Applied Behavior Analysis in the Treatment of Severe Psychiatric Disorders: A Bibliography.

ERIC Educational Resources Information Center

Scotti, Joseph R.; And Others

Clinical research in the area of severe psychiatric disorders constituted the major focus for the discipline of applied behavior analysis during the early 1960s. Recently, however, there appears to be a notable lack of a behavioral focus within many inpatient psychiatric settings and a relative dearth of published behavioral treatment studies with…

Clinical misconduct among South Korean nursing students.

PubMed

Park, Eun-Jun; Park, Seungmi; Jang, In-Sun

2014-12-01

This study examines the extent and predictors of unethical clinical behaviors among nursing students in South Korea. From survey data of 345 undergraduate nursing students, unethical clinical behaviors were examined with respect to 11 individual characteristics, frequency and perceived seriousness of classroom cheating, two factors of individual attitude, and four contextual factors. Qualitative data from two focus group interviews were analyzed to explore reasons for and contexts of unethical clinical behaviors. About sixty-six percent of the participants engaged in one or more unethical clinical behaviors over a one-semester period. The prevalence of such behaviors varied widely from 1.7% to 40.9% and was related to the type of nursing program, the number of clinical practicum semesters completed, ethical attitudes toward cheating behaviors, the frequency of cheating on assignments, the frequency of cheating on exams, the perceived prevalence of cheating by peers, and prior knowledge of academic integrity. According to the regression analysis, the last four variables explained 29.4% of the variance in the prevalence of unethical clinical behaviors. In addition, multiple reasons and possible interventions for clinical misconduct were reported during the focus group interviews. Unlike cheating in the classroom, clinical misconduct was strongly induced by clinical nurses and poor clinical practice environments. In sum, unethical clinical behaviors were widespread among the participants and need to be corrected. Copyright © 2014 Elsevier Ltd. All rights reserved.

Acceptance and Commitment Therapy and Behavioral Activation for the Treatment of Depression: Description and Comparison

ERIC Educational Resources Information Center

Kanter, Jonathan W.; Baruch, David E.; Gaynor, Scott T.

2006-01-01

The field of clinical behavior analysis is growing rapidly and has the potential to affect and transform mainstream cognitive behavior therapy. To have such an impact, the field must provide a formulation of and intervention strategies for clinical depression, the "common cold" of outpatient populations. Two treatments for depression have emerged:…

The Role of Shaping the Client's Interpretations in Functional Analytic Psychotherapy

ERIC Educational Resources Information Center

Abreu, Paulo Roberto; Hubner, Maria Martha Costa; Lucchese, Fernanda

2012-01-01

Clinical behavior analysis often targets the shaping of clients' functional interpretations of/or rules about his own behavior. These are referred to as clinically relevant behavior 3 (CRB3) in functional analytic psychotherapy (FAP). We suggest that CRB3s should be seen as contingency-specifying stimuli (CSS), due to the their ability to change…

Parenting Stress through the Lens of Different Clinical Groups: a Systematic Review & Meta-Analysis

PubMed Central

Mendez, Lucybel; Graziano, Paulo A.; Bagner, Daniel M.

2017-01-01

Research has demonstrated an association between parenting stress and child behavior problems, and suggested levels of parenting stress are higher among parents of children at risk for behavior problems, such as those with autism and developmental delay (ASD/DD). The goal of the present study was to conduct a systematic review of parenting stress and child behavior problems among different clinical groups (i.e., ASD/DD, chronic illness, with or at-risk for behavioral and/or mood disorders). We also examined demographic and methodological variables as moderators and differences in overall levels of parenting stress between the clinical groups. This systematic review documents a link between parenting stress and child behavior problems with an emphasis on externalizing behavior. One-hundred thirty-three studies were included for quantitative analysis. Parenting stress was more strongly related to child externalizing (weighted ES r = 0.57, d = 1.39) than internalizing (weighted ES r = 0.37, d = 0.79) problems. Moderation analyses indicated that the association between parenting stress and behavior problems was stronger among studies which had mostly male and clinic-recruited samples. Overall, parenting stress levels were higher for parents of children with ASD/DD compared to parents of children from other clinical groups. Findings document the association between parenting stress and child behavior problems and highlight the importance of assessing parenting stress as part of routine care and throughout behavioral intervention programs, especially for groups of children at high risk for behavior problems, such as children with ASD/DD, in order to identify support for both the parent(s) and child. PMID:28555335

Parent Training Research: An Analysis of the Empirical Literature 1975-1985.

ERIC Educational Resources Information Center

Wiese, Margaret R. Rogers; Kramer, Jack J.

1988-01-01

Reviewed 18 journals with behavioral psychology, clinical or counseling psychology, school psychology, and special education emphases. Results indicated that behavioral journals published most empirically based parent training articles, followed by clinical or counseling psychology, special education, and school psychology journals. Parents with…

Impulsive Behavior and Associated Clinical Variables in Parkinson's Disease

PubMed Central

Abosch, Aviva; Gupte, Akshay; Eberly, Lynn E.; Tuite, Paul J.; Nance, Martha; Grant, Jon E.

2011-01-01

Parkinson's disease (PD) is a degenerative brain disorder accompanied by the loss of dopaminergic neurons and the presence of motor and non-motor symptoms. We performed a cross-sectional, questionnaire-based analysis of impulsive behavior in our PD clinic population to assess prevalence and associated characteristics. We found a higher prevalence of impulsive behavior (29.7%) than previously reported, and found multiple, concurrent impulsive behaviors in 26% of subjects reporting impulsive behavior. Our findings contribute to the growing awareness of impulsive behavior in PD, and support the need for longitudinal studies to assess changes in impulsive behaviors in Parkinson's patients. PMID:21300194

NREM Arousal Parasomnias and Their Distinction from Nocturnal Frontal Lobe Epilepsy: A Video EEG Analysis

PubMed Central

Derry, Christopher P.; Harvey, A. Simon; Walker, Matthew C.; Duncan, John S.; Berkovic, Samuel F.

2009-01-01

Study Objectives. To describe the semiological features of NREM arousal parasomnias in detail and identify features that can be used to reliably distinguish parasomnias from nocturnal frontal lobe epilepsy (NFLE). Design. Systematic semiologial evaluation of parasomnias and NFLE seizures recorded on video-EEG monitoring. Patients. 120 events (57 parasomnias, 63 NFLE seizures) from 44 subjects (14 males). Interventions. The presence or absence of 68 elemental clinical features was determined in parasomnias and NFLE seizures. Qualitative analysis of behavior patterns and ictal EEG was undertaken. Statistical analysis was undertaken using established techniques. Results. Elemental clinical features strongly favoring parasomnias included: interactive behavior, failure to wake after event, and indistinct offset (all P < 0.001). Cluster analysis confirmed differences in both the frequency and combination of elemental features in parasomnias and NFLE. A diagnostic decision tree generated from these data correctly classified 94% of events. While sleep stage at onset was discriminatory (82% of seizures occurred during stage 1 or 2 sleep, with 100% of parasomnias occurring from stage 3 or 4 sleep), ictal EEG features were less useful. Video analysis of parasomnias identified three principal behavioral patterns: arousal behavior (92% of events); non-agitated motor behavior (72%); distressed emotional behavior (51%). Conclusions Our results broadly support the concept of confusion arousals, somnambulism and night terrors as prototypical behavior patterns of NREM parasomnias, but as a hierarchical continuum rather than distinct entities. Our observations provide an evidence base to assist in the clinical diagnosis of NREM parasomnias, and their distinction from NFLE seizures, on semiological grounds. Citation: Derry CP; Harvey AS; Walker MC; Duncan JS; Berkovic SF. NREM arousal parasomnias and their distinction from nocturnal frontal lobe epilepsy: a video EEG analysis. SLEEP 2009;32(12):1637-1644. PMID:20041600

Financial Analysis of Behavioral Health Services in a Pediatric Endocrinology Clinic.

PubMed

Yarbro, Jessica L; Mehlenbeck, Robyn

2016-09-01

This article addresses a current need in psychological practice by describing a financially feasible model that moves toward integrated care of behavioral health services in a pediatric endocrinology clinic. Financial information (costs and revenue associated with behavioral health services) for the clinic, over an 18-month period (July 2012 to December 2013), was obtained through the hospital's financial department. The clinic meets one half day per week. Over the 18-month period, the behavioral health services generated a net gain of $3661.45 in the favor of the clinic. We determined that the psychologist and clinical psychology residents needed to see a total of four patients per half-day clinic for the clinic to "break-even." We describe one financially feasible way of integrating behavioral health services into a pediatric endocrinology clinic in the hope that this will be generalizable to other medical settings. © The Author 2015. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Applying the theory of planned behavior: nursing students' intention to seek clinical experiences using the essential clinical behavior database.

PubMed

Meyer, Linda

2002-03-01

This study examined the antecedents and determinants predictive of whether nursing students (N = 92) intend to ask for assignments to perform nursing behaviors after using a database to record essential clinical behaviors. The results of applying the theory of planned behavior (TPB) to behavioral intention using multivariant path analysis suggested that the endogenous variables, attitude and subjective norms, had a significant effect on the intention to ask for assignments to perform nursing behaviors. In addition, it was primarily through attitudes and subjective norms that the respective antecedents or exogenous variables, behavioral beliefs and normative beliefs, affected the intention to ask for assignments to perform nursing behaviors. The lack of direct influence of perceived behavioral control on intention and the direct negative impact of control belief on intention were contrary to expectations, given the tenets of the TPB.

The impact of applied behavior analysis on diverse areas of research.

PubMed Central

Kazdin, A E

1975-01-01

The impact of applied behavior analysis on various disciplines and areas of research was assessed through two major analyses. First, the relationship of applied behavior analysis to the general area of "behavior modification" was evaluated by examining the citation characteristics of journal articles in JABA and three other behavior-modification journals. Second, the penetration of applied behavior analysis into diverse areas and disciplines, including behavior modification, psychiatry, clinical psychology, education, special education, retardation, speech and hearing, counselling, and law enforcement and correction was assessed. Twenty-five journals representing diverse research areas were evaluated from 1968 to 1974 to assess the extent to which operant techniques were applied for therapeutic, rehabilitative, and educative purposes and the degree to which methodological desiderata of applied behavior analysis were met. The analyses revealed diverse publication outlets for applied behavior analysis in various disciplines. PMID:1184488

Hair Mineral Analysis and Disruptive Behavior in Clinically Normal Young Men.

ERIC Educational Resources Information Center

Struempler, Richard E.; And Others

1985-01-01

Forty young navy recruits were selected for hair mineral analysis on the basis of three criteria: mental test scores, demerits during training, and premature discharge from the navy. Statistical analysis revealed several significant relationships between behavioral criteria and mineral measures. Findings confirmed, in a nonclinical sample, hair…

Thinking about thinking and feeling about feeling

PubMed Central

Moore, J.

2000-01-01

Traditional clinical psychology generally posits “mental” events that differ from “behavioral” events. Mental events are not publicly observable, take place in a different dimension from overt behavior, and are the topic of primary concern. For example, mental events are often taken to be causes of troublesome overt behavior. In addition, the mental events themselves may be regarded as troublesome, independent of their relation to any specific overt behavior. Therapy is usually aimed at fixing these troublesome mental events, under an assumption that improvement in the client's status will follow in due course. Behavior analysis has its own position on the relations among clinical matters, overt behavior, and such private events as thinking and feeling. In a behavior-analytic view, private events are behavioral phenomena rather than mental phenomena. They are not initiating causes of behavior; rather, they are themselves caused by antecedent conditions, but they may contribute to discriminative control over subsequent behavior, both verbal and nonverbal. Verbal processes are viewed as vitally important in understanding troublesome behavior. However, the circumstances that cause both the troublesome private events and the troublesome behavior in the first place still need to be addressed. Finally, clinical behavior analysis will need to market its insights into diagnosis and treatment very adroitly, because it rejects the mentalism upon which most traditional forms of therapy are predicated and the mentalism that most consumers expect to encounter. PMID:22478337

A Systematic Review and Meta-Analysis of the Efficacy of Cognitive Behavioral Therapy for the Management of Pediatric Migraine.

PubMed

Ng, Qin Xiang; Venkatanarayanan, Nandini; Kumar, Lakshmi

2017-03-01

Migraine headaches are common in children and adolescents. Current pharmacologic treatment options are limited despite the prevalence and debilitating effects of pediatric migraine. Cognitive behavioral therapy (CBT) is an evidence-based practice that focuses on the development of coping strategies and cognitive restructuring to alter the pain experience. Till date, no meta-analysis has been done to examine the use of CBT in pediatric migraine. Using the keywords (cognitive behavioral therapy OR cognitive behavior therapy OR cognitive behavioral therapy OR cognitive behavior therapy OR CBT) AND (headache OR migraine), a preliminary search on the PubMed and Ovid database yielded 3841 articles published in English between 1 Jan 1980 and 1 May 2016. Full articles were also reviewed for references of interest. After data extraction, 14 studies were included in the meta-analysis. The results of the meta-analysis well-support the clinical role of CBT in the management of pediatric migraine. The pooled odds ratios of clinically significant improvement, that is, 50% or greater headache activity reduction post-treatment and at follow-up (3 months or later) were OR 9.11 (95% CI: 5.01 to 16.58, P < .001) and OR 9.18 (95% CI: 5.69 to 14.81, P < .001) respectively, demonstrating significant clinical improvement with CBT as compared with wait-list control, placebo, or standard medication. Furthermore, the clinical improvement was stable, even at a 1-year follow-up as evident in some of the studies. There is good evidence that CBT is beneficial to children suffering from migraine, and may also augment the efficacy of standard medications such as amitriptyline. © 2016 American Headache Society.

The effect of pre-travel advice on sexual risk behavior abroad: a systematic review.

PubMed

Croughs, Mieke; Remmen, Roy; Van den Ende, Jef

2014-01-01

Travelers often have casual sex abroad and the risk of acquiring a sexually transmitted infection (STI) associated with casual travel sex is considered to be threefold higher compared to the risk of casual sex in the home country. Consequently, international guidelines recommend including STI advice in the pre-travel consultation. We performed a systematic review on the effect of a pre-travel STI intervention on sexual risk behavior abroad. In September 2012, a systematic analysis and meta-analysis of peer reviewed literature were performed on the relation between pre-travel STI advice for travelers and sexual risk behavior abroad. Primary outcome measure consisted of the number of travelers with a new sexual partner abroad; secondary outcome measure entailed the proportion of consistent condom use. Six studies were identified for inclusion in the review, of which three clinical trials on the effect of a motivational intervention compared to standard pre-travel STI advice qualified for the meta-analysis. Two of these trials were performed in US marines deployed abroad and one in visitors of a travel clinic. The extensive motivational training program of the marines led to a reduction in sexual risk behavior, while the brief motivational intervention in the travel clinic was not superior to standard advice. The meta-analysis established no overall effect on risk behavior abroad. No clinical trials on the effect of a standard pre-travel STI discussion were found, but a cohort study reported that no relation was found between the recall of a nonstructured pre-travel STI discussion and sexual risk behavior, while the recall of reading the STI information appeared to be related to more consistent condom use. Motivational pre-travel STI intervention was not found to be superior to standard STI advice, while no clinical trials on the effect of standard pre-travel STI advice were found. © 2013 International Society of Travel Medicine.

Modeling eye gaze patterns in clinician-patient interaction with lag sequential analysis.

PubMed

Montague, Enid; Xu, Jie; Chen, Ping-Yu; Asan, Onur; Barrett, Bruce P; Chewning, Betty

2011-10-01

The aim of this study was to examine whether lag sequential analysis could be used to describe eye gaze orientation between clinicians and patients in the medical encounter. This topic is particularly important as new technologies are implemented into multiuser health care settings in which trust is critical and nonverbal cues are integral to achieving trust. This analysis method could lead to design guidelines for technologies and more effective assessments of interventions. Nonverbal communication patterns are important aspects of clinician-patient interactions and may affect patient outcomes. The eye gaze behaviors of clinicians and patients in 110 videotaped medical encounters were analyzed using the lag sequential method to identify significant behavior sequences. Lag sequential analysis included both event-based lag and time-based lag. Results from event-based lag analysis showed that the patient's gaze followed that of the clinician, whereas the clinician's gaze did not follow the patient's. Time-based sequential analysis showed that responses from the patient usually occurred within 2 s after the initial behavior of the clinician. Our data suggest that the clinician's gaze significantly affects the medical encounter but that the converse is not true. Findings from this research have implications for the design of clinical work systems and modeling interactions. Similar research methods could be used to identify different behavior patterns in clinical settings (physical layout, technology, etc.) to facilitate and evaluate clinical work system designs.

Modeling Eye Gaze Patterns in Clinician-Patient Interaction with Lag Sequential Analysis

PubMed Central

Montague, E; Xu, J; Asan, O; Chen, P; Chewning, B; Barrett, B

2011-01-01

Objective The aim of this study was to examine whether lag-sequential analysis could be used to describe eye gaze orientation between clinicians and patients in the medical encounter. This topic is particularly important as new technologies are implemented into multi-user health care settings where trust is critical and nonverbal cues are integral to achieving trust. This analysis method could lead to design guidelines for technologies and more effective assessments of interventions. Background Nonverbal communication patterns are important aspects of clinician-patient interactions and may impact patient outcomes. Method Eye gaze behaviors of clinicians and patients in 110-videotaped medical encounters were analyzed using the lag-sequential method to identify significant behavior sequences. Lag-sequential analysis included both event-based lag and time-based lag. Results Results from event-based lag analysis showed that the patients’ gaze followed that of clinicians, while clinicians did not follow patients. Time-based sequential analysis showed that responses from the patient usually occurred within two seconds after the initial behavior of the clinician. Conclusion Our data suggest that the clinician’s gaze significantly affects the medical encounter but not the converse. Application Findings from this research have implications for the design of clinical work systems and modeling interactions. Similar research methods could be used to identify different behavior patterns in clinical settings (physical layout, technology, etc.) to facilitate and evaluate clinical work system designs. PMID:22046723

Applying behavior analysis to clinical problems: review and analysis of habit reversal.

PubMed Central

Miltenberger, R G; Fuqua, R W; Woods, D W

1998-01-01

This article provides a review and analysis of habit reversal, a multicomponent procedure developed by Azrin and Nunn (1973, 1974) for the treatment of nervous habits, tics, and stuttering. The article starts with a discussion of the behaviors treated with habit reversal, behavioral covariation among habits, and functional analysis and assessment of habits. Research on habit reversal and simplified versions of the procedure is then described. Next the article discusses the limitations of habit reversal and the evidence for its generality. The article concludes with an analysis of the behavioral processes involved in habit reversal and suggestions for future research. PMID:9757583

Patterns of Self-care in Adults With Heart Failure and Their Associations With Sociodemographic and Clinical Characteristics, Quality of Life, and Hospitalizations: A Cluster Analysis.

PubMed

Vellone, Ercole; Fida, Roberta; Ghezzi, Valerio; D'Agostino, Fabio; Biagioli, Valentina; Paturzo, Marco; Strömberg, Anna; Alvaro, Rosaria; Jaarsma, Tiny

Self-care is important in heart failure (HF) treatment, but patients may have difficulties and be inconsistent in its performance. Inconsistencies in self-care behaviors may mirror patterns of self-care in HF patients that are worth identifying to provide interventions tailored to patients. The aims of this study are to identify clusters of HF patients in relation to self-care behaviors and to examine and compare the profile of each HF patient cluster considering the patient's sociodemographics, clinical variables, quality of life, and hospitalizations. This was a secondary analysis of data from a cross-sectional study in which we enrolled 1192 HF patients across Italy. A cluster analysis was used to identify clusters of patients based on the European Heart Failure Self-care Behaviour Scale factor scores. Analysis of variance and χ test were used to examine the characteristics of each cluster. Patients were 72.4 years old on average, and 58% were men. Four clusters of patients were identified: (1) high consistent adherence with high consulting behaviors, characterized by younger patients, with higher formal education and higher income, less clinically compromised, with the best physical and mental quality of life (QOL) and lowest hospitalization rates; (2) low consistent adherence with low consulting behaviors, characterized mainly by male patients, with lower formal education and lowest income, more clinically compromised, and worse mental QOL; (3) inconsistent adherence with low consulting behaviors, characterized by patients who were less likely to have a caregiver, with the longest illness duration, the highest number of prescribed medications, and the best mental QOL; (4) and inconsistent adherence with high consulting behaviors, characterized by patients who were mostly female, with lower formal education, worst cognitive impairment, worst physical and mental QOL, and higher hospitalization rates. The 4 clusters identified in this study and their associated characteristics could be used to tailor interventions aimed at improving self-care behaviors in HF patients.

Predicting healthcare employees' participation in an office redesign program: attitudes, norms and behavioral control.

PubMed

Mohr, David C; VanDeusen Lukas, Carol; Meterko, Mark

2008-11-02

The study examined the extent to which components based on a modified version of the theory of planned behavior explained employee participation in a new clinical office program designed to reduce patient waiting times in primary care clinics. We regressed extent of employee participation on attitudes about the program, group norms, and perceived behavioral control along with individual and clinic characteristics using a hierarchical linear mixed model. Perceived group norms were one of the best predictors of employee participation. Attitudes about the program were also significant, but to a lesser degree. Behavioral control, however, was not a significant predictor. Respondents with at least one year of clinic tenure, or who were team leaders, first line supervisor, or managers had greater participation rates. Analysis at the clinic level indicated clinics with scores in the highest quartile clinic scores on group norms, attitudes, and behavioral control scores were significantly higher on levels of overall participation than clinics in the lowest quartile. Findings suggest that establishing strong norms and values may influence employee participation in a change program in a group setting. Supervisory level was also significant with greater responsibility being associated with greater participation.

Defining behavior-environment interactions: translating and developing an experimental and applied behavior-analytic vocabulary in and to the national language.

PubMed

Tuomisto, Martti T; Parkkinen, Lauri

2012-05-01

Verbal behavior, as in the use of terms, is an important part of scientific activity in general and behavior analysis in particular. Many glossaries and dictionaries of behavior analysis have been published in English, but few in any other language. Here we review the area of behavior analytic terminology, its translations, and development in languages other than English. As an example, we use our own mother tongue, Finnish, which provides a suitable example of the process of translation and development of behavior analytic terminology, because it differs from Indo-European languages and entails specific advantages and challenges in the translation process. We have published three editions of a general dictionary of behavior analysis including 801 terms relevant to the experimental analysis of behavior and applied behavior analysis and one edition of a dictionary of applied and clinical behavior analysis containing 280 terms. Because this work has been important to us, we hope this review will encourage similar work by behavior analysts in other countries whose native language is not English. Behavior analysis as an advanced science deserves widespread international dissemination and proper translations are essential to that goal.

Vector analysis of postcardiotomy behavioral phenomena.

PubMed

Caston, J C; Miller, W C; Felber, W J

1975-04-01

The classification of postcardiotomy behavioral phenomena in Figure 1 is proposed for use as a clinical instrument to analyze etiological determinants. The utilization of a vector analysis analogy inherently denies absolutism. Classifications A-P are presented as prototypes of certain ratio imbalances of the metabolic, hemodynamic, environmental, and psychic vectors. Such a system allows for change from one type to another according to the individuality of the patient and the highly specific changes in his clinical presentation. A vector analysis also allows for infinite intermediary ratio imbalances between classification types as a function of time. Thus, postcardiotomy behavioral phenomena could be viewed as the vector summation of hemodynamic, metabolic, environmental, and psychic processes at a given point in time. Elaboration of unknown determinants in this complex syndrome appears to be task for the future.

Exploring associations of clinical and social parameters with violent behaviors among psychiatric patients.

PubMed

Dai, Hong-Jie; Su, Emily Chia-Yu; Uddin, Mohy; Jonnagaddala, Jitendra; Wu, Chi-Shin; Syed-Abdul, Shabbir

2017-11-01

Evidence has revealed interesting associations of clinical and social parameters with violent behaviors of patients with psychiatric disorders. Men are more violent preceding and during hospitalization, whereas women are more violent than men throughout the 3days following a hospital admission. It has also been proven that mental disorders may be a consistent risk factor for the occurrence of violence. In order to better understand violent behaviors of patients with psychiatric disorders, it is important to investigate both the clinical symptoms and psychosocial factors that accompany violence in these patients. In this study, we utilized a dataset released by the Partners Healthcare and Neuropsychiatric Genome-scale and RDoC Individualized Domains project of Harvard Medical School to develop a unique text mining pipeline that processes unstructured clinical data in order to recognize clinical and social parameters such asage, gender, history of alcohol use, and violent behaviors, and explored the associations between these parameters and violent behaviors of patients with psychiatric disorders. The aim of our work was to demonstrate the feasibility of mining factors that are strongly associated with violent behaviors among psychiatric patients from unstructured psychiatric evaluation records using clinical text mining. Experiment results showed that stimulants, followed by a family history of violent behavior, suicidal behaviors, and financial stress were strongly associated with violent behaviors. Key aspects explicated in this paper include employing our text mining pipeline to extract clinical and social factors linked with violent behaviors, generating association rules to uncover possible associations between these factors and violent behaviors, and lastly the ranking of top rules associated with violent behaviors using statistical analysis and interpretation. Copyright © 2017. Published by Elsevier Inc.

Defining Behavior–Environment Interactions: Translating and Developing an Experimental and Applied Behavior-Analytic Vocabulary in and to the National Language

PubMed Central

Tuomisto, Martti T; Parkkinen, Lauri

2012-01-01

Verbal behavior, as in the use of terms, is an important part of scientific activity in general and behavior analysis in particular. Many glossaries and dictionaries of behavior analysis have been published in English, but few in any other language. Here we review the area of behavior analytic terminology, its translations, and development in languages other than English. As an example, we use our own mother tongue, Finnish, which provides a suitable example of the process of translation and development of behavior analytic terminology, because it differs from Indo-European languages and entails specific advantages and challenges in the translation process. We have published three editions of a general dictionary of behavior analysis including 801 terms relevant to the experimental analysis of behavior and applied behavior analysis and one edition of a dictionary of applied and clinical behavior analysis containing 280 terms. Because this work has been important to us, we hope this review will encourage similar work by behavior analysts in other countries whose native language is not English. Behavior analysis as an advanced science deserves widespread international dissemination and proper translations are essential to that goal. PMID:22693363

Observed Family Interactions among Subtypes of Eating Disorders Using Structural Analysis of Social Behavior.

ERIC Educational Resources Information Center

Humphrey, Laura Lynn

1989-01-01

Compared observations of family interactions among anorexic, bulimic-anorexic, bulimic, and normal families (N=74 families) consisting of father, mother, and teenage daughter. Benjamin's structural analysis of social behavior methodology differentiated clinical from normal families. Found unique patterns among subtypes of eating disorders which…

The Berlin Inventory of Gambling behavior - Screening (BIG-S): Validation using a clinical sample.

PubMed

Wejbera, Martin; Müller, Kai W; Becker, Jan; Beutel, Manfred E

2017-05-18

Published diagnostic questionnaires for gambling disorder in German are either based on DSM-III criteria or focus on aspects other than life time prevalence. This study was designed to assess the usability of the DSM-IV criteria based Berlin Inventory of Gambling Behavior Screening tool in a clinical sample and adapt it to DSM-5 criteria. In a sample of 432 patients presenting for behavioral addiction assessment at the University Medical Center Mainz, we checked the screening tool's results against clinical diagnosis and compared a subsample of n=300 clinically diagnosed gambling disorder patients with a comparison group of n=132. The BIG-S produced a sensitivity of 99.7% and a specificity of 96.2%. The instrument's unidimensionality and the diagnostic improvements of DSM-5 criteria were verified by exploratory and confirmatory factor analysis as well as receiver operating characteristic analysis. The BIG-S is a reliable and valid screening tool for gambling disorder and demonstrated its concise and comprehensible operationalization of current DSM-5 criteria in a clinical setting.

Clinimetrics and clinical psychometrics: macro- and micro-analysis.

PubMed

Tomba, Elena; Bech, Per

2012-01-01

Clinimetrics was introduced three decades ago to specify the domain of clinical markers in clinical medicine (indexes or rating scales). In this perspective, clinical validity is the platform for selecting the various indexes or rating scales (macro-analysis). Psychometric validation of these indexes or rating scales is the measuring aspect (micro-analysis). Clinical judgment analysis by experienced psychiatrists is included in the macro-analysis and the item response theory models are especially preferred in the micro-analysis when using the total score as a sufficient statistic. Clinical assessment tools covering severity of illness scales, prognostic measures, issues of co-morbidity, longitudinal assessments, recovery, stressors, lifestyle, psychological well-being, and illness behavior have been identified. The constructive dialogue in clinimetrics between clinical judgment and psychometric validation procedures is outlined for generating developments of clinical practice in psychiatry. Copyright © 2012 S. Karger AG, Basel.

In Search of Meaning: Values in Modern Clinical Behavior Analysis

ERIC Educational Resources Information Center

Plumb, Jennifer C.; Stewart, Ian; Dahl, JoAnne; Lundgren, Tobias

2009-01-01

Skinner described behavior analysis as the field of values and purpose. However, he defined these concepts in terms of a history of reinforcement and failed to specify whether and how human and nonhuman values might differ. Human values have been seen as theoretically central within a number of nonbehavioral traditions in psychology, including…

Development and initial evaluation of an instrument to assess physiotherapists' clinical reasoning focused on clients' behavior change.

PubMed

Elvén, Maria; Hochwälder, Jacek; Dean, Elizabeth; Söderlund, Anne

2018-05-01

A systematically developed and evaluated instrument is needed to support investigations of physiotherapists' clinical reasoning integrated with the process of clients' behavior change. This study's aim was to develop an instrument to assess physiotherapy students' and physiotherapists' clinical reasoning focused on clients' activity-related behavior and behavior change, and initiate its evaluation, including feasibility and content validity. The study was conducted in three phases: 1) determination of instrument structure and item generation, based on a model, guidelines for assessing clinical reasoning, and existing measures; 2) cognitive interviews with five physiotherapy students to evaluate item understanding and feasibility; and 3) a Delphi process with 18 experts to evaluate content relevance. Phase 1 resulted in an instrument with four domains: Physiotherapist; Input from client; Functional behavioral analysis; and Strategies for behavior change. The instrument consists of case scenarios followed by items in which key features are identified, prioritized, or interpreted. Phase 2 resulted in revisions of problems and approval of feasibility. Phase 3 demonstrated high level of consensus regarding the instrument's content relevance. This feasible and content-validated instrument shows potential for use in investigations of physiotherapy students' and physiotherapists' clinical reasoning, however continued development and testing are needed.

A dietary behaviors measure for use with low-income, Spanish-speaking Caribbean Latinos with type 2 diabetes: The Latino Dietary Behaviors Questionnaire (LDBQ)

PubMed Central

Fernandez, Senaida; Olendzki, Barbara; Rosal, Milagros C.

2011-01-01

This study examines the validity of a Spanish-language dietary behaviors self-report questionnaire (LDBQ) for Latinos with diabetes. The sample (n = 252) was Spanish-speaking, female (77%), middle-aged (mean age = 55 years), low-education (56% < 8th grade education), and low-income (50% < $10,000 annual household income). Baseline and 12-month measures were collected as part of a randomized clinical trial. LDBQ reliability, validity, and sensitivity to change over time were evaluated using exploratory factor analysis; internal consistency analysis; and correlation analysis using baseline and change scores for: LDBQ, three day 24-hour dietary recall nutrient mean, and clinical measures. Cronbach’s alphas were moderate. Four factors were identified at both time points. Significant baseline correlations (r) were found for LDBQ total scores, factor scores and: caloric intake (r = −.29 to −.34); total dietary fiber (r = .19); sodium (r = −.24 to −.30); percent calories from total fat (r = −.16); fat subtypes (r = −.16 to .15); and percent calories from protein (r = .17). Twelvemonth data produced a similar pattern. T-tests of LDBQ change scores showed significantly greater change in dietary behaviors for the intervention group than for the control group, t(135) = −4.17, p < .01. LDBQ change scores correlated significantly with mean 24-hour nutrient intake and a subset of clinical measures, but were not associated with clinical change scores (except HDL). The LDBQ is a useful tool to assess and target behaviors for change and assess intervention effects. PMID:21443994

Interactive Pharmacological and Behavioral Management of a Hyperactive Attention Deficit Disordered Child in an Elective Pharmacy Clerkship.

ERIC Educational Resources Information Center

Hill, John W.; Gourley, Dick R.

The principles of behavior analysis and basic behavioral definitions were utilized by clinical pharmacy students within an interdisciplinary setting to recognize and reinforce the spontaneously occurring on-task desirable behaviors of an 8-year-old hyperactive, attention deficit disordered child. Data gathered by pharmacy students from a case…

The Efficacy of Noncontingent Escape for Decreasing Children's Disruptive Behavior During Restorative Dental Treatment

PubMed Central

O'Callaghan, Patrick M; Allen, Keith D; Powell, Shawn; Salama, Fouad

2006-01-01

We evaluated the effectiveness of a dentist-implemented behavioral intervention in which brief escape from dental treatment was provided on a regular basis, independent of the child's behavior. Within a multiple baseline design across subjects, 5 children, ages 4 to 7 years, were provided with temporary escape from dental treatment on a fixed-time schedule. The intervals were signaled by an electronic timer worn by the dentist. Clinically significant reductions were observed in physically disruptive behavior across all 5 children with the introduction of noncontingent escape, and verbally disruptive behavior was markedly reduced in 4 of the 5 children. In addition, the dental staff's use of physical restraint was reduced to near zero across all 5 children. The research extends the literature in both clinical dentistry and in applied behavior analysis by demonstrating that a dentist can easily and effectively implement noncontingent reinforcement to produce clinically significant and socially important changes in children's health behavior. PMID:16813038

Patients Covertly Recording Clinical Encounters: Threat or Opportunity? A Qualitative Analysis of Online Texts

PubMed Central

Tsulukidze, Maka; Grande, Stuart W.; Thompson, Rachel; Rudd, Kenneth; Elwyn, Glyn

2015-01-01

Background The phenomenon of patients covertly recording clinical encounters has generated controversial media reports. This study aims to examine the phenomenon and analyze the underlying issues. Methods and Findings We conducted a qualitative analysis of online posts, articles, blogs, and forums (texts) discussing patients covertly recording clinical encounters. Using Google and Google Blog search engines, we identified and analyzed 62 eligible texts published in multiple countries between 2006 and 2013. Thematic analysis revealed four key themes: 1) a new behavior that elicits strong reactions, both positive and negative, 2) an erosion of trust, 3) shifting patient-clinician roles and relationships, and 4) the existence of confused and conflicting responses. When patients covertly record clinical encounters – a behavior made possible by various digital recording technologies – strong reactions are evoked among a range of stakeholders. The behavior represents one consequence of an erosion of trust between patients and clinicians, and when discovered, leads to further deterioration of trust. Confused and conflicting responses to the phenomenon by patients and clinicians highlight the need for policy guidance. Conclusions This study describes strong reactions, both positive and negative, to the phenomenon of patients covertly recording clinical encounters. The availability of smartphones capable of digital recording, and shifting attitudes to patient-clinician relationships, seems to have led to this behavior, mostly viewed as a threat by clinicians but as a welcome and helpful innovation by some patients, possibly indicating a perception of subordination and a lack of empowerment. Further examination of this tension and its implications is needed. PMID:25933002

Gender-specific effects of depression and suicidal ideation in prosocial behaviors.

PubMed

Cáceda, Ricardo; Moskovciak, Tori; Prendes-Alvarez, Stefania; Wojas, Justyna; Engel, Anzhelika; Wilker, Samantha H; Gamboa, Jorge L; Stowe, Zachary N

2014-01-01

Prosocial behaviors are essential to the ability to relate to others. Women typically display greater prosocial behavior than men. The impact of depression on prosocial behaviors and how gender interacts with those effects are not fully understood. We explored the role of gender in the potential effects of depression on prosocial behavior. We examined prosocial behaviors using a modified version of the Trust Game in a clinical population and community controls. Study participants were characterized on the severity of depression and anxiety, presence of suicidal ideation, history of childhood trauma, recent stressful life events, and impulsivity. We correlated behavioral outcomes with gender and clinical variables using analysis of variance and multiple regression analysis. The 89 participants comprised four study groups: depressed women, depressed men, healthy women and healthy men (n = 16-36). Depressed men exhibited reciprocity more frequently than healthy men. Depression induced an inversion of the gender-specific pattern of self-centered behavior. Suicidal ideation was associated with increased reciprocity behavior in both genders, and enhancement of the effect of depression on gender-specific self-centered behavior. Depression, particularly suicidal ideation, is associated with reversal of gender-specific patterns of prosocial behavior, suggesting abnormalities in sexual hormones regulation. This explanation is supported by known abnormalities in the hypothalamus-pituitary-adrenal and hypothalamus-pituitary-gonadal axes found in depression.

A Randomized Clinical Trial Comparison between Pivotal Response Treatment (PRT) and Structured Applied Behavior Analysis (ABA) Intervention for Children with Autism

ERIC Educational Resources Information Center

Mohammadzaheri, Fereshteh; Koegel, Lynn Kern; Rezaee, Mohammad; Rafiee, Seyed Majid

2014-01-01

Accumulating studies are documenting specific motivational variables that, when combined into a naturalistic teaching paradigm, can positively influence the effectiveness of interventions for children with autism spectrum disorder (ASD). The purpose of this study was to compare two applied behavior analysis (ABA) intervention procedures, a…

Application of Latent Class Analysis to Identify Behavioral Patterns of Response to Behavioral Lifestyle Interventions in Overweight and Obese Adults

PubMed Central

Fitzpatrick, Stephanie L.; Coughlin, Janelle W.; Appel, Lawrence J.; Tyson, Crystal; Stevens, Victor J.; Jerome, Gerald J.; Dalcin, Arlene; Brantley, Phillip J.; Hill-Briggs, Felicia

2016-01-01

Background Examining responders and non-responders to behavioral lifestyle interventions among overweight/obese adults with additional comorbidities may aid in refining and tailoring obesity treatment. Purpose The purpose of this study is to demonstrate the use of latent class analysis to identify patterns of response to behavioral lifestyle interventions based on adherence to diet and exercise recommendations. Method Repeated measures latent class analysis was applied to two clinical trial datasets, combination of two active interventions in the PREMIER Trial (n=501) and phase 1 of the Weight Loss Maintenance Trial (WLM; n=1685), to identify patterns of response to behavioral lifestyle interventions. Treatment response was based on adherence to daily recommendations for fruit/vegetable, fat, saturated fat, sodium, and exercise at baseline and 6 months. Results In PREMIER, three distinct latent classes emerged: responders (45.9 %), non-responders (23.6 %), and early adherers (30.5 %). Responders and Early Adherers had greater weight loss at 6 and 18 months and were more likely to meet behavioral recommendations at 18 months than Non-responders. For WLM, there were four latent classes: partial responders (16 %), non-responders (40 %), early adherers (2 %), and fruit/veggie only responders (41 %). Non-responders in WLM had significantly less weight loss at 6 months compared to that of the other three latent classes. Conclusion Latent class analysis is a useful method to apply to clinical trial data to identify distinct patterns of response to behavioral interventions. Overweight/ obese participants who respond to behavioral lifestyle treatment (i.e., meet behavioral recommendations) have significantly greater weight loss than that of participants who do not make behavioral changes. PMID:25331853

Application of Latent Class Analysis to Identify Behavioral Patterns of Response to Behavioral Lifestyle Interventions in Overweight and Obese Adults.

PubMed

Fitzpatrick, Stephanie L; Coughlin, Janelle W; Appel, Lawrence J; Tyson, Crystal; Stevens, Victor J; Jerome, Gerald J; Dalcin, Arlene; Brantley, Phillip J; Hill-Briggs, Felicia

2015-08-01

Examining responders and non-responders to behavioral lifestyle interventions among overweight/obese adults with additional comorbidities may aid in refining and tailoring obesity treatment. The purpose of this study is to demonstrate the use of latent class analysis to identify patterns of response to behavioral lifestyle interventions based on adherence to diet and exercise recommendations. Repeated measures latent class analysis was applied to two clinical trial datasets, combination of two active interventions in the PREMIER Trial (n = 501) and phase 1 of the Weight Loss Maintenance Trial (WLM; n = 1685), to identify patterns of response to behavioral lifestyle interventions. Treatment response was based on adherence to daily recommendations for fruit/vegetable, fat, saturated fat, sodium, and exercise at baseline and 6 months. In PREMIER, three distinct latent classes emerged: responders (45.9%), non-responders (23.6%), and early adherers (30.5%). Responders and Early Adherers had greater weight loss at 6 and 18 months and were more likely to meet behavioral recommendations at 18 months than Non-responders. For WLM, there were four latent classes: partial responders (16%), non-responders (40%), early adherers (2%), and fruit/veggie only responders (41%). Non-responders in WLM had significantly less weight loss at 6 months compared to that of the other three latent classes. Latent class analysis is a useful method to apply to clinical trial data to identify distinct patterns of response to behavioral interventions. Overweight/ obese participants who respond to behavioral lifestyle treatment (i.e., meet behavioral recommendations) have significantly greater weight loss than that of participants who do not make behavioral changes.

Flexible modulation of network connectivity related to cognition in Alzheimer's disease.

PubMed

McLaren, Donald G; Sperling, Reisa A; Atri, Alireza

2014-10-15

Functional neuroimaging tools, such as fMRI methods, may elucidate the neural correlates of clinical, behavioral, and cognitive performance. Most functional imaging studies focus on regional task-related activity or resting state connectivity rather than how changes in functional connectivity across conditions and tasks are related to cognitive and behavioral performance. To investigate the promise of characterizing context-dependent connectivity-behavior relationships, this study applies the method of generalized psychophysiological interactions (gPPI) to assess the patterns of associative-memory-related fMRI hippocampal functional connectivity in Alzheimer's disease (AD) associated with performance on memory and other cognitively demanding neuropsychological tests and clinical measures. Twenty-four subjects with mild AD dementia (ages 54-82, nine females) participated in a face-name paired-associate encoding memory study. Generalized PPI analysis was used to estimate the connectivity between the hippocampus and the whole brain during encoding. The difference in hippocampal-whole brain connectivity between encoding novel and encoding repeated face-name pairs was used in multiple-regression analyses as an independent predictor for 10 behavioral, neuropsychological and clinical tests. The analysis revealed connectivity-behavior relationships that were distributed, dynamically overlapping, and task-specific within and across intrinsic networks; hippocampal-whole brain connectivity-behavior relationships were not isolated to single networks, but spanned multiple brain networks. Importantly, these spatially distributed performance patterns were unique for each measure. In general, out-of-network behavioral associations with encoding novel greater than repeated face-name pairs hippocampal-connectivity were observed in the default-mode network, while correlations with encoding repeated greater than novel face-name pairs hippocampal-connectivity were observed in the executive control network (p<0.05, cluster corrected). Psychophysiological interactions revealed significantly more extensive and robust associations between paired-associate encoding task-dependent hippocampal-whole brain connectivity and performance on memory and behavioral/clinical measures than previously revealed by standard activity-behavior analysis. Compared to resting state and task-activation methods, gPPI analyses may be more sensitive to reveal additional complementary information regarding subtle within- and between-network relations. The patterns of robust correlations between hippocampal-whole brain connectivity and behavioral measures identified here suggest that there are 'coordinated states' in the brain; that the dynamic range of these states is related to behavior and cognition; and that these states can be observed and quantified, even in individuals with mild AD. Copyright © 2014 Elsevier Inc. All rights reserved.

Automated Clinical Assessment from Smart home-based Behavior Data

PubMed Central

Dawadi, Prafulla Nath; Cook, Diane Joyce; Schmitter-Edgecombe, Maureen

2016-01-01

Smart home technologies offer potential benefits for assisting clinicians by automating health monitoring and well-being assessment. In this paper, we examine the actual benefits of smart home-based analysis by monitoring daily behaviour in the home and predicting standard clinical assessment scores of the residents. To accomplish this goal, we propose a Clinical Assessment using Activity Behavior (CAAB) approach to model a smart home resident’s daily behavior and predict the corresponding standard clinical assessment scores. CAAB uses statistical features that describe characteristics of a resident’s daily activity performance to train machine learning algorithms that predict the clinical assessment scores. We evaluate the performance of CAAB utilizing smart home sensor data collected from 18 smart homes over two years using prediction and classification-based experiments. In the prediction-based experiments, we obtain a statistically significant correlation (r = 0.72) between CAAB-predicted and clinician-provided cognitive assessment scores and a statistically significant correlation (r = 0.45) between CAAB-predicted and clinician-provided mobility scores. Similarly, for the classification-based experiments, we find CAAB has a classification accuracy of 72% while classifying cognitive assessment scores and 76% while classifying mobility scores. These prediction and classification results suggest that it is feasible to predict standard clinical scores using smart home sensor data and learning-based data analysis. PMID:26292348

Recent Research on Emergent Verbal Behavior: Clinical Applications and Future Directions

ERIC Educational Resources Information Center

Grow, Laura L.; Kodak, Tiffany

2010-01-01

Previous research on the acquisition of verbal behavior in children with developmental disabilities has focused on teaching four primary verbal operants: (1) "mand"; (2) "tact"; (3) "echoic"; and (4) "intraverbal". In Skinner's (1957) analysis of verbal behavior, he stated that each verbal operant is maintained by unique antecedent and consequence…

A Meta-Analysis of Trials Evaluating Patient Education and Counseling for Three Groups of Preventive Health Behaviors.

ERIC Educational Resources Information Center

Mullen, Patricia Dolan; Simons-Morton, Denise G.; Ramirez, Gilbert; Frankowski, Ralph F.; Green, Lawrence W.; Mains, Douglas A.

1997-01-01

The overall effectiveness of patient education and counseling on preventive health behaviors was examined across published clinical trials, 1971-1994. The effectiveness of various approaches for modifying specific types of behaviors among patients without diagnosed disease was assessed. Multiple regression models indicated differences among…

The Challenge of Understanding Process in Clinical Behavior Analysis: The Case of Functional Analytic Psychotherapy

ERIC Educational Resources Information Center

Follette, William C.; Bonow, Jordan T.

2009-01-01

Whether explicitly acknowledged or not, behavior-analytic principles are at the heart of most, if not all, empirically supported therapies. However, the change process in psychotherapy is only now being rigorously studied. Functional analytic psychotherapy (FAP; Kohlenberg & Tsai, 1991; Tsai et al., 2009) explicitly identifies behavioral-change…

A Meta-Analysis of the Relationship between Trait Mindfulness and Substance Use Behaviors

PubMed Central

Karyadi, Kenny A.; VanderVeen, J. Davis; Cyders, Melissa A.

2014-01-01

Background The relationship between trait mindfulness and substance use behaviors has been inconsistent across studies. The current study is a meta-analysis aimed at quantifying the magnitude of this relationship, and at determining how this relationship varies in context of (1) mindfulness facets, (2) substance type, (3) sample characteristics, and (4) substance use severity. Methods A literature search was conducted using electronic databases. The literature search yielded 303 articles, but only 39 articles met inclusion criteria to be included in this meta-analysis. The relationship was quantified as a Pearson's r correlation coefficient for all studies. Results Findings indicated a small, negative, and significant relationship between trait mindfulness and substance use behaviors (r = -0.13). This relationship varied across substance type, clinical status of the sample, and substance use severity. Although not significant, relationship sizes showed different patterns across mindfulness facets. Conclusions This meta-analysis quantified the relationship between trait mindfulness and substance use behaviors, which can be used as future effect size estimates. Findings also clarify inconsistency in previous work by indicating that the trait mindfulness-substance use behaviors relationship was more robust: (1) for alcohol use and tobacco use behaviors; (2) for problematic substance use behaviors; and (3) with inpatient clinical samples. Further work should continue to examine if acting with awareness, non-judgment, and non-reactivity mindfulness facets are more robustly associated with substance use behaviors. Failure to consider these factors, or collapsing across these factors, could explain the smaller or inconsistently reported associations across previous studies. PMID:25113434

Upgrading from VVI to DDD pacing Mode during elective replacement of pulse generator: a comparative clinical-functional analysis.

PubMed

Teno, Luiz Antonio Castilho; Costa, Roberto; Martinelli Filho, Martino; Castilho, Fabian Cecchi Teno; Ruiz, Ivan

2007-02-01

Evaluate the clinical and functional behavior of the ventricular and atrioventricular stimulation modes in the elective replacement of pulse generator in patients with chagasic cardiopathy and atrioventricular block. Twenty-seven patients under ventricular and atrioventricular stimulation were comparatively evaluated at the beginning of the study, and alternately in ventricular and atrioventricular modes in two 90-day phases, with regard to: the clinical behavior evaluated according to quality of life and functional class, and the functional behavior evaluated by transthoracic echocardiography and the six-minute walk test. The statistical analysis was performed with patients at baseline, and under ventricular and atrioventricular modes, using the chi-square test and the repeated measures analysis of variance, and taking into consideration a 0.05 level of significance. The mean quality-of-life scores were: functional capacity (VVI 71.3+/-18.2 , DDD 69.3+/-20.4); overall health status (VVI 68.1+/-21.8, DDD 69.4+/-19.4) and vitality (VVI 64.8+/-24.6 , DDD 67.6+/-25.5); on echocardiography: LVEF (VVI 52.5+/-12.8 , DDD 51.8+/-14.9), LVDD (VVI 53.0+/-7.7 , DDD 42.4+/-7.8), LA (VVI 38.6+/-5.4 DDD 38.5+/-5.1), and in the six-minute walk test: distance walked (VVI 463.4+/-84.7, DDD 462.6+/-63.4). There were four cases of complications, three of them associated with the change in stimulation mode. This study showed no differences between the two stimulation modes in the clinical behavior assessed by quality of life and functional class, and in the functional behavior, evaluated according to the ecochardiographic findings and the six-minute walk test.

Effectiveness of and Dropout from Outpatient Cognitive Behavioral Therapy for Adult Unipolar Depression: A Meta-Analysis of Nonrandomized Effectiveness Studies

ERIC Educational Resources Information Center

Hans, Eva; Hiller, Wolfgang

2013-01-01

Objective: The primary aim of this study was to assess the overall effectiveness of and dropout from individual and group outpatient cognitive behavioral therapy (CBT) for adults with a primary diagnosis of unipolar depressive disorder in routine clinical practice. Method: We conducted a random effects meta-analysis of 34 nonrandomized…

Second-generation antipsychotic use in schizophrenia and associated weight gain: a critical review and meta-analysis of behavioral and pharmacologic treatments.

PubMed

Das, Chandan; Mendez, Guillermo; Jagasia, Sonal; Labbate, Lawrence A

2012-08-01

Weight gain in schizophrenia, particularly secondary to second-generation antipsychotic (SGA) use, is a common adverse effect and often is associated with significant physical and psychological morbidity. We performed a critical literature review of all controlled clinical trials for pharmacologic and/or behavioral management of SGA-induced weight gain in schizophrenia patients by searching PubMed and Google Scholar. A meta-analysis was performed to estimate and compare weight changes for various medications and behavioral interventions. Sample sizes generally were small. Clinical trials were 6 weeks to 1 year, and weight loss was modest with any treatment. Although several adjunctive pharmacologic treatments showed no weight loss, sibutramine, metformin, and topiramate showed some benefit. Amantadine and orlistat were somewhat less effective and had lower rates of tolerability. Among the behavioral therapies, nutritional counseling combined with exercise showed the most benefit. Behavioral therapies, although modest, showed the most consistent benefits compared with controls. Scheduled pharmacologic treatment to prevent weight gain or promote weight loss in schizophrenia patients on SGA therapy is limited based on current studies. Switching antipsychotic agents has not been established as a long-term solution. Additional long-term studies are required to influence clinical practice.

Clinical Profiles of Children with Disruptive Behaviors Based on the Severity of Their Conduct Problems, Callous-Unemotional Traits and Emotional Difficulties.

PubMed

Andrade, Brendan F; Sorge, Geoff B; Na, Jennifer Jiwon; Wharton-Shukster, Erika

2015-08-01

This study identified clinical profiles of referred children based on the severity of callous-unemotional (CU) traits, emotional difficulties, and conduct problems. Parents of 166 children (132 males) aged 6-12 years referred to a hospital clinic because of disruptive behavior completed measures to assess these key indicators, and person-centered analysis was used to identify profiles. Four distinct profiles were identified that include: (1) Children low in severity on the three domains, (2) Children high in severity on the three domains, (3) Children high in severity in conduct problems and CU traits with minimal emotional difficulties, and (4) Children high in severity in conduct problems and emotional difficulties with minimal CU traits. Profiles differed in degree of aggression and behavioral impairment. Findings show that clinic-referred children with disruptive behaviors can be grouped based on these important indicators into profiles that have important implications for assessment and treatment selection.

Advances in the indirect, descriptive, and experimental approaches to the functional analysis of problem behavior.

PubMed

Wightman, Jade; Julio, Flávia; Virués-Ortega, Javier

2014-05-01

Experimental functional analysis is an assessment methodology to identify the environmental factors that maintain problem behavior in individuals with developmental disabilities and in other populations. Functional analysis provides the basis for the development of reinforcement-based approaches to treatment. This article reviews the procedures, validity, and clinical implementation of the methodological variations of functional analysis and function-based interventions. We present six variations of functional analysis methodology in addition to the typical functional analysis: brief functional analysis, single-function tests, latency-based functional analysis, functional analysis of precursors, and trial-based functional analysis. We also present the three general categories of function-based interventions: extinction, antecedent manipulation, and differential reinforcement. Functional analysis methodology is a valid and efficient approach to the assessment of problem behavior and the selection of treatment strategies.

Behavioral Analysis of Visitors to a Medical Institution's Website Using Markov Chain Monte Carlo Methods.

PubMed

Suzuki, Teppei; Tani, Yuji; Ogasawara, Katsuhiko

2016-07-25

Consistent with the "attention, interest, desire, memory, action" (AIDMA) model of consumer behavior, patients collect information about available medical institutions using the Internet to select information for their particular needs. Studies of consumer behavior may be found in areas other than medical institution websites. Such research uses Web access logs for visitor search behavior. At this time, research applying the patient searching behavior model to medical institution website visitors is lacking. We have developed a hospital website search behavior model using a Bayesian approach to clarify the behavior of medical institution website visitors and determine the probability of their visits, classified by search keyword. We used the website data access log of a clinic of internal medicine and gastroenterology in the Sapporo suburbs, collecting data from January 1 through June 31, 2011. The contents of the 6 website pages included the following: home, news, content introduction for medical examinations, mammography screening, holiday person-on-duty information, and other. The search keywords we identified as best expressing website visitor needs were listed as the top 4 headings from the access log: clinic name, clinic name + regional name, clinic name + medical examination, and mammography screening. Using the search keywords as the explaining variable, we built a binomial probit model that allows inspection of the contents of each purpose variable. Using this model, we determined a beta value and generated a posterior distribution. We performed the simulation using Markov Chain Monte Carlo methods with a noninformation prior distribution for this model and determined the visit probability classified by keyword for each category. In the case of the keyword "clinic name," the visit probability to the website, repeated visit to the website, and contents page for medical examination was positive. In the case of the keyword "clinic name and regional name," the probability for a repeated visit to the website and the mammography screening page was negative. In the case of the keyword "clinic name + medical examination," the visit probability to the website was positive, and the visit probability to the information page was negative. When visitors referred to the keywords "mammography screening," the visit probability to the mammography screening page was positive (95% highest posterior density interval = 3.38-26.66). Further analysis for not only the clinic website but also various other medical institution websites is necessary to build a general inspection model for medical institution websites; we want to consider this in future research. Additionally, we hope to use the results obtained in this study as a prior distribution for future work to conduct higher-precision analysis.

Behavioral Analysis of Visitors to a Medical Institution’s Website Using Markov Chain Monte Carlo Methods

PubMed Central

Tani, Yuji

2016-01-01

Background Consistent with the “attention, interest, desire, memory, action” (AIDMA) model of consumer behavior, patients collect information about available medical institutions using the Internet to select information for their particular needs. Studies of consumer behavior may be found in areas other than medical institution websites. Such research uses Web access logs for visitor search behavior. At this time, research applying the patient searching behavior model to medical institution website visitors is lacking. Objective We have developed a hospital website search behavior model using a Bayesian approach to clarify the behavior of medical institution website visitors and determine the probability of their visits, classified by search keyword. Methods We used the website data access log of a clinic of internal medicine and gastroenterology in the Sapporo suburbs, collecting data from January 1 through June 31, 2011. The contents of the 6 website pages included the following: home, news, content introduction for medical examinations, mammography screening, holiday person-on-duty information, and other. The search keywords we identified as best expressing website visitor needs were listed as the top 4 headings from the access log: clinic name, clinic name + regional name, clinic name + medical examination, and mammography screening. Using the search keywords as the explaining variable, we built a binomial probit model that allows inspection of the contents of each purpose variable. Using this model, we determined a beta value and generated a posterior distribution. We performed the simulation using Markov Chain Monte Carlo methods with a noninformation prior distribution for this model and determined the visit probability classified by keyword for each category. Results In the case of the keyword “clinic name,” the visit probability to the website, repeated visit to the website, and contents page for medical examination was positive. In the case of the keyword “clinic name and regional name,” the probability for a repeated visit to the website and the mammography screening page was negative. In the case of the keyword “clinic name + medical examination,” the visit probability to the website was positive, and the visit probability to the information page was negative. When visitors referred to the keywords “mammography screening,” the visit probability to the mammography screening page was positive (95% highest posterior density interval = 3.38-26.66). Conclusions Further analysis for not only the clinic website but also various other medical institution websites is necessary to build a general inspection model for medical institution websites; we want to consider this in future research. Additionally, we hope to use the results obtained in this study as a prior distribution for future work to conduct higher-precision analysis. PMID:27457537

Comprehensive Psychometric Analysis of the Eyberg Child Behavior Inventory in Children with Autism Spectrum Disorder

ERIC Educational Resources Information Center

Jeter, Kathryn; Zlomke, Kimberly; Shawler, Paul; Sullivan, Maureen

2017-01-01

Many assessment measures have only been validated for one specific diagnostic population, which is costly and reduces the clinical utility of assessments. The Eyberg Child Behavior Inventory (ECBI) is one popular measure designed to assess disruptive behavior problems in youth. The ECBI has sound psychometric properties in typically developing…

Barriers and Facilitators to Deaf Trauma Survivors' Help-Seeking Behavior: Lessons for Behavioral Clinical Trials Research

ERIC Educational Resources Information Center

Anderson, Melissa L.; Wolf Craig, Kelly S.; Ziedonis, Douglas M.

2017-01-01

Deaf individuals experience significant obstacles to participating in behavioral health research when careful consideration is not given to accessibility during the design of study methodology. To inform such considerations, we conducted an exploratory secondary analysis of a mixed-methods study that originally explored 16 Deaf trauma survivors'…

Normative Emotional Responses to Behavior Analysis Jargon or How Not to Use Words to Win Friends and Influence People.

PubMed

Critchfield, Thomas S; Doepke, Karla J; Kimberly Epting, L; Becirevic, Amel; Reed, Derek D; Fienup, Daniel M; Kremsreiter, Jamie L; Ecott, Cheryl L

2017-06-01

It has been suggested that non-experts regard the jargon of behavior analysis as abrasive, harsh, and unpleasant. If this is true, excessive reliance on jargon could interfere with the dissemination of effective services. To address this often discussed but rarely studied issue, we consulted a large, public domain list of English words that have been rated by members of the general public for the emotional reactions they evoke. Selected words that behavior analysts use as technical terms were compared to selected words that are commonly used to discuss general science, general clinical work, and behavioral assessment. There was a tendency for behavior analysis terms to register as more unpleasant than other kinds of professional terms and also as more unpleasant than English words generally. We suggest possible reasons for this finding, discuss its relevance to the challenge of deciding how to communicate with consumers who do not yet understand or value behavior analysis, and advocate for systematic research to guide the marketing of behavior analysis.

Research training of Developmental-Behavioral Pediatrics fellows: a survey of fellowship directors by Developmental-Behavioral Pediatrics Research Network.

PubMed

Wiley, Susan; Schonfeld, David J; Fredstrom, Bridget; Huffman, Lynne

2013-01-01

To describe research training in Developmental-Behavioral Pediatrics (DBP) Fellowship Programs. Thirty-five US-accredited DBP fellowships were contacted through the Developmental-Behavioral Pediatrics Research Network to complete an online survey on scholarly work and research training. With an 83% response rate, responding programs represented 110 (87 filled) fellowship positions. External funding for fellowship positions was minimal (11 positions fully funded, 13 funded above 50% of cost). Structured research training included didactic lectures, web-based training, university courses, direct mentoring, journal clubs, and required reading. Of the 159 fellows described, spanning a 5-year training period, the majority chose projects relying on their own data collection (57%) rather than joining an existing research study and focused on clinical research (86%). Among 96 fellows with completed scholarly work, 29% were observational/epidemiological studies, 22% secondary analyses of large data sets, 16% community-based research, and 15% survey design. A limited number of fellows pursued basic science, meta-analysis/critical appraisal of the literature, or analysis of public policy. Barriers to successful fellow research are as follows: lack of time and money, challenges in balancing clinical demands and protected faculty research time, limited faculty research opportunities, time or expertise, and a lack of infrastructure for fellow research mentoring. The scholarly work of fellows in DBP fellowship programs has primarily focused on clinical research using observational/epidemiological research and secondary analysis of large data set. Barriers largely in faculty time and expertise for research mentoring and inadequate funding in programs that have high clinical demands and little resources for research efforts were noted.

Can virtual reality exposure therapy gains be generalized to real-life? A meta-analysis of studies applying behavioral assessments.

PubMed

Morina, Nexhmedin; Ijntema, Hiske; Meyerbröker, Katharina; Emmelkamp, Paul M G

2015-11-01

In virtual reality exposure therapy (VRET), patients are exposed to virtual environments that resemble feared real-life situations. The aim of the current study was to assess the extent to which VRET gains can be observed in real-life situations. We conducted a meta-analysis of clinical trials applying VRET to specific phobias and measuring treatment outcome by means of behavioral laboratory tests or recordings of behavioral activities in real-life. Data sources were searches of databases (Medline, PsycInfo, and Cochrane). We included in total 14 clinical trials on specific phobias. Results revealed that patients undergoing VRET did significantly better on behavioral assessments following treatment than before treatment, with an aggregated uncontrolled effect size of g = 1.23. Furthermore, patients undergoing VRET performed better on behavioral assessments at post-treatment than patients on wait-list (g = 1.41). Additionally, results of behavioral assessment at post-treatment and at follow-up revealed no significant differences between VRET and exposure in vivo (g = -0.09 and 0.53, respectively). Finally, behavioral measurement effect sizes were similar to those calculated from self-report measures. The findings demonstrate that VRET can produce significant behavior change in real-life situations and support its application in treating specific phobias. Copyright © 2015 Elsevier Ltd. All rights reserved.

A Randomized Clinical Trial Comparison Between Pivotal Response Treatment (PRT) and Adult-Driven Applied Behavior Analysis (ABA) Intervention on Disruptive Behaviors in Public School Children with Autism.

PubMed

Mohammadzaheri, Fereshteh; Koegel, Lynn Kern; Rezaei, Mohammad; Bakhshi, Enayatolah

2015-09-01

Children with autism often demonstrate disruptive behaviors during demanding teaching tasks. Language intervention can be particularly difficult as it involves social and communicative areas, which are challenging for this population. The purpose of this study was to compare two intervention conditions, a naturalistic approach, Pivotal Response Treatment (PRT) with an adult-directed ABA approach on disruptive behavior during language intervention in the public schools. A randomized clinical trial design was used with two groups of children, matched according to age, sex and mean length of utterance. The data showed that the children demonstrated significantly lower levels of disruptive behavior during the PRT condition. The results are discussed with respect to antecedent manipulations that may be helpful in reducing disruptive behavior.

A Randomized Clinical Trial Comparison Between Pivotal Response Treatment (PRT) and Adult-Driven Applied Behavior Analysis (ABA) Intervention on Disruptive Behaviors in Public School Children with Autism

PubMed Central

Mohammadzaheri, Fereshteh; Koegel, Lynn Kern; Rezaei, Mohammad; Bakhshi, Enayatolah

2015-01-01

Children with autism often demonstrate disruptive behaviors during demanding teaching tasks. Language intervention can be particularly difficult as it involves social and communicative areas, which are challenging for this population. The purpose of this study was to compare two intervention conditions, a naturalistic approach, Pivotal Response Treatment (PRT) with a structured ABA approach on disruptive behavior during language intervention in the public schools. A Randomized Clinical Trial (RCT) design was used with two groups of children, matched according to age, sex and mean length of utterance. The data showed that the children demonstrated significantly lower levels of disruptive behavior during the PRT condition. The results are discussed with respect to antecedent manipulations that may be helpful in reducing disruptive behavior. PMID:25953148

Behavioral and cognitive outcomes for clinical trials in children with neurofibromatosis type 1.

PubMed

van der Vaart, Thijs; Rietman, André B; Plasschaert, Ellen; Legius, Eric; Elgersma, Ype; Moll, Henriëtte A

2016-01-12

To evaluate the appropriateness of cognitive and behavioral outcome measures in clinical trials in neurofibromatosis type 1 (NF1) by analyzing the degree of deficits compared to reference groups, test-retest reliability, and how scores correlate between outcome measures. Data were analyzed from the Simvastatin for cognitive deficits and behavioral problems in patients with neurofibromatosis type 1 (NF1-SIMCODA) trial, a randomized placebo-controlled trial of simvastatin for cognitive deficits and behavioral problems in children with NF1. Outcome measures were compared with age-specific reference groups to identify domains of dysfunction. Pearson r was computed for before and after measurements within the placebo group to assess test-retest reliability. Principal component analysis was used to identify the internal structure in the outcome data. Strongest mean score deviations from the reference groups were observed for full-scale intelligence (-1.1 SD), Rey Complex Figure Test delayed recall (-2.0 SD), attention problems (-1.2 SD), and social problems (-1.1 SD). Long-term test-retest reliability were excellent for Wechsler scales (r > 0.88), but poor to moderate for other neuropsychological tests (r range 0.52-0.81) and Child Behavioral Checklist subscales (r range 0.40-0.79). The correlation structure revealed 2 strong components in the outcome measures behavior and cognition, with no correlation between these components. Scores on psychosocial quality of life correlate strongly with behavioral problems and less with cognitive deficits. Children with NF1 show distinct deficits in multiple domains. Many outcome measures showed weak test-retest correlations over the 1-year trial period. Cognitive and behavioral outcomes are complementary. This analysis demonstrates the need to include reliable outcome measures on a variety of cognitive and behavioral domains in clinical trials for NF1. © 2015 American Academy of Neurology.

MAOA, childhood maltreatment and antisocial behavior: Meta-analysis of a gene-environment interaction

PubMed Central

Byrd, Amy L.; Manuck, Stephen B.

2013-01-01

Background In a seminal study of gene-environment interaction, childhood maltreatment predicted antisocial behavior more strongly in males carrying an MAOA promoter variant of lesser, compared to higher, transcriptional efficiency. Many further investigations have been reported, including studies of other early environmental exposures and females. Here we report a meta-analysis of studies testing the interaction of MAOA genotype and childhood adversities on antisocial outcomes in predominantly non-clinical samples. Method Included were 27 peer-reviewed, English-language studies published through August, 2012, that contained indicators of maltreatment or “other” family (e.g., parenting, sociodemographic) hardships; MAOA genotype; indices of aggressive and antisocial behavior; and statistical test of genotype-environment interaction. Studies of forensic and exclusively clinical samples, clinical cohorts lacking proportionally matched controls, or outcomes non-specific for antisocial behavior were excluded. The Liptak-Stouffer weighted Z-test for meta-analysis was implemented to maximize study inclusion and calculated separately for male and female cohorts. Results Across 20 male cohorts, early adversity presaged antisocial outcomes more strongly for low, relative to high, activity MAOA genotype (P=.0044). Stratified analyses showed the interaction specific to maltreatment (P=.0000008) and robust to several sensitivity analyses. Across 11 female cohorts, MAOA did not interact with combined early life adversities, whereas maltreatment alone predicted antisocial behaviors preferentially, but weakly, in females of high activity MAOA genotype (P=.02). Conclusions We found common regulatory variation in MAOA to moderate effects of childhood maltreatment on male antisocial behaviors, confirming a sentinel finding in research on gene-environment interaction. An analogous, but less consistent, finding in females warrants further investigation. PMID:23786983

Using Integrative Data Analysis to Examine Changes in Alcohol Use and Changes in Sexual Risk Behavior across Four Samples of STI Clinic Patients

PubMed Central

Walsh, Jennifer L.; Weinhardt, Lance S.; Kalichman, Seth C.; Carey, Michael P.

2016-01-01

Background Patients in sexually transmitted infection (STI) clinics report high levels of alcohol use, which are associated with risky sexual behavior. However, no studies have examined how changes in alcohol use relate to changes in sexual risk behavior. Purpose We used parallel process latent growth modeling to explore how changes in alcohol use related to changes in sexual behavior across four samples of clinic patients. Methods Patients participating in HIV prevention trials from urban clinics in the Northeastern and Midwestern U.S. (N = 3,761, 59% male, 72% Black) completed measures at 3mo intervals over 9-12mo. Integrative data analysis was used to create composite measures of alcohol use across samples. Sexual risk measures were counts of partners and unprotected sex acts. Parallel process models tested whether alcohol use changes were correlated with changes in number of partners and unprotected sex. Results Growth models with good fit showed decreases that slowed over time in sexual risk behaviors and alcohol use. Parallel process models showed positive correlations between levels of (rs =.17-.40, ps < .001) and changes in (rs = .21-.80, ps < .05) alcohol use and number of sexual partners across studies. There were strong associations between levels of (rs = .25-.43, ps < .001) and changes in (rs = .24-.57, ps < .01) alcohol use and unprotected sex in one study recruiting hazardous drinkers. Conclusions Across four samples of clinic patients, reductions in alcohol use were associated with reductions in the number of sexual partners. HIV prevention interventions may be strengthened by addressing alcohol use. PMID:27550626

Patterns in clinical students' self-regulated learning behavior: a Q-methodology study.

PubMed

Berkhout, Joris J; Teunissen, Pim W; Helmich, Esther; van Exel, Job; van der Vleuten, Cees P M; Jaarsma, Debbie A D C

2017-03-01

Students feel insufficiently supported in clinical environments to engage in active learning and achieve a high level of self-regulation. As a result clinical learning is highly demanding for students. Because of large differences between students, supervisors may not know how to support them in their learning process. We explored patterns in undergraduate students' self-regulated learning behavior in the clinical environment, to improve tailored supervision, using Q-methodology. Q-methodology uses features of both qualitative and quantitative methods for the systematic investigation of subjective issues by having participants sort statements along a continuum to represent their opinion. We enrolled 74 students between December 2014 and April 2015 and had them characterize their learning behavior by sorting 52 statements about self-regulated learning behavior and explaining their response. The statements used for the sorting were extracted from a previous study. The data was analyzed using by-person factor analysis to identify clusters of individuals with similar sorts of the statements. The resulting factors and qualitative data were used to interpret and describe the patterns that emerged. Five resulting patterns were identified in students' self-regulated learning behavior in the clinical environment, which we labelled: Engaged, Critically opportunistic, Uncertain, Restrained and Effortful. The five patterns varied mostly regarding goals, metacognition, communication, effort, and dependence on external regulation for learning. These discrete patterns in students' self-regulated learning behavior in the clinical environment are part of a complex interaction between student and learning context. The results suggest that developing self-regulated learning behavior might best be supported regarding individual students' needs.

Factors relating to transmission of viral hepatitis in a United States military population stationed in Thailand.

PubMed

Scott, R M; Schneider, R J; Snitbhan, R; Karwacki, J J

1981-05-01

To determine the incidence of clinical and inapparent hepatitis in a US military population stationed in Thailand, the authors prospectively studied a cohort of 326 men during one year. Clinical hepatitis A occurred in one man (clinical attack rate = 3.1/1000 men/year), and clinical hepatitis B was found in four men (clinical attack rate = 12.3/1000 men/year). No non-A, non-B hepatitis was identified. There was no serologically identified inapparent hepatitis A but inapparent hepatitis B occurred in 17 men. The apparent/inapparent ratio for hepatitis B was 1:4.25. Serotype analysis suggested that hepatitis B virus largely originated from Thai contacts, although 23% of cases were derived from western sources. To determine the relative contribution of 16 statistically significant (out of 67 studied) behavioral variables to the transmission of HBV, a factor analysis and a multivariate correlation analysis were employed. Factor analysis indicated that social and sexual contact with the indigenous population, including prostitutes, residence within the Thai community and marijuana use were behavioral areas that were associated with the acquisition of hepatitis B. Residence in the Thai community during the first four-month period in Thailand, sexual contact with a prostitute during the third four-month period, and ever having maintained a Thai mistress were found to be significant and independent risk factors by multiple regression analysis.

Millon Clinical Multiaxial Inventory-III Subtypes of Opioid Dependence: Validity and Matching to Behavioral Therapies

ERIC Educational Resources Information Center

Ball, Samuel A.; Nich, Charla; Rounsaville, Bruce J.; Eagan, Dorothy; Carroll, Kathleen M.

2004-01-01

The concurrent and predictive validity of 2 different methods of Millon Clinical Multiaxial Inventory-III subtyping (protocol sorting, cluster analysis) was evaluated in 125 recently detoxified opioid-dependent outpatients in a 12-week randomized clinical trial. Participants received naltrexone and relapse prevention group counseling and were…

Behavioral Marital Bibliotherapy: An Initial Investigation of Therapeutic Efficacy.

ERIC Educational Resources Information Center

Bornstein, Philip H.; And Others

1984-01-01

Reports an attempt to validate a self-help behavioral marital bibliotherapy program. Evaluated five clinical distressed couples via a multiple baseline analysis. Treatment involved reading and exercises covering communications, problem solving, and sexual dysfunction. Results were highly variable and reflected minimal change. (BH)

Using Analogue Functional Analysis to Measure Variations in Problem Behavior Rate and Function after Psychotropic Medication Changes: A Clinical Demonstration

ERIC Educational Resources Information Center

Valdovinos, Maria G.; Nelson, Samantha M.; Kuhle, Jennifer L.; Dierks, Abigail M.

2009-01-01

Individuals with intellectual and developmental disabilities are often prescribed psychotropic medication to treat behaviors such as aggression and self-injury. Evaluation of these medications is often based on caregiver report or changes in frequency of behavior. The purpose of this research was to characterize the rate and function of problem…

Self-management support in primary care: enactments, disruptions, and conversational consequences.

PubMed

Thille, Patricia; Ward, Natalie; Russell, Grant

2014-05-01

A common refrain in chronic disease management is that patients and clinicians need to enact new roles: patients as their own caregivers; clinicians as professional supporters of patient self-management activities. These roles are central to self-management support (SMS), an approach that emphasizes a clinical partnership, and promotes patient identification and achievement of realistic and short-term behavioral goals. With SMS, behavior change is the desired end, not the means to a desired biomedical end. Shifting SMS concepts into clinical practice has proven to be difficult and inconsistent, creating potential, unknown risks or harms to patients. We completed a discourse analysis of 16 clinical dialogues between diabetic patients and clinicians, collected during a study of six Ontario Family Health Teams, to explore the questions of risks and harms relating to SMS implementation. We observed varying degrees of incomplete implementation of SMS, as well as interactions that actively negated the core principles. Contrary to SMS principles, clinicians tended to emphasize behavioral changes as means to achieve biomedical ends, though to varying degrees. We present two appointments in detail, highlighting how linking behavior change closely with biomedical measures often elicited face-saving defenses from patients. The subsequent dialogue shifted attention away from problem solving and behavior change into active negotiation of responsibility and identity. Interactions that oriented more to SMS concepts elicited fewer defensive maneuvers from patients. Our analysis helps explicate one additional mechanism by which self-management talk threatens the clinical relationship, and highlights a promising method to mitigate this threat. Copyright © 2014 Elsevier Ltd. All rights reserved.

Behavioral Economics and Empirical Public Policy

ERIC Educational Resources Information Center

Hursh, Steven R.; Roma, Peter G.

2013-01-01

The application of economics principles to the analysis of behavior has yielded novel insights on value and choice across contexts ranging from laboratory animal research to clinical populations to national trends of global impact. Recent innovations in demand curve methods provide a credible means of quantitatively comparing qualitatively…

A Content Analysis of Problematic Behavior in Counselor Education Programs

ERIC Educational Resources Information Center

Brown, Maranda

2013-01-01

Counselor education programs are obligated by accreditation standards and professional codes of ethics to identify counselors-in-training whose academic, clinical, and personal performance indicate problematic behavior that would potentially prevent them from entering the profession (McAdams, Foster, & Ward, 2007; Rust, Raskin, & Hill,…

Maternal-child dyads of functioning: the intergenerational impact of violence against women on children.

PubMed

McFarlane, Judith; Symes, Lene; Binder, Brenda K; Maddoux, John; Paulson, Rene

2014-11-01

Violence against women is a global epidemic with potential consequences of injury, illness, and death. Children exposed to the violence may also be impacted with functional impairments. Little is known of the inter-generational impact of violence experienced by the mother from an intimate partner on functioning of her children. No dyad analysis was found in the literature. To examine the inter-generational impact of violence against women on the behavioral functioning of children, 300 mothers reporting intimate partner abuse and one randomly chosen child, age 18 months to 16 years of age; were evaluated for borderline and clinical diagnostic levels of problem behaviors. Linear, Logistic, and Ordinal regression models were applied. Mothers' problem behavior scores were significantly related to children's problem behavior scores (internalizing r = 0.611, externalizing r = 0.494, total problems r = 0.662, all ps < 0.001). Mothers who reported clinical and borderline clinical internalized problems (i.e., depression, anxiety) were 7 times more likely to have children with the same problems and mothers with borderline clinical and clinical external problems (i.e., aggression, hostility) were 4.5 times more likely to have children with the same external problems. These dyadic analyses provide evidence of a direct relationship of maternal functioning on child behavioral functioning. Intervention strategies to decrease internalizing maternal behavioral problems, such as depression, anxiety, and post traumatic stress disorder, and/or externalizing problems, such as hostility and aggression, can be expected to have a pass through, secondary impact on the behavioral functioning of children. Awareness of the relationship between intimate partner violence against mothers and child behavioral function can support interventions that decrease the distress experienced by mothers and their children, interrupt intergenerational transmission of abusive behaviors, and promote better maternal child functioning.

