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PubMed2004

Understanding denial in sexual offenders: a review of cognitive and motivational processes to avoid responsibility.

Treatment of sexual offenders is routinely complicated by the presence of denial. This article examines how denial is related to the willingness to take responsibility for offense-related thoughts and actions and how conceptualizations of denial have developed and changed over time. Multiple facets of denial are described in detail, along with an assessment of how different forms of denial undermine acceptance of responsibility throughout treatment. Evidence is presented to show that resistance and denial often hinge on cognitive and motivational processes that are commonly accepted as fundamental treatment targets rather than treatment obstacles. The authors propose that denial may be best understood as the acceptance of explanations that reduce accountability and are reinforced by distorted beliefs and self-deceptive thinking processes. The article concludes with a discussion of the rich clinical information embedded in different expressions of denial and the benefits of treatment strategies designed to assess and work through them.

Cognition Disorders↗
PubMed2005

Under the influence: taking alcohol issues into the college classroom.

Alcohol use and abuse among college students pose an enormous and unique public health problem that is associated with significant harm to students. Colleges nationwide are seeking to address student alcohol use through a variety of programs and policies. An effort at Georgetown University in Washington, D.C., combines a campus-wide dialogue on the subject with the infusion of alcohol issues into the curriculum of an undergraduate course in the School of Nursing and Health Studies. Course evaluations indicate that participants benefited from the curriculum infusion approach. Participants became aware of the health education resources available to students and the campus culture contributing to alcohol. In addition, student participants evaluated their own alcohol use, with significant modifications of alcohol consumption behaviors.

Alcoholism↗
PubMed2006

Policy makers ignoring science and scientists ignoring policy: the medical ethical challenges of heroin treatment.

A decade of research in Switzerland, The Netherlands, Germany, and Spain now constitutes a massive body of work supporting the use of heroin treatment for the most difficult patients addicted to opiates. These trials concur on this method's safety and efficacy and are now serving as a prelude to the institution of heroin treatment in clinical practice throughout Europe. While the different sampling and research protocols for heroin treatment in these studies were important to the academic claims about specific results and conclusions that could be drawn from each study, the overall outcomes were quite clear--and uniformly positive. They all find that the use of prescribed pharmaceutical heroin does exactly what it is intended to do: it reaches a treatment refractory group of addicts by engaging them in a positive healthcare relationship with a physician, it reduces their criminal activity, improves their health status, and increases their social tenure through more stable housing, employment, and contact with family. The Canadian trial (NAOMI), now underway for over a year, but not yet completed, now faces a dilemma about what to do with its patients who have successfully completed 12 months of heroin and must be withdrawn from heroin and transferred to other treatments in accordance with the research protocol approved by Government of Canada, federal granting body and host institutions. The problem is that the principal criterion for acceptance to NAOMI was their history of repeated failure in these very same treatment programs to which they will now be referred. The existence of the results from abroad (some of which were not yet available when NAOMI was designed and initiated) now raises a very important question for Canada: is it ethical to continue to prohibit the medical use of heroin treatment that has already been shown to be feasible and effective in numerous medical studies throughout the world? And while this is being worked out, is it acceptable to require patients who have been successfully treated with heroin in Canada, to be forced to move back to less effective treatments (treatments that failed to be efficacious in the past)? This essay discusses this dilemma and places it in the broader context of ethics, science, and health policy. It makes the case for continuation of the current successful patients in heroin treatment and the institution of heroin treatment to all Canadian patients living with active addictions who qualify.

Journal Article↗
PubMed2006

Shelter-based palliative care for the homeless terminally ill.

BACKGROUND: The homeless have high rates of mortality, but live in environments not conducive to terminal care. Traditional palliative care hospitals may be reluctant to accept such patients, due to behavior or lifestyle concerns. The Ottawa Inner City Health Project (OICHP) is a pilot study to improve health care delivery to homeless adults. This is a retrospective analysis of a cohort of terminally ill homeless individuals and the effectiveness of shelter-based palliative care. As proof of principle, a cost comparison was performed. METHODS: 28 consecutive homeless terminally ill patients were admitted and died at a shelter-based palliative care hospice. Demographics, diagnoses at admission and course were recorded. Burden of illness was assessed by medical and psychiatric diagnoses, addictions, Karnofsky scale and symptom management. An expert panel was convened to identify alternate care locations. Using standard costing scales, direct versus alternate care costs were compared. RESULTS: 28 patients had a mean age 49 years; average length of stay 120 days. DIAGNOSES: liver disease 43%, HIV/AIDS 25%, malignancy 25% and other 8%. Addiction to drugs or alcohol and mental illness in 82% of patients. Karnofsky performance score mean 40 +/- 16.8. Pain management with continuous opiates in 71%. The majority reunited with family. Compared to alternate care locations, the hospice projected 1.39 million dollars savings for the patients described. CONCLUSION: The homeless terminally ill have a heavy burden of disease including physical illness, psychiatric conditions and addictions. Shelter-based palliative care can provide effective end-of-life care to terminally ill homeless individuals at potentially substantial cost savings.

