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Motivating health: strategies for the nurse practitioner.

PURPOSE: To provide the nurse practitioner (NP) with a practical prescription for acquiring expertise in health behavior change using integrated principles from the transtheoretical model of change and motivational interviewing. DATA SOURCES: Extensive literature review of current theory and research on health behavior change. CONCLUSION: Expertise in motivating health behavior change is essential to effective health promotion and to the NP role. IMPLICATIONS FOR PRACTICE: Lifestyle choices are principal contributors to the leading causes of death and most chronic diseases in the United States. Traditional health behavior interventions are often ineffective in motivating and sustaining lifestyle change.

Health Behavior↗

The self-care motivation model: theory and practice in healthy human development.

Effective health education and behavior motivation programs are needed to promote the compliance of children and young adults with preventive health care practices. Health promotion and primary prevention programs must consider the entire individual as well as his or her environment if positive behavior changes are to be maintained. This paper introduces an innovative model for self-care motivation curriculum development. The model prescribes the use of value clarification, enhanced physical/cognitive/affective awareness, positive lifestyle choices, and self-reinforcement skills training whereby individuals learn to become self-motivated and reinforcing agents for their own primary preventive health practices. It is theorized that by developing self-care and self-regulation skills, students will achieve and maintain higher levels of wellness, thus improving the quality of their lives and ensuring healthy human development.

Health Education↗

Sex differences in the prediction of academic achievement using the Children's Motivation Analysis Test.

The Children's Motivation Analysis Test (CMAT), together with standardised achievement tests in mathematics and reading, was administered to a large sample of Australian elementary school children. Stepwise forward regression analyses were conducted on subsamples of 209 males and 179 females (cases with missing data previously excluded). Several of the CMAT dynamic traits significantly predicted achievement scores. The most useful predictors were conscientiousness (Superego) and family (Home) orientation. These results, based on objective motivation measurement, represent the beginnings of a new approach for research into children's motivation structure.

Achievement↗

Pupils' perceptions of school and teachers. II--Relationships with motivation and approaches to learning.

The previous article has described the development of scales designed to measure pupils' perceptions of school and teachers. Previous comparative studies have shown interesting differences in motivation and approaches to learning between Britain and Hungary, which were considered to reflect different methods of teaching. This article explores the relationships between a set of inventory scores describing perceptions of school and teachers and another set indicating school motivation and approaches to learning. The complete inventory was given to samples of 516 12-15 year-old pupils in five British schools and a comparable sample of 602 pupils in Hungary. The factor structure of the combined inventory was investigated, together with correlational analyses at scale and item level which suggested that relationships did exist between perceptions of school and teachers, levels of school motivation, and approaches to learning.

Adolescent↗

Contingency learning in chronic schizophrenia and its relevance to social motivation deficit.

The present study investigates the ability of chronic schizophrenic patients to learn to obtain social rewards when the incentive value of the contingent social event is known. From a group of 40 chronic patients tested for responsivity to social rewards, socially responsive and socially unresponsive patients were selected and compared on a learning task. Patients who were highly motivated to obtain social reinforcement did not emit the reinforced response during 300 learning trials any more frequently than did patients who were not motivated by social rewards. It was only when the experimental contingency was specified that responsive and unresponsive patients could be differentiated. The implications of these findings for social motivation theories of schizophrenia are discussed.

Adult↗

Nucleus accumbens dopamine and the regulation of effort in food-seeking behavior: implications for studies of natural motivation, psychiatry, and drug abuse.

For several decades, it has been suggested that dopamine (DA), especially in nucleus accumbens, mediates the primary reinforcing characteristics of natural stimuli such as food, as well as drugs of abuse. Yet, several fundamental aspects of primary food reinforcement, motivation, and appetite are left intact after interference with accumbens DA transmission. Recent studies have shown that accumbens DA is involved in responsiveness to conditioned stimuli and activational aspects of motivation. In concurrent choice tasks, accumbens DA depletions cause animals to reallocate their choice behavior in the direction of instrumental behaviors that involve less effort. Also, an emerging body of evidence has demonstrated that the effects of accumbens DA depletions on instrumental food-seeking behavior can vary greatly depending upon the task. For example, some schedules of reinforcement are insensitive to the effects of DA depletions, whereas others are highly sensitive (e.g., large fixed ratios). Accumbens DA depletions slow the rate of operant responding, blunt the rate-facilitating effects of moderate-sized ratios, and enhance the rate-suppressing effects of very large ratios (i.e., produce ratio strain). Accumbens DA may be important for enabling rats to overcome behavioral constraints, such as work-related response costs, and may be critical for the behavioral organization and conditioning processes that enable animals to engage in vigorous responses, such as barrier climbing, or to emit large numbers of responses in ratio schedules in the absence of primary reinforcement. The involvement of accumbens DA in activational aspects of motivation has implications for energy-related disorders in psychiatry, as well as aspects of drug-seeking behavior.

