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PubMed1992

Treatment of depressive and obsessive-compulsive symptoms in OCD by imipramine and behaviour therapy.

The efficacy of behavioural treatment of obsessive-compulsive disorder (OCD) has been well documented. However, severely depressed OCD patients showed fewer short- and long-term benefits than less depressed patients. The present study tested the hypothesis that reduction of depression by imipramine prior to behaviour therapy would enhance the effects of behavioural therapy on depressed OC patients. Thirty-eight patients were divided into highly and mildly depressed groups according to their scores on the Beck Depression Inventory; half of each group received imipramine and half received placebo for six weeks. All patients then received three weeks of daily behavioural treatment (exposure and response prevention) followed by 12 weekly sessions of supportive psychotherapy. Results indicated that although imipramine improved depressive symptoms in depressed patients, it did not affect OC symptoms. Behaviour therapy markedly reduced OC symptoms but, contrary to our hypothesis, imipramine did not potentiate the effects of behaviour therapy. No differences between highly depressed and mildly depressed patients on OC symptoms were found in their responses to behavioural or supportive therapy.

Adult↗
PubMed1995

Community care for people with challenging behaviours and mild learning disability: an evaluation of an assessment and treatment unit.

This paper reports a three-year evaluation of the Mental Impairment Evaluation and Treatment Service (MIETS). MIETS, a hospital-based unit, seeks to prepare clients with a mild learning disability and challenging behaviours for resettlement in the community. The evaluation focuses on the progress of 34 clients from preadmission to six months post-discharge. The majority of clients came from hospitals or prisons, were on medication and were referred for serious challenging behaviours. For a subsample of the clients the Vineland and the Adaptive Behaviour Scale, Part II were used to assess changes in behaviour and a general trend of statistically significant decreases in maladaptive behaviour was observed. In contrast to the comprehensive assessment and treatments, behavioural observations on eight clients show that levels of participation and social engagement are not high. Twenty of the 34 clients were resettled in the community and maintained a community placement for a least six months. Some districts were unable to implement the placement recommendations; had they done so the rate of community placement would have been 80 percent. It is concluded that community care is a viable option for people with challenging behaviour; without the specialist inputs of MIETS few of the clients would have achieved community placements, but questions are raised about the length of admission.

Adolescent↗
PubMed1993

The relationship between students' behaviour at home and attention and achievement in elementary school.

In this study a model is proposed in which attention in the classroom is supposed to mediate the relationship between home background factors and achievement in school. Home background factors in the study were the socioeconomic status of the parents (SES) and the amount of problem behaviour of the child at home. The latter was supposed to be an indicator of the adequacy of parental discipline practices. For attention a distinction is made between a behavioural component termed attentional behaviour, and a cognitive component termed attention regulation. The effects of attention were studied for two domains of achievement, namely reading comprehension and arithmetic. The model was tested by means of structural equations modelling in a sample (N = 376) of 9-year-old children attending grade 6 of regular elementary schools in the Netherlands. The results showed that attention can be considered as an important mediator between home problem behaviour and achievement in school. The absence of problem behaviour at home had a substantial positive relationship with attention, the latter having moderate effects on arithmetic achievement and reading comprehension. No effects of SES on attention were found. Distinguishing between attentional behaviour and attention regulation, it appeared that the latter is equally related to both types of achievement. Interestingly, however, classroom attentional behaviour was more closely related to arithmetic achievement than to reading comprehension. Finally, SES appeared not to be related to arithmetic achievement but exerted a small direct effect on reading comprehension.

Achievement↗
PubMed1998

Secondary school teachers' perception of pupils' undesirable behaviours.