An Evaluation of Instructive Feedback to Teach Play Behavior to a Child with Autism Spectrum Disorder.

PubMed

Grow, Laura L; Kodak, Tiffany; Clements, Andrea

2017-09-01

Instructive feedback is used to expose learners to secondary targets during skill acquisition programs (Reichow & Wolery, in Journal of Applied Behavior Analysis, 44 , 327-340, 2011; Werts, Wolery, Gast, & Holcombe, in Journal of Behavioral Education, 5 , 55-75, 1995). Although unrelated feedback may have clinical utility in practice, very little research has evaluated unrelated instructive feedback, particularly for promoting play behavior (Colozzi, Ward, & Crotty, in Education and Training in Developmental Disabilities, 43 , 226-248, 2008). The purpose of the study was to determine if play emerged after embedding instructive feedback during the consequence portion of discrete trial training to teach tacts. An adapted alternating treatments design was used to compare tact training with and without instructive feedback for play behaviors. Instructive feedback resulted in the emergence of play behaviors during tabletop instruction and a play area of a classroom. We discuss the results in terms of clinical practice and future research.

Digital Parent Training for Children with Disruptive Behaviors: Systematic Review and Meta-Analysis of Randomized Trials.

PubMed

Baumel, Amit; Pawar, Aditya; Kane, John M; Correll, Christoph U

2016-10-01

Digital-based parent training (DPT) programs for parents of children with disruptive behaviors have been developed and tested in randomized trials. The aim of this study was to quantitatively assess the efficacy of these programs versus a control condition. We conducted a systematic review and random effects meta-analysis of peer-reviewed randomized studies comparing DPT targeting children with disruptive behaviors versus a control group (wait list or no treatment). Altogether, seven studies (n = 718) were meta-analyzed. Compared to the control groups, DPT resulted in significantly greater improvement in child behavior (effect size [ES] = 0.44, 95% confidence interval [CI] = 0.21-0.66, studies = 7), parent behavior (ES = 0.41, 95% CI = 0.25-0.57, studies = 6), and parental confidence (ES = 0.36, 95% CI = 0.12-0.59, studies = 4). The improvement in child behavior was moderated by age group and severity of clinical presentation, which overlapped 100%. While DPT was superior to control conditions in studies of young children (mean age <7 years) with a clinical range of disruptive behaviors (ES = 0.61, 95% CI = 0.40-0.82, studies = 4), results were nonsignificant in studies of older children (mean age >11 years) with a nonclinical range of symptoms (ES = 0.21, 95% CI = -0.01 to 0.42, studies = 3). Analyses yielded similar results of higher ESs favoring studies of young children with clinical range disruptive behaviors for parent behavior and parental confidence, but the differences were not significant. Results further suggested that in studies of younger children, interactive programs (e.g., computerized programs) were more effective in improving child behavior compared to noninteractive programs (e.g., watching video clips) (p < 0.05). Although additional studies are needed, DPT holds promise as a potentially scalable evidence-based treatment of children with disruptive behaviors that can save human resources.

The Structure of Pathological Gambling among Korean Gamblers: A Cluster and Factor Analysis of Clinical and Demographic Characteristics

ERIC Educational Resources Information Center

Lee, Tae Kyung; LaBrie, Richard A.; Grant, Jon E.; Kim, Suck Won; Shaffer, Howard J.

2008-01-01

This paper reports the underlying structure of the demographic and clinical characteristics of level 3 (i.e., pathological) Korean casino gamblers. The participants reported their gambling behavior and clinical characteristics known to be associated with gambling problems (e.g., alcohol use problems, eating disorders, depression, anxiety, and…

A Randomized Clinical Trial Comparison between Pivotal Response Treatment (PRT) and Adult-Driven Applied Behavior Analysis (ABA) Intervention on Disruptive Behaviors in Public School Children with Autism

ERIC Educational Resources Information Center

Mohammadzaheri, Fereshteh; Koegel, Lynn Kern; Rezaei, Mohammad; Bakhshi, Enayatolah

2015-01-01

Children with autism often demonstrate disruptive behaviors during demanding teaching tasks. Language intervention can be particularly difficult as it involves social and communicative areas, which are challenging for this population. The purpose of this study was to compare two intervention conditions, a naturalistic approach, Pivotal Response…

Interpreting problematic behavior: systematic compensatory adaptations as emergent phenomena in autism.

PubMed

Damico, Jack S; Nelson, Ryan L

2005-01-01

Based upon an emergent account of pragmatic ability and disability, this article provides theoretical and empirical support for a conceptually deeper understanding of some systematic behaviors that have served as diagnostic indices in communicatively impaired populations. Specifically, by employing conversation analysis, several examples of problematic behaviors in autism are analysed as a specific type of compensatory adaptation. Theoretical and clinical implications are discussed.

The Integration of Behavioral Science Theory and Clinical Experience for Second-Year Medical Students.

ERIC Educational Resources Information Center

Taylor, Kathryn M.; And Others

1983-01-01

A program is described that relates behavioral science research to cancer care, encourages frank discussion and objective analysis of oncology practice, and attempts to dispell the myth that cancer patients are not medically manageable. A wide range of teaching methods are used. (MSE)

Phencyclidine and violence: clinical and legal issues.

PubMed

Brecher, M; Wang, B W; Wong, H; Morgan, J P

1988-12-01

Phencyclidine (PCP) abuse has diminished since PCP's intrusion into American culture in the late 1970s. One of its legacies is the assumption that it provokes violent behavior in humans with predictable regularity. This assumption is so accepted that ingestion of the drug both accidentally and knowingly prior to committing a crime has been used as a defense in criminal trials. We reviewed 81 clinical reports of toxicity in humans published chiefly in North American medical journals. We searched for descriptions of violent behavior in these reports and subjected them to the following questions: (1) Was the violent behavior corroborated or only self-reported? (2) Was the presence of PCP confirmed by analysis of bodily fluids or postmortem tissue? (3) Was the presence of other drugs excluded by similar analysis of bodily fluids? We had planned to examine the reports to see whether clinicians sought evidence of previous violent behavior, but such an inquiry was rarely conducted. Of the hundreds of patients described, only three satisfied these criteria. Further, some of the papers offered evidence that reports of violence were exaggerated. These findings plus the pre-1970 prospective evaluation of thousands of patients with PCP, in which violence was never reported, led us to conclude that clinical and forensic assumptions about PCP and violence are not warranted.

[Practice of Behavioral Activation in Cognitive-behavioral Therapy].

PubMed

Kitagawa, Nobuki

2015-01-01

An approach focusing on behavioral activation (BA) was adopted in the cognitive therapy of A. T. Beck, and it came to be considered that BA can play an important role in cognitive-behavioral therapy (CBT) for depression. Therefore, in recent years, BA based on clinical behavior analysis has been developed as a new treatment (Martell, et al.). The core characteristics are as follows: 1) focusing attention on context in daily life to promote the behavior control of patients and avoidance of a hatred experience ; 2) breaking the vicious circle; 3) promoting the behavior according to the purpose that the patients originally expect; 4) recognizing a relationship between behavior and the situation (contingency), thereby recovering self-efficacy tied to the long-term results that one originally expects. This does not increase pleasant activity at random when the patient is inactive, or give a sense of accomplishment. We know that depression is maintained by conducting functional analysis of detailed life behavior, and encourage the patients to have healthy behavior according to individual values. We help them to complete schedules regardless of mood and reflect on the results patiently. It is considered that those processes are important. BA may be easy to apply in clinical practice and effective for the chronic cases, or the patients in a convalescent stage. Also, in principle in the CBT for major depression, it may be effective that behavioral activation is provided in an early stage, and cognitive reconstruction in a latter stage. However, an approach to carry out functional analysis by small steps with careful activity monitoring is essential when the symptoms are severe. Furthermore, it should be considered that the way of psychoeducation requires caution because we encourage rest in the treatment of depression in our country. In particular, we must be careful not to take an attitude that an inactive behavior pattern is unproductive only based model cases.

Modeling the Longitudinal Direct and Indirect Effects of Attitudes, Self-Efficacy, and Behavioral Intentions on Practice Behavior Outcomes of Suicide Intervention Training.

PubMed

Osteen, Philip; Frey, Jodi M; Woods, MaKenna N; Ko, Jungyai; Shipe, Stacey

2017-08-01

The purpose of this study was to use a longitudinal path analysis to test attitudes toward suicide prevention, self-efficacy, and behavioral intentions as mediators/moderators of clinical skill development over time following suicide intervention training. Results support a direct effect of attitudes on practice behaviors and self-efficacy, but no moderating effect. Self-efficacy performed as a mediator of practice behaviors over time. Behavioral intention had a direct effect on practice behaviors and mediated the relationship between attitudes and practice behaviors. Implications for research and practice are discussed. © 2016 The American Association of Suicidology.

Behavioral phenomenology in Alzheimer's disease, frontotemporal dementia, and late-life depression: a retrospective analysis.

PubMed

Swartz, J R; Miller, B L; Lesser, I M; Booth, R; Darby, A; Wohl, M; Benson, D F

1997-04-01

Often patients in the early stages of Alzheimer's disease (AD), frontotemporal dementia (FTD), and late-life depression can be difficult to differentiate clinically. Although subtle cognitive distinctions exist between these disorders, noncognitive behavioral phenomenology may provide additional discriminating power. In 19 subjects with AD, 19 with FTD, 16 with late-life psychotic depression (LLPD), and 19 with late-life nonpsychotic depression (LLNPD), noncognitive behavioral symptoms were quantified retrospectively using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) and compared using both a one-way ANOVA and a multivariate stepwise discriminant analysis, which utilized a jackknife procedure. The FTD group showed the highest mean total SCAN score, while the AD group showed the lowest. ANOVA showed significant differences in the mean total SCAN scores between the four diagnostic groups (P < .0001). With the discriminant analysis, the four disorders demonstrated different clusters of behavioral abnormalities and were differentiated by these symptoms (P < .0001). A subset of 14 SCAN item group symptoms was identified that collectively classified the following percentages of subjects in each diagnostic category: AD 94.7%, FTD 100%, LLPD 87.5%, and LLNPD 100%. These results indicate that AD, FTD, LLPD, and LLNPD were distinguished retrospectively by the SCAN without using cognitive data. Better definition of the longitudinal course of noncognitive behavioral symptoms in different dementias and psychiatric disorders will be valuable both for diagnosis and to help define behavioral syndromes that are associated with selective neuroanatomic and neurochemical brain pathology.

Effect of Play-based Therapy on Meta-cognitive and Behavioral Aspects of Executive Function: A Randomized, Controlled, Clinical Trial on the Students With Learning Disabilities.

PubMed

Karamali Esmaili, Samaneh; Shafaroodi, Narges; Hassani Mehraban, Afsoon; Parand, Akram; Zarei, Masoume; Akbari-Zardkhaneh, Saeed

2017-01-01

Although the effect of educational methods on executive function (EF) is well known, training this function by a playful method is debatable. The current study aimed at investigating if a play-based intervention is effective on metacognitive and behavioral skills of EF in students with specific learning disabilities. In the current randomized, clinical trial, 49 subjects within the age range of 7 to 11 years with specific learning disabilities were randomly assigned into the intervention (25 subjects; mean age 8.5±1.33 years) and control (24 subjects; mean age 8.7±1.03 years) groups. Subjects in the intervention group received EF group training based on playing activities; subjects in the control group received no intervention. The behavior rating inventory of executive function (BRIEF) was administered to evaluate the behavioral and cognitive aspects of EF. The duration of the intervention was 6 hours per week for 9 weeks. Multivariate analysis of covariance was used to compare mean changes (before and after) in the BRIEF scores between the groups. The assumptions of multivariate analysis of covariance were examined. After controlling pre-test conditions, the intervention and control groups scored significantly differently on both the metacognition (P=0.002; effect size=0.20) and behavior regulation indices (P=0.01; effect size=0.12) of BRIEF. Play-based therapy is effective on the metacognitive and behavioral aspects of EF in students with specific learning disabilities. Professionals can use play-based therapy rather than educational approaches in clinical practice to enhance EF skills.

Using EHR audit trail logs to analyze clinical workflow: A case study from community-based ambulatory clinics.

PubMed

Wu, Danny T Y; Smart, Nikolas; Ciemins, Elizabeth L; Lanham, Holly J; Lindberg, Curt; Zheng, Kai

2017-01-01

To develop a workflow-supported clinical documentation system, it is a critical first step to understand clinical workflow. While Time and Motion studies has been regarded as the gold standard of workflow analysis, this method can be resource consuming and its data may be biased due to the cognitive limitation of human observers. In this study, we aimed to evaluate the feasibility and validity of using EHR audit trail logs to analyze clinical workflow. Specifically, we compared three known workflow changes from our previous study with the corresponding EHR audit trail logs of the study participants. The results showed that EHR audit trail logs can be a valid source for clinical workflow analysis, and can provide an objective view of clinicians' behaviors, multi-dimensional comparisons, and a highly extensible analysis framework.

Behavioral analysis of preterm neonates included in a tactile and kinesthetic stimulation program during hospitalization.

PubMed

Ferreira, Andréia M; Bergamasco, Niélsy H P

2010-01-01

To evaluate the effect of tactile and kinesthetic stimulation on behavioral and clinical development in preterm neonates while still in the hospital. Thirty-two clinically stable preterm infants weighing <2.500 grams, with no significant perinatal asphyxia, were allocated to two groups: a control group (CG) in which no intervention was made (n=16) and a study group (SG) in which the newborn infants received tactile and kinesthetic stimulation (n=16). Data on the infants' clinical progress were collected from medical charts and behavioral evaluations by means of a series of weekly, eight-minute films recorded from the time of inclusion into the study until hospital discharge. There was a trend towards a shorter duration of hospital stay, increased daily weight gain and a predominance of self-regulated behavior (regular breathing, state of alertness, balanced tonus, a range of postures, coordinated movements, hand-to-face movement control, suction, grip, support) in infants in the SG. With respect to motor control, comparative analysis of postconceptional ages according to age-bracket (I - 31-33 weeks 6/7; II - 34-36 weeks 6/7; and III - 37-39 weeks 6/7) revealed balanced tonus and coordinated voluntary movements in all three periods, a longer time spent in a range of postures (age bracket I) or in flexion (age bracket II) and more regular breathing in age bracket I in the SG. In the hospital, tactile and kinesthetic stimulation was shown to have a positive effect, contributing towards adjustment and self-regulation of behavior in the preterm newborn infant. Article registered in the Australian New Zealand Clinical Trials Registry (ANZCTR) under the number ACTRN12610000133033.

Assessing the Social Acceptability of the Functional Analysis of Problem Behavior

ERIC Educational Resources Information Center

Langthorne, Paul; McGill, Peter

2011-01-01

Although the clinical utility of the functional analysis is well established, its social acceptability has received minimal attention. The current study assessed the social acceptability of functional analysis procedures among 10 parents and 3 teachers of children who had recently received functional analyses. Participants completed a 9-item…

A Mobile Computing Solution for Collecting Functional Analysis Data on a Pocket PC

PubMed Central

Jackson, James; Dixon, Mark R

2007-01-01

The present paper provides a task analysis for creating a computerized data system using a Pocket PC and Microsoft Visual Basic. With Visual Basic software and any handheld device running the Windows Moble operating system, this task analysis will allow behavior analysts to program and customize their own functional analysis data-collection system. The program will allow the user to select the type of behavior to be recorded, choose between interval and frequency data collection, and summarize data for graphing and analysis. We also provide suggestions for customizing the data-collection system for idiosyncratic research and clinical needs. PMID:17624078

Is Sensory Over-Responsivity Distinguishable from Childhood Behavior Problems? A Phenotypic and Genetic Analysis

ERIC Educational Resources Information Center

Van Hulle, Carol A.; Schmidt, Nicole L.; Goldsmith, H. Hill

2012-01-01

Background: Although impaired sensory processing accompanies various clinical conditions, the question of its status as an independent disorder remains open. Our goal was to delineate the comorbidity (or lack thereof) between childhood psychopathology and sensory over-responsivity (SOR) in middle childhood using phenotypic and behavior-genetic…

Translating the Theoretical into Practical: A Logical Framework of Functional Analytic Psychotherapy Interactions for Research, Training, and Clinical Purposes

ERIC Educational Resources Information Center

Weeks, Cristal E.; Kanter, Jonathan W.; Bonow, Jordan T.; Landes, Sara J.; Busch, Andrew M.

2012-01-01

Functional analytic psychotherapy (FAP) provides a behavioral analysis of the psychotherapy relationship that directly applies basic research findings to outpatient psychotherapy settings. Specifically, FAP suggests that a therapist's in vivo (i.e., in-session) contingent responding to targeted client behaviors, particularly positive reinforcement…

Development and Application of the Lincoln Adherence Instrument Record for Assessing Client Adherence to Advice in Dog Behavior Consultations and Success.

PubMed

Lamb, Lisanna; Affenzeller, Nadja; Hewison, Lynn; McPeake, Kevin James; Zulch, Helen; Mills, Daniel S

2018-01-01

Adherence to the advice of medical practitioners is critical to successful treatment outcomes and has been much researched in human health, but is less well studied in the veterinary and clinical animal behavior fields. Given that the management of behavior problems often requires substantial change in established client behavior, it is likely that adherence is a substantive issue affecting success. However, little is known about the relationships between relevant factors, and there is no established way of assessing these. Therefore, the aim of this study was to develop an instrument for coding factors likely to impinge on pet owner adherence to behavior advice and validate its utility through the identification of the factors appearing to relate most closely to a successful treatment outcome in a sample population from our clinic. Potential factors affecting adherence were identified from human health and animal behavior studies, and a survey instrument developed with items matched to these factors. Forty-two dog owners who had attended the University of Lincoln Animal Behavior Clinic over a 2-year period provided data used in the analysis. The assessment of treatment outcome success by clients and clinicians was correlated, but clinicians tended to overestimate success by half a point on a 5-point scale. Eleven items relating to adherence were found to correlate with client ratings of treatment success in a univariate analysis, with three of these remaining in an ordinal logistic regression model. These three related to trust in the advice given by the clinician, concern over distress caused to the pet in the longer term and the perceived recommendation of treatment measures that had failed. By further examining the relationship between all of these factors in a hierarchical cluster analysis, we were able to postulate ways in which we might be able to improve client adherence and thus treatment success. This provides a model for the application of the instrument in any veterinary behavior practice wishing to use client feedback to rationalize areas of the consultation which might be improved.

Development and Application of the Lincoln Adherence Instrument Record for Assessing Client Adherence to Advice in Dog Behavior Consultations and Success

PubMed Central

Lamb, Lisanna; Affenzeller, Nadja; Hewison, Lynn; McPeake, Kevin James; Zulch, Helen; Mills, Daniel S.

2018-01-01

Adherence to the advice of medical practitioners is critical to successful treatment outcomes and has been much researched in human health, but is less well studied in the veterinary and clinical animal behavior fields. Given that the management of behavior problems often requires substantial change in established client behavior, it is likely that adherence is a substantive issue affecting success. However, little is known about the relationships between relevant factors, and there is no established way of assessing these. Therefore, the aim of this study was to develop an instrument for coding factors likely to impinge on pet owner adherence to behavior advice and validate its utility through the identification of the factors appearing to relate most closely to a successful treatment outcome in a sample population from our clinic. Potential factors affecting adherence were identified from human health and animal behavior studies, and a survey instrument developed with items matched to these factors. Forty-two dog owners who had attended the University of Lincoln Animal Behavior Clinic over a 2-year period provided data used in the analysis. The assessment of treatment outcome success by clients and clinicians was correlated, but clinicians tended to overestimate success by half a point on a 5-point scale. Eleven items relating to adherence were found to correlate with client ratings of treatment success in a univariate analysis, with three of these remaining in an ordinal logistic regression model. These three related to trust in the advice given by the clinician, concern over distress caused to the pet in the longer term and the perceived recommendation of treatment measures that had failed. By further examining the relationship between all of these factors in a hierarchical cluster analysis, we were able to postulate ways in which we might be able to improve client adherence and thus treatment success. This provides a model for the application of the instrument in any veterinary behavior practice wishing to use client feedback to rationalize areas of the consultation which might be improved. PMID:29560356

A Case Study in the Misrepresentation of Applied Behavior Analysis in Autism: The Gernsbacher Lectures

PubMed Central

Morris, Edward K

2009-01-01

I know that most men, including those at ease with problems of the greatest complexity, can seldom accept the simplest and most obvious truth if it be such as would oblige them to admit the falsity of conclusions which they have proudly taught to others, and which they have woven, thread by thread, into the fabrics of their life. (Tolstoy, 1894) This article presents a case study in the misrepresentation of applied behavior analysis for autism based on Morton Ann Gernsbacher's presentation of a lecture titled “The Science of Autism: Beyond the Myths and Misconceptions.” Her misrepresentations involve the characterization of applied behavior analysis, descriptions of practice guidelines, reviews of the treatment literature, presentations of the clinical trials research, and conclusions about those trials (e.g., children's improvements are due to development, not applied behavior analysis). The article also reviews applied behavior analysis' professional endorsements and research support, and addresses issues in professional conduct. It ends by noting the deleterious effects that misrepresenting any research on autism (e.g., biological, developmental, behavioral) have on our understanding and treating it in a transdisciplinary context. PMID:22478522

Therapist Effects on Functional Analysis Outcomes with Young Children

ERIC Educational Resources Information Center

Huete, John M.; Kurtz, Patricia F.

2010-01-01

Analog functional analyses (FAs) are commonly used to assess factors that maintain problem behavior of individuals with intellectual disabilities. These analyses are usually conducted by trained staff in clinic settings. However, recent research suggests that FAs conducted by unfamiliar individuals, such as hospital or clinic staff, may result in…

Development of an instrument to measure the use of behaviors taught in the American Physical Therapy Association Clinical Instructor Education and Credentialing Program (APTA CIECP): a pilot study.

PubMed

Bridges, Patricia H; Carter, Vincent; Rehm, Stephanie; Tintl, Sara Bowers; Halperin, Rebecca; Kniesly, Elizabeth; Pelino, Soni

2013-01-01

Conduct a pilot study to establish the reliability and validity of a survey instrument that directly measures the objectives and content of the APTA CIECP; and measure the self-reported frequency of use of the behaviors taught in the APTA CIECP. Eighteen (18) APTA credentialed CIs. Develop a web-based survey consisting of 58 items representative of the behaviors taught in the APTA CIECP and 8 demographic characteristics. Establish the content validity and reliability of the survey instrument. Conduct a descriptive analysis of the frequency of self-reported use of the behaviors. The APTA Clinical Instructor Education Board (CIEB) reviewed the items and determined that the items matched the objectives and content of the APTA CIECP, thereby establishing content validity. Cronbach's alpha coefficients ranging from 0.79-0.90 confirmed the reliability. The overall mean for all items on a 1-6 scale was 4.81. The content validity and reliability of the survey instrument were established. The outcomes of this pilot study suggest that when measured by a valid and reliable instrument that is representative of the objectives and content of the CIECP, the behaviors taught in the CIECP are being applied in the clinical setting by APTA credentialed clinical instructors.

[Qualitative research of self-management behavior in patients with advanced schistosomiasis].

PubMed

Wang, Jian-ping; Wang, Xing-ju; Bao, Hui-hong; Zhang, Hong; Xu, Zheng-rong

2013-10-01

To explore the self-management behavior of patients with advanced schistosomiasis, so as to provide the evidence for improving clinical nursing. A total of 18 patients with advanced schistosomiasis were interviewed in depth by using a semi structured interview method. The results were analyzed with Miles and Huberman content analysis method. Most of the patients with advanced schistosomiasis had self-management control behavior and were cooperated with medical assistance because of their seriously illness. Based on data analysis, the symptom management, follow-up management, a healthy lifestyle, medication awareness, and emotional management were obtained. The patients with advanced schistosomiasis have self management control behavior. Health care workers should promote the patients, their families and social people to participate in the self-management behavior of advanced schistosomiasis patients.

Demographic and Clinical Profile of Patients With Dementia Receiving Electroconvulsive Therapy: A Case-Control Study.

PubMed

Zhang, Qing-E; Sha, Sha; Ungvari, Gabor S; Chiu, Helen F K; Ng, Chee H; He, Hong-Bo; Forester, Brent P; Xiang, Yu-Tao

2016-09-01

Little is known about the clinical characteristics of patients with dementia receiving electroconvulsive therapy (ECT) for the treatment of behavioral symptoms. This study examined the demographic and clinical profile of patients with dementia receiving ECT in China. This was a retrospective, case-control study. The sample was composed of 23 patients with dementia treated with ECT and 71 sex- and age-matched controls treated for a period of 8 years (2007-2014) at the National Clinical Research Centre of Mental Disorders, China. Sociodemographic and clinical data were collected from the electronic chart management system. Multiple logistic regression analysis revealed that ECT was independently associated with high risk for suicide at admission. The recorded indications for ECT included both high risk for suicide and aggressive behavior. Most patients responded to ECT satisfactorily (56.5%) or partially (34.8%) with only mild-moderate transient memory impairment (30.4%). Although this is a preliminary study limited by the retrospective design and small sample size, findings suggest that ECT is an effective and safe therapeutic intervention to reduce the risk for suicide and aggressive behavior in dementia.

Behavior Change Pathways to Voluntary Medical Male Circumcision: Narrative Interviews with Circumcision Clients in Zambia

PubMed Central

Price, Jessica E.; Phiri, Lyson; Mulenga, Drosin; Hewett, Paul C.; Topp, Stephanie M.; Shiliya, Nicholas; Hatzold, Karin

2014-01-01

As an HIV prevention strategy, the scale-up of voluntary medical male circumcision (VMMC) is underway in 14 countries in Africa. For prevention impact, these countries must perform millions of circumcisions in adolescent and adult men before 2015. Although acceptability of VMMC in the region is well documented and service delivery efforts have proven successful, countries remain behind in meeting circumcision targets. A better understanding of men's VMMC-seeking behaviors and experiences is needed to improve communication and interventions to accelerate uptake. To this end, we conducted semi-structured interviews with 40 clients waiting for surgical circumcision at clinics in Zambia. Based on Stages of Change behavioral theory, men were asked to recount how they learned about adult circumcision, why they decided it was right for them, what they feared most, how they overcame their fears, and the steps they took to make it to the clinic that day. Thematic analysis across all cases allowed us to identify key behavior change triggers while within-case analysis elucidated variants of one predominant behavior change pattern. Major stages included: awareness and critical belief adjustment, norming pressures and personalization of advantages, a period of fear management and finally VMMC-seeking. Qualitative comparative analysis of ever-married and never-married men revealed important similarities and differences between the two groups. Unprompted, 17 of the men described one to four failed prior attempts to become circumcised. Experienced more frequently by older men, failed VMMC attempts were often due to service-side barriers. Findings highlight intervention opportunities to increase VMMC uptake. Reaching uncircumcised men via close male friends and female sex partners and tailoring messages to stage-specific concerns and needs would help accelerate men's movement through the behavior change process. Expanding service access is also needed to meet current demand. Improving clinic efficiencies and introducing time-saving procedures and advance scheduling options should be considered. PMID:25375790

Artificial neural network modeling using clinical and knowledge independent variables predicts salt intake reduction behavior

PubMed Central

Isma’eel, Hussain A.; Sakr, George E.; Almedawar, Mohamad M.; Fathallah, Jihan; Garabedian, Torkom; Eddine, Savo Bou Zein

2015-01-01

Background High dietary salt intake is directly linked to hypertension and cardiovascular diseases (CVDs). Predicting behaviors regarding salt intake habits is vital to guide interventions and increase their effectiveness. We aim to compare the accuracy of an artificial neural network (ANN) based tool that predicts behavior from key knowledge questions along with clinical data in a high cardiovascular risk cohort relative to the least square models (LSM) method. Methods We collected knowledge, attitude and behavior data on 115 patients. A behavior score was calculated to classify patients’ behavior towards reducing salt intake. Accuracy comparison between ANN and regression analysis was calculated using the bootstrap technique with 200 iterations. Results Starting from a 69-item questionnaire, a reduced model was developed and included eight knowledge items found to result in the highest accuracy of 62% CI (58-67%). The best prediction accuracy in the full and reduced models was attained by ANN at 66% and 62%, respectively, compared to full and reduced LSM at 40% and 34%, respectively. The average relative increase in accuracy over all in the full and reduced models is 82% and 102%, respectively. Conclusions Using ANN modeling, we can predict salt reduction behaviors with 66% accuracy. The statistical model has been implemented in an online calculator and can be used in clinics to estimate the patient’s behavior. This will help implementation in future research to further prove clinical utility of this tool to guide therapeutic salt reduction interventions in high cardiovascular risk individuals. PMID:26090333

Clinical teaching based on principles of cognitive apprenticeship: views of experienced clinical teachers.

PubMed

Stalmeijer, Renée E; Dolmans, Diana H J M; Snellen-Balendong, Hetty A M; van Santen-Hoeufft, Marijke; Wolfhagen, Ineke H A P; Scherpbier, Albert J J A

2013-06-01

To explore (1) whether an instructional model based on principles of cognitive apprenticeship fits with the practice of experienced clinical teachers and (2) which factors influence clinical teaching during clerkships from an environmental, teacher, and student level as perceived by the clinical teachers themselves. The model was designed to apply directly to teaching behaviors of clinical teachers and consists of three phases, advocating teaching behaviors such as modeling, creating a safe learning environment, coaching, knowledge articulation, and exploration. A purposive sample of 17 experienced clinical teachers from five different disciplines and four different teaching hospitals took part in semistructured individual interviews. Two researchers independently performed a thematic analysis of the interview transcripts. Coding was discussed within the research team until consensus was reached. All participants recognized the theoretical model as a structured picture of the practice of teaching activities during both regular and senior clerkships. According to participants, modeling and creating a safe learning environment were fundamental to the learning process of both regular and senior clerkship students. Division of teaching responsibilities, longer rotations, and proactive behavior of teachers and students ensured that teachers were able to apply all steps in the model. The theoretical model can offer valuable guidance in structuring clinical teaching activities and offers suggestions for the design of effective clerkships.

Anxiety and oppositional behavior profiles among youth with selective mutism.

PubMed

Diliberto, Rachele A; Kearney, Christopher A

2016-01-01

Selective mutism (SM) is a debilitating condition in which a child does not speak in social situations where speech is expected. The clinical conceptualization of SM has been debated historically, with evidence pointing partly to anxious and oppositional behavior profiles. Behavioral characteristics were examined in a clinical sample of 57 youth formally diagnosed with selective mutism. Parents rated children across internalizing and externalizing behaviors on the Child Behavior Checklist. Eighteen highly rated items were subjected to exploratory and then confirmatory factor analysis. Anxiety and oppositional behavior factors were derived. The anxious behavior profile was associated with social anxiety disorder symptoms, social problems, and aggressive behaviors but not oppositional defiant disorder symptoms. The oppositional behavior profile was associated with aggressive behaviors, oppositional defiant disorder symptoms, social problems, and inversely to social anxiety disorder symptoms. Results are consistent with emerging research regarding subgroups of children with SM. Behavior profiles are discussed as well with respect to assessment and treatment implications. Readers will learn about the nature of children with selective mutism as well as behaviors that differentiate anxious and oppositional behavior profiles. Items that comprise anxious and oppositional behavior profiles are presented. These item profiles may have ramifications for assessment and treatment. Copyright © 2015 Elsevier Inc. All rights reserved.

Pharmacists' and prescribers' neonatal abstinence syndrome (NAS) prevention behaviors: a preliminary analysis.

PubMed

Hagemeier, Nicholas E; Click, Ivy A; Flippin, Heather; Gilliam, Holly; Ross, Alexandra; Basden, Jeri Ann; Carico, Ronald

2018-02-01

Background Maternal opioid use and neonatal abstinence syndrome (NAS) incidence have increased markedly in the US in recent years. Objectives (1) To assess prescribers' and community pharmacists' guideline-based NAS prevention behaviors; (2) to describe providers' perceptions of contraceptive appropriateness in female patients of childbearing age. Method Cross-sectional study of 100 randomly selected primary care physicians, 100 prescribers authorized to engage in in-office treatment of opioid use disorders with buprenorphine, 100 pain management clinic directors, and 100 community pharmacists in Tennessee (N = 400 providers total) to evaluate self-reported engagement in 15 NAS prevention behaviors and perceived appropriateness of 8 contraceptive methods in opioid using women of childbearing age. Results An overall response rate of 17.5% was obtained. Pain clinic directors reported the most engagement in NAS prevention, engaging 80% or more of female patients of childbearing age prescribed an opioid in 11 prevention behaviors, followed by buprenorphine prescribers (8 behaviors), primary care physicians (5 behaviors), and community pharmacists (2 behaviors). Pain clinic directors, primary care physicians, and community pharmacists perceived oral contraceptive pills and patches to be as appropriate as long-acting, reversible forms of contraception (e.g., implants, injectable depots, intrauterine devices). Conclusion Provider engagement in behaviors that could prevent NAS is variable. Interventions should be implemented that equip providers to engage patients in conversations about long-acting, reversible contraception.

An exploration of the structure of mentors' behavior in nursing education using exploratory factor analysis and Mokken scale analysis.

PubMed

Chen, Yanhua; Watson, Roger; Hilton, Andrea

2016-05-01

To understand nursing students' expectation from their mentors and assess mentors' performance, a scale of mentors' behavior was developed based on literature review and focus group in China. This study aims to explore the structure of mentors' behavior. A cross-sectional survey. Data were collected from nursing students in three hospitals in southwest China in 2014. A total of 669 pre-registered nursing students in their final year clinical learning participated in this study. Exploratory factor analysis and Mokken scale analysis was employed to explore the structure and hierarchical property of mentors' behavior. Three dimensions (professional development, facilitating learning and psychosocial support) were identified by factor analysis and confirmed by Mokken scaling analysis. The three sub-scales showed internal consistency reliability from 87% to 91%, and moderate to strong precision in ordering students' expectation about mentors' behavior and a small Mokken scale showing hierarchy was identified. Some insight into the structure of mentoring in nursing education has been obtained and a scale which could be used in the study of mentoring and in the preparation of mentors has been developed. Copyright © 2016 Elsevier Ltd. All rights reserved.

[Cognitive, linguistic, motoric, and social deficits in schoolstarters with behavioral disorders].

PubMed

Korsch, Franziska; Petermann, Ulrike; Schmidt, Sören; Petermann, Franz

2013-01-01

Studies show that ADHD, conduct disorders, and anxiety disorders are clinical disorders mostly diagnosed in schoolstarters. The preschool medical examination in Bremen was therefore extended by behavioral screenings. Based on their screening results from the SEU (health examination for school entry) 2011 in Bremen, 67 preschoolers were tested for behavioral disorders. Subsequently, children with behavioral or emotional symptoms (N = 56) were compared to symptomfree controls (N = 52) for their cognitive, motoric, linguistic, and social-emotional development. Psychosocial health was obtained through external assessment by the parents and kindergarten teachers. Results of the WPPSI-III, M-ABC-2, and ET 6-6 were included in the analysis. 32 children met the criteria for behavioral disorders. Children with behavioral or emotional symptoms showed significant lower scores on tests measuring cognitive, motoric, linguistic and emotional development compared to controls. Results suggest that there is necessity to screen all preschoolers for behavioral disorders before entering school. Because children with clinical or subclinical behavioral disorders showed major developmental deficits compared to children without behavioral symptoms, it is essential to conduct a multiple assessment on children with suspected behavioral disorders to ensure early developmental support and adequate interventional programs.

A Cross-sectional population-based investigation into behavioral change in amyotrophic lateral sclerosis: subphenotypes, staging, cognitive predictors, and survival.

PubMed

Burke, Tom; Pinto-Grau, Marta; Lonergan, Katie; Bede, Peter; O'Sullivan, Meabhdh; Heverin, Mark; Vajda, Alice; McLaughlin, Russell L; Pender, Niall; Hardiman, Orla

2017-05-01

Amyotrophic Lateral Sclerosis (ALS) is a clinically heterogeneous neurodegenerative disorder associated with cognitive and behavioral impairment. The primary aim of this study was to identify behavioral subphenotypes in ALS using a custom designed behavioral assessment tool (Beaumont Behavioural Inventory, BBI). Secondary aims were to (1) investigate the predictive nature of cognitive assessment on behavioral change, (2) report the behavioral profile associated with the C9 orf 72 expansion, (3) categorize behavioral change through disease staging, and (4) to investigate the relationship between cross-sectional behavioral classification and survival. A cross-sectional population-based research design was applied to examine behavioral data from ALS patients ( n  = 317) and healthy controls ( n  = 66). Patients were screened for the C9orf72 repeat expansion. A subcohort of ALS patients completed an extensive cognitive assessment battery ( n  = 65), to investigate predictors of behavior change. Principal component analysis (PCA) determined factors associated with altered behavior. Survival data were extracted from the Irish ALS register. No behavioral changes were reported in 180 patients (57%); 95 patients had mild-moderate behavioral change (30%); 42 patients met the cut-off for Clinically Severe Behavioral Change (13%), suggestive of a bvFTD diagnosis. The most frequently endorsed behaviors in ALS were reduced concern for hygiene (36.8%), irritability (36.2%), new unusual habits (33.4%), and increased apathy (31.1%). Five independent factors were identified through factor analysis. Social cognitive performance was predictive of behavior change ( P  = 0.031), yielding an R 2  = 0.188. Behavioral categorization (mild/moderate/severe) at the time of assessment was not associated with survival ( P  = 0.198). These data imply the presence of distinct subphenotypes of behavioral change in ALS, which most likely reflect subcategories of extramotor network disruption.

Using statistical process control to make data-based clinical decisions.

PubMed

Pfadt, A; Wheeler, D J

1995-01-01

Applied behavior analysis is based on an investigation of variability due to interrelationships among antecedents, behavior, and consequences. This permits testable hypotheses about the causes of behavior as well as for the course of treatment to be evaluated empirically. Such information provides corrective feedback for making data-based clinical decisions. This paper considers how a different approach to the analysis of variability based on the writings of Walter Shewart and W. Edwards Deming in the area of industrial quality control helps to achieve similar objectives. Statistical process control (SPC) was developed to implement a process of continual product improvement while achieving compliance with production standards and other requirements for promoting customer satisfaction. SPC involves the use of simple statistical tools, such as histograms and control charts, as well as problem-solving techniques, such as flow charts, cause-and-effect diagrams, and Pareto charts, to implement Deming's management philosophy. These data-analytic procedures can be incorporated into a human service organization to help to achieve its stated objectives in a manner that leads to continuous improvement in the functioning of the clients who are its customers. Examples are provided to illustrate how SPC procedures can be used to analyze behavioral data. Issues related to the application of these tools for making data-based clinical decisions and for creating an organizational climate that promotes their routine use in applied settings are also considered.

A Systematic Review of Brief Functional Analysis Methodology with Typically Developing Children

ERIC Educational Resources Information Center

Gardner, Andrew W.; Spencer, Trina D.; Boelter, Eric W.; DuBard, Melanie; Jennett, Heather K.

2012-01-01

Brief functional analysis (BFA) is an abbreviated assessment methodology derived from traditional extended functional analysis methods. BFAs are often conducted when time constraints in clinics, schools or homes are of concern. While BFAs have been used extensively to identify the function of problem behavior for children with disabilities, their…

Factors Associated with Sexual Behavior Problems in Young Sexually Abused Children.

ERIC Educational Resources Information Center

Hall, Darlene Kordich; Mathews, Fred; Pearce, John

1998-01-01

Analysis of data from the clinical records of 100 sexually abused boys and girls, ages 3-7 years, identified five variables predictive of sexual behavior problems, including sexual arousal of the child during the abuse, perpetrator's use of sadism, a history of physical and emotional abuse, and who the child blames for the abuse. (DB)

Cognitive-Behavioral Therapy for Adult Anxiety Disorders in Clinical Practice: A Meta-Analysis of Effectiveness Studies

ERIC Educational Resources Information Center

Stewart, Rebecca E.; Chambless, Dianne L.

2009-01-01

The efficacy of cognitive-behavioral therapy (CBT) for anxiety in adults is well established. In the present study, the authors examined whether CBT tested under well-controlled conditions generalizes to less-controlled, real-world circumstances. Fifty-six effectiveness studies of CBT for adult anxiety disorders were located and synthesized.…

Cognitive-Behavioral Treatment for Panic Disorder with Agoraphobia: A Randomized, Controlled Trial and Cost-Effectiveness Analysis

ERIC Educational Resources Information Center

Roberge, Pasquale; Marchand, Andre; Reinharz, Daniel; Savard, Pierre

2008-01-01

A randomized, controlled trial was conducted to examine the cost-effectiveness of cognitive-behavioral treatment (CBT) for panic disorder with agoraphobia. A total of 100 participants were randomly assigned to standard (n = 33), group (n = 35), and brief (n = 32) treatment conditions. Results show significant clinical and statistical improvement…

[A behavioral conceptualization of motivation in the therapeutic process].

PubMed

Froján Parga, María Xesús; Alpañés Freitag, Manuel; Calero Elvira, Ana; Vargas de la Cruz, Ivette

2010-11-01

Motivation has traditionally been conceptualized as something situated inside the person, which might explain certain behaviors and play a causal role in overt changes in behavior. This type of approach was assumed by the Transtheoretical Model of Change and Motivational Interviewing in the area of clinical and health psychology. In contrast, the behavioral concept of establishing operation is defined as a stimulus or environmental operation that momentarily alters the functions of other stimuli and the response probability, which allows us to study motivation without making inferences or assuming a cognitivist terminology. From this point of view, the study of motivation in therapy implies the analysis of the effect that certain verbalizations of the therapist have on the client's behavior. Moreover, we propose that the analysis of therapists' motivating verbalizations should focus on descriptions of the past, present and future consequences of the client's behavior.

Monogenic Mouse Models of Autism Spectrum Disorders: Common Mechanisms and Missing Links

PubMed Central

Hulbert, Samuel W.; Jiang, Yong-hui

2016-01-01

Autism Spectrum Disorders (ASDs) present unique challenges in the fields of genetics and neurobiology because of the clinical and molecular heterogeneity underlying these disorders. Genetic mutations found in ASD patients provide opportunities to dissect the molecular and circuit mechanisms underlying autistic behaviors using animal models. Ongoing studies of genetically modified models have offered critical insight into possible common mechanisms arising from different mutations, but links between molecular abnormalities and behavioral phenotypes remain elusive. The challenges encountered in modeling autism in mice demand a new analytic paradigm that integrates behavioral analysis with circuit-level analysis in genetically modified models with strong construct validity. PMID:26733386

What's in a Trial? On the Importance of Distinguishing Between Experimental Lab Studies and Randomized Controlled Trials: The Case of Cognitive Bias Modification and Alcohol Use Disorders.

PubMed

Wiers, Reinout W; Boffo, Marilisa; Field, Matt

2018-05-01

Recently, the National Institutes of Health (NIH) redefined clinical trials to include any study involving behavioral or biomedical interventions. In line with a general framework from experimental medicine, we argue that it is crucial to distinguish between experimental laboratory studies aimed at revealing psychological mechanisms underlying behavior and randomized controlled trials (RCTs) in clinical samples aimed at testing the efficacy of an intervention. As an illustration, we reviewed the current state of the evidence on the efficacy of cognitive bias modification (CBM) interventions in alcohol use disorders. A recent meta-analysis "cast serious doubts on the clinical utility of CBM interventions for addiction." That analysis combined experimental laboratory studies and RCTs. We demonstrated that, when studies are differentiated regarding study type (experimental laboratory study or RCT), mode of delivery (controlled experiment or Internet), and population (healthy volunteers or patients), the following effects are found: (a) short-lived effects of CBM on drinking behavior in experimental laboratory studies in students, but only when the bias is successfully manipulated; (b) small but robust effects of CBM on treatment outcome when administered as an adjunct to established treatments in clinical settings in RCTs with alcohol-dependent patients; and (c) nonspecific effects (reduced drinking irrespective of condition) in RCTs of CBM administered online to problem drinkers. We discuss how CBM might be improved when it is better integrated into regular treatment, especially cognitive behavioral therapy, and we conclude that disregarding the difference between experimental laboratory studies and RCTs can lead to invalid conclusions.

Clinical needs of in-treatment pregnant women with co-occurring disorders: implications for primary care.

PubMed

Lee King, Patricia A; Duan, Lei; Amaro, Hortensia

2015-01-01

We investigated social vulnerability and behavioral health clinical profiles (symptom severity) of pregnant women with co-occurring disorders, defined as substance abuse, mental illness, and trauma at treatment entry compared to their nonpregnant counterparts and the role of interpersonal abuse in clinical presentation among pregnant women. Our objective was to provide primary health care providers with insight into the needs of pregnant patients with high behavioral health risks to serve them better during the critical window of opportunity for long-term impact. We conducted cross-sectional secondary analysis of baseline data from women enrolled in treatment programs in the Women, Co-occurring Disorders and Violence Study from nine sites across the United States. We used analysis of variance and Cochran-Mantel-Haenszel statistical analyses to compare means and frequencies of social vulnerability indicators and baseline Addiction Severity Index, Brief Symptom Inventory of mental health, and Posttraumatic Stress Diagnostic Scale scores between 152 pregnant and 2,577 nonpregnant women, and between pregnant women with and without current interpersonal abuse. Compared to nonpregnant women, pregnant women evidenced more social vulnerability but better behavioral health clinical profiles at treatment entry. Current interpersonal abuse was associated with increased mental health and trauma symptomatology but not with alcohol or drug abuse severity among pregnant women. The prenatal period is an important time for screening and intervention for factors such as social vulnerability and co-occurring disorders, known to affect pregnancy and infant outcomes; social and behavioral health services are particularly essential among pregnant women with co-occurring disorders.

75 FR 37438 - Minnesota Rural Health Cooperative; Analysis of the Agreement Containing Consent Order to Aid...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-29

... benefit consumers; and (2) the price agreements are reasonably necessary to realize those efficiencies... behavior, none of the programs creates enforceable obligations for physicians to improve their clinical... engage in them on its own without any involvement from the other clinics. Finally, the challenged conduct...

Sedentary Behavior and the Risk of Depression in Patients With Acute Coronary Syndromes.

PubMed

Zhu, Yidan; Blumenthal, James A; Shi, Chuan; Jiang, Ronghuan; Patel, Anushka; Zhang, Aihua; Yu, Xin; Gao, Runlin; Wu, Yangfeng

2018-06-15

Although there is good evidence that sedentary behavior is associated with poor health outcomes in healthy persons and patients with cardiovascular disease, the mental health consequences of sedentary behavior have not been widely studied. In this report, we conducted a cross-sectional analysis to examine the relation of self-reported sedentary behavior and depression in a sample of 4,043 hospitalized men and women with acute coronary syndrome enrolled in a randomized clinical trial in rural China. Sedentary behavior was assessed by self-report, and depression was assessed with the Patient Health Questionnaire-9 (PHQ-9); a subset of 1,209 patients also completed the Beck Depression Inventory-II. Results revealed that greater sedentary behavior was associated with higher levels of depressive symptoms measured by both the PHQ-9 (p <0.001) and the Beck Depression Inventory-II (p <0.001). Compared with patients who reported that they were seldom sedentary, patients reporting that they were frequently sedentary were 4.7 times (odds ratio 4.73, 95% confidence interval 2.71 to 8.24) more likely to be clinically depressed defined as PHQ-9 scores ≥10 after adjusting for demographic factors, lifestyle behaviors, clinical characteristics, and in-hospital treatments. In conclusion, greater sedentary behavior is significantly related to greater depression in Chinese patients with acute coronary syndrome, independent of physical activity. These findings suggest that strategies to reduce sedentary behavior may improve medical outcomes and reduce risk for depression. Copyright © 2018 Elsevier Inc. All rights reserved.

Barriers and Facilitators to Deaf Trauma Survivors' Help-Seeking Behavior: Lessons for Behavioral Clinical Trials Research.

PubMed

Anderson, Melissa L; Wolf Craig, Kelly S; Ziedonis, Douglas M

2017-01-01

Deaf individuals experience significant obstacles to participating in behavioral health research when careful consideration is not given to accessibility during the design of study methodology. To inform such considerations, we conducted an exploratory secondary analysis of a mixed-methods study that originally explored 16 Deaf trauma survivors' help-seeking experiences. Our objective was to identify key findings and qualitative themes from consumers' own words that could be applied to the design of behavioral clinical trials methodology. In many ways, the themes that emerged were not wholly dissimilar from the general preferences of members of other sociolinguistic minority groups-a need for communication access, empathy, respect, strict confidentiality procedures, trust, and transparency of the research process. Yet, how these themes are applied to the inclusion of Deaf research participants is distinct from any other sociolinguistic minority population, given Deaf people's unique sensory and linguistic characteristics. We summarize our findings in a preliminary "Checklist for Designing Deaf Behavioral Clinical Trials" to operationalize the steps researchers can take to apply Deaf-friendly approaches in their empirical work. © The Author 2016. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Problematic sexual behavior in young adults: Associations across clinical, behavioral, and neurocognitive variables.

PubMed

Leppink, Eric W; Chamberlain, Samuel R; Redden, Sarah A; Grant, Jon E

2016-12-30

A notable number of young adults struggle to control impulsive behavior, resulting in impairment and distress. Assessments of problematic sexual behavior (PSB) have noted clinical differences relative to other populations, but neurocognitive findings have varied. This analysis assesses the clinical presentation and neurocognitive profile of patients with PSB relative to participants without PSB symptoms. A total of 492 participants (18-29) were recruited for a study on impulsivity in young adults. Participants completed diagnostic, self-report, and neurocognitive measures which assessed several cognitive domains. PSB was defined as endorsing fantasies, urges, or sexual behavior that felt out of control or was causing distress. In the sample, 54 (11%) participants reported current PSB. This group was older, reported earlier sexual experiences and alcohol use, and lower quality of life and self-esteem. Comorbidity was greater in the PSB group, particularly for depression and alcohol dependence. The PSB group also showed differences in impulsivity, decision making, spatial working memory, problem solving, and emotional dysregulation. Results suggest associations between PSB psychosocial dysfunction, greater comorbidity, and neurocognitive differences. These associations suggest a more salient impact than typical sexual behavior. Furthermore, this study demonstrated several neurocognitive deficits in the PSB group which have found more mixed support previously. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Pathological and non-pathological variants of restrictive eating behaviors in middle childhood: A latent class analysis.

PubMed

Schmidt, Ricarda; Vogel, Mandy; Hiemisch, Andreas; Kiess, Wieland; Hilbert, Anja

2018-08-01

Although restrictive eating behaviors are very common during early childhood, their precise nature and clinical correlates remain unclear. Especially, there is little evidence on restrictive eating behaviors in older children and their associations with children's shape concern. The present population-based study sought to delineate subgroups of restrictive eating patterns in N = 799 7-14 year old children. Using Latent Class Analysis, children were classified based on six restrictive eating behaviors (for example, picky eating, food neophobia, and eating-related anxiety) and shape concern, separately in three age groups. For cluster validation, sociodemographic and objective anthropometric data, parental feeding practices, and general and eating disorder psychopathology were used. The results showed a 3-cluster solution across all age groups: an asymptomatic class (Cluster 1), a class with restrictive eating behaviors without shape concern (Cluster 2), and a class showing restrictive eating behaviors with prominent shape concern (Cluster 3). The clusters differed in all variables used for validation. Particularly, the proportion of children with symptoms of avoidant/restrictive food intake disorder was greater in Cluster 2 than Clusters 1 and 3. The study underlined the importance of considering shape concern to distinguish between different phenotypes of children's restrictive eating patterns. Longitudinal data are needed to evaluate the clusters' predictive effects on children's growth and development of clinical eating disorders. Copyright © 2018 Elsevier Ltd. All rights reserved.

Can birth order affect temperament, anxiety and behavior in 5 to 7-year-old children in the dental setting?

PubMed

Aminabadi, Naser Asl; Sohrabi, Azin; Erfanparast, Leila K; Oskouei, Sina Ghertasi; Ajami, Behjat Almolook

2011-07-01

The aim of this study was to evaluate the relationships between birth order and child's temperament, anxiety and behavior in the dental setting. A total of 200 healthy children aged 5 to 7 years, were included in this double-blind randomized controlled trial. The study consisted of two sessions. In the initial appointment, parents were provided with instructions and asked to complete children's behavior questionnaire (CBQ). In the second appointment, identical dental treatments were rendered to all subjects. During treatment, Frankl scale for child's behavior, facial Image scale (FIS) for situational anxiety, and clinical anxiety rating scale for clinical anxiety were utilized. Analysis of data was done using U Mann-Whitney and Kruskal-Wallis tests. Only children had higher clinical (p = 0.041) and situational (p < 0.001) anxiety, and more negative behavior (p = 0.013) compared to children with siblings. In children with siblings, first-born child was in increased risk of developing negative behavior (p = 0.008), clinical anxiety (p < 0.001) and situational anxiety (p = 0.006). With an exception (sadness, p < 0.001), no significant differences in temperament scale were observed among children with different birth orders. According to the results, only children and laterborns are at higher risk of developing worse outcomes in the dental setting. The role of birth order has been ignored as a possible factor of behavior during routine dental treatment and these findings may shed light on our understanding of behavior management strategies in the dental setting. Considering the increasing pattern of family with an only child both in modern and developing countries, this is more likely that the dental team will face children with negative outcome during dental treatment.

Mother-child interactions and young child behavior during procedural conscious sedation.

PubMed

Miranda-Remijo, Daniella; Orsini, Mara Rúbia; Corrêa-Faria, Patrícia; Costa, Luciane Rezende

2016-12-03

As many preschoolers are not able to cooperate with health-related invasive procedures, sedation can help with the child's comfort and allow the intervention to be done. It is scarcely known how parents affect children's behavior during dental treatment under conscious sedation. The aim of this exploratory study was to analyze the association between mother-child interactions in day-to-day family life and preschool children's behavior during dental treatment under conscious sedation. This cross-sectional study included 27 children aged 2-6 years and their mothers. The children's behavior during dental treatment under conscious sedation was verified through the analysis of videos and using an observational scale. Social skills of mothers were verified through interviews using the Parental Educative Social Skills Interview Script (RE-HSE-P); the sum of the scores allowed the establishment of the categories "clinical" and "non-clinical". We presented descriptive analyses and bivariate associations. Children's overall behavior during dental sedation was: very poor (n = 2), poor (n = 1), regular (n = 2), good (n = 9), very good (n = 9) and excellent (n = 4). Social skills varied: parental educational social skills (n = 24 clinical vs. n = 3 non-clinical); child social skills (n = 20 vs. n = 7), context variables (n = 15 vs. n = 12), negative educational practices (n = 12 vs. n = 15), child behavior problems (n = 7 vs. n = 20). There was no association between child behavior under sedation and social skills categories (P > 0.05). The majority of interviewed mothers reported issues in parental educational social skills and child social skills, which did not affect the outcomes of the children's behavior during the procedural conscious sedation.

Interest in Health Behavior Intervention Delivery Modalities Among Cancer Survivors: A Cross-Sectional Study

PubMed Central

Basen-Engquist, Karen; Cox, Matthew G; Lyons, Elizabeth J; Carmack, Cindy L; Blalock, Janice A; Demark-Wahnefried, Wendy

2016-01-01

Background Effective, broad-reaching channels are important for the delivery of health behavior interventions in order to meet the needs of the growing population of cancer survivors in the United States. New technology presents opportunities to increase the reach of health behavior change interventions and therefore their overall impact. However, evidence suggests that older adults may be slower in their adoption of these technologies than the general population. Survivors’ interest for more traditional channels of delivery (eg, clinic) versus new technology-based channels (eg, smartphones) may depend on a variety of factors, including demographics, current health status, and the behavior requiring intervention. Objective The aim of this study was to determine the factors that predict cancer survivors’ interest in new technology-based health behavior intervention modalities versus traditional modalities. Methods Surveys were mailed to 1871 survivors of breast, prostate, and colorectal cancer. Participants’ demographics, diet and physical activity behaviors, interest in health behavior interventions, and interest in intervention delivery modalities were collected. Using path analysis, we explored the relationship between four intervention modality variables (ie, clinic, telephone, computer, and smartphone) and potential predictors of modality interest. Results In total, 1053 respondents to the survey (56.3% response rate); 847 provided complete data for this analysis. Delivery channel interest was highest for computer-based interventions (236/847, 27.9% very/extremely interested) and lowest for smartphone–based interventions (73/847, 8.6%), with interest in clinic-based (147/847, 17.3%) and telephone-delivered (143/847, 16.9%) falling in between. Use of other technology platforms, such as Web cameras and social networking sites, was positively predictive of interest in technology-based delivery channels. Older survivors were less likely to report interest in smartphone–based diet interventions. Physical activity, fruit and vegetable consumption, weight status, and age moderated relationships between interest in targeted intervention behavior and modality. Conclusions This study identified several predictors of survivor interest in various health behavior intervention delivery modalities. Overall, computer-based interventions were found to be most acceptable, while smartphones were the least. Factors related to survivors’ current technology use and health status play a role in their interest for technology-based intervention versus more traditional delivery channels. Future health behavior change research in this population should consider participants’ demographic, clinical, and lifestyle characteristics when selecting a delivery channel. Furthermore, current health behavior interventions for older cancer survivors may be best delivered over the Internet. Smartphone interventions may be feasible in the future following further adoption and familiarization by this particular population. PMID:28410164

Development of a simple 12-item theory-based instrument to assess the impact of continuing professional development on clinical behavioral intentions.

PubMed

Légaré, France; Borduas, Francine; Freitas, Adriana; Jacques, André; Godin, Gaston; Luconi, Francesca; Grimshaw, Jeremy

2014-01-01

Decision-makers in organizations providing continuing professional development (CPD) have identified the need for routine assessment of its impact on practice. We sought to develop a theory-based instrument for evaluating the impact of CPD activities on health professionals' clinical behavioral intentions. Our multipronged study had four phases. 1) We systematically reviewed the literature for instruments that used socio-cognitive theories to assess healthcare professionals' clinically-oriented behavioral intentions and/or behaviors; we extracted items relating to the theoretical constructs of an integrated model of healthcare professionals' behaviors and removed duplicates. 2) A committee of researchers and CPD decision-makers selected a pool of items relevant to CPD. 3) An international group of experts (n = 70) reached consensus on the most relevant items using electronic Delphi surveys. 4) We created a preliminary instrument with the items found most relevant and assessed its factorial validity, internal consistency and reliability (weighted kappa) over a two-week period among 138 physicians attending a CPD activity. Out of 72 potentially relevant instruments, 47 were analyzed. Of the 1218 items extracted from these, 16% were discarded as improperly phrased and 70% discarded as duplicates. Mapping the remaining items onto the constructs of the integrated model of healthcare professionals' behaviors yielded a minimum of 18 and a maximum of 275 items per construct. The partnership committee retained 61 items covering all seven constructs. Two iterations of the Delphi process produced consensus on a provisional 40-item questionnaire. Exploratory factorial analysis following test-retest resulted in a 12-item questionnaire. Cronbach's coefficients for the constructs varied from 0.77 to 0.85. A 12-item theory-based instrument for assessing the impact of CPD activities on health professionals' clinical behavioral intentions showed adequate validity and reliability. Further studies could assess its responsiveness to behavior change following CPD activities and its capacity to predict health professionals' clinical performance.

Development of a Simple 12-Item Theory-Based Instrument to Assess the Impact of Continuing Professional Development on Clinical Behavioral Intentions

PubMed Central

Légaré, France; Borduas, Francine; Freitas, Adriana; Jacques, André; Godin, Gaston; Luconi, Francesca; Grimshaw, Jeremy

2014-01-01

Background Decision-makers in organizations providing continuing professional development (CPD) have identified the need for routine assessment of its impact on practice. We sought to develop a theory-based instrument for evaluating the impact of CPD activities on health professionals' clinical behavioral intentions. Methods and Findings Our multipronged study had four phases. 1) We systematically reviewed the literature for instruments that used socio-cognitive theories to assess healthcare professionals' clinically-oriented behavioral intentions and/or behaviors; we extracted items relating to the theoretical constructs of an integrated model of healthcare professionals' behaviors and removed duplicates. 2) A committee of researchers and CPD decision-makers selected a pool of items relevant to CPD. 3) An international group of experts (n = 70) reached consensus on the most relevant items using electronic Delphi surveys. 4) We created a preliminary instrument with the items found most relevant and assessed its factorial validity, internal consistency and reliability (weighted kappa) over a two-week period among 138 physicians attending a CPD activity. Out of 72 potentially relevant instruments, 47 were analyzed. Of the 1218 items extracted from these, 16% were discarded as improperly phrased and 70% discarded as duplicates. Mapping the remaining items onto the constructs of the integrated model of healthcare professionals' behaviors yielded a minimum of 18 and a maximum of 275 items per construct. The partnership committee retained 61 items covering all seven constructs. Two iterations of the Delphi process produced consensus on a provisional 40-item questionnaire. Exploratory factorial analysis following test-retest resulted in a 12-item questionnaire. Cronbach's coefficients for the constructs varied from 0.77 to 0.85. Conclusion A 12-item theory-based instrument for assessing the impact of CPD activities on health professionals' clinical behavioral intentions showed adequate validity and reliability. Further studies could assess its responsiveness to behavior change following CPD activities and its capacity to predict health professionals' clinical performance. PMID:24643173

Behavioral Analysis of Chinese Adult Patients with Type 1 Diabetes on Self-monitoring of Blood Glucose.

PubMed

Qin, Zhao-Yi; Yan, Jin-Hua; Yang, Dai-Zhi; Deng, Hong-Rong; Yao, Bin; Weng, Jian-Ping

The information-motivation-behavioral skills (IMB) model of health behavior is an effective tool to evaluate the behavior of diabetes self-management. The purpose of this study was to explore behavioral factors affecting the practice of self-monitoring of blood glucose (SMBG) within the frame of IMB model of health behavioral among adult patients with type 1 diabetes in a single diabetes clinic in China. A questionnaire with three subscales on SMBG information, motivation, and behavioral skills based on IMB model was developed. Validity and reliability of the measures were examined and guaranteed. Adult patients with type 1 diabetes visiting our diabetes clinic from January to March 2012 (n = 55) were consecutively interviewed. The self-completion questionnaires were administered and finished at face-to-face interviews among these patients. Both descriptive and correlational analyses were made. Fifty-five patients finished the questionnaires, with the median duration of diabetes 4.5 years and the median of SMBG frequency 2.00. Specific SMBG information deficits, motivation obstacles, and behavioral skill limitations were identified in a substantial proportion of participants. Scores of SMBG motivation (r = 0.299, P= 0.026) and behavioral skills (r = 0.425, P= 0.001) were significantly correlated with SMBG frequency. The multiple correlation of SMBG information, SMBG motivation, and SMBG behavioral skills with SMBG frequency was R = 0.411 (R2 = 0.169, P= 0.023). Adult patients with type 1 diabetes in our clinic had substantial SMBG information deficits, motivation obstacles, and skill limitations. This information provided potential-focused education targets for diabetes health-care providers.

Explicating Filipino student nurses' preferences of clinical instructors' attributes: A conjoint analysis.

PubMed

Factor, Elisa Monette R; de Guzman, Allan B

2017-08-01

The role of clinical instructor in student nurses' preparation for the professional nursing practice cannot be underestimated. The extent to which such role is achieved depends highly on the instructors' ability to realize the desired qualities expected of them. While a number of empirical studies have qualitatively explored the attributes of an effective clinical instructor, no attempt has ventured yet on the power of experimental vignettes for conjoint analysis in explicating the preferences of a select group of Filipino student nurses relative to their clinical instructors' attributes. Junior and senior nursing students (n=227), recruited from one of the comprehensive universities in the Philippines, were asked to sort out orthogonal cards generated by Sawtooth Software. As shown, the full-profile conjoint analysis was considerably fit for this study: Pearson's R=0.988, (p<0.05) and Kendall's t=0.944, (p<0.05). Results indicated that the student nurses are one in terms of their most preferred clinical instructor attribute, which was clinical teaching capacity (38.14%) followed by interpersonal relationship and caring behavior (33.17%). In regard to the clinical teaching capability, a clinical instructor who parallels clinical teaching skills with the students' understanding and experience (0.089) was the highest part-worth. As for the interpersonal relationship and caring behavior, the highest part-worth was a clinical instructor who respects a student nurse as an individual and cares about him/her as a person (0.114). Findings of this study can be a basis for clinical instructors as to which qualities to cultivate best to facilitate a first-rate clinical nursing instruction. Likewise, the results of this study can inform current practices of clinical instructors by making them aware of how they can nurture a pedagogical approach consistent with the student nurses' preferences. Copyright © 2017 Elsevier Ltd. All rights reserved.

Baseline Factors Predicting Placebo Response to Treatment in Children and Adolescents With Autism Spectrum Disorders

PubMed Central

King, Bryan H.; Dukes, Kimberly; Donnelly, Craig L.; Sikich, Linmarie; McCracken, James T.; Scahill, Lawrence; Hollander, Eric; Bregman, Joel D.; Anagnostou, Evdokia; Robinson, Fay; Sullivan, Lisa; Hirtz, Deborah

2016-01-01

IMPORTANCE The finding of factors that differentially predict the likelihood of response to placebo over that of an active drug could have a significant impact on study design in this population. OBJECTIVE To identify possible nonspecific, baseline predictors of response to intervention in a large randomized clinical trial of children and adolescents with autism spectrum disorders. DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial of citalopram hydrobromide for children and adolescents with autism spectrum disorders and prominent repetitive behavior. Baseline data at study entry were examined with respect to final outcome to determine if response predictors could be identified. A total of 149 children and adolescents 5 to 17 years of age (mean [SD] age, 9.4 [3.1] years) from 6 academic centers were randomly assigned to citalopram (n = 73) or placebo (n = 76). Participants had autistic disorder, Asperger syndrome, or pervasive developmental disorder, not otherwise specified; had illness severity ratings that were moderate or more than moderate on the Clinical Global Impression–Severity scale; and scored moderate or more than moderate on compulsive behaviors measured with the modified Children’s Yale-Brown Obsessive-Compulsive Scale. INTERVENTIONS Twelve weeks of treatment with citalopram (10 mg/5 mL) or placebo. The mean (SD) maximum dose of citalopram was 16.5 (6.5) mg by mouth daily (maximum dose, 20 mg/d). MAIN OUTCOMES AND MEASURES A positive response was defined as having a score of at least much improved on the Clinical Global Impression–Improvement scale at week 12. Baseline measures included demographic (sex, age, weight, and pubertal status), clinical, and family measures. Clinical variables included baseline illness severity ratings (the Aberrant Behavior Checklist, the Child and Adolescent Symptom Inventory, the Vineland Adaptive Behavior Scales, the Repetitive Behavior Scale–Revised, and the Children’s Yale-Brown Obsessive-Compulsive Scale). Family measures included the Caregiver Strain Questionnaire. RESULTS Several baseline predictors of response were identified, and a principal component analysis yielded 3 composite measures (disruptive behavior, autism/mood, and caregiver strain) that significantly predicted response at week 12. Specifically, participants in the placebo group were significantly less likely than participants in the citalopram group to respond at week 12 if they entered the study more symptomatic on each of the 3 composite measures, and they were at least 2 times less likely to be responders. CONCLUSIONS AND RELEVANCE This analysis suggests strategies that may be useful in anticipating and potentially mitigating the nonspecific response in randomized clinical trials of children and adolescents with autism spectrum disorders. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00086645 PMID:24061784

Etiological Distinctions between Aggressive and Non-Aggressive Antisocial Behavior: Results from a Nuclear Twin Family Model

ERIC Educational Resources Information Center

Burt, S. Alexandra; Klump, Kelly L.

2012-01-01

A recent meta-analysis of 103 studies Burt ("Clinical Psychology Review," 29:163-178, 2009a) highlighted the presence of etiological distinctions between aggressive (AGG) and non-aggressive rule-breaking (RB) dimensions of antisocial behavior, such that AGG was more heritable than was RB, whereas RB was more influenced by the shared…

Psychological and behavioral differences between low back pain populations: a comparative analysis of chiropractic, primary and secondary care patients.

PubMed

Eklund, Andreas; Bergström, Gunnar; Bodin, Lennart; Axén, Iben

2015-10-19

Psychological, behavioral and social factors have long been considered important in the development of persistent pain. Little is known about how chiropractic low back pain (LBP) patients compare to other LBP patients in terms of psychological/behavioral characteristics. In this cross-sectional study, the aim was to investigate patients with LBP as regards to psychosocial/behavioral characteristics by describing a chiropractic primary care population and comparing this sample to three other populations using the MPI-S instrument. Thus, four different samples were compared. A: Four hundred eighty subjects from chiropractic primary care clinics. B: One hundred twenty-eight subjects from a gainfully employed population (sick listed with high risk of developing chronicity). C: Two hundred seventy-three subjects from a secondary care rehabilitation clinic. D: Two hundred thirty-five subjects from secondary care clinics. The Swedish version of the Multidimensional Pain Inventory (MPI-S) was used to collect data. Subjects were classified using a cluster analytic strategy into three pre-defined subgroups (named adaptive copers, dysfunctional and interpersonally distressed). The data show statistically significant overall differences across samples for the subgroups based on psychological and behavioral characteristics. The cluster classifications placed (in terms of the proportions of the adaptive copers and dysfunctional subgroups) sample A between B and the two secondary care samples C and D. The chiropractic primary care sample was more affected by pain and worse off with regards to psychological and behavioral characteristics compared to the other primary care sample. Based on our findings from the MPI-S instrument the 4 samples may be considered statistically and clinically different. Sample A comes from an ongoing trial registered at clinical trials.gov; NCT01539863 , February 22, 2012.

Innovations in primary care behavioral health: a pilot study across the U.S. Air Force.

PubMed

Landoll, Ryan R; Nielsen, Matthew K; Waggoner, Kathryn K; Najera, Elizabeth

2018-05-04

Integrated primary care services have grown in popularity in recent years and demonstrated significant benefits to the patient experience, patient health, and health care operations. However, broader systems-level factors for health care organizations, such as utilization, access, and cost, have been understudied. The current study reviews the results of quality improvement project conducted by the U.S. Air Force, which has practiced integrated primary care behavioral health for over 20 years. This study focuses on exploring how shifting the access point for behavioral from specialty mental health clinics to primary care, along with the use of technicians in patient care, can improve a range of health outcomes. Retrospective data analysis was conducted on an internal Air Force quality improvement project implemented at three military treatment facilities from October 2014 to September 2015. Positive preliminary support for these innovations was seen in the form of expanded patient populations, decreased time to first appointment, increased patient encounters, and decreased purchased community care compared with non-participating sites. Incorporation of behavioral health technicians further increased number of patient encounters while maintaining high levels of patient satisfaction across diverse clinical settings; in fact, patients preferred appointments with both technicians and behavioral health providers, compared with appointments with behavioral health providers only. These findings encourage further systematic review of systems-level factors in primary care behavioral health and adoption of the use of provider extenders in primary care behavioral health clinics.

What Is the Relationship Between a Preclerkship Portfolio Review and Later Performance in Clerkships?

PubMed

O'Brien, Celia Laird; Thomas, John X; Green, Marianne M

2018-01-01

Medical educators struggle to find effective ways to assess essential competencies such as communication, professionalism, and teamwork. Portfolio-based assessment provides one method of addressing this problem by allowing faculty reviewers to judge performance, as based on a longitudinal record of student behavior. At the Feinberg School of Medicine, the portfolio system measures behavioral competence using multiple assessments collected over time. This study examines whether a preclerkship portfolio review is a valid method of identifying problematic student behavior affecting later performance in clerkships. The authors divided students into two groups based on a summative preclerkship portfolio review in 2014: students who had concerning behavior in one or more competencies and students progressing satisfactorily. They compared how students in these groups later performed on two clerkship outcomes as of October 2015: final grades in required clerkships, and performance on a clerkship clinical composite score. They used Mann-Whitney tests and multiple linear regression to examine the relationship between portfolio review results and clerkship outcomes. They used USMLE Step 1 to control for knowledge acquisition. Students with concerning behavior preclerkship received significantly lower clerkship grades than students progressing satisfactorily (P = .002). They also scored significantly lower on the clinical composite score (P < .001). Regression analysis indicated concerning behavior was associated with lower clinical composite scores, even after controlling for knowledge acquisition. The results show a preclerkship portfolio review can identify behaviors that impact clerkship performance. A comprehensive portfolio system is a valid way to measure behavioral competencies.

Do Parents Expect Pediatricians to Pay Attention to Behavioral Health?

PubMed

Larson, Justine Julia; Lynch, Sean; Tarver, Leslie Bishop; Mitchell, Laura; Frosch, Emily; Solomon, Barry

2015-08-01

This study is a qualitative analysis examining caregivers' expectations for pediatricians with regard to behavioral health care. Fifty-five parents/caregivers of children seen in an urban primary care clinic participated in semistructured interviews. Participants were parents or guardians of children between the ages of 2 and 17 years, referred from the pediatric clinic to the mental health center. Interviews were analyzed using grounded theory methods. Pertinent themes were the following: expected range of care, components of an effective primary care provider (PCP) relationship, action of the PCP, and parent reaction to PCP intervention. Forty-seven percent of caregivers saw the PCP role as strictly for physical health care; 53% expected the PCP to have a role in both physical and behavioral health. Responses were overwhelmingly positive from caregivers when the PCP asked about or conducted a behavioral health intervention. Caregivers did not consistently expect but responded positively to PCPs engaging around behavioral health concerns. © The Author(s) 2015.

Sexual Behavior Latent Classes Among Men Who Have Sex With Men: Associations With Sexually Transmitted Infections.

PubMed

Rice, Cara E; Norris Turner, Abigail; Lanza, Stephanie T

2017-01-01

Men who have sex with men (MSM) are at disproportionate risk of acquisition of sexually transmitted infections (STIs). We used latent class analysis (LCA) to examine patterns of sexual behavior among MSM and how those patterns are related to STIs. We examined patterns of sexual behavior using behavioral and clinical data from a cross-sectional study of 235 MSM who presented to an urban sexual health clinic for STI testing. Analyzed data were collected using a combination of interviewer- and self-administered surveys and electronic health records. We used LCA to identify underlying subgroups of men based on their sexual behavior, described the demographics of the latent classes, and examined the association between the latent classes and STI status. We identified three latent classes of sexual behavior: Unprotected Anal Intercourse (UAI) Only (67%), Partner Seekers (14%), and Multiple Behaviors (19%). Men in the Multiple Behaviors class had a 67% probability of being STI positive, followed by men in the UAI Only class (27%) and men in the Partner Seekers class (22%). Examining the intersection of a variety of sexual practices indicates particular subgroups of MSM have the highest probability of being STI positive.

Association Between Childhood Traumatic Stress and Behavior in the Pediatric Dental Clinic.

PubMed

Mitchual, Serena; da Fonseca, Marcio A; Raja, Sheela; Weatherspoon, Darien; Koerber, Anne

2017-05-15

The purpose of this study was to examine the relationship between a history of potentially traumatic events (PTE) and a child's behavior during dental treatment. Parents of healthy children, age four years and older and attending their initial dental appointment at a university pediatric dental clinic, were asked to complete the Traumatic Events Screening Inventory-Parent Report Revised and a demographic survey. Following the dental appointment, a pediatric dental resident reported the child's behavior using the Frankl scale. A total of 170 parent-child pairs participated; 53 percent of parents indicated their child had experienced at least one PTE; 44 percent reported their child had a prior negative experience at the dentist. Adjusted multivariable logistic regression analysis showed no significant association between PTE history and poor dental behavior (P=0.994), but a significant association was observed between a previous negative dental experience and poor dental behavior (P=0.000) as well as between age (younger than five years old) and poor behavior (P=0.006). Children with a history of potentially traumatic events did not exhibit uncooperative behavior more often than those who did not. A previous negative dental experience and the child's young age were significantly associated with uncooperative behavior.

Job analysis and student assessment tool: perfusion education clinical preceptor.

PubMed

Riley, Jeffrey B

2007-09-01

The perfusion education system centers on the cardiac surgery operating room and the perfusionist teacher who serves as a preceptor for the perfusion student. One method to improve the quality of perfusion education is to create a valid method for perfusion students to give feedback to clinical teachers. The preceptor job analysis consisted of a literature review and interviews with preceptors to list their critical tasks, critical incidents, and cognitive and behavioral competencies. Behaviorally anchored rating traits associated with the preceptors' tasks were identified. Students voted to validate the instrument items. The perfusion instructor rating instrument with a 0-4, "very weak" to "very strong" Likert rating scale was used. The five preceptor traits for student evaluation of clinical instruction (SECI) are as follows: The clinical instructor (1) encourages self-learning, (2) encourages clinical reasoning, (3) meets student's learning needs, (4) gives continuous feedback, and (5) represents a good role model. Scores from 430 student-preceptor relationships for 28 students rotating at 24 affiliate institutions with 134 clinical instructors were evaluated. The mean overall good preceptor average (GPA) was 3.45 +/- 0.76 and was skewed to the left, ranging from 0.0 to 4.0 (median = 3.8). Only 21 of the SECI relationships earned a GPA < 2.0. Analyzing the role of the clinical instructor and performing SECI are methods to provide valid information to improve the quality of a perfusion education program.

Meta-Analysis of Day Treatment and Contingency-Management Dismantling Research: Birmingham Homeless Cocaine Studies (1990-2006)

ERIC Educational Resources Information Center

Schumacher, Joseph E.; Milby, Jesse B.; Wallace, Dennis; Meehan, Dawna-Cricket; Kertesz, Stefan; Vuchinich, Rudy; Dunning, Jonathan; Usdan, Stuart

2007-01-01

Four successive randomized clinical trials studying contingency management (CM), involving various treatment arms of drug-abstinent housing and work therapy and day treatment (DT) with a behavioral component, were compared on common drug abstinence outcomes at 2 treatment completion points (2 and 6 months). The clinical trials were conducted from…

A Brief Experimental Analysis of Reinforcer and Response Dimensions Related to Self-Control in an Outpatient Clinic

ERIC Educational Resources Information Center

Falcomata, Terry S.; Cooper-Brown, Linda J.; Wacker, David P.; Gardner, Andrew W.; Boelter, Eric W.