Adult↗
PubMed2004

Seizure-alerting and -response behaviors in dogs living with epileptic children.

There is little evidence for the ability of dogs to anticipate human seizures. Families of epileptic children were surveyed to investigate seizure-related behaviors in dogs. Approximately 40% of families owned a dog, about 40% of these had seizure-specific behavior, and about 40% of these (approximately 15% overall) showed anticipatory ability. Anticipation occurred early and was both sensitive and specific. Quality of life was higher in families with a dog that responded to seizures.

Adolescent↗
PubMed2003

DanceSafe and ecstasy: protection or promotion?

Since dangerous additives to the drug ecstasy can cause potentially lethal hyperthermia, the organization DanceSafe tests ecstasy for such adulterants. This study of over 700 college students examined whether individuals will use or abstain from ecstasy regardless of DanceSafe's presence at raves or whether DanceSafe erodes a powerful deterrent (i.e., the fear of hazardous additives) which may make nonusers more likely to try it. About 1/5 of nonusers said they might be more likely to try ecstasy if DanceSafe were present. In comparison to nonusers who plan to abstain, however, they were also more likely to be cigarette smokers, drink and use marijuana regularly at parties, and have more friends who use ecstasy. Further study of DanceSafe's impact on ecstasy use is warranted.

Adolescent↗
PubMed2006

Gender differences in social representations of aggression: the phenomenological experience of differences in inhibitory control?

Women are more likely than men to experience acts of aggression as expressive (a loss of self-control) than as instrumental (control over others). We propose that this might arise from differences in behavioural restraint. If women have better inhibitory control, aggressive behaviour should occur less frequently yet should be experienced as more emotionally 'out of control' because women can tolerate higher levels of anger before inhibitory control is breached. Participants (N = 606) aged 13-24 completed the Multidimensional Personality Questionnaire (MPQ), the State-Trait Anger Expression Inventory-2 (STAXI-2) and Expagg. A more expressive view of aggression was associated with higher levels of STAXI anger control and higher levels of MPQ constraint. However, it was the harm avoidance component of constraint, rather than control versus impulsivity, that was the stronger predictor. While behavioural inhibition is built on an infrastructure of fear, the latter may be more important in explaining gender differences in social representations of aggression.

Adolescent↗
PubMed2006

The eternal quest for optimal balance between maximizing pleasure and minimizing harm: the compensatory health beliefs model.

Particularly in the health domain, humans thrive to reach an equilibrium between maximizing pleasure and minimizing harm. We propose that a cognitive strategy people employ to reach this equilibrium is the activation of Compensatory Health Beliefs (CHBs). CHBs are beliefs that the negative effects of an unhealthy behaviour can be compensated for, or "neutralized," by engaging in another, healthy behaviour. "I can eat this piece of cake now because I will exercise this evening" is an example of such beliefs. Our theoretical framework aims at explaining why people create CHBs and how they employ CHBs to regulate their health behaviours. The model extends current health behaviour models by explicitly integrating the motivational conflict that emerges from the interplay between affective states (i.e., cravings or desires) and motivation (i.e., health goals). As predicted by the model, previous research has shown that holding CHBs hinder an individual's success at positive health behaviour change, and may explain why many people fail to adhere to behaviour change programs such as dieting or exercising. Moreover, future research using the model and implications for possible interventions are discussed.

Attitude to Health↗
PubMedDate not supplied

When things go wrong: how health care organizations deal with major failures.

Concern about patient safety, caused in part by high-profile major failures in which many patients have been harmed, is rising worldwide. This paper draws on examples of such failures from several countries to analyze how these events are dealt with and to identify lessons and recommendations for policy. Better systems are needed for reporting and investigating failures and for implementing the lessons learned. The culture of secrecy, professional protectionism, defensiveness, and deference to authority is central to such major failures, and preventing future failures depends on cultural as much as structural change in health care systems and organizations.

Developed Countries↗
PubMed2003

Correlates of sexual risk behaviors among HIV-positive men who have sex with men.

This study examines correlates of unprotected sexual risk practices of an ethnically diverse sample of HIV-seropositive men who have sex with men (MSM) from the New York City and San Francisco metropolitan areas. Participants completed a self-report survey that assessed sexual risk behaviors and potential correlates. A total of 367 men reported sex with a casual male partner in the previous 3 months. Participants were divided into three groups based on level of HIV-transmission risk with HIV negative or unknown-status partners: no unprotected anal sex (58.9%), unprotected receptive anal sex only (14.2%), and unprotected insertive anal sex (22.6%). Multivariate logistic regression analyses indicated that men reporting unprotected anal insertive sex perceived less responsibility to protect their partners from HIV. Men reporting no unprotected anal sex also reported less use of nitrate inhalants, lower temptation for unsafe sex, and fewer HIV-negative and unknown-status partners. Men reporting unprotected receptive anal sex were less anxious than the other two groups but also reported greater depression than those not reporting unprotected anal sex and greater loneliness than those reporting unprotected anal insertive sex. Implications for interventions with HIV-positive MSM are presented.