Animals↗

Cocaine- and amphetamine-regulated transcript (CART) peptides modulate the locomotor and motivational properties of psychostimulants.

Drug addiction results from a subversion of neural circuits that control motivation. Although the hedonic and addictive properties of psychostimulants and drugs of abuse are predominantly attributed to dopamine and glutamate, it is appreciated that other signaling molecules in the brain are important. This study suggests that cocaine- and amphetamine-regulated transcript (CART) peptides modulate the locomotor and motivational properties of psychostimulants. The behavioral effects of cocaine and amphetamine were examined in Carttm1Amgen knockout (Cart KO) and wild-type (WT) mice. Acute amphetamine administration increased in locomotor activity in WT mice, but this response was attenuated in Cart KO mice. Repeated amphetamine produced locomotor sensitization in WT mice but hardly any in Cart KO mice. Amphetamine elicited conditioned place preference in both genotypes, but amphetamine's potency was reduced in the Cart KO mice. Intravenous cocaine self-administration was observed in both genotypes, but Cart KO mice consumed less cocaine and responded less for cocaine than WT mice. The behavioral effects of psychostimulants were reduced in the mutant Cart KO mice. By contrast, open field activity and sucrose preference of drug-naive mice WT and Cart KO mice were not significantly different. The attenuated effects of amphetamine and cocaine in Cart KO mice suggest a positive neuromodulatory role for CART peptides in the locomotor and motivational properties of psychostimulants and implicate CART peptides in psychostimulant addiction.

Amphetamine↗

Neurons in paradoxical sleep and motivated behavior.

Single-cell recordings were taken with electrodes permanently implanted in unrestrained rats during normal sleep, paradoxical sleep, quiet awake, and highly motivated awake periods. In most areas, neuronal activity increased when normal sleep changed to paradoxical sleep. The hypothalamus showed a significantly greater increase than most other areas. The hippocampus differed strikingly from all other areas by showing a decrement in all cases. The average firing rates in paradoxical sleep exceeded those of the quiet awake state as well as those of normal sleep. Comparison of paradoxical sleep with motivated behavior illustrated that changes in brain activity during paradoxical sleep were related to anatomically specifiable groupings, but no such differentiation appeared in motivated behavior.

Animals↗

Biochemical characterization of a mutationally altered protein translocase: proton motive force stimulation of the initiation phase of translocation.

Protein translocation across the Escherichia coli plasma membrane is facilitated by concerted actions of the SecYEG integral membrane complex and the SecA ATPase. A secY mutation (secY39) affects Arg357, an evolutionarily conserved and functionally important residue, and impairs the translocation function in vivo and in vitro. In this study, we used the "superactive" mutant forms of SecA, which suppress the SecY39 deficiency, to characterize the mutationally altered SecY39EG translocase. It was found that SecY39-mediated preprotein translocation exhibited absolute dependence on the proton motive force. The proton motive force-dependent step proved to lie before signal peptide cleavage. We suggest that the proton motive force assists in the initiation phase of protein translocation.

Adenosine Triphosphatases↗

The mechanism of the tyrosine transporter TyrP supports a proton motive tyrosine decarboxylation pathway in Lactobacillus brevis.

