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Therapist and client behaviors in the first interview: effects on session impact and treatment duration.

The first-session behaviors of therapists and clients in 38 cases were observationally coded and their relations to client ratings of session impact and treatment duration were examined. Results indicate that few first-session global types of behaviors of participants affect treatment duration. Clients may suspend judgment about continuing in therapy until after they have attended more than one session, regardless of the first interview's impact. Thus, the first interview may be less crucial than traditionally asserted. It also appears that first-session behaviors of therapists and clients that are associated with greater impact may vary as a function of client type, that is, individuals as opposed to couples and families.

Adolescent↗

Help-seeking timeline followback for problem drinkers: preliminary comparison with agency records of treatment contacts.

OBJECTIVE: A pilot study assessed the utility of the Timeline Followback (TLFB) method to collect information on help seeking. METHOD: Using the TLFB method, 34 clients (26 men) who had attended at least one session of an outpatient alcohol treatment program reported on treatment contacts, including any supplemental services (e.g., psychiatric care). TLFB reports of help seeking at that agency were compared with agency records of treatment contacts. RESULTS: Clients reported on their help-seeking behavior for a period of approximately 8 months after they had completed an initial assessment for the outpatient treatment. With regard to the number of outpatient sessions they attended, intraclass correlations and equivalence testing showed that the TLFB data were comparable to the agency records of treatment contacts. Analysis of week-to-week correspondence of the presence or absence of help-seeking episodes showed good agreement between TLFB and the agency records for most participants, although there was substantial variation. Degree of correspondence was not associated with the length of the recall period or individual differences (e.g., drinking pattern). Older participants, however, tended to have lower week-to-week concordance than did younger participants. CONCLUSIONS: These data provide preliminary support for the utility of a help-seeking TLFB instrument to assess addiction- and mental health-related contacts. This instrument may be especially useful in research in which collecting temporal patterns of help seeking is of interest (e.g., in studies examining factors influencing the delay in help seeking after relapse).

Adult↗

Gender differences in factor structure of the Self-Administered Alcoholism Screening Test.

Recent studies have revealed differences between men and women alcoholics in symptoms, consequences, and help-seeking behavior related to alcohol usage. Based on these findings, it was hypothesized that gender differences also would appear on alcohol screening instruments. The Self-Administered Alcoholism Screening Test (Colligan, Davis, & Morse, 1988: SAAST: Swenson & Morse, 1975) of 1,920 men and 1,775 women was subjected to a within-gender, principle-components, factor analysis with a varimax rotation. Gender differences at the component level were revealed. Men endorsed the "help-seeking for alcohol-related problems" component while women endorsed the "help-seeking for emotional problems" component. In addition, men expressed concern about receiving a psychiatric label while women expressed concern about receiving a drinker label. The results suggest that different items need to be used in screening women for alcohol-related problems.

Adult↗

Temporal trend and factors associated with delayed hospital admission of stroke patients.

The effectiveness of stroke treatment depends on the time interval between onset of symptoms and admission to hospital. The purpose of our investigation was to assess, over a 10-year period, the mean delay in admission to hospital in stroke patients to determine factors which might be associated with this delay, to define the putative number of patients available for accrual in clinical trials, and to identify strategies aimed at decreasing the time to admission. We collected data on all stroke patients consecutively admitted to our clinic from 1986 to 1995. The following variables were investigated: age, sex, educational and occupational level, home accommodation, family and personal history of vascular disease or factors known to affect the risk of vascular disease, and type and severity of stroke. The individual and independent contribution of these variables was assessed by univariate and multivariate analysis. The accurate time of stroke onset was established for 760 patients. Of these, 24.7% were admitted within 1 h from the onset of symptoms, 41% within 2 h, 54% within 4 h and 72.5% within 12 h. The mean delay was 21 +/- 2 h (SE) and the median was 3.5 h. Acute onset of neurological deficits, stroke severity and family history of cerebrovascular disease were associated with earlier presentation. According to the current guidelines for thrombolytic therapy, only 16% of the patients could have been included in a clinical trial. This study suggests that despite a relatively short time to hospital admission in most patients and an altered help-seeking behavior over time, many stroke patients did not present early enough to be recruited for clinical trials or to benefit from new treatments. The majority of patients with timely presentation were not eligible for acute treatment, or were subjects with severe stroke for whom caution is advised before initiating thrombolytic therapy. It has been suggested that the patient's indecision to seek medical help is the most important reason for a delayed hospital admission of stroke patients. These results underscore the importance of interventions aimed at reducing the delay in stroke treatment induced by patients who are unaware of the decisive role of the time of treatment induction. The finding that earliest admissions for stroke comprised patients with a previous history of cerebrovascular disease suggests that an education campaign might highlight the importance of an early admission.

