89; 95% CI, 3.62-18.16; P =.003) and showed a trend (19% vs 50%) for less institutionalization due to behavioral disturbance. For patients with higher depression scores at baseline, those in the RDAD group improved significantly more at 3 months on the Hamilton Depression Rating Scale (mean difference, 2.21; 95% CI, 0.22-4.20; P =.04) and maintained that improvement at 24 months (mean difference, 2.14; 95% CI, 0.14-4.17; P =.04). CONCLUSION: Exercise training combined with teaching caregivers behavioral management techniques improved physical health and depression in patients with Alzheimer disease.

Activities of Daily Living↗
PubMed2006

Randomized controlled trial of a social support ('buddy') intervention for smoking cessation.

OBJECTIVE: To assess the effectiveness of including a social support intervention ('buddy system') in a group treatment programme to aid smoking cessation. METHODS: Five hundred and sixty-three smokers attended groups at a smokers' clinic. These groups were randomized either to be (a) groups in which smokers were paired with another person to provide mutual support (buddy condition: n=237 in 14 groups) or (b) to receive the same treatment without the buddy component (control: n=326 in 20 groups). Participants were seen weekly for the first 4 weeks after stopping then followed up again after 26 weeks. RESULTS: Smokers in the buddy condition were no more likely than smokers in the control condition to stay abstinent at 1, 4 or 26 weeks. The effect was in the right direction at week one post-quit but after controlling for potential confounders the difference was not significant (odds ratio=1.45 (95% CI; 0.92-2.29), p=0.06). CONCLUSIONS: We were unable to show that a buddy system improved abstinence rates of group treatment programmes. This might be due to the high level of social support already achieved through the groups. PRACTICE IMPLICATIONS: The buddy system is a simple and very low cost addition to a group treatment programme; but the results from this study suggest that the kind of buddy system tested may not add substantially to the success rates. However there may be merits in a more intensive or protracted form of buddying.

Adult↗
PubMedDate not supplied

Fathers parenting chronically ill children: concerns and coping strategies.

The concerns and coping strategies of fathers with chronically ill children and those they perceived as their wives' were identified. In this descriptive study of fathers of chronically ill children seen in three specialty clinics of a pediatric hospital, 48 completed the Hymovich Family Perception Inventory (FPI). Eighty-five percent or more identified seven concerns for themselves and perceived their wives to have seven concerns. Four of the concerns were the same as their own. Four coping strategies were identified as used by more than 85% of the fathers and 3 by their spouses. Two strategies were the same for both groups; all dealt with problem solving and information gathering. Nurses can address fathers' concerns and support them in the use of positive coping strategies, which supports family-centered care.

Adaptation, Psychological↗
PubMedDate not supplied

Psychometric properties of a new measure of fathers' involvement in the management of pediatric chronic diseases.

OBJECTIVE: Despite theoretical and empirical reasons suggesting its potential importance, paternal involvement in the management of pediatric chronic diseases has rarely been a primary focus of research on family adaptation to pediatric disease. This may be due to a lack of appropriate tools to measure relevant behaviors. This study assessed the reliability and validity of the Dads' Active Disease Support scale (DADS), which was designed to measure male and female caregivers' estimates of the amount and helpfulness of paternal involvement in managing six pediatric chronic diseases. METHOD: A sample of 224 heterosexual couples completed the DADS and measures of mother, child, and family functioning, yielding 190 who completed data sets. Of these, 91 mothers and 88 fathers completed the DADS again after a 1-month interval. RESULTS: Results confirmed DADS internal consistency, test-retest reliability, and interparent agreement. Confirmatory factor analysis supported its construct validity: A two-factor model (amount and helpfulness of fathers' involvement) best accounted for participants' responses. Significant correlations with scores on the Family Assessment Device supported DADS convergent validity. DADS scores of mothers and fathers suggest substantial room for improvement in both the amount and the helpfulness of paternal involvement in disease management. Mothers provided significantly higher ratings of the helpfulness of fathers' involvement than did fathers. CONCLUSIONS: The DADS appears to be a reliable and valid measure for studies of the associations between paternal involvement in disease management and child, maternal, and family adaptation to pediatric chronic medical conditions.

