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PubMedDate not supplied

Normative beliefs of health behavior professionals regarding the psychosocial and environmental factors that influence health behavior change related to smoking cessation, regular exercise, and weight loss.

PURPOSE: To examine the degree of consensus among health behavior change professionals regarding the personal and environmental factors they believe most strongly influence health behavior decisions related to smoking cessation, regular exercise, and weight loss. DESIGN: A factorial survey design was implemented. This method combines the positive elements from simple sample surveys and factorial experiment designs. A total of 44 independent psychosocial and environmental variables are used to randomly construct vignettes, or short stories, to collect dependent variable data. SUBJECTS: A probability sample of 311 health behavior change professionals was selected from the Society for Public Health Education, Inc., the Society of Behavioral Medicine, and faculty from the 1986 Harvard University Symposium on Health Promotion in the Work Place. MEASURES: Judgment ratings on the probability that the person described in each vignette would initiate the behavior in question. RESULTS: Multivariate analysis indicates that the multidimensional model explained approximately one half of the variance in the judgments across the three health behaviors (smoking cessation, R2 = .52; weight loss, R2 = .49; and regular exercise, R2 = .49). CONCLUSIONS: These data suggest a high degree of consensus among the sample regarding the personal and environmental factors that influence health behavior judgments. Here, the subjects perceive both behavioral intentions and self-efficacy as the most powerful determinants of judgments to initiate weight loss, regular exercise, and smoking cessation.

Attitude of Health Personnel↗
PubMed2002

Biophysical controls of carbon flows in three successional Douglas-fir stands based on eddy-covariance measurements.

We measured net carbon flux (F(CO2)) and net H2O flux (F(H2O)) by the eddy-covariance method at three Douglas-fir (Pseudotsuga menziesii (Mirb.) Franco)-western hemlock (Tsuga heterophylla (Raf.) Sarg.) sites located in the Wind River Valley of southern Washington State, USA. Stands were approximately 20, 40 and 450 years old and measurements were made between June 15 and October 15 of 1998 in the 40- and 450-year-old stands, and of 1999 in the 20- and 450-year-old stands. Our objectives were to determine if there were differences among the stands in: (1) patterns of daytime F(CO2) during summer and early autumn; (2) empirically modeled relationships between local climatic factors (e.g., light, vapor pressure deficit (VPD), soil water content, temperature and net radiation) and daytime F(CO2); and (3) water-use efficiency (WUE). We used the Landsberg equation, a logarithmic power function and linear regression to model relationships between F(CO2) and physical variables. Overall, given the same irradiance, F(CO2) was 1.0-3.9 mol m-2 s-1 higher (P < 0.0001 for both seasons) at the two young stands than at the old-growth stand. During summer and early autumn, F(CO2) averaged 4.2 and 6.1 mol m-2 s-1 at the 20- and 40-year-old stand, respectively. In contrast, the 450-year-old forest averaged 2.2 and 3.2 mol m-2 s-1 in 1998 and 1999, respectively. Increases in VPD were associated with reduced F(CO2) at all three stands, with the greatest apparent constraints occurring at the old-growth stand. Correlations between F(CO2) and all other environmental variables differed among ecosystems, with soil temperature showing a negative correlation and net radiation showing a positive correlation. In the old-growth stand, WUE was significantly greater (P < 0.0001) in the drier summer of 1998 (2.7 mg g-1) than in 1999 (1.0 mg g-1). Although we did not use replicates in our study, the results indicate that there are large differences in F(CO2) among Douglas-fir stands of different ages growing in the same general area, and that variations in age structure and site conditions need to be considered when scaling flux measurements from individual points to the landscape level.

Carbon Dioxide↗
PubMed1981

Methanogenesis in freshwater sediments: inherent variability and effects of environmental contaminants.

Temporal and spatial variability of methanogenesis and the effects of environmental contamination on methanogenesis were examined in freshwater sediments. Temporal and spatial variation was found to be significant in uncontaminated freshwater reservoir sediments. The relative concentration of organic matter and temperature explained approximately 43% of the total variability. Known environmental contaminants marginally inhibited methanogenesis and only a coal conversion effluent and phenanthrene, 100 mg L-1, demonstrated statistically significant inhibition of methanogenesis under acute dosing conditions. Methyl viologen, a potent inhibitor of pure culture methanogenesis, inhibited sediment methanogenesis at high concentrations, i.e., 2570 mg L-1, indicating that the sediment environment protected the methanogenic population from the toxic effects of the environmental contaminants.