Adult↗

Operant rate depressant effects of ethanol in mice selectively bred for differential neurosensitivity to ethanol.

Few studies have investigated genetic differences in the effects of ethanol on operant schedule-controlled behaviors. The use of genetically defined populations in sensitive measures of complex behavior can help determine genetically covarying responses to ethanol as well as environmental contexts important for demonstrating genetic differences. The purpose of the present study was to investigate the rate depressant effects of ethanol on two lines of mice selectively bred for increased, LS/Ibg (LS), and decreased, SS/Ibg (SS), sensitivity to the acute narcotic effects of ethanol. Ethanol dose-dependently decreased high rates of behavior maintained by fixed ratio responding for water in both the LS and SS mice. Interestingly, the LS and SS mice did not differ in the rate depressant effects of ethanol under these conditions despite the sensitivity of this measure to the CNS effects of drugs and the very large differences between these lines in sensitivity to numerous other ethanol-related effects. While the SS mice were slightly less sensitive, and LS mice tended to show a low dose rate increasing effect, none of the differences were significant as ED50 values for rate depression differed by only 2.5 percent. The results of this experiment demonstrate that sensitivity to the effects of ethanol on fixed ratio responding for water is not genetically related to the acute narcotic effects of ethanol. In addition, the findings show that previously reported differences in operant ethanol self-administration between these two lines of mice are not due to differential sensitivity to the direct effects of ethanol on reinforced behavior.

Animals↗

Two-stage, input-specific synaptic maturation in a nucleus essential for vocal production in the zebra finch.

In most songbirds, vocal learning occurs through two experience-dependent phases, culminating in a reduction of behavioral plasticity called song crystallization. At ends of developmentally plastic periods in other systems, synaptic properties change in a fashion appropriate to limit plasticity. Maturation of glutamatergic synapses often involves a reduction in duration of NMDA receptor (NMDAR)-mediated synaptic responses and a coincident reduction in the contribution of NMDARs to synaptic transmission. We hypothesized that similar changes in the zebra finch song system help limit behavioral plasticity during song development. Nucleus robustus archistriatalis (RA) is a key nucleus in the forebrain song motor pathway and receives glutamatergic input from the motor nucleus HVc. RA also receives glutamatergic input, mediated primarily by NMDARs, from the lateral magnocellular nucleus of the anterior neostriatum, which is part of a circuit essential for learning but not song production. We examined whether synaptic maturation occurs in either input to RA by recording synaptic currents in brain slices prepared from zebra finches of different ages. We find the motor input from HVc to RA uses both AMPA receptors (AMPARs) and NMDARs, and synaptic maturation occurs in two phases: an early reduction in duration of NMDAR-mediated synaptic currents in both inputs, and a later reduction in the NMDAR contribution to synaptic responses in the motor pathway. Although NMDAR kinetics change too early to account for crystallization, the reduction of the relative NMDAR contribution to synaptic transmission could contribute to the onset of crystallization. Thus, synaptic maturation events can be temporally distinct and input-specific and may play different roles in behavioral plasticity.

Aging↗

Team building: key to executive success.

The key to executive success is management of the information overload provided by today's high technology era. Team building, through identification of behavioral styles, helps to enhance self-esteem, utilize inherent skills of individuals, and maximize decision making. The style of the team leader who shares leadership promotes communication patterns that lead to participatory management and harmony within institutions.

Administrative Personnel↗

Water wave communication in the genus Bombina (amphibia).

Amphibians were phylogenetically the first vertebrates to leave the aquatic environment and cope with terrestrial conditions including effects of gravity and substrate on movement and communication. Studies of extant primitive amphibians, which have conserved ancestral morphology and behavior, may help us to understand how gravitational adaptation from aquatic to terrestrial environments occurred. The anuran genus Bombina is a candidate for this type of investigation. In particular, a member of this genus, B. orientalis, is known for its low reaction threshold to minor changes of angular acceleration. We hypothesize that a heightened sensitivity to angular and mechanical accelerations evolved with wave communication. Comparisons of such behavior among B. variegata, B. bombina and B. orientalis may shed light on the evolution of reproductive systems based on water wave communication and relevant vestibular sensitivity. This may represent a transition to derived vocalization modes, which is seen in B. bombina to a certain degree.

Animal Communication↗

Perceptions of elder abuse and help-seeking patterns among African-American, Caucasian American, and Korean-American elderly women.

Thirteen scenarios were used to measure and compare the perceptions of elder abuse and help-seeking behaviors of African-American, Caucasian American, and Korean-American elderly women. Significant group differences existed in their perceptions of elder abuse with regard to six scenarios, and the Korean-American women were substantially less likely to perceive a given situation as abusive than the other groups. The three groups also showed significant differences in their intended use of formal and informal sources of help in the case of elder abuse.