Adolescent↗
PubMed2005

The utility of collateral informant assessment in college alcohol research: results from a longitudinal prevention trial.

OBJECTIVE: Collateral informants have been used to assess independently the validity of college student self-report data. However, it is unclear under what conditions collateral reports might be valid and useful in college research. We present two studies that examine aspects of these issues using data from 1,264 college student participants in a brief intervention prevention trial conducted at a public university. METHOD: The first study describes the characteristics and predictors of agreement on reports of alcohol use and problems from 219 student-collateral informant pairs. The second study investigates potential "pipeline effects"; that is, whether collateral verification resulted in changes in student self-reports on two subsequent survey assessments over 1 year using longitudinal data from 1,264 students. RESULTS: Little support was found for the assumption that nondependent college drinkers underreport drinking behaviors and consequences. Collaterals who reported more occasions of drinking together, higher confidence in the report and a close relationship with the participant provided reports that were more consistent with participant drinking reports. No evidence was found that pipeline effects of collateral verification improve the accuracy of college student self-reports at future assessments. CONCLUSIONS: The results from this study are consistent with much of the published literature showing that using collateral reports to verify the self-reports of college students (and adults) may result in increased, not decreased, misclassification error. These findings suggest that the time and expense required to collect collateral data in the college setting has limited utility and may be better spent on establishing the proper assessment conditions that will foster accurate and honest self-reporting.

Adult↗
PubMed2006

Syringe exchange programs in Brazil: preliminary assessment of 45 programs.

The present study aims to evaluate the current operation of Brazilian syringe exchange programs (SEP). After consulting national and regional networks of people working in projects/programs aiming to reduce drug-related harm, we identified 134 potential participant programs. Unfortunately, only 45 SEPs answered a survey, even after repeated attempts. The survey addressed: coverage, funding, procurement of basic supplies, managerial capacity, and the local political environment. Findings were triangulated with in-depth interviews with key informants. The main findings included: satisfactory adherence to the initiatives and adequate documentation, but deficiencies in terms of coverage and monitoring, and uneven procurement of resources. Program personnel work mostly on a provisional basis, despite the efforts of local coordinators. Most programs are funded by the National STDs/AIDS Program. A comprehensive agenda aiming to improve current operations should include: concerted efforts to improve local and regional databanks, incentives/sanctions toward full accountability of initiatives carried by the programs, and a genuine culture of monitoring and evaluation.

Brazil↗
PubMed2006

A preliminary evaluation of two behavioral skills training procedures for teaching abduction-prevention skills to schoolchildren.

Although child abduction is a low-rate event, it presents a serious threat to the safety of children. The victims of child abduction face the threat of physical and emotional injury, sexual abuse, and death. Previous research has shown that behavioral skills training (BST) is effective in teaching children abduction-prevention skills, although not all children learn the skills. This study compared BST only to BST with an added in situ training component to teach abduction-prevention skills in a small-group format to schoolchildren. Results showed that both programs were effective in teaching abduction-prevention skills. In addition, the scores for the group that received in situ training were significantly higher than scores for the group that received BST alone at the 3-month follow-up assessment.

Child↗
PubMed2005

The role of training in global tobacco control research.

Despite the pandemic nature of the tobacco control problem, little attention has been given to the role of research training in stemming the global tide of tobacco use. Tobacco research plays a critical role in both shaping policy and saving lives, and training new tobacco researchers is an important part of the tobacco control agenda. There are several conceptual training models, all of which emphasize communicative partnerships and multidisciplinary approaches. It also is important to take cultural background and specificity into account when shaping research and training agendas. We present a number of successful training initiatives and address both the strengths and the pitfalls of these endeavors.

Biomedical Research↗
PubMed2005

A longitudinal assessment of the impact of smoke-free worksite policies on tobacco use.

OBJECTIVES: In this cohort study, we assessed the impact of smoke-free work-site policies on smoking cessation behaviors. METHODS: Smokers were tracked as part of the Community Intervention Trial for Smoking Cessation. Telephone surveys were administered to 1967 employed smokers in 1993 and 2001. Data were gathered on personal and demographic characteristics, tobacco use behaviors, and restrictiveness of worksite smoking policies. RESULTS: People who worked in environments that changed to or maintained smoke-free policies between 1993 and 2001 were 1.9 times more likely (odds ratio [OR] = 1.92; 95% confidence interval [CI] = 1.11, 3.32) than people whose worksites did not do so to have stopped smoking by 2001. Continuing smokers decreased their average daily consumption by 2.57 cigarettes. People working in environments that had smoke-free policies in place in both 1993 and 2001 were 2.3 times more likely (OR=2.29; 95% CI=1.08, 4.45) than people not working in such environments to have quit by 2001, and continuing smokers reported a decline in average daily consumption of 3.85 cigarettes. CONCLUSIONS: Smoke-free worksite policies help employees reduce their cigarette consumption and stop smoking.

Adult↗