BACKGROUND: Previous studies provide inconclusive evidence with regard to the influence that teacher, pupil and school characteristics have on teachers' attitudes towards problem behaviours. AIMS: To investigate the seriousness of several behaviours as perceived by secondary school teachers, and the extent to which these perceptions are influenced by a number of characteristics. SAMPLE: A sample of 605 randomly selected teachers from 16 state secondary schools participated in the study. METHODS: A questionnaire survey method was employed: RESULTS: Drug abuse, cruelty/bullying and destroying were perceived as the most serious behaviours whereas inquisitiveness and whispering were rated as the least serious. Significant grade level differences were observed in all but two of the 49 behaviours, these being masturbation and obscene notes. While smoking and heterosexual activity were perceived significantly more serious in Form 1-2 than in Form 4-5 pupils, the converse was true for all the remaining forms of behaviour. Irrespective of grade level, a number of significant pupil sex and teacher sex differences were observed. Whereas cheating, lying, masturbation and heterosexual activity were perceived to be significantly more serious in girls than in boys, the converse is true for dreaminess, disorderliness, silliness, quarrelsomeness, and restlessness. While female teachers perceived masturbation and obscene notes significantly more serious than male teachers the opposite is true for disorderliness. School selectivity and teaching experience were important moderators of the perceived seriousness of problem behaviours. CONCLUSIONS: The study provides additional evidence of the importance of certain teacher, pupil and school characteristics as moderators of teachers' perception of the seriousness of behaviour.

Adolescent↗
PubMed1986

Attitudes and normative beliefs as predictors of smoking intentions and behaviours: a test of three models.

This paper considers three potentially important modifications to the theory of reasoned action (Fishbein, 1980). It was hypothesized that behavioural norms, or beliefs about the behaviours of others, are important influences above and beyond subjective norms; the effects of attitudes and normative beliefs on intentions and behaviours are interdependent and interactive rather than additive; and the beliefs underlying subjective and behavioural norms are multidimensional rather than unidimensional. These hypotheses were tested in two surveys of smoking intentions and behaviour. The respondents in the first study were primary school children and those in the second study were college students. In both cases behavioural norms and the attitude-normative belief interactions led to significant increases in the prediction of smoking intentions and behaviour. Exploratory factor analyses also suggested that the beliefs underlying subjective norms may be multidimensional rather than unidimensional. These results thus support the hypotheses and suggest that the theory of reasoned action should be modified accordingly.

Adolescent↗
PubMed1998

Some tests of the distinction between attitude and perceived behavioural control.

Although perceived behavioural control has recently become a popular variable for use in predicting behaviour or intention to behave, it is far from clear that this variable is theoretically distinguishable from attitude. Consequently, we performed some tests of the distinction between attitude and perceived behavioural control. In Expt 1, using participants from an American university, the semantic differential scales that have often been used to measure attitude and perceived behavioural control were submitted to factor analyses. Consistent with the distinction, a two-factor solution resulted in the attitude and perceived behavioural control items clearly loading on different factors. Further, Expt 2 demonstrated that the attitude factor predicts behavioural beliefs and does not predict control beliefs, but the reverse is true concerning the perceived behavioural control factor. Finally, in Expts 3-5, the beliefs presumed to underlie these two variables were cluster analysed. Consistent with the distinction, and paralleling findings obtained by Trafimow & Fishbein (1995), the order in which participants wrote down their beliefs exhibited significant clustering by belief type.

Adult↗
PubMed1998

Can social cognitive models contribute to the effectiveness of HIV-preventive behavioural interventions? A brief review of the literature and a reply to Joffe (1996; 1997) and Fife-Schaw (1997)

A recent debate in the British Journal of Medical Psychology has considered the role of social cognitive models, such as the theory of reasoned action and the theory of planned behaviour, in understanding HIV-preventive behaviour. In this paper we clarify some of the assumptions involved in applications of social cognitive models. We briefly review available evidence on the capacity of such models to predict HIV-preventive sexual behaviour and outline a number of criteria for judging their predictive success. The importance of behavioural prediction for the development of effective HIV-preventive behavioural interventions is discussed and recent evaluations of interventions based on these models are reviewed. We conclude that the models are effective in predicting HIV-preventive behaviours and provide empirically supported theoretical guidance on psychological changes likely to result in HIV-preventive behaviour change. In addition we argue that, to date, evaluations of theoretically specified interventions are encouraging. Further development and rigorous testing of HIV/AIDS interventions based on social cognitive models is recommended.

Cognition↗
PubMed1966

The effects of hypothalamic implants of ovarian steroids on oestrous behaviour in rabbits.