Black or African American↗

Disclosing HIV seropositivity to significant others.

OBJECTIVES: To examine gay men's patterns of self-disclosure of HIV seropositivity to friends, lovers, relatives and colleagues; to assess the effects of disclosure; and to identify reasons for not disclosing to particular individuals. DESIGN: Longitudinal questionnaire survey of gay men. METHODS: A total of 163 HIV-positive men participating in the AIDS Behavioral Research Project, a longitudinal study of San Francisco gay men, completed questionnaires about their self-disclosure patterns, health status, and psychological well-being. RESULTS: HIV-positive men were most likely to disclose their status to lovers and closest gay friends. Asymptomatic men were less likely to disclose to relatives and colleagues than symptomatic men. Friends and lovers were rated as responding more helpfully than relatives and colleagues. Men who perceived their significant others as responding more helpfully were less depressed and anxious currently and 1 year later. A variety of reasons were given for not disclosing, including not wanting to worry others, fear of discrimination, fear of disrupting relationships, and emotional self-protection. CONCLUSION: While disclosure can have advantages for both HIV-positive individuals and their significant others, HIV-positive individuals must be assured that the benefits of doing so will outweigh the potential costs.

Adult↗

Pavlovian conditioning of sexual arousal: parametric and background manipulations.

Recent studies have shown that a Pavlovian conditioned stimulus (CS) for unconsummated sexual arousal can increase the rate of copulation in the rat. This report includes five experiments examining the effects of parametric manipulations on the conditioned arousal response. Results show that between six and nine trials are necessary for reliable conditioning, but extinction is somewhat slower than acquisition. The function for the CS-US (unconditioned stimulus) interval is quadratic, with a minimum of several minutes required for effective conditioning. In the first three experiments, it appeared that background cues were conditioned as well as the designated CSs, and this was tested explicitly in the last two studies. In one, the effect of background cues was shown by training and testing in different situations; in the second, background cues were shown to be subject to latent inhibition. These results demonstrate the influence of Pavlovian learning in sexual behavior and help to provide the basis for an animal model of the acquisition of deviant sexual arousal in humans.

Animals↗

Responses of elderly spouse caregivers.

In this paper three categories of variables were identified to predict spouses' reactions to caregiving roles: patient characteristics, the caregiving environment, and characteristics of the caregiver. Measures of these variables were administered to 159 spouse caregivers. Four domains of caregivers' responses were identified: negative emotional reactions, feelings of responsibility for the patient, feelings of abandonment by family, and impact of caregiving on daily schedules. These domains were influenced most by patient negative behaviors, physical health, and age, and by caregiver age, employment, and emotional status. Amount of assistance, affective support, and hours of care also were predictive of spouse responses.

Activities of Daily Living↗

Parallel process in the family medicine system: issues and challenges for resident training.

This article uses the concept of parallel process to examine resident training as one component in a system of interlocking relationships. Parallel process is defined, and its applicability to the dynamic exchange of help-seeking and help-giving behaviors which lies at the core of the health care system is examined. The concept of stages or phases in parallel process development next is explored. A relational model for optimal functioning between resident-patient and attending-resident is proposed, as well as an illustrative examination of one of the more problematic issues which a parallel process analysis can bring to light. Therapeutic interventions to enhance help-giving and help-seeking at different levels of the system are defined and analyzed, and educational implications for resident training are summarized.

Internship and Residency↗

Lay recommendations on how to treat mental disorders.

BACKGROUND: Beliefs about the helpfulness of interventions are influencing the individual help-seeking behavior in case of mental illnesses. It is important to identify these beliefs as professional helpers are asked to consider them in their treatment recommendations. OBJECTIVE: Assessing lay proposals for an appropriate treatment of mental illnesses. METHODS: We conducted a representative opinion survey in Switzerland. Eighteen treatment proposals were presented with respect to a vignette either depicting schizophrenia or depression. Respondents were asked to indicate the proposals considered to be helpful for treatment and those considered to be harmful, respectively. RESULTS: 'Psychologist,' 'general practitioner,' 'fresh air, and 'psychiatrist' were mostly proposed as being helpful. Among several psychiatric treatment approaches 'psychotherapy' was favored, while psychopharmacological treatment and electroconvulsive therapy were only proposed by less than one-fourth of the interviewees. Especially psychotropic drugs were considered to be harmful. Treatment by a psychiatrist was regarded as being more helpful for schizophrenic individuals than for depressive persons. For a person experiencing a life crisis, treatment by a psychiatrist and psychological treatment were viewed as being harmful, and non-medical interventions were preferred. However, for persons thought to be mentally ill, psychiatric and psychopharmacological treatments were recommended. CONCLUSION: Mental health professionals are regarded as being helpful although their treatment methods are seen as being less helpful. A clear distinction is made between lay proposals for depression and schizophrenia. However, the perception of whether a condition is considered to be an illness or a life crisis has significantly more influence on lay treatment proposals than the cited diagnosis in the vignette.

