The Effect of Cognitive-Behavioral Therapy versus Treatment as Usual for Anxiety in Children with Autism Spectrum Disorders: A Randomized, Controlled Trial

ERIC Educational Resources Information Center

Storch, Eric A.; Arnold, Elysse B.; Lewin, Adam B.; Nadeau, Josh M.; Jones, Anna M.; De Nadai, Alessandro S.; Mutch, P. Jane; Selles, Robert R.; Ung, Danielle; Murphy, Tanya K.

2013-01-01

Objective: To examine the efficacy of a modular cognitive-behavioral therapy (CBT) protocol relative to treatment as usual (TAU) among children with high-functioning autism spectrum disorders (ASD) and clinically significant anxiety. Method: A total of 45 children (7-11 years of age) with high-functioning ASD and clinically significant anxiety…

Binge Eating, Purging, or Both: Eating Disorder Psychopathology Findings from an Internet Community Survey

PubMed Central

Roberto, Christina A.; Grilo, Carlos M.; Masheb, Robin M.; White, Marney A.

2010-01-01

Objective This study aimed to compare bulimia nervosa (BN), binge eating disorder (BED), and purging disorder (PD) on clinically significant variables and examine the utility of once versus twice-weekly diagnostic thresholds for disturbed eating behaviors. Method 234 women with BN, BED, or PD were identified through self-report measures via an online survey and categorized based on either once-weekly or twice-weekly disturbed eating behaviors. Results BN emerged as a more severe disorder than BED and PD. The three groups differed significantly in self-reported restraint and disinhibition and the BN and BED groups reported higher levels of depression than PD. For BN, those engaging in behaviors twice-weekly versus once-weekly were more symptomatic. Discussion The BN, BED, and PD groups differed in clinically meaningful ways. Future research need to clarify the relationship between mood disturbances and eating behaviors. Reducing the twice-weekly behavior threshold for BN would capture individuals with clinically significant eating disorders, though the twice-weekly threshold may provide important information about disorder severity for both BN and BED. PMID:19862702

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).

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.

Health behaviors, care needs and attitudes towards self-prescription: a cross-sectional survey among Dutch medical students.

PubMed

Van der Veer, Tjeerd; Frings-Dresen, Monique H W; Sluiter, Judith K

2011-01-01

There is a growing awareness of the potent ways in which the wellbeing of physicians impacts the health of their patients. The purpose of this study was to investigate the health behaviors, care needs and attitudes towards self-prescription of Dutch medical students, and any differences between junior preclinical and senior clinically active students. All students (n = 2695) of a major Dutch medical school were invited for an online survey. Physical activity, eating habits, alcohol consumption, smoking, Body Mass Index, substance use and amount of sleep per night were inquired, as well as their need for different forms of care and their attitude towards self-prescription. Data of 902 students were used. Physical activity levels (90% sufficient) and smoking prevalence (94% non-smokers) were satisfying. Healthy eating habits (51% insufficient) and alcohol consumption (46% excessive) were worrying. Body Mass Indexes were acceptable (20% unhealthy). We found no significant differences in health behaviors between preclinical and clinically active students. Care needs were significantly lower among clinically active students. (p<0.05) Student acceptance of self-prescription was significantly higher among clinically active students. (p<0.001) Unhealthy behaviors are prevalent among medical students, but are no more prevalent during the clinical study phase. The need for specific forms of care appears lower with study progression. This could be worrying as the acceptance of self-care and self-prescription is higher among senior clinical students. Medical faculties need to address students' unhealthy behaviors and meet their care needs for the benefit of both the future physicians as well as their patients.

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.

[Development and Effects of Assertiveness Training applying Dongsasub Training for Nursing Students in Clinical Practice].

PubMed

Kim, Myoungsuk

2016-08-01

This study was conducted to develop assertiveness training applying Dongsasub training for junior nursing students, and to verify effectiveness of the training on assertiveness behavior, self-esteem, clinical practice stress, and clinical competence. The study design was a non-equivalent control group non-synchronized design. Participants were 63 nursing students in clinical training (31 students in the experimental group and 32 students in the control group). The assertiveness training applying Dongsasub training consisted of four sessions. Outcome variables included assertiveness behavior, self-esteem, clinical practice stress, and clinical competence. Data were analyzed using Chi-square, Fisher's exact test and independent samples t-test with SPSS/WIN 21.0. Scores of assertiveness behavior (t=-2.49, p=.015), self-esteem (t=-4.80, p<.001) and clinical competence (t=-2.33, p=.023) were significantly higher and clinical practice stress (t=4.22, p<.001) was significantly lower in the experimental group compared to the control group. Results indicate that the assertiveness training applying Dongsasub training can be used as a nursing intervention to lower clinical practice stress and improve the clinical competence of nursing students.

Identifying treatment responders and predictors of improvement after cognitive-behavioral therapy for juvenile fibromyalgia.

PubMed

Sil, Soumitri; Arnold, Lesley M; Lynch-Jordan, Anne; Ting, Tracy V; Peugh, James; Cunningham, Natoshia; Powers, Scott W; Lovell, Daniel J; Hashkes, Philip J; Passo, Murray; Schikler, Kenneth N; Kashikar-Zuck, Susmita

2014-07-01

The primary objective of this study was to estimate a clinically significant and quantifiable change in functional disability to identify treatment responders in a clinical trial of cognitive-behavioral therapy (CBT) for youth with juvenile fibromyalgia (JFM). The second objective was to examine whether baseline functional disability (Functional Disability Inventory), pain intensity, depressive symptoms (Children's Depression Inventory), coping self-efficacy (Pain Coping Questionnaire), and parental pain history predicted treatment response in disability at 6-month follow-up. Participants were 100 adolescents (11-18 years of age) with JFM enrolled in a recently published clinical trial comparing CBT to a fibromyalgia education (FE) intervention. Patients were identified as achieving a clinically significant change in disability (i.e., were considered treatment responders) if they achieved both a reliable magnitude of change (estimated as a > or = 7.8-point reduction on the FDI) using the Reliable Change Index, and a reduction in FDI disability grade based on established clinical reference points. Using this rigorous standard, 40% of patients who received CBT (20 of 50) were identified as treatment responders, compared to 28% who received FE (14 of 50). For CBT, patients with greater initial disability and higher coping efficacy were significantly more likely to achieve a clinically significant improvement in functioning. Pain intensity, depressive symptoms, and parent pain history did not significantly predict treatment response. Estimating clinically significant change for outcome measures in behavioral trials sets a high bar but is a potentially valuable approach to improve the quality of clinical trials, to enhance interpretability of treatment effects, and to challenge researchers to develop more potent and tailored interventions. Copyright © 2014 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

Does Integrated Behavioral Health Care Reduce Mental Health Disparities for Latinos? Initial Findings

PubMed Central

Bridges, Ana J.; Andrews, Arthur R.; Villalobos, Bianca T.; Pastrana, Freddie A.; Cavell, Timothy A.; Gomez, Debbie

2014-01-01

Integrated behavioral health care (IBHC) is a model of mental health care service delivery that seeks to reduce stigma and service utilization barriers by embedding mental health professionals into the primary care team. This study explored whether IBHC service referrals, utilization, and outcomes were comparable for Latinos and non-Latino White primary care patients. Data for the current study were collected from 793 consecutive patients (63.8% Latino; M age = 29.02 years [SD = 17.96]; 35.1% under 18 years; 65.3% women; 54.3% uninsured) seen for behavioral health services in 2 primary care clinics during a 10.5 month period. The most common presenting concerns were depression (21.6%), anxiety (18.5%), adjustment disorder (13.0%), and externalizing behavior problems (9.8%). Results revealed that while Latino patients had significantly lower self-reported psychiatric distress, significantly higher clinician-assigned global assessment of functioning scores, and fewer received a psychiatric diagnosis at their initial visit compared to non-Latino White patients, both groups had comparable utilization rates, comparable and clinically significant improvements in symptoms (Cohen’s d values > .50), and expressed high satisfaction with integrated behavioral services. These data provide preliminary evidence suggesting integration of behavioral health services into primary care clinics may help reduce mental health disparities for Latinos. PMID:25309845

Behavioral health care for adolescents with poorly controlled diabetes via Skype: does working alliance remain intact?