1. The brains of ovariectomized female rabbits which were anoestrous in behaviour when tested with vigorous males were implanted either bilaterally or unilaterally with 10% oestradiol benzoate in cholestrol.2. Rabbits with implants in the ventromedial-premammillary hypothalamus ca. 1 mm lateral to the mid line became highly oestrous in behaviour within 1-2 days of implantation and mated 100% of the times tested. Implants of blank tubing, cholesterol or progesterone in this area, or oestrogen implants elsewhere in the hypothalamus had no effect on sexual behaviour.3. The uteri of all females implanted with diluted oestrogen were atrophic and similar to those of castrate controls, indicating that the effects of hypothalamic implants on sexual behaviour were direct local effects of oestrogen on the C.N.S.4. Rabbits implanted bilaterally with undiluted oestradiol benzoate showed some slight systemic spread of the implanted oestrogen. Oestrous behaviour was evoked within an average of 3.4 days by implantation into a large hypothalamic area, presumably as a result of oestrogen diffusing from the site of implantation to the critical ventromedial-premammillary region.5. Injections of progesterone in dosages known to block oestrous behaviour in intact or oestrogen-primed rabbits, failed to block this behaviour in females implanted with pure oestrogen in the ventromedial-premammillary hypothalamus.6. Implantation of progestins into the ventromedial-premammillary area in overiectomized rabbits did not usually inhibit oestrous behaviour induced by small threshold doses of systemically administered oestrogen. The possibilities that oestrogen and progesterone (1) interact in different areas of the C.N.S. or (2) compete for ;steroid receptors' in the ventromedial-premammillary hypothalamus are discussed.

Journal Article↗
PubMed1995

Illness behaviour in patients with arthritis.

OBJECTIVES: To determine if there are specific patterns of illness behaviour in patients with arthritis, and if abnormal patterns of illness behaviour are associated with withdrawal from trials of anti-inflammatory drugs, and to examine which aspects of illness behaviour are perceived by rheumatologist to be related to the disease process. METHODS: The illness behaviour questionnaire (IBQ) was administered to 211 patients with rheumatoid arthritis (RA) and 107 patients with osteoarthritis (OA) participating in five drug trials of NSAIDs at the beginning of the studies, and was commented upon by 17 clinical rheumatologists. RESULTS: Factor analysis of 211 patients with RA produced a unique factor solution. RA patients were more preoccupied with their illness and its effects and worried more about their health than patients with OA. Patients who withdrew from drug trials showed behaviour patterns similar to those of chronic pain patients, and different from those of patients who completed the studies. When asked to account for a rheumatoid patient's response to the IBQ, rheumatologists focused on physical symptoms and did not recognise some of the psychological issues which patients saw as being relevant. CONCLUSIONS: We have demonstrated differences in illness behaviour between patients with OA and with RA. Patients withdrawing from drug trials of NSAIDs showed differences in illness behaviour compared with those successfully completing the trials. Rheumatologists underestimated the impact of the disease on their RA patients' psychological well being.

Adolescent↗
PubMed1996

Cognitive behaviour therapy for the chronic fatigue syndrome: a randomized controlled trial.

OBJECTIVE: To evaluate the acceptability and efficacy of adding cognitive behaviour therapy to the medical care of patients presenting with the chronic fatigue syndrome. DESIGN: Randomised controlled trial with final assessment at 12 months. SETTING: An infectious diseases outpatient clinic. SUBJECTS: 60 consecutively referred patients meeting consensus criteria for the chronic fatigue syndrome. INTERVENTIONS: Medical care comprised assessment, advice, and follow up in general practice. Patients who received cognitive behaviour therapy were offered 16 individual weekly sessions in addition to their medical care. MAIN OUTCOME MEASURES: The proportions of patients (a) who achieved normal daily functioning (Karnofsky score 80 or more) and (b) who achieved a clinically significant improvement in functioning (change in Karnofsky score 10 points or more) by 12 months after randomisation. RESULTS: Only two eligible patients refused to participate. All randomised patients completed treatment. An intention to treat analysis showed that 73% (22/30) of recipients of cognitive behaviour therapy achieved a satisfactory outcome as compared with 27% (8/30) of patients who were given only medical care (difference 47 percentage points; 95% confidence interval 24 to 69). Similar differences were observed in subsidiary outcome measures. The improvement in disability among patients given cognitive behaviour therapy continued after completion of therapy. Illness beliefs and coping behaviour previously associated with a poor outcome changed more with cognitive behaviour therapy than with medical care alone. CONCLUSION: Adding cognitive behaviour therapy to the medical care of patients with the chronic fatigue syndrome is acceptable to patients and leads to a sustained reduction in functional impairment.