2010-01-01

We conducted an assessment of self-control and impulsivity with 9 children referred to an outpatient clinic for impulsive, inattentive, and hyperactive behaviors. Each condition of the assessment consisted of a choice between 2 concurrently presented math or writing tasks, with 1 alternative reflecting impulsive responding and 1 alternative…

Mechanisms of behavior modification in clinical behavioral medicine in China.

PubMed

Yang, Zhiyin; Su, Zhonghua; Ji, Feng; Zhu, Min; Bai, Bo

2014-08-01

Behavior modification, as the core of clinical behavioral medicine, is often used in clinical settings. We seek to summarize behavior modification techniques that are commonly used in clinical practice of behavioral medicine in China and discuss possible biobehavioral mechanisms. We reviewed common behavior modification techniques in clinical settings in China, and we reviewed studies that explored possible biobehavioral mechanisms. Commonly used clinical approaches of behavior modification in China include behavior therapy, cognitive therapy, cognitive-behavioral therapy, health education, behavior management, behavioral relaxation training, stress management intervention, desensitization therapy, biofeedback therapy, and music therapy. These techniques have been applied in the clinical treatment of a variety of diseases, such as chronic diseases, psychosomatic diseases, and psychological disorders. The biobehavioral mechanisms of these techniques involve the autonomic nervous system, neuroendocrine system, neurobiochemistry, and neuroplasticity. Behavior modification techniques are commonly used in the treatment of a variety of somatic and psychological disorders in China. Multiple biobehavioral mechanisms are involved in successful behavior modification.

Promoting the behaviorological analysis of verbal behavior

PubMed Central

Eshleman, John W.; Vargas, Ernest A.

1988-01-01

An important contribution of radical behavioral science is its analysis of verbal behavior. Slowly but surely an increasing number of efforts verify the propositions explicit or inherent in Skinner's theory of verbal behavior, or apply his analysis to clinical or educational practice. But both the theory and the effort to apply it are met with silence. Such silent neglect simply varies the calumnious attention usually given to behavioristic science. In recent years several papers have called attention to how non-behaviorists have habitually misrepresented the science of behavior and its underlying philosophy of radical behaviorism (Cooke, 1984; DellaLana, 1982; Morris, 1985; Todd, 1987a; Todd & Morris, 1981; Todd & Morris, 1983). These authors offer various solutions. Their preferred strategy stresses an increased effort to disseminate accurate information about behavioristic science to the press and to the world at large. They generally address, however, errors of commission, not omission. Further, their solutions tend to dwell on “processes” instead of “products.” This paper first reviews the problem of misrepresentation of the science. It then addresses the principal error of omission in the psychological literature, and offers a solution based on achieving new products resulting from new verbal behavior technology. PMID:22477561

The measurement of "eating-disorder-thoughts" and "eating-disorder-behaviors": Implications for assessment and detection of eating disorders in epidemiological studies.

PubMed

Miller, Jessie L; Vaillancourt, Tracy; Hanna, Steven E

2009-04-01

To test a theoretically driven second-order factor model of eating disorders, with eating-disordered thoughts and eating-disordered behaviors representing the higher order factors, we conducted a confirmatory factor analysis using a female university student sample (N=1816). The 'Thought' latent construct was comprised of indicators representing fear of fat and dissatisfaction with body shape/weight and the latent construct 'Behavior' was comprised of indicators representing binging, purging and restricting. From the thought and behavior latent factors, composite groups were created by varying the level of thoughts and behaviors (high, moderate, and few/or none). We examined the independent contributions of thoughts and behaviors on a measure of psychopathology (depression). A second-order model of "eating disorder thoughts" and "eating disorder behaviors" was supported by the data, based on model fit, factor loadings, and model parsimony. Mean scores on depression were clinically significant for groups engaged in any level of eating disorder behavior whereas thoughts contributed to risk for depression only at the extreme end. Because of the disproportionate representation of eating disorder thoughts (high) and eating disorder behaviors (low) in non-clinical populations, the measurement and detection of eating disorders may be enhanced by measuring thoughts separate from behaviors.

Latent Profiles of Externalizing Psychopathology and Their Relation to Children's Aggression and Social Behavior.

PubMed

Andrade, Brendan F; Wade, Mark

2016-01-01

This study identified profiles of clinic-referred children with disruptive behavior and determined the association between identified profiles and children's aggression, peer problems, and prosocial skills. Parents and teachers of 208 children (163 boys) aged 6 to 12 years (Mage = 8.80, SD = 1.75) completed measures to assess children's callous-unemotional (CU) traits, inattentive-impulsive-overactive (IO) and oppositional-defiant (OD) behavior, aggression, and social behaviors. Latent class analysis was used to identify the profiles, and the pseudoclass draw method to test the equality of means for each of the aggression and social behavioral outcomes across the latent classes. Five profiles were identified: (1) Low (35.6% of children), with relatively low levels of CU traits and IO and OD behavior; (2) Low-Moderate (30.8%), with low-moderate levels of CU traits, low IO and moderate OD behavior; (3) Moderate (21.6%), with moderate levels of CU traits and IO and moderate-high OD behavior; (4) Moderate-High (7.2%), with moderate-high levels of CU traits, high IO and moderate-high OD behavior; and (5) High (4.8%), with high levels of CU traits, IO and OD behavior. Children categorized into profiles showed important differences in level of aggression and social behavior. The overlap between CU traits, IO, and OD behavior add to understanding of child psychopathology that influences behavior and clinical outcomes.

A career path in clinical pathways.

PubMed

Bower, K A

1998-03-01

Much like the development of a clinical path, the creation of a career path requires knowledge of patterns of behavior, needs for standardized education and skill development, along with variance analysis and individualized care. This nationally known nursing entrepreneur tells the story of her involvement in the development of case management and clinical pathways and how she turned that into a successful business that has changed how patient care is managed nationally and internationally.

Child Witness to Domestic Abuse: Baseline Data Analysis for a Seven-Year Prospective Study.

PubMed

Blair, Faye; McFarlane, Judith; Nava, Angeles; Gilroy, Heidi; Maddoux, John

2015-01-01

Children who witness the abuse of their mother by an intimate partner suffer negative effects on behavioral functioning. In this study, 300 abused women seeking services for abuse were interviewed regarding how often their child had witnessed the abuse. Baseline data for this study found that boys who witnessed abuse had externalizing and internalizing behavioral problems comparable to boys in clinical treatment. Girls did not display clinically significant behaviors. For evidence-based programs to interrupt the effect of witness to violence on children, empirical data that are gender-specific are needed. Findings support the need to screen mothers for abuse during well-child visits and offer education to all mothers on the possible effects of child witness to violence in the home.

MAOA, childhood maltreatment, and antisocial behavior: meta-analysis of a gene-environment interaction.

PubMed

Byrd, Amy L; Manuck, Stephen B

2014-01-01

In a seminal study of gene-environment interaction, childhood maltreatment predicted antisocial behavior more strongly in male subjects carrying an MAOA promoter variant of lesser, compared with higher, transcriptional efficiency. Many further investigations have been reported, including studies of other early environmental exposures and female subjects. Here, we report a meta-analysis of studies testing the interaction of MAOA genotype and childhood adversities on antisocial outcomes in predominantly nonclinical samples. Included were 27 peer-reviewed, English-language studies published through August, 2012, that contained indicators of maltreatment or other family (e.g., parenting, sociodemographic) hardships; MAOA genotype; indices of aggressive and antisocial behavior; and statistical test of genotype-environment interaction. Studies of forensic and exclusively clinical samples, clinical cohorts lacking proportionally matched control subjects, or outcomes nonspecific for antisocial behavior were excluded. The Liptak-Stouffer weighted Z-test for meta-analysis was implemented to maximize study inclusion and calculated separately for male and female cohorts. Across 20 male cohorts, early adversity presaged antisocial outcomes more strongly for low-activity, relative to high- activity, MAOA genotype (p = .0044). Stratified analyses showed the interaction specific to maltreatment (p = .00000082) and robust to several sensitivity analyses. Across 11 female cohorts, MAOA did not interact with combined early life adversities, whereas maltreatment alone predicted antisocial behaviors preferentially, but weakly, in female subjects of high-activity MAOA genotype (p = .02). We found common regulatory variation in MAOA to moderate effects of childhood maltreatment on male antisocial behaviors, confirming a sentinel finding in research on gene-environment interaction. An analogous, but less consistent, finding in female subjects warrants further investigation. Copyright © 2014 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.

[Structural Equation Modeling of Self-Management in Patients with Hemodialysis].

PubMed

Cha, Jieun

2017-02-01

The purpose of this study was to construct and test a hypothetical model of self-management in patients with hemodialysis based on the Self-Regulation Model and resource-coping perspective. Data were collected from 215 adults receiving hemodialysis in 17 local clinics and one tertiary hospital in 2016. The Hemodialysis Self-management Instrument, the Revised Illness Perception Questionnaire, Herth Hope Index and Multidimensional Scale of Perceived Social Support were used. The exogenous variable was social context; the endogenous variables were cognitive illness representation, hope, self-management behavior, and illness outcome. For data analysis, descriptive statistics, Pearson correlation analysis, factor analysis, and structural equation modeling were performed. The hypothetical model with six paths showed a good fitness to the empirical data: GFI=.96, AGFI=.90, CFI=.95, RMSEA=.08, SRMR=.04. The factors that had an influence on self-management behavior were social context (β=.84), hope and cognitive illness representation (β=.37 and β=.27) explaining 92.4% of the variance. Self-management behavior mediated the relationship between psychosocial coping resources and illness outcome. This research specifies a more complete spectrum of the self-management process. It is important to recognize the array of clinical resources available to support patients' self-management. Healthcare providers can facilitate self-management through collaborative care and understanding the ideas and emotions that each patient has about the illness, and ultimately improve the health outcomes. This framework can be used to guide self-management intervention development and assure effective clinical assessment. © 2017 Korean Society of Nursing Science

Gender research in the National Institute on Drug Abuse National Treatment Clinical Trials Network: a summary of findings.

PubMed

Greenfield, Shelly F; Rosa, Carmen; Putnins, Susan I; Green, Carla A; Brooks, Audrey J; Calsyn, Donald A; Cohen, Lisa R; Erickson, Sarah; Gordon, Susan M; Haynes, Louise; Killeen, Therese; Miele, Gloria; Tross, Susan; Winhusen, Theresa

2011-09-01

The National Institute of Drug Abuse's National Drug Abuse Treatment Clinical Trials Network (CTN) was established to foster translation of research into practice in substance abuse treatment settings. The CTN provides a unique opportunity to examine in multi-site, translational clinical trials, the outcomes of treatment interventions targeting vulnerable subgroups of women; the comparative effectiveness of gender-specific protocols to reduce risk behaviors; and gender differences in clinical outcomes. To review gender-related findings from published CTN clinical trials and related studies from January 2000 to March 2010. CTN studies were selected for review if they focused on treatment outcomes or services for special populations of women with substance use disorders (SUDs) including those with trauma histories, pregnancy, co-occurring eating and other psychiatric disorders, and HIV risk behaviors; or implemented gender-specific protocols. The CTN has randomized 11,500 participants (41% women) across 200 clinics in 24 randomized controlled trials in community settings, of which 4 have been gender-specific. This article summarizes gender-related findings from CTN clinical trials and related studies, focusing on trauma histories, pregnancy, co-occurring eating and other psychiatric disorders, and HIV risk behaviors. These published studies have expanded the evidence base regarding interventions for vulnerable groups of women with SUDs as well as gender-specific interventions to reduce HIV risk behaviors in substance-using men and women. The results also underscore the complexity of accounting for gender in the design of clinical trials and analysis of results. To fully understand the relevance of gender-specific moderators and mediators of outcome, it is essential that future translational studies adopt more sophisticated approaches to understanding and measuring gender-relevant factors and plan sample sizes that are adequate to support more nuanced analytic methods.

USING MICROSOFT OFFICE EXCEL® 2007 TO CONDUCT GENERALIZED MATCHING ANALYSES

PubMed Central

Reed, Derek D

2009-01-01

The generalized matching equation is a robust and empirically supported means of analyzing relations between reinforcement and behavior. Unfortunately, no simple task analysis is available to behavior analysts interested in using the matching equation to evaluate data in clinical or applied settings. This technical article presents a task analysis for the use of Microsoft Excel to analyze and plot the generalized matching equation. Using a data-based case example and a step-by-step guide for completing the analysis, these instructions are intended to promote the use of quantitative analyses by researchers with little to no experience in quantitative analyses or the matching law. PMID:20514196

Using Microsoft Office Excel 2007 to conduct generalized matching analyses.

PubMed

Reed, Derek D

2009-01-01

The generalized matching equation is a robust and empirically supported means of analyzing relations between reinforcement and behavior. Unfortunately, no simple task analysis is available to behavior analysts interested in using the matching equation to evaluate data in clinical or applied settings. This technical article presents a task analysis for the use of Microsoft Excel to analyze and plot the generalized matching equation. Using a data-based case example and a step-by-step guide for completing the analysis, these instructions are intended to promote the use of quantitative analyses by researchers with little to no experience in quantitative analyses or the matching law.

Bayesian imperfect information analysis for clinical recurrent data

PubMed Central

Chang, Chih-Kuang; Chang, Chi-Chang

2015-01-01

In medical research, clinical practice must often be undertaken with imperfect information from limited resources. This study applied Bayesian imperfect information-value analysis to realistic situations to produce likelihood functions and posterior distributions, to a clinical decision-making problem for recurrent events. In this study, three kinds of failure models are considered, and our methods illustrated with an analysis of imperfect information from a trial of immunotherapy in the treatment of chronic granulomatous disease. In addition, we present evidence toward a better understanding of the differing behaviors along with concomitant variables. Based on the results of simulations, the imperfect information value of the concomitant variables was evaluated and different realistic situations were compared to see which could yield more accurate results for medical decision-making. PMID:25565853

Podiatric medical students' perceptions of professionalism in the clinical setting: a qualitative analysis.

PubMed

Parsley, Nancy L; Harris, Ilene B

2012-01-01

The teaching and assessment of professionalism have become central areas of research and practice in medicine and in allopathic and osteopathic undergraduate and graduate medical education generally. In contrast, discussion of professionalism as it relates to podiatric medical education is nearly nonexistent in the literature. A study of podiatric medical students' perceptions of professionalism-related issues in the clinical setting was performed using a qualitative analysis. A written survey was sent to 88 students who had recently completed their clinical training experiences. The survey was completed anonymously, and all identifying information was redacted before analysis of the data, which was performed using thematic content analysis with constant comparative analysis. In addition, basic demographic information was acquired as part of the data collection process. Sixty-six students (75%) responded and agreed to participate in the survey. Students provided written reports of lapses in professional behavior that they had witnessed, heard about, or been personally involved in performing. The study confirmed that podiatric medical students had experienced various types of professional lapses in behavior, and six predominant themes were identified. This study, which was performed with a selected group of individuals at a single institution, serves as an initial assessment of the needs of podiatric medical students and will be useful for developing professionalism-related instructional activities that could benefit students in the future.

[Psychometric Characteristics of the Clinical Nursing Mentors' Behavior Scale].

PubMed

Zhao, Rong; Chen, Yan-Hua; Yu, Hui-Ting; Xiao, Lu; Wen, Jing; Yeh, Tzu-Pei

2017-08-01

The behavior of mentors impacts the quality and experience of nursing students who are studying in clinical placement. Accurately assessing the behavior of mentors is fundamental to training, regulating, guiding, and improving their behavior and quality of teaching. To test the validity and reliability of the Clinical Nursing Mentors' Behavior Scale (CNMBS) among mentors. This study included three stages. During the first stage, seven Chinese experts were invited to evaluate content validity. During the second stage, the test-retest reliability was examined with 63 mentors. During the third stage, a cross-sectional study was conducted. Seven hundred and sixty-six nursing mentors from five hospitals in Beijing, Shenzhen, and Sichuan completed the survey either online or in hard copy form. The data collected from the questionnaire were analyzed using item analysis, construct validity, internal consistency and discriminant validity, with the results used to determine the psychometric characteristics of the CNMBS. The content validity index for the CNMBS was .91. The intra-class correlation coefficient was .89; the range of the item discrimination critical ratio was 9.42-22.43 (p < .001), and the item-total correlation was .35- .70 (p < .001). The three factors of "guiding personal growth", "promoting professional development", and "providing psychosocial support" and a total of 23 items were identified, with item factor loadings ranging from .51 to .79. The three factors explained 50.99% of total variance. The internal consistency of the CNMBS earned a Cronbach's α coefficient of .92, while those of the three subscales were .89, .86 and .75, respectively. The Clinical Nursing Mentors' Behavior Scale demonstrated high validity and reliability, supporting the CNMBS as a valid tool for assessing the teaching behavior of mentors.

Clinical decision support provided within physician order entry systems: a systematic review of features effective for changing clinician behavior.

PubMed

Kawamoto, Kensaku; Lobach, David F

2003-01-01

Computerized physician order entry (CPOE) systems represent an important tool for providing clinical decision support. In undertaking this systematic review, our objective was to identify the features of CPOE-based clinical decision support systems (CDSSs) most effective at modifying clinician behavior. For this review, two independent reviewers systematically identified randomized controlled trials that evaluated the effectiveness of CPOE-based CDSSs in changing clinician behavior. Furthermore, each included study was assessed for the presence of 14 CDSS features. We screened 10,023 citations and included 11 studies. Of the 10 studies comparing a CPOE-based CDSS intervention against a non-CDSS control group, 7 reported a significant desired change in professional practice. Moreover, meta-regression analysis revealed that automatic provision of the decision support was strongly associated with improved professional practice (adjusted odds ratio, 23.72; 95% confidence interval, 1.75-infiniti). Thus, we conclude that automatic provision of decision support is a critical feature of successful CPOE-based CDSS interventions.

Military Suicide Research Consortium

DTIC Science & Technology

2016-10-01

just prior to the time of death: An analysis with implications for understanding suicidal behavior. Journal of Abnormal Psychology , 124(2), 460-461...suicidal behavior. Journal of Abnormal Psychology , 123(4), 835-840. doi: 10.1037/a0037480 Johnson, L. L., O’Connor, S.S., Kaminer, B., Jobes, D. A...Journal of Clinical and Consulting Psychology ; Journal of Abnormal Psychology ; International Journal of Psychology ; Archives of Suicide Research

Base Rates of Social Skills Acquisition/Performance Deficits, Strengths, and Problem Behaviors: An Analysis of the Social Skills Improvement System-Rating Scales

ERIC Educational Resources Information Center

Gresham, Frank M.; Elliott, Stephen N.; Kettler, Ryan J.

2010-01-01

Base rate information is important in clinical assessment because one cannot know how unusual or typical a phenomenon is without first knowing its base rate in the population. This study empirically determined the base rates of social skills acquisition and performance deficits, social skills strengths, and problem behaviors using a nationally…

Maternal Depression History Moderates Parenting Responses to Compliant and Noncompliant Behaviors of Children with ADHD

PubMed Central

Thomas, Sharon R.; O’Brien, Kelly A.; Clarke, Tana L.; Liu, Yihao; Chronis-Tuscano, Andrea

2014-01-01

Maternal depression and parenting are robust predictors of developmental outcomes for children with attention-deficit/hyperactivity disorder (ADHD). However, methods commonly used to examine parent-child interactions in these families do not account for temporal associations between child and parent behavior that have been theorized to maintain negative child behavior. Moreover, studies examining associations between maternal depression and parenting in families of children with ADHD have not compared mothers who were currently depressed, remitted, and never clinically depressed. This study utilized sequential analysis to examine how maternal reinforcement of compliant and noncompliant child behavior differs as a function of maternal depression history. Within the 82 participating mother-child dyads, 21 mothers were currently depressed, 29 mothers had a lifetime history of depression but were in remission for at least 1 month, and 32 mothers had never been clinically depressed. 24 girls (29.6%) and 57 boys (70.4%) between the ages of 6–12 year old (M = 8.7, SD = 2.0) and were diagnosed with ADHD. Results indicated that all mothers were less likely to respond optimally than non-optimally to child compliant and noncompliant behaviors during observed parent-child interactions; however, currently depressed mothers were least likely to reinforce child compliance and responded most coercively to child noncompliance relative to the other groups. Remitted mothers in this sample were more coercive than never clinically depressed mothers, but were more likely to follow through with commands than never clinically depressed mothers. Implications for behavioral parent training programs aimed at skill development for depressed mothers of children with ADHD are discussed. PMID:25413021

Clusters of Healthy and Unhealthy Eating Behaviors are Associated with Body Mass Index Among Adults

PubMed Central

Heerman, William J.; Jackson, Natalie; Hargreaves, Margaret; Mulvaney, Shelagh A.; Schlundt, David; Wallston, Kenneth A.; Rothman, Russell L.

2017-01-01

Objective To identify eating styles from 6 eating behaviors and test their association with Body Mass Index (BMI) among adults. Design Cross-sectional analysis of self-report survey data Setting 12 primary care and specialty clinics in 5 states Participants 11,776 adult patients consented to participate; 9,977 completed survey questions. Variables measured Frequency of eating healthy food; frequency of eating unhealthy food; breakfast frequency; frequency of snacking; overall diet quality; and problem eating behaviors. The primary dependent variable was BMI, calculated from self-reported height and weight data. Analysis Kmeans cluster analysis of eating behaviors was used to determine eating styles. A categorical variable representing each eating style cluster was entered in a multivariate linear regression predicting BMI, controlling for covariates. Results Four eating styles were identified and defined by healthy vs. unhealthy diet patterns and engagement in problem eating behaviors. Each group had significantly higher average BMI than the healthy eating style: healthy with problem eating behaviors (β=1.9, p<0.001); unhealthy (β=2.5, p<0.001), and unhealthy with problem eating behaviors (β=5.1, p<0.001). Conclusions Future attempts to improve eating styles should address not only the consumption of healthy foods, but also snacking behaviors and the emotional component of eating. PMID:28363804

The 3D model of debriefing: defusing, discovering, and deepening.

PubMed

Zigmont, Jason J; Kappus, Liana J; Sudikoff, Stephanie N

2011-04-01

The experiential learning process involves participation in key experiences and analysis of those experiences. In health care, these experiences can occur through high-fidelity simulation or in the actual clinical setting. The most important component of this process is the postexperience analysis or debriefing. During the debriefing, individuals must reflect upon the experience, identify the mental models that led to behaviors or cognitive processes, and then build or enhance new mental models to be used in future experiences. On the basis of adult learning theory, the Kolb Experiential Learning Cycle, and the Learning Outcomes Model, we structured a framework for facilitators of debriefings entitled "the 3D Model of Debriefing: Defusing, Discovering, and Deepening." It incorporates common phases prevalent in the debriefing literature, including description of and reactions to the experience, analysis of behaviors, and application or synthesis of new knowledge into clinical practice. It can be used to enhance learning after real or simulated events. Copyright © 2011 Elsevier Inc. All rights reserved.

Genetic association of impulsivity in young adults: a multivariate study

PubMed Central

Khadka, S; Narayanan, B; Meda, S A; Gelernter, J; Han, S; Sawyer, B; Aslanzadeh, F; Stevens, M C; Hawkins, K A; Anticevic, A; Potenza, M N; Pearlson, G D

2014-01-01

Impulsivity is a heritable, multifaceted construct with clinically relevant links to multiple psychopathologies. We assessed impulsivity in young adult (N~2100) participants in a longitudinal study, using self-report questionnaires and computer-based behavioral tasks. Analysis was restricted to the subset (N=426) who underwent genotyping. Multivariate association between impulsivity measures and single-nucleotide polymorphism data was implemented using parallel independent component analysis (Para-ICA). Pathways associated with multiple genes in components that correlated significantly with impulsivity phenotypes were then identified using a pathway enrichment analysis. Para-ICA revealed two significantly correlated genotype–phenotype component pairs. One impulsivity component included the reward responsiveness subscale and behavioral inhibition scale of the Behavioral-Inhibition System/Behavioral-Activation System scale, and the second impulsivity component included the non-planning subscale of the Barratt Impulsiveness Scale and the Experiential Discounting Task. Pathway analysis identified processes related to neurogenesis, nervous system signal generation/amplification, neurotransmission and immune response. We identified various genes and gene regulatory pathways associated with empirically derived impulsivity components. Our study suggests that gene networks implicated previously in brain development, neurotransmission and immune response are related to impulsive tendencies and behaviors. PMID:25268255

A Middle-Range Explanatory Theory of Self-Management Behavior for Collaborative Research and Practice.

PubMed

Blok, Amanda C

2017-04-01

To report an analysis of the concept of self-management behaviors. Self-management behaviors are typically associated with disease management, with frequent use by nurse researchers related to chronic illness management and by international health organizations for development of disease management interventions. A concept analysis was conducted within the context of Orem's self-care framework. Walker and Avant's eight-step concept analysis approach guided the analysis. Academic databases were searched for relevant literature including CIHAHL, Cochrane Databases of Systematic Reviews and Register of Controlled Trials, MEDLINE, PsycARTICLES and PsycINFO, and SocINDEX. Literature using the term "self-management behavior" and published between April 2001 and March 2015 was analyzed for attributes, antecedents, and consequences. A total of 189 journal articles were reviewed. Self-management behaviors are defined as proactive actions related to lifestyle, a problem, planning, collaborating, and mental support, as well as reactive actions related to a circumstantial change, to achieve a goal influenced by the antecedents of physical, psychological, socioeconomic, and cultural characteristics, as well as collaborative and received support. The theoretical definition and middle-range explanatory theory of self-management behaviors will guide future collaborative research and clinical practice for disease management. © 2016 Wiley Periodicals, Inc.

Social Problem Solving and Depressive Symptoms over Time: A Randomized Clinical Trial of Cognitive-Behavioral Analysis System of Psychotherapy, Brief Supportive Psychotherapy, and Pharmacotherapy

ERIC Educational Resources Information Center

Klein, Daniel N.; Leon, Andrew C.; Li, Chunshan; D'Zurilla, Thomas J.; Black, Sarah R.; Vivian, Dina; Dowling, Frank; Arnow, Bruce A.; Manber, Rachel; Markowitz, John C.; Kocsis, James H.

2011-01-01

Objective: Depression is associated with poor social problem solving, and psychotherapies that focus on problem-solving skills are efficacious in treating depression. We examined the associations between treatment, social problem solving, and depression in a randomized clinical trial testing the efficacy of psychotherapy augmentation for…

The Munroe-Meyer Approach: Continuous Integration of Didactic Instruction, Research, and Clinical Practice.

PubMed

Zangrillo, Amanda N; Warzak, William J; Volkert, Valerie M; Valleley, Rachel J; Shriver, Mark D; Rodriguez, Nicole M; Roberts, Holly J; Piazza, Cathleen C; Peterson, Kathryn M; Milnes, Suzanne M; Menousek, Kathryn M; Mathews, Terri L; Luczynski, Kevin C; Kupzyk, Sara S; Kuhn, Brett R; Higgins, William J; Grennan, Allison O; Greer, Brian D; Fisher, Wayne W; Evans, Joseph H; Allen, Keith D

2016-05-01

Increased demand for applied behavior analysis (ABA) services has increased the need for additional masters-level practitioners and doctoral-level academicians and clinical directors. Based on these needs, the University of Nebraska Medical Center's (UNMC) Munroe-Meyer Institute has developed a PhD program. The academic structure at UNMC allowed us to create our PhD program in a relatively quick and efficient manner. Our PhD program has many unique features, including (a) close integration of didactic instruction with clinical and research training provided by leading experts in ABA in which students immediately apply concepts introduced in the classroom during coordinated clinical and research practica; (b) structured grant writing training in which students learn to write and submit an NIH-level grant; (c) financial support in the form of a stipend of $23,400 per year, free health benefits, and a full-tuition waiver for up to 12 credits per semester for UNMC courses (a benefits package worth approximately $50,000 per year for an out-of-state student); and (d) encouragement and financial support to present papers at local, regional, and national behavior analysis conferences.

Estimating individual benefits of medical or behavioral treatments in severely ill patients.

PubMed

Diaz, Francisco J

2017-01-01

There is a need for statistical methods appropriate for the analysis of clinical trials from a personalized-medicine viewpoint as opposed to the common statistical practice that simply examines average treatment effects. This article proposes an approach to quantifying, reporting and analyzing individual benefits of medical or behavioral treatments to severely ill patients with chronic conditions, using data from clinical trials. The approach is a new development of a published framework for measuring the severity of a chronic disease and the benefits treatments provide to individuals, which utilizes regression models with random coefficients. Here, a patient is considered to be severely ill if the patient's basal severity is close to one. This allows the derivation of a very flexible family of probability distributions of individual benefits that depend on treatment duration and the covariates included in the regression model. Our approach may enrich the statistical analysis of clinical trials of severely ill patients because it allows investigating the probability distribution of individual benefits in the patient population and the variables that influence it, and we can also measure the benefits achieved in specific patients including new patients. We illustrate our approach using data from a clinical trial of the anti-depressant imipramine.

The Crucible simulation: Behavioral simulation improves clinical leadership skills and understanding of complex health policy change.

PubMed

Cohen, Daniel; Vlaev, Ivo; McMahon, Laurie; Harvey, Sarah; Mitchell, Andy; Borovoi, Leah; Darzi, Ara

2017-05-11

The Health and Social Care Act 2012 represents the most complex National Health Service reforms in history. High-quality clinical leadership is important for successful implementation of health service reform. However, little is known about the effectiveness of current leadership training. This study describes the use of a behavioral simulation to improve the knowledge and leadership of a cohort of medical doctors expected to take leadership roles in the National Health Service. A day-long behavioral simulation (The Crucible) was developed and run based on a fictitious but realistic health economy. Participants completed pre- and postsimulation questionnaires generating qualitative and quantitative data. Leadership skills, knowledge, and behavior change processes described by the "theory of planned behavior" were self-assessed pre- and postsimulation. Sixty-nine medical doctors attended. Participants deemed the simulation immersive and relevant. Significant improvements were shown in perceived knowledge, capability, attitudes, subjective norms, intentions, and leadership competency following the program. Nearly one third of participants reported that they had implemented knowledge and skills from the simulation into practice within 4 weeks. This study systematically demonstrates the effectiveness of behavioral simulation for clinical management training and understanding of health policy reform. Potential future uses and strategies for analysis are discussed. High-quality care requires understanding of health systems and strong leadership. Policymakers should consider the use of behavioral simulation to improve understanding of health service reform and development of leadership skills in clinicians, who readily adopt skills from simulation into everyday practice.

Functional Analysis in Public Schools: A Summary of 90 Functional Analyses

ERIC Educational Resources Information Center

Mueller, Michael M.; Nkosi, Ajamu; Hine, Jeffrey F.

2011-01-01

Several review and epidemiological studies have been conducted over recent years to inform behavior analysts of functional analysis outcomes. None to date have closely examined demographic and clinical data for functional analyses conducted exclusively in public school settings. The current paper presents a data-based summary of 90 functional…

Health Behaviors Predict Higher Interleukin-6 levels Among Patients Newly Diagnosed with Head and Neck Squamous Cell Carcinoma

PubMed Central

Duffy, Sonia A.; Teknos, Theodoros; Taylor, Jeremy M.G.; Fowler, Karen E.; Islam, Mozaffarul; Wolf, Gregory T.; McLean, Scott; Ghanem, Tamer A.; Terrell, Jeffrey E.

2013-01-01

Background Health behaviors have been shown to be associated with recurrence risk and survival rates in cancer patients and are also associated with Interleukin-6 levels, but few epidemiologic studies have investigated the relationship of health behaviors and Interleukin-6 among cancer populations. The purpose of the study is to look at the relationship between five health behaviors: smoking, alcohol problems, body mass index (a marker of nutritional status), physical activity, and sleep and pretreatment Interleukin-6 levels in persons with head and neck cancer. Methods Patients (N=409) were recruited in otolaryngology clinic waiting rooms and invited to complete written surveys. A medical record audit was also conducted. Descriptive statistics and multivariate analyses were conducted to determine which health behaviors were associated with higher Interleukin-6 levels controlling for demographic and clinical variables among newly diagnosed head and neck cancer patients. Results While smoking, alcohol problems, body mass index, physical activity, and sleep were associated with Interleukin-6 levels in bivariate analysis, only smoking (current and former) and decreased sleep were independent predictors of higher Interleukin-6 levels in multivariate regression analysis. Covariates associated with higher Interleukin-6 levels were age and higher tumor stage, while comorbidities were marginally significant. Conclusion Health behaviors, particularly smoking and sleep disturbances, are associated with higher Interleukin-6 levels among head and neck cancer patients. Impact Treating health behavior problems, especially smoking and sleep disturbances, may be beneficial to decreasing Interleukin-6 levels which could have a beneficial effect on overall cancer treatment outcomes. PMID:23300019

Health behaviors predict higher interleukin-6 levels among patients newly diagnosed with head and neck squamous cell carcinoma.

PubMed

Duffy, Sonia A; Teknos, Theodoros; Taylor, Jeremy M G; Fowler, Karen E; Islam, Mozaffarul; Wolf, Gregory T; McLean, Scott; Ghanem, Tamer A; Terrell, Jeffrey E

2013-03-01

Health behaviors have been shown to be associated with recurrence risk and survival rates in patients with cancer and are also associated with interleukin-6 (IL-6) levels, but few epidemiologic studies have investigated the relationship of health behaviors and IL-6 among cancer populations. The purpose of the study is to look at the relationship between five health behaviors, viz.: smoking, alcohol problems, body mass index (BMI; a marker of nutritional status), physical activity, and sleep and pretreatment IL-6 levels in persons with head and neck cancer. Patients (N = 409) were recruited in otolaryngology clinic waiting rooms and invited to complete written surveys. A medical record audit was also conducted. Descriptive statistics and multivariate analyses were conducted to determine which health behaviors were associated with higher IL-6 levels controlling for demographic and clinical variables among patients with newly diagnosed head and neck cancer. While smoking, alcohol problems, BMI, physical activity, and sleep were associated with IL-6 levels in bivariate analysis, only smoking (current and former) and decreased sleep were independent predictors of higher IL-6 levels in multivariate regression analysis. Covariates associated with higher IL-6 levels were age and higher tumor stage, whereas comorbidities were marginally significant. Health behaviors, particularly smoking and sleep disturbances, are associated with higher IL-6 levels among patients with head and neck cancer. Treating health behavior problems, especially smoking and sleep disturbances, may be beneficial to decreasing IL-6 levels, which could have a beneficial effect on overall cancer treatment outcomes.

Exposure to Different Types of Violence and Subsequent Sexual Risk Behavior among Female STD Clinic Patients: A Latent Class Analysis

PubMed Central

Walsh, Jennifer L.; Senn, Theresa E.; Carey, Michael P.

2013-01-01

Objective Diverse forms of violence, including childhood maltreatment (CM), intimate partner violence (IPV), and exposure to community violence (ECV), have been linked separately with sexual risk behaviors. However, few studies have explored multiple experiences of violence simultaneously in relation to sexual risk-taking, especially in women who are most vulnerable to violent experiences. Methods Participants were 481 women (66% African American, Mage = 27 years) attending a publicly-funded STD clinic who reported on their past and current experiences with violence and their current sexual risk behavior. We identified patterns of experience with violence using latent class analysis (LCA) and investigated which combinations of experiences were associated with the riskiest sexual outcomes. Results Four classes of women with different experiences of violence were identified: Low Violence (39%), Predominantly ECV (20%), Predominantly CM (23%), and Multiply Victimized (18%). Women in the Multiply Victimized and Predominantly ECV classes reported the highest levels of sexual risk behavior, including more lifetime sexual partners and a greater likelihood of receiving STD treatment and using substances before sex. Conclusions Women with different patterns of violent experiences differed in their sexual risk behavior. Interventions to reduce sexual risk should address violence against women, focusing on experiences with multiple types of violence and experiences specifically with ECV. Additional research is needed to determine the best ways to address violence in sexual risk reduction interventions. PMID:23626921

Is Sex with Older Male Partners Associated with Higher Sexual Risk Behavior Among Young Black MSM?

PubMed

Chamberlain, Nicholas; Mena, Leandro A; Geter, Angelica; Crosby, Richard A

2017-08-01

Participants at a sexual health clinic completed a survey with questions regarding sexual risk behavior and partner characteristics. Of 585 participants eligible for analysis, 124 reported generally having older male partners. These participants were significantly more likely to be HIV-infected (p < 0.001), have four or more sex partners as a "bottom" (p = 0.04), have concurrent partners (p = 0.01), and have partners suspected of having an sexually transmitted infection (p = 0.05) than participants without older partners. With analysis restricted to HIV- individuals, risk behaviors did not differ significantly between the groups. HIV- individuals with older partners may be at increased risk of HIV infection due to increased HIV prevalence among older sexual partners and not due to increased risk behaviors with these partners.

A parent-report Gender Identity Questionnaire for Children: A cross-national, cross-clinic comparative analysis.

PubMed

Cohen-Kettenis, Peggy T; Wallien, Madeleine; Johnson, Laurel L; Owen-Anderson, Allison F H; Bradley, Susan J; Zucker, Kenneth J

2006-07-01

A one-factor, 14-item parent-report Gender Identity Questionnaire for Children (GIQC) was developed in a sample of 325 clinic-referred children with gender identity problems and 504 controls from Toronto, Canada (Johnson et al., 2004). In this study, we report a cross-national, cross-clinic comparative analysis of the GIQC on gender-referred children (N = 338) from Toronto and gender-referred children (N = 175) from Utrecht, The Netherlands. Across clinics, the results showed both similarities and differences. Gender-referred boys from Utrecht had a significantly higher total score (indicating more cross-gender behavior) than did gender-referred boys from Toronto, but there was no significant difference for girls. In the Toronto sample, the gender-referred girls had a significantly higher total score than the gender-referred boys, but there was no significant sex difference in the Utrecht sample. Across both clinics, gender-referred children who met the complete DSM criteria for gender identity disorder (GID) had a significantly higher cross-gender score than the gender-referred children who were subthreshold for GID (Cohen's d = 1.11). The results of this study provide the first empirical evidence of relative similarity in cross-gender behavior in a sample of gender-referred children from western Europe when compared to North American children. The results also provide some support for cross-clinic consistency in clinician-based diagnosis of GID.

Effects of Adenotonsillectomy on Parent-Reported Behavior in Children With Obstructive Sleep Apnea

PubMed Central

Thomas, Nina Hattiangadi; Xanthopoulos, Melissa S.; Kim, Ji Young; Shults, Justine; Escobar, Emma; Giordani, Bruno; Hodges, Elise; Chervin, Ronald D.; Paruthi, Shalini; Rosen, Carol L.; Taylor, Gerry H.; Arens, Raanan; Katz, Eliot S.; Beebe, Dean W.; Redline, Susan; Radcliffe, Jerilynn

2017-01-01

Abstract Objectives: The childhood obstructive sleep apnea syndrome (OSAS) is associated with behavioral abnormalities. Studies on the effects of OSAS treatment on behavior are conflicting, with few studies using a randomized design. Further, studies may be confounded by the inclusion of behavioral outcome measures directly related to sleep. The objective of this study was to determine the effect of adenotonsillectomy on behavior in children with OSAS. We hypothesized that surgery would improve behavioral ratings, even when sleep symptom items were excluded from the analysis. Methods: This was a secondary analysis of Child Behavior Checklist (CBCL) data, with and without exclusion of sleep-specific items, from the Childhood Adenotonsillectomy Trial (CHAT). CBCL was completed by caregivers of 380 children (7.0+1.4 [range 5–9] years) with OSAS randomized to early adenotonsillectomy (eAT) versus 7 months of watchful waiting with supportive care (WWSC). Results: There was a high prevalence of behavioral problems at baseline; 16.6% of children had a Total Problems score in the clinically abnormal range. At follow-up, there were significant improvements in Total Problems (p < .001), Internalizing Behaviors (p = .04), Somatic Complaints (p = .01), and Thought Problems (p = .01) in eAT vs. WWSC participants. When specific sleep-related question items were removed from the analysis, eAT showed an overall improvement in Total (p = .02) and Other (p = .01) problems. Black children had less improvement in behavior following eAT than white children, but this difference attenuated when sleep-related items were excluded. Conclusions: This large, randomized trial showed that adenotonsillectomy for OSAS improved parent-rated behavioral problems, even when sleep-specific behavioral issues were excluded from the analysis. PMID:28199697

Predictability of the future development of aggressive behavior of cranial dural arteriovenous fistulas based on decision tree analysis.

PubMed

Satomi, Junichiro; Ghaibeh, A Ammar; Moriguchi, Hiroki; Nagahiro, Shinji

2015-07-01

The severity of clinical signs and symptoms of cranial dural arteriovenous fistulas (DAVFs) are well correlated with their pattern of venous drainage. Although the presence of cortical venous drainage can be considered a potential predictor of aggressive DAVF behaviors, such as intracranial hemorrhage or progressive neurological deficits due to venous congestion, accurate statistical analyses are currently not available. Using a decision tree data mining method, the authors aimed at clarifying the predictability of the future development of aggressive behaviors of DAVF and at identifying the main causative factors. Of 266 DAVF patients, 89 were eligible for analysis. Under observational management, 51 patients presented with intracranial hemorrhage/infarction during the follow-up period. The authors created a decision tree able to assess the risk for the development of aggressive DAVF behavior. Evaluated by 10-fold cross-validation, the decision tree's accuracy, sensitivity, and specificity were 85.28%, 88.33%, and 80.83%, respectively. The tree shows that the main factor in symptomatic patients was the presence of cortical venous drainage. In its absence, the lesion location determined the risk of a DAVF developing aggressive behavior. Decision tree analysis accurately predicts the future development of aggressive DAVF behavior.

Interpersonal behaviors and socioemotional interaction of medical students in a virtual clinical encounter

PubMed Central

2014-01-01

Background The virtual clinical encounter (VCE) may function as an important support for medical students in or prior to clinical practice to train and ease communication and socioemotional interactions with patients. Few studies have however focused on the dynamics of interpersonal behaviors in clinical interviewing with a virtual patient (VP) and the affective responses evoked by such a learning experience. The study was designed to investigate the dynamics and congruence of interpersonal behaviors and socioemotional interaction exhibited during the learning experience in a VCE, and to evaluate which interaction design characteristics contribute most to the behavioral and affective engagement in medical students. Methods Thirty medical students (sixth semester) participated voluntarily in an exploratory observational study with a highly interactive VP case based on a trustworthy VP encounter with a natural and realistic dialogue interface. Students worked collaboratively in pairs. They were videotaped for further behavioral analysis and self-reported (in both a survey and an interview) their personal opinions, perceptions and attitudes about the VCE. A mixed methods approach was applied. Results All participants demonstrated an adequate, respectful and relevant clinical case management and to obtain psychosocial history. The collaborative workspace played its role and led to dynamic and engaged discussions fostering thus shared understanding. The results suggest that the VCE studied was perceived as a meaningful, intrinsically motivational and activating learning environment, and was found to socially and emotionally engage learners. We also found that VCEs have the potential to support the development of relevant and congruent interpersonal communication skills in trainees. Conclusions By taking advantage of socioemotional interaction, VCEs promote not only critical reflection skills or strategy-selection skills, but also to develop listening and nonverbal skills, induce self-awareness and target coping behaviours. We believe that, if applied in early medical education, this learning approach may facilitate clinical encounters at an early stage and contribute to responsible clinical decision making. PMID:24685070

Sex differences in behavioral outcome following neonatal hypoxia ischemia: insights from a clinical meta-analysis and a rodent model of induced hypoxic ischemic brain injury.

PubMed

Smith, Amanda L; Alexander, Michelle; Rosenkrantz, Ted S; Sadek, Mona Lisa; Fitch, R Holly

2014-04-01

Hypoxia ischemia (HI; reduced oxygen and/or blood flow to the brain) is one of the most common injuries among preterm infants and term infants with birth complications. Both populations show cognitive/behavioral deficits, including impairments in sensory, learning/memory, and attention domains. Clinical data suggests a sex difference in HI outcomes, with males exhibiting more severe cognitive/behavioral deficits relative to matched females. Our laboratory has also reported more severe behavioral deficits among male rats with induced HI relative to females with comparable injury (Hill et al., 2011a,b). The current study initially examined published clinical studies from the past 20years where long-term IQ outcome scores for matched groups of male and female premature infants were reported separately (IQ being the most common outcome measure). A meta-analysis revealed a female "advantage," as indicated by significantly better scores on performance and full scale IQ (but not verbal IQ) for premature females. We then utilized a rodent model of neonatal HI injury to assess sham and postnatal day 7 (P7) HI male and female rats on a battery of behavioral tasks. Results showed expected deficits in HI male rats, but also showed task-dependent sex differences, with HI males having significantly larger deficits than HI females on some tasks but equivalent deficits on other tasks. In contrast to behavioral results, post mortem neuropathology associated with HI was comparable across sex. These findings suggest: 1) neonatal female "protection" in some behavioral domains, as indexed by superior outcome following early injury relative to males; and 2) female protection may entail sex-specific plasticity or compensation, rather than a reduction in gross neuropathology. Further exploration of the mechanisms underlying this sex effect could aid in neuroprotection efforts for at-risk neonates in general, and males in particular. Moreover, our current report of comparable anatomical damage coupled with differences in cognitive outcomes (by sex) provides a framework for future studies to examine neural mechanisms underlying sex differences in cognition and behavior in general. Copyright © 2014. Published by Elsevier Inc.

Interest in Health Behavior Intervention Delivery Modalities Among Cancer Survivors: A Cross-Sectional Study.

PubMed

Martin, Emily C; Basen-Engquist, Karen; Cox, Matthew G; Lyons, Elizabeth J; Carmack, Cindy L; Blalock, Janice A; Demark-Wahnefried, Wendy

2016-02-11

Effective, broad-reaching channels are important for the delivery of health behavior interventions in order to meet the needs of the growing population of cancer survivors in the United States. New technology presents opportunities to increase the reach of health behavior change interventions and therefore their overall impact. However, evidence suggests that older adults may be slower in their adoption of these technologies than the general population. Survivors' interest for more traditional channels of delivery (eg, clinic) versus new technology-based channels (eg, smartphones) may depend on a variety of factors, including demographics, current health status, and the behavior requiring intervention. The aim of this study was to determine the factors that predict cancer survivors' interest in new technology-based health behavior intervention modalities versus traditional modalities. Surveys were mailed to 1871 survivors of breast, prostate, and colorectal cancer. Participants' demographics, diet and physical activity behaviors, interest in health behavior interventions, and interest in intervention delivery modalities were collected. Using path analysis, we explored the relationship between four intervention modality variables (ie, clinic, telephone, computer, and smartphone) and potential predictors of modality interest. In total, 1053 respondents to the survey (56.3% response rate); 847 provided complete data for this analysis. Delivery channel interest was highest for computer-based interventions (236/847, 27.9% very/extremely interested) and lowest for smartphone-based interventions (73/847, 8.6%), with interest in clinic-based (147/847, 17.3%) and telephone-delivered (143/847, 16.9%) falling in between. Use of other technology platforms, such as Web cameras and social networking sites, was positively predictive of interest in technology-based delivery channels. Older survivors were less likely to report interest in smartphone-based diet interventions. Physical activity, fruit and vegetable consumption, weight status, and age moderated relationships between interest in targeted intervention behavior and modality. This study identified several predictors of survivor interest in various health behavior intervention delivery modalities. Overall, computer-based interventions were found to be most acceptable, while smartphones were the least. Factors related to survivors' current technology use and health status play a role in their interest for technology-based intervention versus more traditional delivery channels. Future health behavior change research in this population should consider participants' demographic, clinical, and lifestyle characteristics when selecting a delivery channel. Furthermore, current health behavior interventions for older cancer survivors may be best delivered over the Internet. Smartphone interventions may be feasible in the future following further adoption and familiarization by this particular population. ©Emily C Martin, Karen Basen-Engquist, Matthew G Cox, Elizabeth J Lyons, Cindy L Carmack, Janice A Blalock, Wendy Demark-Wahnefried. Originally published in JMIR Cancer (http://cancer.jmir.org), 11.02.2016.

Job Analysis and Student Assessment Tool: Perfusion Education Clinical Preceptor

PubMed Central

Riley, Jeffrey B.

2007-01-01

Abstract: The perfusion education system centers on the cardiac surgery operating room and the perfusionist teacher who serves as a preceptor for the perfusion student. One method to improve the quality of perfusion education is to create a valid method for perfusion students to give feedback to clinical teachers. The preceptor job analysis consisted of a literature review and interviews with preceptors to list their critical tasks, critical incidents, and cognitive and behavioral competencies. Behaviorally anchored rating traits associated with the preceptors’ tasks were identified. Students voted to validate the instrument items. The perfusion instructor rating instrument with a 0–4, “very weak” to “very strong” Likert rating scale was used. The five preceptor traits for student evaluation of clinical instruction (SECI) are as follows: The clinical instructor (1) encourages self-learning, (2) encourages clinical reasoning, (3) meets student’s learning needs, (4) gives continuous feedback, and (5) represents a good role model. Scores from 430 student–preceptor relationships for 28 students rotating at 24 affiliate institutions with 134 clinical instructors were evaluated. The mean overall good preceptor average (GPA) was 3.45 ± 0.76 and was skewed to the left, ranging from 0.0 to 4.0 (median = 3.8). Only 21 of the SECI relationships earned a GPA <2.0. Analyzing the role of the clinical instructor and performing SECI are methods to provide valid information to improve the quality of a perfusion education program. PMID:17972453

Child and Adolescent Clinical Features Preceding Adult Suicide Attempts.

PubMed

Serra, Giulia; Koukopoulos, Athanasios; De Chiara, Lavinia; Napoletano, Flavia; Koukopoulos, Alexia; Sani, Gabriele; Faedda, Gianni L; Girardi, Paolo; Reginaldi, Daniela; Baldessarini, Ross J

2017-07-03

The objective of this study was to identify the predictive value of juvenile factors for adult suicidal behavior. We reviewed clinical records to compare factors identified in childhood and adolescence between adult suicidal versus nonsuicidal major affective disorder subjects. Suicide attempts occurred in 23.1% of subjects. Age-at-first-symptom was 14.2 vs. 20.2 years among suicidal versus nonsuicidal subjects (p < 0.0001). More prevalent in suicidal versus non-suicidal subjects by multivariate analysis were: depressive symptoms, hyper-emotionality, younger-at-first-affective-episode, family suicide history, childhood mood-swings, and adolescence low self-esteem. Presence of one factor yielded a Bayesian sensitivity of 64%, specificity of 50%, and negative predictive power of 86%. Several juvenile factors were associated with adult suicidal behavior; their absence was strongly associated with a lack of adult suicidal behavior.

Factors associated with sealant outcome in 2 pediatric dental clinics: a multivariate hierarchical analysis.

PubMed

West, Nathan G; Ilief-Ala, Melina A; Douglass, Joanna M; Hagadorn, James I

2011-01-01

This study's purpose was to determine whether one-time sealants placed by pediatric dental residents vs dental students have different outcomes. The effect of isolation technique, behavior, duration of follow-up, and caries history was also examined. Records from 2 inner-city pediatric dental clinics were audited for 6- to 10-year-old patients with a permanent first molar sealant with at least 2 years of follow-up. A successful sealant was a one-time sealant that received no further treatment and was sealed or unsealed but not carious or restored at the final audit. Charts from 203 children with 481 sealants were audited. Of these, 281 sealants were failures. Univariate analysis revealed longer follow-up and younger age were associated with sealant failure. Operator type, child behavior, and isolation technique were not associated with sealant failure. After adjusting for follow-up duration, increased age at treatment reduced the odds of sealant failure while a history of caries reduced the protective effect of increased age. After adjusting for these factors, practitioner type, behavior, and type of isolation were not associated with sealant outcome in multivariate analysis. Age at sealant placement, history of caries prior to placement, and longer duration of follow-up are associated with sealant failure.

[Children, standardization and mental health: historical figures and current chains of thought in the clinical diagnosis of attention deficit disorder and hyperactivity].

PubMed

Bianchi, Eugenia

2015-01-01

The article describes and analyzes the behavioral and neurological aspects that bring together discussions on attention deficit disorder and hyperactivity and outlines some historical conceptual antecedents. Descriptive statements focusing on the behavior of those diagnosed predominate in the behavioral dimension. Etiological explanations, principally on brain function in the neurological dimension are included. The analysis was based on documentary materials such as historical studies, interviews with health professionals in Buenos Aires between 2008 and 2011, specialized publications, psychometric instruments and psychiatric manuals.

Eating Behavior, Stress, and Adiposity: Discordance Between Perception and Physiology.

PubMed

Joseph, Paule V; Davidson, Hannah R; Boulineaux, Christina M; Fourie, Nicolaas H; Franks, Alexis T; Abey, Sarah K; Henderson, Wendy A

2018-01-01

The purpose of the study was to examine the interrelationships among stress, eating behavior, and adiposity in a cohort of normal- and overweight individuals. Clinical markers of physiological stress (fasting serum cortisol) and adiposity (body mass index [BMI] and percent body fat) were obtained from participants selected for a natural history protocol ( n = 107). Self-reported data on eating behavior (using the Three-Factor Eating Questionnaire subscales such as Cognitive Restraint, Disinhibition, and Hunger) and psychological stress (via the Perceived Stress Scale) were evaluated. Demographic information was incorporated using principal component analysis, which revealed sex- and weight-based differences in stress, adiposity, and eating behavior measures. Following a cross-sectional and descriptive analysis, significant correlations were found between the Disinhibition and Hunger eating behavior subscales and measures of adiposity including BMI ( r = .30, p = .002 and r = .20, p = .036, respectively) and percent body fat ( r = .43, p = .000 and r = .22, p = .022, respectively). Relationships between stress measures and eating behavior were also evident in the analysis. Disinhibition and Hunger correlated positively with perceived stress ( r = .32, p .001 and r = .26, p = .008, respectively). However, Disinhibition varied inversely with serum cortisol levels ( r = -.25, p = .009). Future studies are warranted to better understand this paradox underlying the effects of perceived and physiological stress on eating behavior.

Establishing the feasibility of direct observation in the assessment of tics in children with chronic tic disorders.

PubMed

Himle, Michael B; Chang, Susanna; Woods, Douglas W; Pearlman, Amanda; Buzzella, Brian; Bunaciu, Liviu; Piacentini, John C

2006-01-01

Behavior analysis has been at the forefront in establishing effective treatments for children and adults with chronic tic disorders. As is customary in behavior analysis, the efficacy of these treatments has been established using direct-observation assessment methods. Although behavior-analytic treatments have enjoyed acceptance and integration into mainstream health care practices for tic disorders (e.g., psychiatry and neurology), the use of direct observation as a primary assessment tool has been neglected in favor of less objective methods. Hesitation to use direct observation appears to stem largely from concerns about the generalizability of clinic observations to other settings (e.g., home) and a lack of consensus regarding the most appropriate and feasible techniques for conducting and scoring direct observation. The purpose of the current study was to evaluate and establish a reliable, valid, and feasible direct-observation protocol capable of being transported to research and clinical settings. A total of 43 children with tic disorders, collected from two outpatient specialty clinics, were assessed using direct (videotape samples) and indirect (Yale Global Tic Severity Scale; YGTSS) methods. Videotaped observation samples were collected across 3 consecutive weeks and two different settings (clinic and home), were scored using both exact frequency counts and partial-interval coding, and were compared to data from a common indirect measure of tic severity (the YGTSS). In addition, various lengths of videotaped segments were scored to determine the optimal observation length. Results show that (a) clinic-based observations correspond well to home-based observations, (b) brief direct-observation segments scored with time-sampling methods reliably quantified tics, and (c) indirect methods did not consistently correspond with the direct methods.

Bladder Carcinoma Data with Clinical Risk Factors and Molecular Markers: A Cluster Analysis

PubMed Central

Redondo-Gonzalez, Enrique; de Castro, Leandro Nunes; Moreno-Sierra, Jesús; Maestro de las Casas, María Luisa; Vera-Gonzalez, Vicente; Ferrari, Daniel Gomes; Corchado, Juan Manuel

2015-01-01

Bladder cancer occurs in the epithelial lining of the urinary bladder and is amongst the most common types of cancer in humans, killing thousands of people a year. This paper is based on the hypothesis that the use of clinical and histopathological data together with information about the concentration of various molecular markers in patients is useful for the prediction of outcomes and the design of treatments of nonmuscle invasive bladder carcinoma (NMIBC). A population of 45 patients with a new diagnosis of NMIBC was selected. Patients with benign prostatic hyperplasia (BPH), muscle invasive bladder carcinoma (MIBC), carcinoma in situ (CIS), and NMIBC recurrent tumors were not included due to their different clinical behavior. Clinical history was obtained by means of anamnesis and physical examination, and preoperative imaging and urine cytology were carried out for all patients. Then, patients underwent conventional transurethral resection (TURBT) and some proteomic analyses quantified the biomarkers (p53, neu, and EGFR). A postoperative follow-up was performed to detect relapse and progression. Clusterings were performed to find groups with clinical, molecular markers, histopathological prognostic factors, and statistics about recurrence, progression, and overall survival of patients with NMIBC. Four groups were found according to tumor sizes, risk of relapse or progression, and biological behavior. Outlier patients were also detected and categorized according to their clinical characters and biological behavior. PMID:25866762

Cleveland Clinic Rehabilitation Research Program

DTIC Science & Technology

2014-10-01

risks have been identified that would require a new risk analysis. The study is now registered as a pilot clinical trial. Use of tDCS , TMS and structural...using behavioral recording and electroencephalographic ( EEG ) recording and results were published. Study 2: The motor cortex (M1) and the...four pilot projects. Study 1: Magnetic stimulation and epilepsy In this study, transcranial magnetic stimulation ( TMS ) will be tested for its

Psychiatric Morbidity Pattern in a Child Guidance Clinic.

PubMed

Chaudhury, S; Prasad, P L; Zacharias, R; Madhusudan, T; Saini, R

2007-04-01

There is a paucity of Indian studies on psychiatric morbidity in children. Present work was undertaken in a child guidance clinic in armed forces. Retrospective analysis of 213 patients who attended a child guidance clinic was done. Majority (n=138) were boys. 55.9% were referred from paediatric outpatient department while medical officers in periphery referred 38.5%. The diagnoses was mental retardation in 30.97%, behavioral and emotional disorders in 23.06% and neurotic, stress related and somatoform disorders in 15.98% cases.

The structure of mental health research: networks of influence among psychiatry and clinical psychology journals.

PubMed

Haslam, N; Lusher, D

2011-12-01

Psychiatry and clinical psychology are the two dominant disciplines in mental health research, but the structure of scientific influence and information flow within and between them has never been mapped. Citations among 96 of the highest impact psychiatry and clinical psychology journals were examined, based on 10 052 articles published in 2008. Network analysis explored patterns of influence between journal clusters. Psychiatry journals tended to have greater influence than clinical psychology journals, and their influence was asymmetrical: clinical psychology journals cited psychiatry journals at a much higher rate than the reverse. Eight journal clusters were found, most dominated by a single discipline. Their citation network revealed an influential central cluster of 'core psychiatry' journals that had close affinities with a 'psychopharmacology' cluster. A group of 'core clinical psychology' journals was linked to a 'behavior therapy' cluster but both were subordinate to psychiatry journals. Clinical psychology journals were less integrated than psychiatry journals, and 'health psychology/behavioral medicine' and 'neuropsychology' clusters were relatively peripheral to the network. Scientific publication in the mental health field is largely organized along disciplinary lines, and is to some degree hierarchical, with clinical psychology journals tending to be structurally subordinate to psychiatry journals.

Using Telemedicine to Conduct Behavioral Assessments

PubMed Central

Barretto, Anjali; Wacker, David P; Harding, Jay; Lee, John; Berg, Wendy K

2006-01-01

We describe the use of telemedicine by the Biobehavioral Service at the University of Iowa Hospitals and Clinics to conduct brief functional analyses for children with developmental and behavioral disorders who live in rural areas of Iowa. Instead of being served at our outpatient facility, participants received initial behavioral assessments in their local schools or social service agencies via videoconference. Case descriptions for 2 participants whose evaluations were conducted via telemedicine, and a brief summary of all outpatient assessments conducted over a 4-year period by the Biobehavioral Service, are provided. This report extends previous applications of functional analysis procedures by examining brief behavioral assessments conducted via telemedicine. PMID:17020213

Academic misconduct in nursing students: behaviors, attitudes, rationalizations, and cultural identity.

PubMed

McCrink, Andrea

2010-11-01

The purpose of this study was to gain knowledge about academic misconduct in associate degree nursing students enrolled in two nursing programs in the northeastern United States. Study respondents (n = 193) identified the frequency of engagement in behaviors of misconduct in both the classroom and clinical setting and their attitudes toward the identified behaviors of misconduct, neutralization behaviors, ethical standards of the nursing profession, and the ethic of caring within the nursing profession. Findings were consistent with previous research on academic misconduct in baccalaureate nursing students. Analysis of self-reported cultural identities refuted the prevailing literature on academic misconduct across differing cultures and nations. Copyright 2010, SLACK Incorporated.

Symptoms of Depression and Challenging Behaviours in People with Intellectual Disability: A Bayesian Analysis. Brief Report

ERIC Educational Resources Information Center

Tsiouris, John; Mann, Rachel; Patti, Paul; Sturmey, Peter

2004-01-01

Clinicians need to know the likelihood of a condition given a positive or negative diagnostic test. In this study a Bayesian analysis of the Clinical Behavior Checklist for Persons with Intellectual Disabilities (CBCPID) to predict depression in people with intellectual disability was conducted. The CBCPID was administered to 92 adults with…

Socio-Demographic, Clinical and Behavioral Characteristics Associated with a History of Suicide Attempts among Psychiatric Outpatients: A Case Control Study in a Northern Mexican City.

PubMed

Alvarado-Esquivel, Cosme; Sánchez-Anguiano, Luis Francisco; Arnaud-Gil, Carlos Alberto; Hernández-Tinoco, Jesús; Molina-Espinoza, Luis Fernando; Rábago-Sánchez, Elizabeth

2014-03-01

Little is known about the epidemiology of suicide attempts among psychiatric outpatients in Mexico. This study was aimed to determine the socio-demographic, clinical and behavioral characteristics associated with suicide attempts in psychiatric outpatients in two public hospitals in Durango, Mexico. Two hundred seventy six psychiatric outpatients (154 suicide attempters and 122 patients without suicide attempt history) attended the two public hospitals in Durango City, Mexico were included in this study. Socio-demographic, clinical and behavioral characteristics were obtained retrospectively from all outpatients and compared in relation to the presence or absence of suicide attempt history. Increased prevalence of suicide attempts was associated with mental and behavioral disorders due to psychoactive substance use (F10-19) (P=0.01), schizophrenia, schizotypal and delusional disorders (F20-29) (P=0.02), mood (affective) disorders (F30-39) (P<0.001), and disorders of adult personality and behavior (F60-69) (P<0.001). Multivariate analysis showed that suicide attempts were associated with young age (OR=1.21, 95% CI: 1.06-1.39; P=0.003), female gender (OR=2.98, 95% CI: 1.55-5.73; P=0.001), urban residence (OR=2.31, 95% CI: 1.17-4.57; P=0.01), memory impairment (OR=1.91, 95% CI: 1.07-3.40; P=0.02), alcohol consumption (OR=2.39, 95% CI: 1.21-4.70; P=0.01), and sexual promiscuity (OR=3.90, 95% CI: 1.74-8.77; P<0.001). We report the association of suicide attempts with socio-demographic, clinical and behavioral characteristics in psychiatric outpatients in Mexico. Results may be useful for an optimal planning of preventive measures against suicide attempts in psychiatric outpatients.

Gender Research in the National Institute on Drug Abuse National Treatment Clinical Trials Network: A Summary of Findings

PubMed Central

Greenfield, Shelly F.; Rosa, Carmen; Putnins, Susan I.; Green, Carla A.; Brooks, Audrey J.; Calsyn, Donald A.; Cohen, Lisa R.; Erickson, Sarah; Gordon, Susan M.; Haynes, Louise; Killeen, Therese; Miele, Gloria; Tross, Susan; Winhusen, Theresa

2011-01-01

Background The NIDA National Drug Abuse Treatment Clinical Trials Network (CTN) was established to foster translation of research into practice in substance abuse treatment settings. The CTN provides a unique opportunity to examine in multi-site, translational clinical trials, the outcomes of treatment interventions targeting vulnerable sub-groups of women; the comparative effectiveness of gender-specific protocols to reduce risk behaviors; and gender differences in clinical outcomes. Objectives To review gender-related findings from published CTN clinical trials and related studies from January, 2000 through March, 2010. Methods CTN studies were selected for review if they focused on treatment outcomes or services for special populations of women with substance use disorders (SUDs) including those with trauma histories, pregnancy, co-occurring eating and other psychiatric disorders and HIV risk behaviors; or implemented gender-specific protocols. Results The CTN has randomized 11,500 participants (41% women) across 200 clinics in 24 randomized clinical trials in community settings, of which 4 have been gender-specific. This paper summarizes gender-related findings from CTN clinical trials and related studies, focusing on trauma histories, pregnancy, co-occurring eating and other psychiatric disorders, and HIV risk behaviors. Conclusions These published studies have expanded the evidence base regarding interventions for vulnerable groups of women with SUDs as well as gender-specific interventions to reduce HIV risk behaviors in substance using men and women. The results also underscore the complexity of accounting for gender in the design of clinical trials and analysis of results. Scientific Relevance To fully understand the relevance of gender-specific moderators and mediators of outcome, it is essential that future translational studies adopt more sophisticated approaches to understanding and measuring gender-relevant factors and plan sample sizes that are adequate to support more nuanced analytic methods. PMID:21854272

Dissociative Experiences during Sexual Behavior among a Sample of Adults Living with HIV Infection and a History of Childhood Sexual Abuse

PubMed Central

Hansen, Nathan B.; Brown, Lauren J.; Tsatkin, Elizabeth; Zelgowski, Brittany; Nightingale, Vienna

2012-01-01

Little attention has been given to the occurrence of dissociative symptoms during sexual behavior in adults who have experienced childhood sexual abuse (CSA). For this study, 57 adults living with HIV infection who had experienced CSA and were entering a treatment study for traumatic stress completed study assessments and clinical interviews, including a 15-item scale of Dissociative Experiences during Sexual Behavior. Predictor variables included DSM-IV-TR diagnoses of PTSD and Dissociative Disorders, Rape by an Intimate Partner, Duration of CSA, Number of Perpetrators of CSA, and Current Sexual Satisfaction. A multiple regression analysis was conducted to identify significant associations between predictors and dissociation during sex. Mean differences by clinical diagnosis were also examined. Results indicated that PTSD, Dissociative Disorders, Rape by an Intimate Partner, Duration of CSA, and Number of Perpetrators of CSA were associated with increased dissociation during sexual behavior. Dissociation during sex likely increases vulnerability to sexual revictimization and risky sexual behavior. Standard behavioral prevention interventions may be ineffective for sexual situations when dissociation occurs, and prevention efforts should be integrated with mental health care for those who have experienced CSA. PMID:22545567

Sensory features and repetitive behaviors in children with autism and developmental delays.

PubMed

Boyd, Brian A; Baranek, Grace T; Sideris, John; Poe, Michele D; Watson, Linda R; Patten, Elena; Miller, Heather

2010-04-01

This study combined parent and observational measures to examine the association between aberrant sensory features and restricted, repetitive behaviors in children with autism (N=67) and those with developmental delays (N=42). Confirmatory factor analysis was used to empirically validate three sensory constructs of interest: hyperresponsiveness, hyporesponsiveness, and sensory seeking. Examining the association between the three derived sensory factor scores and scores on the Repetitive Behavior Scales--Revised revealed the co-occurrence of these behaviors in both clinical groups. Specifically, high levels of hyperresponsive behaviors predicted high levels of repetitive behaviors, and the relationship between these variables remained the same controlling for mental age. We primarily found non-significant associations between hyporesponsiveness or sensory seeking and repetitive behaviors, with the exception that sensory seeking was associated with ritualistic/sameness behaviors. These findings suggest that shared neurobiological mechanisms may underlie hyperresponsive sensory symptoms and repetitive behaviors and have implications for diagnostic classification as well as intervention.

Analysis of internet use behaviors among clinical medical students in China.

PubMed

Yang, Hua; Chen, Yunxiang; Zheng, Liqiang; Xu, Xin; Cao, Xia

2014-04-02

The availability of internet-based information resources is increasing and the appropriate use of such resources is an important subject for clinical medical students. The aims of this study were to investigate the behaviors of clinical medical students regarding the use of internet-based activities, to analyze the behavior and characteristics of the students' information demands, and to discuss the behaviors and time preferences related to internet use of students with different levels of education. Librarians obtained real-time feedback from 999 clinical medical students to record online activities. The data was recorded in a standard form and then analyzed statistically. There were significant differences in the use of the internet for learning activities among the different groups of clinical medical students (P < 0.0001). Learning accounted for 73.5% of all internet use for doctoral candidates, 47.6% of internet use for master's candidates, 28.7% of internet use for seven-year undergraduate students, and 14.1% of use for five-year undergraduate students. There was also a significant difference in the proportions of leisure and e-commerce activities among the student groups (P < 0.0001), with five-year students displaying the highest total proportion of these activities (59.4% and 18.8%). Internet use for entertainment activities was the same for all groups of clinical medical students. Time of day of internet use was consistent across all student groups, but internet use differed by day of the week (P < 0.01). There was no difference among the time of day of internet use for learning, leisure and entertainment activities during a single day (P > 0.05), but e-commerce activities varied according to time of day (P < 0.05). Learning and e-commerce activities by clinical medical students did not vary by day of the week (P > 0.05), but the distributions of leisure and entertainment activities were different according to day of the week (P < 0.05). A stronger demand for learning is associated with a higher academic level of clinical medical students. Differences exist among student groups regarding internet use behaviors and internet use during different time periods.

[Effect of doctor-patient communication education on oral clinical practice].

PubMed

Wang, Yi; Tang, Yu; He, Yan; Zhu, Ya-qin

2012-08-01

To evaluate the effect of doctor-patient communication education on dental clinical practice. The process of 61 dental interns' clinical practice was divided into two stages. The dental interns were taught with traditional teaching method in the first stage. Doctor-patient communication and communication skill training were added to the second stage. Scale of medical student's doctor-patient communication behavior was used to evaluate the dental interns' behavior by themselves after two stages. The SEGUE frame work was used to evaluate the dental interns' behavior by teachers after two stages. All statistical analysis was performed using SPSS 13.0 software package. The result of scale of medical student's doctor-patient communication behavior was analyzed using Fisher exact test or Chi-square test. The score of the SEGUE frame work was analyzed using Student's t test. The result of Scale of medical student's doctor-patient communication behavior showed only 37.71% of dental interns could establish good doctor-patient relationship in the first stage. After doctor-patient communication and communication skill training, the percentage became 75.4%. The result of the SEGUE frame work showed the score was raised from 16.066±3.308 to 21.867±2.456, and a significant difference was found between the two stages. Doctor-Patient communication education can improve dental interns' communication skills and help to establish a good doctor-patient relationship.

Demographics, behavior problems, and psychosexual characteristics of adolescents with gender identity disorder or transvestic fetishism.

PubMed

Zucker, Kenneth J; Bradley, Susan J; Owen-Anderson, Allison; Kibblewhite, Sarah J; Wood, Hayley; Singh, Devita; Choi, Kathryn

2012-01-01

This study provided a descriptive and quantitative comparative analysis of data from an assessment protocol for adolescents referred clinically for gender identity disorder (n = 192; 105 boys, 87 girls) or transvestic fetishism (n = 137, all boys). The protocol included information on demographics, behavior problems, and psychosexual measures. Gender identity disorder and transvestic fetishism youth had high rates of general behavior problems and poor peer relations. On the psychosexual measures, gender identity disorder patients had considerably greater cross-gender behavior and gender dysphoria than did transvestic fetishism youth and other control youth. Male gender identity disorder patients classified as having a nonhomosexual sexual orientation (in relation to birth sex) reported more indicators of transvestic fetishism than did male gender identity disorder patients classified as having a homosexual sexual orientation (in relation to birth sex). The percentage of transvestic fetishism youth and male gender identity disorder patients with a nonhomosexual sexual orientation self-reported similar degrees of behaviors pertaining to transvestic fetishism. Last, male and female gender identity disorder patients with a homosexual sexual orientation had more recalled cross-gender behavior during childhood and more concurrent cross-gender behavior and gender dysphoria than did patients with a nonhomosexual sexual orientation. The authors discuss the clinical utility of their assessment protocol.

Social construction: vistas in clinical child and adolescent psychology.

PubMed

Gergen, Kenneth J; Lightfoot, Cynthia; Sydow, Lisa

2004-06-01

We explore here the potentials of a social constructionist orientation to knowledge for research and clinical practice. Dialogues on social construction emphasize the communal origins of knowledge. They stress the cultural basis of knowledge claims, the significance of language, the value saturation of all knowledge, and the significance of relationships as opposed to individuals. An initial illustration of constructionism in action centers on adolescent risk behavior. Such behavior is often constructed negatively within popular writings and the social science and thus ignores the meaning of such actions to the adolescents themselves. Discourse analysis indicates that for adolescents risky behavior serves important functions of enhancing group solidarity and establishing positive identity. A second illustration, exploring the implications of constructionism for therapy, places a strong emphasis on the therapist as a collaborator in the building of meaning. Traditional investments in diagnosis and treatment are replaced with the collaborative creation of new possibilities for action.

Self-Care Behaviors in Heart Failure.

PubMed

Cavalcante, Agueda Maria Ruiz Zimmer; Lopes, Camila Takao; Brunori, Evelise Fadini Reis; Swanson, Elizabeth; Moorhead, Sue Ann; Bachion, Maria Márcia; de Barros, Alba Lucia Bottura Leite

2017-05-18

To identify self-care behaviors, instruments, techniques, parameters for the assessment of self-care behaviors in people with heart failure, compare these behaviors with the indicators of the Nursing Outcomes Classification outcome, Self Management: Cardiac Disease. Integrative literature review performed in Lilacs, Medline, CINAHL, and Cochrane, including publications from 2009 to 2015. One thousand six hundred ninety-one articles were retrieved from the search, of which 165 were selected for analysis. Ten self-care behaviors and several different assessment instruments, techniques, and parameters were identified. The addition and removal of some indicators are proposed, based on this review. The data provide substrate for the development of conceptual and operational definitions of the indicators, making the outcome more applicable for use in clinical practice. © 2017 NANDA International, Inc.

Usability testing of Avoiding Diabetes Thru Action Plan Targeting (ADAPT) decision support for integrating care-based counseling of pre-diabetes in an electronic health record.

PubMed

Chrimes, Dillon; Kitos, Nicole R; Kushniruk, Andre; Mann, Devin M

2014-09-01

Usability testing can be used to evaluate human-computer interaction (HCI) and communication in shared decision making (SDM) for patient-provider behavioral change and behavioral contracting. Traditional evaluations of usability using scripted or mock patient scenarios with think-aloud protocol analysis provide a way to identify HCI issues. In this paper we describe the application of these methods in the evaluation of the Avoiding Diabetes Thru Action Plan Targeting (ADAPT) tool, and test the usability of the tool to support the ADAPT framework for integrated care counseling of pre-diabetes. The think-aloud protocol analysis typically does not provide an assessment of how patient-provider interactions are effected in "live" clinical workflow or whether a tool is successful. Therefore, "Near-live" clinical simulations involving applied simulation methods were used to compliment the think-aloud results. This complementary usability technique was used to test the end-user HCI and tool performance by more closely mimicking the clinical workflow and capturing interaction sequences along with assessing the functionality of computer module prototypes on clinician workflow. We expected this method to further complement and provide different usability findings as compared to think-aloud analysis. Together, this mixed method evaluation provided comprehensive and realistic feedback for iterative refinement of the ADAPT system prior to implementation. The study employed two phases of testing of a new interactive ADAPT tool that embedded an evidence-based shared goal setting component into primary care workflow for dealing with pre-diabetes counseling within a commercial physician office electronic health record (EHR). Phase I applied usability testing that involved "think-aloud" protocol analysis of eight primary care providers interacting with several scripted clinical scenarios. Phase II used "near-live" clinical simulations of five providers interacting with standardized trained patient actors enacting the clinical scenario of counseling for pre-diabetes, each of whom had a pedometer that recorded the number of steps taken over a week. In both phases, all sessions were audio-taped and motion screen-capture software was activated for onscreen recordings. Transcripts were coded using iterative qualitative content analysis methods. In Phase I, the impact of the components and layout of ADAPT on user's Navigation, Understandability, and Workflow were associated with the largest volume of negative comments (i.e. approximately 80% of end-user commentary), while Usability and Content of ADAPT were representative of more positive than negative user commentary. The heuristic category of Usability had a positive-to-negative comment ratio of 2.1, reflecting positive perception of the usability of the tool, its functionality, and overall co-productive utilization of ADAPT. However, there were mixed perceptions about content (i.e., how the information was displayed, organized and described in the tool). In Phase II, the duration of patient encounters was approximately 10 min with all of the Patient Instructions (prescriptions) and behavioral contracting being activated at the end of each visit. Upon activation, providers accepted the pathway prescribed by the tool 100% of the time and completed all the fields in the tool in the simulation cases. Only 14% of encounter time was spent using the functionality of the ADAPT tool in terms of keystrokes and entering relevant data. The rest of the time was spent on communication and dialog to populate the patient instructions. In all cases, the interaction sequence of reviewing and discussing exercise and diet of the patient was linked to the functionality of the ADAPT tool in terms of monitoring, response-efficacy, self-efficacy, and negotiation in the patient-provider dialog. There was a change from one-way dialog to two-way dialog and negotiation that ended in a behavioral contract. This change demonstrated the tool's sequence, which supported recording current exercise and diet followed by a diet and exercise goal setting procedure to reduce the risk of diabetes onset. This study demonstrated that "think-aloud" protocol analysis with "near-live" clinical simulations provided a successful usability evaluation of a new primary care pre-diabetes shared goal setting tool. Each phase of the study provided complementary observations on problems with the new onscreen tool and was used to show the influence of the ADAPT framework on the usability, workflow integration, and communication between the patient and provider. The think-aloud tests with the provider showed the tool can be used according to the ADAPT framework (exercise-to-diet behavior change and tool utilization), while the clinical simulations revealed the ADAPT framework to realistically support patient-provider communication to obtain behavioral change contract. SDM interactions and mechanisms affecting protocol-based care can be more completely captured by combining "near-live" clinical simulations with traditional "think-aloud analysis" which augments clinician utilization. More analysis is required to verify if the rich communication actions found in Phase II compliment clinical workflows. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

The moral development of baccalaureate nursing students: understanding unethical behavior in classroom and clinical settings.