PubMed

Freeman, Kurt A; Duke, Danny C; Harris, Michael A

2013-05-01

Increasingly various technologies are being tested to deliver behavioral health care. Delivering services via videoconferencing shows promise. Given that the patient-provider relationship is a strong predictor of patient adherence to medical regimens, addressing relationship quality when services are not delivered face-to-face is critical. To that end, we compared the therapeutic alliance when behavioral health care was delivered to youth with poorly controlled type 1 diabetes mellitus (T1DM) and their caregivers in-clinic with the same services delivered via Internet-based videoconferencing (i.e., Skype™). Seventy-one adolescents with poorly controlled T1DM (hemoglobin A1c ≥9%) and one of their caregivers received up to 10 sessions of a family-based behavioral health intervention previously shown to improve adherence to diabetes regimens and family functioning; 32 were randomized to the Skype condition. Youth and caregivers completed the working alliance inventory (WAI), a 36-item measure of therapeutic alliance, at the end of treatment. Additionally, the number of behavioral health sessions completed was tracked. No significant differences in WAI scores were found for those receiving behavioral health care via Skype versus in-clinic. Youth WAI goal and total scores were significantly associated with the number of sessions completed for those in the clinic group. Behavioral health can be delivered to youth with T1DM via Internet-based videoconferencing without significantly impacting the therapeutic relationship. Thus, for those adolescents with T1DM who require specialized behavioral health care that targets T1DM management, Internet-based teleconferencing represents a viable alternative to clinic-based care. © 2013 Diabetes Technology Society.

Behavioral Health Care for Adolescents with Poorly Controlled Diabetes via Skype: Does Working Alliance Remain Intact?

PubMed Central

Freeman, Kurt A.; Duke, Danny C.; Harris, Michael A.

2013-01-01

Background: Increasingly various technologies are being tested to deliver behavioral health care. Delivering services via videoconferencing shows promise. Given that the patient–provider relationship is a strong predictor of patient adherence to medical regimens, addressing relationship quality when services are not delivered face-to-face is critical. To that end, we compared the therapeutic alliance when behavioral health care was delivered to youth with poorly controlled type 1 diabetes mellitus (T1DM) and their caregivers in-clinic with the same services delivered via Internet-based videoconferencing (i.e., Skype™). Methods: Seventy-one adolescents with poorly controlled T1DM (hemoglobin A1c ≥9%) and one of their caregivers received up to 10 sessions of a family-based behavioral health intervention previously shown to improve adherence to diabetes regimens and family functioning; 32 were randomized to the Skype condition. Youth and caregivers completed the working alliance inventory (WAI), a 36-item measure of therapeutic alliance, at the end of treatment. Additionally, the number of behavioral health sessions completed was tracked. Results: No significant differences in WAI scores were found for those receiving behavioral health care via Skype versus in-clinic. Youth WAI goal and total scores were significantly associated with the number of sessions completed for those in the clinic group. Conclusion: Behavioral health can be delivered to youth with T1DM via Internet-based videoconferencing without significantly impacting the therapeutic relationship. Thus, for those adolescents with T1DM who require specialized behavioral health care that targets T1DM management, Internet-based teleconferencing represents a viable alternative to clinic-based care. PMID:23759406

[The clinical predictors of heteroaggressive behaviour of the women serving sentence in penitentiary].

PubMed

Shaklein, K N; Bardenshtein, L M; Demcheva, N K

To identify clinical predictors of heteroaggressive behavior. Three hundreds and three women serving sentence in a penal colony were examined using clinical, neurologic and statistical methods. The main group consisted of 225 women with heteroaggressive behavior, the control group included 78 women without aggressive behavior. Differences between the main and control groups in the structure of mental disorders and key syndromes were revealed. The authors conclude that the states with elements of dysphoria, dysthymia, decompensation of personality disorders, which are defined in the various forms of mental pathology, are the most significant predictors of heteroaggressive behavior in women in the penal colony.

Clinically Significant Behavior Problems During the Initial 18 Months Following Early Childhood Traumatic Brain Injury

PubMed Central

Chapman, Leah A.; Wade, Shari L.; Walz, Nicolay C.; Taylor, H. Gerry; Stancin, Terry; Yeates, Keith O.

2014-01-01

The present study looked at the emergence of clinically significant problems in behavior, executive function skills (EF), and social competence during the initial 18 months following TBI in young children relative to a cohort of children with orthopedic injuries (OI) and the environmental factors that predict difficulties postinjury. Children, ages 3-7 years, hospitalized for severe TBI moderate TBI, or OI were seen shortly after their injury (M = 40 days) and again 6 months, 12 months, and 18 months postinjury. Behavioral parent self-reports, demographic data, family functioning reports, and home environment reports were collected at injury baseline and each time point post injury. Results suggest that, compared to the OI group, the severe TBI developed significantly more externalizing behavior problems and EF problems following injury that persisted through the 18-month follow-up. Minimal social competence difficulties appeared at the 18-month follow-up, suggesting a possible pattern of emerging deficits rather than a recovery over time. Predictors of the emergence of clinically significant problems included permissive parenting, family dysfunction, and low SES. The findings are similar to those found in school-aged children. PMID:20175634

Clinical differences in children with autism spectrum disorder with and without food selectivity.

PubMed

Postorino, Valentina; Sanges, Veronica; Giovagnoli, Giulia; Fatta, Laura Maria; De Peppo, Lavinia; Armando, Marco; Vicari, Stefano; Mazzone, Luigi

2015-09-01

Several studies have described the atypical eating behaviors frequently occurring in children with Autism Spectrum Disorder (ASD), and food selectivity is the most frequent of these problems. The everyday management of mealtime behaviors among children with ASD can have a negative impact on family routines and become a significant stressor for families. However, much remains unknown about why food selectivity is so prevalent among individuals with ASD. The objective of this study was to investigate clinical and behavioral features in individuals with ASD with the aim of identifying distinctive clinical profiles in children with and without food selectivity. A total of 158 children with ASD were enrolled in this study: 79 participants with food selectivity (FS) were age and sex matched with 79 participants without food selectivity (No FS). All participants and their parents completed a battery of psychological tests for a comprehensive evaluation of ASD symptoms, cognitive abilities, adaptive skills, behavioral problems and parental stress level. No statistically significant difference on gastrointestinal symptoms and growth adequacy was found between the FS group and the No FS group. Overall, the FS group showed significantly higher rates of ASD symptoms as compared to the No FS group in the questionnaires completed by parents. Furthermore, parents of the FS group reported significantly higher levels of parental stress and a larger degree of their children's behavioral problems as compared to the No FS group. Finally, there were no differences between the FS and the No FS group on any adaptive skill domain. Our findings suggest that the identification of distinctive clinical and behavioral patterns in children with ASD and food selectivity is a crucial issue for parents and therapists in the daily management. Copyright © 2015 Elsevier Ltd. 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.

Parent-rated emotional-behavioral and executive functioning in childhood epilepsy.

PubMed

Kavanaugh, Brian C; Scarborough, Vanessa Ramos; Salorio, Cynthia F

2015-01-01

The present study examined clinical and demographic risk factors associated with parent-rated emotional-behavioral and executive functioning in children and adolescents with epilepsy. The medical records of 152 children and adolescents with epilepsy referred for neuropsychological evaluation were reviewed. Results indicated that the sample displayed significantly elevated symptoms across the emotional-behavioral and executive domains assessed. Executive functioning and behavioral symptoms had the highest rates of clinically elevated scores, with lowest rates of elevated scores in internalizing and externalizing emotional problems. Only 34% of those participants with clinically significant emotional-behavioral or executive functioning difficulties had a history of psychological or counseling services, highlighting the underserved mental health needs of this population. In regard to clinical factors, the majority of seizure-related variables were not associated with emotional-behavioral or executive functioning. However, the frequency of seizures (i.e., seizure status) was associated with behavioral regulation aspects of executive functioning, and the age at evaluation was associated with externalizing problems and behavioral symptoms. Family psychiatric history (with the exception of ADHD) was associated with all domains of executive and emotional-behavioral functioning. In summary, emotional-behavioral and executive functioning difficulties frequently co-occur with seizures in childhood epilepsy, with both seizure-related and demographic factors contributing to the presentation of such neurobehavioral comorbidities. The present findings provide treatment providers of childhood epilepsy with important information to assist in better identifying children and adolescents who may be at risk for neurobehavioral comorbidities and may benefit from intervention. Copyright © 2014 Elsevier Inc. All rights reserved.

Prevalence and correlates of psychopathology in children and adolescents evaluated with the strengths and difficulties questionnaire dysregulation profile in a clinical setting.