Adaptation, Psychological↗
PubMed1999

Longitudinal study of behaviour disorders in low birthweight infants.

AIM: To compare the prevalence of childhood and adolescent behavioural problems in low birthweight infants with matched controls. METHODS: A cohort study of a geographically defined population of survivors of </=1500 g birthweight born in 1980 and 1981 and age, sex, and school matched controls was undertaken. Children with a clinical disability were excluded. Data from Rutter questionnaires, completed by parents and teachers when the children were aged 8 and again at age 14 years, were assessed. RESULTS: From an initial 40 321 births in 1980-81 there were 399 of birthweight </=1500 g, of whom 219 survived to age 8. After exclusion of the 42 children with clinical disability, 177 cases comprised the sample. Of these, 10 (6%) refused or could not be contacted, leaving 167 cases for each of whom a matched control was obtained. At age 14 years, both parent and teacher questionnaires showed an increased prevalence of behavioural problems in cases compared with controls. The presence of a pervasive behavioural problem, when the responses of parents and teachers were concordant, was present in 9% of cases and 3% of controls. There were 132 pairs where the cases and controls were the same at ages 8 and 14 years and provided longitudinal data. The parental questionnaire showed there was a significant decrease in the prevalence of behavioural problems for cases and controls between the ages of 8 and 14 years. There was almost no longitudinal change in the prevalence of behavioural problems as shown by the teacher questionnaires. CONCLUSION: Although low birthweight infants are at increased risk of behavioural problems, because they comprise only a small proportion of all births, their population attributable risk for behavioural disorder is around 2-3%.

Adolescent↗
PubMed1992

Behavioural and psychosocial sequelae of severe closed head injury and regional cerebral blood flow: a SPECT study.

Thirty six patients (31 male, 5 female) who had suffered severe closed head injury were re-examined at an average of 39.3 (SD 12.8, range 7-66) months after the injury. Behavioural symptoms were measured using the Giessen test. The relatives' reports were used for data analysis to ensure that results were valid. The neurophysical impairment subscale of the Glasgow assessment schedule was completed by two neurologists, and the number connection test was completed by each patient. The adjective mood scale was completed by each relative. All patients were investigated by single photon emission computerised tomography (SPECT). Exploratory factor analysis using the principal components method was carried out separately for SPECT results and psychological measures and correlations were sought between the resulting factors. Factor analysis of the data from the Giessen test identified social isolation, disinhibition, and aggressive behaviour as major components of post-traumatic personality changes; it indicates that these behavioural features are independent of the level of neurological and neuropsychological impairment, which loaded on a single independent factor. Relatives' psychic health seemed to be relatively resistant to physical and cognitive disability and was mainly affected by disinhibitive behaviour. The highest correlation was between frontal flow indices and disinhibitive behaviour (p less than 0.01): the severity of disinhibition increased with lower frontal flow rates. There was a significant but somewhat weaker correlation (p less than 0.05) between flow indices of the left cerebral hemisphere and social isolation. Low flow values of the right brain regions were related to aggressive behaviour (p less than 0.05). Neurological and cognitive impairment correlated negatively with the thalamus; worse neurological and cognitive performance indicate by raised scores on the neurophysical scale and on the number connection test was associated with low thalamic flow values. The results support the importance of lesion location in the production of post traumatic behavioural disorders.

Adolescent↗
PubMed1992

Musculoskeletal symptoms and type A behaviour in blue collar workers.

