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Assessing the loneliness of workers with mental retardation.

This study was designed to determine whether a reliable instrument could be developed to measure the loneliness experienced by workers with mental retardation. In addition, supervisors were asked to rate subjects on loneliness and four other behavioral subtypes in order to determine whether there was a relation between these ratings and the loneliness questionnaire. Three groups of subjects were assessed: persons with mild, moderate, and severe mental retardation. Results indicated that the Worker Loneliness Questionnaire was a reliable instrument for use with persons with mild and moderate mental retardation. In addition, the results showed that some individuals were lonely; however, this was not a pervasive feeling. The implications for measuring the self-perceptions of individuals with mental retardation were discussed.

Adult↗

Improving smoking cessation counseling by family practice residents.

BACKGROUND: While programs to train residents in smoking cessation counseling skills have been devised, few have assessed trainee behavioral changes in practice settings where residents were blind to the evaluation of their behavior. This study assessed the effectiveness of a training program in smoking cessation counseling and chart-prompting system in increasing the frequency and quality of counseling by residents at three clinic sites. METHODS: Twenty-eight residents participated in a training program that included epidemiology, discussion of attitudes, counseling techniques, videotaped examples, and small group role play. The chart-prompting system was implemented at two clinics 1 month after training. Patient exit interviews, during which information on resident counseling on smoking cessation was obtained, were conducted before training, after training, at 3-month follow-up, and at 6-month follow-up. Questionnaires assessing knowledge, attitudes, and self-perceived counseling behaviors were completed by residents at pretraining, posttraining, and 6-month follow-up periods. RESULTS: Interviews with 517 smokers were analyzed. Results showed an increase in counseling at 3-month follow-up but a regression toward baseline at 6 months. Counseling improved at clinics where chart prompting was initiated. The number of counseling behaviors decreased when the number of patients seen increased. Whether a patient received counseling was positively associated with prior contact with the physician. There was no correlation between resident self-perception and patient report. CONCLUSIONS: A training program in smoking cessation counseling and a chart-prompting system did not result in a lasting change in resident behavior. System factors may play an important role in long-term behavior change.

Clinical Competence↗

Dentofacial appearance: a comparison of patient self-assessment techniques.

Self-perceptions of facial appearance are important in patients' willingness to seek treatment. Unfortunately, patients usually only perceive defects of the mandible, making counseling regarding other facial deformities difficult for the orthodontist and oral surgeon. Self-drawings of profile form may be used by orthodontists to determine patients' understanding of their facial defects and to help educate patients about their defects and the need for surgical or other correction. This study of 35 patients seeking orthognathic surgery revealed that patients' self-ratings of their vertical, mandibular, maxillary, and dentoalveolar defects are correlated with some cephalometric measures, as are their self-drawings of the vertical and mandibular dimensions. Therefore, it appears that the two self-assessment techniques may be used simultaneously to illustrate defects on different dimensions. Overall body image and facial image were not associated with cephalometric measures, suggesting that patients' general feelings about their facial appearance are unrelated to their descriptions of their features or to objectively determined defects. However, self-ratings on specific features of the face were correlated with cephalometric measures of nasal height, on both hard and soft tissue dimensions.

Adult↗

The demographics of disability.