Anaerobiosis↗
PubMed1996

The inheritance of factors associated with joint mobility.

From a sample of 1,500 individuals belonging to 442 migrant nuclear families from northeastern Brazil, information on the interphalangial mobility was obtained: (a) the grades of extension of both the right and left thumbs and (b) the angle (in degrees) formed by the distant and proximal phalanx of the thumb. The first principal component of these variables was estimated and called "extensibility." A negative association of extensibility and age, as well as with inbreeding, was detected. Complex segregation analysis was applied to extensibility and both a multigenic mechanism and an extra transmissible component were detected. Mendelian inheritance was rejected, while a model with multifactorial inheritance, together with a factor that is inherited with a transmission probability different from 1/2 (tau = 0.63), was not rejected. These findings were supported by path analysis, which showed an important biologic inheritance (h2 = 0.675) and the existence of a small but significant cultural component (c2 = 0.003). The observed "inbreeding" effect, therefore, could not be attributed to a genetic mechanism and probably is the effect of concomitant environmental variability.

Brazil↗
PubMed1994

Determinants of stunting and recovery from stunting in northwest Uganda.

BACKGROUND: Socioeconomic deprivation is associated with unhealthy living conditions and insufficient nutrient intake which affect linear growth. This study investigates the major risk factors which influence stunting in Northwest Uganda, the age range at which growth failure is more likely to occur, and the age at which chances of recovery are higher. METHODS: In February-March 1987, 1072 children < 5 years, were selected from 30 villages in Arua district (Northwest Uganda) and included in a longitudinal study. The children were measured for length and height; household socioeconomic and environmental variables were collected in order to assess risk factors for the future development of stunting. Two years after baseline, the height of the children was measured again. RESULTS: Children who were < 29 months old at baseline were at higher risk for linear growth faltering in the following 2 years; income, mother's education and presence of stunting at baseline were significant predictors of stunting. However, being stunted at age < 6 months or between 54 and 59 months old carried the same risk of remaining stunted after 2 years, and the probability of recovering from stunting was the same in every age group. CONCLUSIONS: These results suggest that, in this population, linear growth is influenced by environmental factors. It is a dynamic process continuing beyond the first 2-3 years of life, and the probability of catching up is very similar across all age groups < 5 years old. Recovery from stunting is more associated with mother's education than with income.

Age Factors↗
PubMed2026

Metagenomics Reveals Microbial Community Shifts Associated With Contrasting Anthropogenic Impacts in Freshwater Sources of A Coastal Protected Area in Southeastern Brazil.

This study aimed to characterize freshwater microbial communities, environmental drivers, and anthropogenic impact patterns across three sites on Marambaia Island (southeastern Brazil) using metagenomics. Samples collected from freshwater sources used for human consumption were processed through concentration, nucleic acid extraction, and sequencing on the Illumina NextSeq 2000 platform. A total of 67.2 million reads were assembled into 89,230 bacterial contigs, mostly attributed to Gammaproteobacteria, Alphaproteobacteria, and Betaproteobacteria. Sites under lower anthropogenic influence exhibited higher microbial diversity, whereas impacted sites showed enrichment of opportunistic and fecal-associated genera. A heterogeneous anthropogenic impact profile was observed across sites, corroborated by the proposed Anthropogenic Impact Index (AII). Fourteen antimicrobial resistance genes conferring resistance to beta-lactams, quinolones, sulfonamides, tetracyclines, and macrolides were detected predominantly in sewage-impacted areas, indicating potential diffuse contamination. Redundancy analysis revealed that environmental variables explained 88.1% of microbial community variation, with conductivity, salinity, and turbidity as key drivers. These findings demonstrate the applicability of metagenomics as a powerful tool for assessing microbial diversity, ecological dynamics, and contamination risks in vulnerable freshwater systems.

Brazil↗
PubMed1996

Serotonin transporters in the rat frontal cortex: lack of circadian rhythmicity but down-regulation by food restriction.