OBJECTIVE: Type A behaviour pattern, characterised by excessive competitiveness, impatience, hostility and time urgency, has been previously investigated as a risk factor for coronary heart disease. There are few studies concerning musculoskeletal symptoms and type A behaviour. Could there be a higher frequency of musculoskeletal symptoms with a more pronounced type A behaviour? DESIGN: A cross sectional retrospective study. Standardised nordic questionnaires were used for the analysis of musculoskeletal symptoms and the Bortner questionnaire and its subscales (1) speed and (2) hard driving and competitiveness were used to assess type A behaviour. SETTING: Factory based (a manufacturing industry where they make ventilating shafts). SUBJECTS: 58 blue collar workers (51 men and seven women). Mean age was 36.9 years. Mean employment time was seven years. MAIN OUTCOME MEASURE: Blue collar workers with musculoskeletal symptoms had a more pronounced type A behaviour than those without symptoms. RESULTS: For shoulder symptoms during the past 12 months blue collar workers had a more pronounced type A behaviour (p < 0.001). For symptoms during the past seven days the results were significant for the neck (p < 0.01), the shoulder (p < 0.01), and also for lower back pain (p < 0.05). There were no differences in age, psychosocial factors, or psychosomatic symptoms. According to the Bortner subscales, the speed subscale seems to be more important than the hard driving and competitiveness subscales. CONCLUSIONS: Blue collar workers with a more pronounced type A behaviour seem to have a higher incidence of musculoskeletal symptoms.

Adult↗
PubMed2004

Surveillance and modelling of HIV, STI, and risk behaviours in concentrated HIV epidemics.

BACKGROUND: HIV epidemics in most countries are highly concentrated among population subgroups such as female sex workers, injecting drug users, men who have sex with men, mobile populations, and their sexual partners. The perception that they are important only when they cause epidemic expansion to general populations has obscured a critical lack of coverage of preventive interventions in these groups, as well as appropriate methods for monitoring epidemic and behavioural risk trends. The difficulties in accessing such groups have likewise often cast doubt on the representativeness of observed disease and behavioural risk estimates and their validity and reliability, particularly those related to sampling and the measurement of risk behaviours. OBJECTIVES: To review methodological obstacles in conducting surveillance with population subgroups in concentrated HIV epidemics, elaborate on recent advancements that partially overcome these obstacles, and illustrate the importance of modelling integrated HIV, STI, and behavioural surveillance data. METHODS: Review of published HIV, STI, and behavioural surveillance data, research on epidemic dynamics, and case studies from selected countries. CONCLUSIONS: The population subgroups that merit regular and systematic surveillance in concentrated epidemics are best determined through extensive assessment and careful definition. Adherence to recently refined chain referral and time location sampling methods can help to ensure more representative samples. Finally, because of the inherent limitations of cross sectional surveys in understanding associations between complex sexual behaviours and HIV and STI transmission, mathematical models using multiple year data offer opportunities for integrated analysis of behavioural change and HIV/STI trends.

Cross-Sectional Studies↗
PubMed2006

Declines in HIV prevalence can be associated with changing sexual behaviour in Uganda, urban Kenya, Zimbabwe, and urban Haiti.

OBJECTIVE: To determine whether observed changes in HIV prevalence in countries with generalised HIV epidemics are associated with changes in sexual risk behaviour. METHODS: A mathematical model was developed to explore the relation between prevalence recorded at antenatal clinics (ANCs) and the pattern of incidence of infection throughout the population. To create a null model a range of assumptions about sexual behaviour, natural history of infection, and sampling biases in ANC populations were explored to determine which factors maximised declines in prevalence in the absence of behaviour change. Modelled prevalence, where possible based on locally collected behavioural data, was compared with the observed prevalence data in urban Haiti, urban Kenya, urban Cote d'Ivoire, Malawi, Zimbabwe, Rwanda, Uganda, and urban Ethiopia. RESULTS: Recent downturns in prevalence observed in urban Kenya, Zimbabwe, and urban Haiti, like Uganda before them, could only be replicated in the model through reductions in risk associated with changes in behaviour. In contrast, prevalence trends in urban Cote d'Ivoire, Malawi, urban Ethiopia, and Rwanda show no signs of changed sexual behaviour. CONCLUSIONS: Changes in patterns of HIV prevalence in urban Kenya, Zimbabwe, and urban Haiti are quite recent and caution is required because of doubts over the accuracy and representativeness of these estimates. Nonetheless, the observed changes are consistent with behaviour change and not the natural course of the HIV epidemic.

Adolescent↗
PubMed2006

Behavioural data as an adjunct to HIV surveillance data.