Adaptation, Psychological↗
PubMed2000

Facilitating a multidisciplinary parent support & education group guided by Allen's developmental health nursing model.

Parents are generally the primary source of support and nurturing for children experiencing an eating disorder; yet, they often feel blamed for the illness. Guided by the developmental health model, the group focused on parents' competence and helped them share solutions; reframed situations related to development in adolescence and mid-life; and shifted the emphasis to process to help parents understand behaviors. Parents became partners in helping their children recover by sharing solutions and creating learning opportunities from adversity.

Adolescent↗
PubMed1993

Influence of Drug Use on Adolescent Sexual Activity.

Because of the biopsychosocial events associated with adolescence, young people are at increased risk for engaging in risky behaviors that help them to cope with the transition into adulthood. The concept of covariation suggests that adolescents at risk for substance abuse are also at risk for unsafe sexual activity; both behaviors greatly compromise future well-being. The author examines the specific effects of various drugs on sexual behavior.

Journal Article↗
PubMed2004

Larval feeding behavior of three co-occurring species of container mosquitoes.

Interspecific differences in foraging behavior may help to determine whether the outcome of interspecific competition is coexistence or exclusion. Mosquitoes in the genus Culex are commonly described as foraging primarily by filtering the water column. This behavior contrasts with that of other container-dwelling genera, such as Aedes and Ochlerotatus, that are thought to forage primarily by browsing on container and detritus surfaces. We compared the feeding behavior of Cx. pipiens, Ae. albopictus, and Oc. triseriatus in a laboratory experiment in which we monitored behavior of individual mosquitoes in two different food environment treatments: food suspended in the water column only and food attached to leaf surfaces only. For each mosquito in each food environment, we quantified the time allocated by larvae to one of four positions and to one of three activities. The effect of treatment was significant, with individuals in Fluid Only environments spending more time resting-filtering at the surface, and individuals in Leaf Only environments spending more time browsing on walls. There were significant differences among species, with Cx. pipiens spending more time at the surface than the other species, which spent more time thrashing below the surface. There was no significant interaction of species and treatment, indicating that all three species modify their behavior in similar ways in these environments. Contrary to current understanding, our data suggest that Cx. pipiens browse as frequently as do these potential competitors but show a greater concentration of foraging effort at the top of a container.

Aedes↗
PubMed2005

Adolescent health: a rural community's approach.

INTRODUCTION: Significant health problems encountered in adulthood often have their roots in health behaviours initiated during adolescence. In order to reverse this trend, school and health personnel, as well as parents and other community members working with high school students, need to be aware of the health-related beliefs and choices that guide the behaviours of teenagers. Although a wide variety of research has been conducted on this topic among urban adolescents, less is known about the health beliefs and behaviors of adolescents residing in rural areas, particularly in Canada. In general, rural Canadians are less healthy than their urban counterparts. Building on the knowledge and understanding of their own community, key stakeholders were invited to engage in the design and implementation of a participatory action research project aimed at understanding and improving the health of rural adolescents. METHODS: A group of parents, teachers, students, school administrators and public health nurses engaged in a participatory action research project to better understand determinants of the health of rural adolescents at a high school in Western Canada. Group members developed and administered a health survey to 288 students from a small rural high school, in an effort to identify areas of concern and interest regarding health practices and beliefs of rural adolescents, and to take action on these identified concerns. RESULTS: Results indicated some interesting but potentially worrying trends in this population. For example, while frequent involvement in a physical activity was noted by 75.9% of participants, close to half of the females (48%) described their body image as 'a little overweight' or 'definitely overweight', and approximately 25.8% of respondents noted that they skipped meals most of the time. Differences between the genders were apparent in several categories. For example, more girls smoked (16.2%) than boys (12.3%), and more males (55.0%) than females (41%) had tried illegal drugs. Participants indicated awareness of other health-compromising behaviours, including unsafe driving habits and high stress levels, and acknowledged several steps they wanted to take to improve their health, as well as the barriers to taking those steps. Students identified improved nutrition, stress reduction, and increased levels of physical activity as particular important health goals. Students also recommended ways in which information and support could be provided within the school environment to enable them to achieve their health-related goals. Several activities developed in collaboration with students have incorporated the recommendations, and have spawned other activities in response to the ongoing identification of new concerns. CONCLUSIONS: The process of including the rural community in the identification of health assets and needs from the perspective of students -- as well as the planning and implementation of appropriate strategies to address those needs -- demonstrates the strengths inherent within a small rural population. Community members' awareness of the need to create a healthy environment for youth is reflected in their willingness to participate in activities leading to improved health. Greater awareness of the health needs of rural adolescents, and of the influence of gender in some aspects of health behaviors, will help researchers to explore ways in which the unique culture of rural communities can be harnessed to help shape health-focused interventions.