Molecular biological findings have indicated that the affinity and the density of presynaptic serotonin transporters may be subject to adaptive regulation, but the physiological conditions that may act to trigger such changes are presently unknown. By means of [3H]paroxetine binding to rat cortical membranes, we studied the influence of two physiological variables that are clearly associated with altered serotonergic activity--circadian rhythm and semistarvation--on K(D)and Bmax values of the serotonin transporter of the rat frontal cortex. No circadian fluctuations of both parameters were observed. Also, semistarvation (50% reduction of normal voluntary food intake) for 2 days had no effect on either K(D) or Bmax values of cortical [3H]paroxetine binding. Food restriction for either 7 days or 2 weeks, however, resulted in a significant, approximately 30%, reduction of the density of cortical serotonin transporters with unchanged transporter affinity. These findings indicate that long-term changes in the density of cortical serotonin transporters can be induced by long-lasting alterations of certain environmental variables. Because the duration and the radius of action of presynaptically released serotonin are governed by the efficiency of the reuptake mechanism, such adaptive changes of serotonin transporter density must be expected to cause long-term alterations of the modulatory impact of the central serotonin system on certain brain functions.

Animals↗
PubMed1978

Ecology and health.

Health is commonly conceived as having fixed and universal aims, while conditions interposed by environmental and cultural conditions are often ignored or at least shunted to one side. Rejecting this point of view, the author asserts that health in any society should be defined in terms of ecological reality--that is, in terms of the cultural and environmental variables affecting the population. He also notes that acceptance of this concept does not imply perpetuation of a natural but static situation. Rather, it implies searching for ways to improve the situation without necessarily striving for international goals that may be unsuitable or impossible to achieve. The concept also implies that we should ask how to define a satisfactory health level for a given set of conditions--and then consider how to achieve that level. The search for answers to these questions and subsequent programs based on the results will require a multidisciplinary approach. Within this context two PAHO facilities, the Pan American Center for Human Ecology and Health (ECO) and the Pan American Center and Engineering and Environmental Sciences (CEPIS), can provide strong support for activities in the Americas. Specifically, ECO is in a good position to collaborate on ecological planning, model-building, and research evaluation, while CEPIS is geared to provide advice and assistance in the key field of environmental sanitation.

Cultural Characteristics↗
PubMed2004

Effects of plant diversity, community composition and environmental parameters on productivity in montane European grasslands.

In the past years, a number of studies have used experimental plant communities to test if biodiversity influences ecosystem functioning such as productivity. It has been argued, however, that the results achieved in experimental studies may have little predictive value for species loss in natural ecosystems. Studies in natural ecosystems have been equivocal, mainly because in natural ecosystems differences in diversity are often confounded with differences in land use history or abiotic parameters. In this study, we investigated the effect of plant diversity on ecosystem functioning in semi-natural grasslands. In an area of 10x20 km, we selected 78 sites and tested the effects of various measures of diversity and plant community composition on productivity. We separated the effects of plant diversity on ecosystem functioning from potentially confounding effects of community composition, management or environmental parameters, using multivariate statistical analyses. In the investigated grasslands, simple measures of biodiversity were insignificant predictors of productivity. However, plant community composition explained productivity very well (R2=0.31) and was a better predictor than environmental variables (soil and site characteristics) or management regime. Thus, complex measures such as community composition and structure are important drivers for ecosystem functions in semi-natural grasslands. Furthermore, our data show that it is difficult to extrapolate results from experimental studies to semi-natural ecosystems, although there is a need to investigate natural ecosystems to fully understand the relationship of biodiversity and ecosystem functioning.

Biodiversity↗
PubMed2006

Effectiveness of environmental cluster analysis in representing regional species diversity.

A major challenge of regional conservation planning is the identification of sets of sites that together represent the overall biodiversity of the relevant region. Environmental cluster analysis (ECA) has been proposed as a potential tool for efficient selection of conservation sites, but the consequences of methodological decisions involved in its application have not been tested so far. We evaluated the performance of ECA with respect to two such decisions: the choice of the clustering algorithm (single linkage, complete linkage, unweighted arithmetic average, unweighted centroid, Ward's minimum variance, and the ALOC algorithm) and the weight given to different groups of environmental variables (rainfall, temperature, and lithology). Specifically we tested how these decisions affect the spatial configuration of clusters of sites defined by the ECA, whether and how they affect the effectiveness of the ECA (i.e., its ability to represent regional species diversity), and whether the effectiveness of alternative methods of hierarchical clustering can be predicted a priori based on the cophenetic correlation. We used an extensive database of the flora of Israel to test these questions. Differences in both the clustering algorithm and the weighting regime had considerable effects on the spatial configuration of the ECA clusters. The single-linkage algorithm produced mostly single-cell clusters plus a single large-sized cluster and was therefore found inappropriate for environmental regionalization. The effectiveness of the ECA was also sensitive to changes in the clustering algorithm and the weighting regime. Yet, most combinations of clustering algorithms and weighting regimes performed significantly better in capturing regional biodiversity than random null models. The main deviation was classifications based on Ward's minimum variance algorithm, which performed less well relative to all other algorithms. The two algorithms that showed the highest effectiveness (unweighted average and unweighted centroid clustering) also exhibited the highest values of the cophenetic correlation, suggesting that this index may serve as a potential indicator for the effectiveness of alternative ECA algorithms.