PubMed

Baxter, Pamela E; Boblin, Sheryl L

2007-01-01

Unethical behavior in both classroom and clinical settings is a concern for nurse educators and has the potential to greatly influence the quality of patient care. A review of the literature suggests that students may view unethical clinical behaviors as different from unethical classroom behaviors because they recognize that clinical behaviors may have a direct effect on patient care. An overview of three moral theories, proposed by Kohlberg, Gilligan, and Rest, provides insight into the reasons for unethical behavior. These theories provide the foundation for strategies nurse educators can use to help reduce unethical behavior in both classroom and clinical settings in an attempt to ensure quality patient care.

Behavior management for children and adolescents with acquired brain injury.

PubMed

Slifer, Keith J; Amari, Adrianna

2009-01-01

Behavioral problems such as disinhibition, irritability, restlessness, distractibility, and aggression are common after acquired brain injury (ABI). The persistence and severity of these problems impair the brain-injured individual's reintegration into family, school, and community life. Since the early 1980s, behavior analysis and therapy have been used to address the behavioral sequelae of ABI. These interventions are based on principles of learning and behavior that have been robustly successful when applied across a broad range of other clinical populations. Most of the research on behavioral treatment after ABI has involved clinical case studies or studies employing single-subject experimental designs across a series of cases. The literature supports the effectiveness of these interventions across ages, injury severities, and stages of recovery after ABI. Recommended guidelines for behavior management include: direct behavioral observations, systematic assessment of environmental and within-patient variables associated with aberrant behavior, antecedent management to minimize the probability of aberrant behavior, provision of functionally equivalent alternative means of controlling the environment, and differential reinforcement to shape positive behavior and coping strategies while not inadvertently shaping emergent, disruptive sequelae. This package of interventions requires direction by a highly skilled behavioral psychologist or therapist who systematically monitors target behavior to evaluate progress and guide treatment decisions. A coordinated multisite effort is needed to design intervention protocols that can be studied prospectively in randomized controlled trials. However, there will continue to be an important role for single subject experimental design for studying the results of individualized interventions and obtaining pilot data to guide subsequent randomized controlled trails. (c) 2009 Wiley-Liss, Inc.

Efficacy of brief behavioral counselling by allied health professionals to promote physical activity in people with peripheral arterial disease (BIPP): study protocol for a multi-center randomized controlled trial.

PubMed

Burton, Nicola W; Ademi, Zanfina; Best, Stuart; Fiatarone Singh, Maria A; Jenkins, Jason S; Lawson, Kenny D; Leicht, Anthony S; Mavros, Yorgi; Noble, Yian; Norman, Paul; Norman, Richard; Parmenter, Belinda J; Pinchbeck, Jenna; Reid, Christopher M; Rowbotham, Sophie E; Yip, Lisan; Golledge, Jonathan

2016-11-09

Physical activity is recommended for people with peripheral arterial disease (PAD), and can improve walking capacity and quality of life; and reduce pain, requirement for surgery and cardiovascular events. This trial will assess the efficacy of a brief behavioral counselling intervention delivered by allied health professionals to improve physical activity in people with PAD. This is a multi-center randomised controlled trial in four cities across Australia. Participants (N = 200) will be recruited from specialist vascular clinics, general practitioners and research databases and randomised to either the control or intervention group. Both groups will receive usual medical care, a written PAD management information sheet including advice to walk, and four individualised contacts from a protocol-trained allied health professional over 3 months (weeks 1, 2, 6, 12). The control group will receive four 15-min telephone calls with general discussion about PAD symptoms and health and wellbeing. The intervention group will receive behavioral counselling via two 1-h face-to-face sessions and two 15-min telephone calls. The counselling is based on the 5A framework and will promote interval walking for 3 × 40 min/week. Assessments will be conducted at baseline, and 4, 12 and 24 months by staff blinded to participant allocation. Objectively assessed outcomes include physical activity (primary), sedentary behavior, lower limb body function, walking capacity, cardiorespiratory fitness, event-based claudication index, vascular interventions, clinical events, cardiovascular function, circulating markers, and anthropometric measures. Self-reported outcomes include physical activity and sedentary behavior, walking ability, pain severity, and health-related quality of life. Data will be analysed using an intention-to-treat approach. An economic evaluation will assess whether embedding the intervention into routine care would likely be value for money. A cost-effectiveness analysis will estimate change in cost per change in activity indicators due to the intervention, and a cost-utility analysis will assess change in cost per quality-adjusted life year. A full uncertainty analysis will be undertaken, including a value of information analysis, to evaluate the economic case for further research. This trial will evaluate the efficacy and cost-effectiveness of a brief behavioral counselling intervention for a common cardiovascular disease with significant burden. ACTRN 12614000592640 Australian New Zealand Clinical Trials Registry. Registration Date 4 June 2014.

Testing for EMC (electromagnetic compatibility) in the clinical environment.

PubMed

Paperman, D; David, Y; Martinez, M

1996-01-01

Testing for electromagnetic compatibility (EMC) in the clinical environment introduces a host of complex conditions not normally encountered under laboratory conditions. In the clinical environment, various radio-frequency (RF) sources of electromagnetic interference (EMI) may be present throughout the entire spectrum of interest. Isolating and analyzing the impact from the sources of interference to medical devices involves a multidisciplinary approach based on training in, and knowledge of, the following: operation of medical devices and their susceptibility to EMI; RF propagation modalities and interaction theory; spectrum analysis systems and techniques (preferably with signature analysis capabilities) and calibrated antennas; the investigation methodology of suspected EMC problems, and testing protocols and standards. Using combinations of standard test procedures adapted for the clinical environment with personnel that have an understanding of radio-frequency behavior increases the probability of controlling, proactively, EMI in the clinical environment, thus providing for a safe and more effective patient care environment.

Familial clustering of epilepsy and behavioral disorders: Evidence for a shared genetic basis

PubMed Central

Hesdorffer, Dale C.; Caplan, Rochelle; Berg, Anne T.

2011-01-01

Purpose To examine whether family history of unprovoked seizures is associated with behavioral disorders in epilepsy probands, thereby supporting the hypothesis of shared underlying genetic susceptibility to these disorders. Methods We conducted an analysis of the 308 probands with childhood onset epilepsy from the Connecticut Study of Epilepsy with information on first degree family history of unprovoked seizures and of febrile seizures whose parents completed the Child Behavior Checklist (CBCL) at the 9-year follow-up. Clinical cut-offs for CBCL problem and DSM-Oriented scales were examined. The association between first degree family history of unprovoked seizure and behavioral disorders was assessed separately in uncomplicated and complicated epilepsy and separately for first degree family history of febrile seizures. A subanalysis, accounting for the tendency for behavioral disorders to run in families, adjusted for siblings with the same disorder as the proband. Prevalence ratios were used to describe the associations. Key findings In probands with uncomplicated epilepsy, first degree family history of unprovoked seizure was significantly associated with clinical cut-offs for Total Problems and Internalizing Disorders. Among Internalizing Disorders, clinical cut-offs for Withdrawn/Depressed, and DSM-Oriented scales for Affective Disorder and Anxiety Disorder were significantly associated with family history of unprovoked seizures. Clinical cut-offs for Aggressive Behavior and Delinquent Behavior, and DSM-Oriented scales for Conduct Disorder and Oppositional Defiant Disorder were significantly associated with family history of unprovoked seizure. Adjustment for siblings with the same disorder revealed significant associations for the relationship between first degree family history of unprovoked seizure and Total Problems and Agressive Behavior in probands with uncomplicated epilepsy; marginally significant results were seen for Internalizing Disorder, Withdrawn/Depressed and Anxiety Disorder. There was no association between family history of unprovoked seizure and behavioral problems in probands with complicated epilepsy. First degree family history of febrile seizure was not associated with behavioral problems in probands with uncomplicated or in those with complicated epilepsy. Significance Increased occurrence of behavioral disorders in probands with uncomplicated epilepsy and first degree family history of unprovoked seizure suggests familial clustering of these disorders. This supports the idea that behavioral disorders may be another manifestation of the underlying pathophysiology involved in epilepsy or closely related to it. PMID:22191626

Familial clustering of epilepsy and behavioral disorders: evidence for a shared genetic basis.

PubMed

Hesdorffer, Dale C; Caplan, Rochelle; Berg, Anne T

2012-02-01

To examine whether family history of unprovoked seizures is associated with behavioral disorders in epilepsy probands, thereby supporting the hypothesis of shared underlying genetic susceptibility to these disorders. We conducted an analysis of the 308 probands with childhood onset epilepsy from the Connecticut Study of Epilepsy with information on first-degree family history of unprovoked seizures and of febrile seizures whose parents completed the Child Behavior Checklist (CBCL) at the 9-year follow-up. Clinical cutoffs for CBCL problem and Diagnostic and Statistical Manual of Mental Disorders (DSM)-Oriented scales were examined. The association between first-degree family history of unprovoked seizure and behavioral disorders was assessed separately in uncomplicated and complicated epilepsy and separately for first-degree family history of febrile seizures. A subanalysis, accounting for the tendency for behavioral disorders to run in families, was adjusted for siblings with the same disorder as the proband. Prevalence ratios were used to describe the associations. In probands with uncomplicated epilepsy, first-degree family history of unprovoked seizure was significantly associated with clinical cutoffs for Total Problems and Internalizing Disorders. Among Internalizing Disorders, clinical cutoffs for Withdrawn/Depressed, and DSM-Oriented scales for Affective Disorder and Anxiety Disorder were significantly associated with family history of unprovoked seizures. Clinical cutoffs for Aggressive Behavior and Delinquent Behavior, and DSM-Oriented scales for Conduct Disorder and Oppositional Defiant Disorder were significantly associated with family history of unprovoked seizure. Adjustment for siblings with the same disorder revealed significant associations for the relationship between first-degree family history of unprovoked seizure and Total Problems and Aggressive Behavior in probands with uncomplicated epilepsy; marginally significant results were seen for Internalizing Disorder, Withdrawn/Depressed, and Anxiety Disorder. There was no association between family history of unprovoked seizure and behavioral problems in probands with complicated epilepsy. First-degree family history of febrile seizure was not associated with behavioral problems in probands with uncomplicated or in those with complicated epilepsy. Increased occurrence of behavioral disorders in probands with uncomplicated epilepsy and first degree family history of unprovoked seizure suggests familial clustering of these disorders. This supports the idea that behavioral disorders may be another manifestation of the underlying pathophysiology involved in epilepsy or closely related to it. Wiley Periodicals, Inc. © 2011 International League Against Epilepsy.

Students' description of factors contributing to a meaningful clinical experience in entry-level physical therapist professional education.

PubMed

Rindflesch, Aaron; Hoversten, Kelsey; Patterson, Britta; Thomas, Laura; Dunfee, Heidi

2013-01-01

The objective of this study was to identify student, clinical instructor (CI), and environmental characteristics and behaviors that make for positive clinical experiences as perceived by physical therapy students. Nine third-year physical therapist students from entry-level physial therapist education programs around the United States participated in this study. In this phenomenologic study, participants were interviewed using open-ended questions designed to facilitate rich description. Interviews were recorded, transcribed, validated, and analyzed. Themes were identified through collaborative analysis using constant comparative coding. Students described student, CI, and environmental factors and behaviors that contribute to a quality clinical experience, including: the students' demonstration of initiative to prepare for the clinical experience and preparation after clinic hours; the importance of the CI's insight, allowing CIs to ascertain how much guidance to give in order to foster independence in the student; and the clinical environment's ability to welcome a student and provide the student with novel learning experiences. The student descriptions, including positive and negative examples shared by the interviewees, demonstrate essential characteristics that contribute to a positive clinical experience. Many of the factors identified by students can be influenced by student and CI training and preparation prior to the clinical experience.

Pathways to Late-Life Suicidal Behavior: Cluster Analysis and Predictive Validation of Suicidal Behavior in a Sample of Older Adults With Major Depression.

PubMed

Szanto, Katalin; Galfalvy, Hanga; Vanyukov, Polina M; Keilp, John G; Dombrovski, Alexandre Y

Clinical heterogeneity is a key challenge to understanding suicidal risk, as different pathways to suicidal behavior are likely to exist. We aimed to identify such pathways by uncovering latent classes of late-life depression cases and relating them to prior and future suicidal behavior. Data were collected from June 2010 to September 2015. In this longitudinal study we examined distinct associations of clinical and cognitive/decision-making factors with suicidal behavior in 194 older (50+ years) nondemented, depressed patients; 57 nonpsychiatric healthy controls provided benchmark data. The DSM-IV was used to establish diagnostic criteria. We identified multivariate patterns of risk factors, defining clusters based on personality traits, perceived social support, cognitive performance, and decision-making in an analysis blinded to participants' history of suicidal behavior. We validated these clusters using past and prospective suicidal ideation and behavior. Of 5 clusters identified, 3 were associated with high risk for suicidal behavior: (1) cognitive deficits, dysfunctional personality, low social support, high willingness to delay future rewards, and overrepresentation of high-lethality attempters; (2) high-personality pathology (ie, low self-esteem), minimal or no cognitive deficits, and overrepresentation of low-lethality attempters and ideators; (3) cognitive deficits, inability to delay future rewards, and similar distribution of high- and low-lethality attempters. There were significant between-cluster differences in number (P < .001) and lethality (P = .002) of past suicide attempts and in the likelihood of future suicide attempts (P = .010, 30 attempts by 22 patients, 2 fatal) and emergency psychiatric hospitalizations to prevent suicide (P = .005, 31 participants). Three pathways to suicidal behavior in older patients were found, marked by (1) very high levels of cognitive and dispositional risk factors suggesting a dementia prodrome, (2) dysfunctional personality traits, and (3) impulsive decision-making and cognitive deficits. © Copyright 2018 Physicians Postgraduate Press, Inc.

The Use of Trial-Based Functional Analysis in Public School Classrooms for Two Students with Developmental Disabilities

ERIC Educational Resources Information Center

Rispoli, Mandy J.; Davis, Heather S.; Goodwyn, Fara D.; Camargo, Siglia

2013-01-01

Analogue functional analyses are a well-researched means of determining behavioral function in research and clinical contexts. However, conducting analogue functional analyses in school settings can be problematic and may lead to inconclusive results. The purpose of this study was to compare the results of a trial-based functional analysis with…

Model depicting aspects of audit and feedback that impact physicians' acceptance of clinical performance feedback.

PubMed

Payne, Velma L; Hysong, Sylvia J

2016-07-13

Audit and feedback (A&F) is a strategy that has been used in various disciplines for performance and quality improvement. There is limited research regarding medical professionals' acceptance of clinical-performance feedback and whether feedback impacts clinical practice. The objectives of our research were to (1) investigate aspects of A&F that impact physicians' acceptance of performance feedback; (2) determine actions physicians take when receiving feedback; and (3) determine if feedback impacts physicians' patient-management behavior. In this qualitative study, we employed grounded theory methods to perform a secondary analysis of semi-structured interviews with 12 VA primary care physicians. We analyzed a subset of interview questions from the primary study, which aimed to determine how providers of high, low and moderately performing VA medical centers use performance feedback to maintain and improve quality of care, and determine perceived utility of performance feedback. Based on the themes emergent from our analysis and their observed relationships, we developed a model depicting aspects of the A&F process that impact feedback acceptance and physicians' patient-management behavior. The model is comprised of three core components - Reaction, Action and Impact - and depicts elements associated with feedback recipients' reaction to feedback, action taken when feedback is received, and physicians modifying their patient-management behavior. Feedback characteristics, the environment, external locus-of-control components, core values, emotion and the assessment process induce or deter reaction, action and impact. Feedback characteristics (content and timeliness), and the procedural justice of the assessment process (unjust penalties) impact feedback acceptance. External locus-of-control elements (financial incentives, competition), the environment (patient volume, time constraints) and emotion impact patient-management behavior. Receiving feedback generated intense emotion within physicians. The underlying source of the emotion was the assessment process, not the feedback. The emotional response impacted acceptance, impelled action or inaction, and impacted patient-management behavior. Emotion intensity was associated with type of action taken (defensive, proactive, retroactive). Feedback acceptance and impact have as much to do with the performance assessment process as it does the feedback. In order to enhance feedback acceptance and the impact of feedback, developers of clinical performance systems and feedback interventions should consider multiple design elements.

Heart health whispering: A randomized, controlled pilot study to promote nursing student perspective-taking on carers' health risk behaviors.

PubMed

Lobchuk, Michelle; Hoplock, Lisa; Halas, Gayle; West, Christina; Dika, Cheryl; Schroeder, Wilma; Ashcroft, Terri; Clouston, Kathleen Chambers; Lemoine, Jocelyne

2018-01-01

Lifestyle counseling is described as a "major breakthrough" in the control of chronic diseases. Counseling can be challenging to nurses due their lack of motivation to counsel, hesitancy to appear non-judgmental, lack of empathy, and lack of time. Nurses voice their need for more training in counseling communication skills. Our main objective was to engage in ongoing development and testing of a promising Heart Health Whispering perspective-taking intervention on nursing students' clinical empathy, perceptual understanding, and client readiness to alter health risk behaviors. In this randomized controlled pilot study, the full intervention (perspective-taking instructions, practice, and video-feedback) and partial intervention (video-feedback only) comprised 24 and 18 nursing students, respectively. Quantitative data were collected with a 10-item pre- and post-intervention clinical empathy tool, a one-item 'readiness to change' health risk behavior tool plus similarity ratings on students' empathic accuracy were calculated. Data were analyzed using Independent Samples t Tests and mixed model ANCOVA models. Students' and actors' evaluative responses toward the intervention phases were collected by handwritten notes, and analyzed using content analysis and constant comparison techniques. The main finding was that students in the full intervention group reported greater clinical empathy in the post versus baseline condition. Students underestimated their clinical empathy in comparison to carers' reports in the post-condition. In both intervention groups, carers reported more readiness to change in the post-condition. Carers identified favorable and unfavorable perceptions and outcomes of approaches taken by students . Students desired immediate and direct feedback after the video-dialogue and -tagging exercise. Heart Health Whispering is a promising intervention to help educators in basic and continuing education to bolster nurse confidence in empathic conversations on health risk behaviors. This intervention incorporates commonly used strategies to teach empathic communication along with a novel video-analysis application of a perspective-taking task. Student and carer actor comments highlighted the value in opportunities for students to engage in self-evaluation and practicing the empathic process of taking the client's perspective on health risk behaviors.

Frontal lobe seizures: from clinical semiology to localization.

PubMed

Bonini, Francesca; McGonigal, Aileen; Trébuchon, Agnès; Gavaret, Martine; Bartolomei, Fabrice; Giusiano, Bernard; Chauvel, Patrick

2014-02-01

Frontal lobe seizures are difficult to characterize according to semiologic and electrical features. We wished to establish whether different semiologic subgroups can be identified and whether these relate to anatomic organization. We assessed all seizures from 54 patients with frontal lobe epilepsy that were explored with stereoelectroencephalography (SEEG) during presurgical evaluation. Semiologic features and concomitant intracerebral EEG changes were documented and quantified. These variables were examined using Principal Component Analysis and Cluster Analysis, and semiologic features correlated with anatomic localization. Four main groups of patients were identified according to semiologic features, and correlated with specific patterns of anatomic seizure localization. Group 1 was characterized clinically by elementary motor signs and involved precentral and premotor regions. Group 2 was characterized by a combination of elementary motor signs and nonintegrated gestural motor behavior, and involved both premotor and prefrontal regions. Group 3 was characterized by integrated gestural motor behavior with distal stereotypies and involved anterior lateral and medial prefrontal regions. Group 4 was characterized by seizures with fearful behavior and involved the paralimbic system (ventromedial prefrontal cortex ± anterior temporal structures). The groups were organized along a rostrocaudal axis, representing bands within a spectrum rather than rigid categories. The more anterior the seizure organization, the more likely was the occurrence of integrated behavior during seizures. Distal stereotypies were associated with the most anterior prefrontal localizations, whereas proximal stereotypies occurred in more posterior prefrontal regions. Meaningful categorization of frontal seizures in terms of semiology is possible and correlates with anatomic organization along a rostrocaudal axis, in keeping with current hypotheses of frontal lobe hierarchical organization. The proposed electroclinical categorization offers pointers as to the likely zone of organization of networks underlying semiologic production, thus aiding presurgical localization. Furthermore, analysis of ictal motor behavior in prefrontal seizures, including stereotypies, leads to deciphering the cortico-subcortical networks that produce such behaviors. Wiley Periodicals, Inc. © 2013 International League Against Epilepsy.

Clinical, psychological and maternal characteristics in early functional constipation.

PubMed

Kilincaslan, Huseyin; Abali, Osman; Demirkaya, Sevcan Karakoc; Bilici, Mustafa

2014-08-01

This cross-sectional study investigated the clinical features of functional constipation (FC) at preschool age, as well as emotional and behavioral characteristics of the children, psychological symptom level and parental attitudes of the mothers, and compared these with that of non-referred typically developing controls with normal intestinal habits. Participants included 65 children with FC (mean age, 43.6 ± 15.4 months; range, 25-72 months), 59 healthy controls (mean age, 46.9 ± 14.5 months; range, 25-72 months) and the mothers of the children. The Childhood Behavior Checklist, Symptom Checklist 90 and Parental Attitude Research Instrument were filled in by the mothers. Participants with FC had higher problem scores than the comparison children in a variety of emotional and behavioral parameters. Approximately half exhibited internalizing and one-third had externalizing problems in the clinical range. The mothers of the patient group had higher levels of psychological distress, overprotective parenting and strict discipline. On multiple logistic regression analysis child psychopathology, maternal education level and maternal distress were independently associated with FC. Behavior problems are common in children with FC from an early age. Low level of education and high psychological distress of the mothers seem to be important risk factors for constipation and should be assessed carefully in the management of these cases. © 2013 Japan Pediatric Society.

Cumulative trauma, hyperarousal, and suicidality in the general population: a path analysis.

PubMed

Briere, John; Godbout, Natacha; Dias, Colin

2015-01-01

Although trauma exposure and posttraumatic stress disorder (PTSD) both have been linked to suicidal thoughts and behavior, the underlying basis for this relationship is not clear. In a sample of 357 trauma-exposed individuals from the general population, younger participant age, cumulative trauma exposure, and all three Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, PTSD clusters (reexperiencing, avoidance, and hyperarousal) were correlated with clinical levels of suicidality. However, logistic regression analysis indicated that when all PTSD clusters were considered simultaneously, only hyperarousal continued to be predictive. A path analysis confirmed that posttraumatic hyperarousal (but not other components of PTSD) fully mediated the relationship between extent of trauma exposure and degree of suicidal thoughts and behaviors.

Therapeutic non-adherence: a rational behavior revealing patient preferences?

PubMed

Lamiraud, Karine; Geoffard, Pierre-Yves

2007-11-01

This paper offers an indirect measure of patient welfare based on whether patients comply with the prescription they receive. Adherence behavior is supposed to reveal patients' subjective valuations of particular therapies. We write a simple theoretical model of patient adherence behavior, that reflects the trade-off between perceived costs and observed regimen efficacy. A discrete choice framework is then used for the estimation, i.e. the comparison of the incremental benefit of drug intake between two regimens. Consequently, the empirical analysis is based on the identification of patient and drug characteristics associated with adherence. The econometric approach is implemented through a bivariate panel two-equation simultaneous system studying jointly the factors associated with adherence and response to treatment. The data come from a randomized clinical trial conducted in France between 1999 and 2001 and comparing the efficacy of two tritherapy strategies in HIV disease. Both the theoretical and empirical results suggest that, for comparable clinical efficacy and toxicity levels, a higher adherence level is associated with higher patient welfare, thus adding valuable information to conclusions drawn by a mere biostatistical analysis. Therefore, from the perspective of the patient, the adherence-enhancing drug must be favored. Our results based on panel data also stress that unobserved patient characteristics account substantially for drug valuation and that the assessment evolves during the course of the treatment. Furthermore, we provide a new framework for the analysis of adherence data. The microeconometric framework highlights that non-adherence is an endogenous behavior, thus suggesting new ways for improving adherence. (c) 2007 John Wiley & Sons, Ltd.

Possible Solutions as a Concept in Behavior Change Interventions.

PubMed

Mahoney, Diane E

2018-04-24

Nurses are uniquely positioned to implement behavior change interventions. Yet, nursing interventions have traditionally resulted from nurses problem-solving rather than allowing the patient to self-generate possible solutions for attaining specific health outcomes. The purpose of this review is to clarify the meaning of possible solutions in behavior change interventions. Walker and Avant's method on concept analysis serves as the framework for examination of the possible solutions. Possible solutions can be defined as continuous strategies initiated by patients and families to overcome existing health problems. As nurses engage in behavior change interventions, supporting patients and families in problem-solving will optimize health outcomes and transform clinical practice. © 2018 NANDA International, Inc.

Clinical observation, pharmacotherapy and referral on discharge of patients with anxiety disorder in a psychiatric emergency service.

PubMed

Pailhez, Guillem; Majó, Albert; Córcoles, David; Ginés, José M; Arcega, José M; Castaño, Juan; Merino, Ana; Bulbena, Antonio; Pérez, Víctor

2015-01-01

To analyze factors associated with clinical observation, pharmacotherapy and referral on discharge of patients with anxiety disorder (AD) seeking care at a psychiatric emergency unit. A total of 5003 consecutive visits were reviewed over a three-year period at a psychiatric emergency service in a tertiary university hospital. Data collected included sociodemographic and clinical information as well as the Global Assessment of Functioning (GAF) and the Severity Psychiatric Illness (SPI) scale scores. Of all the visits, 992 (19.8%) were diagnosed of AD. Of these, 19.6% required clinical observation and 72.2% were referred to a psychiatrist at discharge. Regression analysis showed that referral to psychiatry was associated with being male, native, psychiatric background, greater severity, lower global functioning, and behavioral disorders. Clinical observation (in a box) was associated with being female, greater severity, and psychotic or behavioral symptoms. Prescription of benzodiazepines was associated with anxiety, no history of addiction, and lower global functioning. Antidepressants were associated with being a native, anxiety with no history of addiction, and lower functioning. Antipsychotics were associated with being native, psychiatric background (not addiction), anxiety, and lower functioning. Behavior, psychiatric background and illness severity were determinants of referral to a specialist. Besides these, psychotic symptoms and non-specific clinical symptoms were determinants of observation. Drug prescription in AD is less frequent if the main complaint is not anxiety and depends more on the level of functioning than on that of severity.

Effects of Adenotonsillectomy on Parent-Reported Behavior in Children With Obstructive Sleep Apnea.

PubMed

Thomas, Nina Hattiangadi; Xanthopoulos, Melissa S; Kim, Ji Young; Shults, Justine; Escobar, Emma; Giordani, Bruno; Hodges, Elise; Chervin, Ronald D; Paruthi, Shalini; Rosen, Carol L; Taylor, Gerry H; Arens, Raanan; Katz, Eliot S; Beebe, Dean W; Redline, Susan; Radcliffe, Jerilynn; Marcus, Carole L

2017-04-01

The childhood obstructive sleep apnea syndrome (OSAS) is associated with behavioral abnormalities. Studies on the effects of OSAS treatment on behavior are conflicting, with few studies using a randomized design. Further, studies may be confounded by the inclusion of behavioral outcome measures directly related to sleep. The objective of this study was to determine the effect of adenotonsillectomy on behavior in children with OSAS. We hypothesized that surgery would improve behavioral ratings, even when sleep symptom items were excluded from the analysis. This was a secondary analysis of Child Behavior Checklist (CBCL) data, with and without exclusion of sleep-specific items, from the Childhood Adenotonsillectomy Trial (CHAT). CBCL was completed by caregivers of 380 children (7.0+1.4 [range 5-9] years) with OSAS randomized to early adenotonsillectomy (eAT) versus 7 months of watchful waiting with supportive care (WWSC). There was a high prevalence of behavioral problems at baseline; 16.6% of children had a Total Problems score in the clinically abnormal range. At follow-up, there were significant improvements in Total Problems (p < .001), Internalizing Behaviors (p = .04), Somatic Complaints (p = .01), and Thought Problems (p = .01) in eAT vs. WWSC participants. When specific sleep-related question items were removed from the analysis, eAT showed an overall improvement in Total (p = .02) and Other (p = .01) problems. Black children had less improvement in behavior following eAT than white children, but this difference attenuated when sleep-related items were excluded. This large, randomized trial showed that adenotonsillectomy for OSAS improved parent-rated behavioral problems, even when sleep-specific behavioral issues were excluded from the analysis. © Sleep Research Society 2017. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved. For permissions, please e-mail journals.permissions@oup.com.

MR scanning, tattoo inks, and risk of thermal burn: An experimental study of iron oxide and organic pigments: Effect on temperature and magnetic behavior referenced to chemical analysis.

PubMed

Alsing, K K; Johannesen, H H; Hvass Hansen, R; Dirks, M; Olsen, O; Serup, J

2018-05-01

Tattooed persons examined with magnetic resonance imaging (MRI) can develop burning sensation suggested in the literature to be thermal burn from the procedure. MRI-induced thermal effect and magnetic behavior of known tattoo pigments were examined ex vivo. Magnetic resonance imaging effects on 3 commonly used commercial ink stock products marketed for cosmetic tattooing was studied. A main study tested 22 formulations based on 11 pigment raw materials, for example, one line of 11 called pastes and another called dispersions. Samples were spread in petri dishes and tested with a 0.97 T neodymium solid magnet to observe visual magnetic behavior. Before MRI, the surface temperature of the ink was measured using an infrared probe. Samples were placed in a clinical 3T scanner. Two scans were performed, that is, one in the isocenter and one 30 cm away from the center. After scanning, the surface temperature was measured again. Chemical analysis of samples was performed by mass spectroscopy. Mean temperature increase measured in the isocenter ranged between 0.14 and 0.26°C (P < .01) and in the off-center position from -0.16 to 0.21°C (P < .01). Such low increase of temperature is clinically irrelevant. Chemical analysis showed high concentrations of iron, but also nickel and chrome were found as contaminants. High concentration of iron was not associated with any increase of temperature or any physical draw or move of ink. The study could not confirm any clinically relevant temperature increase of tattoo pigments after MRI. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

The Treatment of Severe Childhood Aggression Study: 12 Weeks of Extended, Blinded Treatment in Clinical Responders.

PubMed

Findling, Robert L; Townsend, Lisa; Brown, Nicole V; Arnold, L Eugene; Gadow, Kenneth D; Kolko, David J; McNamara, Nora K; Gary, Devin S; Kaplin, Dana B; Farmer, Cristan A; Kipp, Heidi; Williams, Craig; Butter, Eric M; Bukstein, Oscar G; Rice, Robert; Buchan-Page, Kristin; Molina, Brooke S G; Aman, Michael G

2017-02-01

Previous "Treatment of Severe Childhood Aggression" (TOSCA) reports demonstrated that many children with severe physical aggression and attention-deficit/hyperactivity disorder (ADHD) responded well to two randomized treatments (parent training [PT]+stimulant+placebo = Basic vs. PT+stimulant+risperidone = Augmented) for 9 weeks. An important clinical question is whether these favorable outcomes are maintained over longer times. Clinical responders to the 9-week trial (n = 103/168), defined as Clinical Global Impressions (CGI)-Improvement of much/very much improved plus substantial reduction in parent ratings of disruptiveness, were followed another 12 weeks (21 weeks total) while remaining on blinded treatment. Outcome measures included Clinical Global Impressions scale, Nisonger Child Behavior Rating Form (NCBRF), other parent/teacher-rated scales, laboratory tests, clinician ratings of abnormal movement, and other adverse events (AEs). Parent ratings of problem behavior showed minimal worsening of behavior from end of the 9-week acute trial (expected from regression to the mean after selecting best responders), but outcomes at Extension endpoint were meaningfully improved compared with acute study baseline. As expected, outcomes for Basic and Augmented treatment did not differ among these children selected for good clinical response. During Extension, more Augmented subjects had elevated prolactin; there were no clinically confirmed cases of tardive dyskinesia. Delayed sleep onset was the most frequent Basic AE. We also conducted a last-observation-carried-forward analysis, which included both nonresponders and responders. We found that, at the end of Extension, Augmented subjects had more improvement than Basic subjects on the NCBRF Positive Social subscale (p = 0.005; d = 0.44), the Antisocial Behavior Scale Reactive Aggression subscale (p = 0.03; d = 0.36), and marginally so on the Disruptive Behavior Total subscale (p = 0.058; d = 0.29, the primary outcome). The medium-term outcomes were good for the participants in both treatment groups, perhaps because they were selected for good response. When nonresponders were included in ITT analyses, there was some indication that Augmented surpassed Basic treatment.

The Treatment of Severe Childhood Aggression Study: 12 Weeks of Extended, Blinded Treatment in Clinical Responders

PubMed Central

Townsend, Lisa; Brown, Nicole V.; Arnold, L. Eugene; Gadow, Kenneth D.; Kolko, David J.; McNamara, Nora K.; Gary, Devin S.; Kaplin, Dana B.; Farmer, Cristan A.; Kipp, Heidi; Williams, Craig; Butter, Eric M.; Bukstein, Oscar G.; Rice, Robert; Buchan-Page, Kristin; Molina, Brooke S.G.; Aman, Michael G.

2017-01-01

Abstract Objectives: Previous “Treatment of Severe Childhood Aggression” (TOSCA) reports demonstrated that many children with severe physical aggression and attention-deficit/hyperactivity disorder (ADHD) responded well to two randomized treatments (parent training [PT]+stimulant+placebo = Basic vs. PT+stimulant+risperidone = Augmented) for 9 weeks. An important clinical question is whether these favorable outcomes are maintained over longer times. Methods: Clinical responders to the 9-week trial (n = 103/168), defined as Clinical Global Impressions (CGI)-Improvement of much/very much improved plus substantial reduction in parent ratings of disruptiveness, were followed another 12 weeks (21 weeks total) while remaining on blinded treatment. Outcome measures included Clinical Global Impressions scale, Nisonger Child Behavior Rating Form (NCBRF), other parent/teacher-rated scales, laboratory tests, clinician ratings of abnormal movement, and other adverse events (AEs). Results: Parent ratings of problem behavior showed minimal worsening of behavior from end of the 9-week acute trial (expected from regression to the mean after selecting best responders), but outcomes at Extension endpoint were meaningfully improved compared with acute study baseline. As expected, outcomes for Basic and Augmented treatment did not differ among these children selected for good clinical response. During Extension, more Augmented subjects had elevated prolactin; there were no clinically confirmed cases of tardive dyskinesia. Delayed sleep onset was the most frequent Basic AE. We also conducted a last-observation-carried-forward analysis, which included both nonresponders and responders. We found that, at the end of Extension, Augmented subjects had more improvement than Basic subjects on the NCBRF Positive Social subscale (p = 0.005; d = 0.44), the Antisocial Behavior Scale Reactive Aggression subscale (p = 0.03; d = 0.36), and marginally so on the Disruptive Behavior Total subscale (p = 0.058; d = 0.29, the primary outcome). Conclusions: The medium-term outcomes were good for the participants in both treatment groups, perhaps because they were selected for good response. When nonresponders were included in ITT analyses, there was some indication that Augmented surpassed Basic treatment. PMID:28212067

The intersection of physician wellbeing and clinical application of diabetes guidelines.

PubMed

Seehusen, Dean A; Deavers, Justin; Mainous, Arch G; Ledford, Christy J W

2018-05-01

Prediabetes (preDM) and diabetes are complex conditions that place significant strain on medical providers. This can have a negative impact on providers' wellbeing and could impact clinical decisions. We investigated the interplay of caring for patients with prediabetes, physician mental wellbeing, and clinical care. Using the theory of planned behavior, we conducted a secondary analysis to evaluate physicians' self-reported provision of care to patients with preDM. We evaluated the effect of mental wellbeing and perceived barriers to caring for patients with preDM. Among 1015 academic physicians, a greater perception of barriers to care and a higher percentage of patients seen with preDM were both significantly associated with a less positive physician state of mind. Physician state of mind was not associated with self-reported clinical behavior. Physician perception of patient barriers has a positive correlation with their likelihood of prescribing metformin for preDM. Caring for a larger proportion of patients with preDM is associated with worse mental wellbeing. Physician attitudes and subjective norms may predict adherence to guidelines, while physician attitudes and wellbeing affect self-reported prescribing behavior. Future research should evaluate ways to lessen the psychological burden of caring for patients with diabetes and preDM. Published by Elsevier B.V.

Best practices in social and behavioral research: report from the Enhancing Clinical Research Professional's Training and Qualifications project.

PubMed

Murphy, Susan L; Byks-Jazayeri, Christine; Calvin-Naylor, Nancy; Divecha, Vic; Anderson, Elizabeth; Eakin, Brenda; Fair, Alecia; Denton, Laura

2017-02-01

This article discusses the process of defining competencies and development of a best practices training course for investigators and clinical research coordinators who conduct social and behavioral research. The first project phase established recommendations for training in Good Clinical Practice (GCP) and was done in conjunction with representatives from 62 Clinical and Translational Science Award (CTSA) hubs. Diversity in behavioral clinical trials and differences in regulation of behavioral trials compared with clinical trials involving drugs, devices, or biologics necessitated a separate Social and Behavioral Work Group. This group worked with CTSA representatives to tailor competencies and fundamental GCP principles into best practices for social and behavioral research. Although concepts underlying GCP were deemed similar across all clinical trials, not all areas were equally applicable and the ways in which GCP would be enacted differ for behavioral trials. It was determined that suitable training in best practices for social and behavioral research was lacking. Based on the training need, an e-learning course for best practices is available to all CTSA sites. Each institution is able to track outcomes for its employees to help achieve standardized competency-based best practices for social and behavioral investigators and staff.

Differential Reinforcement of Alternative Behavior Increases Resistance to Extinction: Clinical Demonstration, Animal Modeling, and Clinical Test of One Solution

ERIC Educational Resources Information Center

Mace, F. Charles; McComas, Jennifer J.; Mauro, Benjamin C.; Progar, Patrick R.; Taylor, Bridget; Ervin, Ruth; Zangrillo, Amanda N.

2010-01-01

Basic research with pigeons on behavioral momentum suggests that differential reinforcement of alternative behavior (DRA) can increase the resistance of target behavior to change. This finding suggests that clinical applications of DRA may inadvertently increase the persistence of target behavior even as it decreases its frequency. We conducted…

Role Models and Teachers: medical students perception of teaching-learning methods in clinical settings, a qualitative study from Sri Lanka.

PubMed

Jayasuriya-Illesinghe, Vathsala; Nazeer, Ishra; Athauda, Lathika; Perera, Jennifer

2016-02-09

Medical education research in general, and those focusing on clinical settings in particular, have been a low priority in South Asia. This explorative study from 3 medical schools in Sri Lanka, a South Asian country, describes undergraduate medical students' experiences during their final year clinical training with the aim of understanding the teaching-learning experiences. Using qualitative methods we conducted an exploratory study. Twenty eight graduates from 3 medical schools participated in individual interviews. Interview recordings were transcribed verbatim and analyzed using qualitative content analysis method. Emergent themes reveled 2 types of teaching-learning experiences, role modeling, and purposive teaching. In role modelling, students were expected to observe teachers while they conduct their clinical work, however, this method failed to create positive learning experiences. The clinical teachers who predominantly used this method appeared to be 'figurative' role models and were not perceived as modelling professional behaviors. In contrast, purposeful teaching allowed dedicated time for teacher-student interactions and teachers who created these learning experiences were more likely to be seen as 'true' role models. Students' responses and reciprocations to these interactions were influenced by their perception of teachers' behaviors, attitudes, and the type of teaching-learning situations created for them. Making a distinction between role modeling and purposeful teaching is important for students in clinical training settings. Clinical teachers' awareness of their own manifest professional characterizes, attitudes, and behaviors, could help create better teaching-learning experiences. Moreover, broader systemic reforms are needed to address the prevailing culture of teaching by humiliation and subordination.

Relationships Between Personal Beliefs and Treatment Acceptability, and Preferences for Behavioral Treatments

PubMed Central

Sidani, Souraya; Miranda, Joyal; Epstein, Dana R.; Bootzin, Richard R.; Cousins, Jennifer; Moritz, Patricia

2009-01-01

Background The literature on preferences for behavioral interventions is limited in terms of understanding treatment-related factors that underlie treatment choice. The objectives of this study were to examine the direct relationships between personal beliefs about clinical condition, perception of treatment acceptability, and preferences for behavioral interventions for insomnia. Methods The data set used in this study was obtained from 431 persons with insomnia who participated in a partially randomized clinical trial and expressed preferences for treatment options. The data were collected at baseline. Logistic regression was used to examine the relationships between personal beliefs and treatment acceptability, and preferences. The relationships between personal beliefs and perception of treatment acceptability were explored with correlational analysis. Results Perception of treatment acceptability was associated with preferences. Persons viewing the option as convenient tended to choose that option for managing insomnia. Personal beliefs were not related to preferences. However, beliefs about sleep promoting behaviors were correlated with perceived treatment effectiveness. Conclusions Perception of treatment acceptability underlies expressed preferences for behavioral interventions. Personal beliefs about insomnia are not directly associated with preferences. Importance is highlighted for providing information about treatment options and exploring perception of each option’s acceptability during the process of treatment selection. PMID:19604500

Translating basic behavioral and social science research to clinical application: the EVOLVE mixed methods approach.

PubMed

Peterson, Janey C; Czajkowski, Susan; Charlson, Mary E; Link, Alissa R; Wells, Martin T; Isen, Alice M; Mancuso, Carol A; Allegrante, John P; Boutin-Foster, Carla; Ogedegbe, Gbenga; Jobe, Jared B

2013-04-01

To describe a mixed-methods approach to develop and test a basic behavioral science-informed intervention to motivate behavior change in 3 high-risk clinical populations. Our theoretically derived intervention comprised a combination of positive affect and self-affirmation (PA/SA), which we applied to 3 clinical chronic disease populations. We employed a sequential mixed methods model (EVOLVE) to design and test the PA/SA intervention in order to increase physical activity in people with coronary artery disease (post-percutaneous coronary intervention [PCI]) or asthma (ASM) and to improve medication adherence in African Americans with hypertension (HTN). In an initial qualitative phase, we explored participant values and beliefs. We next pilot tested and refined the intervention and then conducted 3 randomized controlled trials with parallel study design. Participants were randomized to combined PA/SA versus an informational control and were followed bimonthly for 12 months, assessing for health behaviors and interval medical events. Over 4.5 years, we enrolled 1,056 participants. Changes were sequentially made to the intervention during the qualitative and pilot phases. The 3 randomized controlled trials enrolled 242 participants who had undergone PCI, 258 with ASM, and 256 with HTN (n = 756). Overall, 45.1% of PA/SA participants versus 33.6% of informational control participants achieved successful behavior change (p = .001). In multivariate analysis, PA/SA intervention remained a significant predictor of achieving behavior change (p < .002, odds ratio = 1.66), 95% CI [1.22, 2.27], controlling for baseline negative affect, comorbidity, gender, race/ethnicity, medical events, smoking, and age. The EVOLVE method is a means by which basic behavioral science research can be translated into efficacious interventions for chronic disease populations.

Translating Basic Behavioral and Social Science Research to Clinical Application: The EVOLVE Mixed Methods Approach

PubMed Central

Peterson, Janey C.; Czajkowski, Susan; Charlson, Mary E.; Link, Alissa R.; Wells, Martin T.; Isen, Alice M.; Mancuso, Carol A.; Allegrante, John P.; Boutin-Foster, Carla; Ogedegbe, Gbenga; Jobe, Jared B.

2012-01-01

Objective To describe a mixed-methods approach to develop and test a basic behavioral science-informed intervention to motivate behavior change in three high-risk clinical populations. Our theoretically-derived intervention comprised a combination of positive affect and self-affirmation (PA/SA) which we applied to three clinical chronic disease populations. Methods We employed a sequential mixed methods model (EVOLVE) to design and test the PA/SA intervention in order to increase physical activity in people with coronary artery disease (post-percutaneous coronary intervention [PCI]) or asthma (ASM), and to improve medication adherence in African Americans with hypertension (HTN). In an initial qualitative phase, we explored participant values and beliefs. We next pilot tested and refined the intervention, and then conducted three randomized controlled trials (RCTs) with parallel study design. Participants were randomized to combined PA/SA vs. an informational control (IC) and followed bimonthly for 12 months, assessing for health behaviors and interval medical events. Results Over 4.5 years, we enrolled 1,056 participants. Changes were sequentially made to the intervention during the qualitative and pilot phases. The three RCTs enrolled 242 PCI, 258 ASM and 256 HTN participants (n=756). Overall, 45.1% of PA/SA participants versus 33.6% of IC participants achieved successful behavior change (p=0.001). In multivariate analysis PA/SA intervention remained a significant predictor of achieving behavior change (p<0.002, OR=1.66, 95% CI 1.22–2.27), controlling for baseline negative affect, comorbidity, gender, race/ethnicity, medical events, smoking and age. Conclusions The EVOLVE method is a means by which basic behavioral science research can be translated into efficacious interventions for chronic disease populations. PMID:22963594

Dyadic Behavior Analysis in Depression Severity Assessment Interviews

PubMed Central

Scherer, Stefan; Hammal, Zakia; Yang, Ying; Morency, Louis-Philippe; Cohn, Jeffrey F.

2016-01-01

Previous literature suggests that depression impacts vocal timing of both participants and clinical interviewers but is mixed with respect to acoustic features. To investigate further, 57 middle-aged adults (men and women) with Major Depression Disorder and their clinical interviewers (all women) were studied. Participants were interviewed for depression severity on up to four occasions over a 21 week period using the Hamilton Rating Scale for Depression (HRSD), which is a criterion measure for depression severity in clinical trials. Acoustic features were extracted for both participants and interviewers using COVAREP Toolbox. Missing data occurred due to missed appointments, technical problems, or insufficient vocal samples. Data from 36 participants and their interviewers met criteria and were included for analysis to compare between high and low depression severity. Acoustic features for participants varied between men and women as expected, and failed to vary with depression severity for participants. For interviewers, acoustic characteristics strongly varied with severity of the interviewee’s depression. Accommodation - the tendency of interactants to adapt their communicative behavior to each other - between interviewers and interviewees was inversely related to depression severity. These findings suggest that interviewers modify their acoustic features in response to depression severity, and depression severity strongly impacts interpersonal accommodation. PMID:28345076

Junior nursing students' experiences of vertical violence during clinical rotations.

PubMed

Thomas, Sandra P; Burk, Renee

2009-01-01

Horizontal violence is a form of workplace violence, a phenomenon that is prevalent in the nursing profession. Research has revealed a variety of negative peer-to-peer behaviors that lower morale and lead to turnover. However, little research has been conducted on "eating our young" (violence occurring between individuals with unequal power, such as staff nurse and student). We propose "vertical violence" as the appropriate term when abusive registered nurse (RN) behavior is directed towards students. We report a content analysis of stories written by junior nursing students about incidents of injustice perpetrated by staff RNs during their clinical experiences. Four levels of injustice were described. Nursing leadership, both in hospitals and educational institutions, must become engaged in efforts to eradicate vertical violence towards students.

Determining Smoking Cessation Related Information, Motivation, and Behavioral Skills among Opiate Dependent Smokers in Methadone Treatment

PubMed Central

Cooperman, Nina A.; Richter, Kimber P.; Bernstein, Steven L.; Steinberg, Marc L.; Williams, Jill M.

2015-01-01

Background Over 80% of people in methadone treatment smoke cigarettes, and existing smoking cessation interventions have been minimally effective. Objective To develop an Information-Motivation-Behavioral Skills (IMB) Model of behavior change based smoking cessation intervention for methadone maintained smokers, we examined smoking cessation related information, motivation, and behavioral skills in this population. Methods Current or former smokers in methadone treatment (n=35) participated in focus groups. Ten methadone clinic counselors participated in an individual interview. A content analysis was conducted using deductive and inductive approaches. Results Commonly known information, motivation, and behavioral skills factors related to smoking cessation were described. These factors included: the health effects of smoking and treatment options for quitting (information); pregnancy and cost of cigarettes (motivators); and coping with emotions, finding social support, and pharmacotherapy adherence (behavioral skills). Information, motivation, and behavioral skills factors specific to methadone maintained smokers were also described. These factors included: the relationship between quitting smoking and drug relapse (information), the belief that smoking is the same as using drugs (motivator); and coping with methadone clinic culture and applying skills used to quit drugs to quitting smoking (behavioral skills). Information, motivation, and behavioral skills strengths and deficits varied by individual. Conclusions Methadone maintained smokers could benefit from research on an IMB Model based smoking cessation intervention that is individualized, addresses IMB factors common among all smokers, and also addresses IMB factors unique to this population. PMID:25559697

Dissociative experiences during sexual behavior among a sample of adults living with HIV infection and a history of childhood sexual abuse.

PubMed

Hansen, Nathan B; Brown, Lauren J; Tsatkin, Elizabeth; Zelgowski, Brittany; Nightingale, Vienna

2012-01-01

Little attention has been given to the occurrence of dissociative symptoms during sexual behavior in adults who have experienced childhood sexual abuse (CSA). For this study, 57 adults living with HIV infection who had experienced CSA and were entering a treatment study for traumatic stress completed study assessments and clinical interviews, including a 15-item scale of dissociative experiences during sexual behavior. Predictor variables included Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision diagnoses of posttraumatic stress disorder (PTSD) and dissociative disorders, rape by an intimate partner, duration of CSA, number of perpetrators of CSA, and current sexual satisfaction. A multiple regression analysis was conducted to identify significant associations between predictors and dissociation during sex. Mean differences by clinical diagnosis were also examined. Results indicated that PTSD, dissociative disorders, rape by an intimate partner, duration of CSA, and number of perpetrators of CSA were associated with increased dissociation during sexual behavior. Dissociation during sex likely increases vulnerability to sexual revictimization and risky sexual behavior. Standard behavioral prevention interventions may be ineffective for sexual situations when dissociation occurs, and prevention efforts should be integrated with mental health care for those who have experienced CSA.

Relationships between self-determination theory and theory of planned behavior applied to physical activity and exercise behavior in chronic pain.

PubMed

Brooks, Jessica M; Iwanaga, Kanako; Chiu, Chung-Yi; Cotton, Brandi Parker; Deiches, Jon; Morrison, Blaise; Moser, Erin; Chan, Fong

2017-08-01

This study examined the relationships between self-determination theory (SDT) and theory of planned behavior (TpB) applied to physical activity and exercise behavior (PA&E) in people with chronic pain. Two hundred and eleven adults with chronic musculoskeletal pain (28 males and 183 females, age range 18 to 82 years, mean age 43 years) were recruited from online support groups and clinic networks in the United States. Participants completed SDT measures relevant to PA&E on perceived autonomy support, autonomy, competence, and relatedness, as well as TpB measures relevant to PA&E on intention, attitudes, subjective norms, and perceived behavioral control. Correlational techniques and canonical correlation analysis were performed to examine the relationships and variance within and between theoretical dimensions. Overall, the SDT set accounted for 37% of the TpB variance and the TpB set accounted for 32% of the SDT set variance. The results indicate there are statistical similarities and differences between concepts in SDT and TpB models for PA&E. Using both empirical guidance and clinical expertise, researchers and practitioners should attempt to select and integrate non-redundant and complementary components from SDT, TpB, and other related health behavior theories.

Effect Sizes and Primary Outcomes in Large-Budget, Cardiovascular-Related Behavioral Randomized Controlled Trials Funded by NIH Since 1980

PubMed Central

Irvin, Veronica L.; Kaplan, Robert M.

2015-01-01

Purpose We reviewed large-budget, National Institutes of Health (NIH)-supported randomized controlled trials (RCTs) with behavioral interventions to assess (1) publication rates, (2) trial registration, (3) use of objective measures, (4) significant behavior and physiological change, and (5) effect sizes. Methods We identified large-budget grants (>$500,000/year) funded by NIH (National Heart Lung and Blood Institute (NHLBI) or National Institute of Diabetes & Digestive and Kidney Diseases (NIDDK)) for cardiovascular disease (dates January 1, 1980 to December 31, 2012). Among 106 grants that potentially met inclusion criteria, 20 studies were not published and 48 publications were excluded, leaving 38 publications for analysis. ClinicalTrials.gov abstracts were used to determine whether outcome measures had been pre-specified. Results Three fourths of trials were registered in ClinicalTrials.gov and all published pre-specified outcomes. Twenty-six trials reported a behavioral outcome with 81 % reporting significant improvements for the target behavior. Thirty-two trials reported a physiological outcome. All were objectively measured, and 81 % reported significant benefit. Seventeen trials reported morbidity outcomes, and seven reported a significant benefit. Nine trials assessed mortality, and all were null for this outcome. Conclusions Behavioral trials complied with trial registration standards. Most reported a physiological benefit, but few documented morbidity or mortality benefits. PMID:26507906

Dimensional profiles of male to female gender identity disorder: an exploratory research.

PubMed

Fisher, Alessandra D; Bandini, Elisa; Ricca, Valdo; Ferruccio, Naika; Corona, Giovanni; Meriggiola, Maria C; Jannini, Emmanuele A; Manieri, Chiara; Ristori, Jiska; Forti, Gianni; Mannucci, Edoardo; Maggi, Mario

2010-07-01

Male-to-Female Gender Identity Disorder (MtF GID) is a complex phenomenon that could be better evaluated by using a dimensional approach. To explore the aggregation of clinical manifestations of MtF GID in order to identify meaningful variables describing the heterogeneity of the disorder. A consecutive series of 80 MtF GID subjects (mean age 37 +/- 10.3 years), referred to the Interdepartmental Center for Assistance Gender Identity Disorder of Florence and to other Italian centers from July 2008 to June 2009, was studied. Diagnosis was based on formal psychiatric classification criteria. Factor analysis was performed. Several socio-demographic and clinical parameters were investigated. Patients were asked to complete the Bem Sex Role Inventory (BSRI, a self-rating scale to evaluate gender role) and Symptom Checklist-90 Revised (SCL-90-R, a self-rating scale to measure psychological state). Factor analysis identified two dimensional factors: Factor 1 was associated with sexual orientation, and Factor 2 related to behavioral and psychological correlates of early GID development. No correlation was observed between the two factors. A positive correlation between Factor 2 and feminine BSRI score was found, along with a negative correlation between Factor 2 and undifferentiated BSRI score. Moreover, a significant association between SCL-90-R Phobic subscale score and Factor 2 was observed. A variety of other socio-demographic parameters and clinical features were associated with both factors. Behavioral and psychological correlates of Factor 1 (sexual orientation) and Factor 2 (gender identity) do not constitute the framework of two separate clinical entities, but instead represent two dimensions of the complex MtF GID structure, which can be variably intertwined in the same subject. By using factor analysis, we offer a new approach capable of delineating a psychopathological and clinical profile of MtF GID patients.

Usability testing of Avoiding Diabetes Thru Action Plan Targeting (ADAPT) decision support for integrating care-based counseling of pre-diabetes in an electronic health record

PubMed Central

Chrimes, Dillon; Kushniruk, Andre; Kitos, Nicole R.

2014-01-01

Purpose Usability testing can be used to evaluate human computer interaction (HCI) and communication in shared decision making (SDM) for patient-provider behavioral change and behavioral contracting. Traditional evaluations of usability using scripted or mock patient scenarios with think-aloud protocol analysis provide a to identify HCI issues. In this paper we describe the application of these methods in the evaluation of the Avoiding Diabetes Thru Action Plan Targeting (ADAPT) tool, and test the usability of the tool to support the ADAPT framework for integrated care counseling of pre-diabetes. The think-aloud protocol analysis typically does not provide an assessment of how patient-provider interactions are effected in “live” clinical workflow or whether a tool is successful. Therefore, “Near-live” clinical simulations involving applied simulation methods were used to compliment the think-aloud results. This complementary usability technique was used to test the end-user HCI and tool performance by more closely mimicking the clinical workflow and capturing interaction sequences along with assessing the functionality of computer module prototypes on clinician workflow. We expected this method to further complement and provide different usability findings as compared to think-aloud analysis. Together, this mixed method evaluation provided comprehensive and realistic feedback for iterative refinement of the ADAPT system prior to implementation. Methods The study employed two phases of testing of a new interactive ADAPT tool that embedded an evidence-based shared goal setting component into primary care workflow for dealing with pre-diabetes counseling within a commercial physician office electronic health record (EHR). Phase I applied usability testing that involved “think-aloud” protocol analysis of 8 primary care providers interacting with several scripted clinical scenarios. Phase II used “near-live” clinical simulations of 5 providers interacting with standardized trained patient actors enacting the clinical scenario of counseling for pre-diabetes, each of whom had a pedometer that recorded the number of steps taken over a week. In both phases, all sessions were audio-taped and motion screen-capture software was activated for onscreen recordings. Transcripts were coded using iterative qualitative content analysis methods. Results In Phase I, the impact of the components and layout of ADAPT on user’s Navigation, Understandability, and Workflow were associated with the largest volume of negative comments (i.e. approximately 80% of end-user commentary), while Usability and Content of ADAPT were representative of more positive than negative user commentary. The heuristic category of Usability had a positive-to-negative comment ratio of 2.1, reflecting positive perception of the usability of the tool, its functionality, and overall co-productive utilization of ADAPT. However, there were mixed perceptions about content (i.e., how the information was displayed, organized and described in the tool). In Phase II, the duration of patient encounters was approximately 10 minutes with all of the Patient Instructions (prescriptions) and behavioral contracting being activated at the end of each visit. Upon activation, providers accepted the pathway prescribed by the tool 100% of the time and completed all the fields in the tool in the simulation cases. Only 14% of encounter time was spent using the functionality of the ADAPT tool in terms of keystrokes and entering relevant data. The rest of the time was spent on communication and dialogue to populate the patient instructions. In all cases, the interaction sequence of reviewing and discussing exercise and diet of the patient was linked to the functionality of the ADAPT tool in terms of monitoring, response-efficacy, self-efficacy, and negotiation in the patient-provider dialogue. There was a change from one-way dialogue to two-way dialogue and negotiation that ended in a behavioral contract. This change demonstrated the tool’s sequence, which supported recording current exercise and diet followed by a diet and exercise goal setting procedure to reduce the risk of diabetes onset. Conclusions This study demonstrated that “think-aloud” protocol analysis with “near-live” clinical simulations provided a successful usability evaluation of a new primary care pre-diabetes shared goal setting tool. Each phase of the study provided complementary observations on problems with the new onscreen tool and was used to show the influence of the ADAPT framework on the usability, workflow integration, and communication between the patient and provider. The think-aloud tests with the provider showed the tool can be used according to the ADAPT framework (exercise-to-diet behavior change and tool utilization), while the clinical simulations revealed the ADAPT framework to realistically support patient-provider communication to obtain behavioral change contract. SDM interactions and mechanisms affecting protocol-based care can be more completely captured by combining “near-live” clinical simulations with traditional “think-aloud analysis” which augments clinician utilization. More analysis is required to verify if the rich communication actions found in Phase II compliment clinical workflows. PMID:24981988

Combined Socio-Behavioral Evaluation Improves the Differential Diagnosis Between the Behavioral Variant of Frontotemporal Dementia and Alzheimer's Disease: In Search of Neuropsychological Markers.

PubMed

Dodich, Alessandra; Cerami, Chiara; Cappa, Stefano F; Marcone, Alessandra; Golzi, Valeria; Zamboni, Michele; Giusti, Maria Cristina; Iannaccone, Sandro

2018-01-01

Current diagnostic criteria for behavioral variant of frontotemporal dementia (bvFTD) and typical Alzheimer's disease (AD) include a differential pattern of neuropsychological impairments (episodic memory deficit in typical AD and dysexecutive syndrome in bvFTD). There is, however, large evidence of a frequent overlap in neuropsychological features, making the differential diagnosis extremely difficult. In this retrospective study, we evaluated the diagnostic value of different cognitive and neurobehavioral markers in bvFTD and AD patient groups. We included 95 dementia patients with a clinical and biomarker evidence of bvFTD (n = 48) or typical AD (n = 47) pathology. A clinical 2-year follow-up confirmed clinical classification. Performances at basic cognitive tasks (memory, executive functions, visuo-spatial, language) as well as social cognition skills and neurobehavioral profiles have been recorded. A stepwise logistic regression model compared the neuropsychological profiles between groups and assessed the accuracy of cognitive and neurobehavioral markers in discriminating bvFTD from AD. Statistical comparison between patient groups proved social cognition and episodic memory impairments as main cognitive signatures of bvFTD and AD neuropsychological profiles, respectively. Only half of bvFTD patients showed attentive/executive deficits, questioning their role as cognitive marker of bvFTD. Notably, the large majority of bvFTD sample (i.e., 70%) poorly performed at delayed recall tasks. Logistic regression analysis identified social cognition performances, Frontal Behavioral Inventory and Mini-Mental State Examination scores as the best combination in distinguishing bvFTD from AD. Social cognition tasks and socio-behavioral questionnaires are recommended in clinical settings to improve the accuracy of early diagnosis of bvFTD.

Effectiveness of outpatient cognitive-behavioral therapy for adolescents under routine care conditions on behavioral and emotional problems rated by parents and patients: an observational study.

PubMed

Walter, Daniel; Dachs, Lydia; Faber, Martin; Goletz, Hildegard; Goertz-Dorten, Anja; Hautmann, Christopher; Kinnen, Claudia; Rademacher, Christiane; Schuermann, Stephanie; Metternich-Kaizman, Tanja Wolff; Doepfner, Manfred

2018-01-01

Few studies have examined the effectiveness of outpatient cognitive-behavioral therapy (CBT) delivered in routine care settings for children and adolescents with mental disorders. This observational study examined changes in behavioral and emotional problems of adolescents with mental disorders during routine outpatient CBT delivered at a university outpatient clinic and compared them with a historical control group of youths who received academic tutoring of comparable length and intensity. Assessments were made at the start and end of treatment (pre- and post-assessment) using parent ratings of the German versions of the Child Behavior Checklist (CBCL) and self-ratings of the Youth Self-Report (YSR) scale. For the main analysis, 677 adolescents aged 11‒21 years had complete data. Changes from pre- to post-assessment showed significant reductions in mental health problems on both parent- and self-ratings. Pre- to post-effect sizes (Cohen's d) were small-to-medium for the total sample (d = 0.23 to d = 0.62) and medium-to-large for those adolescents rated in the clinical range on each (sub)scale at the start of treatment (d = 0.65 to d = 1.48). We obtained medium net effect sizes (d = 0.69) for the CBCL and YSR total scores when patients in the clinical range were compared to historical controls. However, a substantial part of the sample remained in the clinical range at treatment end. The results suggest that CBT is effective for adolescents with mental disorders when administered under routine care conditions but must be interpreted conservatively due to the lack of a direct control condition.

Mobile Technology Boosts the Effectiveness of Psychotherapy and Behavioral Interventions: A Meta-analysis

PubMed Central

Lindhiem, Oliver; Bennett, Charles B.; Rosen, Dana; Silk, Jennifer

2015-01-01

We conducted a meta-analysis on the effects of mobile technology on treatment outcome for psychotherapy and other behavioral interventions. Our search of the literature resulted in 26 empirical articles describing 25 clinical trials testing the benefits of smartphone applications, PDAs, or text messaging systems either to supplement treatment or substitute for direct contact with a clinician. Overall, mobile technology use was associated with superior treatment outcome across all study designs and control conditions, ES = .34, p < .0001. For the subset of 10 studies that looked specifically at the added benefit of mobile technology using a rigorous “Treatment” versus “Treatment + Mobile” design, effect sizes were only slightly more modest (ES = .27) and still significant (p < .05). Overall, the results support the role of mobile technology for the delivery of psychotherapy and other behavioral interventions. PMID:26187164

Analysis of Expert Diagnosis of a Computer Simulation of Congenital Heart Disease

ERIC Educational Resources Information Center

Johnson, Paul E.; And Others

1975-01-01

It is concluded that while behavior of experts in the hospital and clinic is the primary means of evaluating successful student performance, computer simulations of patient cases offer the opportunity to use expert data in the calibration of student error. (Editor)

Knowledge translation of the American College of Emergency Physicians' clinical policy on syncope using computerized clinical decision support.

PubMed

Melnick, Edward R; Genes, Nicholas G; Chawla, Neal K; Akerman, Meredith; Baumlin, Kevin M; Jagoda, Andy

2010-06-01

To influence physician practice behavior after implementation of a computerized clinical decision support system (CDSS) based upon the recommendations from the 2007 ACEP Clinical Policy on Syncope. This was a pre-post intervention with a prospective cohort and retrospective controls. We conducted a medical chart review of consecutive adult patients with syncope. A computerized CDSS prompting physicians to explain their decision-making regarding imaging and admission in syncope patients based upon ACEP Clinical Policy recommendations was embedded into the emergency department information system (EDIS). The medical records of 410 consecutive adult patients presenting with syncope were reviewed prior to implementation, and 301 records were reviewed after implementation. Primary outcomes were physician practice behavior demonstrated by admission rate and rate of head computed tomography (CT) imaging before and after implementation. There was a significant difference in admission rate pre- and post-intervention (68.1% vs. 60.5% respectively, p = 0.036). There was no significant difference in the head CT imaging rate pre- and post-intervention (39.8% vs. 43.2%, p = 0.358). There were seven physicians who saw ten or more patients during the pre- and post-intervention. Subset analysis of these seven physicians' practice behavior revealed a slight significant difference in the admission rate pre- and post-intervention (74.3% vs. 63.9%, p = 0.0495) and no significant difference in the head CT scan rate pre- and post-intervention (42.9% vs. 45.4%, p = 0.660). The introduction of an evidence-based CDSS based upon ACEP Clinical Policy recommendations on syncope correlated with a change in physician practice behavior in an urban academic emergency department. This change suggests emergency medicine clinical practice guideline recommendations can be incorporated into the physician workflow of an EDIS to enhance the quality of practice.

Self-defeating behaviors in organizations: the relationship between thwarted belonging and interpersonal work behaviors.

PubMed

Thau, Stefan; Aquino, Karl; Poortvliet, P Marijn

2007-05-01

This multisource field study applied belongingness theory to examine whether thwarted belonging, defined as the perceived discrepancy between one's desired and actual levels of belonging with respect to one's coworkers, predicts interpersonal work behaviors that are self-defeating. Controlling for demographic variables, job type, justice constructs, and trust in organization in a multilevel regression analysis using data from 130 employees of a clinical chemical laboratory and their supervisors, the authors found that employees who perceive greater levels of desired coworker belonging than actual levels of coworker belonging were more likely to engage in interpersonally harmful and less likely to engage in interpersonally helpful behaviors. Implications for the application of belongingness theory to explain self-defeating behaviors in organizations are discussed. 2007 APA, all rights reserved

A Comparison of Teacher Checklists Used over 15 Days and a One-Day Antecedent Analysis to Conduct a Medication Trial

ERIC Educational Resources Information Center

Smith, R.; Larsen, D.; Derby, K. M.; McLaughlin, T. F.; Weber, K. P.; Brown, K.; Herring, M.

2004-01-01

A one-day antecedent analysis and an extended school-based double-blind medication trial were used to assess the effects of Ritalin on the disruptive behavior of a child diagnosed with ADHD. The evaluations took place in an outpatient clinic and in the child's general education classroom. The results of both evaluations indicated that the…

Human behavioral research in space: quandaries for research subjects and researchers

NASA Technical Reports Server (NTRS)

Shepanek, Marc

2005-01-01

With the advent of long-duration spaceflight on board the International Space Station (ISS) and possible future missions beyond low Earth orbit (LEO) such as Mars, it is critical that those at NASA have a realistic assessment of the challenges that will face individuals on long-duration missions so that they can develop preventive and real-time countermeasures to behavioral health issues. While space travellers are very interested in having countermeasures to the deleterious effects of space missions, they have a powerful disincentive to participate in this research if they feel it could in any way negatively affect their flight status. The behavioral issues of isolation and confinement for extended-duration space missions are reviewed. Areas of basic and clinical behavioral research are listed. And the classical clinical model for research is not considered appropriate for the current configuration of the space program. The use of analogue environments and advanced statistical analysis are suggested as ways to address the limited spaceflight research opportunities. The challenge of research subject or patient confidentiality vs. mission safety and issues of personal flight status are addressed.

Human behavioral research in space: quandaries for research subjects and researchers.

PubMed

Shepanek, Marc

2005-06-01

With the advent of long-duration spaceflight on board the International Space Station (ISS) and possible future missions beyond low Earth orbit (LEO) such as Mars, it is critical that those at NASA have a realistic assessment of the challenges that will face individuals on long-duration missions so that they can develop preventive and real-time countermeasures to behavioral health issues. While space travellers are very interested in having countermeasures to the deleterious effects of space missions, they have a powerful disincentive to participate in this research if they feel it could in any way negatively affect their flight status. The behavioral issues of isolation and confinement for extended-duration space missions are reviewed. Areas of basic and clinical behavioral research are listed. And the classical clinical model for research is not considered appropriate for the current configuration of the space program. The use of analogue environments and advanced statistical analysis are suggested as ways to address the limited spaceflight research opportunities. The challenge of research subject or patient confidentiality vs. mission safety and issues of personal flight status are addressed.

The Professionalism Assessment of Clinical Teachers (PACT): The Reliability and Validity of a Novel Tool to Evaluate Professional and Clinical Teaching Behaviors

ERIC Educational Resources Information Center

Young, Meredith E.; Cruess, Sylvia R.; Cruess, Richard L.; Steinert, Yvonne

2014-01-01

Physicians function as clinicians, teachers, and role models within the clinical environment. Negative learning environments have been shown to be due to many factors, including the presence of unprofessional behaviors among clinical teachers. Reliable and valid assessments of clinical teacher performance, including professional behaviors, may…

CKD Self-management: Phenotypes and Associations With Clinical Outcomes.

PubMed

Schrauben, Sarah J; Hsu, Jesse Y; Rosas, Sylvia E; Jaar, Bernard G; Zhang, Xiaoming; Deo, Rajat; Saab, Georges; Chen, Jing; Lederer, Swati; Kanthety, Radhika; Hamm, L Lee; Ricardo, Ana C; Lash, James P; Feldman, Harold I; Anderson, Amanda H

2018-03-24

To slow chronic kidney disease (CKD) progression and its complications, patients need to engage in self-management behaviors. The objective of this study was to classify CKD self-management behaviors into phenotypes and assess the association of these phenotypes with clinical outcomes. Prospective cohort study. Adults with mild to moderate CKD enrolled in the Chronic Renal Insufficiency Cohort (CRIC) Study. 3,939 participants in the CRIC Study recruited between 2003 and 2008 served as the derivation cohort and 1,560 participants recruited between 2013 and 2015 served as the validation cohort. CKD self-management behavior phenotypes. CKD progression, atherosclerotic events, heart failure events, death from any cause. Latent class analysis stratified by diabetes was used to identify CKD self-management phenotypes based on measures of body mass index, diet, physical activity, blood pressure, smoking status, and hemoglobin A 1c concentration (if diabetic); Cox proportional hazards models. 3 identified phenotypes varied according to the extent of implementation of recommended CKD self-management behaviors: phenotype I characterized study participants with the most recommended behaviors; phenotype II, participants with a mixture of recommended and not recommended behaviors; and phenotype III, participants with minimal recommended behaviors. In multivariable-adjusted models for those with and without diabetes, phenotype III was strongly associated with CKD progression (HRs of 1.82 and 1.49), death (HRs of 1.95 and 4.14), and atherosclerotic events (HRs of 2.54 and 1.90; each P < 0.05). Phenotype II was associated with atherosclerotic events and death among those with and without diabetes. No consensus definition of CKD self-management; limited to baseline behavior data. There are potentially 3 CKD self-management behavior phenotypes that distinguish risk for clinical outcomes. These phenotypes may inform the development of studies and guidelines regarding optimal self-management. Copyright © 2018 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

Design and validation of a questionnaire for measuring perceived risk of skin cancer.

PubMed

Morales-Sánchez, M A; Peralta-Pedrero, M L; Domínguez-Gómez, M A

2014-04-01

A perceived risk of cancer encourages preventive behavior while the lack of such a perception is a barrier to risk reduction. There are no instruments in Spanish to measure this perceived risk and thus quantify response to interventions for preventing this disease at a population level. The aim of this study was to design and validate a self-administered questionnaire for measuring the perceived risk of skin cancer. A self-administered questionnaire with a visual Likert-type scale was designed based on the results of the analysis of the content of a survey performed in 100 patients in the Dr. Ladislao de la Pascua Skin Clinic, Distrito Federal México, Mexico. Subsequently, the questionnaire was administered to a sample of 359 adult patients who attended the clinic for the first time. As no gold standard exists for measuring the perceived risk of skin cancer, the construct was validated through factor analysis. The final questionnaire had 18 items. The internal consistency measured with Cronbach α was 0.824 overall. In the factor analysis, 4 factors (denoted as affective, behavioral, severity, and susceptibility) and an indicator of risk accounted for 65.133% of the variance. The psychometric properties of the scale were appropriate for measuring the perception of risk in adult patients (aged 18 years or more) who attended the dermatology clinic. Copyright © 2013 Elsevier España, S.L. and AEDV. All rights reserved.

Depression remission, receipt of problem-solving therapy, and self-care behavior frequency among low-income, predominantly Hispanic diabetes patients.

PubMed

Oh, Hyunsung; Ell, Kathleen

2016-01-01

This study explored whether depression remission and problem-solving therapy (PST) receipt are associated with more frequent self-care behaviors via cross-sectional and prospective analyses. We analyzed data from a randomized clinical trial (N=387) that tested collaborative depression care among predominantly Hispanic patients with diabetes in safety-net clinics. Data at 12-month follow-up, measured with the Patient Health Questionnaire-9 and Hopkins Symptom Checklist-20, were used to define depression remission. PST was provided by a bilingual social worker. Multivariate regression analysis was used to examine associations between predictors and frequency change of each self-care behavior (healthy diet, exercise, self-blood glucose monitoring, and foot care between baseline and 12-month (N=281), 18-month (N=249), and 24-month (N=235) follow-up surveys. Inconsistent relationships were observed depending on the instrument to identify depression remission, type of self-care behaviors, and time when self-care behavior was measured. Significant associations were more likely to be observed in cross-sectional analyses. PST receipt was not associated with self-care behaviors. Depression remission or the receipt of PST may not be a reliable antecedent for more frequent self-care behaviors among this group. A few recommendations for studies were offered to enhance existing depression care for diabetes patients. Copyright © 2016 Elsevier Inc. All rights reserved.

Association between physicians’ interaction with pharmaceutical companies and their clinical practices: A systematic review and meta-analysis

PubMed Central

Al-Khaled, Lina; Kahale, Lara A.; Nas, Hala; El-Jardali, Fadi

2017-01-01

Background Pharmaceutical company representatives likely influence the prescribing habits and professional behaviors of physicians. The objective of this study was to systematically review the association between physicians’ interactions with pharmaceutical companies and their clinical practices. Methods We used the standard systematic review methodology. Observational and experimental study designs examining any type of targeted interaction between practicing physicians and pharmaceutical companies were eligible. The search strategy included a search of MEDLINE and EMBASE databases up to July 2016. Two reviewers selected studies, abstracted data, and assessed risk of bias in duplicate and independently. We assessed the quality of evidence using the GRADE approach. Results Twenty articles reporting on 19 studies met our inclusion criteria. All of these studies were conducted in high-income countries and examined different types of interactions, including detailing, industry-funded continuing medical education, and receiving free gifts. While all included studies assessed prescribing behaviors, four studies also assessed financial outcomes, one assessed physicians’ knowledge, and one assessed their beliefs. None of the studies assessed clinical outcomes. Out of the 19 studies, 15 found a consistent association between interactions promoting a medication, and inappropriately increased prescribing rates, lower prescribing quality, and/or increased prescribing costs. The remaining four studies found both associations and lack of significant associations for the different types of exposures and drugs examined in the studies. A meta-analysis of six of these studies found a statistically significant association between exposure and physicians’ prescribing behaviors (OR = 2.52; 95% CI 1.82–3.50). The quality of evidence was downgraded to moderate for risk of bias and inconsistency. Sensitivity analysis excluding studies at high risk of bias did not substantially change these results. A subgroup analysis did not find a difference by type of exposure. Conclusion There is moderate quality evidence that physicians’ interactions with pharmaceutical companies are associated with their prescribing patterns and quality. PMID:28406971

Predicting Health Care Utilization After Behavioral Health Referral Using Natural Language Processing and Machine Learning.

PubMed

Roysden, Nathaniel; Wright, Adam

2015-01-01

Mental health problems are an independent predictor of increased healthcare utilization. We created random forest classifiers for predicting two outcomes following a patient's first behavioral health encounter: decreased utilization by any amount (AUROC 0.74) and ultra-high absolute utilization (AUROC 0.88). These models may be used for clinical decision support by referring providers, to automatically detect patients who may benefit from referral, for cost management, or for risk/protection factor analysis.

CREATING AN IPHONE APPLICATION FOR COLLECTING CONTINUOUS ABC DATA

PubMed Central

Whiting, Seth W; Dixon, Mark R

2012-01-01

This paper provides an overview and task analysis for creating a continuous ABC data-collection application using Xcode on a Mac computer. Behavior analysts can program an ABC data collection system, complete with a customized list of target clients, antecedents, behaviors, and consequences to be recorded, and have the data automatically sent to an e-mail account after observations have concluded. Further suggestions are provided to customize the ABC data- collection system for individual preferences and clinical needs. PMID:23060682

Creating an iPhone application for collecting continuous ABC data.