In this article, I have attempted to clarify some of the disparate estimates and ways of measuring disability that have been used in different surveys. The definitional issue has implications for the size of the population that will be covered by the ADA. I have reviewed several perspectives, including that of researchers, disability advocates, and individual self-perceptions, which need to be considered in understanding the meaning of disability. Disability involves limitations in actions and activities because of mental and physical impairments. Comparison of these different perspectives reveals that the differences lie in the range of activities that are considered. At least 36 million persons, over 14 percent of the U.S. population, are limited in selected activities. Depending on what are considered to be major life activities, the population covered by the ADA could vastly exceed that figure. Little information is available about the extent to which persons with disabilities, however defined, are affected by discrimination and unequal treatment. Limited data are available from one survey conducted by the International Center for the Disabled, which indicate that as many as 66 percent of persons with activity limitations who are not working would like a job. On the other hand, many persons with activity limitations indicate that their limitations are an important cause of their unemployment. About a quarter of persons with activity limitations due to impairments have experienced discrimination in some form. The impact of the ADA will likely vary by impairment. Because the prevalence of chronic diseases is far greater than the prevalence of physical and sensory impairments, chronic diseases are more frequently the cause of disability. The risk of disability is highest for impairments with low prevalence. Because states and local areas differ in the prevalence of disability, the impact of the ADA will also be likely to vary by geographic area. For some states, the rate of work disability is more than twice the rate of other states. Yet, research indicates that much of the variation is due to socioeconomic characteristics of areas. This reflects, at the macroeconomic level, that persons with disabilities are more likely to be poor and less educated than persons without disabilities. Because of differences in understanding what disability is and insufficient knowledge about the extent of the problem of discrimination toward persons with disabilities, assessment of the potential impact of the ADA is challenging.(ABSTRACT TRUNCATED AT 400 WORDS)

Activities of Daily Living↗

Microteaching: a model for employee counseling education.

An instructional model for the implementation and use of videotape simulation to improve dietetic students' skills in employee counseling was explored in the coordinated undergraduate program at the University of Tennessee, Knoxville. A five-day intensive workshop was conducted for senior students in the program, utilizing the microteaching technique. Students and actors simulated an employee counseling session on videotape; then, a small group and a clinical instructor evaluated the session. Suggestions from these evaluations were used in a repeat of the situation on videotape. A team of experts randomly viewed all the situations, judging a significant improvement in composite scores for the workshop participants. The students indicated on a Self-Perception of Confidence (SPOC) scale that they felt a higher degree of comfort in handling potential employee counseling after completing the workshop. They were pleased with the workshop and suggested expansion of the technique to other phases of their dietetic education.

Counseling↗

[An objective method for forming diagnostic sub-groups of ulcer patients].

79 ulcer patients were arranged in 6 seb-groups by means of a Q-analysis. Relevant items of their self-images in the Giessen-Test selected through factor analysis were the basis of this sub-grouping. Description of the sub-groups was based on factor analysis of 5 dimensions and discriminance analysis of 3 dimensions obtained in the self-perceptions and self-images. The patient's view of his illness, his social status and his physical ailments were also included as dimensions of the 6 sub-groups. A clinically obtained typology of the characteristics of these sub-groups was checked and verified.

Conflict, Psychological↗

Attitudes of adolescents to their body build and the problem of juvenile obesity.

Prevalence of obesity, attitude to body weight and dimensions, eating habits, opinions on good nutrition and on the causes and prevention of obesity were studied in two groups of Israeli children, each comprising about 500 boys and girls, 13--14 years old. Mean relative weight was close to median weight for height, although 9 per cent of both boys and girls weighed more than 120 per cent of median weight. Weight was closely related to triceps skinfold thickness. Twenty-six per cent of the boys and 15 per cent of the girls rated themselves as thin, 61 per cent of children of both sexes as medium, and 13 per cent of the boys and 25 per cent of the girls as obese. Self-perception of body build was more closely related to weight than to skinfold thickness. Two-thirds of the boys and over one-half of the girls were satisfied with their weight, but dissatisfaction with size and shape was often expressed. Boys wished to have larger muscles and chest circumference and many girls, even when not obese, wanted to be smaller in size and shape. Most of the obese children wanted to lose weight. Of 499 children examined, 16 boys (7 per cent of the sample) and 58 (21 per cent) girls reported for dietary therapy. While most of these children were obese, by either subjective or objective criteria, an appreciable number of nonobese children were also dieting. The children's own perception of their body build seemed to be a strong motivation to diet for weight control. Most of the dieters did not receive any dietary advice from professional people. Over two-thirds of both boys and girls believed that daily consumption of milk, bread, fruits, eggs, cheese, meat, and tomatoes is desirable. More overweight than thin and normal-weight children indicated that, to prevent obesity, all kinds of food are permissible, but only in limited amounts. Most children believed in the fattening value of cakes, sweets, fried and fatty foods, potatoes, bread and nuts. Overweight children, particularly girls, reported eating less bread, cake and cream, adding less sugar to beverages, and eating sweets and ice cream less frequently than thin and normal-weight children. Overweight teen-agers appear to be more conscious of their food intake than under- and normal-weight children.