Adolescent↗

The behavioral risk factor surveys: III. Chronic heavy alcohol use in the United States.

Results of adult telephone interview data from aggregated state surveys show significant chronic alcohol use (two or more drinks per day) by 8.7 percent of the U.S. population. Rates are higher in men than in women (13.8 percent versus 4.0 percent, and higher in whites than in blacks (9.1 percent versus 4.5 percent). Women 25-44 years of age have significantly lower rates (2.9 percent) than women 18-24 (5.7 percent) or women 45-64 (4.6 percent). Also, rates are higher in heavy smokers (over one pack per day) than nonsmokers (22.4 percent versus 5.9 percent), among nonusers of seatbelts than users of seatbelts (10.5 percent versus 6.2 percent), and in those who reported driving after having had "too much" to drink than in those who did not (32.3 percent versus 7.5 percent). Overweight women (2.7 percent) and those who eat in response to stress (3.1 percent) have lower rates of chronic heavy alcohol use than those without these risk factors. Alcohol-related morbidity contributes substantially to the loss of productive life. We conclude that examining alcohol consumption in the light of other lifestyle behaviors would help in the design of effective prevention programs based on multiple risk factor interventions.

Adult↗

Urinary incontinence as a worldwide problem.

OBJECTIVES: This paper reviews the literature on the prevalence of urinary incontinence (UI) and demonstrates its impact as a worldwide problem. METHODS: A MEDLINE search was performed to review population-based studies in English. Studies were grouped according to demographic variables and type of incontinence. Risk factors, help-seeking behavior, and quality of life measures were analyzed. RESULTS: The median prevalence of female UI was 27.6% (range: 4.8-58.4%) and prevalence of significant incontinence increased with age. The commonest cause of UI was stress (50%), then mixed (32%) and finally urge (14%). Risk factors included parity, obesity, chronic cough, depression, poor health, lower urinary tract symptoms, previous hysterectomy, and stroke. Although quality of life was affected, most patients did not seek help. CONCLUSION: UI is a prevalent cross-cultural condition. Future studies should rely on universally accepted standardized definitions to produce meaningful evidence-based conclusions, as well as project the costs of this global healthcare problem.

Adolescent↗

Motivations for caregiving in adult intimate relationships: influences on caregiving behavior and relationship functioning.

This study identified and examined the correlates of specific motivations for caregiving in romantic couples (N = 194 couples). At Time 1, couple members completed measures assessing motivations for caregiving, the quality of caregiving that occurs in the relationship, and personal and relationship characteristics that might influence caregiving motivations. Relationship functioning was then assessed 2 to 3 months later. Results revealed that (a) there are a number of distinct motivations for providing and for not providing care to one's partner, (b) the motivations are associated with various personal features of the caregiver and the recipient, (c) the caregiver's perceptions of the relationship influence his or her caregiving motives, (d) different motivations for caregiving predict different patterns of caregiving behavior, and (e) responsive caregiving predicts the recipient's perceptions of healthy relationship functioning both immediately and over time. Implications of identifying the motivations that promote or inhibit the provision of responsive support in intimate relationships are discussed.

Adolescent↗

Attachment and psychosomatic medicine: developmental contributions to stress and disease.

OBJECTIVE: The object of this study was to evaluate the evidence linking attachment insecurity to illness. Attachment theory describes lifelong patterns of response to threat that are learned in the interaction between an infant and his or her primary caregiver. Despite its biopsychosocial domain, attachment theory has only recently been applied to psychosomatic medicine. METHOD: MEDLINE and PsychInfo databases were searched from 1966 to 2000 for English language papers with key words "attachment" and "object relations." Papers and their cited references were reviewed if they were directly related to physical illness, symptoms, or physiology. A hypothetical causal model was developed. RESULTS: Direct and indirect evidence from survey studies supports an association between attachment insecurity and disease. Animal studies and human experiments suggest that attachment contributes to individual differences in physiological stress response. There is also less robust support for insecure attachment leading to symptom reporting and to more frequent health risk behaviors, especially substance use and treatment nonadherence. Evidence supports the prediction from attachment theory that the benefits of social support derive more from attachment relationships than nonattachment relationships. CONCLUSIONS: Although the available data are suggestive rather than conclusive, the data can be organized into a model that describe attachment insecurity leading to disease risk through three mechanisms. These are increased susceptibility to stress, increased use of external regulators of affect, and altered help-seeking behavior. This model warrants further prospective investigation.

Arousal↗