Algorithms↗
PubMed2026

A marine-derived fungal genome of Annulohypoxylon annulatoides reveals AT-rich isochores with putative regulatory functions.

Marine and coastal fungi experience intense environmental variability, yet the genomic features associated with tolerance to such conditions remain unclear. From 56 fungal isolates collected along the Lailai rocky shore in northern Taiwan, we selected the coastal isolate Annulohypoxylon annulatoides RYS0019 for phenotypic and genomic investigation because of its prevalence and distinctive stress-response profile. Compared with 5 bark-derived conspecific strains, RYS0019 showed distinct growth and recovery dynamics under salinity, temperature, and UV-associated stress treatments. We generated a high-quality 41.8 Mb de novo genome assembly with 11,523 predicted proteins and compared it with 15 other Hypoxylaceae genomes. Across Annulohypoxylon genomes, we identified variably sized and dispersed AT-rich isochores that are repeat-enriched and gene-poor. Despite variation in AT content, core gene content and Pfam domain profiles remained broadly conserved. Most AT-rich isochores were embedded within syntenically conserved regions and showed limited positional conservation across species, supporting recurrent, lineage-specific formation or expansion after species divergence. These regions also exhibit several sequence and structural features consistent with scaffold/matrix attachment regions, raising the possibility that they influence higher-order genome organization or context-dependent regulation. Together, our findings identify repeat-rich genome architecture as a dynamic feature of Annulohypoxylon genome evolution and provide a framework for testing how such regions may contribute to fungal environmental flexibility.

Genome, Fungal↗
PubMed2005

PET imaging of dopamine D2 receptors in monkey models of cocaine abuse: genetic predisposition versus environmental modulation.

OBJECTIVE: Animals self-administer many of the drugs that humans abuse, including cocaine. This article describes studies using preclinical animal models to differentiate the influences of neurobiological predisposition from environmental modulation of cocaine addiction, including studies from the authors' laboratory using nonhuman primates. METHOD: Addiction is described in terms of vulnerability, maintenance, and abstinence. This review focuses on dopamine receptor function, in particular that of the D2-like receptors, as measured by the noninvasive imaging procedure positron emission tomography. Findings from human studies of addiction and animal models are reviewed. RESULTS: There appears to be an inverse relationship between D2 receptor availability and vulnerability to the reinforcing effects of cocaine. Environmental variables can increase or decrease D2 receptor binding in an orderly fashion, and the resulting changes in D2 function influence the vulnerability to abuse cocaine. In maintenance, chronic cocaine exposure produces decreases in D2 receptor binding, which may be a mechanism that contributes to continued drug use. Finally, during abstinence there are individual differences in rates of recovery of D2 receptor availability. CONCLUSIONS: The goal of the preclinical research described in this review is to achieve a better understanding of individual differences in susceptibility and vulnerability to the reinforcing effects of cocaine. It is clear that the development of novel animal models will extend our understanding of the neurobiological basis of drug addiction to include a greater appreciation of the role of environmental factors in affecting predisposition, mediating continued drug use, and triggering relapse.

Animals↗
PubMed1998

Peanut hulls as a litter source for broiler breeder replacement pullets.

Broiler breeder pullets were reared on either peanut hulls or pine shavings to determine effects of litter type on growth performance and litter characteristics. Pullets were reared to 20 wk of age in rooms initially bedded with 8 cm of clean shavings or hulls. Heating and ventilation were standardized in all rooms. Restricted skip-a-day feeding was used to attain recommended growth curves. Water was continuously provided for ad libitum consumption. Litter and environmental variables were measured throughout rearing and 2 wk after pullets were removed from the litter materials. Feed consumption, BW, mortality, and uniformity at 20 wk were not affected by litter type; however, gizzard weights were decreased in pullets reared on hulls. Litter bulk density increased with use and was greater for shavings through 11 wk, but not thereafter. Particle size decreased with use in both litter types. Through 11 wk, there were more particles in the > 4 mm range and less in the < 1.7 mm range with hulls. Litter moisture increased with use but was not affected by litter type. Litter pH was greater in unused shavings, but during and after use was generally greater in hulls. With both litter types, litter and environmental ammonia levels increased to 11 wk then decreased; however, this effect was more pronounced for hulls. Bacteria populations were not affected by litter type; however, greater fungal populations were observed in shavings at 7 and 15 wk. Aflatoxins were detected in unused hulls but not shavings. Because aflatoxin levels decreased during use and Aspergillus flavus and Aspergillus parasiticus populations were not detected in samples collected during use, aflatoxins observed were presumed to have been formed prior to use. Peanut hulls performed similarly to pine shavings as a litter source for breeder pullets; however, the specific influence of the aflatoxins contained in this litter source on bird performance deserves further study.