Adolescent↗

Physical estimation and attraction scales: rationale and research.

Rationale, development, and validation studies for the Physical Estimation and Attraction Scales (PEAS) are dicussed. A psychological model for physical activity participation is advanced which utilizes Estimation (self-perceptions of physical ability) and Attraction (measured interest in physical activity) as mediating variables in physical ability, physical activity participation, self-esteem relationships. Tests of the model have inferred physical ability from performance at motor fitness tests, participation from paper and pencil self-reports, and self-esteem from several of the more widely used measures of general self-esteem. Conclusions developed from studying these variables in male adolescent samples are presented.

Adolescent↗

["Therapeutic play" als clinical short-term group therapy in rehabilitative and preventive internal medicine (author's transl)].

A method of therapeutic play was presented which was used with young patients in treatment at a health resort. The patients were diagnosed as suffering from the vegetative syndrome. They also exhibited psychological problems such as difficulty in establishing interpersonal relationships, inhibition and depressive tendencies. This method consisting of a three-stage program of self-perception, interaction and role playing has been used successfully as short-term group therapy in the context of treatment at a health resort as the investigation of 49 participants shows.

Adolescent↗

Factors associated with condom use among sexually active female adolescents.

A health belief model of condom use was used to identify factors associated with condom use in 390 sexually active female adolescents, aged 12 through 19 years, recruited at the time of a visit for reproductive health care. Fifty-six percent were white and the remainder black. Nineteen percent had genitourinary infections with Chlamydia trachomatis. Forty-six percent reported having had more than one sexual partner in the preceding year. Reported condom use for at least one specific reason (prevention of pregnancy, sexually transmitted disease, or acquired immunodeficiency syndrome) increased as behavioral, emotional, and sexually transmitted disease risk decreased, and as cognitive maturity and positive condom attitudes increased. Although uses of condoms to prevent pregnancy, sexually transmitted disease, and acquired immunodeficiency syndrome were positively intercorrelated, each made a contribution to explaining condom use at most recent coitus (odds ratios 2.95, 3.96, and 2.81, respectively). After statistical adjustment for the reported reasons for previous condom use, behavioral risk was the only additional factor associated with condom use at the most recent sexual encounter; women who participated in more risk behaviors (substance and alcohol use and minor delinquency) were less likely to have used a condom (odds ratio 0.61). Knowledge about sexually transmitted disease and acquired immunodeficiency syndrome, and concurrent use of contraceptive pills, were not related to condom practices. The data suggest that adolescents' perceptions about condoms, including the individual functions of condoms for contraception and for prevention of sexually transmitted disease, may be important in determining their use. Engaging in unprotected intercourse may be part of a larger behavioral domain that includes other unhealthy behaviors.

Adolescent↗

Development and validation of a condom self-efficacy scale for college students.