The tyrosine decarboxylase operon of Lactobacillus brevis IOEB9809 contains, adjacent to the tyrosine decarboxylase gene, a gene for TyrP, a putative tyrosine transporter. The two genes potentially form a proton motive tyrosine decarboxylation pathway. The putative tyrosine transporter gene of L. brevis was expressed in Lactococcus lactis and functionally characterized using right-side-out membranes. The transporter very efficiently catalyzes homologous tyrosine-tyrosine exchange and heterologous exchange between tyrosine and its decarboxylation product tyramine. Tyrosine-tyramine exchange was shown to be electrogenic. In addition to the exchange mode, the transporter catalyzes tyrosine uniport but at a much lower rate. Analysis of the substrate specificity of the transporter by use of a set of 19 different tyrosine substrate analogues showed that the main interactions between the protein and the substrates involve the amino group and the phenyl ring with the para hydroxyl group. The carboxylate group that is removed in the decarboxylation reaction does not seem to contribute to the affinity of the protein for the substrates significantly. The properties of the TyrP protein are those typical for precursor-product exchangers that operate in proton motive decarboxylation pathways. It is proposed that tyrosine decarboxylation in L. brevis results in proton motive force generation by an indirect proton pumping mechanism.

Amino Acid Transport Systems↗

Randomised controlled trial of home based motivational interviewing by midwives to help pregnant smokers quit or cut down.

OBJECTIVE: To determine whether motivational interviewing--a behavioural therapy for addictions-provided at home by specially trained midwives helps pregnant smokers to quit. DESIGN: Randomised controlled non-blinded trial analysed by intention to treat. SETTING: Clinics attached to two maternity hospitals in Glasgow. PARTICIPANTS: 762/1684 pregnant women who were regular smokers at antenatal booking: 351 in intervention group and 411 in control group. INTERVENTIONS: All women received standard health promotion information. Women in the intervention group were offered motivational interviewing at home. All interviews were recorded. MAIN OUTCOME MEASURES: Self reported smoking cessation verified by plasma or salivary cotinine concentration. RESULTS: 17/351 (4.8%) women in the intervention group stopped smoking (according to self report and serum cotinine concentration < 13.7 ng/ml) compared with 19/411(4.6%) in the control group. Fifteen (4.2%) women in the intervention group cut down (self report and cotinine concentration less than half that at booking) compared with 26 (6.3%) in the control group. Fewer women in the intervention group reported smoking more (18 (5.1%) v 44 (10.7%); relative risk 0.48, 95% confidence interval 0.28 to 0.81). Birth weight did not differ significantly (mean 3078 g v 3048 g). CONCLUSION: Good quality motivational interviewing did not significantly increase smoking cessation among pregnant women.

Adult↗

Goal theory, motivation, and school achievement: an integrative review.

The purpose of this review is to document the directions and recent progress in our understanding of the motivational dynamics of school achievement. Based on the accumulating research it is concluded that the quality of student learning as well as the will to continue learning depends closely on an interaction between the kinds of social and academic goals students bring to the classroom, the motivating properties of these goals and prevailing classroom reward structures. Implications for school reform that follow uniquely from a motivational and goal-theory perspective are also explored.

Educational Status↗

Reward, motivation, and emotion systems associated with early-stage intense romantic love.

Early-stage romantic love can induce euphoria, is a cross-cultural phenomenon, and is possibly a developed form of a mammalian drive to pursue preferred mates. It has an important influence on social behaviors that have reproductive and genetic consequences. To determine which reward and motivation systems may be involved, we used functional magnetic resonance imaging and studied 10 women and 7 men who were intensely "in love" from 1 to 17 mo. Participants alternately viewed a photograph of their beloved and a photograph of a familiar individual, interspersed with a distraction-attention task. Group activation specific to the beloved under the two control conditions occurred in dopamine-rich areas associated with mammalian reward and motivation, namely the right ventral tegmental area and the right postero-dorsal body and medial caudate nucleus. Activation in the left ventral tegmental area was correlated with facial attractiveness scores. Activation in the right anteromedial caudate was correlated with questionnaire scores that quantified intensity of romantic passion. In the left insula-putamen-globus pallidus, activation correlated with trait affect intensity. The results suggest that romantic love uses subcortical reward and motivation systems to focus on a specific individual, that limbic cortical regions process individual emotion factors, and that there is localization heterogeneity for reward functions in the human brain.

Adolescent↗

Motivational symptoms of depression mask preclinical Alzheimer's disease in elderly subjects.