Aflatoxins↗
PubMed2026

Multi-omics reveal microbial functional traits and antifungal metabolites associated with lower Pseudogymnoascus destructans loads in bat cave soils.

White-nose syndrome, caused by Pseudogymnoascus destructans (Pd), is a major fungal disease threatening hibernating bats. Cave soils can serve as environmental reservoirs for Pd, yet the microbial and biochemical mechanisms underlying naturally low Pd burdens in some cave environments remain poorly understood. Here, we integrated soil microbiome profiling, metagenomics, metabolomics, multi-omics network analysis, and in vitro validation to investigate the ecological and functional basis of differential Pd loads in hibernating bat caves in Northeast China. The three caves shared cold, humid, and weakly acidic microenvironments, but differed significantly in electrical conductivity, soil water content, nutrient availability, and extracellular enzyme activities. Soil microbial communities showed significant inter-cave variation in composition, diversity, and niche breadth, with stochastic processes contributing substantially to community assembly. Environmental variables, particularly pH and Pd load, were important predictors of microbial community structure. Functional analyses revealed that the low-Pd Gezi Cave was enriched in genes associated with organic carbon degradation, nitrogen input and retention, and secondary metabolism. Metabolomic profiling further identified cave-specific metabolite signatures, among which Biochanin A, 4-Hydroxybenzaldehyde, Vanillin, and Arachidonic acid were negatively correlated with Pd loads. Integrated pathway and network analyses showed that differential genes and metabolites jointly mapped to secondary metabolite biosynthesis, aminobenzoate degradation, and flavonoid degradation pathways, forming a microbe-metabolite-functional gene coupling network involving key taxa such as Rhodococcus, Pseudorhodoplanes, and Rhodoplanes. In vitro assays confirmed that 4-Hydroxybenzaldehyde, Coumarin, and Vanillin inhibited Pd growth. Structural equation modelling further indicated that environmental heterogeneity was associated with variation in Pd loads through microbial functional attributes and metabolite profiles. These findings suggest that naturally low-Pd cave soils are associated with coordinated environmental filtering, microbial functional specialization, and antifungal metabolite production, providing mechanistic insight into microbial and biochemical constraints on Pd persistence in cave reservoirs.

Animals↗
PubMed1991

Computer simulation of Boophilus cattle tick (Acari: Ixodidae) population dynamics.

A comprehensive computer model was developed for simulation of the population dynamics of the cattle ticks, Boophilus microplus (Canestrini) and B. annulatus (Say). The model is deterministic and based on a dynamic life table with weekly time steps. The model simulates the effects of major environmental variables, such as ambient temperature, saturation deficit, precipitation, type of pasture, type of cattle, and cattle density on Boophilus cattle tick population dynamics. General validity of the model is established by comparing simulated and observed yearly densities of standard female ticks/host/day. B. microplus population comparisons were made for a series of years using weekly weather data from two locations in Queensland, Australia. The model also produced acceptable values for initial population growth rate, generation time, and 3-yr population density when historical weather at 7 locations in Australia and 23 locations in the Americas were used. This model provides a framework for the study of Babesia transmission by Boophilus ticks, and can be used to study the effects of control technologies and to develop more efficient and environmentally acceptable eradication strategies for Boophilus ticks.

Animals↗
PubMed2001

Effects of fish farm loadings on seagrass (Posidonia oceanica) distribution, growth and photosynthesis.