PubMed

Carballo, Juan José; Serrano-Drozdowskyj, Elena; García Nieto, Rebeca; Díaz de Neira-Hernando, Mónica; Pérez-Fominaya, Margarita; Molina-Pizarro, Cristian Antonio; De León-Martínez, Victoria; Baca-García, Enrique

2014-01-01

The clinical presentation of children and adolescents referred to mental health services is frequently complicated by comorbid and severe affective and behavioral dysregulation. This dysregulation phenotype seems to be an indicator of overall psychopathology, symptom severity and functional impairment. Currently, this phenotype is assessed by the Child Behavior Checklist. However, the widely used Strengths and Difficulties Questionnaire (SDQ) has been recently validated to screen the Dysregulation Profile (SDQ-DP) in clinical settings. The objective of this study was to determine the prevalence and demographic, psychosocial and clinical correlates of the SDQ-DP phenotype in a Spanish clinical sample. In a clinical sample of 623 consecutively referred children and adolescents (4-17 years old), we compared clinical and sociodemographic correlates between subjects who met the SDQ-DP criteria (DP) and those who did not (NO_DP). Sociodemographic data, parent-rated SDQ, Children's Global Assessment Scale, Clinical Global Impression, family Apgar scale and clinical diagnoses were collected by experienced child and adolescent psychiatrists. Overall in our sample, 175 subjects (28.1%) met the SDQ-DP criteria (DP group). Compared with the NO_DP group, the DP subjects had significantly higher scores on internalizing and externalizing psychopathology, problems with peers and overall problems as well as significantly lower scores on prosocial behavior. Clinical diagnoses assigned revealed that DP subjects showed significantly greater psychiatric comorbidity. DP subjects also showed significantly worse family functioning and increased symptom severity and significantly lower scores on psychosocial functioning. A high prevalence of children and adolescents with the dysregulated profile, assessed by the SDQ-DP, was found in our clinical setting. The SDQ-DP may serve as an index of overall psychological severity and functional impairment. In addition, it may indicate family dysfunction. Further research is needed to validate the clinical value of SDQ-DP by examining longitudinal stability, heritability, adult outcome, risk factors and diagnostic correlates. © 2014 S. Karger AG, Basel.

Outcomes and Utilization of a Low Intensity Workplace Weight Loss Program

PubMed Central

Carpenter, Kelly M.; Lovejoy, Jennifer C.; Lange, Jane M.; Hapgood, Jenny E.; Zbikowski, Susan M.

2014-01-01

Obesity is related to high health care costs and lost productivity in the workplace. Employers are increasingly sponsoring weight loss and wellness programs to ameliorate these costs. We evaluated weight loss outcomes, treatment utilization, and health behavior change in a low intensity phone- and web-based, employer-sponsored weight loss program. The intervention included three proactive counseling phone calls with a registered dietician and a behavioral health coach as well as a comprehensive website. At six months, one third of those who responded to the follow-up survey had lost a clinically significant amount of weight (≥5% of body weight). Clinically significant weight loss was predicted by the use of both the counseling calls and the website. When examining specific features of the web site, the weight tracking tool was the most predictive of weight loss. Health behavior changes such as eating more fruits and vegetables, increasing physical activity, and reducing stress were all predictive of clinically significant weight loss. Although limited by the low follow-up rate, this evaluation suggests that even low intensity weight loss programs can lead to clinical weight loss for a significant number of participants. PMID:24688791

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.

Anger and Sadness Perception in Clinically Referred Preschoolers: Emotion Processes and Externalizing Behavior Symptoms

ERIC Educational Resources Information Center

Martin, Sarah E.; Boekamp, John R.; McConville, David W.; Wheeler, Elizabeth E.

2010-01-01

This study examined emotion perception processes in preschool aged children presenting with clinically significant emotional and behavior problems, with emphasis on sadness perception accuracy (i.e., the ability to correctly identify sadness from expressive and situational cues) and anger perception bias (i.e., the tendency to perceive anger in…

History of Childhood Abuse, Drinking Motives, Alcohol Use, and Sexual Risk Behavior Among STD Clinic Patients in St. Petersburg, Russia: A Cross-Sectional Study.

PubMed

Abdala, Nadia; Li, Fangyong; Shaboltas, Alla V; Skochilov, Roman V; Krasnoselskikh, Tatiana V

2016-03-01

The relationship between level of childhood abuse (physical and emotional) and sexual risk behavior of sexually transmitted disease clinic patients in St. Petersburg, Russia was examined through path analyses. Mediating variables investigated were: Alcohol Use Disorder Identification Test (AUDIT), drinking motives (for social interaction, to enhance mood, to facilitate sexual encounters), intimate partner violence (IPV), anxiety, and depression symptoms. Results showed a significant indirect effect of childhood abuse on women's sexual risk behavior: higher level of childhood abuse was associated with a greater likelihood of IPV, motivations to drink, leading to higher AUDIT scores and correlated to higher likelihood of having multiple, new or casual sexual partner(s). No significant effect was identified in paths to condom use. Among men, childhood abuse had no significant effect on sexual risk behavior. Reduction in alcohol-related sexual risk behavior may be achieved by addressing the effects of childhood abuse among female participants.

History of Childhood Abuse, Drinking Motives, Alcohol Use, and Sexual Risk Behavior among STD clinic patients in St. Petersburg, Russia: a cross-sectional study

PubMed Central

Abdala, Nadia; Li, Fangyong; Shaboltas, Alla V.; Skochilov, Roman V.; Krasnoselskikh, Tatiana V.

2015-01-01

The relationship between level of childhood abuse (physical and emotional) and sexual risk behavior of sexually transmitted disease (STD) clinic patients in St. Petersburg, Russia was examined through path analyses. Mediating variables investigated were: Alcohol Use Disorder Identification Test (AUDIT), drinking motives (for social interaction, to enhance mood, to facilitate sexual encounters), intimate partner violence (IPV), anxiety, and depression symptoms. Results showed a significant indirect effect of childhood abuse on women’s sexual risk behavior: higher level of childhood abuse was associated with a greater likelihood of IPV, motivations to drink, leading to higher AUDIT scores and correlated to higher likelihood of having multiple, new or casual sexual partner(s). No significant effect was identified in paths to condom use. Among men, childhood abuse had no significant effect on sexual risk behavior. Reduction in alcohol-related sexual risk behavior may be achieved by addressing the effects of childhood abuse among female participants. PMID:25801476

Relations among behavioral inhibition, shame- and guilt-proneness, and anxiety disorders symptoms in non-clinical children.

PubMed

Muris, Peter; Meesters, Cor; Bouwman, Leanne; Notermans, Sabine

2015-04-01

This study examined relationships between the self-conscious emotions of shame and guilt, behavioral inhibition (as an index of anxiety proneness), and anxiety disorder symptoms in non-clinical children aged 8-13 years (N = 126), using children's self-report data. Results showed that there were positive and significant correlations between shame and guilt, behavioral inhibition, and anxiety disorders symptoms. When controlling for the overlap between shame and guilt, it was found that shame (but not guilt) remained significantly associated with higher levels of anxiety proneness and anxiety symptoms. Further, when controlling for the effect of behavioral inhibition, shame still accounted for a significant proportion of the variance of total anxiety and generalized anxiety scores. For these anxiety problems, support emerged for a model in which shame acted as a partial mediator in the relation between behavioral inhibition and anxiety. These results indicate that the self-conscious emotion of shame is a robust correlate of anxiety pathology in children.

An analysis of music therapy student practicum behaviors and their relationship to clinical effectiveness: an exploratory investigation.

PubMed

Darrow, A A; Johnson, C M; Ghetti, C M; Achey, C A

2001-01-01

The purpose of the present study was to investigate specific clinical behaviors exhibited by music therapy students in their 1st through 4th semesters of practicum. A secondary purpose of the study was to determine if a relationship exists between therapy students' behaviors and their assessed clinical success. Participants were instructed to submit 20-minutes of videotape from one practicum session, chosen at random from the current practicum semester. Two trained observers then viewed the videotapes and simultaneously recorded the occurrence and duration of practicum student behaviors using SCRIBE, a data collection computer program. The SCRIBE program was configured to include 5 broad categories of therapist behaviors: musical behaviors (singing, playing, listening), physical behaviors (such as hand-over-hand assistance, cueing, or clapping), verbal behaviors (therapy-related verbal interactions or other), a combination of two of the above, and other nonspecified behaviors. The percentage of time practicum students exhibited behaviors within in each category was calculated for all session segments. These same videotapes were also evaluated by 2 professional board certified music therapists who were unfamiliar with the practicum students. Students were assigned an overall rating for clinical effectiveness. Evaluators were also asked to provide comments related to their ratings. A descriptive analysis of clinical behaviors indicate that students spend nearly 40% of their practicum time engaged in musical behaviors and over 50% of their time engaged in verbal behaviors. No significant differences were found in the behaviors exhibited by students in the various practicum levels; however, behavioral differences were found for individual student therapists. Additionally, no relationship was found between students' behaviors and their clinical effectiveness. An analysis of comments by the evaluators indicates that the quantity of musical behaviors does not affect clinical effectiveness as much as the quality of the musical behaviors. Evaluator comments also indicate that students identified as personable or as having rapport with their clients were also more effective in the practicum setting.