BACKGROUND: Second generation surveillance for HIV aims to improve the validity and utility of routine serial HIV prevalence data. It includes the collection of data on sexual behaviour and sexually transmitted disease prevalence. METHODS: This paper reviews the function of sexual behaviour data in HIV surveillance and the methods used to determine which behaviours are monitored and how changes in behaviour can be assessed. RESULTS: Sexual behaviour data provide a poor predictor of the future spread of HIV, but these data can provide corroboration of changes in HIV incidence and assist in attributing changes to particular aspects of risk. Significance tests should be used to assess changes in behaviour, but this requires transparent reporting of methods and sample sizes. CONCLUSIONS: Collection of behavioural data will provide important retrospective information about the HIV epidemic progress and should not be neglected because of the focus on improving HIV sero-surveillance.

Adolescent↗
PubMed2006

HIV prevalence and sexual behaviour changes measured in an antenatal clinic setting in northern Tanzania.

OBJECTIVES: To assess the feasibility of collecting sexual behaviour data during HIV surveillance in antenatal care (ANC) clinics, and to establish whether these data can provide information about the correlates of HIV infection in this population. METHODS: Sexual behaviour surveys were conducted in the context of two HIV sentinel surveillance rounds in 11 ANC clinics in north west Tanzania between 2000 and 2002. Responses of individual women were anonymously linked to their HIV status. Three clinic catchment areas overlapped with a community based longitudinal study, which provided independent estimates of HIV prevalence and sexual behaviour. Changes between rounds and differentials between clinics were assessed and a two level logistic regression model used to identify behavioural and contextual correlates of HIV in 3689 women under 25 years of age. RESULTS: Women attending clinics were willing to participate in the study. The sexual behaviour data obtained were internally consistent and tallied reasonably well with sexual behaviour data collected in the community overlapping the clinic catchment. Clear relations emerged between HIV infection and measures of sexual exposure: OR 1.20 (95% CL 1.12 to 1.28) for each year of premarital exposure and 1.09 (1.04 to 1.16) for each year after first marriage; background prevalence OR 1.15 (1.04 to 1.26) associated with each percentage point increase in background prevalence at the clinic; and certain partnership variables such as partner's age OR 0.58 (0.45 to 0.76) if partner less than 10 years older. CONCLUSION: Conducting sexual behaviour surveys in the context of ANC clinics surveillance is feasible and yields useful data.

Adult↗
PubMed2002

The feasibility of integrated STI prevalence and behaviour surveys in developing countries.

BACKGROUND: In countries where STI/HIV prevalence data and behavioural data are scarce UNAIDS second generation HIV surveillance guidelines recommend measuring STI/HIV prevalence and risk behaviours in vulnerable populations but do not recommend conducting these surveys concurrently because of concerns about participation rates, cost, and provision of services. OBJECTIVES: To assess the feasibility of conducting a national combined STD prevalence and behaviour survey in Mali among vulnerable populations with the intention of institutionalisation. METHODS: From March to June 2000 an integrated STI prevalence and behaviour survey was conducted using cluster sampling among five risk groups in four sites in Mali, west Africa. 2229 individuals in non-traditional settings such as taxi/bus stations, market areas, households, and brothels participated in any one or all components of the study: (1) behavioural questionnaire, (2) urine sample for Neisseria gonorrhoeae (GC)/Chlamydia trachomatis (CT) testing, (3) a fingerstick drop of blood for syphilis, and/or (4) HIV testing. RESULTS: High participation rates of 84%-100% were achieved despite specimen collection and HIV testing. Rates fell only slightly when participants were asked to provide biological samples and participants were more likely to provide urine than blood. Rates among the different groups for HIV and syphilis testing are similar and suggest that refusal was most probably because of a reluctance to give blood rather than because of HIV testing. The cost of the biological component added approximately $30 per participant. Included in the $30 are the costs of training, participant services, laboratory personnel and supplies, STI drugs, and STI testing costs. The total cost of the survey was $154,905. Biomarkers aided in validation of answers to behavioural questions. Consenting individuals received HIV pretest and post-test counselling and referral to a trained health provider for treatment of STI and the provision of services provided the framework for interventions in the groups following the survey. CONCLUSION: This represents an effective methodology for collecting risk behaviour and STI/HIV prevalence information concurrently and should be considered by countries expanding STI/HIV surveillance as part of UNAIDS second generation HIV surveillance.

Automobile Driving↗