Adolescent↗
PubMed1978

Adaptive behavior and Uzgiris-Hunt Scale performance of young, developmentally disabled children.

The relationship between performance on a Piaget-based infant scale and adaptive behavior was assessed for 25 developmentally disabled infants and preschool children. Results indicated a significant relationship between these measures. Canonical analysis suggested the relevance of the Piagetian abilities of object permanence and foresight and the adaptive behavior skills of self-help and social behavior for this relationship. Discussion centered on research implications emerging from these findings.

Child Development↗
PubMed1990

Behavior of urban based child caretakers in the home treatment of diarrheal diseases.

Behaviors of low income urban mothers and child caretakers in the treatment of childhood less than 5 year diarrhea were analysed from a surveillance study conducted between August 1988 and July 1989. Help seeking behaviors of mothers and caretakers for 412 episodes of child diarrhea were as follows: investigators 37.1%, drug stores 18.2%, wait and see or self treatment 17.0%, private clinics 12.6%, near by hospital 10.2%, and local health center 4.9%. Major treatment practices included ORT alone (54%) and ORT plus antibiotics and/or antidiarrheal drug (22%). Overall ORT usage was 76%. Twelve percent of diarrheal episodes no treatment was given to the children. Antimicrobials were believed to be essential in addition to ORT especially when diarrhea was associated with fever, vomiting and bloody stools. Thirty-six percent of invasive diarrhea cases (Shigella, Salmonella, Campylobacter) were treated with antibiotics. Only 18.2% of noninvasive diarrhea received antibiotics, most of this antibiotic use being in rotavirus diarrhea where vomiting and some fever are prominent. Availability of oral rehydration salts (ORS) and good experience with ORT were the key to the extensive use or ORT in this study. A surprisingly small number of mothers and child caretakers (4.9%) sought help from the local health center when their children had diarrhea.

Anti-Bacterial Agents↗
PubMed1990

Explanatory models of major depression and implications for help-seeking among immigrant Chinese-American women.

This study explores the explanatory models of major depression in a group of 40 recently immigrated Chinese-American women, and demonstrates the significant relationship between problem conceptualization and help-seeking behavior. Respondents are presented a vignette depicting major depression, from which they are asked to conceptualize the problem described and answer questions regarding its cause, impact and potential sources for help-seeking. Those who provide a psychological conceptualization are likely not to suggest professional services, but to turn to themselves and family and friends for assistance. On the other hand, those who hold a physical conceptualization are likely to seek out medical services. Implications for effective mental health service delivery to this population are discussed.

Acculturation↗
PubMed2004

Cooperation between Drosophila flies in searching behavior.

In Drosophila melanogaster food search behaviour, groups of flies swarm around and aggregate on patches of food. We wondered whether flies explore their environment in a cooperative way as interactions between individual flies within a population might influence the flies' ability to locate food sources. We have shown that the food search behavior in the fruit fly Drosophila is a two-step process. Firstly, 'primer' flies search the environment and randomly land on different food patches. Secondly, the remaining group of flies move to the most favorable food source and aggregate there. We call this a 'search-aggregation' cycle. Our data demonstrate that flies do not individually assess all available food resources. Rather, social interactions between flies appear to affect their choice of a specific food patch. A genetic analysis of this 'search-aggregation' behavior shows that flies carrying mutations in specific genes (for example, the dunce (dnc) gene which codes for a phosphodiesterase) were defective in this search-aggregation behavior when compared to normal flies. Future investigations of the neuronal signaling involved in this behavior will help us to understand the complexities of this aspect of Drosophila social behaviour.