PubMed

Whiting, Seth W; Dixon, Mark R

2012-01-01

This paper provides an overview and task analysis for creating a continuous ABC data-collection application using Xcode on a Mac computer. Behavior analysts can program an ABC data collection system, complete with a customized list of target clients, antecedents, behaviors, and consequences to be recorded, and have the data automatically sent to an e-mail account after observations have concluded. Further suggestions are provided to customize the ABC data- collection system for individual preferences and clinical needs.

The Health Seeking Behaviors and Perceptions of Iranian Patient with Osteoarthritis about Pain Management: A Qualitative Study

PubMed Central

Zamanzadeh, Vahid; Ahmadi, Fazlollah; Foolady, Marjaneh; Behshid, Mozhgan; Irajpoor, Alireza

2017-01-01

Introduction: Pain is the main reason for patients with osteoarthritis (OA) to visit health clinics. Health seeking behaviors indicate unmet patient needs and lack of understanding of OA pain patterns. This study aimed to describe the experiences of Iranian patients with OA and explore their health seeking behaviors and perceptions on pain management related to osteoarthritis. Methods: Using a qualitative approach, data was collected by interviewing 19 patients, 2 family members, and 5 health care providers from the in-patient and out-patient clinics, and physicians’ offices. Data saturation was reached after 31 in-depth and semi-structured interviews (five second interviews). Data were analyzed by qualitative content analysis, using comparison, reflection and interpretation techniques. The criteria used to enhance rigor included credibility, transferability, dependability, and confirmability. Results: Two main categories and six subcategories emerged from data analysis. The first main category included "adapting to the reality" which had three subcategories: Facing OA pain, seeking health care, and accepting pain as a part of life. The second main category included "behavior fluctuation" with three subcategory of role conflict, responsibility for self-care and, adherence to prescribed treatment versus self-treatment. Conclusion: Care seeking behaviors for chronic pain sufferers are void of cultural, emotional, social and financial situation and patient expectations. Some misconceptions emerged about the health problem and its management, which may lead to negative attitudes toward treatment and therapists and finally lead to non-adherence to treatment. Patients need for education to enhance appropriate health care utilization. PMID:28299300

The Health Seeking Behaviors and Perceptions of Iranian Patient with Osteoarthritis about Pain Management: A Qualitative Study.

PubMed

Zamanzadeh, Vahid; Ahmadi, Fazlollah; Foolady, Marjaneh; Behshid, Mozhgan; Irajpoor, Alireza

2017-03-01

Introduction: Pain is the main reason for patients with osteoarthritis (OA) to visit health clinics. Health seeking behaviors indicate unmet patient needs and lack of understanding of OA pain patterns. This study aimed to describe the experiences of Iranian patients with OA and explore their health seeking behaviors and perceptions on pain management related to osteoarthritis. Methods: Using a qualitative approach, data was collected by interviewing 19 patients, 2 family members, and 5 health care providers from the in-patient and out-patient clinics, and physicians' offices. Data saturation was reached after 31 in-depth and semi-structured interviews (five second interviews). Data were analyzed by qualitative content analysis, using comparison, reflection and interpretation techniques. The criteria used to enhance rigor included credibility, transferability, dependability, and confirmability. Results: Two main categories and six subcategories emerged from data analysis. The first main category included "adapting to the reality" which had three subcategories: Facing OA pain, seeking health care, and accepting pain as a part of life. The second main category included "behavior fluctuation" with three subcategory of role conflict, responsibility for self-care and, adherence to prescribed treatment versus self-treatment. Conclusion: Care seeking behaviors for chronic pain sufferers are void of cultural, emotional, social and financial situation and patient expectations. Some misconceptions emerged about the health problem and its management, which may lead to negative attitudes toward treatment and therapists and finally lead to non-adherence to treatment. Patients need for education to enhance appropriate health care utilization.

Investigating bang for your training buck: a randomized controlled trial comparing three methods of training clinicians in two core strategies of dialectical behavior therapy.

PubMed

Dimeff, Linda A; Harned, Melanie S; Woodcock, Eric A; Skutch, Julie M; Koerner, Kelly; Linehan, Marsha M

2015-05-01

The present study examined the efficacy of online training (OLT), instructor-led training (ILT), and a treatment manual (TM) in training mental health clinicians in two core strategies of Dialectical Behavior Therapy (DBT): chain analysis and validation. A randomized controlled trial compared OLT, ILT, and TM among clinicians naïve to DBT (N=172) who were assessed at baseline, post-training, and 30, 60, and 90 days following training. Primary outcomes included satisfaction, self-efficacy, motivation, knowledge, clinical proficiency, and clinical use. Overall, ILT outperformed OLT and TM in satisfaction, self-efficacy, and motivation, whereas OLT was the most effective method for increasing knowledge. The conditions did not differ in observer-rated clinical proficiency or self-reported clinical use, which both increased to moderate levels after training. In addition, ILT was particularly effective at improving motivation to use chain analysis, whereas OLT was particularly effective at increasing knowledge of validation strategies. These findings suggest that these types of brief, didactic trainings may be effective methods of increasing knowledge of new treatment strategies, but may not be sufficient to enable clinicians to achieve a high level of clinical use or proficiency. Additional research examining the possible advantages of matching training methods to types of treatment strategies may help to determine a tailored, more effective approach to training clinicians in empirically supported treatments. Copyright © 2015. Published by Elsevier Ltd.

Applying Advanced Analytical Approaches to Characterize the Impact of Specific Clinical Gaps and Profiles on the Management of Rheumatoid Arthritis.

PubMed

Ruiz-Cordell, Karyn D; Joubin, Kathy; Haimowitz, Steven

2016-01-01

The goal of this study was to add a predictive modeling approach to the meta-analysis of continuing medical education curricula to determine whether this technique can be used to better understand clinical decision making. Using the education of rheumatologists on rheumatoid arthritis management as a model, this study demonstrates how the combined methodology has the ability to not only characterize learning gaps but also identify those proficiency areas that have the greatest impact on clinical behavior. The meta-analysis included seven curricula with 25 activities. Learners who identified as rheumatologists were evaluated across multiple learning domains, using a uniform methodology to characterize learning gains and gaps. A performance composite variable (called the treatment individualization and optimization score) was then established as a target upon which predictive analytics were conducted. Significant predictors of the target included items related to the knowledge of rheumatologists and confidence concerning 1) treatment guidelines and 2) tests that measure disease activity. In addition, a striking demographic predictor related to geographic practice setting was also identified. The results demonstrate the power of advanced analytics to identify key predictors that influence clinical behaviors. Furthermore, the ability to provide an expected magnitude of change if these predictors are addressed has the potential to substantially refine educational priorities to those drivers that, if targeted, will most effectively overcome clinical barriers and lead to the greatest success in achieving treatment goals.

Fear Avoidance and Clinical Outcomes from Mild Traumatic Brain Injury.

PubMed

Silverberg, Noah D; Panenka, William; Iverson, Grant L

2018-04-18

Characterizing psychological factors that contribute to persistent symptoms after mild traumatic brain injury (MTBI) can inform early intervention. To determine whether fear avoidance, a known risk factor for chronic disability after musculoskeletal injury, is associated with worse clinical outcomes from MTBI, adults were recruited from four outpatient MTBI clinics and assessed at their first clinic visit (M=2.7, SD=1.5 weeks post-injury) and again 4-5 months later. Of 273 patients screened, 102 completed the initial assessment and 87 returned for the outcome assessment. The initial assessment included a battery of questionnaires that measure activity avoidance and associated fears. Endurance, an opposite behavior pattern, was measured with the Behavioral Response to Illness Questionnaire. The multidimensional outcome assessment included measures of post-concussion symptoms (British Columbia Postconcussion Symptom Inventory), functional disability (World Health Organization Disability Assessment Schedule-12 2.0), return to work status, and psychiatric complications (MINI Neuropsychiatric Interview). A single component was retained from principal components analysis of the six avoidance subscales. In generalized linear modeling, the avoidance composite score predicted symptom severity (95% confidence interval [CI] for B= 1.22-6.33) and disability (95% CI for B=2.16-5.48), but not return to work (95% CI for B=-0.68-0.24). The avoidance composite was also associated with an increased risk for depression (OR=1.76, 95% CI=1.02-3.02) and anxiety disorders (OR=1.89, 95% CI=1.16-3.19). Endurance behavior predicted the same outcomes, except for depression. In summary, avoidance and endurance behavior were associated with a range of adverse clinical outcomes from MTBI. These may represent early intervention targets.

A preliminary analysis of the effects of coaching feedback on teacher implementation fidelity of first step to success.

PubMed

Rodriguez, Billie Jo; Loman, Sheldon L; Horner, Robert H

2009-01-01

First Step to Success (FSS) is a "manualized" intervention with documented effectiveness in reducing problem behaviors for young children at risk for school failure. This study is a preliminary analysis focusing on the role of performance feedback from FSS coaches on the fidelity with which teachers implemented FSS. Three typically developing students (2 kindergarten and 1 first grade) and their respective teachers served as participants. Student behavior and teacher implementation fidelity were assessed using a nonconcurrent multiple baseline design across student/teacher dyads, in which a no coaching baseline was followed by a performance feedback condition. The baseline phase showed modest levels of implementation fidelity and initial low levels of problem behavior followed by gradually increasing trends. A relation was demonstrated between coaching feedback and improved implementation fidelity. In addition, improved fidelity was associated with improvements in student problem behavior. Implications are drawn for clinical application of FSS and other "manualized" interventions.

Integrating Best Practices in Positive Behavior Support and Clinical Psychology for a Child with Autism and Anxiety-Related Problem Behavior: A Clinical Case Study

ERIC Educational Resources Information Center

Neufeld, Vanessa; Law, Kimberley C. Y.; Lucyshyn, Joseph M.

2014-01-01

This clinical case study investigated the effectiveness of a multicomponent intervention for a child with autism and anxiety-related problem behavior that integrated components of cognitive behavior therapy (CBT) with positive behavior support (PBS). One child with autism and his family participated. The dependent variable was the number of steps…

Comparison of Traditional and Trial-Based Methodologies for Conducting Functional Analyses

ERIC Educational Resources Information Center

LaRue, Robert H.; Lenard, Karen; Weiss, Mary Jane; Bamond, Meredith; Palmieri, Mark; Kelley, Michael E.

2010-01-01

Functional analysis represents a sophisticated and empirically supported functional assessment procedure. While these procedures have garnered considerable empirical support, they are often underused in clinical practice. Safety risks resulting from the evocation of maladaptive behavior and the length of time required to conduct functional…

An evaluation of nursing students' communication ability during practical clinical training.

PubMed

Xie, Jianfei; Ding, Siqing; Wang, Chunmei; Liu, Aizhong

2013-08-01

To investigate communication abilities and other influential factors on nursing students at the beginning of clinical practical session. A cluster sample of 312 nursing students from 22 nursing colleges or universities was recruited. Communication ability of these participants was evaluated by 4 questionnaires for demographic data, clinical communication behavior, treatment communication skills and interpersonal communication skills at the beginning of clinical practical session. The stability and accuracy of the questionnaires were established with an overall content validity index of 0.78, the Cronbach's Alpha index ranged from 0.872 to 0.951, and the letter index fluctuates from 0.85 to 0.89. Results demonstrated that 88.1% of the nursing students require extra training in clinical communication behavior, treatment communication skills, and interpersonal communication skills. The Pearson analysis revealed significantly positive correlations between communication abilities and the students' educational level, clinical training experience, living circumstances and number of siblings. Most nursing students need communication skill training. Multiple factors, including educational level, living circumstances, number of siblings, and training experience significantly affect nursing students' communication abilities. Our study suggested a need to widely establish a communication course or clinical communication training program to improve nursing students' communication skills. Copyright © 2012 Elsevier Ltd. All rights reserved.

How Exemplary Inpatient Teaching Physicians Foster Clinical Reasoning.

PubMed

Houchens, Nathan; Harrod, Molly; Fowler, Karen E; Moody, Stephanie; Saint, Sanjay

2017-09-01

Clinical reasoning is a crucial component of training in health professions. These cognitive skills are necessary to provide quality care and avoid diagnostic error. Much previous literature has focused on teaching clinical reasoning in nonclinical environments and does not include learner reflections. The authors sought to explore, through multiple perspectives including learners, techniques used by exemplary inpatient clinician-educators for explicitly cultivating clinical reasoning. The authors conducted (2014-2015) a multisite, exploratory qualitative study examining how excellent clinician-educators foster clinical reasoning during general medicine rounds. This was accomplished through interviews of educators, focus group discussions with learners, and direct observations of clinical teaching. The authors reviewed field notes and transcripts using techniques of thematic analysis. Twelve clinician-educators, 57 current learners, and 26 former learners participated in observations and interviews. The techniques and behaviors of educators were categorized into 4 themes, including 1) emphasizing organization and prioritization, 2) accessing prior knowledge, 3) thinking aloud, and 4) analyzing the literature. The findings of this comprehensive study both confirm strategies found in previous literature and provide novel approaches. This is the first study to incorporate the perspectives of learners. Educators' techniques and behaviors, identified through direct observation and supported by reflections from the entire team, can inform best practices for the teaching of clinical reasoning. Copyright © 2017 Elsevier Inc. All rights reserved.

A disease specific questionnaire for assessing behavior in individuals with Prader-Willi syndrome.

PubMed

Avrahamy, Hamutal; Pollak, Yehuda; Shriki-Tal, Liron; Genstil, Larry; Hirsch, Harry J; Gross-Tsur, Varda; Benarroch, Fortu

2015-04-01

Prader-Willi syndrome (PWS) is a genetic multisystem disorder with various medical, cognitive, behavioral and psychiatric problems. PWS is caused by the lack of expression of paternal genes on chromosome 15q2-q13 due to a deletion (70-75%), uniparental disomy (25-30%) or imprinting center defect (<5%). The common PWS behavioral and psychiatric characteristics are very typical in all ethnicities and were reported worldwide. Still, each individual has a specific profile of these common traits and the severity of his or her symptoms varies over time. Behavioral problems are the most important factor affecting the quality of life of both the individuals and their families. There is a need for a standardized tool to assess the specific behavioral profile of each individual and its present severity, in order to enable physicians to tailor the specific treatment needed and assist in a more accurate clinical follow up. To the best of our knowledge no such a tool has been standardized and published. We developed, based on the literature (mainly Forster and Gourash's paradigm) and our clinical experience, a 37 item disease specific questionnaire, the "PWS Behavioral Questionnaire" (PWSBQ) for assessing behavior in PWS patients. The purpose of the present study was to validate this tool in the entire adolescent and adult PWS population in Israel. The PWSBQ focuses on five major domains-abnormal emotional regulation, food-seeking related behavior, lack of flexibility, oppositional behavior and interpersonal problems and lastly body related behaviors. Caregivers of all Hebrew speaking individuals with PWS over the age of 12 years attending the Israeli national multidisciplinary PWS clinic were recruited. Of the 54 eligible individuals, 53 participated. They were interviewed with the PWSBQ and in addition filled the "Hyperphagia Questionnaire" and the "Child Behavioral Checklist" (CBCL). After verifying the questionnaire's content validity, all items on the PWSBQ were analyzed for internal reliability by calculating Cronbach's α. Criterion validity was evaluated by correlation testing with regard to the Hyperphagia Questionnaire and CBCL. In order to assess the questionnaire's interpretability, the correlation between the PWSBQ and the "Clinical Global Impression" (CGI) scores was evaluated. The PWSBQ total score was positively correlated with both the CBCL total score and the CGI score (0.662 and 0.549, p<0.001 respectively). Of the five domains, four had acceptable internal reliability (excluding the body related behaviors domain, which was thus removed from the total score). Criterion validity was established for the four domains remaining in the statistical analysis (abnormal emotional regulation, food seeking related behavior, lack of flexibility and oppositional behavior and interpersonal problems). Our findings suggest that the PWSBQ is a valid and reliable tool for the assessment of current behavioral problems among individuals with PWS. Although further research is needed in order to verify PWSBQ's ability to identify changes in the behavioral status of a given individual, it can now be used both in research and in a clinical setting, enabling the physician to plan the most suitable treatment based on the current behavioral status. Copyright © 2014 Elsevier Inc. All rights reserved.

[Prevalence of intimate partner violence in heterosexual men attending HIV voluntary counsel and test clinics and related factors in Shanghai].

PubMed

Liu, Y; Yang, Y M; Ning, Z; Zheng, H; Liu, H; Tang, H F; Zhang, Y Y; He, N

2016-07-01

To understand prevalence of intimate partner violence(IPV)in heterosexual men(HM)attending HIV voluntary counseling and testing(VCT)clinics and related factors in Shanghai. All the HM attending two VCT clinics in Shanghai during March-August, 2015 were recruited to participate in a cross-sectional survey with questionnaire interview and blood test for HIV. IPV was evaluated by using the questionnaire developed by WHO Multi-Country Study on Women' s Health and Domestic Violence against Women. A total of 327 participants were recruited, their average age was 29.4 years(s∶6.1). Among them 60.2%(197/327)were aged 26-35, 57.8%(189/327)never married, 78.8%(260/327)had educational level of ≥college degree, 49.5%(162/327)were not local residents; 72.2%(236/327)had steady female partners, 72.2%(236/327)had 2 or more female partners in the past year, 6.1%(20/327)reported being diagnosed with sexually transmitted disease(STD). 1.8%(6/327)were tested to be HIV-positive. 28.4%(93/327)had IPV behaviors against heterosexual partners. Multivariate logistic regression analysis indicated that IPV behavior against heterosexual partners was significantly associated with experience of commercial sex(aOR=2.19, 95%CI: 1.16-4.15)and witness of domestic violence in early life(aOR=3.19; 95%CI: 1.58-6.45). IPV prevalence was relatively high in HM attendants in VCT clinics in Shanghai and IPV intervention is needed to conduct in VCT clinics. Multivariate regression analysis showed that the factors associated with IPV behaviors included having sex with female sex workers and the witness of domestic violence between parents. Future research is needed to further explore the association between IPV and HIV infection.

Interim methadone and patient navigation in jail: Rationale and design of a randomized clinical trial.

PubMed

Schwartz, Robert P; Kelly, Sharon M; Mitchell, Shannon G; Dunlap, Laura; Zarkin, Gary A; Sharma, Anjalee; O'Grady, Kevin E; Jaffe, Jerome H

2016-07-01

Methadone maintenance is an effective treatment for opioid dependence but is rarely initiated in US jails. Patient navigation is a promising approach to improve continuity of care but has not been tested in bridging the gap between jail- and community-based drug treatment programs. This is an open-label randomized clinical trial among 300 adult opioid dependent newly-arrested detainees that will compare three treatment conditions: methadone maintenance without routine counseling (termed Interim Methadone; IM) initiated in jail v. IM and patient navigation v. enhanced treatment-as-usual. The two primary outcomes will be: (1) the rate of entry into treatment for opioid use disorder within 30days from release and (2) frequency of opioid positive urine tests over the 12-month follow-up period. An economic analysis will examine the costs, cost-effectiveness, and cost-benefit ratio of the study interventions. We describe the background and rationale for the study, its aims, hypotheses, and study design. Given the large number of opioid dependent detainees in the US and elsewhere, initiating IM at the time of incarceration could be a significant public health and clinical approach to reducing relapse, recidivism, HIV-risk behavior, and criminal behavior. An economic analysis will be conducted to assist policy makers in determining the utility of adopting this approach. ClinicalTrials.gov: NCT02334215. Copyright © 2016 Elsevier Inc. All rights reserved.

Analysis of internet use behaviors among clinical medical students in China

PubMed Central

2014-01-01

Background The availability of internet-based information resources is increasing and the appropriate use of such resources is an important subject for clinical medical students. The aims of this study were to investigate the behaviors of clinical medical students regarding the use of internet-based activities, to analyze the behavior and characteristics of the students’ information demands, and to discuss the behaviors and time preferences related to internet use of students with different levels of education. Methods Librarians obtained real-time feedback from 999 clinical medical students to record online activities. The data was recorded in a standard form and then analyzed statistically. Results There were significant differences in the use of the internet for learning activities among the different groups of clinical medical students (P < 0.0001). Learning accounted for 73.5% of all internet use for doctoral candidates, 47.6% of internet use for master’s candidates, 28.7% of internet use for seven-year undergraduate students, and 14.1% of use for five-year undergraduate students. There was also a significant difference in the proportions of leisure and e-commerce activities among the student groups (P < 0.0001), with five-year students displaying the highest total proportion of these activities (59.4% and 18.8%). Internet use for entertainment activities was the same for all groups of clinical medical students. Time of day of internet use was consistent across all student groups, but internet use differed by day of the week (P < 0.01). There was no difference among the time of day of internet use for learning, leisure and entertainment activities during a single day (P > 0.05), but e-commerce activities varied according to time of day (P < 0.05). Learning and e-commerce activities by clinical medical students did not vary by day of the week (P > 0.05), but the distributions of leisure and entertainment activities were different according to day of the week (P < 0.05). Conclusions A stronger demand for learning is associated with a higher academic level of clinical medical students. Differences exist among student groups regarding internet use behaviors and internet use during different time periods. PMID:24690437

Setting apart the affected: the use of behavioral criteria in animal models of post traumatic stress disorder.

PubMed

Cohen, Hagit; Zohar, Joseph; Matar, Michael A; Zeev, Kaplan; Loewenthal, Uri; Richter-Levin, Gal

2004-11-01

Post-traumatic stress disorder (PTSD) affects about 20-30% of exposed individuals. Clinical studies of PTSD generally employ stringent criteria for inclusion in study populations, and yet in animal studies the data collection and analysis are generally expressed as a function of exposed vs nonexposed populations, regardless of individual variation in response. Prior data support an approach to animal models analogous to inclusion criteria in clinical studies. This series of studies sought to assess prevalence rates of maladaptive vs adaptive responses determined according to a more stringent approach to the concept of inclusion/exclusion criteria (cutoff behavioral criteria-CBC), consisting of two successive behavioral tests (elevated plus maze and acoustic startle response tests). The rats were exposed to stressors in two different paradigms; exposure to a predator and underwater trauma. The prevalence rates of maladaptive responses to stress in these two distinct models dropped over time from 90% in the acute phase to 25% enduring/maladaptive response at 7 days, to remain constant over 30 days. As setting the affected individuals apart from the unaffected approximates clinical studies, it might also help to clarify some of the pending issues in PTSD research.

Nursing students' intentions to use research as a predictor of use one year post graduation: a prospective study.

PubMed

Forsman, Henrietta; Wallin, Lars; Gustavsson, Petter; Rudman, Ann

2012-09-01

Graduating nursing students are expected to have acquired the necessary skills to provide research-based care to patients. However, recent studies have shown that new graduate nurses report their extent of research use as relatively low. Because behavior intention is a well-known predictor of subsequent behavior, this gives reasons to further investigate graduating nursing students' intentions to use research in clinical practice after undergraduate study. To investigate graduating nursing students' intentions to use research in clinical practice and, furthermore, to investigate whether intention in itself and as a mediating variable can predict subsequent research use behavior in clinical practice one year post graduation. A follow-up study was performed of graduating nursing students in their final semester of undergraduate study (2006) and at one year post graduation (2008). Data were collected within the larger national survey LANE (Longitudinal Analysis of Nursing Education). A sample of 1319 respondents was prospectively followed. Graduating nursing students' intentions to use research instrumentally were studied as a predictor of their subsequent instrumental research use one year post graduation. A statistical full mediation model was tested to evaluate the effects of intention and factors from undergraduate study on subsequent research use in daily care. Thirty-four percent of the nursing students intended to use research on more than half or almost every working shift in their future clinical practice. Intention showed a direct effect on research use behavior. In addition, significant indirect effects on research use were shown for capability beliefs (regarding practicing the principles of evidence-based practice) and perceived support for research use (from campus and clinical education), where intention acted as a mediating factor for those effects. Students rated a modest level of intention to use research evidence. Intentions close to graduation acted as an essential predictor of subsequent research use behavior, both through a direct effect and as a mediating variable. These findings give support for designing future interventions aiming at influencing students' intention to use research to improve subsequent behavior. Focusing on strengthening students' capability beliefs and providing support for research use appear as promising target activities. Copyright © 2012 Elsevier Ltd. All rights reserved.

Workshop-based training in trauma-focused CBT: an in-depth analysis of impact on provider practices.

PubMed

Jensen-Doss, Amanda; Cusack, Karen J; de Arellano, Michael A

2008-08-01

Despite evidence that more intensive methods are more effective, many clinical settings continue to train practitioners using workshops. To more fully understand the strengths and limitations of workshops, the present investigation studied changes in practitioner behavior following a workshop in trauma-focused cognitive-behavioral therapy (TF-CBT). A chart review indicated no changes in TF-CBT use following the training, although therapists indicated that CBT was the most effective treatment for traumatized youths and was their primary approach to treating trauma. Analysis of client factors indicated weak relationships between technique use and treatment need. Implications of these findings for future training efforts are discussed.

Behavioral aspects of clinical trials. An integrated framework from behavior theory.

PubMed

Morrow, G R; Hickok, J T; Burish, T G

1994-11-01

A less-than-optimal proportion of patients with cancer are entered into National Cancer Institute-sponsored clinical trials. This article reviews the literature on accrual in oncology clinical trials to characterize the extent of the problem, identify reasons for low accrual, and suggest ways to promote accrual. Four well known theories of health behavior (the Health Belief Model, Subjective Expected Utility Theory, Protection Motivation Theory, and the Theory of Reasoned Action) point to central concepts involved in understanding patient health-related behavior: (1) the probability that an unwelcomed health event will happen to a patient, (2) the severity of that event if it does occur, (3) the effectiveness of a particular behavior (such as taking part in a clinical trial) to modify the severity, and (4) the cost of adopting that behavior. These concepts form a framework for integrating the available information about accrual to clinical oncology trials. Patient and physician factors previously related to clinical trials suggest specific recommendations for increasing accrual to clinical oncology trials.

Clusters of Healthy and Unhealthy Eating Behaviors Are Associated With Body Mass Index Among Adults.

PubMed

Heerman, William J; Jackson, Natalie; Hargreaves, Margaret; Mulvaney, Shelagh A; Schlundt, David; Wallston, Kenneth A; Rothman, Russell L

2017-05-01

To identify eating styles from 6 eating behaviors and test their association with body mass index (BMI) among adults. Cross-sectional analysis of self-report survey data. Twelve primary care and specialty clinics in 5 states. Of 11,776 adult patients who consented to participate, 9,977 completed survey questions. Frequency of eating healthy food, frequency of eating unhealthy food, breakfast frequency, frequency of snacking, overall diet quality, and problem eating behaviors. The primary dependent variable was BMI, calculated from self-reported height and weight data. k-Means cluster analysis of eating behaviors was used to determine eating styles. A categorical variable representing each eating style cluster was entered in a multivariate linear regression predicting BMI, controlling for covariates. Four eating styles were identified and defined by healthy vs unhealthy diet patterns and engagement in problem eating behaviors. Each group had significantly higher average BMI than the healthy eating style: healthy with problem eating behaviors (β = 1.9; P < .001), unhealthy (β = 2.5; P < .001), and unhealthy with problem eating behaviors (β = 5.1; P < .001). Future attempts to improve eating styles should address not only the consumption of healthy foods but also snacking behaviors and the emotional component of eating. Copyright © 2017 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.

Disordered eating behavior and mental health correlates among treatment seeking obese women.

PubMed

Altamura, M; Rossi, G; Aquilano, P; De Fazio, P; Segura-Garcia, C; Rossetti, M; Petrone, A; Lo Russo, T; Vendemiale, G; Bellomo, A

2015-01-01

Previous research has suggest that obesity is associated with increased risk for psychopathological disorders, however, little is known about which obese patients are most vulnerable to psychopathological disorders. We therefore investigated 126 treatment-seeking obese women to describe eating disorder pathology and mental health correlates, and to identify disordered eating behaviors that may place obese at increased risk for psychopathological disorders. The Structured Clinical Interview for DSM-IV (SCID) was used to identify Eating Disorders (ED). A battery of psychological tests, including the Anxiety Scale Questionnaire (ASQ,) Clinical Depression Questionnaire (CDQ), Eating Disorder Inventory-2 (EDI-2) Eating Attitudes Test-26 (EAT-26) scales and structured clinical interview were administered to all the patients. We analyzed the link between psychopathological disorders and eating attitudes by using both multiple regression analysis and non-parametric correlation. Disordered eating behaviors and emotional behavioral aspects related to Anorexia Nervosa, such as ineffectiveness, are strongly linked to the depression and anxiety in obese subjects. No correlation was found between psychopathological disorders and age or anthropometric measurements. Findings corroborate earlier work indicating that psychological distress is elevated in obese treatment seeking, bolstering the need for mental health assessment of such individuals. The feeling of ineffectiveness constitutes the major predictor of psychopathological aspects. This is an important result which may inform the development of effective interventions for obese patients and prevention of psychopathological disorders.

A Meta-Analysis of Serious Digital Games for Healthy Lifestyle Promotion

PubMed Central

DeSmet, Ann; Van Ryckeghem, Dimitri; Compernolle, Sofie; Baranowski, Tom; Thompson, Debbe; Crombez, Geert; Poels, Karolien; Van Lippevelde, Wendy; Bastiaensens, Sara; Van Cleemput, Katrien; Vandebosch, Heidi; De Bourdeaudhuij, Ilse

2015-01-01

Several systematic reviews have described health-promoting effects of serious games but so far no meta-analysis has been reported. This paper presents a meta-analysis of 54 serious digital game studies for healthy lifestyle promotion, in which we investigated the overall effectiveness of serious digital games on healthy lifestyle promotion outcomes and the role of theoretically and clinically important moderators. Findings showed serious games have small positive effects on healthy lifestyles (g=0.260, 95% CI 0.148; 0.373) and their determinants (g=0.334, 95% CI 0.260; 0.407), especially for knowledge. Effects on clinical outcomes were significant, but much smaller (g=0.079, 95% CI 0.038; 0.120). Long-term effects were maintained for all outcomes except for behavior. Serious games are best individually tailored to both socio-demographic and change need information, and benefit from a strong focus on game theories or a dual theoretical foundation in both behavioral prediction and game theories. They can be effective either as a stand-alone or multi-component programs, and appeal to populations regardless of age and gender. Given that effects of games remain heterogeneous, further exploration of which game features create larger effects are needed. PMID:25172024

On Internal Validity in Multiple Baseline Designs

ERIC Educational Resources Information Center

Pustejovsky, James E.

2014-01-01

Single-case designs are a class of research designs for evaluating intervention effects on individual cases. The designs are widely applied in certain fields, including special education, school psychology, clinical psychology, social work, and applied behavior analysis. The multiple baseline design (MBD) is the most frequently used single-case…

Self-Handicapping by Task Choice: An Attribute Ambiguity Analysis.

ERIC Educational Resources Information Center

Handelsman, Mitchell M.; And Others

Self-handicapping strategies are behaviors or choices of performance settings which allow people to maintain self-esteem by avoiding negative self-relevant attributions. People will behave in such a way that accurate, nonambiguous attributions about their performance cannot be made. Research on self-handicapping has focused on clinically relevant…

Personality Subtypes among Driving-While-Intoxicated Offenders: Relationship to Drinking Behavior and Driving Risk.

ERIC Educational Resources Information Center

Donovan, Dennis M.; Marlatt, G. Alan

1982-01-01

Investigated the empirical derivation of clinically and theoretically meaningful subtypes among males arrested for driving while intoxicated. Five subtypes were defined through cluster analysis of driving--attitudinal, personality, and hostility measures. Two subtypes were found to have particularly high levels of risk-enhancing traits. (Author)

Heart Rate Variability – a Tool to Differentiate Positive and Negative Affective States in Pigs?

USDA-ARS?s Scientific Manuscript database

The causal neurophysiological processes, such as autonomic nervous system activity, that mediate behavioral and physiological reactivity to an environment have largely been ignored. Heart rate variability (HRV) analysis is a clinical diagnostic tool used to assess affective states (stressful and ple...

Evaluating Acceptance and Commitment Therapy: An Analysis of a Recent Critique

ERIC Educational Resources Information Center

Gaudiano, Brandon A.

2011-01-01

Acceptance and commitment therapy (ACT) is a newer psychotherapy that has generated much clinical and research interest in recent years. However, the approach has begun to receive strong criticism from proponents of traditional cognitive-behavioral therapy (CBT). Hofmann and Asmundson (2008) recently compared and contrasted ACT and traditional…

Evaluating Acceptance and Commitment Therapy: An Analysis of a Recent Critique

ERIC Educational Resources Information Center

Gaudiano, Brandon A.

2009-01-01

Acceptance and commitment therapy (ACT) is a newer psychotherapy that has generated much clinical and research interest in recent years. However, the approach has begun to receive strong criticism from proponents of traditional cognitive-behavioral therapy (CBT). Hofmann and Asmundson (2008) recently compared and contrasted ACT and traditional…

Extrinsic and Intrinsic Help-Seeking Motivation in the Assessment of Cognitive Decline.

PubMed

Haussmann, Robert; Mayer-Pelinski, René; Borchardt, Maike; Beier, Fabrice; Helling, Franziska; Buthut, Maria; Meissner, Gisa; Lange, Jan; Zweiniger, Anne; Donix, Markus

2018-06-01

Diagnostic assessments for dementia include the evaluation of subjective memory impairment, dementia worries, or depressive symptoms. Data on the predictive value of these factors remain unclear, and varying help-seeking behavior may contribute to this finding. We investigate whether differentiating help-seeking motivation from other psychological factors associated with cognitive impairment would enhance the prediction of diagnostic outcomes in a memory clinic. We obtained information on help-seeking motivation from 171 patients who underwent routine diagnostic assessments. Utilizing a discriminant correspondence analysis, our results indicate that extrinsic motivation increases the likelihood of receiving a dementia diagnosis, whereas depression or the duration of deficits carries discriminatory information to further guide the differentiation of prodromal dementia. Recognizing motivational aspects of help-seeking behavior can complement the clinical evaluation of cognitive performance.

Mobile technology boosts the effectiveness of psychotherapy and behavioral interventions: a meta-analysis.

PubMed

Lindhiem, Oliver; Bennett, Charles B; Rosen, Dana; Silk, Jennifer

2015-11-01

We conducted a meta-analysis on the effects of mobile technology on treatment outcome for psychotherapy and other behavioral interventions. Our search of the literature resulted in 26 empirical articles describing 25 clinical trials testing the benefits of smartphone applications, personal digital assistants (PDAs), or text messaging systems either to supplement treatment or substitute for direct contact with a clinician. Overall, mobile technology use was associated with superior treatment outcome across all study designs and control conditions, effect size (ES) = .34, p < .0001. For the subset of 10 studies that looked specifically at the added benefit of mobile technology using a rigorous "Treatment" versus "Treatment + Mobile" design, effect sizes were only slightly more modest (ES = .27) and still significant (p < .05). Overall, the results support the role of mobile technology for the delivery of psychotherapy and other behavioral interventions. © The Author(s) 2015.

Gender differences in nonfatal suicidal behavior in Pakistan: significance of sociocultural factors.

PubMed

Khan, M M; Reza, H

1998-01-01

Suicidal behavior is an understudied subject in Pakistan. A variety of social, legal, and religious factors make reporting and data collection on suicide and nonfatal suicidal behavior difficult. To study the problem, a retrospective case-note analysis was carried out in which the sociodemographic and clinical characteristics of 262 female and 185 male suicidal individuals admitted to a university hospital in Karachi, Pakistan, are compared. Three quarters of the suicidal persons were under the age of 30 years. Compared to men, women were younger and more often married. Both women and men tended to use self-poisoning with benzodiazepines, but more women used organophosphate insecticides. In Pakistani society, legal, social, and economic discrimination predisposes women to psychological distress and subsequent suicidal behavior. The study highlights the need for culture-specific research on suicidal behavior in Pakistan.

Maternal cell phone use during pregnancy and child behavioral problems in five birth cohorts.

PubMed

Birks, Laura; Guxens, Mònica; Papadopoulou, Eleni; Alexander, Jan; Ballester, Ferran; Estarlich, Marisa; Gallastegi, Mara; Ha, Mina; Haugen, Margaretha; Huss, Anke; Kheifets, Leeka; Lim, Hyungryul; Olsen, Jørn; Santa-Marina, Loreto; Sudan, Madhuri; Vermeulen, Roel; Vrijkotte, Tanja; Cardis, Elisabeth; Vrijheid, Martine

2017-07-01

Previous studies have reported associations between prenatal cell phone use and child behavioral problems, but findings have been inconsistent and based on retrospective assessment of cell phone use. This study aimed to assess this association in a multi-national analysis, using data from three cohorts with prospective data on prenatal cell phone use, together with previously published data from two cohorts with retrospectively collected cell phone use data. We used individual participant data from 83,884 mother-child pairs in the five cohorts from Denmark (1996-2002), Korea (2006-2011), the Netherlands (2003-2004), Norway (2004-2008), and Spain (2003-2008). We categorized cell phone use into none, low, medium, and high, based on frequency of calls during pregnancy reported by the mothers. Child behavioral problems (reported by mothers using the Strengths and Difficulties Questionnaire or Child Behavior Checklist) were classified in the borderline/clinical and clinical ranges using validated cut-offs in children aged 5-7years. Cohort specific risk estimates were meta-analyzed. Overall, 38.8% of mothers, mostly from the Danish cohort, reported no cell phone use during pregnancy and these mothers were less likely to have a child with overall behavioral, hyperactivity/inattention or emotional problems. Evidence for a trend of increasing risk of child behavioral problems through the maternal cell phone use categories was observed for hyperactivity/inattention problems (OR for problems in the clinical range: 1.11, 95%CI 1.01, 1.22; 1.28, 95%CI 1.12, 1.48, among children of medium and high users, respectively). This association was fairly consistent across cohorts and between cohorts with retrospectively and prospectively collected cell phone use data. Maternal cell phone use during pregnancy may be associated with an increased risk for behavioral problems, particularly hyperactivity/inattention problems, in the offspring. The interpretation of these results is unclear as uncontrolled confounding may influence both maternal cell phone use and child behavioral problems. Copyright © 2017 Elsevier Ltd. All rights reserved.

Impulsivity profiles in pathological slot machine gamblers.

PubMed

Aragay, Núria; Barrios, Maite; Ramirez-Gendrau, Isabel; Garcia-Caballero, Anna; Garrido, Gemma; Ramos-Grille, Irene; Galindo, Yésika; Martin-Dombrowski, Jonatan; Vallès, Vicenç

2018-05-01

In gambling disorder (GD), impulsivity has been related with severity, treatment outcome and a greater dropout rate. The aim of the study is to obtain an empirical classification of GD patients based on their impulsivity and compare the resulting groups in terms of sociodemographic, clinical and gambling behavior variables. 126 patients with slot machine GD attending the Pathological Gambling Unit between 2013 and 2016 were included. The UPPS-P Impulsive Behavior Scale was used to assess impulsivity, and the severity of past-year gambling behavior was established with the Screen for Gambling problems questionnaire (NODS). Depression and anxiety symptoms and executive function were also assessed. A two-step cluster analysis was carried out to determine impulsivity profiles. According to the UPPS-P data, two clusters were generated. Cluster 1 showed the highest scores on all the UPPS-P subscales, whereas patients from cluster 2 exhibited only high scores on two UPPS-P subscales: Negative Urgency and Lack of premeditation. Additionally, patients on cluster 1 were younger and showed significantly higher scores on the Beck Depression Inventory and on the State-Trait Anxiety Inventory questionnaires, worse emotional regulation and executive functioning, and reported more psychiatric comorbidity compared to patients in cluster 2. With regard to gambling behavior, cluster 1 patients had significantly higher NODS scores and a higher percentage presented active gambling behavior at treatment start than in cluster 2. We found two impulsivity subtypes of slot machine gamblers. Patients with high impulsivity showed more severe gambling behavior, more clinical psychopathology and worse emotional regulation and executive functioning than those with lower levels of impulsivity. These two different clinical profiles may require different therapeutic approaches. Copyright © 2018 Elsevier Inc. All rights reserved.

An Etiological Approach to Sexual Offender Assessment: CAse Formulation Incorporating Risk Assessment (CAFIRA).

PubMed

Craig, Leam A; Rettenberger, Martin

2018-05-19

Case formulations (CF) have been the cornerstone of effective practice in clinical psychology since the 1950s and now form one of the core competencies in clinical and forensic assessment. The use of CFs within forensic settings is becoming more relevant when working with offenders who have experienced significant trauma, suffered from personality disorder, and have displayed sexually abusive behavior. Furthermore, most North American and European jurisdictions insist that expert witnesses adopt an idiosyncratic approach to risk assessment and consider the characteristics of the individual as part of a wider formulation of the problem behavior. This article focuses specifically on CF incorporating risk assessment procedures of sexual offenders. While empirical support for the use of risk analysis and formulation in managing offending behavior generally, and sexual offending behavior in particular, is limited, there is mounting evidence to suggest that CF can improve understanding of an individual's problem sexual behaviors. We argue that by integrating risk formulations into the CF provides a conceptually robust link between the etiologically development of the problem sexual behavior and effective assessment and risk management of sexual offenders. As forensic treatment programs increasingly moved toward strength-based approaches, in keeping with the Risk-Need-Responsivity principles Andrews and Bonta (2004), and the Good Lives Model Ward and Stewart (Prof Psychol Res Pract 34:353-60, 2003) of offender rehabilitation, the use of CFs in the assessment, treatment, and management of sexual offenders is indispensable. We present an etiological framework for understanding risk in an individual sexual offender by integrating a case formulation model to include the use of (static, stable, and acute) actuarial and clinical risk assessment measures as well as protective risk factors, referred to as the CAse Formulation Incorporating Risk Assessment (CAFIRA) model.

Behavioral medicine and clinical health psychology: introduction to the special issue.

PubMed

Christensen, Alan J; Nezu, Arthur M

2013-04-01

This issue represents the 4th Journal of Consulting and Clinical Psychology special issue on behavioral medicine and clinical health psychology over the past 4 decades. Recent developments in health care policy, as well as in the maturation of the science, make a special issue in this area particularly timely. This collection includes state of the clinical science reviews, reports of clinical trials, and articles addressing theory and methods in behavioral medicine and clinical health psychology. A multilevel, ecological perspective that considers multiple levels of influences (e.g., cultural influences on behavior-health linkages, individual differences) is salient throughout many of the articles. Our hope is that this sampling of this broad field, and coverage of some key issues and areas, will play a role in stimulating the next 10 years of research, practice, and policy implementation in behavioral medicine and clinical health psychology.

[Renal hematoma after extracorporeal shockwave lithotripsy in a series of 324 consecutive sessions with the DOLI-S lithotripter: incidents, characteristrics, multifactorial analysis and review].

PubMed

Orozco Fariñas, Rodolfo; Iglesias Prieto, José Ignacio; Massarrah Halabi, Jorge; Mancebo Gómez, José M; Perez-Castro Ellendt, Enrique

2008-10-01

The objective is to know the prevalence of renal hematoma after lithotripsy in our unit, as well as the incidence of symptomatic and/or progressive hematomas, their clinical behavior and management, and also the factors potentially influencing those features. A prospective study in which we analyzed various parameters from the database on 314 patients undergoing SWL on 324 renal units. SPSS 15.01 was employed for statistical analysis under supervision of biostatistics experts. The diagnosis of hematoma was obtained with clinical data (history and physical examination), blood analysis, and ultrasound, this latter with the complement of CT scan in isolated cases. All patients underwent follow-up by means of phone contacts over a period between 7-19 months after lithotripsy. The prevalence of hematoma was 13% but only 6.2% were symptomatic. Accumulated incidence of hematoma with progressive evolution was 2.16%, and blood transfusion requirement due to hematoma was 0.92% of all lithotripsies, which represents 7.14% or them. Factors statistically associated with the incidence of hematoma were: number of shock waves (over 2300), total energy (above 150J), number of KV (above 17.5), preoperative microhematuria, perioperative hypertension, cystine lithiasis, hydrocalyx, caliceal localizations (mainly lower calyces), the association of coronary artery disease with hypertension, or hepatic diseases, chronic hepatopathy, elevation of transaminases, usual intake of anti platelet aggregation drugs and nonsteroidal anti-inflammatory drugs (mainly with prior low-weight heparin treatment for hematoma progression), and a combination of the previous with preoperative hypertension (for symptomatic hematoma), as well as the presence of multiple stones treated in the some session, with different degrees of association for the various subgroups of hematomas. We observed differences in clinical behavior depending on the type of hematoma (subcapsular and perirenal) and 12% of the patients with hematoma remained symptomatic between 2 and six months later. Renal hematoma after shock wave lithotripsy is more frequent than what is believed. Hematoma's size and evolution depend on multiple factors some of them with a greater weight (hepatopathy, perioperative blood pressure behavior, usual intake of anti-aggregation drugs with need of perioperative low weight heparin) which a greater risk when three or more factors concurred. Subcapsular and perirenal hematomas have a different clinical behavior. Initial ultrasound hematoma diameters equal 24 cm were more prone to progression. The risk of symptomatic clinical presentation or progression was evident within the first five days after shockwave lithotripsy even when asymptomatic or clinically/radiologically stable over the first 24 hours, therefore, careful follow-up and physical resting is counselled over the first week in patients with high risk, and relative physical resting during at least five days in all patients undergoing treatment. Lumbar pain may persist up to six months in some patients with renal clinically significant hematoma after shockwave lithotripsy.

Influence of the medication environment on the unsafe medication behavior of nurses: A path analysis.

PubMed

Yu, Xi; Li, Ce; Gao, Xueqin; Liu, Furong; Lin, Ping

2018-04-20

To explore the relationship between the medication environment and the unsafe medication behavior of nurses and to analyze its influence path. Unsafe medication behavior is the direct cause of medication error. The organizational environment is the foundation of and plays a guiding role in work behavior. Whether the medication environment correlates with the unsafe medication behavior of nurses remains unclear. This study used a correlative design with self-administered questionnaires, and the SHEL model, an acronym of its elements of software, hardware, environment, and liveware, was used as the framework for the medication environment. A survey was conducted among 1012 clinical nurses from five tertiary hospitals in China using the nurse unsafe medication behavior scale (NUMBS) and the nurses' perceptions of the medication environment scale (NPMES). Data were collected from January to February 2017. Path analyses were used to examine the hypothesized model. The medication environment correlated negatively with unsafe medication behavior (r=-0.48, p<0.001). The path analysis showed that software, liveware and nurses' personal factors directly affected unsafe medication behavior. Software, hardware and the environment indirectly influenced unsafe medication behavior, and nurses' personal factors played a mediating role in the relationships of unsafe medication behavior with software, hardware, and the environment. The unsafe medication behavior of nurses should be further improved. The medication environment was a predictor of unsafe medication behavior. Care managers should actively improve the medication environment to reduce the incidence of unsafe medication behaviors. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Subtypes of female juvenile offenders: a cluster analysis of the Millon Adolescent Clinical Inventory.

PubMed

Stefurak, Tres; Calhoun, Georgia B

2007-01-01

The current study sought to explore subtypes of adolescents within a sample of female juvenile offenders. Using the Millon Adolescent Clinical Inventory with 101 female juvenile offenders, a two-step cluster analysis was performed beginning with a Ward's method hierarchical cluster analysis followed by a K-Means iterative partitioning cluster analysis. The results suggest an optimal three-cluster solution, with cluster profiles leading to the following group labels: Externalizing Problems, Depressed/Interpersonally Ambivalent, and Anxious Prosocial. Analysis along the factors of age, race, offense typology and offense chronicity were conducted to further understand the nature of found clusters. Only the effect for race was significant with the Anxious Prosocial and Depressed Intepersonally Ambivalent clusters appearing disproportionately comprised of African American girls. To establish external validity, clusters were compared across scales of the Behavioral Assessment System for Children - Self Report of Personality, and corroborative distinctions between clusters were found here.

The 7q11.23 Microduplication Syndrome: A Clinical Report with Review of Literature

PubMed Central

Abbas, Elham; Cox, Devin M.; Smith, Teri; Butler, Merlin G.

2016-01-01

We report a 14-year-old adolescent girl with selective mutism (SM) and a 7q11.23 microduplication detected by chromosomal microarray (CMA) analysis and reviewed the literature from 18 published clinical reports. Our patient had specific phobias, SM, extreme anxiety, obesity, cutis marmorata, and a round appearing face with a short neck and over folded ears. We reviewed the published clinical, cognitive, behavioral, and cytogenetic findings grouped by speech and language delay, growth and development, craniofacial, clinical, and behavior and cognitive features due to the 7q11.23 microduplication. This microduplication syndrome is characterized by speech delay (91%), social anxiety (42%), attention deficit hyperactivity disorder (ADHD, 37%), autism spectrum disorder (29%), and separation anxiety (13%). Other findings include abnormal brain imaging (80%), congenital heart and vascular defects (54%), and mild intellectual disability (38%). We then compared the phenotype with Williams–Beuren syndrome (WBS) which is due to a deletion of the same chromosome region. Both syndromes have abnormal brain imaging, hypotonia, delayed motor development, joint laxity, mild intellectual disability, ADHD, autism, and poor visuospatial skills but opposite or dissimilar findings regarding speech and behavioral patterns, cardiovascular problems, and social interaction. Those with WBS are prone to have hyperverbal speech, lack of stranger anxiety, and supravalvular aortic stenosis while those with the 7q11.23 microduplication have speech delay, SM, social anxiety, and are prone to aortic dilatation. PMID:27617154

The 7q11.23 Microduplication Syndrome: A Clinical Report with Review of Literature.

PubMed

Abbas, Elham; Cox, Devin M; Smith, Teri; Butler, Merlin G

2016-09-01

We report a 14-year-old adolescent girl with selective mutism (SM) and a 7q11.23 microduplication detected by chromosomal microarray (CMA) analysis and reviewed the literature from 18 published clinical reports. Our patient had specific phobias, SM, extreme anxiety, obesity, cutis marmorata, and a round appearing face with a short neck and over folded ears. We reviewed the published clinical, cognitive, behavioral, and cytogenetic findings grouped by speech and language delay, growth and development, craniofacial, clinical, and behavior and cognitive features due to the 7q11.23 microduplication. This microduplication syndrome is characterized by speech delay (91%), social anxiety (42%), attention deficit hyperactivity disorder (ADHD, 37%), autism spectrum disorder (29%), and separation anxiety (13%). Other findings include abnormal brain imaging (80%), congenital heart and vascular defects (54%), and mild intellectual disability (38%). We then compared the phenotype with Williams-Beuren syndrome (WBS) which is due to a deletion of the same chromosome region. Both syndromes have abnormal brain imaging, hypotonia, delayed motor development, joint laxity, mild intellectual disability, ADHD, autism, and poor visuospatial skills but opposite or dissimilar findings regarding speech and behavioral patterns, cardiovascular problems, and social interaction. Those with WBS are prone to have hyperverbal speech, lack of stranger anxiety, and supravalvular aortic stenosis while those with the 7q11.23 microduplication have speech delay, SM, social anxiety, and are prone to aortic dilatation.

Adolescent Maturation of Dopamine D1 and D2 Receptor Function and Interactions in Rodents

PubMed Central

Dwyer, Jennifer B.; Leslie, Frances M.

2016-01-01

Adolescence is a developmental period characterized by heightened vulnerability to illicit drug use and the onset of neuropsychiatric disorders. These clinical phenomena likely share common neurobiological substrates, as mesocorticolimbic dopamine systems actively mature during this period. Whereas prior studies have examined age-dependent changes in dopamine receptor binding, there have been fewer functional analyses. The aim of the present study was therefore to determine whether the functional consequences of D1 and D2-like activation are age-dependent. Adolescent and adult rats were given direct D1 and D2 agonists, alone and in combination. Locomotor and stereotypic behaviors were measured, and brains were collected for analysis of mRNA expression for the immediate early genes (IEGs), cfos and arc. Adolescents showed enhanced D2-like receptor control of locomotor and repetitive behaviors, which transitioned to dominant D1-like mechanisms in adulthood. When low doses of agonists were co-administered, adults showed supra-additive behavioral responses to D1/D2 combinations, whereas adolescents did not, which may suggest age differences in D1/D2 synergy. D1/D2-stimulated IEG expression was particularly prominent in the bed nucleus of the stria terminalis (BNST). Given the BNST’s function as an integrator of corticostriatal, hippocampal, and stress-related circuitry, and the importance of neural network dynamics in producing behavior, an exploratory functional network analysis of regional IEG expression was performed. This data-driven analysis demonstrated similar developmental trajectories as those described in humans and suggested that dopaminergic drugs alter forebrain coordinated gene expression age dependently. D1/D2 recruitment of stress nuclei into functional networks was associated with low behavioral output in adolescents. Network analysis presents a novel tool to assess pharmacological action, and highlights critical developmental changes in functional neural circuitry. Immature D1/D2 interactions in adolescents may underlie their unique responses to drugs of abuse and vulnerability to psychopathology. These data highlight the need for age-specific pharmacotherapy design and clinical application in adolescence. PMID:26784516

Getting Inside the Expert's Head: An Analysis of Physician Cognitive Processes During Trauma Resuscitations.

PubMed

White, Matthew R; Braund, Heather; Howes, Daniel; Egan, Rylan; Gegenfurtner, Andreas; van Merrienboer, Jeroen J G; Szulewski, Adam

2018-04-23

Crisis resource management skills are integral to leading the resuscitation of a critically ill patient. Despite their importance, crisis resource management skills (and their associated cognitive processes) have traditionally been difficult to study in the real world. The objective of this study was to derive key cognitive processes underpinning expert performance in resuscitation medicine, using a new eye-tracking-based video capture method during clinical cases. During an 18-month period, a sample of 10 trauma resuscitations led by 4 expert trauma team leaders was analyzed. The physician team leaders were outfitted with mobile eye-tracking glasses for each case. After each resuscitation, participants were debriefed with a modified cognitive task analysis, based on a cued-recall protocol, augmented by viewing their own first-person perspective eye-tracking video from the clinical encounter. Eye-tracking technology was successfully applied as a tool to aid in the qualitative analysis of expert performance in a clinical setting. All participants stated that using these methods helped uncover previously unconscious aspects of their cognition. Overall, 5 major themes were derived from the interviews: logistic awareness, managing uncertainty, visual fixation behaviors, selective attendance to information, and anticipatory behaviors. The novel approach of cognitive task analysis augmented by eye tracking allowed the derivation of 5 unique cognitive processes underpinning expert performance in leading a resuscitation. An understanding of these cognitive processes has the potential to enhance educational methods and to create new assessment modalities of these previously tacit aspects of expertise in this field. Copyright © 2018 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

What is hypomania? Tetrachoric factor analysis and kernel estimation of DSM-IV hypomanic symptoms.

PubMed

Benazzi, Franco

2009-11-01

The DSM-IV definition of hypomania, which relies on clinical consensus and historical tradition, includes several "nonspecific" symptoms. The aim of this study was to identify the core symptoms of DSM-IV hypomania. In an outpatient private practice, 266 bipolar II disorder (BP-II) and 138 major depressive disorder (MDD) remitted patients were interviewed by a bipolar-trained psychiatrist, for different study goals. Patients were questioned, using the Structured Clinical Interview for DSM-IV, about the most common symptoms and duration of recent threshold and subthreshold hypomanic episodes. Data were recorded between 2002 and 2006. Four different samples, assessed with the same methodology, were pooled for the present analyses. Tetrachoric factor analysis was used to identify core hypomanic symptoms. Distribution of symptoms by kernel estimation was inspected for bimodality. Validity of core hypomania was tested by receiver operating characteristic (ROC) analysis. The distribution of subthreshold and threshold hypomanic episodes did not show bimodality. Tetrachoric factor analysis found 2 uncorrelated factors: factor 1 included the "classic" symptoms elevated mood, inflated self-esteem, decreased need for sleep, talkativeness, and increase in goal-directed activity (overactivity); factor 2 included the "nonspecific" symptoms irritable mood, racing/crowded thoughts, and distractibility. Factor 1 discriminatory accuracy for distinguishing BP-II versus MDD was high (ROC area = 0.94). The distribution of the 5-symptom episodes of factor 1 showed clear-cut bimodality. Similar results were found for episodes limited to 3 behavioral symptoms of factor 1 (decreased need for sleep, talkativeness, and overactivity) and 4 behavioral symptoms of factor 1 (adding elevated mood), with high discriminatory accuracy. A core, categorical DSM-IV hypomania was found that included 3 to 5 symptoms, ie, behavioral symptoms and elevated mood. Behavioral symptoms (overactivity domain) could be the basic phenotype of hypomania. This finding could help in probing for hypomania and reduce misdiagnosis. Biologic research could focus more on the underpinnings of the overactivity domain specifically. Copyright 2009 Physicians Postgraduate Press, Inc.

An exploration of how Mexican American WIC mothers obtain information about behaviors associated with childhood obesity risk

PubMed Central

Cole, Suzanne M.; McKenney-Shubert, Shannon J.; Jones, Sonya J.; Peterson, Karen E.

2016-01-01

Objective To explore how a sample of Mexican American mothers with preschool-aged children recruited from a Midwestern WIC clinic obtain information about 4 behaviors associated with childhood obesity risk: eating, physical activity, screen time and sleep. Methods One-on-1, structured interviews, in which participants were asked how they communicated with family, learned to take care of their first infant and obtained information about the 4 targeted behaviors for their preschool-aged child. Setting An urban WIC clinic in the Midwest. Participants Forty Mexican-descent WIC mothers with children ages 3–4. Phenomenon of Interest Exposure to information about the 4 targeted behaviors among Mexican-descent mothers participating in WIC. Analysis Quantitative and qualitative data were used to characterize and compare across participants. Results Participants primarily obtained information from their child’s maternal grandmother during their first child’s infancy and from health professionals for their preschool-aged child. Participants typically obtained information through interpersonal communication, television and magazines. Participants were most interested in healthy eating information and least interested in screen time information. Some participants did not seek information. Conclusions Participants engaged in different patterns of information seeking across their child’s development and the 4 behaviors, suggesting that future research should be behaviorally specific. Findings from this study suggest several hypotheses to test in future research. PMID:27876321

Comparative analysis of torsional and bending behavior through finite-element models of 5 Ni-Ti endodontic instruments.

PubMed

Arbab-Chirani, Reza; Chevalier, Valérie; Arbab-Chirani, Shabnam; Calloch, Sylvain

2011-01-01

The objectives of this study were to compare numerically the bending and torsional mechanical behavior of 5 endodontic rotary Ni-Ti instruments with equivalent size and various designs for tapers, pitch, and cutting blades.First, the geometries of Hero (20/0.06), HeroShaper (20/0.06), ProFile (20/0.06), Mtwo (20/0.06), and ProTaper F1 were generated by finite element code. Then, the 2 most representative clinical loadings, i.e., bending and torsion, were studied with an ad hoc model for the superelasticity of Ni-Ti. Bending was generated by tip deflection and torsion by a constant twist-angle of the tip. Mechanical behavior of these 5 endodontic rotary Ni-Ti instruments could be evaluated and compared. Protaper F1 presented the greatest level of bending stress and torque. Hero and HeroShaper were more rigid than ProFile and Mtwo. This numerical comparison evaluated the effects of the geometrical parameters on the instrumental mechanical behavior. The 5 endodontic instruments, investigated in the present study, do not have the same bending and torsional mechanical behavior. Each clinician must be aware of these behavior differences so as to use the adequate file according to the clinical situation and to the manufacturer's recommendations. Copyright © 2011 Mosby, Inc. All rights reserved.

Deployment-Related Psychiatric and Behavioral Conditions and Their Association with Functional Disability in OEF/OIF/OND Veterans

PubMed Central

Lippa, Sara M.; Fonda, Jennifer R.; Fortier, Catherine B.; Amick, Melissa A.; Kenna, Alexandra; Milberg, William P.; McGlinchey, Regina E.

2017-01-01

Understanding the factors that influence veterans’ functional outcome after deployment is critical to provide appropriately targeted care. Mild traumatic brain injury (mTBI) and posttraumatic stress disorder (PTSD) have been related to disability, but other psychiatric and behavioral conditions are not as well examined. We investigated the impact of deployment-related psychiatric and behavioral conditions on disability among 255 OEF/OIF/OND service members and veterans. Structured clinical interviews assessed TBI and the psychiatric conditions of depression, PTSD, anxiety, and substance use. Self-report questionnaires assessed disability and the behavioral conditions of sleep disturbance and pain. Over 90% of participants had a psychiatric and/or behavioral condition, with approximately half presenting with ≥ 3 conditions. Exploratory factor analysis revealed 4 clinically relevant psychiatric and behavioral factors which accounted for 76.9% of the variance: (a) depression, PTSD, and military mTBI (deployment trauma factor); (b) pain and sleep (somatic factor); (c) anxiety disorders, other than PTSD (anxiety factor); and (d) substance abuse or dependence (substance use factor). Individuals with the conditions comprising the deployment trauma factor were more likely to be substantially disabled than individuals with depression and PTSD, but no military mTBI, OR = 3.52; 95% CI [1.09, 11.37]. Depression, PTSD, and a history of military mTBI may comprise an especially harmful combination associated with high risk for substantial disability. PMID:25703936

An expanded framework to define and measure shared decision-making in dialogue: A 'top-down' and 'bottom-up' approach.

PubMed

Callon, Wynne; Beach, Mary Catherine; Links, Anne R; Wasserman, Carly; Boss, Emily F

2018-03-11

We aimed to develop a comprehensive, descriptive framework to measure shared decision making (SDM) in clinical encounters. We combined a top-down (theoretical) approach with a bottom-up approach based on audio-recorded dialogue to identify all communication processes related to decision making. We coded 55 pediatric otolaryngology visits using the framework and report interrater reliability. We identified 14 clinician behaviors and 5 patient behaviors that have not been previously described, and developed a new SDM framework that is descriptive (what does happen) rather than normative (what should happen). Through the bottom-up approach we identified three broad domains not present in other SDM frameworks: socioemotional support, understandability of clinician dialogue, and recommendation-giving. We also specify the ways in which decision-making roles are assumed implicitly rather than discussed explicitly. Interrater reliability was >75% for 92% of the coded behaviors. This SDM framework allows for a more expansive understanding and analysis of how decision making takes place in clinical encounters, including new domains and behaviors not present in existing measures. We hope that this new framework will bring attention to a broader conception of SDM and allow researchers to further explore the new domains and behaviors identified. Copyright © 2018. Published by Elsevier B.V.

Firefighter hearing health: an informatics approach to screening, measurement, and research.

PubMed

Hong, OiSaeng; Monsen, Karen A; Kerr, Madeleine J; Chin, Dal Lae; Lytton, Amy B; Martin, Karen S

2012-10-01

The purpose of this study was to evaluate the use of a standardized interface terminology, the Omaha System, with respect to noise-induced hearing loss (NIHL). A descriptive, correlational design was employed for this secondary analysis with the data from an ongoing hearing protection intervention study. A total of 346 firefighters were included. First, an evidence-based standardized care plan (EB-SCP) for hearing screening was developed and validated by clinical experts. Second, occupational health records were used to compute Omaha System Knowledge, Behavior, and Status outcomes. Third, research data were mapped to Omaha System rating scales. For Knowledge, the mean score was close to 'adequate' (3.7). For Behavior, the mean score was close to 'rarely appropriate' (2.2). For Status, the mean score was close to 'minimal sign/symptom' (4.4). Significant positive relationships were found between Knowledge and Behavior (Spearman's rho =.13, p =.01), and between Behavior and hearing Status (Spearman's rho =.12, p =.02). Findings support the validity of the new Knowledge, Behavior, and hearing Status. Informatics methods such as the standardized NIHL EB-SCP and outcome data sets will create opportunities for clinical decision support and data exchange across various health care settings, thus supporting population-based hearing health assessments and outcomes.

Determining Smoking Cessation Related Information, Motivation, and Behavioral Skills among Opiate Dependent Smokers in Methadone Treatment.

PubMed

Cooperman, Nina A; Richter, Kimber P; Bernstein, Steven L; Steinberg, Marc L; Williams, Jill M

2015-04-01

Over 80% of people in methadone treatment smoke cigarettes, and existing smoking cessation interventions have been minimally effective. To develop an Information-Motivation-Behavioral Skills (IMB) Model of behavior change based smoking cessation intervention for methadone maintained smokers, we examined smoking cessation related IMB factors in this population. Current or former smokers in methadone treatment (n = 35) participated in focus groups. Ten methadone clinic counselors participated in an individual interview. A content analysis was conducted using deductive and inductive approaches. Commonly known IMB factors related to smoking cessation were described. These factors included: the health effects of smoking and treatment options for quitting (information); pregnancy and cost of cigarettes (motivators); and coping with emotions, finding social support, and pharmacotherapy adherence (behavioral skills). IMB factors specific to methadone maintained smokers were also described. These factors included: the relationship between quitting smoking and drug relapse (information), the belief that smoking is the same as using drugs (motivator); and coping with methadone clinic culture and applying skills used to quit drugs to quitting smoking (behavioral skills). IMB strengths and deficits varied by individual. Methadone maintained smokers could benefit from research on an IMB Model based smoking cessation intervention that is individualized, addresses IMB factors common among all smokers, and also addresses IMB factors unique to this population.

Prevalence and characteristics of addictive behaviors in a community sample: A latent class analysis.

PubMed

Deleuze, Jory; Rochat, Lucien; Romo, Lucia; Van der Linden, Martial; Achab, Sophia; Thorens, Gabriel; Khazaal, Yasser; Zullino, Daniele; Maurage, Pierre; Rothen, Stéphane; Billieux, Joël

2015-06-01

While addictions to substances such as alcohol, tobacco, and other drugs have been extensively investigated, interest has been growing in potential non-substance-related addictive behaviors (e.g., excessive gambling, buying or playing video games). In the current study, we sought to determine the prevalence and characteristics of a wide range of addictive behaviors in a general population sample and to identify reliable subgroups of individuals displaying addictive behaviors. Seven hundred seventy participants completed an online survey. The survey screened for the presence and characteristics of the main recognized substance and behavioral addictions (alcohol, tobacco, cannabis, other drugs, gambling, compulsive shopping, intensive exercise, Internet and mobile phone overuse, intensive work involvement, and overeating) in a three-month period. Key aspects of addiction were measured for each reported behavior, including negative outcomes, emotional triggers (positive and negative emotional contexts), search for stimulation or pleasure, loss of control, and cognitive salience. Latent class analysis allowed us to identify three theoretically and clinically relevant subgroups of individuals. The first class groups problematic users, i.e., addiction-prone individuals. The second class groups at-risk users who frequently engage in potentially addictive behaviors to regulate emotional states (especially overinvolvement in common behaviors such as eating, working, or buying). The third class groups individuals who are not prone to addictive behaviors. The existence of different groups in the population sheds new light on the distinction between problematic and non-problematic addiction-like behaviors.

Clinical processes in behavioral couples therapy.

PubMed

Fischer, Daniel J; Fink, Brandi C

2014-03-01

Behavioral couples therapy is a broad term for couples therapies that use behavioral techniques based on principles of operant conditioning, such as reinforcement. Behavioral shaping and rehearsal and acceptance are clinical processes found across contemporary behavioral couples therapies. These clinical processes are useful for assessment and case formulation, as well as teaching couples new methods of conflict resolution. Although these clinical processes assist therapists in achieving efficient and effective therapeutic change with distressed couples by rapidly stemming couples' corrosive affective exchanges, they also address the thoughts, emotions, and issues of trust and intimacy that are important aspects of the human experience in the context of a couple. Vignettes are provided to illustrate the clinical processes described. (PsycINFO Database Record (c) 2014 APA, all rights reserved).

Delayed reward discounting and addictive behavior: a meta-analysis.

PubMed

MacKillop, James; Amlung, Michael T; Few, Lauren R; Ray, Lara A; Sweet, Lawrence H; Munafò, Marcus R

2011-08-01

Delayed reward discounting (DRD) is a behavioral economic index of impulsivity and numerous studies have examined DRD in relation to addictive behavior. To synthesize the findings across the literature, the current review is a meta-analysis of studies comparing DRD between criterion groups exhibiting addictive behavior and control groups. The meta-analysis sought to characterize the overall patterns of findings, systematic variability by sample and study type, and possible small study (publication) bias. Literature reviews identified 310 candidate articles from which 46 studies reporting 64 comparisons were identified (total N=56,013). From the total comparisons identified, a small magnitude effect was evident (d= .15; p< .00001) with very high heterogeneity of effect size. Based on systematic observed differences, large studies assessing DRD with a small number of self-report items were removed and an analysis of 57 comparisons (n=3,329) using equivalent methods and exhibiting acceptable heterogeneity revealed a medium magnitude effect (d= .58; p< .00001). Further analyses revealed significantly larger effect sizes for studies using clinical samples (d= .61) compared with studies using nonclinical samples (d=.45). Indices of small study bias among the various comparisons suggested varying levels of influence by unpublished findings, ranging from minimal to moderate. These results provide strong evidence of greater DRD in individuals exhibiting addictive behavior in general and particularly in individuals who meet criteria for an addictive disorder. Implications for the assessment of DRD and research priorities are discussed.

Delayed reward discounting and addictive behavior: a meta-analysis

PubMed Central

Amlung, Michael T.; Few, Lauren R.; Ray, Lara A.; Sweet, Lawrence H.; Munafò, Marcus R.

2011-01-01

Rationale Delayed reward discounting (DRD) is a behavioral economic index of impulsivity and numerous studies have examined DRD in relation to addictive behavior. To synthesize the findings across the literature, the current review is a meta-analysis of studies comparing DRD between criterion groups exhibiting addictive behavior and control groups. Objectives The meta-analysis sought to characterize the overall patterns of findings, systematic variability by sample and study type, and possible small study (publication) bias. Methods Literature reviews identified 310 candidate articles from which 46 studies reporting 64 comparisons were identified (total N=56,013). Results From the total comparisons identified, a small magnitude effect was evident (d=.15; p<.00001) with very high heterogeneity of effect size. Based on systematic observed differences, large studies assessing DRD with a small number of self-report items were removed and an analysis of 57 comparisons (n=3,329) using equivalent methods and exhibiting acceptable heterogeneity revealed a medium magnitude effect (d=.58; p<.00001). Further analyses revealed significantly larger effect sizes for studies using clinical samples (d=.61) compared with studies using nonclinical samples (d=.45). Indices of small study bias among the various comparisons suggested varying levels of influence by unpublished findings, ranging from minimal to moderate. Conclusions These results provide strong evidence of greater DRD in individuals exhibiting addictive behavior in general and particularly in individuals who meet criteria for an addictive disorder. Implications for the assessment of DRD and research priorities are discussed. PMID:21373791

Psychometric characteristics of the BRIEF scale for the assessment of executive functions in Spanish clinical population.

PubMed

García Fernández, Trinidad; González-Pienda, Julio Antonio; Rodríguez Pérez, Celestino; Álvarez García, David; Álvarez Pérez, Luis

2014-01-01

The Behavior Rating Inventory of Executive Functions (BRIEF) scale, completed by families, is widely known in the assessment of executive functions in children and adolescents. However, its application is limited to English-speaking population. This study analyzes the preliminary results from its application in a Spanish clinical sample, comprising 125 participants aged 5-18 years. Internal structure and reliability of the translated scale were analyzed, as well as its relationship with other behavioral measures through the analysis of their correlations with the Assessment of Attention Deficit Hyperactivity Disorder Scale (EDAH). The results were compared with those from the original validation study. The data revealed the presence of the same internal structure, as well as acceptable internal consistency and significant correlations with the Attention Deficit and Hyperactivity components of the EDAH scale. This study provides preliminary evidence of the utility of the BRIEF scale in cultural contexts different from the original, particularly in Spanish clinical population.

Measuring the individual benefit of a medical or behavioral treatment using generalized linear mixed-effects models.

PubMed

Diaz, Francisco J

2016-10-15

We propose statistical definitions of the individual benefit of a medical or behavioral treatment and of the severity of a chronic illness. These definitions are used to develop a graphical method that can be used by statisticians and clinicians in the data analysis of clinical trials from the perspective of personalized medicine. The method focuses on assessing and comparing individual effects of treatments rather than average effects and can be used with continuous and discrete responses, including dichotomous and count responses. The method is based on new developments in generalized linear mixed-effects models, which are introduced in this article. To illustrate, analyses of data from the Sequenced Treatment Alternatives to Relieve Depression clinical trial of sequences of treatments for depression and data from a clinical trial of respiratory treatments are presented. The estimation of individual benefits is also explained. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Latent class analysis of eating and impulsive behavioral symptoms in Taiwanese women with bulimia nervosa.

PubMed

Tseng, Mei-Chih Meg; Hu, Fu-Chang

2012-01-01

The implications of impulsivity in its relationship with binge-eating or purging behaviors remain unclear. This study examined the patterns of eating behaviors and co-morbid impulsive behaviors in individuals with bulimia nervosa n optimally homogeneous classes using latent class analysis (LCA). All participants (n=180) were asked to complete a series of self-reported inventories of impulsive behaviors and other psychological measures. Information regarding the lifetime presence of symptoms of eating disorder was assessed by clinical interviews. LCA was conducted using eating disorder symptoms, impulsive behaviors, and the number of purging methods. Three latent classes of bulimic women were identified. These were women who exhibited relatively higher rates of purging, symptoms of impulsive behavior, and multiple purging methods (17.8%), women who used no more than one purging method with a low occurrence of impulsive behavior (41.7%), and women who showed higher rates of purging behaviors and the use of multiple purging methods with a low rate of impulsive behavior (41.7%). The impulsive sub-group had comparable severity of eating-related measures, frequency of binge-eating, and higher levels of general psychopathology than that of the other two sub-groups. This study provides empirical support for the existence of an impulsive subgroup with distinctive features among a non-Western group of BN patients. This study also suggests that mechanisms other than impulse dysregulation may exist for the development of binge-eating and purging behaviors in bulimia nervosa patients, or the mechanisms contributing to binge-eating and impulsive behaviors may be different. Copyright © 2011 Elsevier Inc. All rights reserved.

Relations between Behavioral Inhibition, Big Five Personality Factors, and Anxiety Disorder Symptoms in Non-Clinical and Clinically Anxious Children

ERIC Educational Resources Information Center

Vreeke, Leonie J.; Muris, Peter

2012-01-01

This study examined the relations between behavioral inhibition, Big Five personality traits, and anxiety disorder symptoms in non-clinical children (n = 147) and clinically anxious children (n = 45) aged 6-13 years. Parents completed the Behavioral Inhibition Questionnaire-Short Form, the Big Five Questionnaire for Children, and the Screen for…

HIV-related sexual risk behavior among African American adolescent girls.

PubMed

Danielson, Carla Kmett; Walsh, Kate; McCauley, Jenna; Ruggiero, Kenneth J; Brown, Jennifer L; Sales, Jessica M; Rose, Eve; Wingood, Gina M; Diclemente, Ralph J

2014-05-01

Latent class analysis (LCA) is a useful statistical tool that can be used to enhance understanding of how various patterns of combined sexual behavior risk factors may confer differential levels of HIV infection risk and to identify subtypes among African American adolescent girls. Data for this analysis is derived from baseline assessments completed prior to randomization in an HIV prevention trial. Participants were African American girls (n=701) aged 14-20 years presenting to sexual health clinics. Girls completed an audio computer-assisted self-interview, which assessed a range of variables regarding sexual history and current and past sexual behavior. Two latent classes were identified with the probability statistics for the two groups in this model being 0.89 and 0.88, respectively. In the final multivariate model, class 1 (the "higher risk" group; n=331) was distinguished by a higher likelihood of >5 lifetime sexual partners, having sex while high on alcohol/drugs, less frequent condom use, and history of sexually transmitted diseases (STDs), when compared with class 2 (the "lower risk" group; n=370). The derived model correctly classified 85.3% of participants into the two groups and accounted for 71% of the variance in the latent HIV-related sexual behavior risk variable. The higher risk class also had worse scores on all hypothesized correlates (e.g., self-esteem, history of sexual assault or physical abuse) relative to the lower risk class. Sexual health clinics represent a unique point of access for HIV-related sexual risk behavior intervention delivery by capitalizing on contact with adolescent girls when they present for services. Four empirically supported risk factors differentiated higher versus lower HIV risk. Replication of these findings is warranted and may offer an empirical basis for parsimonious screening recommendations for girls presenting for sexual healthcare services.

Reduced short interval cortical inhibition correlates with atomoxetine response in children with attention-deficit hyperactivity disorder (ADHD).

PubMed

Chen, Tina H; Wu, Steve W; Welge, Jeffrey A; Dixon, Stephan G; Shahana, Nasrin; Huddleston, David A; Sarvis, Adam R; Sallee, Floyd R; Gilbert, Donald L

2014-12-01

Clinical trials in children with attention-deficit hyperactivity disorder (ADHD) show variability in behavioral responses to the selective norepinephrine reuptake inhibitor atomoxetine. The objective of this study was to determine whether transcranial magnetic stimulation-evoked short interval cortical inhibition might be a biomarker predicting, or correlating with, clinical atomoxetine response. At baseline and after 4 weeks of atomoxetine treatment in 7- to 12-year-old children with ADHD, transcranial magnetic stimulation short interval cortical inhibition was measured, blinded to clinical improvement. Primary analysis was by multivariate analysis of covariance. Baseline short interval cortical inhibition did not predict clinical responses. However, paradoxically, after 4 weeks of atomoxetine, mean short interval cortical inhibition was reduced 31.9% in responders and increased 6.1% in nonresponders (analysis of covariance t 41 = 2.88; P = .0063). Percentage reductions in short interval cortical inhibition correlated with reductions in the ADHD Rating Scale (r = 0.50; P = .0005). In children ages 7 to 12 years with ADHD treated with atomoxetine, improvements in clinical symptoms are correlated with reductions in motor cortex short interval cortical inhibition. © The Author(s) 2014.

Exploring learning content and knowledge transfer in baccalaureate nursing students using a hybrid mental health practice experience.