Integrated Behavior Therapy for Selective Mutism: a randomized controlled pilot study.

PubMed

Bergman, R Lindsey; Gonzalez, Araceli; Piacentini, John; Keller, Melody L

2013-10-01

To evaluate the feasibility, acceptability, and preliminary efficacy of a novel behavioral intervention for reducing symptoms of selective mutism and increasing functional speech. A total of 21 children ages 4 to 8 with primary selective mutism were randomized to 24 weeks of Integrated Behavior Therapy for Selective Mutism (IBTSM) or a 12-week Waitlist control. Clinical outcomes were assessed using blind independent evaluators, parent-, and teacher-report, and an objective behavioral measure. Treatment recipients completed a three-month follow-up to assess durability of treatment gains. Data indicated increased functional speaking behavior post-treatment as rated by parents and teachers, with a high rate of treatment responders as rated by blind independent evaluators (75%). Conversely, children in the Waitlist comparison group did not experience significant improvements in speaking behaviors. Children who received IBTSM also demonstrated significant improvements in number of words spoken at school compared to baseline, however, significant group differences did not emerge. Treatment recipients also experienced significant reductions in social anxiety per parent, but not teacher, report. Clinical gains were maintained over 3 month follow-up. IBTSM appears to be a promising new intervention that is efficacious in increasing functional speaking behaviors, feasible, and acceptable to parents and teachers. Copyright © 2013 Elsevier Ltd. All rights reserved.

Placebo-like response in absence of treatment in children with Autism.

PubMed

Jones, Rebecca M; Carberry, Caroline; Hamo, Amarelle; Lord, Catherine

2017-09-01

Caregiver report is the most common measure of change in pediatric psychiatry. Yet, placebo response rates pose significant challenges to reliably detect a treatment response. The present study simulated an eight-week clinical trial protocol for Autism Spectrum Disorder (ASD) for the purpose of testing the feasibility and validity of several outcome measures. Twenty caregivers answered questions about their child's behavior on their smartphone each week and completed a battery of paper questionnaires during weeks one and eight. No treatment was administered. Caregivers reported a significant decrease in problem behaviors on the Aberrant Behavior Checklist (ABC) (29% decrease) and general ASD behaviors on the Social Responsiveness Scale (SRS) (7% decrease). There was also a trend of behavior improvement from smartphone questions but no significant changes in clinical ratings of core diagnostic features of ASD. Participation in a comprehensive protocol in the absence of a particular treatment significantly influenced how caregivers perceived the severity of their children's problem behaviors. These placebo-like effects represent substantial challenges for randomized controlled trials (RCTs) that use treatment as usual and have implications for future behavioral and pharmacological treatment trial designs. Autism Res 2017, 10: 1567-1572. © 2017 International Society for Autism Research, Wiley Periodicals, Inc. © 2017 International Society for Autism Research, Wiley Periodicals, Inc.

Psychological, behavioral, and clinical effects of intra-oral camera: a randomized control trial on adults with gingivitis.

PubMed

Araújo, Mário-Rui; Alvarez, Maria-João; Godinho, Cristina A; Pereira, Cícero

2016-12-01

To evaluate the effects of using an intra-oral camera (IOC) during supportive periodontal therapy (SPT), on the psychological, behavioral, and clinical parameters of patients with gingivitis, outlined by evidence and a theory-based framework. A group of 78 adult patients with gingivitis receiving an SPT was randomized into two groups: IOC and control. Bleeding on Marginal Probing (BOMP), self-reported dental hygiene behaviors, and psychological determinants of behavior change (outcome expectancies, self-efficacy, and planning) and IOC opinion were evaluated 1 week before or during the appointment and 4 months later. Repeated-measures anova was used to compare groups over time. Almost all the patients brushed their teeth daily, while 78% either never or hardly ever used dental floss. The IOC group showed significant improvements in BOMP index (P < 0.001), self-reported flossing (P < 0.05), and self-efficacy (P < 0.05) compared to the control group. The use of IOC significantly improves clinical, behavioral, and psychological determinants of periodontal health 4 months after treatment. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Relations of the Big-Five personality dimensions to autodestructive behavior in clinical and non-clinical adolescent populations.

PubMed

Kotrla Topic, Marina; Perkovic Kovacevic, Marina; Mlacic, Boris

2012-10-01

To examine the relationship between the Big-Five personality model and autodestructive behavior symptoms, namely Autodestructiveness and Suicidal Depression in two groups of participants: clinical and non-clinical adolescents. Two groups of participants, clinical (adolescents with diagnosis of psychiatric disorder based on clinical impression and according to valid diagnostic criteria, N=92) and non-clinical (high-school students, N=87), completed two sets of questionnaires: the Autodestructiveness Scale which provided data on Autodestructiveness and Suicidal Depression, and the International Personality Item Pool (IPIP), which provided data on the Big -Five personality dimensions. Clinical group showed significantly higher values on the Autodestructiveness scale in general, as well as on Suicidal Depression, Aggressiveness, and Borderline subscales than the non-clinical group. Some of the dimensions of the Big-Five personality model, ie, Emotional Stability, Conscientiousness, and Agreeableness showed significant relationship (hierarchical regression analyses, P values for β coefficients from 0.000 to 0.021) with Autodestructiveness and Suicidal Depression, even after controlling for the sex and group effects or, when analyzing Suicidal Depression, after controlling the effect of other subscales. The results indicate that dimensions of the Big-Five model are important when evaluating adolescent psychiatric patients and adolescents from general population at risk of self-destructive behavior.

Relations of the Big-Five personality dimensions to autodestructive behavior in clinical and non-clinical adolescent populations

PubMed Central

Kotrla Topić, Marina; Perković Kovačević, Marina; Mlačić, Boris

2012-01-01

Aim To examine the relationship between the Big-Five personality model and autodestructive behavior symptoms, namely Autodestructiveness and Suicidal Depression in two groups of participants: clinical and non-clinical adolescents. Methods Two groups of participants, clinical (adolescents with diagnosis of psychiatric disorder based on clinical impression and according to valid diagnostic criteria, N = 92) and non-clinical (high-school students, N = 87), completed two sets of questionnaires: the Autodestructiveness Scale which provided data on Autodestructiveness and Suicidal Depression, and the International Personality Item Pool (IPIP), which provided data on the Big -Five personality dimensions. Results Clinical group showed significantly higher values on the Autodestructiveness scale in general, as well as on Suicidal Depression, Aggressiveness, and Borderline subscales than the non-clinical group. Some of the dimensions of the Big-Five personality model, ie, Emotional Stability, Conscientiousness, and Agreeableness showed significant relationship (hierarchical regression analyses, P values for β coefficients from <0.001 to 0.021) with Autodestructivness and Suicidal Depression, even after controlling for the sex and group effects or, when analyzing Suicidal Depression, after controlling the effect of other subscales. Conclusion The results indicate that dimensions of the Big-Five model are important when evaluating adolescent psychiatric patients and adolescents from general population at risk of self-destructive behavior. PMID:23100207

Self-reported oral health behavior and attitudes of dental and technology students in Lithuania.