This study proposed to develop and validate a scale for the college population that measures self-efficacy in using condoms. The Condom Use Self-Efficacy Scale (CUSES) was derived from several sources and consisted of 28 items describing an individual's feelings of confidence about being able to purchase condoms, put them on and take them off, and negotiate their use with a new sexual partner. This scale was administered to a sample of 768 college students. It was found to possess adequate reliability (Cronbach's alpha = .91; test-retest correlation = .81) and correlated well with the Attitude Toward the Condom Scale (r = .51) and the Contraceptive Self-Efficacy Scale for women (r = .55). Our scale also correlated with a measure of intention to use condoms (r = .40) but was unrelated to a measure of social desirability. Students who differed on measures of previous condom use as well as on sexual intercourse experience also showed significant differences on this scale in the expected direction, indicating evidence of this scale's discriminant validity. The potential uses of this scale in a college population are discussed, along with the issues underlying condom usage self-efficacy.

Adolescent↗

The sexual behaviour of bisexual men in relation to HIV transmission.

Relatively little is known about the behaviour of bisexual men which may help in assessing their role in HIV transmission. A sample of 60 behaviourally bisexual men were asked about their sexual behaviour with male and female partners and their perceptions of risk of HIV infection. Only a minority of men engaged in unprotected anal sex with their male partners while two thirds had unprotected vaginal sex with their female partners. This asymmetrical pattern of sexual behaviour reflects a differential perception of risk of HIV infection with male and female partners. A quarter of the men had unprotected penetrative sex with both male and female partners in the previous year. The pattern of risk behaviour varied amongst men living in gay, heterosexual or bisexual contexts.

Adult↗

Parenting enhancement among Egyptian mothers in a tertiary care setting.

This study tested the efficacy and effectiveness of systematically planned parenting enhancement program aimed toward breaking the cycle of high-risk mothers producing high-risk babies in Egypt. The assumption is that self-esteem and self-care are requisites to effective parenting, which can be enhanced or impeded by human and environmental forces. Given that parenting is a learned behavior, it can be repatterned by modifying human-environmental processes.

Adolescent↗

Differential impact of abortion on adolescents and adults.

The purpose of this study was to compare adolescent and adult reactions to abortion. A sample of 252 women from 42 states was obtained from a national survey of organizations serving as support groups for women who have had negative reactions to abortion. The age analysis was run using t-tests. Results indicated that the adolescents were significantly more likely to be dissatisfied with the choice of abortion than were the older subjects, to have abortions later in the gestational period, to be dissatisfied with services at the time of the abortion, to feel forced by circumstances to have the abortion, to report being misinformed at the time of the abortion, and to report greater severity of psychological stress. The conclusions suggest that the adolescents' problems may be due to a combination of developmental limitations and the nature of counseling at the time of the abortion.

Abortion Applicants↗

Patterns of demographic change in the Americas.

Considerable scholarly debate has focused on the nature of demographic change in the Americas before and after 1492. Recent research on human skeletal samples and related archeological materials suggests that morbidity and mortality were increasing throughout much of the Western Hemisphere before 1492 in response to increased population density, increased sedentism, and changing subsistence. The evidence suggests that after 1492 population reduction was caused not by continental pandemics but by localized or regional epidemics augmented by social and economic disruption. The twentieth century has witnessed remarkable Native American population recovery, fueled both by improvements in health care and changing definitions of "being Indian."

Disease Outbreaks↗

Targeting the audience for AIDS messages by actual and perceived risk.

Since there are many ways to segment an audience into target groups, we suggest that a productive strategy for AIDS education is to divide the audience by their actual and perceived risk. We provide an example in which we segmented an urban U.S. sample and make suggestions as to how messages appropriate for each group can be constructed. In our sample, the "unthreatened" accurately assessed their low risk of AIDS, and showed high knowledge and tolerance rates. The "panicked," who included more women and Hispanics, inaccurately thought themselves at high risk because of misunderstandings about the causes of AIDS, and showed more intolerance of people with AIDS. "Deniers" continued to have multiple sexual partners and take precautions irregularly, despite seeing AIDS as a social problem and having more education and AIDS knowledge. In contrast, "gamblers" recognized their higher risk of AIDS and were most likely to have taken some action, although not enough to prevent sexual transmission of the HIV virus.

Acquired Immunodeficiency Syndrome↗