PubMed

Booth, Richard G; Scerbo, Christina Ko; Sinclair, Barbara; Hancock, Michele; Reid, David; Denomy, Eileen

2017-04-01

Little research has been completed exploring knowledge development and transfer from and between simulated and clinical practice settings in nurse education. This study sought to explore the content learned, and the knowledge transferred, in a hybrid mental health clinical course consisting of simulated and clinical setting experiences. A qualitative, interpretive descriptive study design. Clinical practice consisted of six 10-hour shifts in a clinical setting combined with six two-hour simulations. 12 baccalaureate nursing students enrolled in a compressed time frame program at a large, urban, Canadian university participated. Document analysis and a focus group were used to draw thematic representations of content and knowledge transfer between clinical environments (i.e., simulated and clinical settings) using the constant comparative data analysis technique. Four major themes arose: (a) professional nursing behaviors; (b) understanding of the mental health nursing role; (c) confidence gained in interview skills; and, (d) unexpected learning. Nurse educators should further explore the intermingling of simulation and clinical practice in terms of knowledge development and transfer with the goal of preparing students to function within the mental health nursing specialty. Copyright © 2017 Elsevier Ltd. All rights reserved.

Clinical Importance of Steps Taken per Day among Persons with Multiple Sclerosis

PubMed Central

Motl, Robert W.; Pilutti, Lara A.; Learmonth, Yvonne C.; Goldman, Myla D.; Brown, Ted

2013-01-01

Background The number of steps taken per day (steps/day) provides a reliable and valid outcome of free-living walking behavior in persons with multiple sclerosis (MS). Objective This study examined the clinical meaningfulness of steps/day using the minimal clinically important difference (MCID) value across stages representing the developing impact of MS. Methods This study was a secondary analysis of de-identified data from 15 investigations totaling 786 persons with MS and 157 healthy controls. All participants provided demographic information and wore an accelerometer or pedometer during the waking hours of a 7-day period. Those with MS further provided real-life, health, and clinical information and completed the Multiple Sclerosis Walking Scale-12 (MSWS-12) and Patient Determined Disease Steps (PDDS) scale. MCID estimates were based on regression analyses and analysis of variance for between group differences. Results The mean MCID from self-report scales that capture subtle changes in ambulation (1-point change in PDSS scores and 10-point change in MSWS-12 scores) was 779 steps/day (14% of mean score for MS sample); the mean MCID for clinical/health outcomes (MS type, duration, weight status) was 1,455 steps/day (26% of mean score for MS sample); real-life anchors (unemployment, divorce, assistive device use) resulted in a mean MCID of 2,580 steps/day (45% of mean score for MS sample); and the MCID for the cumulative impact of MS (MS vs. control) was 2,747 steps/day (48% of mean score for MS sample). Conclusion The change in motion sensor output of ∼800 steps/day appears to represent a lower-bound estimate of clinically meaningful change in free-living walking behavior in interventions of MS. PMID:24023843

The impact of clinical use on the torsional behavior of Reciproc and WaveOne instruments.

PubMed

Magalhães, Rafael Rodrigues Soares de; Braga, Lígia Carolina Moreira; Pereira, Érika Sales Joviano; Peixoto, Isabella Faria da Cunha; Buono, Vicente Tadeu Lopes; Bahia, Maria Guiomar de Azevedo

2016-01-01

The aim of this study was to assess the influence of clinical use, in vivo, on the torsional behavior of Reciproc and WaveOne instruments considering the possibility that they degraded with use. Diameter at each millimeter, pitch length, and area at 3 mm from the tip were determined for both types of instruments. Twenty-four instruments, size 25, 0.08 taper, of each system were divided into two groups (n=12 each): Control Group (CG), in which new Reciproc (RC) and WaveOne Primary (WO) instruments were tested in torsion until rupture based on ISO 3630-1; and Experimental Group (EG), in which each new instrument was clinically used to clean and shape the root canals of one molar. After clinical use, the instruments were analyzed using optical and scanning electron microscopy and subsequently tested in torsion until fracture. Data were analyzed using one-way analysis of variance at a=.05. WO instruments showed significantly higher mean values of cross-sectional area A3 (P=0.000) and smaller pitch lengths than RC instruments with no statistically significant differences in the diameter at D3 (P=0.521). No significant differences in torsional resistance between the RC and WO new instruments (P=0.134) were found. The clinical use resulted in a tendency of reduction in the maximum torque of the analyzed instruments but no statistically significant difference was observed between them (P=0.327). During the preparation of the root canals, two fractured RC instruments and longitudinal and transversal cracks in RC and WO instruments were observed through SEM analysis. After clinical use, no statistically significant reduction in the torsional resistance was observed.

Predicting Condom Use Using the Information-Motivation-Behavioral Skills (IMB) Model: A Multivariate Latent Growth Curve Analysis

PubMed Central

Senn, Theresa E.; Scott-Sheldon, Lori A. J.; Vanable, Peter A.; Carey, Michael P.

2011-01-01

Background The Information-Motivation-Behavioral Skills (IMB) model often guides sexual risk reduction programs even though no studies have examined covariation in the theory’s constructs in a dynamic fashion with longitudinal data. Purpose Using new developments in latent growth modeling, we explore how changes in information, motivation, and behavioral skills over 9 months relate to changes in condom use among STD clinic patients. Methods Participants (N = 1281, 50% female, 66% African American) completed measures of IMB constructs at three time points. We used parallel process latent growth modeling to examine associations among intercepts and slopes of IMB constructs. Results Initial levels of motivation, behavioral skills, and condom use were all positively associated, with behavioral skills partially mediating associations between motivation and condom use. Changes over time in behavioral skills positively related to changes in condom use. Conclusions Results support the key role of behavioral skills in sexual risk reduction, suggesting these skills should be targeted in HIV prevention interventions. PMID:21638196

Behavior Problems Inventory (BPI): Psychometric characteristics of an instrument for routine assessment of persons with psychoses and related disorders.

PubMed

Vázquez Morejón, Antonio J; Vázquez-Morejón, Raquel; Bellido Zanin, Gloria

2018-03-22

This study explores the psychometric characteristics of the Behavior Problems Inventory (BPI), an instrument for routine clinical assessment of behavior problems in outpatients with psychosis based on information provided by key family informants. Six hundred and twenty-one patients diagnosed with psychosis and bipolar affective disorder (ICD-10 F20-F31) attended at Community Mental Health Units were evaluated in routine reviews using the BPI and the Social Functioning Scale (SFS). Twenty-five subjects were simultaneously administered the Social Behavior Schedule (SBS) and 28 were again administered the BPI eight weeks later. The instrument shows adequate psychometric characteristics with high internal consistency and robust temporal reliability, as well as satisfactory concurrent and construct validity. Factor analysis identified three factors: Underactivity/Social Withdrawal, Active Problems and Lack of Impulse Control, with adequate saturation of the items on each of the factors. The BPI is easy to apply, reliable and valid, takes up little of valuable clinical time, allowing routine assessment in public service contexts for persons diagnosed with psychosis and bipolar affective disorder for whom key family informants are available. Published by Elsevier B.V.

The Adolescent Behavioral Activation Program: Adapting Behavioral Activation as a Treatment for Depression in Adolescence.

PubMed

McCauley, Elizabeth; Gudmundsen, Gretchen; Schloredt, Kelly; Martell, Christopher; Rhew, Isaac; Hubley, Samuel; Dimidjian, Sona

2016-01-01

This study aimed to examine implementation feasibility and initial treatment outcomes of a behavioral activation (BA) based treatment for adolescent depression, the Adolescent Behavioral Activation Program (A-BAP). A randomized, controlled trial was conducted with 60 clinically referred adolescents with a depressive disorder who were randomized to receive either 14 sessions of A-BAP or uncontrolled evidenced-based practice for depression. The urban sample was 64% female, predominantly Non-Hispanic White (67%), and had an average age of 14.9 years. Measures of depression, global functioning, activation, and avoidance were obtained through clinical interviews and/or through parent and adolescent self-report at preintervention and end of intervention. Intent-to-treat linear mixed effects modeling and logistic regression analysis revealed that both conditions produced statistically significant improvement from pretreatment to end of treatment in depression, global functioning, and activation and avoidance. There were no significant differences across treatment conditions. These findings provide the first step in establishing the efficacy of BA as a treatment for adolescent depression and support the need for ongoing research on BA as a way to enhance the strategies available for treatment of depression in this population.

An open trial of outpatient group therapy for bulimic disorders: combination program of cognitive behavioral therapy with assertive training and self-esteem enhancement.

PubMed

Shiina, Akihiro; Nakazato, Michiko; Mitsumori, Makoto; Koizumi, Hiroki; Shimizu, Eiji; Fujisaki, Mihisa; Iyo, Masaomi

2005-12-01

The purposes of this study were to examine the therapeutic efficacy of combined group cognitive behavioral therapy (CGCBT) and to explore the characteristics of the patients who failed to complete it. Our group cognitive behavioral therapy combined with assertiveness training for alexithymia and self-esteem enhancement therapy were attended over a 10-week period. Twenty-five participants were enrolled in the study. The clinical symptoms were assessed before and after treatment, using rating scales including the Eating Disorder Inventory-2, the Bulimic Investigatory Test, Edinburgh, the Toronto Alexithymia Scale, the Rosenberg Self-Esteem Scale, and Global Assessment of Functioning. Sixteen participants (64%) completed the CGCBT program. Completion of the CGCBT resulted in significant improvements in reducing binge-eating behavior and improving social functioning. Eight patients (32%) significantly improved using the Clinical Global Impression Change (CGI-C). Stepwise logistic regression analysis of the results indicated that a lower age (P=0.04) and psychiatric comorbidity (P=0.06) were predictors of dropout from the CGCBT program. Our CGCBT program is a promising first-line treatment for bulimic outpatients. Lower age and the presence of comorbidity had effects on dropout rates.

Good cognitive performances in a child with Prader-Willi syndrome.

PubMed

Nugnes, Rosa; Zito, Eugenio; Mozzillo, Enza; Camarca, Maria Erminia; Riccio, Maria Pia; Terrone, Gaetano; Melis, Daniela; Bravaccio, Carmela; Franzese, Adriana

2013-11-15

We report the case of a child affected by Prader-Willi syndrome (PWS) with good cognitive performances and without relevant behavioral abnormalities.The diagnosis of PWS, suspected on the basis of clinical features and past history, was confirmed by DNA methylation analysis. Additional genetic testing revealed a maternal uniparental disomy. Intellectual profile was analyzed by WISC-III and Raven's Progressive Matrices CPM, while the behavior was evaluated by K-SADS-PL and Child Behavior Checklist/4-18 to the parents.WISC-III test showed a Total Intelligence Quotient (T-IQ = 79) at the border level for age. The Verbal Intelligence Quotient (V-IQ) showed a lower score than the Performance Intelligence Quotient (P-IQ) (78 and 85, respectively). Raven's Matrices CPM showed an intelligence level at 75-90° percentile for age. Concerning behavioral evaluation, a difficulty in impulse control was observed, with persistent but controllable search for food, without a clear psychopathological meaning. Also according to K-SADS-PL no areas of psychopathological dimensions were detected. In conclusion, in presence of consisting clinical features of PWS and high diagnostic suspicion, the diagnosis of PWS should be considered even in presence of a borderline IQ and in absence of psychopathological abnormalities.

Sepsis reconsidered: Identifying novel metrics for behavioral landscape characterization with a high-performance computing implementation of an agent-based model.

PubMed

Cockrell, Chase; An, Gary

2017-10-07

Sepsis affects nearly 1 million people in the United States per year, has a mortality rate of 28-50% and requires more than $20 billion a year in hospital costs. Over a quarter century of research has not yielded a single reliable diagnostic test or a directed therapeutic agent for sepsis. Central to this insufficiency is the fact that sepsis remains a clinical/physiological diagnosis representing a multitude of molecularly heterogeneous pathological trajectories. Advances in computational capabilities offered by High Performance Computing (HPC) platforms call for an evolution in the investigation of sepsis to attempt to define the boundaries of traditional research (bench, clinical and computational) through the use of computational proxy models. We present a novel investigatory and analytical approach, derived from how HPC resources and simulation are used in the physical sciences, to identify the epistemic boundary conditions of the study of clinical sepsis via the use of a proxy agent-based model of systemic inflammation. Current predictive models for sepsis use correlative methods that are limited by patient heterogeneity and data sparseness. We address this issue by using an HPC version of a system-level validated agent-based model of sepsis, the Innate Immune Response ABM (IIRBM), as a proxy system in order to identify boundary conditions for the possible behavioral space for sepsis. We then apply advanced analysis derived from the study of Random Dynamical Systems (RDS) to identify novel means for characterizing system behavior and providing insight into the tractability of traditional investigatory methods. The behavior space of the IIRABM was examined by simulating over 70 million sepsis patients for up to 90 days in a sweep across the following parameters: cardio-respiratory-metabolic resilience; microbial invasiveness; microbial toxigenesis; and degree of nosocomial exposure. In addition to using established methods for describing parameter space, we developed two novel methods for characterizing the behavior of a RDS: Probabilistic Basins of Attraction (PBoA) and Stochastic Trajectory Analysis (STA). Computationally generated behavioral landscapes demonstrated attractor structures around stochastic regions of behavior that could be described in a complementary fashion through use of PBoA and STA. The stochasticity of the boundaries of the attractors highlights the challenge for correlative attempts to characterize and classify clinical sepsis. HPC simulations of models like the IIRABM can be used to generate approximations of the behavior space of sepsis to both establish "boundaries of futility" with respect to existing investigatory approaches and apply system engineering principles to investigate the general dynamic properties of sepsis to provide a pathway for developing control strategies. The issues that bedevil the study and treatment of sepsis, namely clinical data sparseness and inadequate experimental sampling of system behavior space, are fundamental to nearly all biomedical research, manifesting in the "Crisis of Reproducibility" at all levels. HPC-augmented simulation-based research offers an investigatory strategy more consistent with that seen in the physical sciences (which combine experiment, theory and simulation), and an opportunity to utilize the leading advances in HPC, namely deep machine learning and evolutionary computing, to form the basis of an iterative scientific process to meet the full promise of Precision Medicine (right drug, right patient, right time). Copyright © 2017. Published by Elsevier Ltd.

Advances in fMRI Real-Time Neurofeedback.

PubMed

Watanabe, Takeo; Sasaki, Yuka; Shibata, Kazuhisa; Kawato, Mitsuo

2017-12-01

Functional magnetic resonance imaging (fMRI) neurofeedback is a type of biofeedback in which real-time online fMRI signals are used to self-regulate brain function. Since its advent in 2003 significant progress has been made in fMRI neurofeedback techniques. Specifically, the use of implicit protocols, external rewards, multivariate analysis, and connectivity analysis has allowed neuroscientists to explore a possible causal involvement of modified brain activity in modified behavior. These techniques have also been integrated into groundbreaking new neurofeedback technologies, specifically decoded neurofeedback (DecNef) and functional connectivity-based neurofeedback (FCNef). By modulating neural activity and behavior, DecNef and FCNef have substantially advanced both basic and clinical research. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Confirmatory Factor Analysis of the Behavior Rating Inventory of Executive Function-Adult Version in Healthy Adults and Application to Attention-Deficit/Hyperactivity Disorder

PubMed Central

Roth, Robert M.; Lance, Charles E.; Isquith, Peter K.; Fischer, Adina S.; Giancola, Peter R.

2013-01-01

The Behavior Rating Inventory of Executive Function-Adult Version (BRIEF-A) is a questionnaire measure designed to assess executive functioning in everyday life. Analysis of data from the BRIEF-A standardization sample yielded a two-factor solution (labeled Behavioral Regulation and Metacognition). The present investigation employed confirmatory factor analysis (CFA) to evaluate four alternative models of the factor structure of the BRIEF-A self-report form in a sample of 524 healthy young adults. Results indicated that a three-factor model best fits the data: a Metacognition factor, a Behavioral Regulation factor consisting of the Inhibit and Self-Monitor scales, and an Emotional Regulation factor composed of the Emotional Control and Shift scales. The three factors contributed 14%, 19%, and 24% of unique variance to the model, respectively, and a second-order general factor accounted for 41% of variance overall. This three-factor solution is consistent with recent CFAs of the Parent report form of the BRIEF. Furthermore, although the Behavioral Regulation factor score in the two-factor model did not differ between adults with attention-deficit/hyperactivity disorder and a matched healthy comparison group, greater impairment on the Behavioral Regulation factor but not the Emotional Regulation factor was found using the three-factor model. Together, these findings support the multidimensional nature of executive function and the clinical relevance of a three-factor model of the BRIEF-A. PMID:23676185

Effect of Rational-Emotive Behavior Therapy Program on the Symptoms of Burnout Syndrome Among Undergraduate Electronics Work Students in Nigeria.

PubMed

Ogbuanya, Theresa C; Eseadi, Chiedu; Orji, Chibueze T; Omeje, Joachim C; Anyanwu, Joy I; Ugwoke, Samuel C; Edeh, Nkechinyere C

2018-01-01

This research aimed to investigate the effect that rational-emotive behavior therapy had on the symptoms of burnout among undergraduate electronics work students in Southeast Nigeria. This study utilized a pretest-posttest design involving a no-intervention group versus an intervention group. Participants were 124 undergraduate electronics work students who met the inclusion criteria of the study. The intervention consisted of 12 weeks of rational-emotive behavior therapy treatment and 2 weeks of follow-up meetings conducted at 6 months. Self-report questionnaire was used for data collection. Repeated measures analysis of variance and t test were used for data analysis. The results show that rational-emotive behavior therapy had a significant effect on the symptoms of burnout syndrome among the electronics work students in the treatment group compared to their counterparts in the no-intervention group. Finally, the positive gains were significantly maintained by the treatment group at the follow-up. The current study suggests that rational-emotive behavior therapy program can be effective for dealing with burnout syndrome among the population of undergraduates in Nigeria. Further clinical evaluation is needed.

Eating Patterns and Disorders in a College Population: Are College Women's Eating Problems a New Phenomenon?

ERIC Educational Resources Information Center

Hesse-Biber, Sharlene

1989-01-01

Analysis of questionnaires returned by 395 sophomores reveals that the eating difficulties of college women may be a problem that only partially resembles clinical eating disorders. They displayed the behavioral symptoms but not the psychological traits associated with anorexia and bulimia. Diagnosis and treatment issues, and sociocultural…

The PBL-Evaluator: A Web-Based Tool for Assessment in Tutorials.

ERIC Educational Resources Information Center

Chaves, John F.; Chaves, John A.; Lantz, Marilyn S.

1998-01-01

Describes design and use of the PBL Evaluator, a computer-based method of evaluating dental students' clinical problem-solving skills. Analysis of Indiana University students' self-, peer, and tutor ratings for one iteration of a course in critical thinking and professional behavior shows differences in these ratings. The method is found useful…

A Standardized Mean Difference Effect Size for Single Case Designs

ERIC Educational Resources Information Center

Hedges, Larry V.; Pustejovsky, James E.; Shadish, William R.

2012-01-01

Single case designs are a set of research methods for evaluating treatment effects by assigning different treatments to the same individual and measuring outcomes over time and are used across fields such as behavior analysis, clinical psychology, special education, and medicine. Emerging standards for single case designs have focused attention on…

Beyond Values Clarification: Addressing Client Values in Clinical Behavior Analysis

ERIC Educational Resources Information Center

Bonow, Jordan T.; Follette, William C.

2009-01-01

Ethical principles of psychology, as exemplified in the American Psychological Association (APA) Code of Ethics (2002), provide impractical advice for addressing client values during psychotherapy. These principles seem to argue that each client's values should be respected and protected at all times, except in cases in which this would result in…

The Contraceptive Self-Efficacy Scale: Analysis in Four Samples.

ERIC Educational Resources Information Center

Levinson, Ruth Andrea; Wan, Choi K.; Beamer, LuAnn J.

1998-01-01

The relationship of the Contraceptive Self-Efficacy Scale to contraceptive behavior was explored in four female samples: (1) 258 California adolescents, (2) 259 Chicago (Illinois) adolescents, (3) 231 Montreal (Canada) high school students, and (4) 148 college students. Results are discussed in terms of use in research and clinical settings. (SLD)

A Standardized Mean Difference Effect Size for Multiple Baseline Designs across Individuals

ERIC Educational Resources Information Center

Hedges, Larry V.; Pustejovsky, James E.; Shadish, William R.

2013-01-01

Single-case designs are a class of research methods for evaluating treatment effects by measuring outcomes repeatedly over time while systematically introducing different condition (e.g., treatment and control) to the same individual. The designs are used across fields such as behavior analysis, clinical psychology, special education, and…

Perianal disease, small bowel disease, smoking, prior steroid or early azathioprine/biological therapy are predictors of disease behavior change in patients with Crohn's disease.

PubMed

Lakatos, Peter Laszlo; Czegledi, Zsofia; Szamosi, Tamas; Banai, Janos; David, Gyula; Zsigmond, Ferenc; Pandur, Tunde; Erdelyi, Zsuzsanna; Gemela, Orsolya; Papp, Janos; Lakatos, Laszlo

2009-07-28

To assess the combined effect of disease phenotype, smoking and medical therapy [steroid, azathioprine (AZA), AZA/biological therapy] on the probability of disease behavior change in a Caucasian cohort of patients with Crohn's disease (CD). Three hundred and forty well-characterized, unrelated, consecutive CD patients were analyzed (M/F: 155/185, duration: 9.4 +/- 7.5 years) with a complete clinical follow-up. Medical records including disease phenotype according to the Montreal classification, extraintestinal manifestations, use of medications and surgical events were analyzed retrospectively. Patients were interviewed on their smoking habits at the time of diagnosis and during the regular follow-up visits. A change in disease behavior was observed in 30.8% of patients with an initially non-stricturing, non-penetrating disease behavior after a mean disease duration of 9.0 +/- 7.2 years. In a logistic regression analysis corrected for disease duration, perianal disease, smoking, steroid use, early AZA or AZA/biological therapy use were independent predictors of disease behavior change. In a subsequent Kaplan-Meier survival analysis and a proportional Cox regression analysis, disease location (P = 0.001), presence of perianal disease (P < 0.001), prior steroid use (P = 0.006), early AZA (P = 0.005) or AZA/biological therapy (P = 0.002), or smoking (P = 0.032) were independent predictors of disease behavior change. Our data suggest that perianal disease, small bowel disease, smoking, prior steroid use, early AZA or AZA/biological therapy are all predictors of disease behavior change in CD patients.

[Implementation of clinical practice guidelines: how can we close the evidence-practice gap?].

PubMed

Muche-Borowski, Cathleen; Nothacker, M; Kopp, I

2015-01-01

Guidelines are intended as instruments of knowledge transfer to support decision-making by physicians, other health professionals and patients in clinical practice and thereby contribute to quality improvements in healthcare. To date they are an indispensable tool for healthcare. Their benefit for patients can only be seen in application, i.e. the implementation of guideline recommendations. For successful implementation, implementability and practicability play a crucial role and these characteristics can be influenced and should be promoted by the guideline development group. In addition, a force field analysis to identify barriers against and facilitators for the implementation of specific guideline recommendations from the perspective of physicians and patients is recommended to guide the development of an individual implementation strategy and the selection of appropriate interventions. However, implementation cannot be achieved by the guideline development group alone and a universal implementation strategy does not exist. Therefore, a process using theory, analysis, experience and shared responsibility of stakeholders in healthcare is recommended, with the aim to achieve sustainable behavioral change and improve the quality of care by guideline-oriented behavior.

Analysis of Associations between Behavioral Traits and Four Types of Aggression in Shiba Inu

PubMed Central

KANEKO, Fumihiro; ARATA, Sayaka; TAKEUCHI, Yukari; MORI, Yuji

2013-01-01

ABSTRACT Canine aggression is one of the behavioral problems for which veterinary behaviorists are most frequently consulted. Despite this, the classification of canine aggression is controversial, and there are several classification methodologies. While the etiology of canine aggression differs among the types of aggression, the behavioral background underlying aggression is not well understood. Behavior trait-based evaluation of canine aggression would improve the effectiveness and efficiency of managing canine aggression problems. We developed a questionnaire addressing 14 behavioral items and items related to four types of canine aggression (owner-, child-, stranger- and dog-directed aggression) in order to examine the associations between behavioral traits and aggression in Shiba Inu. A total of 400 Shiba Inu owners recruited through dog events (n=134) and veterinary hospitals (n=266) completed the questionnaire. Factor analysis sorted the behavioral items from both the event and clinic samples into four factors: “sociability with humans,” “reactivity to stimuli,” “chase proneness” and “fear of sounds.” While “reactivity to stimuli” correlated significantly positively with all of the four types of aggression (P=0.007 to <0.001), “sociability with humans” correlated significantly negatively with child- and stranger-directed aggression (P<0.001). These results suggest that the behavioral traits involved in canine aggression differ among the types of aggression and that specific behavioral traits are frequently simultaneously involved in several types of aggression. PMID:23719752

Behavior and Symptom Change Among Women Treated with Placebo for Sexual Dysfunction

PubMed Central

Bradford, Andrea; Meston, Cindy M.

2011-01-01

Introduction In clinical trials of drug treatments for women’s sexual dysfunction, placebo responses have often been substantial. However, little is known about the clinical significance, specificity, predictors, and potential mechanisms of placebo response in sexual dysfunction. Aim We aimed to determine the nature and predictors of sexual function outcomes in women treated with placebo for female sexual arousal disorder (FSAD). Methods We conducted a secondary analysis of data from the placebo arm of a 12-week, multisite, randomized controlled pharmaceutical trial for FSAD (N = 50). We analyzed the magnitude, domain specificity, and clinical significance of sexual function scores at baseline, 4, 8, and 12 weeks (post-treatment). We examined longitudinal change in sexual function outcomes as a function of several baseline variables (e.g., age, symptom-related distress) and in relation to changes in sexual behavior frequency during the trial. Main Outcome Measure Female Sexual Function Index total score. Results The magnitude of change at post-treatment was clinically significant in approximately one-third of placebo recipients. Effect sizes were similar across multiple aspects of sexual function. Symptom improvement was strongly related to the frequency of satisfying sexual encounters during treatment. However, the relationship between sexual encounter frequency and outcome varied significantly between participants. Conclusions A substantial number of women experienced clinically significant improvement in sexual function during treatment with placebo. Changes in sexual behavior during the trial, more so than participant age or symptom severity at baseline, appeared to be an important determinant of outcome. Contextual and procedural aspects of the clinical trial may have influenced outcomes in the absence of an active drug treatment. PMID:20849412

[Comparison of human papilloma virus infection status between men who have sex with men recruited from gay bathhouses and HIV voluntary counseling and testing clinics respectively in Urumqi].

PubMed

Tian, T; Cai, A J; Huang, B X; Abidan, Ainiwaer; Wang, H; Dai, J H

2017-01-10

Objective: To understand the human papilloma virus (HPV) infection status in men who have sex with men (MSM) recruited from gay bathhouses and HIV voluntary counseling and testing (VCT) clinics in Urumqi, Xinjiang Uygur autonomous region, and identify the associated risk factors. Methods: A total of 200 MSM aged ≥18 years were recruited by using the " snowballing" sampling method from gay bathhouses and VCT clinics in Urumqi during March-May, 2016. The MSM recruited completed questionnaires after filling in the informed consent form. The information about their demographic characteristics and sexual behaviors were collected, and anal swabs were collected from them for HPV genotyping. Results: The overall HPV infection rate was 54.0 % . The HPV infection rate was 66.7 % (74/111) in MSM from gay bathhouses and 38.2 % (34/89) in MSM from VCT clinics and the high risk type HPV infection rate was 39.6 % (44/111) in MSM from gay bathhouses and 14.6 % (13/89) in MSM from VCT clinics, the differences were significant ( χ (2)=16.112, P <0.05; χ (2)=15.190, P <0.05). Multiple logistic regression analysis indicated that the major risk factors for HPV infection included activity in gay bathhouse ( OR =3.732, 95 % CI : 1.950-7.141) and anal sexual behavior ( OR =2.555, 95 %CI : 1.329-4.912). Conclusion: The prevalence of HPV in MSM from gay bathhouses was higher than that in MSM from VCT clinics, indicating that close attention should be paid to the behavior intervention in MSM.

Memantine in Japanese patients with moderate to severe Alzheimer's disease: meta-analysis of multiple-index responder analyses.

PubMed

Okuizumi, Kaoru; Kamata, Teruyoshi; Matsui, Daiju; Saito, Kengo; Matsumoto, Takuyuki; Fukuchi, Yoshikazu

2018-04-01

Responder analyses assessing clinical worsening have attempted to clarify clinically meaningful drug efficacy enhancements in patients with Alzheimer's disease (AD). This was a meta-analysis of two multicenter, randomized, double-blind, parallel-group, 24-week studies of 633 Japanese patients with moderate to severe AD receiving memantine 20 mg/day (n = 318) or placebo (n = 315). The clinical trial registration number is UMIN000026013. Overall odds ratios (OR) for a reduced likelihood of clinical worsening (memantine versus placebo) were statistically significant on the following individual and combined rating scales: Severe Impairment Battery-Japanese version (SIB-J, OR 0.52; 95% CI: 0.37, 0.73; p = 0.0001); Behavioral Pathology in AD Rating Scale (BEHAVE-AD, OR 0.53; 95% CI: 0.37, 0.75; p = 0.0003); and SIB-J + Clinician's Interview-Based Impression of Change-plus-Japanese version (SIB-J + CIBIC-plus-J; OR 0.53; 95% CI: 0.37, 0.77; p = 0.0009). A significantly reduced risk of triple worsening was evident in the memantine versus placebo group on the combined SIB-J + CIBIC-plus-J + BEHAVE-AD rating scales (OR 0.38; 95% CI: 0.22, 0.65; p = 0.0003). Memantine is a viable treatment option for patients with AD presenting not only with cognitive impairment, but also with a broader range of symptoms, including the behavioral and psychological symptoms of dementia.

Item response theory-based validation of a short form of the Eating Behavior Scale for Japanese adults

PubMed Central

Tayama, Jun; Ogawa, Sayaka; Takeoka, Atsushi; Kobayashi, Masakazu; Shirabe, Susumu

2017-01-01

Abstract Obesity has become a serious social problem in industrialized countries in recent years. Clinically, although the evaluation of dietary behavior abnormalities is as important as any method of risk assessment for obesity, almost all the existing scales with many items may have numerous practical clinical difficulties. In this study, we aimed to prepare a short questionnaire to assess the dietary behavior abnormalities related to obesity. A total of 1032 individuals aged 20 to 59 years participated in the present study. Using item response theory (IRT), we selected the items for a short version from among 30 items of Sakata Eating Behavior Scale (EBS), which is widely used in Japan. As a result of the IRT-based analysis on the original 30-item version, 7 items were adopted as the short version. The correlation between the total score of the original EBS and the EBS short form was extremely high (r = 0.93, P = .001). In examining the criterion validity, for all participants (n = 1032), male (n = 516), and female (n = 516), the correlation coefficients between the total score of the EBS short form and body mass index (BMI) were r = 0.26, r = 0.28, and r = 0.28, respectively. The results of the receiver operating characteristic analysis was performed with obesity BMI > 25 kg/m2 as a dependent variable, the value of the area under the curve in the ROC was significantly higher in the 7-item version than in the total score of the original items (P = .0005). In conclusion, the 7-item EBS short form was created. Furthermore, it was found that the EBS short form is a reliable and valid measure that can be used as an indicator of obesity in both clinical and research settings. PMID:29049248

The nonlinear, complex sequential organization of behavior in schizophrenic patients: neurocognitive strategies and clinical correlations.

PubMed

Paulus, M P; Perry, W; Braff, D L

1999-09-01

Thought disorder is a hallmark of schizophrenia and can be inferred from disorganized behavior. Measures of the sequential organization of behavior are important because they reflect the cognitive processes of the selection and sequencing of behavioral elements, which generate observable and analyzable behavioral patterns. In this context, sequences of choices generated by schizophrenic patients in a two-choice guessing task fluctuate significantly, which reflects an "oscillating dysregulation" between highly predictable and highly unpredictable subsequences within a single test session. In this study, we aimed to clarify the significance of dysregulation by seeing whether demographic, clinical, neuropsychological, and psychological measures predict the degree of dysregulation observed on this two-choice task. Thirty schizophrenic patients repeatedly performed a LEFT or RIGHT key press that was followed by a stimulus, which occurred randomly on the left or right side of the computer screen. Thus, the stimulus location had nothing to do with the key press behavior. The range of key press sequence predictabilities as measured by the dynamical entropy was used to quantify the dysregulation of response sequences and reflects the range of fixity and randomness of the responses. A factor analysis was performed and step-wise multiple regression analyses were used to relate the factor scores to demographic, clinical, symptomatic, Wisconsin Card Sorting Test (WCST), and Rorschach variables. The LEFT/RIGHT key press sequences were determined by three factors: 1) the degree of win-stay/lose-shift strategy; 2) the degree of contextual influence on the current choice; and 3) the degree of dysregulation on the choice task. Demographic and clinical variables did not predict any of the three response patterns on the choice task. In contrast, the WCST and Rorschach test predicted performance on various factors of choice task response patterns. Schizophrenic patients employ several rules, i.e., "win-stay/lose-shift" and "decide according to the previous choice," that fluctuate significantly when generating sequences on this task, confirming that a basic behavioral dysregulation occurs in a single schizophrenic subject across a single test session. The organization or the "temporal architecture" of the behavioral sequences is not related to symptoms per se, but is related to deficits in executive functioning, problem solving, and perceptual organizational abilities.

Effect of Intranasal Oxytocin Administration on Psychiatric Symptoms: A Meta-Analysis of Placebo-Controlled Studies

PubMed Central

Hofmann, Stefan G.; Fang, Angela; Brager, Daniel N.

2015-01-01

Clinical trials of intranasal administration of oxytocin for treating psychiatric problems have yielded mixed results. To conduct a quantitative review of placebo-controlled clinical trials of intranasally-administered oxytocin (OT) for psychiatric symptoms, manual and electronic searches using PubMed and PsycINFO were conducted. Of 1,828 entries, 16 placebo-controlled studies totaling 330 participants were included in the analysis. The overall placebo-controlled effect size was moderately strong (Hedges’ g = 0.67) and robust as suggested by the fail-safe N and funnel plot analysis. OT reduced symptoms of depression, anxiety, autism/repetitive behaviors, psychotic symptoms, and general psychopathology. In the combined sample, symptom reduction was moderated by frequency of administration. Publication year and diagnostic category did not moderate the effect of OT on the clinical outcome measures. We conclude that intranasal administration of OT is a potentially useful intervention for reducing psychiatric symptoms. However, more studies are needed to determine the best treatment target and to identify the mechanism of treatment change. PMID:26094200

Integrated care in rural health: Seeking sustainability.

PubMed

Peterson, Mary; Turgesen, Jeri; Fisk, Laura; McCarthy, Seamus

2017-06-01

The increased awareness of the financial impact associated with social determinants of health coincides with expectations of the Affordable Care Act (HR 3590) to improve care while reducing costs. The integration of behavioral health providers (BHPs) into primary care has demonstrated improved clinical outcomes. This study was designed with 2 aims, including the evaluation of the financial viability of an integrated care model in a rural setting and the demonstration of incorporating practice-based research into clinical work. A rural health plan caring for 22,000 members funded a pilot project placing BHPs in 3 clinics to provide integrated care. Patient utilization of medical services for 6 months following BHP services was compared with baseline utilization. The BHPs treated 256 unique patients, with a total of 459 consultations. The percentage of patients receiving BHP services varied between clinics (Clinic A = 1.4%, Clinic B = 2.7%, and Clinic C = 3.9%). A between-clinic analysis showed differences in medical claims data between baseline and post-BH services. The overall effect sizes for reduced medical utilization for patients at clinics B and C were very large, Hedge's g = -2.31 and -4.79, respectively. Utilization of 4 of the services (emergency, lab, outpatient, and primary care) showed the large reductions in their costs. In contrast, the data for Clinic A showed no change. Patients receiving behavioral health services within the integrated care model may decrease utilization of medical services following treatment, resulting in cost offset. Potential reasons for variability between clinics are discussed. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Evidence to practice: treatment of anxiety in individuals with autism spectrum disorders

PubMed Central

Lang, Russell; Mahoney, Richard; El Zein, Farah; Delaune, Elizabeth; Amidon, Megan

2011-01-01

Clinical question What treatment improves social interactions and reduces reports of anxiety symptoms in individuals with autism spectrum disorders (ASD) and a co-occurring anxiety disorder? Results Systematic reviews and randomized clinical trials suggest that cognitive behavior therapy in tandem with direct instruction of social skills using applied behavior analysis intervention components may be effective for treating anxiety in individuals with high functioning ASD. For individuals with ASD, an anxiety disorder, and an intellectual disability, systematic desensitization may be effective. Implementation Intervention should emphasize teaching social skills. Reinforcers (ie, rewards based upon the client’s interests) should be used to encourage participation in therapy. Treatment should incorporate visual aides and family involvement. Intervention components involving abstract concepts, visualization, and discussions of emotions are less useful given difficulties in abstract reasoning and communication inherent to ASD. PMID:21326652

Evaluation of nursing students' communication abilities in clinical courses in hospitals.

PubMed

Shafakhah, Mahnaz; Zarshenas, Ladan; Sharif, Farkhondeh; Sabet Sarvestani, Raheleh

2015-01-26

Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has established, improving communication as a priority for improving patient safety since 2006. Therefore, the present study aimed to evaluate nursing students' communication abilities to recognize their strengths and weaknesses in communication skills. This cross-sectional study was carried out in 2014. The study participants included all the nursing students who passed two semesters in Fatemeh School of Nursing and Midwifery in Shiraz, Iran. The students' communication skills were assessed using a self-administered questionnaire. Then, the data were entered into the SPSS statistical software (v. 16) and analyzed using both descriptive (mean and percentage) and inferential statistics (Pearson correlation and ANOVA). Among the 200 students who completed the questionnaires, 58% were female and 42% were male with the mean age of 21.79 years (SD=2.14). The results of Pearson correlation analysis demonstrated a significant correlation between the nursing students' clinical communication behavior scores and treatment communication ability scores (P<0.001). The findings demonstrated that most nursing students required improvement in their communication skills in both clinical communication behavior and treatment communication ability. Besides, a significant difference was observed among the students of different terms regarding clinical communication behaviors (P?0.05), but not concerning communication abilities. Nursing students in higher semesters had better communication skills. The results showed that nursing students in this university had a moderate ability in clinical and treatment communication. Thus, paying attention to standard education, curriculum revision, and adding some specific theoretical lessons for improving communication skills are mandatory during the bachelor's degree.

Clinical behavior of Japanese community pharmacists for preventing prescription drug overdose.

PubMed

Shimane, Takuya; Matsumoto, Toshihiko; Wada, Kiyoshi

2015-04-01

Prescription drug abuse, including benzodiazepines, is a growing health problem in Japan. This study examined the community pharmacist's clinical behavior regarding patients who overdose on prescribed drugs, and explored the possibility of overdose prevention by community pharmacists. We surveyed all registered community pharmacies with dispensing functions (n = 1867) in the Saitama Pharmaceutical Association. An anonymous self-administered questionnaire was mailed to each pharmacy. Respondents were asked about clinical behavior such as medication counseling and referral to the prescriber if prescription drug overdose was identified. Among respondents, 26% of community pharmacists reported clinical experience of working with patients who overdosed on prescribed drugs in the previous year. Half of respondents evaluated their practice such as medication counseling and referral to the prescriber as 'good'. On multivariate analysis, a 'poor' self-evaluation of referral to the prescriber was significantly associated with the following perceptions: 'insufficient confidence in communication with prescribers' (odds ratio [OR], 2.7; 95% confidence interval [95%CI]: 1.4-5.3), and 'to avoid trouble with prescribers' (OR, 1.7; 95%CI: 1.0-2.7). Japanese community pharmacists could prevent prescription drug abuse in their practice, but the pharmacists who have insufficient confidence in communication with prescribers and who are afraid of trouble with a prescriber, reported poor self-evaluation for referral to the prescribers. All prescribers should understand the importance of referral by community pharmacists, to assist community pharmacists in playing a critical role in prevention of prescription drug abuse. © 2014 The Authors. Psychiatry and Clinical Neurosciences © 2014 Japanese Society of Psychiatry and Neurology.

Attacking Heterogeneity in Schizophrenia by Deriving Clinical Subgroups From Widely Available Symptom Data.

PubMed

Dickinson, Dwight; Pratt, Danielle N; Giangrande, Evan J; Grunnagle, MeiLin; Orel, Jennifer; Weinberger, Daniel R; Callicott, Joseph H; Berman, Karen F

2018-01-13

Previous research has identified (1) a "deficit" subtype of schizophrenia characterized by enduring negative symptoms and diminished emotionality and (2) a "distress" subtype associated with high emotionality-including anxiety, depression, and stress sensitivity. Individuals in deficit and distress categories differ sharply in development, clinical course and behavior, and show distinct biological markers, perhaps signaling different etiologies. We tested whether deficit and distress subtypes would emerge from a simple but novel data-driven subgrouping analysis, based on Positive and Negative Syndrome Scale (PANSS) negative and distress symptom dimensions, and whether subgrouping was informative regarding other facets of behavior and brain function. PANSS data, and other assessments, were available for 549 people with schizophrenia diagnoses. Negative and distress symptom composite scores were used as indicators in 2-step cluster analyses, which divided the sample into low symptom (n = 301), distress (n = 121), and deficit (n = 127) subgroups. Relative to the low-symptom group, the deficit and distress subgroups had comparably higher total PANSS symptoms (Ps < .001) and were similarly functionally impaired (eg, global functioning [GAF] Ps < .001), but showed markedly different patterns on symptom, cognitive and personality variables, among others. Initial analyses of functional magnetic resonance imaging (fMRI) data from a 182-participant subset of the full sample also suggested distinct patterns of neural recruitment during working memory. The field seeks more neuroscience-based systems for classifying psychiatric conditions, but these are inescapably behavioral disorders. More effective parsing of clinical and behavioral traits could identify homogeneous target groups for further neural system and molecular studies, helping to integrate clinical and neuroscience approaches. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center 2017.

Clinical Symptom Responses to Atypical Antipsychotic Medications in Alzheimer’s Disease: Phase 1 Outcomes from the CATIE-AD Effectiveness Trial

PubMed Central

Sultzer, David L.; Davis, Sonia M.; Tariot, Pierre N.; Dagerman, Karen S.; Lebowitz, Barry D.; Lyketsos, Constantine G.; Rosenheck, Robert A.; Hsiao, John K.; Lieberman, Jeffrey A.; Schneider, Lon S.

2009-01-01

Objective To measure the effects of atypical antipsychotic medication on psychiatric and behavioral symptoms in patients with Alzheimer’s disease (AD) and psychosis or agitated behavior. Method The CATIE-AD effectiveness study included 421 outpatients with AD and psychosis or agitated/aggressive behavior. Patients were assigned randomly to masked flexible-dose treatment with olanzapine, quetiapine, risperidone, or placebo for up to 36 weeks. Patients could be re-randomized to a different medication treatment at the clinician’s discretion, which ended the Phase 1 period. Psychiatric and behavioral symptoms, functional abilities, cognition, care needs, and quality of life were measured at regular intervals. Results At the last observation in Phase 1 compared to placebo, there was greater improvement in patients treated with olanzapine or risperidone on the Neuropsychiatric Inventory total score, with risperidone on the Clinical Global Impression of Change, with olanzapine or risperidone on the Brief Psychiatric Rating Scale (BPRS) Hostile Suspiciousness factor, and with risperidone on the BPRS Psychosis factor. There was worsening with olanzapine on the BPRS Withdrawn Depression factor. Among patients continuing Phase 1 treatment at 12 weeks, there were no significant antipsychotic – placebo group differences on measures of cognition, functional skills, care needs, or quality of life, except for worsening of functional skills in the olanzapine treatment group compared to placebo. Conclusion In this descriptive analysis of clinical outcomes in AD outpatients in usual care settings, some clinical symptoms improved with atypical antipsychotic treatment. Antipsychotic medications may be more effective for particular symptoms, such as anger, aggression, and paranoid ideas. Functional abilities, care needs, or quality of life do not appear to improve with antipsychotic treatment. PMID:18519523

Influence of positive distractions on children in two clinic waiting areas.

PubMed

Pati, Debajyoti; Nanda, Upali

2011-01-01

To examine the influence of positive distraction on the behavior and activity of children in two clinic waiting areas. People spend a considerable proportion of time waiting in hospitals. Studies show that the quality of waiting environments influences the perception of quality of care and caregivers, that perception of waiting time is a better indicator of patient satisfaction than actual waiting time, and that the waiting environment contributes to the perception of wait time. In fact, the attractiveness of the physical environment in waiting areas has been shown to be significantly associated with higher perceived quality of care, less anxiety, and higher reported positive interaction with staff. Can positive distractions in waiting areas improve the waiting experience, as indicated by the behavior and activities of children waiting for treatment? Five distraction conditions were randomly introduced in the waiting area of the dental and cardiac clinics of a major pediatric tertiary care center through a single plasma screen intervention. The attention, behavior, and activities of waiting children were recorded. Data on 158 pediatric patients were collected over 12 days during December 2008 and January 2009. Data analysis shows that the introduction of distraction conditions was associated with more calm behavior and less fine and gross movement, suggesting significant calming effects associated with the distraction conditions. Data also suggest that positive distraction conditions are significant attention grabbers and could be an important contributor to improving the waiting experience for children in hospitals by improving environmental attractiveness.

The Empowering Role of Mobile Apps in Behavior Change Interventions: The Gray Matters Randomized Controlled Trial.

PubMed

Hartin, Phillip J; Nugent, Chris D; McClean, Sally I; Cleland, Ian; Tschanz, JoAnn T; Clark, Christine J; Norton, Maria C

2016-08-02

Health education and behavior change programs targeting specific risk factors have demonstrated their effectiveness in reducing the development of future diseases. Alzheimer disease (AD) shares many of the same risk factors, most of which can be addressed via behavior change. It is therefore theorized that a behavior change intervention targeting these risk factors would likely result in favorable rates of AD prevention. The objective of this study was to reduce the future risk of developing AD, while in the short term promoting vascular health, through behavior change. The study was an interventional randomized controlled trial consisting of subjects who were randomly assigned into either treatment (n=102) or control group (n=42). Outcome measures included various blood-based biomarkers, anthropometric measures, and behaviors related to AD risk. The treatment group was provided with a bespoke "Gray Matters" mobile phone app designed to encourage and facilitate behavior change. The app presented evidence-based educational material relating to AD risk and prevention strategies, facilitated self-reporting of behaviors across 6 behavioral domains, and presented feedback on the user's performance, calculated from reported behaviors against recommended guidelines. This paper explores the rationale for a mobile phone-led intervention and details the app's effect on behavior change and subsequent clinical outcomes. Via the app, the average participant submitted 7.3 (SD 3.2) behavioral logs/day (n=122,719). Analysis of these logs against primary outcome measures revealed that participants who improved their high-density lipoprotein cholesterol levels during the study duration answered a statistically significant higher number of questions per day (mean 8.30, SD 2.29) than those with no improvement (mean 6.52, SD 3.612), t97.74=-3.051, P=.003. Participants who decreased their body mass index (BMI) performed significantly better in attaining their recommended daily goals (mean 56.21 SD 30.4%) than those who increased their BMI (mean 40.12 SD 29.1%), t80 = -2.449, P=.017. In total, 69.2% (n=18) of those who achieved a mean performance percentage of 60% or higher, across all domains, reduced their BMI during the study, whereas 60.7% (n=34) who did not, increased their BMI. One-way analysis of variance of systolic blood pressure category changes showed a significant correlation between reported efforts to reduce stress and category change as a whole, P=.035. An exit survey highlighted that respondents (n=83) reported that the app motivated them to perform physical activity (85.4%) and make healthier food choices (87.5%). In this study, the ubiquitous nature of the mobile phone excelled as a delivery platform for the intervention, enabling the dissemination of educational intervention material while simultaneously monitoring and encouraging positive behavior change, resulting in desirable clinical effects. Sustained effort to maintain the achieved behaviors is expected to mitigate future AD risk. ClinicalTrails.gov NCT02290912; https://clinicaltrials.gov/ct2/show/NCT02290912 (Archived by WebCite at http://www.webcitation.org/6ictUEwnm).

The Empowering Role of Mobile Apps in Behavior Change Interventions: The Gray Matters Randomized Controlled Trial

PubMed Central

Nugent, Chris D; McClean, Sally I; Cleland, Ian; Tschanz, JoAnn T; Clark, Christine J; Norton, Maria C

2016-01-01

Background Health education and behavior change programs targeting specific risk factors have demonstrated their effectiveness in reducing the development of future diseases. Alzheimer disease (AD) shares many of the same risk factors, most of which can be addressed via behavior change. It is therefore theorized that a behavior change intervention targeting these risk factors would likely result in favorable rates of AD prevention. Objective The objective of this study was to reduce the future risk of developing AD, while in the short term promoting vascular health, through behavior change. Methods The study was an interventional randomized controlled trial consisting of subjects who were randomly assigned into either treatment (n=102) or control group (n=42). Outcome measures included various blood-based biomarkers, anthropometric measures, and behaviors related to AD risk. The treatment group was provided with a bespoke “Gray Matters” mobile phone app designed to encourage and facilitate behavior change. The app presented evidence-based educational material relating to AD risk and prevention strategies, facilitated self-reporting of behaviors across 6 behavioral domains, and presented feedback on the user’s performance, calculated from reported behaviors against recommended guidelines. Results This paper explores the rationale for a mobile phone–led intervention and details the app’s effect on behavior change and subsequent clinical outcomes. Via the app, the average participant submitted 7.3 (SD 3.2) behavioral logs/day (n=122,719). Analysis of these logs against primary outcome measures revealed that participants who improved their high-density lipoprotein cholesterol levels during the study duration answered a statistically significant higher number of questions per day (mean 8.30, SD 2.29) than those with no improvement (mean 6.52, SD 3.612), t97.74=−3.051, P=.003. Participants who decreased their body mass index (BMI) performed significantly better in attaining their recommended daily goals (mean 56.21 SD 30.4%) than those who increased their BMI (mean 40.12 SD 29.1%), t80 = −2.449, P=.017. In total, 69.2% (n=18) of those who achieved a mean performance percentage of 60% or higher, across all domains, reduced their BMI during the study, whereas 60.7% (n=34) who did not, increased their BMI. One-way analysis of variance of systolic blood pressure category changes showed a significant correlation between reported efforts to reduce stress and category change as a whole, P=.035. An exit survey highlighted that respondents (n=83) reported that the app motivated them to perform physical activity (85.4%) and make healthier food choices (87.5%). Conclusions In this study, the ubiquitous nature of the mobile phone excelled as a delivery platform for the intervention, enabling the dissemination of educational intervention material while simultaneously monitoring and encouraging positive behavior change, resulting in desirable clinical effects. Sustained effort to maintain the achieved behaviors is expected to mitigate future AD risk. Trial Registration ClinicalTrails.gov NCT02290912; https://clinicaltrials.gov/ct2/show/NCT02290912 (Archived by WebCite at http://www.webcitation.org/6ictUEwnm) PMID:27485822

Factors associated with behavioral problems and cognitive impairment in children with epilepsy of Kinshasa, Democratic Republic of the Congo.

PubMed

Matonda-Ma-Nzuzi, Thierry; Mampunza Ma Miezi, Samuel; Mpembi, Magloire Nkosi; Mvumbi, Diane Muanza; Aloni, Michel Ntentani; Malendakana, Fanny; Mpaka Mbeya, Davin; Lelo, Gilbert Mananga; Charlier-Mikolajczak, Dominique

2018-01-01

Behavioral problems and cognitive impairment are common in children with epilepsy (CWE). In sub-Saharan Africa, little is known about these comorbidities particularly their relationships with socioeconomic features. The goal of this study was to identify clinical and socioeconomic factors associated with behavioral problems and cognitive impairment in CWE of Kinshasa (Democratic Republic of the Congo). This cross-sectional hospital-based study had included 104 CWE aged 6 to 17years. Behavioral problems were assessed by the child behavior checklist. The Wechsler nonverbal scale of ability was used to assess cognitive impairment. At least one behavioral problem was found in 34.6% of CWE. Internalized problems were increasing with father's age (p=0.034). Externalized problems were increasing with the decreased of mother's age (p=0.009) and with a previous antiepileptic treatment (p=0.032). Total behavioral problems were increasing with a previous antiepileptic treatment (p=0.029). Cognitive impairment was present in 73.3% of CWE. It was more common in boys (p=0.013), and it was increasing with a low household daily expenses (p=0.034), with a previous antiepileptic treatment (p=0.041), with an early onset of epileptic seizures (p=0.042), and with a high frequency of epileptic seizures (p=0.011). Behavioral problems and cognitive impairment are common in CWE. Multivariate analysis has shown that behavioral problems were associated with socioeconomic features only. Contrariwise, cognitive impairment was associated with both socioeconomic factors and clinical features. There is a need of more studies to improve knowledge of these comorbidities in the sub-Saharan Africa context. Copyright © 2017 Elsevier Inc. All rights reserved.

Conceptual framework for behavioral and social science in HIV vaccine clinical research

PubMed Central

Lau, Chuen-Yen; Swann, Edith M.; Singh, Sagri; Kafaar, Zuhayr; Meissner, Helen I.; Stansbury, James P.

2011-01-01

HIV vaccine clinical research occurs within a context where biomedical science and social issues are interlinked. Previous HIV vaccine research has considered behavioral and social issues, but often treated them as independent of clinical research processes. Systematic attention to the intersection of behavioral and social issues within a defined clinical research framework is needed to address gaps, such as those related to participation in trials, completion of trials, and the overall research experience. Rigorous attention to these issues at project inception can inform trial design and conduct by matching research approaches to the context in which trials are to be conducted. Conducting behavioral and social sciences research concurrent with vaccine clinical research is important because it can help identify potential barriers to trial implementation, as well as ultimate acceptance and dissemination of trial results. We therefore propose a conceptual framework for behavioral and social science in HIV vaccine clinical research and use examples from the behavioral and social science literature to demonstrate how the model can facilitate identification of significant areas meriting additional exploration. Standardized use of the conceptual framework could improve HIV vaccine clinical research efficiency and relevance. PMID:21821083

Conceptual framework for behavioral and social science in HIV vaccine clinical research.

PubMed

Lau, Chuen-Yen; Swann, Edith M; Singh, Sagri; Kafaar, Zuhayr; Meissner, Helen I; Stansbury, James P

2011-10-13

HIV vaccine clinical research occurs within a context where biomedical science and social issues are interlinked. Previous HIV vaccine research has considered behavioral and social issues, but often treated them as independent of clinical research processes. Systematic attention to the intersection of behavioral and social issues within a defined clinical research framework is needed to address gaps, such as those related to participation in trials, completion of trials, and the overall research experience. Rigorous attention to these issues at project inception can inform trial design and conduct by matching research approaches to the context in which trials are to be conducted. Conducting behavioral and social sciences research concurrent with vaccine clinical research is important because it can help identify potential barriers to trial implementation, as well as ultimate acceptance and dissemination of trial results. We therefore propose a conceptual framework for behavioral and social science in HIV vaccine clinical research and use examples from the behavioral and social science literature to demonstrate how the model can facilitate identification of significant areas meriting additional exploration. Standardized use of the conceptual framework could improve HIV vaccine clinical research efficiency and relevance. Published by Elsevier Ltd.

Support in Clinical Settings as Perceived by Nursing Students in Iran: A Qualitative Study

PubMed Central

Joolaee, Soodabeh; Ashghali Farahani, Mansoureh; Jafarian Amiri, Seyedeh Roghayeh; Varaei, Shokoh

2016-01-01

Background Although support is one of the most substantial needs of nursing students during clinical education, it is not clearly defined in the literature. Objectives The current study aimed to explore the concept of support in clinical settings as perceived by nursing students. Materials and Methods A qualitative content analysis was used to explore the meaning of student support in clinical settings. A purposive sampling with maximum variation was used to select the participants among bachelor nursing students in the nursing school of Babol University of Medical Sciences in the north of Iran. Semi-structured interviews were conducted to gather the perceptions and experiences of seventeen nursing students. Conventional content analysis was applied to analyze the data. Results In the current study, the main theme, nurturance, was emerged with seven subthemes of humanistic behavior with the student, respectful communication with students, accepting the student in the clinical setting, sustaining confidence, need based supervision, accepting the profession in the society and empowerment. Conclusions Nursing students support in the clinical education requires a nurturing care; a care that leads to the sense of worthiness and respectability in students and contributes to the improvement of their clinical abilities. PMID:27331057

Educational Outcomes Associated With School Behavioral Health Interventions: A Review of the Literature.

PubMed

Kase, Courtney; Hoover, Sharon; Boyd, Gina; West, Kristina D; Dubenitz, Joel; Trivedi, Pamala A; Peterson, Hilary J; Stein, Bradley D

2017-07-01

There is an unmet need for behavioral health support and services among children and adolescents, which school behavioral health has the potential to address. Existing reviews and meta-analyses document the behavioral health benefits of school behavioral health programs and frameworks, but few summaries of the academic benefits of such programs exist. We provide exemplars of the academic benefits of school behavioral health programs and frameworks. A literature review identified school behavioral health-related articles and reports. Articles for inclusion were restricted to those that were school-based programs and frameworks in the United States that included an empirical evaluation of intervention academic-related outcomes. Findings from 36 primary research, review, and meta-analysis articles from the past 17 years show the benefits of school behavioral health clinical interventions and targeted interventions on a range of academic outcomes for adolescents. Our findings are consistent with reports documenting health benefits of school behavioral health frameworks and programs and can facilitate further efforts to support school behavioral health for a range of stakeholders interested in the benefits of school behavioral health programs and frameworks on academic outcomes. © 2017, American School Health Association.

Early sexual behavior in a sample of low-income, African American Children.

PubMed

Thigpen, Jeffry W

2009-01-01

This study describes the sexual behavior of 2- to 12-year-old African American children without known histories of sexual abuse and explores the relation of this behavior to gender and age. Primary caregivers were recruited from a public "Well Child" clinic and administered the Child Sexual Behavior Inventory (CSBI), a parental report measure that assesses a broad range of childhood sexual behaviors within 9 specific domains. CSBI data were collected on 249 African American children. Results indicate that African American children display a broad range of sexual behavior that was not reported to frequently occur. Sexual behaviors that involved requesting, planning, or forcing other children and adults into sexual activity were not reported. Although significant differences were not found between frequency levels of sexual behavior reported for boys and girls, the range of sexual behavior observed and reported for girls was narrower in comparison to boys. Significant differences were found between frequency levels of sexual behavior observed and reported for children of different ages. Analysis of the behavioral differences found between children of different ages indicates the emergence of a marked interest in sexuality as African American children approached puberty.

Developing and Piloting a Form for Student Assessment of Faculty Professionalism

ERIC Educational Resources Information Center

Todhunter, Sarah; Cruess, Sylvia R.; Cruess, Richard L.; Young, Meredith; Steinert, Yvonne

2011-01-01

One of the impediments to teaching professionalism is unprofessional behavior amongst clinical teachers. No method of reliably assessing the professional behavior of clinical teachers has yet been reported. The aim of this project was to develop and pilot such a tool. Thirty-four desirable professional behaviors in clinical teachers were…

Lifestyle and Clinical Health Behaviors and PSA Tests

ERIC Educational Resources Information Center

Norris, Cynthia; McFall, Stephanie

2006-01-01

This study assessed the association of lifestyle and clinical health behaviors with prostate specific antigen (PSA) tests. The study used cross-sectional data from the 2002 Behavioral Risk Factor Surveillance System (BRFSS). We used Stata 8.0 to take into account the complex sample design in analyses. Both lifestyle and clinical health behaviors…

Psycho-Cognitive Intervention for ASD from Cross-Species Behavioral Analyses of Infants, Chicks and Common Marmosets.

PubMed

Koshiba, Mamiko; Karino, Genta; Mimura, Koki; Nakamura, Shun; Yui, Kunio; Kunikata, Tetsuya; Yamanouchi, Hideo

2016-01-01

Educational treatment to support social development of children with autism spectrum disorder (ASD) is an important topic in developmental psychiatry. However, it remains difficult to objectively quantify the socio-emotional development of ASD children. To address this problem, we developed a novel analytical method that assesses subjects' complex behaviors using multivariate analysis, 'Behavior Output analysis for Quantitative Emotional State Translation' (BOUQUET). Here, we examine the potential for psycho-cognitive ASD therapy based on comparative evaluations of clinical (human) and experimental (animal) models. Our observations of ASD children (vs. their normally developing siblings) and the domestic chick in socio-sensory deprivation models show the importance of unimodal sensory stimulation, particularly important for tactile- and auditory-biased socialization. Identifying psycho-cognitive elements in early neural development, human newborn infants in neonatal intensive care unit as well as a New World monkey, the common marmoset, also prompted us to focus on the development of voluntary movement against gravity. In summary, striking behavioral similarities between children with ASD and domestic chicks' socio-sensory deprivation models support the role of multimodal sensory-motor integration as a prerequisite step for normal development of socio-emotional and psycho-cognitive functions. Data obtained in the common marmoset model also suggest that switching from primitive anti-gravity reflexes to complex voluntary movement may be a critical milestone for psycho-cognitive development. Combining clinical findings with these animal models, and using multivariate integrative analyses may facilitate the development of effective interventions to improve social functions in infants and in children with neurodevelopmental disorders.

Behavioral Training as New Treatment for Adult Amblyopia: A Meta-Analysis and Systematic Review.

PubMed

Tsirlin, Inna; Colpa, Linda; Goltz, Herbert C; Wong, Agnes M F

2015-06-01

New behavioral treatment methods, including dichoptic training, perceptual learning, and video gaming, have been proposed to improve visual function in adult amblyopia. Here, we conducted a meta-analysis of these methods to investigate the factors involved in amblyopia recovery and their clinical significance. Mean and individual participant data meta-analyses were performed on 24 studies using the new behavioral methods in adults. Studies were identified using PubMed, Google Scholar, and published reviews. The new methods yielded a mean improvement in visual acuity of 0.17 logMAR with 32% participants achieving gains ≥ 0.2 logMAR, and a mean improvement in stereo sensitivity of 0.01 arcsec-1 with 42% of participants improving ≥2 octaves. The most significant predictor of treatment outcome was visual acuity at the onset of treatment. Participants with more severe amblyopia improved more on visual acuity and less on stereo sensitivity than those with milder amblyopia. Better initial stereo sensitivity was a predictor of greater gains in stereo sensitivity following treatment. Treatment type, amblyopia type, age, and training duration did not have any significant influence on visual and stereo acuity outcomes. Our analyses showed that some participants may benefit from the new treatments; however, clinical trials are required to confirm these findings. Despite the diverse nature of the new behavioral methods, the lack of significant differences in visual and stereo sensitivity outcomes among them suggests that visual attention-a common element among the varied treatment methods-may play an important role in amblyopia recovery.

Tryptophan hydroxylase type 2 variants modulate severity and outcome of addictive behaviors in Parkinson's disease.

PubMed

Cilia, Roberto; Benfante, Roberta; Asselta, Rosanna; Marabini, Laura; Cereda, Emanuele; Siri, Chiara; Pezzoli, Gianni; Goldwurm, Stefano; Fornasari, Diego

2016-08-01

Impulse control disorders and compulsive medication intake may occur in a minority of patients with Parkinson's disease (PD). We hypothesize that genetic polymorphisms associated with addiction in the general population may increase the risk for addictive behaviors also in PD. Sixteen polymorphisms in candidate genes belonging to five neurotransmitter systems (dopaminergic, catecholaminergic, serotonergic, glutamatergic, opioidergic) and the BDNF were screened in 154 PD patients with addictive behaviors and 288 PD control subjects. Multivariate analysis investigated clinical and genetic predictors of outcome (remission vs. persistence/relapse) after 1 year and at the last follow-up (5.1 ± 2.5 years). Addictive behaviors were associated with tryptophan hydroxylase type 2 (TPH2) and dopamine transporter gene variants. A subsequent analysis within the group of cases showed a robust association between TPH2 genotype and the severity of addictive behaviors, which survived Bonferroni correction for multiple testing. At multivariate analysis, TPH2 genotype resulted the strongest predictor of no remission at the last follow-up (OR[95%CI], 7.4[3.27-16.78] and 13.2[3.89-44.98] in heterozygous and homozygous carriers, respectively, p < 0.001). The extent of medication dose reduction was not a predictor. TPH2 haplotype analysis confirmed the association with more severe symptoms and lower remission rates in the short- and the long-term (p < 0.005 for all analyses). The serotonergic system is likely to be involved in the pathophysiology of addictive behaviors in PD, modulating the severity of symptoms and the rate of remission at follow-up. If confirmed in larger independent cohorts, TPH2 genotype may become a useful biomarker for the identification of at-risk individuals. Copyright © 2016 Elsevier Ltd. All rights reserved.

How Primary Care Providers Talk to Patients about Genome Sequencing Results: Risk, Rationale, and Recommendation.

PubMed

Vassy, Jason L; Davis, J Kelly; Kirby, Christine; Richardson, Ian J; Green, Robert C; McGuire, Amy L; Ubel, Peter A

2018-06-01

Genomics will play an increasingly prominent role in clinical medicine. To describe how primary care physicians (PCPs) discuss and make clinical recommendations about genome sequencing results. Qualitative analysis. PCPs and their generally healthy patients undergoing genome sequencing. Patients received clinical genome reports that included four categories of results: monogenic disease risk variants (if present), carrier status, five pharmacogenetics results, and polygenic risk estimates for eight cardiometabolic traits. Patients' office visits with their PCPs were audio-recorded, and summative content analysis was used to describe how PCPs discussed genomic results. For each genomic result discussed in 48 PCP-patient visits, we identified a "take-home" message (recommendation), categorized as continuing current management, further treatment, further evaluation, behavior change, remembering for future care, or sharing with family members. We analyzed how PCPs came to each recommendation by identifying 1) how they described the risk or importance of the given result and 2) the rationale they gave for translating that risk into a specific recommendation. Quantitative analysis showed that continuing current management was the most commonly coded recommendation across results overall (492/749, 66%) and for each individual result type except monogenic disease risk results. Pharmacogenetics was the most common result type to prompt a recommendation to remember for future care (94/119, 79%); carrier status was the most common type prompting a recommendation to share with family members (45/54, 83%); and polygenic results were the most common type prompting a behavior change recommendation (55/58, 95%). One-fifth of recommendation codes associated with monogenic results were for further evaluation (6/24, 25%). Rationales for these recommendations included patient context, family context, and scientific/clinical limitations of sequencing. PCPs distinguish substantive differences among categories of genome sequencing results and use clinical judgment to justify continuing current management in generally healthy patients with genomic results.

Longitudinal Effects of Activities, Social Environment, and Psychotropic Medication Use on Behavioral Symptoms of Individuals With Alzheimer's Disease in Nursing Homes.

PubMed

Inventor, Ben R; Farran, Carol J; Paun, Olimpia; Cothran, Fawn; Rajan, Kumar; Swantek, Sandra S; McCann, Judith J

2018-05-08

A secondary data analysis of 25,560 minutes of structured clinical observations from a longitudinal study examined the impact of time-varying background factors, social environment, and psychotropic medication use on behavioral symptoms of nursing home residents with Alzheimer's disease (AD). Data were collected at baseline (N = 177), 12 months (N = 138), and 24 months (N = 111). Mixed-effects regression modeling showed that at 24 months: (a) higher cognitive and physical function and having a private bedroom/bathroom had the most positive influence on resident positive behaviors; (b) use of antipsychotic medications and solitary activities had the most negative influence on resident positive behaviors; (c) higher cognitive function significantly decreased negative behaviors; and (d) care-related activities and total number of psychotropic medications significantly increased negative behaviors. The current study describes risk factors for behavioral disturbances and the impact of activities, social environment, and psychotropic medications on behavioral outcomes in nursing home residents with AD. [Journal of Psychosocial Nursing and Mental Health Services, xx(x), xx-xx.]. Copyright 2018, SLACK Incorporated.

Understanding self-monitoring of blood glucose among individuals with type 1 and type 2 diabetes: an information-motivation-behavioral skills analysis.

PubMed

Fisher, William A; Kohut, Taylor; Schachner, Holly; Stenger, Patricia

2011-01-01

To evaluate self-monitoring of blood glucose (SMBG) information deficits, motivational obstacles, and behavioral skills limitations in individuals with type 1 and type 2 diabetes, and to assess the relationship of these deficits with SMBG frequency. Individuals with type 1 (n = 208; 103 male, 105 female) and type 2 (n = 218; 107 male, 111 female) diabetes participated in an online survey assessing SMBG information, motivation, behavioral skills, and behavior. A substantial proportion of participants scored as SMBG uninformed, unmotivated, and unskilled on specific assessment items. SMBG information, motivation, and behavioral skills deficits were significantly correlated with SMBG frequency, such that individuals with type 1 or type 2 diabetes, who were less informed, less motivated, and less behaviorally skilled, reported lower frequency of SMBG. Common and consequential SMBG information, motivation, and behavioral skills deficits were present, and patients with these gaps were less likely to test frequently. Clinical education focusing on relevant SMBG information, motivation to act, and behavioral skills for acting effectively may be a priority.

Predictors of obturator functioning and satisfaction in Turkish patients using an obturator prosthesis after maxillectomy.

PubMed

Ozdemir-Karatas, Meltem; Balik, Ali; Evlioglu, Gülümser; Uysal, Ömer; Peker, Kadriye

2018-03-01

The aim of this study was to determine the sociodemographic, behavioral, and clinical factors affecting obturator function and satisfaction using the obturator functioning scale (OFS) in maxillectomy patients rehabilitated with obturator prostheses. The study sample consisted of 41 maxillectomy patients. The OFS was translated into Turkish and adapted for assessing obturator functioning and patient satisfaction among Turkish patients. Data were collected from patients' medical records and self-completed questionnaires, including the Turkish version of the OFS, sociodemographic and behavioral characteristics. Descriptive statistics, Mann-Whitney U test, Spearman's correlation coefficient, and backward stepwise multiple linear regression were used for data analysis. Internal consistency (Cronbach's alpha = 0.85) and test-retest reliability (intraclass correlation coefficient = 0.86) were acceptable for the OFS. The most frequently reported problem was "difficulty chewing." Bivariate analysis revealed significant differences in total OFS scores in terms of surgery type, defect size, and education level, except for the other clinical and sociodemographic characteristics and behavioral factors. Education level and surgery type were found to be the most important predictors of patient satisfaction and functioning of the obturator. The Turkish version of the OFS might be a useful tool for clinicians to identify patients who are at risk for poor functioning of the obturator, lack of satisfaction, and unmet needs. Copyright © 2017 Elsevier Inc. All rights reserved.

Longevity of metal-ceramic crowns cemented with self-adhesive resin cement: a prospective clinical study

PubMed

Brondani, Lucas Pradebon; Pereira-Cenci, Tatiana; Wandsher, Vinicius Felipe; Pereira, Gabriel Kalil; Valandro, Luis Felipe; Bergoli, César Dalmolin

2017-04-10

Resin cements are often used for single crown cementation due to their physical properties. Self-adhesive resin cements gained widespread due to their simplified technique compared to regular resin cement. However, there is lacking clinical evidence about the long-term behavior of this material. The aim of this prospective clinical trial was to assess the survival rates of metal-ceramic crowns cemented with self-adhesive resin cement up to six years. One hundred and twenty-nine subjects received 152 metal-ceramic crowns. The cementation procedures were standardized and performed by previously trained operators. The crowns were assessed as to primary outcome (debonding) and FDI criteria. Statistical analysis was performed using Kaplan-Meier statistics and descriptive analysis. Three failures occurred (debonding), resulting in a 97.6% survival rate. FDI criteria assessment resulted in scores 1 and 2 (acceptable clinical evaluation) for all surviving crowns. The use of self-adhesive resin cement is a feasible alternative for metal-ceramic crowns cementation, achieving high and adequate survival rates.

Video capture of clinical care to enhance patient safety

PubMed Central

Weinger, M; Gonzales, D; Slagle, J; Syeed, M

2004-01-01



 Experience from other domains suggests that videotaping and analyzing actual clinical care can provide valuable insights for enhancing patient safety through improvements in the process of care. Methods are described for the videotaping and analysis of clinical care using a high quality portable multi-angle digital video system that enables simultaneous capture of vital signs and time code synchronization of all data streams. An observer can conduct clinician performance assessment (such as workload measurements or behavioral task analysis) either in real time (during videotaping) or while viewing previously recorded videotapes. Supplemental data are synchronized with the video record and stored electronically in a hierarchical database. The video records are transferred to DVD, resulting in a small, cheap, and accessible archive. A number of technical and logistical issues are discussed, including consent of patients and clinicians, maintaining subject privacy and confidentiality, and data security. Using anesthesiology as a test environment, over 270 clinical cases (872 hours) have been successfully videotaped and processed using the system. PMID:15069222

‘Someday it will be the norm’: physician perspectives on the utility of genome sequencing for patient care in the MedSeq Project

PubMed Central

Vassy, Jason L; Christensen, Kurt D; Slashinski, Melody J; Lautenbach, Denise M; Raghavan, Sridharan; Robinson, Jill Oliver; Blumenthal-Barby, Jennifer; Feuerman, Lindsay Zausmer; Lehmann, Lisa Soleymani; Murray, Michael F; Green, Robert C; McGuire, Amy L

2015-01-01

Aim To describe practicing physicians’ perceived clinical utility of genome sequencing. Materials & methods We conducted a mixed-methods analysis of data from 18 primary care physicians and cardiologists in a study of the clinical integration of whole-genome sequencing. Physicians underwent brief genomics continuing medical education before completing surveys and semi-structured interviews. Results Physicians described sequencing as currently lacking clinical utility because of its uncertain interpretation and limited impact on clinical decision-making, but they expressed the idea that its clinical integration was inevitable. Potential clinical uses for sequencing included complementing other clinical information, risk stratification, motivating patient behavior change and pharmacogenetics. Conclusion Physicians given genomics continuing medical education use the language of both evidence-based and personalized medicine in describing the utility of genome-wide testing in patient care. PMID:25642274

Maximizing Effectiveness Trials in PTSD and SUD Through Secondary Analysis: Benefits and Limitations Using the National Institute on Drug Abuse Clinical Trials Network "Women and Trauma" Study as a Case Example.

PubMed

Hien, Denise A; Campbell, Aimee N C; Ruglass, Lesia M; Saavedra, Lissette; Mathews, Abigail G; Kiriakos, Grace; Morgan-Lopez, Antonio

2015-09-01

Recent federal legislation and a renewed focus on integrative care models underscore the need for economical, effective, and science-based behavioral health care treatment. As such, maximizing the impact and reach of treatment research is of great concern. Behavioral health issues, including the frequent co-occurrence of substance use disorders (SUD) and posttraumatic stress disorder (PTSD), are often complex, with a myriad of factors contributing to the success of interventions. Although treatment guides for comorbid SUD/PTSD exist, most patients continue to suffer symptoms following the prescribed treatment course. Further, the study of efficacious treatments has been hampered by methodological challenges (e.g., overreliance on "superiority" designs (i.e., designs structured to test whether or not one treatment statistically surpasses another in terms of effect sizes) and short term interventions). Secondary analyses of randomized controlled clinical trials offer potential benefits to enhance understanding of findings and increase the personalization of treatment. This paper offers a description of the limits of randomized controlled trials as related to SUD/PTSD populations, highlights the benefits and potential pitfalls of secondary analytic techniques, and uses a case example of one of the largest effectiveness trials of behavioral treatment for co-occurring SUD/PTSD conducted within the National Drug Abuse Treatment Clinical Trials Network (NIDA CTN) and producing 19 publications. The paper concludes with implications of this secondary analytic approach to improve addiction researchers' ability to identify best practices for community-based treatment of these disorders. Innovative methods are needed to maximize the benefits of clinical studies and better support SUD/PTSD treatment options for both specialty and non-specialty healthcare settings. Moving forward, planning for and description of secondary analyses in randomized trials should be given equal consideration and care to the primary outcome analysis. Copyright © 2015 Elsevier Inc. All rights reserved.

Treatment dropout and missed appointments among adults with attention-deficit/hyperactivity disorder: associations with patient- and disorder-related factors.

PubMed

Soendergaard, Helle M; Thomsen, Per H; Pedersen, Pernille; Pedersen, Erik; Poulsen, Agnethe E; Nielsen, Jette M; Winther, Lars; Henriksen, Anne; Rungoe, Berit; Soegaard, Hans J

2016-02-01

Knowledge of factors associated with treatment dropout and missed appointments in adults with attention-deficit/hyperactivity disorder (ADHD) is very limited. On the basis of proposed hypotheses that past behavior patterns are more predictive of current behaviors of treatment dropout and missed appointments than are sociodemographic and clinical characteristics, we examined the associations of sociodemographic variables, clinical variables, risk-taking behavior, educational and occupational instability, and behaviors during mandatory schooling with the primary outcome measures of treatment dropout and missed appointments. In a naturalistic cohort study of 151 adult outpatients with ADHD initiating assessment in a Danish ADHD unit from September 1, 2010, to September 1, 2011, the Adult ADHD Self-Report Scale v1.1 symptom checklist (ASRS) and a thorough clinical interview were used to assess ADHD according to DSM-IV-TR criteria. Stepwise logistic regression analysis was used to estimate reported associations. A total of 27% of patients dropped out of treatment and a total of 42% had ≥ 3 missed appointments during treatment. Mood and anxiety disorders significantly lowered the odds of treatment dropout (odds ratio [OR] = 0.18; 95% confidence interval [CI], 0.05-0.65), whereas having started but not completed 2 or more educational programs apart from mandatory schooling significantly increased the odds of dropout (OR = 3.01; 95% CI, 1.32-6.89). Variables significantly associated with most missed appointments were low educational level (OR = 2.19; 95% CI, 1.12-4.31), 3 or more employments of less than 3 months' duration (OR = 2.86; 95% CI, 1.30-6.28), and having skipped class often/very often during mandatory schooling (OR = 2.65; 95% CI, 1.29-5.43). Additionally, the predominantly inattentive ADHD (ADHD-I) subtype lowered the odds of missed appointments (OR = 0.17; 95% CI, 0.05-0.62). Our results suggest that past behavior in terms of highest dropout rates in the educational and occupational systems and highest rates of skipping class during mandatory schooling is equally associated with current behavior of treatment dropout and missed appointments as are sociodemographic and clinical factors. ClinicalTrials.gov identifier: NCT02226445. © Copyright 2015 Physicians Postgraduate Press, Inc.