PubMed

Pacauskiene, Ingrida M; Smailiene, Dalia; Siudikienė, Jolanta; Savanevskyte, Julija; Nedzelskiene, Irena

2014-01-01

The aim of the present study was to assess self-reported oral health habits, attitudes, lifestyle between the sample groups of preclinical and clinical dental and technology students in Lithuania using the Hiroshima University Dental Behavioral Inventory (HU-DBI), and to evaluate the impact of education on their behavior and self-reported oral health. A sample of 183 dental and 75 technology students at the Lithuanian University of Health Sciences, Medical Academy, Faculty of Odontology, and Kaunas University of Technology completed the Lithuanian version the HU-DBI questionnaire with 11 additional items. The data were analyzed using the "SPSS 19.0 for Windows" software package. The mean HU-DBI score of clinical final-year dentistry students was significantly higher (p=0.001) than the score of the preclinical group (6.81 (1.2) and 5.96 (1.5), respectively). The mean scores of both groups of dental students were significantly (p<0.05) higher than that of the technology group (5.37 (1.8)). Oral health behaviors and knowledge were superior in dental students. Dental education had a significant positive impact on the oral health and behavior improvement. The attitudes of the Lithuanian dental students should be further improved by initiating a comprehensive program that would emphasize the importance of oral hygiene before the clinical program starts.

Building youths' resilience within a psychiatric outpatient setting: results from a pilot clinical intervention project.

PubMed

Waaktaar, Trine; Christie, Helen J; Borge, Anne Inger Helmen; Torgersen, Svenn

2004-02-01

The relevance of resilience research for clinical practice has not yet been established. In this intervention pilot study, the aim was to explore how group work based on enhancing the participants' creativity, self-efficacy, active coping, and sense of continuity could be utilized within a clinical context for adolescents with stressful background experiences. 31 participants and 24 parents completed pre-, post-, and 1-yr. follow-up assessments of the youths' behavior difficulties, as well as depression, positive life attitude, coping, and prosocial behavior. Apart from a drop in self-rated prosocial behavior, no significant treatment effects were found. Implications for clinical practice and research are indicated.

Long-term behavioral outcomes after attendance at a secondary prevention clinic for cardiac patients.

PubMed

Worcester, Marian Una Christine; Stojcevski, Zlatko; Murphy, Barbara; Goble, Alan James

2003-01-01

Secondary prevention interventions, including hospital clinics, can help patients improve their risk factors and lifestyles after an acute cardiac event. This study aimed to investigate the long-term behavioral outcomes of attending and nonattending patients consecutively enrolled in a trial of a family-based clinic providing screening, advice, and support 3 months after hospital admission. The study also aimed to identify predictors of long-term smoking status, dietary habit, and physical activity. Semistructured interviews were conducted an average of 30 months after the acute cardiac event with 83 of the 103 nonattending patients and a random sample of 96 patients who had attended the clinic. Behavioral outcomes were investigated, and self-reported risk factors at the time of the acute illness were documented. The patients who had attended the clinic were significantly more likely than nonattenders to report positive dietary changes and, among former smokers, successful cessation of smoking. Furthermore, they reported being more physically active than nonattenders. Using logistic regression, clinic attendance was identified as a significant and independent predictor of all three outcomes. The results of this observational study suggest that attendance at a secondary prevention clinic facilitates maintenance of improved long-term health behaviors, although this finding is based on self-report. Factors possibly responsible for favorable outcomes include strong physician advice and support from a multidisciplinary team of health professionals. Furthermore, the timing of the intervention may have been appropriate for enrollment in a secondary prevention clinic.

Emotion Regulation Enhancement of Cognitive Behavior Therapy for College Student Problem Drinkers: A Pilot Randomized Controlled Trial

ERIC Educational Resources Information Center

Ford, Julian D.; Grasso, Damion J.; Levine, Joan; Tennen, Howard

2018-01-01

This pilot randomized clinical trial tested an emotion regulation enhancement to cognitive behavior therapy (CBT) with 29 college student problem drinkers with histories of complex trauma and current clinically significant traumatic stress symptoms. Participants received eight face-to-face sessions of manualized Internet-supported CBT for problem…

Advantages and Challenges of a Home- and Clinic-Based Model of Behavioral Intervention for Individuals Diagnosed with Autism Spectrum Disorder

ERIC Educational Resources Information Center

Leaf, Justin B.; Leaf, Ronald; McEachin, John; Cihon, Joseph H.; Ferguson, Julia L.

2018-01-01

Researchers have demonstrated that comprehensive behavioral intervention can result in significant improvements in the lives of individuals diagnosed with autism spectrum disorder (ASD; e.g.; Lovaas, "Journal of Consulting and Clinical Psychology" 55(1):3-9, 1987; McEachin et al., "American Journal of Mental Retardation"…

Reliability and Validity of the Rational Behavior Inventory with a Clinical Population.

ERIC Educational Resources Information Center

Shorkey, Clayton T.; Sutton-Simon, Karen

1983-01-01

The Rational Behavior Inventory and other scales of psychological adjustment were administered to mental health outpatients (N=75) who were receiving psychotherapy. Significant correlations were found between all measures in expected directions, and significant pre- to postscale differences identified consistently with expected effects of…

Sexual Risk Behavior Among Youth With Bipolar Disorder: Identifying Demographic and Clinical Risk Factors.

PubMed

Krantz, Megan; Goldstein, Tina; Rooks, Brian; Merranko, John; Liao, Fangzi; Gill, Mary Kay; Diler, Rasim; Hafeman, Danella; Ryan, Neal; Goldstein, Benjamin; Yen, Shirley; Hower, Heather; Hunt, Jeffrey; Keller, Martin; Strober, Michael; Axelson, David; Birmaher, Boris

2018-02-01

This study aims to document rates of sexual activity among youth with bipolar spectrum disorder (BD) and to examine demographic and clinical factors associated with first sexual activity and sexual risk behavior during follow-up. The sample was drawn from the Course and Outcome of Bipolar Youth (COBY) study of 413 youth 7 to 17 years at baseline who met criteria for bipolar spectrum disorder according to the Schedule for Affective Disorders and Schizophrenia for School-Aged Children. Psychiatric symptoms during follow-up were assessed using the Adolescent Longitudinal Interview Follow-Up Evaluation (ALIFE). Sexual behavior and level of sexual risk (e.g., unprotected sex, multiple partners, and/or partners with known sexually transmitted infections) were assessed by trained evaluators using the ALIFE Psychosocial Functioning Scale. Analyses were conducted in relation to first sexual behavior during follow-up and then to subsequent sexual behaviors (mean 9.7 years, standard deviation 3.2). Sexually active COBY youth (n = 292 of 413; 71%) were more likely females, using substances, and not living with both parents. Consistent with findings among healthy youth, earlier first sexual activity in the sample was significantly associated with low socioeconomic status, female sex, comorbid disruptive behavior disorder, and substance use. As with healthy youth, sexual risk behavior during follow-up was significantly associated with non-Caucasian race, low socioeconomic status, substance use, and history of sexual abuse. Of those COBY youth who were sexually active, 11% reported sexual assault or abuse, 36% reported becoming pregnant (or the significant other becoming pregnant), and 15% reported having at least 1 abortion (or the significant other having an abortion) during follow-up. Hypomanic symptoms during follow-up were temporally associated with the greatest risk for sexual risk behavior. Demographic and clinical factors could help identify youth with bipolar spectrum disorder at significantly greatest risk for sexual activity and sexual risk behavior. Attending to sexual risk behaviors in this population is warranted. Copyright © 2017 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.

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.

Using Reliable Change to Calculate Clinically Significant Progress in Children with EBD: A BHRS Program Evaluation

ERIC Educational Resources Information Center

Thoder, Vincent J.; Hesky, James G.; Cautilli, Joseph D.

2010-01-01

Children often have complex emotional and behavioral disorders (ADHD, ODD, Depression, PTSD, etc.). A large amount of research exists in the behavioral treatment of children with these disorders regarding specific behavioral problems. Much less research exists for the treatment of comprehensive problematic behaviors that these children experience…

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.