Animals↗
PubMed2000

The adoption of eating behaviors conducive to weight loss.

Given the plethora of eating behavior techniques that obese individuals might adopt for weight loss, it is not likely that they could, or would be willing to, adopt all of them. Therefore, the purpose of this study was to identify the specific eating behaviors conducive to weight loss adopted during the behavioral treatment of obesity, and to distinguish those that were deemed beneficial from the ones that were not. Fifty obese (BMI 32+/-4 kg/m(2), mean+/-SD), postmenopausal women (60+/-6 years old) participated in a 6-month behavior modification, dietary, low-intensity walking weight loss program. For analysis, they were divided into two groups: "no weight loss" ( 5 kg, n=32). At pre- and posttreatment women completed the Eating Behavior Inventory (EBI) that measures specific strategies conducive to weight loss. Women who lost weight increased their total eating behavior score by 20% (p<0.001) and improved the adoption of 14 eating behaviors, which was more than twice that of the non-weight losers. Topping the list of most strongly adopted behaviors were carefully watching and recording the type and quantity of food consumed. Maintaining a weight graph and weighing daily also were important to these women. Neither group of women adopted potentially helpful eating behaviors such as leaving food uneaten, refusing food offered by others, or shopping from a list. In studies of obesity treatment, attendance at class sessions is one marker of program adherence. More definitively, implementing the EBI in clinical and research obesity treatment programs will provide its leaders with insight into whether participants adopt, ignore, or fight the essential behaviors that will facilitate success toward their personal weight loss goals.

Journal Article↗
PubMedDate not supplied

Consumer preferences and values as an integral key to evidence-based practice.

Although evidence-based practice (EBP) integrates the best evidence from well-designed studies with a clinician's expertise and patient preferences and values, most of what is emphasized in books and reports on EBP is the 5-step EBP process. However, the consideration of patient values and preferences in making clinical decisions is essential to deliver the highest quality of care. This article briefly reviews the status of EBP in the United States, described the ARCC mentorship model, and highlights how to engage consumers in the EBP process.

Attitude of Health Personnel↗
PubMed1994

Locus coeruleus activity in monkey: phasic and tonic changes are associated with altered vigilance.

Impulse activity of individual neurons in the nucleus locus coeruleus (LC) was recorded from chair-restrained, unanesthetized cynomolgus monkeys. LC activity was closely related to the behavioral state of the animal. In alert waking, LC neurons displayed continuous, moderately irregular activity. In contrast, prolonged pauses in activity accompanied drowsiness. These pauses preceded eye closure and occurred 1-3 s before the onset of slow-wave EEG. At awakening, LC activation preceded by up to 3 s desynchronized EEG and eye opening. LC activity during alertness varied tonically. During behavioral agitation LC activity was higher than during goal-directed task behavior (described below). In addition to these changes in tonic activity, LC neurons were also phasically responsive to certain sensory stimuli. These cells responded selectively to unexpected, meaningful sounds. LC neurons were also recorded during a visual oddball discrimination task in which the monkey was required to selectively release a lever in response to an infrequent visual cue (target cue; CS+) to receive juice reward. LC neurons were selectively activated by CS+ cues in this task; no other task events evoked LC activity. The mean latency of CS+ response was 108 ms (90 ms for multicell recordings), more than 150 ms prior to the behavioral response (lever release). These responses became smaller in later epochs during the session, along with deteriorating task performance. It is proposed that these short-lasting stimulus-evoked LC responses may help optimize behavioral responses and increase vigilance to subsequent sensory stimuli. Together, LC may contribute both to maintaining tonic levels of vigilance and to phasically modulating the current vigilance level in a stimulus-dependent mode.

Animals↗