The spatial extent and timing of the impact of fish farms on the distribution and performance of a Posidonia oceanica meadow were examined in an embayment of the south-eastern coast of Spain (Hornillo Bay, Murcia). Changes in seagrass distribution were determined using available seagrass mapping (from 1988, i.e., before the onset of aquaculture activities and 1998) and by successive sampling in 1994 and 1998. Environmental variables (light attenuation coefficient, water-column dissolved nutrients and organic content of sediments) together with plant performance (shoot biomass, leaf growth rate, photosynthetic activity, carbohydrate reserves, the number of leaves per shoot, epiphyte loads and herbivore pressure) were measured in plants affected by organic discharges, and were compared with those found in reference healthy plants over an annual growth cycle. Since the onset of fish farm activity, 11.29 ha of P. oceanica meadow has been completely lost and 9.86 ha significantly degraded, thus resulting in a total affected area which accounts for about 53% of the former meadow, or 7-fold the fish farming area. Unequal propagation of seagrass die-off or degradation reflects the relevance of local factors such as depth and hydrodynamism on the true extent of fish farm impact. Water transparency decreases and dissolved nutrient and organic content of sediments increases in the vicinity of cages compared to distant reference stations, thus supporting the notion of environmental gradients caused by the organic release from cages, which spreads outwards. Shoot size, leaf growth rate and the number of leaves per shoot in plants close to the fish farm decreased. Moreover, low leaf growth and low rhizome carbohydrate concentration (always relative to that found in an undisturbed area) indicated carbon budget imbalances. Since light reduction in the affected area was only modest (31% of light reaching the sea surface, while at the same depth this figure was 39% at the reference site), and light availability was well above the minimum requirement estimated for this species, neither this factor nor epiphyte overgrowth (epiphyte load was lower in the affected area) seem to explain such carbon imbalances or the observed meadow regression. Alternatively, the high herbivore pressure found in the affected zone suggests that overgrazing is one of the main causes of decreasing shoot sizes and hence of carbon imbalance, reduced growth and shoot mortality. The impact of fish farms on seagrasses, therefore, seems to be highly variable and depends on complex interactions between a large number of processes.

Animals↗
PubMed2000

The potential of geographical information systems and remote sensing in the epidemiology and control of human helminth infections.

Geographic information systems (GIS) and remote sensing (RS) technologies are being used increasingly to study the spatial and temporal patterns of infectious diseases. For helminth infections, however, such applications have only recently begun despite the recognition that infection distribution patterns in endemic areas may have profound effects on parasite population dynamics and therefore the design and implementation of successful control programmes. Here, we review the early applications of these technologies to the major human helminths (geohelminths, schistosomes and the major lymphatic filarial worms), which demonstrate the potential of these tools to serve as: (1) an effective data capture, mapping and analysis tool for the development of helminth atlases; (2) an environment for modeling the spatial distribution of infection in relation to RS and environmental variables, hence furthering the understanding of the impact of density-independent factors in underlying observed parasite spatial distributions and their effective prediction; and (3) a focal tool in parasite control programming given their abilities to (i) better define endemic areas, (ii) provide more precise estimates of populations-at-risk, (iii) map their distribution in relation to health facilities and (iv) by facilitating the stratification of areas by infection risk probabilities, to aid in the design of optimal drug or health measure delivery systems. These applications suggest a successful role for GIS/RS applications in investigating the spatial epidemiology of the major human helminths. It is evident that further work addressing a range of critical issues include problems of data quality, the need for a better understanding of the population biological impact of environmental factors on critical stages of the parasite life-cycle, the impacts and consequences of spatial scale on these relationships, and the development and use of appropriate spatially-explicit statistical and modeling techniques in data analysis, is required if the true potential of this tool to helminthology is to be fully realized.

Animals↗
PubMed1998

Predicting resident confidence to lead family meetings.

BACKGROUND AND OBJECTIVES: Family physicians frequently encounter patients' family members in family meetings regarding health care. Although residents are expected to learn how to interview families, no quantitative studies have examined variables associated with building residents' confidence in their ability to lead family meetings. The current study sought to clarify the relationship between a number of training, participant, and situational components and resident confidence. METHODS: All family practice residents (n = 90) in a five-residency program system were sent a survey that examined their experience in and perceived competence to conduct family meetings. Responses were analyzed with a hierarchical regression analysis and an ex post facto univariate analysis. RESULTS: Residents with higher perceived confidence in their ability to run a family meeting were male, had specific training for leading family meetings, had participated in and initiated more family meetings, perceived stronger family physician faculty support, and had more family systems training than lower-confidence residents. CONCLUSIONS: The results highlight the experiential, curricular, and environmental variables that are associated with building resident confidence to lead family meetings. Residents may benefit from early exposure to the skills needed for family meetings and from reinforcement of these skills through observations of skilled practitioners, the expectation that they will initiate meetings, and the opportunity to debrief meetings with supportive faculty. Family meeting curricula should include conflict management skills and incorporate input from other specialists and hospital personnel who meet with families.

Data Collection↗