Alterations in White Matter Integrity in Young Adults with Smartphone Dependence

PubMed Central

Hu, Yuanming; Long, Xiaojing; Lyu, Hanqing; Zhou, Yangyang; Chen, Jianxiang

2017-01-01

Smartphone dependence (SPD) is increasingly regarded as a psychological problem, however, the underlying neural substrates of SPD is still not clear. High resolution magnetic resonance imaging provides a useful tool to help understand and manage the disorder. In this study, a tract-based spatial statistics (TBSS) analysis on diffusion tensor imaging (DTI) was used to measure white matter integrity in young adults with SPD. A total of 49 subjects were recruited and categorized into SPD and control group based on their clinical behavioral tests. To localize regions with abnormal white matter integrity in SPD, the voxel-wise analysis of fractional anisotropy (FA) and mean diffusivity (MD) on the whole brain was performed by TBSS. The correlation between the quantitative variables of brain structures and the behavior measures were performed. Our result demonstrated that SPD had significantly lower white matter integrity than controls in superior longitudinal fasciculus (SLF), superior corona radiata (SCR), internal capsule, external capsule, sagittal stratum, fornix/stria terminalis and midbrain structures. Correlation analysis showed that the observed abnormalities in internal capsule and stria terminalis were correlated with the severity of dependence and behavioral assessments. Our finding facilitated a primary understanding of white matter characteristics in SPD and indicated that the structural deficits might link to behavioral impairments. PMID:29163108

A Latent Class Analysis of Weight-Related Health Behaviors among 2- and 4-year College Students, and Associated Risk of Obesity

PubMed Central

Mathur, C; Stigler, M; Lust, K; Laska, M

2016-01-01

Little is known about the complex patterning of weight-related health behaviors in 2- and 4-year college students. The objective of this study was to identify and describe unique classes of weight-related health behaviors among college youth. Latent class analysis was used to identify homogenous, mutually exclusive classes of nine health behaviors which represent multiple theoretically/clinically relevant dimensions of obesity risk among 2- versus 4-year college students using cross-sectional statewide surveillance data (n= 17,584). Additionally, differences in class membership on selected sociodemographic characteristics were examined using a model-based approach. Analysis was conducted separately for both college groups, and 5 and 4 classes were identified for 2-and 4-year college students, respectively. Four classes were similar across 2-and 4-year college groups and were characterized as “mostly healthy dietary habits, active”, “moderately high screen time, active”, “moderately healthy dietary habits, inactive”, and “moderately high screen time, inactive”. “Moderately healthy dietary habits, high screen time” was the additional class unique to 2-year college students. These classes differed on a number of sociodemographic characteristics, including the proportion in each class who were classified as obese. Implications for prevention scientists and future intervention programs are considered. PMID:24990599

A latent class analysis of weight-related health behaviors among 2- and 4-year college students and associated risk of obesity.

PubMed

Mathur, Charu; Stigler, Melissa; Lust, Katherine; Laska, Melissa

2014-12-01

Little is known about the complex patterning of weight-related health behaviors in 2- and 4-year college students. The objective of this study was to identify and describe unique classes of weight-related health behaviors among college students. Latent class analysis was used to identify homogenous, mutually exclusive classes of nine health behaviors that represent multiple theoretically/clinically relevant dimensions of obesity risk among 2- versus 4-year college students using cross-sectional statewide surveillance data (N = 17,584). Additionally, differences in class membership on selected sociodemographic characteristics were examined using a model-based approach. Analysis was conducted separately for both college groups, and five and four classes were identified for 2- and 4-year college students, respectively. Four classes were similar across 2- and 4-year college groups and were characterized as "mostly healthy dietary habits, active"; "moderately high screen time, active"; "moderately healthy dietary habits, inactive"; and "moderately high screen time, inactive." "Moderately healthy dietary habits, high screen time" was the additional class unique to 2-year college students. These classes differed on a number of sociodemographic characteristics, including the proportion in each class who were classified as obese. Implications for prevention scientists and future intervention programs are considered. © 2014 Society for Public Health Education.

[Modern documentary research on disease menu of acupuncture-moxibustion for mental and behavioral disorder].

PubMed

Hu, You-Ping; Chen, Yong; Xing, Lin; Niu, Bai-Lu; Zhu, Feng-Juan; Han, Jing; Wang, Yu; Bian, Wei; Liu, Cong-Sheng; Wei, Li; Du, Yuan-Hao

2011-10-01

Dominant disease menu of mental and behavioral disorder of acupuncture therapy was summarized and obtained in this article. Literatures on clinical treatment of mental and behavioral disorder with acupuncture were picked up from CBMdisc and CNKI during 1978 to 2007. Types of mental and behavioral disorder and report frequency of each disease treated with acupuncture were counted. And dominant diseases which were favorable to be treated with acupuncture were acquired through analysis and inductive method. Twenty-nine diseases of mental and behavioral disorder are favorable to be treated with acupuncture which were mentioned in totally 1967 related documents. It is found that the number of reports of sleep disorder, depression, hysteria aphronesia, dementia and sexual disorder are ranked as the top five. It is concluded that the preponderant diseases of mental and behavioral disorder treated by acupuncture are dementia, withdrawal syndrome, mental retardation, obsessive-compulsive disorder, sleep disorder, gastrointestinal neurosis (gastrointestinal disorders), depression, alcoholism and globus hystericus.

A multivariate analysis of sex offender recidivism.

PubMed

Scalora, Mario J; Garbin, Calvin

2003-06-01

Sex offender recidivism risk is a multifaceted phenomenon requiring consideration across multiple risk factor domains. The impact of treatment involvement and subsequent recidivism is given limited attention in comparison to other forensic mental health issues. The present analysis is a retrospective study of sex offenders treated at a secure facility utilizing a cognitive-behavioral program matched with an untreated correctional sample. Variables studied included demographic, criminal history, offense related, and treatment progress. Recidivism was assessed through arrest data. Multivariate analysis suggests that recidivism is significantly related to quality of treatment involvement, offender demographics, offense characteristics, and criminal history. Successfully treated offenders were significantly less likely to subsequently reoffend. Recidivists were also significantly younger, less likely married, had engaged in more victim grooming or less violent offending behavior, and had significantly more prior property charges. The authors discuss the clinical and policy implications of the interrelationship between treatment involvement and recidivism.

Some aspects of the anemia of chronic disorders modeled and analyzed by petri net based approach.

PubMed

Formanowicz, Dorota; Sackmann, Andrea; Kozak, Adam; Błażewicz, Jacek; Formanowicz, Piotr

2011-06-01

Anemia of chronic disorders is a very important phenomenon and iron is a crucial factor of this complex process. To better understand this process and its influence on some other factors we have built a mathematical model of the human body iron homeostasis, which possibly most exactly would reflect the metabolism of iron in the case of anemia and inflammation. The model has been formulated in the language of Petri net theory, which allows for its simulation and precise analysis. The obtained results of the analysis of the model's behavior, concerning the influence of anemia and inflammation on the transferrin receptors, and hepcidin concentration changes are the valuable complements to the knowledge following from clinical research. This analysis is one of the first attempts to investigate properties and behavior of a not fully understood biological system on a basis of its Petri net based model.

Disentangling body image: The relative associations of overvaluation, dissatisfaction, and preoccupation with psychological distress and eating disorder behaviors in male and female adolescents.

PubMed

Mitchison, Deborah; Hay, Phillipa; Griffiths, Scott; Murray, Stuart B; Bentley, Caroline; Gratwick-Sarll, Kassandra; Harrison, Carmel; Mond, Jonathan

2017-02-01

The distinctiveness and relative clinical significance of overvaluation, dissatisfaction, and preoccupation with body weight/shape remains inconclusive. This study sought to add to the evidence by testing associations between these three body image constructs and indicators of clinical significance. Male and female secondary students (N = 1,666) aged 12-18 years completed a survey that included measures of dissatisfaction with, overvaluation of, and preoccupation with weight/shape, psychological distress, eating disorder behaviors, and basic demographic information. Conditional process analysis was employed to test the independent and mediating effects of overvaluation, dissatisfaction, and preoccupation on distress, dietary restraint, and objective binge eating. Overvaluation, dissatisfaction, and preoccupation were highly correlated (r = 0.47-0.84). In girls, preoccupation demonstrated the strongest independent and mediating effects on distress, dietary restraint, and binge eating; whereas neither the direct or indirect effects of dissatisfaction on distress and overvaluation on binge eating were significant. Among boys however, the direct and indirect effects of overvaluation, dissatisfaction, and preoccupation on distress and eating disorder behaviors were relatively equal. Preoccupation with weight/shape may be particularly clinically significant in girls, whereas all constructs of body image disturbance may be equally clinically significant in boys. The findings are consistent with the view that these constructs, while closely related, are distinct. © 2016 Wiley Periodicals, Inc.(Int J Eat Disord 2017; 50:118-126). © 2016 Wiley Periodicals, Inc.

A meta-analysis of serious digital games for healthy lifestyle promotion.

PubMed

DeSmet, Ann; Van Ryckeghem, Dimitri; Compernolle, Sofie; Baranowski, Tom; Thompson, Debbe; Crombez, Geert; Poels, Karolien; Van Lippevelde, Wendy; Bastiaensens, Sara; Van Cleemput, Katrien; Vandebosch, Heidi; De Bourdeaudhuij, Ilse

2014-12-01

Several systematic reviews have described health-promoting effects of serious games but so far no meta-analysis has been reported. This paper presents a meta-analysis of 54 serious digital game studies for healthy lifestyle promotion, in which we investigated the overall effectiveness of serious digital games on healthy lifestyle promotion outcomes and the role of theoretically and clinically important moderators. Findings showed that serious games have small positive effects on healthy lifestyles (g=0.260, 95% CI 0.148; 0.373) and their determinants (g=0.334, 95% CI 0.260; 0.407), especially for knowledge. Effects on clinical outcomes were significant, but much smaller (g=0.079, 95% CI 0.038; 0.120). Long-term effects were maintained for all outcomes except for behavior. Serious games are best individually tailored to both socio-demographic and change need information, and benefit from a strong focus on game theories or a dual theoretical foundation in both behavioral prediction and game theories. They can be effective either as a stand-alone or multi-component programs, and appeal to populations regardless of age and gender. Given that effects of games remain heterogeneous, further explorations of which game features create larger effects are needed. Copyright © 2014 Elsevier Inc. All rights reserved.

The effect of therapeutic touch on behavioral symptoms of persons with dementia.

PubMed

Woods, Diana Lynn; Craven, Ruth F; Whitney, Joie

2005-01-01

Approximately 80% of nursing home residents who suffer from Alzheimer's disease and related dementia develop behavioral symptoms of dementia. Given the deleterious side effects of pharmacologic therapy in this population there is an urgent need for clinical trials of nonpharmacologic interventions. To examine the effect of therapeutic touch on the frequency and intensity of behavioral symptoms of dementia. A randomized, double-blind, three-group experimental study: experimental (therapeutic touch), placebo (placebo therapeutic touch), and control (usual care). Fifty-seven residents, aged 67 to 93 years, exhibiting behavioral symptoms of dementia, were randomized to one of the three groups within each of three Special Care Units within three Long-Term Care facilities in a western Canadian province. Behavioral observation was completed every 20 minutes from 8:00AM to 6:00PM for three days pre-intervention and for three days post-intervention by trained observers who were blind to group assignment. The intervention consisted of therapeutic touch given twice daily for 5-7 minutes for three days between 10:00AM and 11:30PM and between 3:00PM and 4:30PM (N = 57). The main outcome variable was overall behavioral symptoms of dementia, consisting of six categories of behaviors: manual manipulation (restlessness), escape restraints, searching and wandering, tapping and banging, pacing and walking, and vocalization. Analysis of variance (ANOVA) (F = 3.331, P = .033) and the Kruskal-Wallis test (chi2 = 6.661, P = .036) indicated a significant difference in overall behavioral symptoms of dementia, manual manipulation and vocalization when the experimental group was compared to the placebo and control groups. The experimental (significant) was more effective in decreasing behavioral symptoms of dementia than usual care, while the placebo group indicated a decreasing trend in behavioral symptoms of dementia compared to usual care. Therapeutic touch offers a nonpharmacological, clinically relevant modality that could be used to decrease behavioral symptoms of dementia, specifically manual manipulation (restlessness) and vocalization, two prevalent behaviors.

Correlates of Healthy Lifestyle Beliefs and Behaviors in Parents of Overweight or Obese Preschool Children Before and After a Cognitive Behavioral Therapy Intervention With Text Messaging.

PubMed

Militello, Lisa K; Melnyk, Bernadette Mazurek; Hekler, Eric; Small, Leigh; Jacobson, Diana

2016-01-01

Significant gaps exist in the published literature regarding the treatment of overweight/obesity in preschool-aged children, especially in primary care settings. Parental influence plays an important factor in the development of healthy behaviors in children, yet there is no consensus about why some behavior change intervention strategies for parents of young children are more influential and effective than others. The purpose of this secondary data analysis was to assess correlations among the study variables (healthy lifestyle beliefs, perceived difficulty, and healthy lifestyle behaviors) in parents of overweight/obese preschool children. A second aim explored if the parent's level of cognitive beliefs and perceived difficulty of engaging in healthy lifestyle behaviors correlated with text messaging cognitive behavioral support. Fifteen preschool-parent dyads from primary care clinics completed a 7-week cognitive behavioral skills building intervention. Beck's Cognitive Theory guided the intervention content, and Fogg's Behavior Model guided the implementation. The intervention was delivered using a combination of face-to-face clinic visits and ecological momentary interventions using text messaging. Supported are the interconnected relationships among the study variables, that is, parental healthy lifestyle beliefs, thoughts, and behaviors. At baseline, parental healthy lifestyle belief scores significantly correlated with perceived difficulty (rs = 0.598, p < .05) and healthy lifestyle behaviors (rs = 0.545, p < .05). These associations strengthened after the intervention. Furthermore, as parental healthy lifestyle beliefs increased and perceived difficulty lessened, their response rate and subsequent feedback lessened to the static text messaging support. Findings from this study support the interconnections between parents' thoughts, feelings, and actions toward healthy lifestyles. As parental beliefs became stronger through cognitive behavioral skills building and tailored text messaging, the need for general support via text messaging lessened, warranting additional research. Published by Elsevier Inc.

The matching law: a tutorial for practitioners.

PubMed

Reed, Derek D; Kaplan, Brent A

2011-01-01

The application of the matching law has historically been limited to use as a quantitative measurement tool in the experimental analysis of behavior to describe temporally extended patterns of behavior-environment relations. In recent years, however, applications of the matching law have been translated to clinical settings and populations to gain a better understanding of how naturally-occurring events affect socially important behaviors. This tutorial provides a brief background of the conceptual foundations of matching, an overview of the various matching equations that have been used in research, and a description of how to interpret the data derived from these equations in the context of numerous examples of matching analyses conducted with socially important behavior. An appendix of resources is provided to direct readers to primary sources, as well as useful articles and books on the topic.

The effectiveness of mindfulness-based interventions for supporting people with intellectual disabilities: a narrative review.

PubMed

Harper, Sarah K; Webb, Thomas L; Rayner, Kelly

2013-05-01

A number of studies have used mindfulness-based interventions to influence the behavior of people with intellectual disabilities, to improve their quality of life, and to reduce challenging behavior. The present review critically evaluates 18 studies and assesses the clinical and academic impact of their findings. Strengths identified included replicable methodological approaches, use of multiple baseline designs, strong construct and criterion validity, and consideration of the mechanisms by which mindfulness influences behavior change. Limitations included a lack of randomized controlled trials, inclusion of qualitative data without structured analysis, limited use of statistical analyses, and problems with sampling leading to difficulties generalizing findings. There was also a paucity of research investigating the impact of "Dialectical Behavior Therapy" and "Acceptance and Commitment Therapy" and the role of mindfulness within these approaches. Further research is warranted in this regard.

Contingency contracting with school problems

PubMed Central

Cantrell, Robert P.; Cantrell, Mary Lynn; Huddleston, Clifton M.; Wooldridge, Ralph L.

1969-01-01

Contingency contracting procedures used in managing problems with school-age children involved analyzing teacher and/or parental reports of behavior problem situations, isolating the most probable contingencies then in effect, the range of reinforcers presently available, and the ways in which they were obtained. The authors prepared written contracts delineating remediative changes in reinforcement contingencies. These contracts specified ways in which the child could obtain existing individualized reinforcers contingent upon approximations to desired appropriate behaviors chosen as incompatible with the referral problem behaviors. Contract procedures were administered by the natural contingency managers, parents and/or teachers, who kept daily records of contracted behaviors and reinforcers. These records were sent to the authors and provided feedback on the progress of the case. Initial results of this procedure have been sufficiently encouraging to warrant recommending an experimental analysis of contingency contracting as a clinical method. PMID:16795222

The Matching Law: A Tutorial for Practitioners

PubMed Central

Kaplan, Brent A

2011-01-01

The application of the matching law has historically been limited to use as a quantitative measurement tool in the experimental analysis of behavior to describe temporally extended patterns of behavior-environment relations. In recent years, however, applications of the matching law have been translated to clinical settings and populations to gain a better understanding of how naturally-occurring events affect socially important behaviors. This tutorial provides a brief background of the conceptual foundations of matching, an overview of the various matching equations that have been used in research, and a description of how to interpret the data derived from these equations in the context of numerous examples of matching analyses conducted with socially important behavior. An appendix of resources is provided to direct readers to primary sources, as well as useful articles and books on the topic. PMID:22649575

The REM Sleep Behavior Disorder Screening Questionnaire: Validation Study of the Korean Version (RBDQ-KR).

PubMed

You, Sooyeoun; Moon, Hye-Jin; Do, So Young; Wing, Yun-Kwok; Sunwoo, Jun-Sang; Jung, Ki-Young; Cho, Yong Won

2017-12-15

REM sleep behavior disorder (RBD) is a parasomnia that is commonly associated with neurodegenerative disorders. We aimed to validate the Hong Kong version of the self-reported RBD questionnaire (RBDQ-HK) with the Korean version (RBDQ-KR) and to investigate its clinical usefulness. One-hundred five patients with RBD and 105 age- and sex-matched controls were enrolled. Thirty were randomly selected for a retest with the questionnaire after 2 to 4 weeks without any treatment. Receiver operating characteristic curve and exploratory factor analysis were used to evaluate the scale, which had a score ranging from 0 to 100. There was no difference in mean age and sex in patients with RBD and control subjects. Patients with RBD had a significantly higher total RBDQ-KR score than the control group ( P < .001). The RBDQ-KR demonstrated high sensitivity (93.3%), specificity (89.5%), positive predictive value (89.9%), and negative predictive value (93.1%). Cronbach α coefficient for internal consistency of the total score of the RBDQ-KR was 0.9, which shows high reliability. Exploratory factor analysis showed two components, dream-related and behavioral factors, consistent with the main clinical features of RBD. Based on the results, the best cutoff for the total score ranging from 0 to 100 was at 18/19 and for factor 2 ranging from 0 to 75 was at 11. This study showed RBDQ-KR is a valid and reliable questionnaire for RBD symptoms and severity in Korea. It serves as an effective tool to identify patients with RBD and to facilitate future clinical and research studies. © 2017 American Academy of Sleep Medicine

Treatment of Suicide Attempters With Bipolar Disorder: A Randomized Clinical Trial Comparing Lithium and Valproate in the Prevention of Suicidal Behavior

PubMed Central

Oquendo, Maria A.; Galfalvy, Hanga C.; Currier, Dianne; Grunebaum, Michael F.; Sher, Leo; Sullivan, Gregory M.; Burke, Ainsley K.; Harkavy-Friedman, Jill; Sublette, M. Elizabeth; Parsey, Ramin V.; Mann, J. John

2013-01-01

Objective Bipolar disorder is associated with high risk for suicidal acts. Observational studies suggest a protective effect of lithium against suicidal behavior. However, testing this effect in randomized clinical trials is logistically and ethically challenging. The authors tested the hypothesis that lithium offers bipolar patients with a history of suicide attempt greater protection against suicidal behavior compared to valproate. Method Patients with bipolar disorder and past suicide attempts (N=98) were randomly assigned to treatment with lithium or valproate, plus adjunctive medications as indicated, in a double-blind 2.5-year trial. An intent-to-treat analysis was performed using the log-rank test for survival data. Two models were fitted: time to suicide attempt and time to suicide event (attempt or hospitalization or change in medication in response to suicide plans). Results There were 45 suicide events in 35 participants, including 18 suicide attempts made by 14 participants, six from the lithium group and eight from the valproate group. There were no suicides. Intent-to-treat analysis using the log-rank test showed no differences between treatment groups in time to suicide attempt or to suicide event. Post hoc power calculations revealed that the modest sample size, reflective of challenges in recruitment, only permits detection of a relative risk of 5 or greater. Conclusions Despite the high frequency of suicide events during the study, this randomized controlled trial detected no difference between lithium and valproate in time to suicide attempt or suicide event in a sample of suicide attempters with bipolar disorder. However, smaller clinically significant differences between the two drugs were not ruled out. PMID:21768611

Congruence of Parents’ and Children’s Perceptions of Parenting: A Meta-analysis

PubMed Central

Korelitz, Katherine E.; Garber, Judy

2016-01-01

Parents and children often report different perspectives about parents’ behaviors. Such lack of congruence is important because it may reflect problems in their relationship and may be associated with children’s maladjustment. We conducted a systematic, quantitative review of parent-child agreement and discrepancy about parenting behaviors, and potential moderators (e.g., children’s age, race, clinical status, family intactness) of the extent of mother-child and father-child congruence. The meta-analyses included 85 studies with 476 effect sizes of the degree of agreement and discrepancy in parent-child reports of three parenting behaviors: acceptance, psychological control, and behavioral control assessed with one of the most widely-used measures of parenting – the Children’s Report of Parent Behavior Inventory (CRPBI). Mother-child and father-child dyads exhibited significant but modest levels of agreement (r) across parenting constructs. The amount and direction of discrepancy (Hedges’ g) varied by the parenting construct and parents’ sex. Overall, parents’ reports were more favorable than their children’s report about the parents’ behaviors. Significant associations were found between the magnitude of agreement/discrepancy and children’s age, race, clinical status, and family intactness. Moderators differed by parenting construct, parents’ sex, and type of effect size. Implications of these findings for researchers and clinicians are discussed and highlight the need for further research about the meaning of parent-child incongruence, its relation to children’s psychopathology, and interventions for reducing it. PMID:27380467

Mobile Technology Interventions for Asthma Self-Management: Systematic Review and Meta-Analysis

PubMed Central

Schüz, Benjamin; Walters, Julia; Walters, E Haydn

2017-01-01

Background Mobile technology interventions (MTI) are becoming increasingly popular in the management of chronic health behaviors. Most MTI allow individuals to monitor medication use, record symptoms, or store and activate disease-management action plans. Therefore, MTI may have the potential to improve low adherence to medication and action plans for individuals with asthma, which is associated with poor clinical outcomes. Objective A systematic review and meta-analysis were conducted to evaluate the efficacy of MTI on clinical outcomes as well as adherence in individuals with asthma. As the use of evidence-based behavior change techniques (BCT) has been shown to improve intervention effects, we also conducted exploratory analyses to determine the role of BCT and engagement with MTI as moderators of MTI efficacy. Methods We searched electronic databases for randomized controlled trials up until June 2016. Random effect models were used to assess the effect of MTI on clinical outcomes as well as adherence to preventer medication or symptom monitoring. Mixed effects models assessed whether the features of the MTI (ie, use of BCT) and how often a person engaged with MTI moderated the effects of MTI. Results The literature search located 11 studies meeting the inclusion criteria, with 9 providing satisfactory data for meta-analysis. Compared with standard treatment, MTI had moderate to large effect sizes (Hedges g) on medication adherence and clinical outcomes. MTI had no additional effects on adherence or clinical outcomes when compared with paper-based monitoring. No moderator effects were found, and the number of studies was small. A narrative review of the two studies, which are not included in the meta-analysis, found similar results. Conclusions This review indicated the efficacy of MTI for self-management in individuals with asthma and also indicated that MTI appears to be as efficacious as paper-based monitoring. This review also suggested a need for robust studies to examine the effects of BCT use and engagement on MTI efficacy to inform the evidence base for MTI in individuals with asthma. PMID:28465281

Childhood Depression: Relation to Adaptive, Clinical and Predictor Variables

PubMed Central

Garaigordobil, Maite; Bernarás, Elena; Jaureguizar, Joana; Machimbarrena, Juan M.

2017-01-01

The study had two goals: (1) to explore the relations between self-assessed childhood depression and other adaptive and clinical variables (2) to identify predictor variables of childhood depression. Participants were 420 students aged 7–10 years old (53.3% boys, 46.7% girls). Results revealed: (1) positive correlations between depression and clinical maladjustment, school maladjustment, emotional symptoms, internalizing and externalizing problems, problem behaviors, emotional reactivity, and childhood stress; and (2) negative correlations between depression and personal adaptation, global self-concept, social skills, and resilience (sense of competence and affiliation). Linear regression analysis including the global dimensions revealed 4 predictors of childhood depression that explained 50.6% of the variance: high clinical maladjustment, low global self-concept, high level of stress, and poor social skills. However, upon introducing the sub-dimensions, 9 predictor variables emerged that explained 56.4% of the variance: many internalizing problems, low family self-concept, high anxiety, low responsibility, low personal self-assessment, high social stress, few aggressive behaviors toward peers, many health/psychosomatic problems, and external locus of control. The discussion addresses the importance of implementing prevention programs for childhood depression at early ages. PMID:28572787

Coping with persistent pain: a comparison of persistent pain sufferers in a specialty pain clinic and in a family practice clinic.

PubMed

Crook, J; Tunks, E; Kalaher, S; Roberts, J

1988-08-01

Coping has been defined as an effort to manage external and internal demands and conflicts that tax or exceed a person's resources. This paper examines the types of coping strategies used by two groups of persistent pain sufferers: one from a family practice clinic and the other from a specialty pain clinic. The relationship between the use of different types of coping strategies and adjustment was determined. The two study groups of persistent pain sufferers differed significantly from each other on many of the indices developed to tap adjustment but did not differ on any of the Billings and Moos original categories of coping strategies. When a factor analysis of coping items was performed, 5 valid clusters relevant to the chronic pain patient samples were determined. The factor the authors entitled 'adversarialness' with the qualities of dysphoric withdrawal, avoidant behavior and catastrophizing was found to explain adjustment defined by several indices. The authors conclude that it may be important to help persistent pain sufferers to alter their attitudes and behavior that tend toward catastrophizing, avoidance and withdrawal, rather than simply concentrate on trying to teach them techniques for 'coping with stress.'

Changes in cerebral blood flow after cognitive behavior therapy in patients with panic disorder: a SPECT study

PubMed Central

Seo, Ho-Jun; Choi, Young Hee; Chung, Yong-An; Rho, Wangku; Chae, Jeong-Ho

2014-01-01

Aim Inconsistent results continue to be reported in studies that examine the neural correlates of cognitive behavioral therapy (CBT) in patients with panic disorder. We examined the changes in regional cerebral blood flow (rCBF) associated with the alleviation of anxiety by CBT in panic patients. Methods The change in rCBF and clinical symptoms before and after CBT were assessed using single photon emission computed tomography and various clinical measures were analyzed. Results Fourteen subjects who completed CBT showed significant improvements in symptoms on clinical measures, including the Panic and Agoraphobic Scale and the Anxiety Sensitivity Index-Revised. After CBT, increased rCBF was detected in the left postcentral gyrus (BA 43), left precentral gyrus (BA 4), and left inferior frontal gyrus (BA 9 and BA 47), whereas decreased rCBF was detected in the left pons. Correlation analysis of the association between the changes in rCBF and changes in each clinical measure did not show significant results. Conclusion We found changes in the rCBF associated with the successful completion of CBT. The present findings may help clarify the effects of CBT on changes in brain activity in panic disorder. PMID:24790449

Translating Basic Behavioral and Social Science Research to Clinical Application: The EVOLVE Mixed Methods Approach

ERIC Educational Resources Information Center

Peterson, Janey C.; Czajkowski, Susan; Charlson, Mary E.; Link, Alissa R.; Wells, Martin T.; Isen, Alice M.; Mancuso, Carol A.; Allegrante, John P.; Boutin-Foster, Carla; Ogedegbe, Gbenga; Jobe, Jared B.

2013-01-01

Objective: To describe a mixed-methods approach to develop and test a basic behavioral science-informed intervention to motivate behavior change in 3 high-risk clinical populations. Our theoretically derived intervention comprised a combination of positive affect and self-affirmation (PA/SA), which we applied to 3 clinical chronic disease…

Millon Clinical Multiaxial Inventory–III Subtypes of Opioid Dependence: Validity and Matching to Behavioral Therapies

PubMed Central

Ball, Samuel A.; Nich, Charla; Rounsaville, Bruce J.; Eagan, Dorothy; Carroll, Kathleen M.

2013-01-01

The concurrent and predictive validity of 2 different methods of Millon Clinical Multiaxial Inventory–III subtyping (protocol sorting, cluster analysis) was evaluated in 125 recently detoxified opioid-dependent outpatients in a 12-week randomized clinical trial. Participants received naltrexone and relapse prevention group counseling and were assigned to 1 of 3 intervention conditions: (a) no-incentive vouchers, (b) incentive vouchers alone, or (c) incentive vouchers plus relationship counseling. Affective disturbance was the most common Axis I protocol-sorted subtype (66%), antisocial–narcissistic was the most common Axis II subtype (46%), and cluster analysis suggested that a 2-cluster solution (high vs. low psychiatric severity) was optimal. Predictive validity analyses indicated less symptom improvement for the higher problem subtypes, and patient treatment matching analyses indicated that some subtypes had better outcomes in the no-incentive voucher conditions. PMID:15301655

Porque me tocó a mi? Mexican American diabetes patients' causal stories and their relationship to treatment behaviors.

PubMed

Hunt, L M; Valenzuela, M A; Pugh, J A

1998-04-01

This paper reports findings from an ethnographic study of self-care behaviors and illness concepts among Mexican-American non-insulin dependent diabetes mellitus (NIDDM) patients. Open-ended interviews were conducted with 49 NIDDM patients from two public hospital outpatient clinics in South Texas. They are self-identified Mexican-Americans who have had NIDDM for at least 1 yr, and have no major impairment due to NIDDM. Interviews focused on their concepts and experiences in managing their illness and their self-care behaviors. Clinical assessment of their glucose control was also extracted from their medical records. The texts of patient interviews were content analyzed through building and refining thematic matrixes focusing on their causal explanations and treatment behaviors. We found patients' causal explanations of their illness often are driven by an effort to connect the illness in a direct and specific way to their personal history and their past experience with treatments. While most cite biomedically accepted causes such as heredity and diet, they elaborate these concepts into personally relevant constructs by citing Provoking Factors, such as behaviors or events. Their causal models are thus both specific to their personal history and consistent with their experiences with treatment success or failure. Based on these findings, we raise a critique of the Locus of Control Model of treatment behavior prevalent in the diabetes education literature. Our analysis suggests that a sense that one's own behavior is important to the disease onset may reflect patients' evaluation of their experience with treatment outcomes, rather than determining their level of activity in treatment.

Disorder-Specific Effects of CBT for Anxious and Depressed Youth: A Meta-Analysis of Candidate Mediators of Change

ERIC Educational Resources Information Center

Chu, Brian C.; Harrison, Tara L.

2007-01-01

The commonalities between anxiety and depression have been discussed before, but few have delineated the potentially different mechanisms through which treatments work for these populations. The current study conducted a comprehensive review of child and adolescent randomized clinical trials that tested cognitive-behavioral therapy (CBT) for…

Behavioral and Environmental Analysis of Self-Reported Dysphonic and Non-Dysphonic High School Music Teachers

ERIC Educational Resources Information Center

Brown, Emily Pence

2016-01-01

Vocal fatigue and dysphonia are considered to be common hazards associated with occupational voice users. Teachers, due to the consistent communication demands of the profession, represent the highest percentage of clinical voice disorder patients (Verdolini & Ramig, 2001). Voice related injuries in teachers could result in lost wages due to…

Behavioral and Environmental Analysis of Self-Reported Dysphonic and Nondysphonic High School Music Teachers

ERIC Educational Resources Information Center

Brown, Emily Pence

2017-01-01

Dysphonia is considered to be a common hazard associated with occupational voice users. Teachers represent the highest percentage of clinical voice disorder patients. Voice injuries in teachers could result in lost wages due to missed work, additional costs for medications, therapy, and surgeries, and teacher attrition. The purpose of this study…

Weight management by phone conference call: A comparison with a traditional face-to-face clinic. Rationale and design for a randomized equivalence trial

PubMed Central

Lambourne, Kate; Washburn, Richard A.; Gibson, Cheryl; Sullivan, Debra K.; Goetz, Jeannine; Lee, Robert; Smith, Bryan K.; Mayo, Matthew S.; Donnelly, Joseph E.

2012-01-01

State-of-the-art treatment for weight management consists of a behavioral intervention to facilitate decreased energy intake and increased physical activity. These interventions are typically delivered face-to-face (FTF) by a health educator to a small group of participants. There are numerous barriers to participation in FTF clinics including availability, scheduling, the expense and time required to travel to the clinic site, and possible need for dependent care. Weight management clinics delivered by conference call have the potential to diminish or eliminate these barriers. The conference call approach may also reduce burden on providers, who could conduct clinic groups from almost any location without the expenses associated with maintaining FTF clinic space. A randomized trial will be conducted in 395 overweight/obese adults (BMI 25–39.9 kg/m2) to determine if weight loss (6 months) and weight maintenance (12 months) are equivalent between weight management interventions utilizing behavioral strategies and pre-packaged meals delivered by either a conference call or the traditional FTF approach. The primary outcome, body weight, will be assessed at baseline, 6, 12 and 18 months. Secondary outcomes including waist circumference, energy and macronutrient intake, and physical activity and will be assessed on the same schedule. In addition, a cost analysis and extensive process evaluation will be completed. PMID:22664647

Weight management by phone conference call: a comparison with a traditional face-to-face clinic. Rationale and design for a randomized equivalence trial.

PubMed

Lambourne, Kate; Washburn, Richard A; Gibson, Cheryl; Sullivan, Debra K; Goetz, Jeannine; Lee, Robert; Smith, Bryan K; Mayo, Matthew S; Donnelly, Joseph E

2012-09-01

State-of-the-art treatment for weight management consists of a behavioral intervention to facilitate decreased energy intake and increased physical activity. These interventions are typically delivered face-to-face (FTF) by a health educator to a small group of participants. There are numerous barriers to participation in FTF clinics including availability, scheduling, the expense and time required to travel to the clinic site, and possible need for dependent care. Weight management clinics delivered by conference call have the potential to diminish or eliminate these barriers. The conference call approach may also reduce burden on providers, who could conduct clinic groups from almost any location without the expenses associated with maintaining FTF clinic space. A randomized trial will be conducted in 395 overweight/obese adults (BMI 25-39.9 kg/m(2)) to determine if weight loss (6 months) and weight maintenance (12 months) are equivalent between weight management interventions utilizing behavioral strategies and pre-packaged meals delivered by either a conference call or the traditional FTF approach. The primary outcome, body weight, will be assessed at baseline, 6, 12 and 18 months. Secondary outcomes including waist circumference, energy and macronutrient intake, and physical activity and will be assessed on the same schedule. In addition, a cost analysis and extensive process evaluation will be completed. Copyright © 2012 Elsevier Inc. All rights reserved.

Recording an Excel(®) Macro to Specify Date Ranges for Clinical Data.

PubMed

Deochand, Neil; Costello, Mack S; Fuqua, R Wayne

2016-09-01

The individuals served by behavior analysts are often funded by Medicaid, insurance companies, or private pay. The first two options usually require progress notes detailing graphically and quantitatively the behavioral outcomes. These progress notes usually come in the form of a written account of milestones achieved or barriers faced, graphical displays of behavioral data, and summary tables. The graphical displays are monthly, quarterly, and annual reports for the individuals that they serve. Microsoft Excel® is one of the most accessible tools by which to accomplish this task; however, presenting the required date ranges can be a time-consuming task. A task analysis is outlined to automate this process and reduce the time taken to accomplish indirect service hours to the clients served.

Impact of music therapy interventions (listening, composition, Orff-based) on the physiological and psychosocial behaviors of hospitalized children: a feasibility study.

PubMed

Colwell, Cynthia M; Edwards, Robin; Hernandez, Emily; Brees, Kristine

2013-01-01

The purpose of this study was to compare three music therapy strategies (music listening, music composition, and Orff-based active engagement) on physiological (heart rate, blood pressure, oxygen saturation, and pain) and psychosocial (anxiety) behaviors of hospitalized children (N=32, 17 females,15 males, ranging in age from 6 to 17). This study was designed and facilitated cooperatively by pediatric nurses and music therapists. Results indicated no clinically significant changes in heart rate, blood pressure, or oxygen saturation (p>.05). Pain and anxiety both decreased significantly (p=.01) but not differentiated among conditions. Videotape analysis determined level of engagement in coping-related behaviors. Copyright © 2013 Elsevier Inc. All rights reserved.

[The structure of psychopathology associated with addictive disorders, against alcohol addiction and the possibility of it's neurometabolic correction in the elderly].

PubMed

Belov, V G; Parfenov, Iu A; Zaplutanov, V A; Khaĭrutdinov, D R

2013-01-01

The article presents the analysis of the structure and dynamics of psychopathology associated with addictive disorders in elderly patients with alcohol dependence. In terms of syndromic approach the structure of neurotic disease in elderly patients with a verified diagnosis of mental and behavioral disorders associated with alcohol consumption was evaluated. In the overall structure of neurotic pathology in these patients the analysis of symptoms of neurotic diseases, the research of the structure of syndromes and their dynamics were carried out, as well as the patient's attitude to the disease and to its manifestations was determined. A factor model of the pathogenesis of neurotic pathology connected with mental and behavioral disorders due to alcohol use in elderly patients was developed. The high clinical effectiveness of the drug "Cytoflavin" used in the reduction of psychiatric symptoms in patients aged from 62 to 74 years with a diagnosis of mental and behavioral disorders associated with alcohol consumption has been shown.

Lessons from social network analyses for behavioral medicine.

PubMed

Rosenquist, James N

2011-03-01

This study presents an overview of the rapidly expanding field of social network analysis, with an emphasis placed on work relevant to behavioral health clinicians and researchers. I outline how social network analysis is a distinct empirical methodology within the social sciences that has the potential to deepen our understanding of how mental health and addiction are influenced by social environmental factors. Whereas there have been a number of recent studies in the mental health literature that discuss social influences on mental illness and addiction, and a number of studies looking at how social networks influence health and behaviors, there are still relatively few studies that combine the two. Those that have suggest that mood symptoms as well as alcohol consumption are clustered within, and may travel along, social networks. Social networks appear to have an important influence on a variety of mental health conditions. This avenue of research has the potential to influence both clinical practice and public policy.

Terminal Behavioral Objectives for Teaching Clinical Toxicology to Clinical Pharmacists

ERIC Educational Resources Information Center

Veltri, Joseph C.; And Others

1976-01-01

As a first step in the development of a competency-based clinical toxicology clerkship, a set of terminal behavioral objectives were developed that reflect the anticipated role that clinical pharmacists should play as part of the clinical toxicology team. The evaluation approaches used at the University of Utah are presented. (LBH)

Analysis of Vertebral Bone Strength, Fracture Pattern, and Fracture Location: A Validation Study Using a Computed Tomography-Based Nonlinear Finite Element Analysis

PubMed Central

Imai, Kazuhiro

2015-01-01

Finite element analysis (FEA) is an advanced computer technique of structural stress analysis developed in engineering mechanics. Because the compressive behavior of vertebral bone shows nonlinear behavior, a nonlinear FEA should be utilized to analyze the clinical vertebral fracture. In this article, a computed tomography-based nonlinear FEA (CT/FEA) to analyze the vertebral bone strength, fracture pattern, and fracture location is introduced. The accuracy of the CT/FEA was validated by performing experimental mechanical testing with human cadaveric specimens. Vertebral bone strength and the minimum principal strain at the vertebral surface were accurately analyzed using the CT/FEA. The experimental fracture pattern and fracture location were also accurately simulated. Optimization of the element size was performed by assessing the accuracy of the CT/FEA, and the optimum element size was assumed to be 2 mm. It is expected that the CT/FEA will be valuable in analyzing vertebral fracture risk and assessing therapeutic effects on osteoporosis. PMID:26029476

Interaction Effect of Social Isolation and High Dose Corticosteroid on Neurogenesis and Emotional Behavior.

PubMed

Chan, Jackie N-M; Lee, Jada C-D; Lee, Sylvia S P; Hui, Katy K Y; Chan, Alan H L; Fung, Timothy K-H; Sánchez-Vidaña, Dalinda I; Lau, Benson W-M; Ngai, Shirley P-C

2017-01-01

Hypercortisolemia is one of the clinical features found in depressed patients. This clinical feature has been mimicked in animal studies via application of exogenous corticosterone (CORT). Previous studies suggested that CORT can induce behavioral disturbance in anxious-depressive like behavior, which is associated with suppressed neurogenesis. Hippocampal neurogenesis plays an important role in adult cognitive and behavioral regulation. Its suppression may thus lead to neuropsychiatric disorders. Similar to the effects of CORT on the animals' depression-like behaviors and neurogenesis, social deprivation has been regarded as one factor that predicts poor prognosis in depression. Furthermore, social isolation is regarded as a stressor to social animals including experimental rodents. Hence, this study aims to examine if social isolation would induce further emotional or anxiety-like behavior disturbance and suppress neurogenesis in an experimental model that was repeatedly treated with CORT. Sprague-Dawley rats were used in this study to determine the effects of different housing conditions, either social isolated or group housing, in vehicle-treated control and CORT-treated animals. Forced swimming test (FST), open field test (OFT) and social interaction test (SIT) were used to assess depression-like, anxiety-like and social behaviors respectively. Immunohistochemistry was performed to quantify the number of proliferative cells and immature neurons in the hippocampus, while dendritic maturation of immature neurons was analyzed by Sholl analysis. Social isolation reduced latency to immobility in FST. Furthermore, social isolation could significantly reduce the ratio of doublecortin and bromodeoxyuridine (BrdU) positive cells of the neurogenesis assay under CORT-treated condition. The current findings suggested that the behavioral and neurological effect of social isolation is dependent on the condition of hypercortisolemia. Furthermore, social isolation may possibly augment the signs and symptoms of depressed patients with potential alteration in neurogenesis.

Demographic, clinical, lifestyle-related, and social-cognitive correlates of physical activity in head and neck cancer survivors.

PubMed

Buffart, Laurien M; de Bree, Remco; Altena, Martine; van der Werff, Sophie; Drossaert, Constance H C; Speksnijder, Caroline M; van den Brekel, Michiel W; Jager-Wittenaar, Harriët; Aaronson, Neil K; Stuiver, Martijn M

2018-05-01

The purpose of the study is to identify demographic, clinical, lifestyle-related, and social-cognitive correlates of physical activity (PA) intention and behavior in head and neck cancer (HNC) survivors using the theory of planned behavior (TPB). Data from two cross-sectional studies on correlates of PA in HNC survivors were pooled. Both studies used self-reports to assess PA and social-cognitive correlates. Potential correlates were collected via self-report or medical records. Univariable and multivariable multilevel linear mixed-effects models were built to identify correlates of PA intention and PA behavior (Z scores). Structural equation model analyses were conducted to study the full TPB model in one analysis, taking into account relevant covariates. In total, 416 HNC survivors were surveyed. Their mean (SD) age was 66.6 (9.4) years; 64% were men, and 78% were diagnosed with laryngeal cancer. The structural equation model showed that PA intention was significantly higher in HNC survivors with a history of exercising, who had a more positive attitude, subjective norm, and perceived behavioral control. Patients with higher PA intention, higher PBC, a lower age, and without unintentional weight loss or comorbidities had higher PA behavior. The model explained 22.9% of the variance in PA intention and 16.1% of the variance in PA behavior. Despite significant pathways of the TPB model, the large proportion variance in PA intention and behavior remaining unexplained suggests the need for better PA behavior (change) models to guide the development of PA promotion programs, particularly for the elderly. Such programs should be tailored to comorbidities and nutritional status.

Inadequate consultation behavior modulates the relationship between type D personality and impaired health status in chronic heart failure.

PubMed

Pelle, Aline J; Schiffer, Angélique A; Smith, Otto R; Widdershoven, Jos W; Denollet, Johan

2010-06-25

Psychological risk factors for impaired health outcomes have been acknowledged in chronic heart failure (CHF), with Type D personality being such a risk factor. Inadequate consultation behavior, a specific aspect of self-management, might be one mechanism in explaining the adverse effect of Type D on health outcomes. In this study we examined the relationship between Type D personality, impaired disease-specific health status, and inadequate consultation behavior. CHF outpatients (n=313) completed the Type D Scale (DS14) at baseline, and the European Heart Failure Self-care Behaviour Scale (EHFScBS) and the Minnesota Living with Heart Failure Questionnaire (MLWHFQ) at 6-month follow-up. Type D personality independently predicted inadequate consultation behavior (OR=1.80, 95%CI [1.03-3.16], p=.04) and impaired health status (OR=3.61, 95%CI [1.93-6.74], p<.001) at 6-month follow-up, adjusting for demographic and clinical variables. Inadequate consultation behavior (OR=1.80, 95%CI [1.11-2.94], p=.02) and NYHA-class (OR=2.83, 95%CI [1.17-4.71], p<.001) were associated with impaired health status, after controlling for demographics, clinical variables, and Type D personality. Post-hoc multivariable analysis pointed out that Type D patients who displayed inadequate consultation behavior were at a 6-fold increased risk of reporting impaired health status, compared to the reference group of non-Type D patients who displayed adequate consultation behavior (OR=6.06, 95%CI [2.53-14.52], p<.001). These findings provide evidence for inadequate behavior as a mechanism that may explain the link between Type D personality and impaired health status. Future studies are warranted to elaborate on these findings. Copyright 2008 Elsevier Ireland Ltd. All rights reserved.

Cost-effectiveness of cognitive behavioral therapy for insomnia comorbid with depression: Analysis of a randomized controlled trial.

PubMed

Watanabe, Norio; Furukawa, Toshiaki A; Shimodera, Shinji; Katsuki, Fujika; Fujita, Hirokazu; Sasaki, Megumi; Sado, Mitsuhiro; Perlis, Michael L

2015-06-01

Although the efficacy of cognitive behavioral therapy for insomnia has been confirmed, dissemination depends on the balance of benefits and costs. This study aimed to examine the cost-effectiveness of cognitive behavioral therapy for insomnia consisting of four weekly individual sessions. We conducted a 4-week randomized controlled trial with a 4-week follow up in outpatient clinics in Japan. Thirty-seven patients diagnosed as having major depressive disorder according to DSM-IV and suffering from chronic insomnia were randomized to receive either treatment as usual (TAU) alone or TAU plus cognitive behavioral therapy for insomnia. Effectiveness was evaluated as quality-adjusted life years (QALY) over 8 weeks' time, estimated by bootstrapping of the observed total scores of the Hamilton Depression Rating Scale. Direct medical costs for cognitive behavioral therapy for insomnia and TAU were also evaluated. We calculated the incremental cost-effectiveness ratio. Over the 8 weeks of the study, the group receiving cognitive behavioral therapy for insomnia plus TAU had significantly higher QALY (P = 0.002) than the TAU-alone group with an incremental value of 0.019 (SD 0.006), and had non-significantly higher costs with an incremental value of 254 (SD 203) USD in direct costs. The incremental cost-effectiveness ratio was 13 678 USD (95% confidence interval: -5691 to 71 316). Adding cognitive behavioral therapy for insomnia demonstrated an approximately 95% chance of gaining one more QALY if a decision-maker was willing to pay 60 000 USD, and approximately 90% for 40 000 USD. Adding cognitive behavioral therapy for insomnia is highly likely to be cost-effective for patients with residual insomnia and concomitant depression. © 2014 The Authors. Psychiatry and Clinical Neurosciences © 2014 Japanese Society of Psychiatry and Neurology.

Alliance ruptures and rupture resolution in cognitive-behavior therapy: a preliminary task analysis.

PubMed

Aspland, Helen; Llewelyn, Susan; Hardy, Gillian E; Barkham, Michael; Stiles, William

2008-11-01

An initial ideal, rational model of alliance rupture and rupture resolution provided by cognitive-behavioral therapy (CBT) experts was assessed and compared with empirical observations of ruptures and their resolution in two cases of successful CBT. The initial rational model emphasized nondefensive acknowledgment and exploration of the rupture. Results indicated differences between what therapists think they should do to resolve ruptures and what they actually do and suggested that the rational model should be expanded to emphasize client validation and empowerment. Therapists' ability to attend to ruptures emerged as an important clinical skill.

Transparency of Outcome Reporting and Trial Registration of Randomized Controlled Trials Published in the Journal of Consulting and Clinical Psychology

PubMed Central

Azar, Marleine; Riehm, Kira E.; McKay, Dean; Thombs, Brett D.

2015-01-01

Background Confidence that randomized controlled trial (RCT) results accurately reflect intervention effectiveness depends on proper trial conduct and the accuracy and completeness of published trial reports. The Journal of Consulting and Clinical Psychology (JCCP) is the primary trials journal amongst American Psychological Association (APA) journals. The objectives of this study were to review RCTs recently published in JCCP to evaluate (1) adequacy of primary outcome analysis definitions; (2) registration status; and, (3) among registered trials, adequacy of outcome registrations. Additionally, we compared results from JCCP to findings from a recent study of top psychosomatic and behavioral medicine journals. Methods Eligible RCTs were published in JCCP in 2013–2014. For each RCT, two investigators independently extracted data on (1) adequacy of outcome analysis definitions in the published report, (2) whether the RCT was registered prior to enrolling patients, and (3) adequacy of outcome registration. Results Of 70 RCTs reviewed, 12 (17.1%) adequately defined primary or secondary outcome analyses, whereas 58 (82.3%) had multiple primary outcome analyses without statistical adjustment or undefined outcome analyses. There were 39 (55.7%) registered trials. Only two trials registered prior to patient enrollment with a single primary outcome variable and time point of assessment. However, in one of the two trials, registered and published outcomes were discrepant. No studies were adequately registered as per Standard Protocol Items: Recommendation for Interventional Trials guidelines. Compared to psychosomatic and behavioral medicine journals, the proportion of published trials with adequate outcome analysis declarations was significantly lower in JCCP (17.1% versus 32.9%; p = 0.029). The proportion of registered trials in JCCP (55.7%) was comparable to behavioral medicine journals (52.6%; p = 0.709). Conclusions The quality of published outcome analysis definitions and trial registrations in JCCP is suboptimal. Greater attention to proper trial registration and outcome analysis definition in published reports is needed. PMID:26581079

Transparency of Outcome Reporting and Trial Registration of Randomized Controlled Trials Published in the Journal of Consulting and Clinical Psychology.

PubMed

Azar, Marleine; Riehm, Kira E; McKay, Dean; Thombs, Brett D

2015-01-01

Confidence that randomized controlled trial (RCT) results accurately reflect intervention effectiveness depends on proper trial conduct and the accuracy and completeness of published trial reports. The Journal of Consulting and Clinical Psychology (JCCP) is the primary trials journal amongst American Psychological Association (APA) journals. The objectives of this study were to review RCTs recently published in JCCP to evaluate (1) adequacy of primary outcome analysis definitions; (2) registration status; and, (3) among registered trials, adequacy of outcome registrations. Additionally, we compared results from JCCP to findings from a recent study of top psychosomatic and behavioral medicine journals. Eligible RCTs were published in JCCP in 2013-2014. For each RCT, two investigators independently extracted data on (1) adequacy of outcome analysis definitions in the published report, (2) whether the RCT was registered prior to enrolling patients, and (3) adequacy of outcome registration. Of 70 RCTs reviewed, 12 (17.1%) adequately defined primary or secondary outcome analyses, whereas 58 (82.3%) had multiple primary outcome analyses without statistical adjustment or undefined outcome analyses. There were 39 (55.7%) registered trials. Only two trials registered prior to patient enrollment with a single primary outcome variable and time point of assessment. However, in one of the two trials, registered and published outcomes were discrepant. No studies were adequately registered as per Standard Protocol Items: Recommendation for Interventional Trials guidelines. Compared to psychosomatic and behavioral medicine journals, the proportion of published trials with adequate outcome analysis declarations was significantly lower in JCCP (17.1% versus 32.9%; p = 0.029). The proportion of registered trials in JCCP (55.7%) was comparable to behavioral medicine journals (52.6%; p = 0.709). The quality of published outcome analysis definitions and trial registrations in JCCP is suboptimal. Greater attention to proper trial registration and outcome analysis definition in published reports is needed.

Diet Behavior Change Techniques in Type 2 Diabetes: A Systematic Review and Meta-analysis.

PubMed

Cradock, Kevin A; ÓLaighin, Gearóid; Finucane, Francis M; McKay, Rhyann; Quinlan, Leo R; Martin Ginis, Kathleen A; Gainforth, Heather L

2017-12-01

Dietary behavior is closely connected to type 2 diabetes. The purpose of this meta-analysis was to identify behavior change techniques (BCTs) and specific components of dietary interventions for patients with type 2 diabetes associated with changes in HbA 1c and body weight. The Cochrane Library, CINAHL, Embase, PubMed, PsycINFO, and Scopus databases were searched. Reports of randomized controlled trials published during 1975-2017 that focused on changing dietary behavior were selected, and methodological rigor, use of BCTs, and fidelity and intervention features were evaluated. In total, 54 studies were included, with 42 different BCTs applied and an average of 7 BCTs used per study. Four BCTs-"problem solving," "feedback on behavior," "adding objects to the environment," and "social comparison"-and the intervention feature "use of theory" were associated with >0.3% (3.3 mmol/mol) reduction in HbA 1c . Meta-analysis revealed that studies that aimed to control or change the environment showed a greater reduction in HbA 1c of 0.5% (5.5 mmol/mol) (95% CI -0.65, -0.34), compared with 0.32% (3.5 mmol/mol) (95% CI -0.40, -0.23) for studies that aimed to change behavior. Limitations of our study were the heterogeneity of dietary interventions and poor quality of reporting of BCTs. This study provides evidence that changing the dietary environment may have more of an effect on HbA 1c in adults with type 2 diabetes than changing dietary behavior. Diet interventions achieved clinically significant reductions in HbA 1c , although initial reductions in body weight diminished over time. If appropriate BCTs and theory are applied, dietary interventions may result in better glucose control. © 2017 by the American Diabetes Association.

Perianal disease, small bowel disease, smoking, prior steroid or early azathioprine/biological therapy are predictors of disease behavior change in patients with Crohn’s disease

PubMed Central

Lakatos, Peter Laszlo; Czegledi, Zsofia; Szamosi, Tamas; Banai, Janos; David, Gyula; Zsigmond, Ferenc; Pandur, Tunde; Erdelyi, Zsuzsanna; Gemela, Orsolya; Papp, Janos; Lakatos, Laszlo

2009-01-01

AIM: To assess the combined effect of disease phenotype, smoking and medical therapy [steroid, azathioprine (AZA), AZA/biological therapy] on the probability of disease behavior change in a Caucasian cohort of patients with Crohn’s disease (CD). METHODS: Three hundred and forty well-characterized, unrelated, consecutive CD patients were analyzed (M/F: 155/185, duration: 9.4 ± 7.5 years) with a complete clinical follow-up. Medical records including disease phenotype according to the Montreal classification, extraintestinal manifestations, use of medications and surgical events were analyzed retrospectively. Patients were interviewed on their smoking habits at the time of diagnosis and during the regular follow-up visits. RESULTS: A change in disease behavior was observed in 30.8% of patients with an initially non-stricturing, non-penetrating disease behavior after a mean disease duration of 9.0 ± 7.2 years. In a logistic regression analysis corrected for disease duration, perianal disease, smoking, steroid use, early AZA or AZA/biological therapy use were independent predictors of disease behavior change. In a subsequent Kaplan-Meier survival analysis and a proportional Cox regression analysis, disease location (P = 0.001), presence of perianal disease (P < 0.001), prior steroid use (P = 0.006), early AZA (P = 0.005) or AZA/biological therapy (P = 0.002), or smoking (P = 0.032) were independent predictors of disease behavior change. CONCLUSION: Our data suggest that perianal disease, small bowel disease, smoking, prior steroid use, early AZA or AZA/biological therapy are all predictors of disease behavior change in CD patients. PMID:19630105

Interim Methadone and Patient Navigation in Jail: Rationale and Design of a Randomized Clinical Trial

PubMed Central

Schwartz, Robert P.; Kelly, Sharon M.; Mitchell, Shannon G.; Dunlap, Laura; Zarkin, Gary A.; Sharma, Anjalee; O’Grady, Kevin E.; Jaffe, Jerome H.

2016-01-01

Background Methadone maintenance is an effective treatment for opioid dependence but is rarely initiated in US jails. Patient navigation is a promising approach to improve continuity of care but has not been tested in bridging the gap between jail- and community-based drug treatment programs. Methods This is an open-label randomized clinical trial among 300 adult opioid dependent newly-arrested detainees that will compare three treatment conditions: methadone maintenance without routine counseling (termed Interim Methadone; IM) initiated in jail v. IM and patient navigation v. enhanced treatment-as-usual. The two primary outcomes will be: (1) the rate of entry into treatment for opioid use disorder within 30 days from release and (2) frequency of opioid positive urine tests over the 12-month follow-up period. An economic analysis will examine the costs, cost-effectiveness, and cost-benefit ratio of the study interventions. Results We describe the background and rationale for the study, its aims, hypotheses, and study design. Conclusions Given the large number of opioid dependent detainees in the US and elsewhere, initiating IM at the time of incarceration could be a significant public health and clinical approach to reducing relapse, recidivism, HIV-risk behavior, and criminal behavior. An economic analysis will be conducted to assist policy makers in determining the utility of adopting this approach. PMID:27282117

Nonsuicidal Self-Injury and Suicidal Behavior: A Latent Class Analysis among Young Adults

PubMed Central

Hamza, Chloe A.; Willoughby, Teena

2013-01-01

Although there is a general consensus among researchers that engagement in nonsuicidal self-injury (NSSI) is associated with increased risk for suicidal behavior, little attention has been given to whether suicidal risk varies among individuals engaging in NSSI. To identify individuals with a history of NSSI who are most at risk for suicidal behavior, we examined individual variability in both NSSI and suicidal behavior among a sample of young adults with a history of NSSI (N = 439, Mage = 19.1). Participants completed self-report measures assessing NSSI, suicidal behavior, and psychosocial adjustment (e.g., depressive symptoms, daily hassles). We conducted a latent class analysis using several characteristics of NSSI and suicidal behaviors as class indicators. Three subgroups of individuals were identified: 1) an infrequent NSSI/not high risk for suicidal behavior group, 2) a frequent NSSI/not high risk for suicidal behavior group, and 3) a frequent NSSI/high risk for suicidal behavior group. Follow-up analyses indicated that individuals in the ‘frequent NSSI/high risk for suicidal behavior’ group met the clinical-cut off score for high suicidal risk and reported significantly greater levels of suicidal ideation, attempts, and risk for future suicidal behavior as compared to the other two classes. Thus, this study is the first to identity variability in suicidal risk among individuals engaging in frequent and multiple methods of NSSI. Class 3 was also differentiated by higher levels of psychosocial impairment relative to the other two classes, as well as a comparison group of non-injuring young adults. Results underscore the importance of assessing individual differences in NSSI characteristics, as well as psychosocial impairment, when assessing risk for suicidal behavior. PMID:23544113

Behavioral Indicators on a Mobile Sensing Platform Predict Clinically Validated Psychiatric Symptoms of Mood and Anxiety Disorders

PubMed Central

Place, Skyler; Rubin, Channah; Gorrostieta, Cristina; Mead, Caroline; Kane, John; Marx, Brian P; Feast, Joshua; Deckersbach, Thilo; Pentland, Alex “Sandy”; Nierenberg, Andrew; Azarbayejani, Ali

2017-01-01

Background There is a critical need for real-time tracking of behavioral indicators of mental disorders. Mobile sensing platforms that objectively and noninvasively collect, store, and analyze behavioral indicators have not yet been clinically validated or scalable. Objective The aim of our study was to report on models of clinical symptoms for post-traumatic stress disorder (PTSD) and depression derived from a scalable mobile sensing platform. Methods A total of 73 participants (67% [49/73] male, 48% [35/73] non-Hispanic white, 33% [24/73] veteran status) who reported at least one symptom of PTSD or depression completed a 12-week field trial. Behavioral indicators were collected through the noninvasive mobile sensing platform on participants’ mobile phones. Clinical symptoms were measured through validated clinical interviews with a licensed clinical social worker. A combination hypothesis and data-driven approach was used to derive key features for modeling symptoms, including the sum of outgoing calls, count of unique numbers texted, absolute distance traveled, dynamic variation of the voice, speaking rate, and voice quality. Participants also reported ease of use and data sharing concerns. Results Behavioral indicators predicted clinically assessed symptoms of depression and PTSD (cross-validated area under the curve [AUC] for depressed mood=.74, fatigue=.56, interest in activities=.75, and social connectedness=.83). Participants reported comfort sharing individual data with physicians (Mean 3.08, SD 1.22), mental health providers (Mean 3.25, SD 1.39), and medical researchers (Mean 3.03, SD 1.36). Conclusions Behavioral indicators passively collected through a mobile sensing platform predicted symptoms of depression and PTSD. The use of mobile sensing platforms can provide clinically validated behavioral indicators in real time; however, further validation of these models and this platform in large clinical samples is needed. PMID:28302595

Validity of the Aberrant Behavior Checklist in a Clinical Sample of Toddlers

ERIC Educational Resources Information Center

Karabekiroglu, Koray; Aman, Michael G.

2009-01-01

We investigated the congruent and criterion validity of the Aberrant Behavior Checklist (ABC) in a clinical sample of toddlers seen over 1 year in Turkey. All consecutive patients (N = 93), 14-43 months old (mean, 30.6 mos.), in a child psychiatry outpatient clinic were included. The ABC, Autism Behavior Checklist (AuBC), and Child Behavior…

Ambiguity Within Nursing Practice: An Evolutionary Concept Analysis.

PubMed

McMahon, Michelle A; Dluhy, Nancy M

2017-02-01

To analyze the concept of ambiguity in a nursing context. Ambiguity is inherent within nursing practice. As health care becomes increasingly complex, nurses must continue to successfully deal with greater amounts of clinical ambiguity. Although ambiguity is discussed in nursing, minimal concept refinement exists to capture the contextual intricacies from a nursing lens. Nurse perception of an ambiguous clinical event, in combination with nurse tolerance level for ambiguity, can impact nurse response. Yet, little is known about what constitutes ambiguity within nursing practice (AWNP). Rodgers evolutionary method was used to explore AWNP, with emphasis on nurse thinking during ambiguous clinical situations. Literature searches across multiple databases yielded 38 articles for analysis. Attributes of AWNP include (a) variations in cues/available information, (b) multiple interpretations, (c) novel/nonroutine presentations, and (d) unpredictable. Antecedents include (a) a context-specific, clinical situation with ambiguous features needing evaluation and (b) an individual to sense a knowledge gap or perceive ambiguity. Consequences include ranges of (a) emotional, (b) behavioral, and (c) cognitive clinician responses. Preliminary findings support AWNP as a distinct concept in which ambiguity perceived by the nurse likely affects judgment, decision making, and clinical interventions. AWNP is a clinically relevant concept requiring continued development.

Applied behaviour analysis and standard treatment in intellectual disability: 2-year outcomes.

PubMed

Hassiotis, Angela; Canagasabey, Anton; Robotham, Daniel; Marston, Louise; Romeo, Renee; King, Michael

2011-06-01

Applied behaviour analysis by a specialist team plus standard treatment for adults with intellectual disability displaying challenging behaviour was reported to be clinically and cost-effective after 6 months. In a 2-year follow-up of the same trial cohort, participants receiving the specialist intervention had significantly lower total and subdomain Aberrant Behavior Checklist scores than those receiving usual care alone. After adjustment for baseline covariates there was no significant difference in costs between the trial arms.

Clinical correlates and repetition of self-harming behaviors among female adolescent victims of sexual abuse.

PubMed

Cyr, Mireille; McDuff, Pierre; Wright, John; Thériault, Chantal; Cinq-Mars, Caroline

2005-01-01

This study investigated self-harming behaviors in 149 female adolescent victims of sexual abuse, first, by determining the rates of nine types of self-mutilating behavior at intake and nine months later and, second, by investigating comorbidity of clinical correlates associated with these behaviors. The adolescents were divided into three groups according to level of self-mutilating behavior and then compared on symptom self-reports; 62.1% of the adolescents engaged in at least one self-mutilating behavior. A graded relation was observed between level of self-mutilating behavior and rate, and total number of clinical disorders. At nine month follow-up, one in four teenagers still reported a moderate or high level of self-harm. The need for systematic assessment and intervention of self-mutilating behaviors is discussed.

Toward a nosology of human aggressive behavior.

PubMed

Eichelman, B; Hartwig, A

1993-01-01

General attempts have been made to catalog or categorize research literature on aggressive behavior. In the animal literature this category has been delineated by clearly observed and described patterns of behavior. These include offensive and defensive expressions in animals and the characterization of attack behaviors by typography into defensive and offensive. The human literature is considerably deficient in the description and categorization of human aggressive behavior. Current nosologies offer no utilitarian schema for characterizing violent behavior in clinical populations regarding the typography of the violence, its prediction, or guidance as to its treatment. The generation of databased nosologies may provide a mechanism for the development of research and clinically relevant nosologies based upon cluster analyses of treatment outcomes and behavioral characteristics. This strategy may provide a more effective approach for further research concerning clinical aggressive or destructive behaviors.

Prosocial Behavior and Depression: a Case for Developmental Gender Differences.

PubMed

Alarcón, Gabriela; Forbes, Erika E

2017-06-01

Prosocial behavior and depression are related constructs that both increase during adolescence and display gender-specific effects. The current review surveys literature examining the association between depressive symptoms and prosociality, measured with behavioral economic paradigms, across development and proposes a theoretical model explaining a mechanism through which adolescent girls have higher risk for depression than boys. Relative to healthy controls, prosocial behavior is reduced in adults with major depressive disorder (MDD) but may be increased in adolescents with MDD. The relationship between non-clinical levels of depressive symptoms and prosocial behavior remains to be studied experimentally; however, self-reported prosocial behavior is negatively associated with depressive symptoms in non-clinical adolescents, which may suggest a shift in the relation of prosocial behavior and depressive symptoms across the non-clinical (i.e., negative) to clinical range (i.e., positive). The effect of gender on these developmental and clinical status shifts has not been studied but could have important implications for understanding the emergence of higher rates of depression in girls than boys during adolescence. We propose that girls are at heightened risk for depression due to higher social-evaluative concern and other-oriented prosocial motivation that emphasize the needs of others over the self, leading to more altruistic prosocial behavior (despite personal cost) and a higher burden that enables depressive symptoms.

An overview of clinical studies on fiber post systems.

PubMed

Dikbas, Idil; Tanalp, Jale

2013-01-01

Intraradicular posts are useful adjuncts in the restoration of endodontically treated teeth. These systems have undergone a significant evolution in recent years, and fiber-reinforced systems have started to be incorporated into routine clinical care more frequently. Despite the high number of laboratory studies pertaining to the characteristics of fiber posts, clinical studies evaluating their general success rates are rather limited. Since clinical investigations are reliable means to achieve information about the general behavior pattern of materials or techniques, assessment of this data will be beneficial to have a better understanding of fiber-reinforced intraradicular post systems. The purpose of this paper was to make a summary of clinical studies regarding various fiber posts. A PubMed search was conducted and articles dating back to 1990 were retrieved. The paper provides an overview of clinical studies on fiber posts specifically in the last decade as well as commentary analysis.

An Overview of Clinical Studies on Fiber Post Systems

PubMed Central

Dikbas, Idil; Tanalp, Jale

2013-01-01

Intraradicular posts are useful adjuncts in the restoration of endodontically treated teeth. These systems have undergone a significant evolution in recent years, and fiber-reinforced systems have started to be incorporated into routine clinical care more frequently. Despite the high number of laboratory studies pertaining to the characteristics of fiber posts, clinical studies evaluating their general success rates are rather limited. Since clinical investigations are reliable means to achieve information about the general behavior pattern of materials or techniques, assessment of this data will be beneficial to have a better understanding of fiber-reinforced intraradicular post systems. The purpose of this paper was to make a summary of clinical studies regarding various fiber posts. A PubMed search was conducted and articles dating back to 1990 were retrieved. The paper provides an overview of clinical studies on fiber posts specifically in the last decade as well as commentary analysis. PMID:24250255

Drug safety assurance through clinical genotyping: near-term considerations for a system-wide implementation of personalized medicine.

PubMed

Kane, Michael D; Springer, John A; Sprague, Jon E

2008-07-01

The rationale and overall system-wide behavior of a clinical genotyping information system (both DNA analysis and data management) requires a near-term, scalable approach, which is emerging in the focused implementation of pharmacogenomics and drug safety assurance. The challenges to implementing a successful clinical genotyping system are described, as are how the benefits of a focused, near-term system for drug safety assessment and assurance overcome the logistical and operational challenges that perpetually hinder the development of a societal-scale clinical genotyping system. This rationale is based on the premise that a focused application domain for clinical genotyping, specifically drug safety assurance, provides a transition paradigm for both professionals and consumers of healthcare, thereby facilitating the movement of genotyping from bench to bedside and paving the way for the adoption of prognostic and diagnostic applications in clinical genomics.

Testing a model of research intention among U.K. clinical psychologists: a logistic regression analysis.

PubMed

Eke, Gemma; Holttum, Sue; Hayward, Mark

2012-03-01

Previous research highlights barriers to clinical psychologists conducting research, but has rarely examined U.K. clinical psychologists. The study investigated U.K. clinical psychologists' self-reported research output and tested part of a theoretical model of factors influencing their intention to conduct research. Questionnaires were mailed to 1,300 U.K. clinical psychologists. Three hundred and seventy-four questionnaires were returned (29% response-rate). This study replicated in a U.K. sample the finding that the modal number of publications was zero, highlighted in a number of U.K. and U.S. studies. Research intention was bimodally distributed, and logistic regression classified 78% of cases successfully. Outcome expectations, perceived behavioral control and normative beliefs mediated between research training environment and intention. Further research should explore how research is negotiated in clinical roles, and this issue should be incorporated into prequalification training. © 2012 Wiley Periodicals, Inc.

Nursing students' perceived stress and coping behaviors in clinical training in Saudi Arabia.

PubMed

Hamaideh, Shaher H; Al-Omari, Hasan; Al-Modallal, Hanan

2017-06-01

Clinical training has been recognized as a stressful experience for nursing students. The aims of this study were to identify levels and types of stressors among nursing students during their clinical training and their coping behaviors. Data were collected using a purposive sampling method from 100 nursing students using a self-reported questionnaire composed of Perceived Stress Scale and Coping Behavior Inventory. Results showed that "assignments and workload" as well as "teachers and nursing staff" were the highest sources of stress in clinical training. The most common coping behaviors used were "problem-solving" and "staying optimistic". There was a significant difference in perceived stress among students in regard to the way of choosing nursing. There were significant differences in coping behaviors in regard to the presence of relatives in nursing, living status and mothers' educational level. The predictors of perceived stress were self-choosing for nursing and the presence of relatives in nursing, while the predictors for coping behaviors were stress from peers and daily life as well as mothers' educational level. Nursing teachers and staff are encouraged to develop strategies that decrease level of stress and promote adaptive coping behaviors among nursing students during their clinical training.

A Study of the Relationship of Parenting Styles, Child Temperament, and Operatory Behavior in Healthy Children.

PubMed

Tsoi, Amanda K; Wilson, Stephen; Thikkurissy, S

2018-05-11

The purpose of this study was to assess the relationship of the child's temperament, parenting styles, and parents' prediction of their child's behavior in the dental setting. Subjects were healthy children 4-12 years of age attending a dental clinic. A Parenting Styles and Dimensions Questionnaire (PSDQ) was given to parents to determine their parenting style. Parents completed the Emotionality, Activity, Sociability Temperament (EAS) survey to measure their child's temperament. Parents were asked to predict their child's behavior using the Frankl Scale. Data analysis included 113 parent/child dyads. Parents accurately predicted their child's behavior 58% of the time. Significant correlations were noted between parent's predictions of behavior and emotionality (r = -.497, p < .001), activity (r = -.217, p < .009), and shyness (r = -.282, p < .002) of EAS. Significant correlations were found between actual behavior and emotionality (r = -.586, p < .001), activity (r = -.196, p < .03), and shyness (r = -.281, p < .003). Parenting style scores did not correlate to predicted or actual behavior; however, categories of PSDQ were related to parental predictions of behavior. Relationships between temperament and parenting may aid in predicting children's behavior in the operatory.

Association between caregiver depression and individual behavioral and psychological symptoms of dementia in Taiwanese patients.

PubMed

Huang, Si-Sheng; Liao, Yi-Cheng; Wang, Wen-Fu

2015-09-01

The aim of this study was to investigate caregiver depression associated with neuropsychiatric symptoms in Taiwanese people. A cross-sectional design was used in this study. Two hundred seventy-six pairs of patients with dementia and their caregivers who visited the memory clinic of a general hospital from July 2001 to October 2008 were recruited. Caregiver depression was evaluated with the Center for Epidemiologic Studies Depression Scale (CES-D); the behavioral and psychological symptoms of dementia were evaluated using the Neuropsychiatric Inventory. Demographic data of the patients and caregivers, including cognitive functions and clinical dementia ratings, were collected. In addition to descriptive statistics, we examined the relationship between each parameter and caregiver depression using Pearson correlation, independent t-test, or analysis of variance. The results showed a statistically significant positive correlation between the total Neuropsychiatric Inventory score and CES-D score (r = 0.345, P < 0.001) in the bivariate analyses. For individual behavioral and psychological symptoms of dementia, agitation/aggression, anxiety, nighttime behavior disturbances, irritability/lability, and hallucinations were the five leading symptoms significantly associated with caregiver depression (CES-D). Carefully managing these symptoms is likely to reduce depression in dementia caregivers. © 2015 Wiley Publishing Asia Pty Ltd.

Are personal characteristics of massage therapists associated with their clinical, educational, and interpersonal behaviors?

PubMed Central

Boulanger, Karen; Campo, Shelly

2013-01-01

Background Social Cognitive Theory suggests that characteristics of health professionals, such as their beliefs in the effectiveness of their care, influence their behavior. Studying the characteristics of massage therapists may, therefore, provide insight into their clinical, educational and interpersonal behavior, which ultimately affects their client interactions. Purpose To examine the association of three personal factors (outcome expectations, expectancies, and practice experience) of the massage therapist and the practice environment with the frequency of three interventional behaviors (clinical, educational, and interpersonal) using Social Cognitive Theory as a theoretical framework. Methods A random sample of licensed massage therapists in Iowa completed a mailed questionnaire. Questions included training in massage, use of specific massage techniques and practices, 11 outcome expectations, and 17 different behaviors with their respective expectancies for contributing to favorable client outcomes. Factor analyses were conducted on the behavior and expectancy items. Regression analyses were used to examine the relationship of massage therapist characteristics to the different categories of behavior. Results The response rate was 40% (N = 151). The most common techniques employed were Swedish massage, trigger point therapy, and stretching. The most common practices recommended to clients were encouraging water intake, heat application, stretching, stress management, and exercise counseling. Expectancies was the only Social Cognitive Theory variable that significantly predicted the frequency of every category of behavior (clinical, interpersonal, education; all ps < .01). Outcome expectations predicted clinical (p = .03) and educational (p < .01), but not interpersonal behavior. No other associations reached statistical significance. Conclusions Massage therapists’ belief in massage to enact a favorable change in a client is strongly associated with their clinical, educational, and interpersonal behavior. Massage therapists were optimistic regarding the ability of massage to provide a favorable outcome, especially if the desired outcome was supported by research. PMID:24000306

Depression and parenting by nonoffending mothers of children who experienced sexual abuse.

PubMed

Santa-Sosa, Eileen J; Steer, Robert A; Deblinger, Esther; Runyon, Melissa K

2013-01-01

Parenting may be one mechanism by which depression in nonoffending mothers impacts child emotional and behavioral adjustment after sexual abuse. This study examined the relationship between self-reported maternal depression and parenting behaviors by nonoffending mothers of children who experienced sexual abuse. The participants were 204 nonoffending biological mother-child pairs recruited from a clinic providing services for children who experienced sexual abuse. The mothers completed pretreatment self-report measures of demographic information, depression, and parenting behaviors. Children (7 to 17 years) completed a measure of mothers' parenting behaviors. Mothers with clinically high levels of self-reported depression employed more inconsistent parenting behavior and provided poorer monitoring/supervision of their children than mothers without clinically high levels of self-reported depression. Implications for clinical practice and future research are discussed.