Impact of a Resident-as-Teacher Workshop on Teaching Behavior of Interns and Learning Outcomes of Medical Students

PubMed Central

Hill, Andrew G.; Srinivasa, Sanket; Hawken, Susan J.; Barrow, Mark; Farrell, Susan E.; Hattie, John; Yu, Tzu-Chieh

2012-01-01

Background Residents and interns are recognized as important clinical teachers and mentors. Resident-as-teacher training programs are known to improve resident attitudes and perceptions toward teaching, as well as their theoretical knowledge, skills, and teaching behavior. The effect of resident-as-teacher programs on learning outcomes of medical students, however, remains unknown. An intervention cohort study was conducted to prospectively investigate the effects of a teacher-training workshop on teaching behavior of participating interns and on the clerkship learning outcomes of instructed fourth-year medical students. Methods The House Officer-as-Teacher Training Workshop was implemented in November 2009 over 1.5 days and attended by all 34 interns from one teaching hospital. Subsequently, between February and August 2010, 124 fourth-year medical students rated the observable teaching behavior of interns during 6-week general surgery clerkships at this intervention hospital as well as at 2 comparable hospitals serving as control sites. Ratings were collected using an anonymous 15-item Intern Clinical Teaching Effectiveness Instrument. Student achievement of clerkship learning outcomes during this period was evaluated using a validated and centralized objective structured clinical examination. Results Medical students completed 101 intern clinical teaching effectiveness instruments. Intern teaching behavior at the intervention hospital was found to be significantly more positive, compared with observed behavior at the control hospitals. Objective structured clinical examination results, however, did not demonstrate any significant intersite differences in student achievement of general surgery clerkship learning outcomes. Conclusions The House Officer-as-Teacher Training Workshop noticeably improved teaching behavior of surgical interns during general surgery clerkships. This improvement did not, however, translate into improved achievement of clerkship learning outcomes by medical students during the study period. PMID:23451304

HIV Prevention Counseling Intervention Delivered During Routine Clinical Care Reduces HIV Risk Behavior in HIV-Infected South Africans Receiving Antiretroviral Therapy: The Izindlela Zokuphila/Options for Health Randomized Trial

PubMed Central

Fisher, Jeffrey D.; Cornman, Deborah H.; Shuper, Paul A.; Christie, Sarah; Pillay, Sandy; Macdonald, Susan; Ngcobo, Ntombenhle; Amico, K. Rivet; Lalloo, Umesh; Friedland, Gerald; Fisher, William A.

2014-01-01

Context Sustainable interventions are needed to minimize HIV risk behavior among people living with HIV (PLWH) in South Africa on antiretroviral therapy (ART), a significant proportion of whom do not achieve viral suppression. Objective To determine whether a brief lay counselor delivered intervention implemented during routine care can reduce risky sex among PLWH on ART. Design Cluster randomized 16 HIV clinical care sites in KwaZulu Natal, South Africa, to intervention or standard-of-care. Setting Publicly funded HIV clinical care sites. Patients 1891 PLWH on ART received the HIV prevention counseling intervention (n = 967) or standard-of-care counseling (n = 924). Intervention Lay counselors delivered a brief intervention using motivational interviewing strategies based on the Information—Motivation—Behavioral Skills (IMB) model during routine clinical care. Main Outcome Measures Number of sexual events without a condom in the past four weeks with partners of any HIV status, and with partners perceived to be HIV-negative or HIV-status unknown, assessed at baseline, 6, 12, and 18 months. Results Intervention participants reported significantly greater reductions in HIV risk behavior on both primary outcomes, compared to standard-of-care participants. Differences in STI incidence between arms were not observed. Conclusion Effective behavioral interventions, delivered by lay counselors within the clinical care setting, are consistent with the strategy of linking HIV care and HIV prevention and integrating biomedical and behavioral approaches to stemming the HIV epidemic. PMID:25230288

Characterization of the of the Pathological and Biochemical Markers That Correlate to the Clinical Features of Autism. Subproject 2. Contribution of Significant Delay of Neuronal Development and Metabolic Shift of Neurons to Clinical Phenotype of Autism

DTIC Science & Technology

2013-04-01

skills, (e) problems with generalization of previously acquired skills, (f) rigidity and resistance to change, (g) social and communication ...their known role in social behavior, communication , and stereotypic behavior results in identification of a structural component of functional deficits...neurons. These abnormalities may contribute to social and communication deficits, and restricted repetitive and stereotyped patterns of behavior. 3

Cognitive and Behavioral Treatments of Agoraphobia: Clinical, Behavioral, and Psychophysiological Outcomes.

ERIC Educational Resources Information Center

Michelson, Larry; And Others

1985-01-01

Agoraphobics (N=37) were randomly assigned to one of three cognitive-behavioral treatments: paradoxical intention, graduated exposure, or progressive deep muscle relaxation training. Results of follow-up analyses revealed statistically significant differences across treatments, tripartite response systems, and assessment phases. (Author/BL)

Research Units of Pediatric Psychopharmacology (RUPP) Autism Network Randomized Clinical Trial of Parent Training and Medication: One-Year Follow-Up

ERIC Educational Resources Information Center

Arnold, L. Eugene; Aman, Michael G.; Li, Xiaobai; Butter, Eric; Humphries, Kristina; Scahill, Lawrence; Lecavalier, Luc; McDougle, Christopher J.; Swiezy, Naomi B.; Handen, Benjamin; Wilson, Krystina; Stigler, Kimberly A.

2012-01-01

Objective: To follow up on a three-site, 24-week randomized clinical trial (N = 124) comparing antipsychotic medication alone (MED) with antipsychotic medication plus parent training in the behavior management (COMB) of children with autism spectrum disorders and severe behavior problems. The COMB treatment had shown a significant advantage for…

A Parent-Mediated Intervention that Targets Responsive Parental Behaviors Increases Attachment Behaviors in Children with ASD: Results from a Randomized Clinical Trial

ERIC Educational Resources Information Center

Siller, Michael; Swanson, Meghan; Gerber, Alan; Hutman, Ted; Sigman, Marian

2014-01-01

The current study is a randomized clinical trial evaluating the efficacy of Focused Playtime Intervention (FPI) in a sample of 70 children with Autism Spectrum Disorder. This parent-mediated intervention has previously been shown to significantly increase responsive parental communication (Siller et al. in "J Autism Dev Disord"…

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

Lisdexamfetamine dimesylate in adults with attention-deficit/ hyperactivity disorder who report clinically significant impairment in executive function: results from a randomized, double-blind, placebo-controlled study.

PubMed

Adler, Lenard A; Dirks, Bryan; Deas, Patrick F; Raychaudhuri, Aparna; Dauphin, Matthew R; Lasser, Robert A; Weisler, Richard H

2013-07-01

Behavioral rating scales that assess impairments in executive function commonly associated with attention-deficit/hyperactivity disorder (ADHD) may offer advantages over neuropsychological testing. The primary objective of this study was to evaluate the efficacy of lisdexamfetamine dimesylate for executive function deficits in adults with ADHD and clinically significant executive function impairment using self-reported Behavior Rating Inventory of Executive Function-Adult version (BRIEF-A) assessments. This randomized double-blind study, conducted between May 2010 and November 2010, screened at least 1 participant at 35 of 39 registered US clinical research sites. Adults (aged 18-55 years) with a primary ADHD diagnosis (meeting full DSM-IV-TR criteria) and executive function deficits (assessed by baseline BRIEF-A Global Executive Composite [GEC] T-scores of at least 65) were randomized to treatment with optimized lisdexamfetamine dimesylate (30 mg/d, 50 mg/d, or 70 mg/d; n = 80) or placebo (n = 81) during a 10-week double-blind treatment period. Outcome measures included the BRIEF-A scales (GEC, index, and clinical subscales). At week 10 or at early termination, lisdexamfetamine dimesylate was associated with significantly greater reductions from baseline in mean BRIEF-A GEC T-scores than placebo (effect size, 0.74; P < .0001) and significantly greater reductions from baseline in mean T-scores for both BRIEF-A index scales (Behavioral Regulation Index and Metacognition Index) and all 9 clinical subscales (P ≤ .0056 for all). At week 10 or at early termination, mean T-scores for BRIEF-A indexes and clinical subscales were below levels of clinically significant executive function deficits (ie, < 65) with lisdexamfetamine dimesylate treatment. The mean (SD) GEC T-score was 57.2 (14.11) for the lisdexamfetamine dimesylate group and 68.3 (17.12) for the placebo group. The safety profile of lisdexamfetamine dimesylate was consistent with other long-acting psychostimulants. Among adults with ADHD and clinically significant executive function deficits, lisdexamfetamine dimesylate was associated with significant improvements in self-reported executive function ratings. ClinicalTrials.gov identifier: NCT01101022. © Copyright 2013 Physicians Postgraduate Press, Inc.

Health-related behavior, profile of health locus of control and acceptance of illness in patients suffering from chronic somatic diseases.