BACKGROUND: Althoughthe relationship between depressive disorders and Alzheimer's disease (AD) is debated, there is evidence that depression may be an early symptom of dementia. OBJECTIVE: To evaluate depression features prospectively in elderly subjects with a view to identifying a subgroup affected by preclinical AD. METHODS: We performed a cohort study on cognitive performances with a 12-month follow-up in out-patients referred to the local Neuropsychology Clinic complaining of memory problems. Two hundred and twenty-two consecutive non-demented subjects were studied using a neuropsychological battery and the Beck Depression Inventory (BDI) and assessed again 1 year later for the possible onset of cognitive impairment. Multivariate analysis was performed to detect independent predictors of dementia development among age, education, neuropsychological test scores and BDI scores and subscores. BDI subscores were obtained by dividing items into three domains corresponding to mood-related, somatic and motivation-related symptoms. RESULTS: At the time of the first evaluation, 124 of the 222 subjects were depressed according to DSM-III-R criteria. At 1 year, 31 of the 124 depressed subjects and 2 non-depressed ones had AD according to NINCDS-ADRDA criteria. Stepwise logistic regression analysis indicated that the subjects who went on to develop dementia had significantly higher total BDI scores and motivational BDI subscores. Among depressed subjects, the probability of being diagnosed with dementia during follow-up was significantly associated with a motivational BDI subscore > or = 7 (odds ratio: 3,885, 95% Cl 154-97,902). COMMENT: Close neuropsychological follow-up of depressed elderly subjects complaining of memory failure and showing apathy is recommended to detect the early stage of AD.

Affect↗

The relationship between legal status, perceived pressure and motivation in treatment for drug dependence: results from a European study of Quasi-Compulsory Treatment.

This paper reports on intake data from Quasi-Compulsory Treatment in Europe, a study of quasi-compulsory treatment (QCT) for drug dependent offenders. It explores the link between formal legal coercion, perceived pressure to be in treatment and motivation amongst a sample of 845 people who entered treatment for drug dependence in five European countries, half of them in quasi-compulsory treatment and half 'voluntarily'. Using both quantitative and qualitative data, it suggests that those who enter treatment under QCT do perceive greater pressure to be in treatment, but that this does not necessarily lead to higher or lower motivation than 'volunteers'. Many drug-dependent offenders value QCT as an opportunity to get treatment. Motivation is mutable and can be developed or diminished by the quality of support and services offered to drug-dependent offenders.

Adult↗

A motivation evaluating rating scale for chronic impaired schizophrenics (MERS).

The attempt is made to structure a rating scale intended to evaluate the motivational level of chronic impaired schizophrenics (defect-schizophrenia). The need for such a measuring tool is stressed, considering mainly the relatively poor symptomatology of these patients, the difficulties to discern changes in the patients' condition and the fact that lack of motivation basically features the schizophrenic impairment. The scale strives to be as comprehensive as possible, extending from the lowest biological level to the highest social and cultural aspects of motivation.

Chronic Disease↗

Therapy motivation in anorexia nervosa: theory and first empirical results.

Anorexia nervosa patients are considered to be unmotivated for psychotherapy of eating disorders, because they present a lack of understanding and feeling for their disease. In order to objectify this lack of therapy motivation we formulated two questionnaires for patients and therapists. The items were obtained from 15 theoretically determined fields of both intra- and interpersonal subsets of motivation, and a 'motivation profile' was gained. In a first clinical application these profiles are obtained from an anorexia sample at the beginning and at the end of an inpatient treatment and combined with the corresponding therapist ratings. The results are compared with two control groups (preattended psychosomatics and somatic patients). Results collected hereby are used for the improvement of our questionnaires and for suggestions concerning further studies.

Adult↗

Motivational readiness and the participation of children with learning and behavior problems in psychoeducational decision making.

Efficacy of a brief cognitive-affective intervention to enhance motivational readiness for participating in a psychoeducational decision-making conference was explored. Although outcomes specific to the preconference intervention were not found, findings of relevance to the hypothesized positive relationship between motivational readiness and actual participation in decision making are reported. The positive and negative findings are discussed in terms of implications for enhancing motivational readiness and for understanding the limited impact of skill training to improve participation and decision making.

Adolescent↗