Development and Clinical Outcomes of a Dialectical Behavior Therapy Clinic

ERIC Educational Resources Information Center

Lajoie, Travis; Sonkiss, Joshua; Rich, Anne

2011-01-01

Objective: The authors describe the first 6 months of a dialectical behavior therapy (DBT) clinic operated by trainees in a general adult psychiatry residency program. The purpose of this report is to provide a model for the creation and maintenance of a formalized resident DBT clinic. Methods: Residents participated in the DBT clinic, attended a…

Psychopathology and parenting: An examination of perceived and observed parenting in mothers with depression and PTSD

PubMed Central

Muzik, Maria; Morelen, Diana; Hruschak, Jessica; Rosenblum, Katherine Lisa; Bocknek, Erika; Beeghly, Marjorie

2016-01-01

Background The postpartum period represents a major transition in the lives of many women, a time when women are at increased risk for the emergence of psychopathology including depression and PTSD. The current study aimed to better understand the unique contributions of clinically significant postpartum depression, PTSD, and comorbid PTSD/depression on mother–infant bonding and observed maternal parenting behaviors (i.e., behavioral sensitivity, negative affect, positive affect) at 6 months postpartum. Methods Mothers (n=164; oversampled for history of childhood maltreatment given parent study's focus on perinatal mental health in women with trauma histories) and infants participated in 6-month home visit during which dyads engaged in interactional tasks varying in level of difficulties. Mothers also reported on their childhood abuse histories, current depression/PTSD symptoms, and bonding with the infant using standardized and validated instruments. Results Mothers with clinically significant depression had the most parenting impairment (self-report and observed). Mothers with clinically significant PTSD alone (due to interpersonal trauma that occurred predominately in childhood) showed similar interactive behaviors to those who were healthy controls or trauma-exposed but resilient (i.e., no postpartum psychopathology). Childhood maltreatment in the absence of postpartum psychopathology did not infer parenting risk. Limitations Findings are limited by (1) small cell sizes per clinical group, limiting power, (2) sample size and sample demographics prohibited examination of third variables that might also impact parenting (e.g., income, education), (3) self-report of symptoms rather than use of psychiatric interviews. Conclusions Findings show that in the context of child abuse history and/or current PTSD, clinically significant maternal depression was the most salient factor during infancy that was associated with parenting impairment at this level of analysis. PMID:27732922

Clinically significant psychiatric symptoms among male carriers of the fragile X premutation, with and without FXTAS, and the mediating influence of executive functioning.

PubMed

Grigsby, Jim; Brega, Angela G; Bennett, Rachael E; Bourgeois, James A; Seritan, Andreea L; Goodrich, Glenn K; Hagerman, Randi J

2016-08-01

To clarify the neuropsychiatric phenotype of fragile X-associated tremor/ataxia syndrome (FXTAS), and assess the extent to which it is mediated by the dysexecutive syndrome that is a major feature of the disorder. We examined the prevalence of clinically meaningful psychiatric symptoms among male carriers of the fragile X premutation, with and without FXTAS, in comparison with men with a normal allele. Measures included the Neuropsychiatric Inventory (NPI), Symptom Checklist-90-R (SCL-90-R), and the Behavioral Dyscontrol Scale, a measure of executive functioning. Between-group differences were evaluated using logistic regression, followed by a mediation analysis with ordinary least squares regression to assess the contribution of dysexecutive syndrome to the observed psychiatric domains. Men with FXTAS showed higher rates of clinically significant symptoms overall and in specific domains: somatization, obsessive compulsive, depression, anxiety, psychoticism, agitation/aggression, apathy/indifference, irritability, and nighttime behavior problems. Post hoc analyses suggested that findings of psychoticism among men with FXTAS may be associated with participants' accurate acknowledgment of cognitive and physical dysfunction, rather than reflecting psychosis. Asymptomatic carriers showed no evidence of clinically significant psychiatric symptoms, but when all carriers were compared with men having a normal FMR1 allele, executive function deficits were found to mediate scores in several domains on both NPI and SCL-90-R. Building on prior research, the results provide evidence that the psychiatric phenotype for men includes clinically meaningful depression, hostility, and irritability, in association with behavioral and attentional disinhibition. It is likely that these problems reflect the effects of impaired executive functioning.

Shared genetic influences between attention-deficit/hyperactivity disorder (ADHD) traits in children and clinical ADHD.

PubMed

Stergiakouli, Evie; Martin, Joanna; Hamshere, Marian L; Langley, Kate; Evans, David M; St Pourcain, Beate; Timpson, Nicholas J; Owen, Michael J; O'Donovan, Michael; Thapar, Anita; Davey Smith, George

2015-04-01

Twin studies and genome-wide complex trait analysis (GCTA) are not in agreement regarding heritability estimates for behavioral traits in children from the general population. This has sparked a debate on the possible difference in genetic architecture between behavioral traits and psychiatric disorders. In this study, we test whether polygenic risk scores associated with variation in attention-deficit/hyperactivity disorder (ADHD) trait levels in children from the general population predict ADHD diagnostic status and severity in an independent clinical sample. Single nucleotide polymorphisms (SNPs) with p < .5 from a genome-wide association study of ADHD traits in 4,546 children (mean age, 7 years 7 months) from the Avon Longitudinal Study of Parents and Children (ALSPAC; general population sample) were selected to calculate polygenic risk scores in 508 children with an ADHD diagnosis (independent clinical sample) and 5,081 control participants. Polygenic scores were tested for association with case-control status and severity of disorder in the clinical sample. Increased polygenic score for ADHD traits predicted ADHD case-control status (odds ratio = 1.17 [95% CI = 1.08-1.28], p = .0003), higher ADHD symptom severity (β = 0.29 [95% CI = 0.04-0.54], p = 0.02), and symptom domain severity in the clinical sample. This study highlights the relevance of additive genetic variance in ADHD, and provides evidence that shared genetic factors contribute to both behavioral traits in the general population and psychiatric disorders at least in the case of ADHD. Copyright © 2015 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.

Derivative component analysis for mass spectral serum proteomic profiles.

PubMed

Han, Henry

2014-01-01

As a promising way to transform medicine, mass spectrometry based proteomics technologies have seen a great progress in identifying disease biomarkers for clinical diagnosis and prognosis. However, there is a lack of effective feature selection methods that are able to capture essential data behaviors to achieve clinical level disease diagnosis. Moreover, it faces a challenge from data reproducibility, which means that no two independent studies have been found to produce same proteomic patterns. Such reproducibility issue causes the identified biomarker patterns to lose repeatability and prevents it from real clinical usage. In this work, we propose a novel machine-learning algorithm: derivative component analysis (DCA) for high-dimensional mass spectral proteomic profiles. As an implicit feature selection algorithm, derivative component analysis examines input proteomics data in a multi-resolution approach by seeking its derivatives to capture latent data characteristics and conduct de-noising. We further demonstrate DCA's advantages in disease diagnosis by viewing input proteomics data as a profile biomarker via integrating it with support vector machines to tackle the reproducibility issue, besides comparing it with state-of-the-art peers. Our results show that high-dimensional proteomics data are actually linearly separable under proposed derivative component analysis (DCA). As a novel multi-resolution feature selection algorithm, DCA not only overcomes the weakness of the traditional methods in subtle data behavior discovery, but also suggests an effective resolution to overcoming proteomics data's reproducibility problem and provides new techniques and insights in translational bioinformatics and machine learning. The DCA-based profile biomarker diagnosis makes clinical level diagnostic performances reproducible across different proteomic data, which is more robust and systematic than the existing biomarker discovery based diagnosis. Our findings demonstrate the feasibility and power of the proposed DCA-based profile biomarker diagnosis in achieving high sensitivity and conquering the data reproducibility issue in serum proteomics. Furthermore, our proposed derivative component analysis suggests the subtle data characteristics gleaning and de-noising are essential in separating true signals from red herrings for high-dimensional proteomic profiles, which can be more important than the conventional feature selection or dimension reduction. In particular, our profile biomarker diagnosis can be generalized to other omics data for derivative component analysis (DCA)'s nature of generic data analysis.

Acceptance and Commitment Therapy and Contextual Behavioral Science: Examining the Progress of a Distinctive Model of Behavioral and Cognitive Therapy

PubMed Central

Hayes, Steven C.; Levin, Michael E.; Plumb-Vilardaga, Jennifer; Villatte, Jennifer L.; Pistorello, Jacqueline

2012-01-01

A number of recent authors have compared acceptance and commitment therapy (ACT) and traditional cognitive behavior therapy (CBT). The present article describes ACT as a distinct and unified model of behavior change, linked to a specific strategy of scientific development, which we term “contextual behavioral science.” We outline the empirical progress of ACT and describe its distinctive development strategy. A contextual behavioral science approach is an inductive attempt to build more adequate psychological systems based on philosophical clarity; the development of basic principles and theories; the development of applied theories linked to basic ones; techniques and components linked to these processes and principles; measurement of theoretically key processes; an emphasis on mediation and moderation in the analysis of applied impact; an interest in effectiveness, dissemination, and training; empirical testing of the research program across a broad range of areas and levels of analysis; and the creation of a more effective scientific and clinical community. We argue that this is a reasonable approach, focused on long-term progress, and that in broad terms it seems to be working. ACT is not hostile to traditional CBT, and is not directly buoyed by whatever weaknesses traditional CBT may have. ACT should be measured at least in part against its own goals as specified by its own developmental strategy. PMID:23611068

Acceptance and commitment therapy and contextual behavioral science: examining the progress of a distinctive model of behavioral and cognitive therapy.

PubMed

Hayes, Steven C; Levin, Michael E; Plumb-Vilardaga, Jennifer; Villatte, Jennifer L; Pistorello, Jacqueline

2013-06-01

A number of recent authors have compared acceptance and commitment therapy (ACT) and traditional cognitive behavior therapy (CBT). The present article describes ACT as a distinct and unified model of behavior change, linked to a specific strategy of scientific development, which we term "contextual behavioral science." We outline the empirical progress of ACT and describe its distinctive development strategy. A contextual behavioral science approach is an inductive attempt to build more adequate psychological systems based on philosophical clarity; the development of basic principles and theories; the development of applied theories linked to basic ones; techniques and components linked to these processes and principles; measurement of theoretically key processes; an emphasis on mediation and moderation in the analysis of applied impact; an interest in effectiveness, dissemination, and training; empirical testing of the research program across a broad range of areas and levels of analysis; and the creation of a more effective scientific and clinical community. We argue that this is a reasonable approach, focused on long-term progress, and that in broad terms it seems to be working. ACT is not hostile to traditional CBT, and is not directly buoyed by whatever weaknesses traditional CBT may have. ACT should be measured at least in part against its own goals as specified by its own developmental strategy. Copyright © 2011. Published by Elsevier Ltd.

[Suicidal Behavior and Attention Decifit Hyperactivity Disorder in Adolescents of Medellin (Colombia), 2011-2012].

PubMed

Restrepo-Bernal, Diana; Bonfante-Olivares, Laura; Torres de Galvis, Yolanda; Berbesi-Fernández, Dedsy; Sierra-Hincapié, Gloria

2014-01-01

Suicide is a public health problem. In Colombia, teenagers are considered a group at high risk for suicidal behavior. To explore the possible association between suicidal behavior and attention deficit hyperactivity disorder in adolescents of Medellin. Observational, cross-sectional, analytical study. The Composite International Diagnostic Interview was applied to a total of 447 adolescents and the sociodemographic, clinical, familiar, and life event variables of interest were analyzed. The descriptive analysis of qualitative variables are presented as absolute values and frequencies, and the age was described with median [interquartile range]. A logistic regression model was constructed with explanatory variables that showed statistical association. Data were analyzed with SPSS® software version 21.0. Of the total, 59.1% were female, and the median age was 16 [14-18] years. Suicidal behavior was presented in 31% of females and 23% of males. Attention deficit was present in 6.3% of adolescents. The logistic regression analysis showed that the variables that best explained the suicidal behavior of adolescents were: female sex, post-traumatic stress disorder, panic disorder, and cocaine use. The diagnosis and early intervention of attention deficit hyperactivity disorder in children may be a useful strategy in the prevention of suicidal behavior in adolescents. Copyright © 2014 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.

Need, Enabling, Predisposing, and Behavioral Determinants of Access to Preventative Care in Argentina: Analysis of the National Survey of Risk Factors

PubMed Central

Jahangir, Eiman; Irazola, Vilma; Rubinstein, Adolfo

2012-01-01

Introduction Health care utilization is an important step to disease management, providing opportunities for prevention and treatment. Anderson’s Health Behavior Model has defined utilization by need, predisposing, and enabling determinants. We hypothesize that need, predisposing, and enabling, highlighting behavioral factors are associated with utilization in Argentina. Methods We performed a logistic regression analysis of the 2005 and 2009 Argentinean Survey of Risk Factors, a cohort of 41,392 and 34,732 individuals, to explore the association between need, enabling, predisposing, and behavioral factors to blood pressure measurement in the last year. Results In the 2005 cohort, blood pressure measurement was associated with perception of health, insurance coverage, basic needs met, and income. Additionally, female sex, civil state, household type, older age groups, education, and alcohol use were associated with utilization. The 2009 cohort showed similar associations with only minor differences between the models. Conclusions We explored the association between utilization of clinical preventive services with need, enabling, predisposing, and behavioral factors. While predisposing and need determinants are associated with utilization, enabling factors such as insurance coverage provides an area for public intervention. These are important findings where policies should be focused to improve utilization of preventive services in Argentina. PMID:22984608

The Relationship of Nursing Faculty Clinical Teaching Behaviors to Student Learning

ERIC Educational Resources Information Center

Kube, Marcia L.

2010-01-01

Clinical experience is the most important component of nursing education (Gaberson & Oermann, 2007; Walker, 2005). As part of the clinical learning environment, the clinical teaching behaviors of nursing faculty have significant potential to influence students' learning. Nurse educators have a responsibility to provide nursing students with…

Meta-analysis of suicidality in placebo-controlled clinical trials of adults taking bupropion.

PubMed

Wightman, Donna S; Foster, Vicki J; Krishen, Alok; Richard, Nathalie E; Modell, Jack G

2010-01-01

To assess a possible relationship between treatment with bupropion (vs placebo) and expressed suicidal ideation and behavior. This analysis, based on the US Food and Drug Administration's (FDA's) analysis of antidepressant suicidality data, included 8,953 adult subjects receiving bupropion and 6,520 adult subjects receiving placebo from randomized, placebo-controlled trials with bupropion conducted between 1976 and 2006 across multiple indications, including major depressive disorder (MDD). A text string search of the adverse event database and case report form comments was performed to identify potential suicidal events. FDA search criteria included the following text strings: accident-, injur-, suic-, or overdos-, including all events coded as accidental overdose, attempt, cut, gas, hang, hung, jump, mutilat-, self damag-, self harm, self inflict-, shoot, slash, poison, asphyxiation, suffocation, firearm, burn, drown, gun, immolat-, and monoxide, and the following terms were added by GlaxoSmithKline to the search criteria: accident, lacerat-, MVA, and hospital. The database search included data beginning from the first dose of study medication through 1 day following the last dose. Suicidal event narratives were classified using the Columbia Classification Algorithm for Suicide Assessment. Additionally, changes on rating scale items for depressed mood and suicidality were analyzed. In the MDD population, the incidence of suicidal behavior or ideation was 17/3,179 (0.53%) versus 11/2,310 (0.48%) for the bupropion and placebo groups, respectively (OR = 1.28; 95% CI, 0.59-2.86). For suicidal behavior, the incidence was 8/3,179 (0.25%) versus 2/2,310 (0.09%), respectively (OR = 3.52; 95% CI, 0.81-24.48). No suicidal behavior event was noted in the other indications, and no completed suicides were reported during treatment. No significant worsening was observed for bupropion relative to placebo on the rating scale items. No differential treatment effects were observed by gender or age; regardless of treatment, however, the 18- to 24-year-old group had the greatest odds of having a suicide event. Although no statistically significant differences were observed between bupropion and placebo in expressed suicidal ideation or behavior, we believe that all patients treated with antidepressants should receive careful monitoring for clinical worsening, suicidality, or unusual changes in behavior.

Perceived mental illness stigma, intimate relationships and sexual risk behavior in youth with mental illness.

PubMed

Elkington, Katherine S; Hackler, Dusty; Walsh, Tracy A; Latack, Jessica A; McKinnon, Karen; Borges, Cristiane; Wright, Eric R; Wainberg, Milton L

2013-05-01

The current study examines the role of mental illness-related stigma on romantic or sexual relationships and sexual behavior among youth with mental illness (MI), including youths' experiences of stigma, the internalization of these experiences, and the behavior associated with managing stigma within romantic and sexual relationships. We conducted in-depth interviews with N=20 youth with mental illness (MI) (55% male, 16-24 years, 75% Latino) from 4 psychiatric outpatient clinics in New York City. We conducted a thematic analysis to investigate shared experiences of MI stigma and its impact on youth's sexual or romantic relationships and associated behaviors. Our analysis revealed four main themes: 1) societal perceptions of those with MI as partners (societal stigma); 2) individual experiences of stigma within relationships (individual level); 3) internalized stigma of self as a partner (social-psychological processes); and 4) managing a stigmatized identity, of which some of the behaviors directly placed them at increased risk for HIV. We found that just under half of the sample (n=9/20) endorsed all themes, including engaging in HIV/STI sexual risk behaviors as a method to manage a stigmatize identity, which suggests that MI stigma and sexual risk may be linked. We discuss differences by gender and diagnosis. Findings provide new information for providers and researchers to address on the role of stigma experiences in the romantic and sexual behavior of youth in psychiatric treatment. Implications for stigma and HIV/STI prevention interventions are discussed.

Perceived mental illness stigma, intimate relationships and sexual risk behavior in youth with mental illness

PubMed Central

Elkington, Katherine S.; Hackler, Dusty; Walsh, Tracy A.; Latack, Jessica A.; McKinnon, Karen; Borges, Cristiane; Wright, Eric R.; Wainberg, Milton L.

2014-01-01

The current study examines the role of mental illness-related stigma on romantic or sexual relationships and sexual behavior among youth with mental illness (MI), including youths’ experiences of stigma, the internalization of these experiences, and the behavior associated with managing stigma within romantic and sexual relationships. We conducted in-depth interviews with N=20 youth with mental illness (MI) (55% male, 16-24 years, 75% Latino) from 4 psychiatric outpatient clinics in New York City. We conducted a thematic analysis to investigate shared experiences of MI stigma and its impact on youth’s sexual or romantic relationships and associated behaviors. Our analysis revealed four main themes: 1) societal perceptions of those with MI as partners (societal stigma); 2) individual experiences of stigma within relationships (individual level); 3) internalized stigma of self as a partner (social-psychological processes); and 4) managing a stigmatized identity, of which some of the behaviors directly placed them at increased risk for HIV. We found that just under half of the sample (n=9/20) endorsed all themes, including engaging in HIV/STI sexual risk behaviors as a method to manage a stigmatize identity, which suggests that MI stigma and sexual risk may be linked. We discuss differences by gender and diagnosis. Findings provide new information for providers and researchers to address on the role of stigma experiences in the romantic and sexual behavior of youth in psychiatric treatment. Implications for stigma and HIV/STI prevention interventions are discussed. PMID:25477706

Evaluating process in child and family interventions: aggression prevention as an example.

PubMed

Tolan, Patrick H; Hanish, Laura D; McKay, Mary M; Dickey, Mitchell H

2002-06-01

This article reports on 2 studies designed to develop and validate a set of measures for use in evaluating processes of child and family interventions. In Study 1 responses from 187 families attending an outpatient clinic for child behavior problems were factor analyzed to identify scales, consistent across sources: Alliance (Satisfactory Relationship with Interventionist and Program Satisfaction), Parenting Skill Attainment, Child Cooperation During Session, Child Prosocial Behavior, and Child Aggressive Behavior. Study 2 focused on patterns of scale scores among 78 families taking part in a 22-week preventive intervention designed to affect family relationships, parenting, and child antisocial and prosocial behaviors. The factor structure identified in Study 1 was replicated. Scale construct validity was demonstrated through across-source convergence, sensitivity to intervention change, and ability to discriminate individual differences. Path analysis validated the scales' utility in explaining key aspects of the intervention process. Implications for evaluating processes in family interventions are discussed.

Assessing app quality through expert peer review: a case study from the gray matters study.

PubMed

Hartin, Phillip J; Cleland, Ian; Nugent, Chris D; McClean, Sally I; Tschanz, JoAnn; Clark, Christine; Norton, Maria C

2016-08-01

Health apps focused on inciting behavior change are becoming increasingly popular. Nevertheless, many lack underlying evidence base, scientific credibility and have limited clinical effectiveness. It is therefore important that apps are well-informed, scientifically credible, peer reviewed and evidence based. This paper presents the use of the Mobile App Rating Scale (MARS) to assess the quality of the Grey Matters app, a cross platform app to deliver health education material and track behavior change across multi-domains with the aim of reducing the risk of developing Alzheimer's disease. The Gray Matters app shows promising results following reviews from 5 Expert raters, achieving a mean overall MARS score of 4.45 ± 0.14. Future work will involve undertaking of a detailed content analysis of behavior change apps to identify common themes and features which may lead to the successful facilitation of sustained behavior change.

The psychological science of addiction.

PubMed

Gifford, Elizabeth; Humphreys, Keith

2007-03-01

To discuss the contributions and future course of the psychological science of addiction. The psychology of addiction includes a tremendous range of scientific activity, from the basic experimental laboratory through increasingly broad relational contexts, including patient-practitioner interactions, families, social networks, institutional settings, economics and culture. Some of the contributions discussed here include applications of behavioral principles, cognitive and behavioral neuroscience and the development and evaluation of addiction treatment. Psychology has at times been guilty of proliferating theories with relatively little pruning, and of overemphasizing intrapersonal explanations for human behavior. However, at its best, defined as the science of the individual in context, psychology is an integrated discipline using diverse methods well-suited to capture the multi-dimensional nature of addictive behavior. Psychology has a unique ability to integrate basic experimental and applied clinical science and to apply the knowledge gained from multiple levels of analysis to the pragmatic goal of reducing the prevalence of addiction.

The functions of assessment: implications for selection and development of devices for assessing repertoires in clinical, educational, and other settings.

PubMed Central

Hawkins, R P

1979-01-01

An attempt is made to identify the many different functions that assessment of an individual's repertoire can serve. Implications of these functions for the character of and evidence about assessment devices are suggested. The functions fall into two general groups, those which influence decisions regarding an individual learner, and those which influence policy, program development, and scientific knowledge. The first group of functions is presented in a rough chronological sequence such that they form a "behavioral assessment funnel," beginning with functions involving broad-band assessment to identify likely persons and skill areas, and narrowing to the precise pinpointing, monitoring, and follow-up functions. The contribution of behavior analysis and behavior therapy to assessment methodology in this sequence is identified as well as the areas where more traditionally conceived methods are still useful. The second group of functions and behavioral contributions to it are then discussed. PMID:541308

High-grade poorly differentiated neuroendocrine carcinoma of the breast with low oncotype Dx recurrence score: A case report.

PubMed

Munoz-Zuluaga, Carlos A; Kotiah, Sandy; Studeman, Kimberley D

2017-01-01

Primary neuroendocrine carcinoma of the breast (NECB) is a rare malignant tumor with controversial biological behavior and a lack of data guiding treatment decisions due to its scarcity. Cancer gene-expression profiling tests provide a better indication of clinical prognosis and help determine the best clinical management versus the traditional clinical and pathological parameters. This is a report of a NECB with a genetic assay that showed a low-risk tumor despite high-grade and poorly differentiated histopathological features. Patient outcomes correlate with the low risk classification without the need for adjuvant chemotherapy despite the standard clinical-pathologic approach. Analysis of cancer related genes expression and outcomes in historical NECB may elucidate new insight of this rare disease.

Computed tomography-based finite element analysis to assess fracture risk and osteoporosis treatment

PubMed Central

Imai, Kazuhiro

2015-01-01

Finite element analysis (FEA) is a computer technique of structural stress analysis and developed in engineering mechanics. FEA has developed to investigate structural behavior of human bones over the past 40 years. When the faster computers have acquired, better FEA, using 3-dimensional computed tomography (CT) has been developed. This CT-based finite element analysis (CT/FEA) has provided clinicians with useful data. In this review, the mechanism of CT/FEA, validation studies of CT/FEA to evaluate accuracy and reliability in human bones, and clinical application studies to assess fracture risk and effects of osteoporosis medication are overviewed. PMID:26309819

Positive Family Intervention for Severe Challenging Behavior I: A Multisite Randomized Clinical Trial

ERIC Educational Resources Information Center

Durand, V. Mark; Hieneman, Meme; Clarke, Shelley; Wang, Mo; Rinaldi, Melissa L.

2013-01-01

The present study was a multisite randomized clinical trial assessing the effects of adding a cognitive-behavioral intervention to positive behavior support (PBS). Fifty-four families who met the criteria of (a) having a child with a developmental disability, (b) whose child displayed serious challenging behavior (e.g., aggression, self-injury,…

Clinical Correlates and Repetition of Self-Harming Behaviors among Female Adolescent Victims of Sexual Abuse

ERIC Educational Resources Information Center

Cyr, Mireille; McDuff, Pierre; Wright, John; Theriault, Chantal; Cinq-Mars, Caroline

2005-01-01

This study investigated self-harming behaviors in 149 female adolescent victims of sexual abuse, first, by determining the rates of nine types of self-mutilating behavior at intake and nine months later and, second, by investigating comorbidity of clinical correlates associated with these behaviors. The adolescents were divided into three groups…

Expanding the Limits of Evidence-Based Medicine: A Discourse Analysis of Cardiac Rehabilitation Clinical Practice Guidelines.

ERIC Educational Resources Information Center

Wise, Meg

Heart attacks are the leading cause of death in the United States, and cardiac rehabilitation, a form of post-MI (myocardial infarction) education, accounts for at most 20% of improved lifestyle behavior that can effectively manage symptoms, delay or prevent subsequent attacks, and lower mortality and morbidity rates. In an attempt to improve…

Student nurses' unethical behavior, social media, and year of birth.

PubMed

Smith, Gloria Copeland; Knudson, Troy Keith

2016-12-01

This study is the result of findings from a previous dissertation conducted by this author on Student Nurses' Unethical Behavior, Boundaries, and Social Media. The use of social media can be detrimental to the nurse-patient relationship if used in an unethical manner. A mixed method, using a quantitative approach based on research questions that explored differences in student nurses' unethical behavior by age (millennial vs nonmillennial) and clinical cohort, the relationship of unethical behavior to the utilization of social media, and analysis on year of birth and unethical behavior. A qualitative approach was used based on a guided faculty interview and common themes of student nurses' unethical behavior. Participants and Research Context: In total, 55 Associate Degree nursing students participated in the study; the research was conducted at Central Texas College. There were eight faculty-guided interviews. Ethical considerations: The main research instrument was an anonymous survey. All participants were assured of their right to an informed consent. All participants were informed of the right to withdraw from the study at any time. Findings indicate a significant correlation between student nurses' unethical behavior and use of social media (p = 0.036) and a significant difference between student unethical conduct by generation (millennials vs nonmillennials (p = 0.033)) and by clinical cohort (p = 0.045). Further findings from the follow-up study on year of birth and student unethical behavior reveal a correlation coefficient of 0.384 with a significance level of 0.003. Surprisingly, the study found that second-semester students had less unethical behavior than first-, third-, and fourth-semester students. The follow-up study found that this is because second-semester students were the oldest cohort. Implications for positive social change for nursing students include improved ethics education that may motivate ethical conduct throughout students' careers nationally and globally for better understanding and promotion of ethics and behavior.

Social Problem Solving and Depressive Symptoms Over Time: A Randomized Clinical Trial of Cognitive Behavioral Analysis System of Psychotherapy, Brief Supportive Psychotherapy, and Pharmacotherapy

PubMed Central

Klein, Daniel N.; Leon, Andrew C.; Li, Chunshan; D’Zurilla, Thomas J.; Black, Sarah R.; Vivian, Dina; Dowling, Frank; Arnow, Bruce A.; Manber, Rachel; Markowitz, John C.; Kocsis, James H.

2011-01-01

Objective Depression is associated with poor social problem-solving, and psychotherapies that focus on problem-solving skills are efficacious in treating depression. We examined the associations between treatment, social problem solving, and depression in a randomized clinical trial testing the efficacy of psychotherapy augmentation for chronically depressed patients who failed to fully respond to an initial trial of pharmacotherapy (Kocsis et al., 2009). Method Participants with chronic depression (n = 491) received Cognitive Behavioral Analysis System of Psychotherapy (CBASP), which emphasizes interpersonal problem-solving, plus medication; Brief Supportive Psychotherapy (BSP) plus medication; or medication alone for 12 weeks. Results CBASP plus pharmacotherapy was associated with significantly greater improvement in social problem solving than BSP plus pharmacotherapy, and a trend for greater improvement in problem solving than pharmacotherapy alone. In addition, change in social problem solving predicted subsequent change in depressive symptoms over time. However, the magnitude of the associations between changes in social problem solving and subsequent depressive symptoms did not differ across treatment conditions. Conclusions It does not appear that improved social problem solving is a mechanism that uniquely distinguishes CBASP from other treatment approaches. PMID:21500885

Evaluating the influence of perceived organizational learning capability on user acceptance of information technology among operating room nurse staff.

PubMed

Lee, Chien-Ching; Lin, Shih-Pin; Yang, Shu-Ling; Tsou, Mei-Yung; Chang, Kuang-Yi

2013-03-01

Medical institutions are eager to introduce new information technology to improve patient safety and clinical efficiency. However, the acceptance of new information technology by medical personnel plays a key role in its adoption and application. This study aims to investigate whether perceived organizational learning capability (OLC) is associated with user acceptance of information technology among operating room nurse staff. Nurse anesthetists and operating room nurses were recruited in this questionnaire survey. A pilot study was performed to ensure the reliability and validity of the translated questionnaire, which consisted of 14 items from the four dimensions of OLC, and 16 items from the four constructs of user acceptance of information technology, including performance expectancy, effort expectancy, social influence, and behavioral intention. Confirmatory factor analysis was applied in the main survey to evaluate the construct validity of the questionnaire. Structural equation modeling was used to test the hypothetical relationships between the four dimensions of user acceptance of information technology and the second-ordered OLC. Goodness of fit of the hypothetic model was also assessed. Performance expectancy, effort expectancy, and social influence positively influenced behavioral intention of users of the clinical information system (all p < 0.001) and accounted for 75% of its variation. The second-ordered OLC was positively associated with performance expectancy, effort expectancy, and social influence (all p < 0.001). However, the hypothetic relationship between perceived OLC and behavioral intention was not significant (p = 0.87). The fit statistical analysis indicated reasonable model fit to data (root mean square error of approximation = 0.07 and comparative fit index = 0.91). Perceived OLC indirectly affects user behavioral intention through the mediation of performance expectancy, effort expectancy, and social influence in the operating room setting. Copyright © 2013. Published by Elsevier B.V.

Facial expressivity during the clinical interview as a predictor functional disability in schizophrenia. a pilot study.

PubMed

Troisi, Alfonso; Pompili, Enrico; Binello, Luigi; Sterpone, Alessandro

2007-03-30

Despite the central role of nonverbal behavior in regulating social interactions, its relationship to functional disability in schizophrenia has received little empirical attention. This study aimed at assessing the relationship of patients' spontaneous facial expressivity during the clinical interview to clinician-rated and self-reported measures of functional disability. The nonverbal behavior of 28 stabilized patients with schizophrenia was analyzed by using the Ethological Coding System for Interviews (ECSI). Functional disability was assessed using the Global Assessment of Functioning (GAF) scale and the Sheehan Disability Scale (DISS). Partial correlation analysis controlling for the confounding effects of neuroleptic treatment showed that facial expressivity was correlated with the GAF score (r=0.42, P=0.03) and the scores on the subscales of the DISS measuring work (r=-0.52, P=0.005) and social (r=-0.50, P=0.007) disability. In a multiple regression model, nonverbal behavior explained variation in patients' work and social disability better than negative symptoms. The results of this pilot study suggest that deficits in encoding affiliative signals may play a role in determining or aggravating functional disability in schizophrenia. One clinical implication of this finding is that remediation training programs designed to improve nonverbal communication could also serve as a useful adjunct for improving work and social functioning in patients with schizophrenia.

Impact of a Computer-assisted Education Program on Factors Related to Asthma Self-management Behavior

PubMed Central

Shegog, Ross; Bartholomew, L. Kay; Parcel, Guy S.; Sockrider, Marianna M.; Mâsse, Louise; Abramson, Stuart L.

2001-01-01

Objective: To evaluate Watch, Discover, Think and Act (WDTA), a theory-based application of CD-ROM educational technology for pediatric asthma self-management education. Design: A prospective pretest posttest randomized intervention trial was used to assess the motivational appeal of the computer-assisted instructional program and evaluate the impact of the program in eliciting change in knowledge, self-efficacy, and attributions of children with asthma. Subjects were recruited from large urban asthma clinics, community clinics, and schools. Seventy-six children 9 to 13 years old were recruited for the evaluation. Results: Repeated-measures analysis of covariance showed that knowledge scores increased significantly for both groups, but no between-group differences were found (P = 0.55); children using the program scored significantly higher (P < 0.01) on questions about steps of self-regulation, prevention strategies, and treatment strategies. These children also demonstrated greater selfefficacy (P < 0.05) and more efficacy building attribution classification of asthma self-management behaviors (P < 0.05) than those children who did not use the program. Conclusion: The WDTA is an intrinsically motivating educational program that has the ability to effect determinants of asthma self-management behavior in 9- to 13-year-old children with asthma. This, coupled with its reported effectiveness in enhancing patient outcomes in clinical settings, indicates that this program has application in pediatric asthma education. PMID:11141512

Camus's L'étranger and the first description of a man with Asperger's syndrome.

PubMed

Shuster, Sam

2018-01-01

The continued discussion about the meaning of Camus's famous novel, L'étranger , provoked a re-reading, and this, in turn, led to its clinical analysis and further investigation. The book rests entirely on the thoughts, words and actions of its central character, Meursault, and these were found to show impairment of social relationships, communication and interaction, with other traits diagnostic of the Asperger's subgroup of the autism spectrum disorder. It was then found that Camus had based Meursault on his close friend Galindo, and a search was therefore made for evidence of Galindo's character; this revealed him to be an intelligent but odd person, who exhibited the characteristic impairment of social and personal behavior of Asperger's syndrome. Thus, Camus had recognized and understood his friend's strange behavior before Asperger's syndrome had been defined; his use of it for the creation of Meursault is therefore the first published account of a man with this disorder. Many of the interpretations and ideas developed from Meursault's words, thoughts and actions must now be reconsidered, as they are a misreading of the words and behavior of a man with Asperger's syndrome. The outcome of this clinical examination of L'étranger is unique; it shows that a precise account of a person with a neurobehavioral disorder was made by a novelist before the disorder had been clinically defined.

Clustering Suicide Attempters: Impulsive-Ambivalent, Well-Planned, or Frequent.

PubMed

Lopez-Castroman, Jorge; Nogue, Erika; Guillaume, Sebastien; Picot, Marie Christine; Courtet, Philippe

2016-06-01

Attempts to predict suicidal behavior within high-risk populations have so far shown insufficient accuracy. Although several psychosocial and clinical features have been consistently associated with suicide attempts, investigations of latent structure in well-characterized populations of suicide attempters are lacking. We analyzed a sample of 1,009 hospitalized suicide attempters that were recruited between 1999 and 2012. Eleven clinically relevant items related to the characteristics of suicidal behavior were submitted to a Hierarchical Ascendant Classification. Phenotypic profiles were compared between the resulting clusters. A decisional tree was constructed to facilitate the differentiation of individuals classified within the first 2 clusters. Most individuals were included in a cluster characterized by less lethal means and planning ("impulse-ambivalent"). A second cluster featured more carefully planned attempts ("well-planned"), more alcohol or drug use before the attempt, and more precautions to avoid interruptions. Finally, a small, third cluster included individuals reporting more attempts ("frequent"), more often serious or violent attempts, and an earlier age at first attempt. Differences across clusters by demographic and clinical characteristics were also found, particularly with the third cluster whose participants had experienced high levels of childhood abuse. Cluster analysis consistently supported 3 distinct clusters of individuals with specific features in their suicidal behaviors and phenotypic profiles that could help clinicians to better focus prevention strategies. © Copyright 2016 Physicians Postgraduate Press, Inc.

[Styles of interpersonal conflict in patients with panic disorder, alcoholism, rheumatoid arthritis and healthy controls: a cluster analysis study].

PubMed

Eher, R; Windhaber, J; Rau, H; Schmitt, M; Kellner, E

2000-05-01

Conflict and conflict resolution in intimate relationships are not only among the most important factors influencing relationship satisfaction but are also seen in association with clinical symptoms. Styles of conflict will be assessed in patients suffering from panic disorder with and without agoraphobia, in alcoholics and in patients suffering from rheumatoid arthritis. 176 patients and healthy controls filled out the Styles of Conflict Inventory and questionnaires concerning severity of clinical symptoms. A cluster analysis revealed 5 types of conflict management. Healthy controls showed predominantely assertive and constructive styles, patients with panic disorder showed high levels of cognitive and/or behavioral aggression. Alcoholics showed high levels of repressed aggression, and patients with rheumatoid arthritis often did not exhibit any aggression during conflict. 5 Clusters of conflict pattern have been identified by cluster analysis. Each patient group showed considerable different patterns of conflict management.

Parents Plus Systemic, Solution-Focused Parent Training Programs: Description, Review of the Evidence Base, and Meta-Analysis.

PubMed

Carr, Alan; Hartnett, Dan; Brosnan, Eileen; Sharry, John

2017-09-01

Parents Plus (PP) programs are systemic, solution-focused, group-based interventions. They are designed for delivery in clinical and community settings as treatment programs for families with child-focused problems, such as behavioral difficulties, disruptive behavior disorders, and emotional disorders in young people with and without developmental disabilities. PP programs have been developed for families of preschoolers, preadolescent children, and teenagers, as well as for separated or divorced families. Seventeen evaluation studies involving over 1,000 families have shown that PP programs have a significant impact on child behavior problems, goal attainment, and parental satisfaction and stress. The effect size of 0.57 (p < .001) from a meta-analysis of 10 controlled studies for child behavior problems compares favorably with those of meta-analyses of other well-established parent training programs with large evidence bases. In controlled studies, PP programs yielded significant (p < .001) effect sizes for goal attainment (d = 1.51), parental satisfaction (d = 0.78), and parental stress reduction (d = 0.54). PP programs may be facilitated by trained front-line mental health and educational professionals. © 2016 Family Process Institute.

Factors affecting ethical behavior in pediatric occupational therapy: A qualitative study

PubMed Central

Kalantari, Minoo; Kamali, Mohammad; Joolaee, Soodabeh; Shafarodi, Narges; Rassafiani, Mehdi

2015-01-01

Background: It is the responsibility of each occupational therapist to always act ethically and professionally in a clinical setting. However, there is little information available concerning the factors influencing ethical behavior of occupational therapists at work. Since no study has been conducted in Iran on this topic, this qualitative study aimed to identify the factors influencing ethical behavior of pediatric occupational therapists. Methods: Twelve pediatric occupational therapists participated in this study. The sampling was purposeful, and the interviews continued until reaching data saturation. All interviews were recorded and transcribed. The data were analyzed by qualitative content analysis, and the ethics of qualitative research was considered. Results: The factors influencing ethical behavior were classified into four main categories including organizational factors, therapist related factors, client’s family issues, and social factors. Conclusion: This study identified numerous factors influencing the ethical behavior of pediatric occupational therapists that could be used to train occupational therapists, human resources managers, professional policy makers, and could also be used to conduct future researches, and produce tools. PMID:26913245

Depressive Symptoms and Externalizing Behaviors among Hispanic Immigrant Adolescents: Examining Longitudinal Effects of Cultural Stress

PubMed Central

Cano, Miguel Ángel; Schwartz, Seth J.; Castillo, Linda G.; Romero, Andrea J.; Huang, Shi; Lorenzo-Blanco, Elma I.; Unger, Jennifer B.; Zamboanga, Byron L.; Des Rosiers, Sabrina E.; Baezconde-Garbanati, Lourdes; Lizzi, Karina M.; Soto, Daniel W.; Oshri, Assaf; Villamar, Juan Andres; Pattarroyo, Monica; Szapocznik, José

2015-01-01

This study examined longitudinal effects of cultural stress (a latent factor comprised of bicultural stress, ethnic discrimination, and negative context of reception) on depressive symptoms and a range of externalizing behaviors among recently (≤5 years in the U.S. at baseline) immigrated Hispanic adolescents. A sample of 302 adolescents (53% boys; mean age 14.51 years) completed baseline measures of perceived ethnic discrimination, bicultural stress, and perceived negative context of reception; and outcome measures of depressive symptoms, cigarette smoking, alcohol use, aggressive behavior, and rule-breaking behavior six months post-baseline. A path analysis indicated that higher cultural stress scores predicted higher levels of all outcomes. These effects were consistent across genders, but varied by study site. Specifically, higher cultural stress scores increased depressive symptoms among participants in Miami, but not in Los Angeles. Findings suggest that cultural stress is a clinically relevant predictor of depressive symptoms and externalizing behaviors among Hispanic immigrant adolescents. PMID:25899132

Validating Female Psychopathy Subtypes: Differences in Personality, Antisocial and Violent Behavior, Substance Abuse, Trauma, and Mental Health

PubMed Central

Hicks, Brian M.; Vaidyanathan, Uma; Patrick, Christopher J.

2010-01-01

Recent empirical investigations utilizing male prisoners have begun to validate clinical conceptualizations of primary and secondary psychopathy subtypes. We extended this literature by identifying similar psychopathic subtypes in female prisoners on the basis of personality structure using model-based cluster analysis. Secondary psychopaths (n = 39) were characterized by personality traits of negative emotionality and low behavioral constraint, an early onset of antisocial and criminal behavior, greater substance use and abuse, more violent behavior and institutional misconduct, and more mental health problems including symptoms of post-traumatic stress disorder and suicide attempts. Primary psychopaths (n = 31) exhibited few distinguishing personality features but were prolific criminals especially in regards to non-violent crime, and exhibited relatively few mental health problems despite substantial exposure to traumatic events. The results support alternative etiological pathways to antisocial and criminal behavior that are evident in personality structure as well as gender similarities and differences in the manifestation of psychopathic personalities. PMID:20582155

Preadoption adversity and long-term clinical-range behavior problems in adopted Chinese girls.

PubMed

Tan, Tony Xing; Camras, Linda A; Kim, Eun Sook

2016-04-01

In this study, we report findings on the role of preadoption adversity on long-term clinical-range problems in adopted Chinese girls. Four waves (2005, 2007, 2009 and 2011) of problem behavior data on 1,223 adopted Chinese girls (M = 4.86 years, SD = 2.82 in 2005) were collected from the adoptive mothers with the Child Behavior Checklist (CBCL). At Wave 1 (2005), data on the following indicators of preadoption adversity was collected: age at adoption, physical signs/symptoms (e.g., sores) of preadoption adversity, developmental delays at arrival, refusal/avoidance behaviors and crying/clinging behaviors toward adoptive parents during the first 3 weeks of adoption. We found that the percentage of clinical-range internalizing problems was 11.1%, 16.5%, 11.3%, and 16.1% at Wave 1, Wave 2, Wave 3, and Wave 4, respectively; the corresponding percentage of clinical-range externalizing problems was 8.4%, 10.5%, 8.4% and 9.9% respectively; and the corresponding percentage of clinical-range total CBCL problems was 9.3%, 13.0%, 9.8% and 12.6% respectively. Analyses with Mplus showed that controlling for demographic variables, indicators of preadoption adversity, except age at adoption, increased the odds for clinical-range behavior problems. Longitudinal path models revealed that controlling for demographic variables and the children's adjustment status in the previous wave, refusal/avoidance remained significant in predicting clinical-range internalizing, externalizing and total CBCL problems at Wave 2, delays at arrival and signs/symptoms were significant in predicting clinical-range internalizing problems at Wave 3. Overall, adoptees with clinical-range CBCL problems in earlier waves were 9-28 times as likely to show clinical-range CBCL problems in subsequent waves. (c) 2016 APA, all rights reserved).

"Diagnosis by behavioral observation" home-videosomnography - a rigorous ethnographic approach to sleep of children with neurodevelopmental conditions.

PubMed

Ipsiroglu, Osman S; Hung, Yi-Hsuan Amy; Chan, Forson; Ross, Michelle L; Veer, Dorothee; Soo, Sonja; Ho, Gloria; Berger, Mai; McAllister, Graham; Garn, Heinrich; Kloesch, Gerhard; Barbosa, Adriano Vilela; Stockler, Sylvia; McKellin, William; Vatikiotis-Bateson, Eric

2015-01-01

Advanced video technology is available for sleep-laboratories. However, low-cost equipment for screening in the home setting has not been identified and tested, nor has a methodology for analysis of video recordings been suggested. We investigated different combinations of hardware/software for home-videosomnography (HVS) and established a process for qualitative and quantitative analysis of HVS-recordings. A case vignette (HVS analysis for a 5.5-year-old girl with major insomnia and several co-morbidities) demonstrates how methodological considerations were addressed and how HVS added value to clinical assessment. We suggest an "ideal set of hardware/software" that is reliable, affordable (∼$500) and portable (=2.8 kg) to conduct non-invasive HVS, which allows time-lapse analyses. The equipment consists of a net-book, a camera with infrared optics, and a video capture device. (1) We present an HVS-analysis protocol consisting of three steps of analysis at varying replay speeds: (a) basic overview and classification at 16× normal speed; (b) second viewing and detailed descriptions at 4-8× normal speed, and (c) viewing, listening, and in-depth descriptions at real-time speed. (2) We also present a custom software program that facilitates video analysis and note-taking (Annotator(©)), and Optical Flow software that automatically quantifies movement for internal quality control of the HVS-recording. The case vignette demonstrates how the HVS-recordings revealed the dimension of insomnia caused by restless legs syndrome, and illustrated the cascade of symptoms, challenging behaviors, and resulting medications. The strategy of using HVS, although requiring validation and reliability testing, opens the floor for a new "observational sleep medicine," which has been useful in describing discomfort-related behavioral movement patterns in patients with communication difficulties presenting with challenging/disruptive sleep/wake behaviors.

Seeing Students Squirm: Nursing Students' Experiences of Bullying Behaviors During Clinical Rotations.

PubMed

Smith, Carolyn R; Gillespie, Gordon Lee; Brown, Kathryn C; Grubb, Paula L

2016-09-01

Bullying remains a troubling problem in the nursing profession. Nursing students may encounter bullying behavior in clinical settings. However, they may not be adequately prepared to recognize and handle bullying behavior when it occurs. This study's purpose was to gain a greater understanding of nursing students' experiences of bullying behaviors in the clinical setting. Using a descriptive qualitative approach, eight focus groups were held with 56 undergraduate baccalaureate nursing students from four college campuses. Focus group data were coded and analyzed for themes. Four categories were identified: Bullying Behaviors, Rationale for Bullying, Response to Bullying, and Recommendations to Address Bullying. Each category and its corresponding themes are presented. Interventions for nurse educators to address the bullying of nursing students in clinical settings are presented. [J Nurs Educ. 2016;55(9):505-513.]. Copyright 2016, SLACK Incorporated.

Seeing Students Squirm: Nursing Students’ Experiences of Bullying Behaviors During Clinical Rotations

PubMed Central

Smith, Carolyn R.; Gillespie, Gordon Lee; Brown, Kathryn C.; Grubb, Paula L.

2016-01-01

Background Bullying remains a troubling problem in the nursing profession. Nursing students may encounter bullying behavior in clinical settings. However nursing students may not be adequately prepared to recognize and handle bullying behavior when it occurs. The purpose of this study was to gain greater understanding of nursing students’ experiences of bullying behaviors in the clinical setting. Method Using a descriptive qualitative approach, eight focus groups were held with 56 undergraduate baccalaureate nursing students from four college campuses. Focus group data were coded and analyzed for themes. Results Four categories of themes were identified: bullying behaviors, rationale for bullying, response to bullying, and recommendations to address bullying. Each category and its corresponding themes are presented. Conclusion Interventions for nurse educators to address bullying of nursing students in clinical settings are presented. PMID:27560118

Measuring Advance Care Planning: Optimizing the Advance Care Planning Engagement Survey.

PubMed

Sudore, Rebecca L; Heyland, Daren K; Barnes, Deborah E; Howard, Michelle; Fassbender, Konrad; Robinson, Carole A; Boscardin, John; You, John J

2017-04-01

A validated 82-item Advance Care Planning (ACP) Engagement Survey measures a broad range of behaviors. However, concise surveys are needed. The objective of this study was to validate shorter versions of the survey. The survey included 57 process (e.g., readiness) and 25 action items (e.g., discussions). For item reduction, we systematically eliminated questions based on face validity, item nonresponse, redundancy, ceiling effects, and factor analysis. We assessed internal consistency (Cronbach's alpha) and construct validity with cross-sectional correlations and the ability of the progressively shorter survey versions to detect change one week after exposure to an ACP intervention (Pearson correlation coefficients). Five hundred one participants (four Canadian and three US sites) were included in item reduction (mean age 69 years [±10], 41% nonwhite). Because of high correlations between readiness and action items, all action items were removed. Because of high correlations and ceiling effects, two process items were removed. Successive factor analysis then created 55-, 34-, 15-, nine-, and four-item versions; 664 participants (from three US ACP clinical trials) were included in validity analysis (age 65 years [±8], 72% nonwhite, 34% Spanish speaking). Cronbach's alphas were high for all versions (four items 0.84-55 items 0.97). Compared with the original survey, cross-sectional correlations were high (four items 0.85; 55 items 0.97) as were delta correlations (four items 0.68; 55 items 0.93). Shorter versions of the ACP Engagement Survey are valid, internally consistent, and able to detect change across a broad range of ACP behaviors for English and Spanish speakers. Shorter ACP surveys can efficiently measure broad ACP behaviors in research and clinical settings. Published by Elsevier Inc.

Development and future perspectives of behavioral medicine in Japan.

PubMed

Nomura, Shinobu

2016-01-01

Development and Future Perspectives of Behavioral Medicine in Japan The study of the "Type A behavior pattern and myocardial infarction" was one of the main themes in the early stage of Behavioral Medicine. After that, behavior modification came to be widely applied to the treatment of various kinds of chronic diseases, and a general concept of Behavioral Medicine was subsequently formed. The Japanese Society of Behavioral Medicine was established in 1992 and is comprised of researchers in the fields of clinical medicine, social medicine, and psycho-behavioral science. Recently, we devised a core curriculum for behavioral science and behavioral medicine and have published a Japanese version of the "Textbook of Behavioral Medicine" in conformity with it. It is a primer that includes all of the basics and clinical applications of Behavioral Medicine and is edited as a manual that can be utilized in clinical practice. We hope this book will contribute to the development of Behavioral Medicine in Japan, to a more healthy life for our people, and to the improvement of the QOL of our patients. In this paper, I discuss the future perspectives from my personal opinion while looking back on the history of Behavioral Medicine in Japan.

Clinical Instructor Characteristics, Behaviors and Skills in Allied Health Care Settings: A Literature Review

ERIC Educational Resources Information Center

Levy, Linda S.; Sexton, Patrick; Willeford, K. Sean; Barnum, Mary G.; Guyer, M. Susan; Gardner, Greg; Fincher, A. Louise

2009-01-01

The purpose of this literature review is to compare both clinical instructor and student perceptions of helpful and hindering clinical instructor characteristics, behaviors and skills in athletic training and allied health care settings. Clinical education in athletic training is similar to that of other allied health care professions. Clinical…

Stigma Related to HIV among Community Health Workers in Chile

PubMed Central

Cianelli, Rosina; Ferrer, Lilian; Norr, Kathleen F.; McCreary, Linda; Irarrázabal, Lisette; Bernales, Margarita; Miner, Sarah

2011-01-01

Purpose When healthcare workers have stigmatizing attitudes toward people living with HIV it may lead to discriminatory behavior that interferes with prevention, treatment, and care. This research examined the HIV-related stigmatizing attitudes reported by health workers in Santiago, Chile. Methods The study used focus group data from the first phase of a larger study to develop and test a HIV prevention intervention for Chilean health workers. Ten focus groups were conducted with Health workers in two communities in Santiago, Chile. Content analysis was used to analyze the data. Results Two central themes emerged: Societal stigma and discrimination towards people living with HIV and healthcare system’s policies related to HIV. Both inaccurate fears of transmission among the general public and Chilean Health workers and societal prejudices against homosexuals contributed to stigmatization and discrimination. Conclusions Health workers did not recognize their own stigmatizing attitudes or discriminatory behaviors, but their discussion indicated that these behaviors and attitudes did exist. Healthcare system issues identified included problems with confidentiality due to the desire to inform other health workers about client HIV status. Health workers must be sensitized to the current stigmatization and misinformation associated with HIV and its negative impacts on persons living with HIV and the general community. Implications All clinical and non-clinical workers at community clinics need mandatory education for HIV prevention that focuses on changing attitudes as well as sharing knowledge. Also, the Chilean law protecting people living with HIV and the confidentiality of their medical care needs to be publicized, along with guidelines for its enactment in clinics and other health facilities. PMID:21687824

Performance of Male and Female C57BL/6J Mice on Motor and Cognitive Tasks Commonly Used in Pre-Clinical Traumatic Brain Injury Research

PubMed Central

Tucker, Laura B.; Fu, Amanda H.

2016-01-01

Abstract To date, clinical trials have failed to find an effective therapy for victims of traumatic brain injury (TBI) who live with motor, cognitive, and psychiatric complaints. Pre-clinical investigators are now encouraged to include male and female subjects in all translational research, which is of particular interest in the field of neurotrauma given that circulating female hormones (progesterone and estrogen) have been demonstrated to exert neuroprotective effects. To determine whether behavior of male and female C57BL6/J mice is differentially impaired by TBI, male and cycling female mice were injured by controlled cortical impact and tested for several weeks with functional assessments commonly employed in pre-clinical research. We found that cognitive and motor impairments post-TBI, as measured by the Morris water maze (MWM) and rotarod, respectively, were largely equivalent in male and female animals. However, spatial working memory, assessed by the y-maze, was poorer in female mice. Female mice were generally more active, as evidenced by greater distance traveled in the first exposure to the open field, greater distance in the y-maze, and faster swimming speeds in the MWM. Statistical analysis showed that variability in all behavioral data was no greater in cycling female mice than it was in male mice. These data all suggest that with careful selection of tests, procedures, and measurements, both sexes can be included in translational TBI research without concern for effect of hormones on functional impairments or behavioral variability. PMID:25951234

Analysis of pain behavior profiles and functional disability in outpatient physical therapy clinics.

PubMed

Hankin, H A; Spencer, T; Kegerreis, S; Worrell, T; Rice, J M

2001-02-01

Descriptive, ex post facto. To determine the proportion of physical therapy outpatients with pain who exhibit various pain behavior profiles, and to determine whether there are differences in functional disability across the profiles. Physical therapists treat many patients who have chronic pain. Research suggests that early identification and multidisciplinary treatment are effective and economical for these patients. The Multidimensional Pain Inventory (MPI) and the Pain Disability Index (PDI) are potential screening tools that could be used in physical therapy clinics to determine which patients should be referred for multidisciplinary treatment. MPI and PDI data were gathered on 57 physical therapy outpatients (mean age 44.3 +/- 14.5 years, 22 men and 35 women) with pain of 3 or more months duration. ANOVA was used to analyze differences in mean PDI scores across the MPI profiles. Of all patients, 42.1% fit the Adaptive Coper profile, 29.8% fit the Interpersonally Distressed profile, and 28.1% fit the Dysfunctional profile. There were significant differences in PDI scores among profile groups. Post hoc analysis showed that the PDI scores of the Adaptive Coper and Interpersonally Distressed groups were different from the Dysfunctional group, but that there was no difference between the Adaptive Coper and Interpersonally Distressed groups. Many patients in outpatient physical therapy settings exhibit behavioral, affective, and cognitive characteristics associated with chronic pain. Thirty-three patients (57.9%) had MPI profiles (interpersonally distressed and dysfunctional) that suggest they might benefit from multidisciplinary treatment.

Innovative use of influential prenatal counseling may improve breastfeeding initiation rates among WIC participants.

PubMed

Hildebrand, Deana A; McCarthy, Pam; Tipton, Debi; Merriman, Connie; Schrank, Melody; Newport, Melinda

2014-01-01

To determine whether integrating influence strategies (reciprocation, consistency, consensus, feeling liked, authority, and scarcity) throughout Chickasaw Nation Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) clinics (1) changed participants' perception of the WIC experience and (2) affected breastfeeding initiation rates. Two-part, quasi-experimental design. Four WIC clinics. Parents and caregivers of children birth to 3 years. Behavior change intervention based on Social Cognitive Theory using Caildini's Principles of Influence. Traditional-model groups (control) received services prior to the intervention; influence-model groups (experimental) received services after initiation of the intervention. The preliminary demonstration project surveyed 2 groups to measure changes in their perceptions of the WIC environment. Secondary data analysis measured changes in breastfeeding initiation in 2 groups of postpartum women. Frequency analysis, independent sample t tests, chi-square for independence, step-wise logistic regression. The demonstration project resulted in 5 improved influence measures (P < .02), aligning with the influence principle of "feeling liked." The model had a small effect (φ = 0.10) in distinguishing breastfeeding initiation; women in the influence model were 1.5 times more likely (95% CI, 1.19-1.86; P < .05) to initiate breastfeeding compared with women in the traditional model, controlling for parity, mother's age, and race. Consistent with Social Cognitive Theory, changing the WIC environment by integrating influence principles may positively affect women's infant feeding decisions and behaviors, specifically breastfeeding initiation rates. Copyright © 2014 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.

Diagnostic Value of the Urine Mucus Test in Childhood Masturbation among Children below 12 Years of Age: A Cross-Sectional Study from Iran

PubMed Central

Doust, Zarin Keihani; Shariat, Mamak; Zabandan, Neda; Tabrizi, Aidin; Tehrani, Fatemeh

2016-01-01

Background: Childhood masturbation (CM) is considered a variant of normal sexual behavior; however, it is commonly misdiagnosed as epilepsy and movement disorders. As the first study from Iran, we analyzed a large population of infants and children with CM in a case-control study and evaluated the value of mucus in urine analysis as an alternative diagnostic tool for CM. Methods: A total of 623 children referred to the Pediatric Neurology Clinic of Imam Khomeini Hospital for an evaluation of seizure or movement disorders were studied between 2008 and 2011. Totally, 359 children were found to have masturbatory behaviors (Group A) and the rest (264) were assigned to Group B. CM was diagnosed by direct observation. Collected data comprised demographic characteristics, clinical and neurodevelopmental examinations, laboratory findings (particularly urine analysis), and electrocardiography. Results: The age of the children with CM was below 12 years old, and the girl-to-boy ratio was 7:1. Mucus in urine was positive in 357 (99.44%) children in Group A and 22 (8.3%) in Group B (P<0.001). A significant correlation was found between the presence of mucus in urine and masturbatory behaviors (P<0.001). Conclusion: Our findings suggest that the presence of mucus in urine can be used as an alternative laboratory test in children with CM below 12 years old and even in infants (≤24 months old). Further studies are needed to confirm the results. PMID:27365549

Rational-emotive and cognitive-behavior therapy (REBT/CBT) versus pharmacotherapy versus REBT/CBT plus pharmacotherapy in the treatment of major depressive disorder in youth; a randomized clinical trial.

PubMed

Iftene, Felicia; Predescu, Elena; Stefan, Simona; David, Daniel

2015-02-28

Major depressive disorder is a highly prevalent and debilitating condition in youth, so developing efficient treatments is a priority for mental health professionals. Psychotherapy (i.e., cognitive behavioral therapy/CBT), pharmacotherapy (i.e., SSRI medication), and their combination have been shown to be effective in treating youth depression; however, the results are still mixed and there are few studies engaging multi-level analyses (i.e., subjective, cognitive, and biological). Therefore, the aims of this randomized control study (RCT) were both theoretical - integrating psychological and biological markers of depression in a multi-level outcome analysis - and practical - testing the generalizability of previous results on depressed Romanian youth population. Eighty-eight (N=88) depressed Romanian youths were randomly allocated to one of the three treatment arms: group Rational Emotive Behavior Therapy (REBT)/CBT (i.e., a form of CBT), pharmacotherapy (i.e., sertraline), and group REBT/CBT plus pharmacotherapy. The results showed that all outcomes (i.e., subjective, cognitive, and biological) significantly change from pre to post-treatment under all treatment conditions at a similar rate and there were no significant differences among conditions at post-test. In case of categorical analysis of the clinical response rate, we found a non-significant trend favoring group REBT/CBT therapy. Results of analyses concerning outcome interrelations are discussed. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Noise-induced tinnitus using individualized gap detection analysis and its relationship with hyperacusis, anxiety, and spatial cognition.

PubMed

Pace, Edward; Zhang, Jinsheng

2013-01-01

Tinnitus has a complex etiology that involves auditory and non-auditory factors and may be accompanied by hyperacusis, anxiety and cognitive changes. Thus far, investigations of the interrelationship between tinnitus and auditory and non-auditory impairment have yielded conflicting results. To further address this issue, we noise exposed rats and assessed them for tinnitus using a gap detection behavioral paradigm combined with statistically-driven analysis to diagnose tinnitus in individual rats. We also tested rats for hearing detection, responsivity, and loss using prepulse inhibition and auditory brainstem response, and for spatial cognition and anxiety using Morris water maze and elevated plus maze. We found that our tinnitus diagnosis method reliably separated noise-exposed rats into tinnitus((+)) and tinnitus((-)) groups and detected no evidence of tinnitus in tinnitus((-)) and control rats. In addition, the tinnitus((+)) group demonstrated enhanced startle amplitude, indicating hyperacusis-like behavior. Despite these results, neither tinnitus, hyperacusis nor hearing loss yielded any significant effects on spatial learning and memory or anxiety, though a majority of rats with the highest anxiety levels had tinnitus. These findings showed that we were able to develop a clinically relevant tinnitus((+)) group and that our diagnosis method is sound. At the same time, like clinical studies, we found that tinnitus does not always result in cognitive-emotional dysfunction, although tinnitus may predispose subjects to certain impairment like anxiety. Other behavioral assessments may be needed to further define the relationship between tinnitus and anxiety, cognitive deficits, and other impairments.

Diagnostic Value of the Urine Mucus Test in Childhood Masturbation among Children below 12 Years of Age: A Cross-Sectional Study from Iran.

PubMed

Doust, Zarin Keihani; Shariat, Mamak; Zabandan, Neda; Tabrizi, Aidin; Tehrani, Fatemeh

2016-07-01

Childhood masturbation (CM) is considered a variant of normal sexual behavior; however, it is commonly misdiagnosed as epilepsy and movement disorders. As the first study from Iran, we analyzed a large population of infants and children with CM in a case-control study and evaluated the value of mucus in urine analysis as an alternative diagnostic tool for CM. A total of 623 children referred to the Pediatric Neurology Clinic of Imam Khomeini Hospital for an evaluation of seizure or movement disorders were studied between 2008 and 2011. Totally, 359 children were found to have masturbatory behaviors (Group A) and the rest (264) were assigned to Group B. CM was diagnosed by direct observation. Collected data comprised demographic characteristics, clinical and neurodevelopmental examinations, laboratory findings (particularly urine analysis), and electrocardiography. The age of the children with CM was below 12 years old, and the girl-to-boy ratio was 7:1. Mucus in urine was positive in 357 (99.44%) children in Group A and 22 (8.3%) in Group B (P<0.001). A significant correlation was found between the presence of mucus in urine and masturbatory behaviors (P<0.001). Our findings suggest that the presence of mucus in urine can be used as an alternative laboratory test in children with CM below 12 years old and even in infants (≤24 months old). Further studies are needed to confirm the results.

Case-Case Analysis Using 7 Years of Travelers' Diarrhea Surveillance Data: Preventive and Travel Medicine Applications in Cusco, Peru.

PubMed

Jennings, Mary Carol; Tilley, Drake H; Ballard, Sarah-Blythe; Villanueva, Miguel; Costa, Fernando Maldonado; Lopez, Martha; Steinberg, Hannah E; Luna, C Giannina; Meza, Rina; Silva, Maria E; Gilman, Robert H; Simons, Mark P; Maves, Ryan C; Cabada, Miguel M

2017-05-01

AbstractIn Cusco, Peru, and South America in general, there is a dearth of travelers' diarrhea (TD) data concerning the clinical features associated with enteropathogen-specific infections and destination-specific risk behaviors. Understanding these factors would allow travel medicine providers to tailor interventions to patients' risk profiles and travel destination. To characterize TD etiology, evaluate region-specific TD risk factors, and examine relationships between preventive recommendations and risk-taking behaviors among medium- to long-term travelers' from high-income countries, we conducted this case-case analysis using 7 years of prospective surveillance data from adult travelers' presenting with TD to a physician in Cusco. At the time of enrollment, participants provided a stool sample and answered survey questions about demographics, risk behaviors, and the clinical features of illness. Stool samples were tested for norovirus (NV), bacteria, and parasites using conventional methods. Data obtained were then analyzed using case-case methods. NV (14%), enterotoxigenic Escherichia coli (11%), and Campylobacter (9%), notably ciprofloxacin-resistant Campylobacter , were the most frequently identified pathogens among adults with TD. Coinfection with multiple enteropathogens occurred in 5% of cases. NV caused severe disease relative to other TD-associated pathogens identified, confining over 90% of infected individuals to bed. Destination-specific risk factors include consumption of the local beverage "chicha," which was associated with Cryptosporidium infection. Preventive interventions, such as vaccines, directed against these pathogens could significantly reduce the burden of TD.

Case–Case Analysis Using 7 Years of Travelers' Diarrhea Surveillance Data: Preventive and Travel Medicine Applications in Cusco, Peru

PubMed Central

Jennings, Mary Carol; Tilley, Drake H.; Ballard, Sarah-Blythe; Villanueva, Miguel; Costa, Fernando Maldonado; Lopez, Martha; Steinberg, Hannah E.; Luna, C. Giannina; Meza, Rina; Silva, Maria E.; Gilman, Robert H.; Simons, Mark P.; Maves, Ryan C.; Cabada, Miguel M.

2017-01-01

In Cusco, Peru, and South America in general, there is a dearth of travelers' diarrhea (TD) data concerning the clinical features associated with enteropathogen-specific infections and destination-specific risk behaviors. Understanding these factors would allow travel medicine providers to tailor interventions to patients' risk profiles and travel destination. To characterize TD etiology, evaluate region-specific TD risk factors, and examine relationships between preventive recommendations and risk-taking behaviors among medium- to long-term travelers' from high-income countries, we conducted this case–case analysis using 7 years of prospective surveillance data from adult travelers' presenting with TD to a physician in Cusco. At the time of enrollment, participants provided a stool sample and answered survey questions about demographics, risk behaviors, and the clinical features of illness. Stool samples were tested for norovirus (NV), bacteria, and parasites using conventional methods. Data obtained were then analyzed using case–case methods. NV (14%), enterotoxigenic Escherichia coli (11%), and Campylobacter (9%), notably ciprofloxacin-resistant Campylobacter, were the most frequently identified pathogens among adults with TD. Coinfection with multiple enteropathogens occurred in 5% of cases. NV caused severe disease relative to other TD-associated pathogens identified, confining over 90% of infected individuals to bed. Destination-specific risk factors include consumption of the local beverage “chicha,” which was associated with Cryptosporidium infection. Preventive interventions, such as vaccines, directed against these pathogens could significantly reduce the burden of TD. PMID:28167602

Pharmaceutical Company Influence on Non-Steroidal Anti-inflammatory Drug Prescribing Behaviors

PubMed Central

Naik, Aanand D.; Woofter, Aaron L.; Skinner, Jessica M.; Abraham, Neena S.

2010-01-01

Objectives Adherence to safer nonsteroidal anti-inflammatory drug (NSAID) prescribing strategies remains low, despite their acceptance as markers of high-quality care and their aggressive dissemination. This study describes the taxonomy of methods used by pharmaceutical companies to influence physicians’ NSAID prescribing behaviors and elicits physicians’ perceptions of and counter-balances to these influences. Study Design In-depth interviews analyzed using the constant comparative method of qualitative data analysis. Methods Qualitative interviews were conducted with physicians representing various clinical specialties. Interviews were transcribed and coded inductively using grounded theory. Recruitment was stopped at 25 participants after the attainment of thematic saturation, when no new concepts emerged from ongoing analysis of consecutive interviews. Results Physicians described a variety of influences that shaped their NSAID prescribing behaviors, including detailing and direct contact with pharmaceutical representatives, requests from patients inspired by direct-to-consumer advertisements, and marketing during medical school and residency training. Physicians described practice guidelines, peer-reviewed evidence and opinions of local physician experts as important counterweights to pharmaceutical company influence. Local physician experts interpreted and provided context for new clinical evidence, practice guidelines and NSAID related marketing. Conclusions The social and communicative strategies used by pharmaceutical companies can be adapted to improve physicians’ adoption of guidelines for safer NSAID prescribing. The communicative interactions between local experts and other physicians who prescribe NSAIDs may be the critical target for future interventions to promote safer NSAID prescribing. PMID:19341315

Prosocial Behavior and Depression: a Case for Developmental Gender Differences

PubMed Central

Forbes, Erika E.

2018-01-01

Purpose of Review Prosocial behavior and depression are related constructs that both increase during adolescence and display gender-specific effects. The current review surveys literature examining the association between depressive symptoms and prosociality, measured with behavioral economic paradigms, across development and proposes a theoretical model explaining a mechanism through which adolescent girls have higher risk for depression than boys. Recent Findings Relative to healthy controls, prosocial behavior is reduced in adults with major depressive disorder (MDD) but may be increased in adolescents with MDD. The relationship between non-clinical levels of depressive symptoms and prosocial behavior remains to be studied experimentally; however, self-reported prosocial behavior is negatively associated with depressive symptoms in non-clinical adolescents, which may suggest a shift in the relation of prosocial behavior and depressive symptoms across the non-clinical (i.e., negative) to clinical range (i.e., positive). Summary The effect of gender on these developmental and clinical status shifts has not been studied but could have important implications for understanding the emergence of higher rates of depression in girls than boys during adolescence. We propose that girls are at heightened risk for depression due to higher social-evaluative concern and other-oriented prosocial motivation that emphasize the needs of others over the self, leading to more altruistic prosocial behavior (despite personal cost) and a higher burden that enables depressive symptoms. PMID:29503791

A Qualitative Study of Cognitive, Behavioral, and Psychosocial Challenges Associated With Pediatric Type 2 Diabetes in Ethnic Minority Parents and Adolescents.

PubMed

St George, Sara M; Pulgarón, Elizabeth R; Ferranti, Dina; Agosto, Yaray; Toro, Maria I; Ramseur, Kevin C; Delamater, Alan M

2017-04-01

Purpose The purpose of this descriptive qualitative study was to explore cognitive, behavioral, and psychosocial challenges associated with having and/or parenting an adolescent with pediatric type 2 diabetes (T2D) from the perspectives of ethnic minority parents and adolescents. Methods Ethnic minority (79.2% non-Hispanic black, 29.6% Hispanic) adolescents (n = 14, 78.6% female, 14.7 ± 1.9 years) and their parents (n = 13, 100% female) participated in either individual family interviews or multifamily focus group sessions. Sessions were audio recorded, transcribed, and coded by a team of 4 raters. QSR NVivo 10 was used to perform a content analysis and to extract coded adolescent and parent responses. Results Six themes corresponding to 3 broad categories (cognitive, behavioral, and psychosocial challenges) emerged. Regarding cognitive challenges, families described difficulties learning about a new disease and managing youth knowledge deficits and/or superficial knowledge. In terms of behavioral challenges, parents and adolescents discussed ongoing difficulties with making and maintaining positive youth health behavior changes as well as with ensuring regimen adherence. Finally, managing youth emotions related to diabetes and navigating social relationships with peers and other family members around the disclosure of T2D were the primary psychosocial challenges to emerge. Conclusions Directions for future research include developing and evaluating brief family interventions and adolescent psychosocial screening measures. Recommendations for clinical practice include increasing family knowledge of T2D, enhancing parenting skills for managing youth behavior change, and conducting routine psychosocial screening during follow-up clinic visits.

Practitioner review: Effective ingredients of prevention programs for youth at risk of persistent juvenile delinquency--recommendations for clinical practice.

PubMed

de Vries, Sanne L A; Hoeve, Machteld; Assink, Mark; Stams, Geert Jan J M; Asscher, Jessica J

2015-02-01

There is a lack of knowledge about specific effective ingredients of prevention programs for youth at risk for persistent delinquent behavior. The present study combines findings of previous studies by examining the effectiveness of programs in preventing persistent juvenile delinquency and by studying which particular program, sample, and study characteristics contribute to the effects. Information on effective ingredients offers specific indications of how programs may be improved in clinical practice. A literature search in PsychINFO, ERIC, PubMed, Sociological Abstracts, Criminal Justice Abstracts, and Google Scholar was performed. Only (quasi)experimental studies and studies that focused on adolescents at risk for (persistent) delinquent behavior were included. Multilevel meta-analysis was conducted on 39 studies (N = 9,084). Participants' ages ranged from 6 to 20 years (M = 14 years, SD = 2.45). The overall effect size was significant and small in magnitude (d = 0.24, p < .001). Behavioral-oriented programs, focusing on parenting skills training, behavioral modeling, or behavioral contracting yielded the largest effects. Multimodal programs and programs carried out in the family context proved to be more beneficial than individual and group-based programs. Less intensive programs yielded larger effects. Prevention programs have positive effects on preventing persistent juvenile delinquency. In order to improve program effectiveness, interventions should be behavioral-oriented, delivered in a family or multimodal format, and the intensity of the program should be matched to the level of risk of the juvenile. © 2014 Association for Child and Adolescent Mental Health.

The impact of clinical use on the torsional behavior of Reciproc and WaveOne instruments

PubMed Central

de MAGALHÃES, Rafael Rodrigues Soares; BRAGA, Lígia Carolina Moreira; PEREIRA, Érika Sales Joviano; PEIXOTO, Isabella Faria da Cunha; BUONO, Vicente Tadeu Lopes; BAHIA, Maria Guiomar de Azevedo

2016-01-01

ABSTRACT Torsional overload is a fracture representative parameter for instruments in single-file techniques. Objective The aim of this study was to assess the influence of clinical use, in vivo, on the torsional behavior of Reciproc and WaveOne instruments considering the possibility that they degraded with use. Material and Methods Diameter at each millimeter, pitch length, and area at 3 mm from the tip were determined for both types of instruments. Twenty-four instruments, size 25, 0.08 taper, of each system were divided into two groups (n=12 each): Control Group (CG), in which new Reciproc (RC) and WaveOne Primary (WO) instruments were tested in torsion until rupture based on ISO 3630-1; and Experimental Group (EG), in which each new instrument was clinically used to clean and shape the root canals of one molar. After clinical use, the instruments were analyzed using optical and scanning electron microscopy and subsequently tested in torsion until fracture. Data were analyzed using one-way analysis of variance at a=.05. Results WO instruments showed significantly higher mean values of cross-sectional area A3 (P=0.000) and smaller pitch lengths than RC instruments with no statistically significant differences in the diameter at D3 (P=0.521). No significant differences in torsional resistance between the RC and WO new instruments (P=0.134) were found. The clinical use resulted in a tendency of reduction in the maximum torque of the analyzed instruments but no statistically significant difference was observed between them (P=0.327). During the preparation of the root canals, two fractured RC instruments and longitudinal and transversal cracks in RC and WO instruments were observed through SEM analysis. Conclusion After clinical use, no statistically significant reduction in the torsional resistance was observed. PMID:27556200

Behavioral Interventions to Prevent or Delay Dementia: Protocol for a Randomized Comparative Effectiveness Study

PubMed Central

Chandler, Melanie; Locke, Dona EC; Fields, Julie; Phatak, Vaishali; Crook, Julia; Hanna, Sherrie; Lunde, Angela; Morris, Miranda; Graff-Radford, Michelle; Hughes, Christine A; Lepore, Susan; Cuc, Andrea; Caselli, Maria; Hurst, Duane; Wethe, Jennifer; Francone, Andrea; Eilertsen, Jeanne; Lucas, Pauline; Hoffman Snyder, Charlene; Kuang, LeeAnn; Becker, Marigrace; Dean, Pamela; Diehl, Nancy; Lofquist, Marvin; Vanderhook, Shirley; Myles, Diana; Cochran, Denise

2017-01-01

Background Currently, people at risk for dementia and their caregivers are confronted with confusing choices about what behavioral interventions are most effective. Objective The objective of this study is to determine which empirically supported behavioral interventions most impact the outcomes highly valued by patients with mild cognitive impairment and their partners. Methods This protocol describes a comparative effectiveness trial targeting 300 participants with mild cognitive impairment and their study partners. The trial is being conducted at the Mayo Clinic campuses in Arizona, Florida, Minnesota, and the University of Washington in Seattle. The study examines the contribution of five behavioral interventions (yoga, memory compensation training, computerized cognitive training, support groups, and wellness education) on primary outcomes of participant and partner quality of life and self-efficacy. In this unique 10-day multicomponent intervention, groups of couples were randomized to have one of the five interventions withheld while receiving the other four. Although the longitudinal follow-up is still under way, enrollment results are available and reported. Results In total, 272 couples have been enrolled in the trial and follow-up visits continue. Outcomes will be assessed at the end-of-intervention and 6-, 12-, and 18-month follow-ups. We anticipate reporting on our primary and secondary outcomes across time points in the next 2 years. Conclusions This paper describes the protocol for a randomized comparative effectiveness study of behavioral interventions to prevent or delay dementia. We describe of the rationale, design, power analysis, and analysis plan. Also because enrollment is complete and we are in follow-up phases of the study, we have included enrollment data from the trial. Trial Registration  ClinicalTrials.gov NCT02265757; http://clinicaltrials.gov/ctsshow/ NCT02265757 (Archived by WebCite at http://www.webcitation.org/6ueRfwSYv) PMID:29180344

Differential Risk Factors for HIV Drug and Sex Risk-Taking Among Non-treatment-seeking Hospitalized Injection Drug Users

PubMed Central

Crooks, Denise; Tsui, Judith; Anderson, Bradley; Dossabhoy, Shernaz; Herman, Debra; Liebschutz, Jane M.; Stein, Michael D.

2016-01-01

Injection drug users (IDUs) are at increased risk of contracting HIV. From a clinical trial assessing an intervention to enhance the linkage of hospitalized patients to opioid treatment after discharge, we conducted multivariate analysis of baseline data from hospitalized IDUs with a history of opioid dependence (n = 104) to identify differences in factors predicting HIV drug and sex risk behaviors. Factors significantly associated with HIV drug risk were being non-Hispanic Caucasian and recent cocaine use. Being female, binge drinking, and poorer mental health were significantly associated with higher sex risk. Because factors predicting HIV sex risk behaviors differ from those predicting HIV drug risk, interventions aimed at specific HIV risks should have different behavioral and substance use targets. PMID:25063229