PubMed

Janowski, Konrad; Kurpas, Donata; Kusz, Joanna; Mroczek, Bozena; Jedynak, Tomasz

2013-01-01

The purpose of the study was to determine health-related behaviors, profile of health locus of control (HLC), and to assess the relationships between these constructs among patients suffering from chronic somatic diseases. Three-hundred adult patients suffering from various chronic diseases participated in the study. The patients' mean age was 54.6 years (SD = 17.57). No statistically significant differences were found between the different clinical groups in health-related behavior, acceptance of illness, internal HLC or chance HLC. Patients with neurologic conditions showed slightly lower powerful others HLC than did some other clinical groups. Health-related behavior was significantly positively related to all three categories of HLC, with most prominent associations observed with powerful others HLC. Only one type of health-related behavior--preventive behavior--correlated significantly and negatively with acceptance of illness. Differences in the frequency of health-related behavior were also found due to gender (women showing more healthy nutritional habits than men), age (older subjects showing more frequent health-promoting behavior), education (higher education was associated with less frequent health-promoting behavior) and marital status (widowed subjects reporting more frequent health-promoting behavior). Health-related behavior in patients with chronic diseases seems to be unrelated to a specific diagnosis; however it shows associations with both internal and external HLC. Sociodemographic factors are also crucial factors determining frequency of health-related behavior in such patients.

Personality, Schizophrenia, and Violence: A Longitudinal Study.

PubMed

Candini, Valentina; Ghisi, Marta; Bottesi, Gioia; Ferrari, Clarissa; Bulgari, Viola; Iozzino, Laura; Boero, Maria Elena; De Francesco, Alessandra; Maggi, Paolo; Segalini, Beatrice; Zuccalli, Vanessa; Giobbio, Gian Marco; Rossi, Giuseppe; de Girolamo, Giovanni

2017-07-31

The aims of this study were (a) to investigate the presence of clinically significant personality traits and personality disorders (PD) in patients living in residential facilities, with or without a history of violence (69 and 46, respectively); and (b) to investigate any associations between clinically significant personality traits and PDs, aggression, impulsivity, hostility, and violent behavior during a 1-year follow-up. The most frequent primary diagnoses were schizophrenia (58.3%) and PD (20.9%). Those with a history of violence demonstrated more antisocial and alcohol dependence features and lower depressive PD symptoms than the control group. Hostility levels, antisocial symptoms, and drug dependence, as well as a Structured Clinical Interview for DSM-IV Axis II diagnosis of PD, predicted aggressive and violent behavior during follow-up. The study confirms the relevance of assessing PDs both to evaluate the risk of violent behavior and to plan appropriate preventive and treatment intervention.

Which information resources are used by general practitioners for updating knowledge regarding diabetes?

PubMed

Tabatabaei-Malazy, Ozra; Nedjat, Saharnaz; Majdzadeh, Reza

2012-04-01

Little is known about the degree of utilization of information resources on diabetes by general practitioners (GPs) and its impact on their clinical behavior in developing countries. Such information is vital if GPs' diabetes knowledge is to be improved. This cross-sectional study recruited 319 GPs in the summer of 2008. Questions were about the updates on diabetes knowledge in the previous two years, utilization of information resources (domestic and foreign journals, congresses, the Internet, reference books, mass media, and peers), attitude toward the importance of each resource, and impact of each resource on clinical behavior. A total of 62% of GPs had used information resources for improving their knowledge on diabetes in the previous two years. Domestic journals accounted for the highest utilization (30%) and the highest importance score (83 points from 100); with the importance score not being affected by sex, years elapsed after graduation, and numbers of diabetic visits. Clinical behavior was not influenced by the information resources listed; whereas knowledge upgrade, irrespective of the sources utilized, had a significantly positive correlation with clinical behavior. Domestic journals constituted the main information resource utilized by the GPs; this resource, however, in tandem with the other information resources on diabetes exerted no significant impact on the GPs' clinical behavior. In contrast to the developed countries, clinical guidelines do not have any place as a source of information and or practice. Indubitably, the improvement of diabetes knowledge transfer requires serious interventions to improve information resources as well as the structure of scientific gatherings and collaborations.

Randomized open-label trial of dextromethorphan in Rett syndrome.

PubMed

Smith-Hicks, Constance L; Gupta, Siddharth; Ewen, Joshua B; Hong, Manisha; Kratz, Lisa; Kelley, Richard; Tierney, Elaine; Vaurio, Rebecca; Bibat, Genila; Sanyal, Abanti; Yenokyan, Gayane; Brereton, Nga; Johnston, Michael V; Naidu, Sakkubai

2017-10-17

To determine safety and perform a preliminary assessment of dose-dependent efficacy of dextromethorphan in normalizing electrographic spikes, clinical seizures, and behavioral and cognitive functions in girls with Rett syndrome. We used a prospective randomized, open-label trial in fast metabolizers of dextromethorphan to examine the effect of dextromethorphan on core clinical features of Rett syndrome. Interictal spike activity and clinical seizures were determined using EEG and parent reporting. Cognitive data were obtained using the Mullen Scales of Early Learning and Vineland Adaptive Behavior Scales, while behavioral data were obtained from parent-completed checklists, the Aberrant Behavior Checklist-Community Version, and the Screen for Social Interaction. Anthropometric data were obtained according to the National Health and Nutrition Examination Survey. The Rett Syndrome Severity Scale provided a clinical global impression of the effect of dextromethorphan on clinical severity. Dextromethorphan is safe for use in 3- to 15-year-old girls with Rett syndrome. Thirty-five girls were treated with 1 of 3 doses of dextromethorphan over a period of 6 months. Statistically significant dose-dependent improvements were seen in clinical seizures, receptive language, and behavioral hyperactivity. There was no significant improvement in global clinical severity as measured by the Rett Syndrome Severity Scale. Dextromethorphan is a potent noncompetitive antagonist of the NMDA receptor channel that is safe for use in young girls with Rett syndrome. Preliminary evidence suggests that dextromethorphan may improve some core features of Rett syndrome. This study provides Class IV evidence that dextromethorphan at various doses does not change EEG spike counts over 6 months, though precision was limited to exclude an important effect. © 2017 American Academy of Neurology.

Poor peer relations predict parent- and self-reported behavioral and emotional problems of adolescents with gender dysphoria: a cross-national, cross-clinic comparative analysis.

PubMed

de Vries, Annelou L C; Steensma, Thomas D; Cohen-Kettenis, Peggy T; VanderLaan, Doug P; Zucker, Kenneth J

2016-06-01

This study is the third in a series to examine behavioral and emotional problems in children and adolescents with gender dysphoria in a comparative analysis between two clinics in Toronto, Ontario, Canada and Amsterdam, the Netherlands. In the present study, we report Child Behavior Checklist (CBCL) and Youth Self-Report (YSR) data on adolescents assessed in the Toronto clinic (n = 177) and the Amsterdam clinic (n = 139). On the CBCL and the YSR, we found that the percentage of adolescents with clinical range behavioral and emotional problems was higher when compared to the non-referred standardization samples but similar to the referred adolescents. On both the CBCL and the YSR, the Toronto adolescents had a significantly higher Total Problem score than the Amsterdam adolescents. Like our earlier studies of CBCL data of children and Teacher's Report Form data of children and adolescents, a measure of poor peer relations was the strongest predictor of CBCL and YSR behavioral and emotional problems in gender dysphoric adolescents.

PTSD’s risky behavior criterion: Relation with DSM-5 PTSD symptom clusters and psychopathology

PubMed Central

Contractor, Ateka A.; Weiss, Nicole H.; Dranger, Paula; Ruggero, Camilo; Armour, Cherie

2017-01-01

A new symptom criterion of reckless and self-destructive behaviors (E2) was recently added to posttraumatic stress disorder’s (PTSD) diagnostic criteria in DSM-5, which is unsurprising given the well-established relation between PTSD and risky behaviors. Researchers have questioned the significance and incremental validity of this symptom criterion within PTSD’s symptomatology. Unprecedented to our knowledge, we aim to compare trauma-exposed groups differing on their endorsement status of the risky behavior symptom on several psychopathology constructs (PTSD, depression, distress tolerance, rumination, anger). The sample included 123 trauma-exposed participants seeking mental health treatment (M age=35.70; 68.30% female) who completed self-report questionnaires assessing PTSD symptoms, depression, rumination, distress tolerance, and anger. Results of independent samples t-tests indicated that participants who endorsed the E2 criterion at a clinically significant level reported significantly greater PTSD subscale severity; depression severity; rumination facets of repetitive thoughts, counterfactual thinking, and problem-focused thinking; and anger reactions; and significantly less absorption and regulation (distress tolerance facets) compared to participants who did not endorse the E2 criterion at a clinically significant level. Results indicate the utility of the E2 criterion in identifying trauma-exposed individual with greater posttraumatic distress, and emphasize the importance of targeting such behaviors in treatment. PMID:28285248

Agreement between parents and teachers on preschool children's behavior in a clinical sample with externalizing behavioral problems.

PubMed

Korsch, Franziska; Petermann, Franz

2014-10-01

An accurate interpretation of information obtained from multiple assessors is indispensible when complex diagnoses of behavioral problems in children need to be confirmed. The present study examined the similarity of parents and kindergarten teachers ratings on children's behavior in a sample of 160 preschool children (a clinical group including 80 children with externalizing behavioral problems and a matched control group including 80 children). Behavioral problems were assessed using the SDQ, and the DISYPS-II questionnaires for ADHD and conduct disorders. The results revealed low levels of parent-teacher agreement for their ratings on the children's behavior in both groups with the highest correlations in the non-clinical sample. Parent-teacher agreement did not differ significantly across the samples. Parent and teacher ratings correlated with the prevalence of externalizing disorders and were found to be almost independent of each other. The results highlight the importance of multiple informants and their independent influence within the diagnostic process.

Does restructuring theory and clinical courses better prepare nursing students to manage residents with challenging behaviors in long-term care settings?

PubMed

O'Connell, Beverly; Guse, Lorna; Greenslade, Loreley

2018-01-30

Bachelor of Nursing students (BN) placed in long-term care encounter residents who exhibit challenging behaviors. Students are often inadequately prepared to manage these behaviors, and this is a source of distress for students. This study explored whether enhancing and restructuring theoretical and clinical courses resulted in student nurses feeling better prepared to manage residents' challenging behaviors and improve their levels of distress. This study was conducted in two phases with 116 BN students (first phase) and 99 students (second phase) where the course on older adults was restructured. The findings of this study indicated that students who felt less prepared experienced greater distress by residents' behaviors than those who felt better prepared. Scheduling a theoretical course on the care of older adults prior to the clinical course placement, as well as offering an online learning module focused on responsive behaviors, significantly increased students' feelings of preparedness to manage residents' complex behaviors.

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

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

The problem of parental nonadherence in clinical behavior analysis: effective treatment is not enough.

PubMed Central

Allen, K D; Warzak, W J

2000-01-01

Applied behavior analysts have developed many effective interventions for common childhood problems and have repeatedly demonstrated that childhood behavior responds to properly managed contingencies. The success of these interventions is dependent upon their basic effectiveness, as demonstrated in the literature, their precise delivery by the clinician to the parent, and adherence to or consistent implementation of the intervention. Unfortunately, arranging the consistent implementation of effective parenting strategies is a significant challenge for behavior analysts who work in homes, schools, and outpatient or primary care clinics. Much has been done to address issues of adherence or implementation in the clinic, but relatively little has been done to increase our understanding of the contingencies that affect parental adherence beyond the supervised clinic environment. An analysis of the contingencies that strengthen or weaken adherence might suggest strategies to improve implementation outside the clinic setting. What follows is an analysis of the variables associated with adherence by parents to recommendations designed to solve common childhood problems. PMID:11051583

Understanding performance and behavior of tightly coupled outpatient systems using RFID: initial experience.

PubMed

Stahl, James E; Holt, Julie K; Gagliano, Nancy J

2011-06-01

Understanding how clinical systems actually behave in an era of limited medical resources is critical. The purpose of this study was to determine if a radiofrequency-identification-based indoor positioning system (IPS) could objectively and unobtrusively capture outpatient clinic behavior. Primary outcomes were flowtime, wait time and patient/clinician face time. Two contrasting clinics were evaluated: a primary care clinic (PC) with templated scheduling and an urgent care clinic (UC) with unconstrained visit time and first-in, first-out scheduling. All staff wore transponders throughout the study period. Patients carried transponders from check in to check out. All patients and staff were allowed to opt out. The study was approved by hospital IRB. Standard descriptive and analytic statistical methods were used. Five hundred twenty-six patients (309 patients (PC), 217 patients (UC)) and 38 clinicians (eight (PC) and 30 (UC)) volunteered between April 30 and July 1, 2008. Total FT was not significantly different across clinics. PC wait time was significantly shorter (7.6 min [SD 15.8]) vs. UC (19.7 min [SD 25.3], p < 0.0001), and PC Face time was significantly longer (29.9 min, [SD 19.1] vs. UC (9.8 min [SD 8.5], p < 0.0001). PC Face time distributions reflected template scheduling structure. In contrast, face time distributions in UC had a smooth log normal distribution with a lower mean value. Our study seems to indicate that an IPS can successfully measure important clinic process measures in live clinical outpatient settings and capture behavioral differences across different outpatient organizational structures.

Cognitive-behavioral therapy for clinical pain control: a 15-year update and its relationship to hypnosis.

PubMed

Tan, S Y; Leucht, C A

1997-10-01

Since Tan's (1982) review of cognitive and cognitive-behavioral methods for pain control was published 15 years ago, significant advances have been made in cognitive-behavioral therapy for pain. The scientific evidence for its efficacy for clinical pain attenuation is now much more substantial and is briefly reviewed. In particular, cognitive-behavioral therapy for chronic pain was recently listed as one of 25 empirically validated or supported psychological treatments available for various disorders. A number of emerging issues are further discussed in light of recent developments and research findings. The relationship of cognitive-behavioral therapy to hypnosis for pain control is briefly addressed, with suggestions for integrating hypnotic and cognitive-behavioral techniques.

Information needs research in the era of the digital medical library.

PubMed Central

Lomax, E. C.; Lowe, H. J.

1998-01-01

The rapid adoption of Internet-accessible information resources by the clinical community, has resulted in an exponential growth in the variety and type of clinical information resources along with an increasing diversity of information technologies to deliver clinical information. To date, little formal work has been done to investigate the significance of new information technologies such as Internet-based digital libraries and multimedia record systems on clinical information need or information seeking behavior. In the work described in this paper, we highlight some results from our recent multimethod research design and investigation of the information-seeking behavior of Pittsburgh area medical oncologists to argue for the use of a multimethod research design as an essential component of any investigation of clinical information need and information-seeking behavior in the era of the digital medical library. PMID:9929301

[Effectiveness of cognitive-behavioral therapy in children and adolescents with obsessive-compulsive disorders treated in an outpatient clinic].

PubMed

Beig, Inga; Döpfner, Manfred; Goletz, Hildegard; Plück, Julia; Dachs, Lydia; Kinnen, Claudia; Walter, Daniel

2017-01-01

Cognitive-behavioral therapy (CBT) is considered as treatment of first choice for children and adolescents with obsessive-compulsive disorders (OCD). However, its effectiveness has so far mostly been examined in randomized controlled trials with strictly manualized interventions. Only few studies have examined whether the effectiveness of CBT for juvenile OCD generalizes to clinical practice. To test the effectiveness of CBT under routine care conditions, data of n = 53 patients with parent-ratings and n = 53 patients with self-ratings that were treated in a university-based outpatient clinic for child and adolescent psychotherapy was analyzed. Pre-post-mean-comparisons, effect sizes and the clinical significance of changes of the symptoms were examined. OCD and comorbid symptoms were significantly reduced during treatment. Strong effect sizes (Cohen’s d) were found for parent rated (d = 0.91) and patient rated (d = 0.88) OCD symptoms. Moderate to strong pre-post-effect sizes were found for the reduction of parent rated (d = 0.55 to d = 0.87) and patient rated (d = 0.46 to d = 0.74) comorbid symptoms. The percentage of children and adolescents who achieved clinically significant improvements and no longer showed dysfunctional OCD symptoms post-treatment was 46.3 % according to the parent-ratings and 59.4 % according to the self-ratings. Concerning comorbid symptoms the same was reached for between 22.5 % and 45.5 % of the patients (parent-ratings) and between 32.0 % and 81.8 % (self-ratings) respectively. Significant reductions in both OCD and comorbid symptoms were demonstrated over the course of cognitive-behavioral therapy of juvenile OCD disorders in a university outpatient clinic for child and adolescent psychotherapy. These results indicate that routine CBT treatment is an effective way to treat juvenile OCD disorders in clinical practice.

Behavior Problems in Postinstitutionalized Romanian Adoptees: Explanatory Parameters in the Adoptive Home

ERIC Educational Resources Information Center

Le Mare, Lucy; Audet, Karyn

2014-01-01

We examined behavior problems in 80 adolescents (39 male; mean age = 15.74 years) adopted in early childhood by Canadians from globally depriving Romanian institutions. Overall, rates of clinically significant behavior problems were comparable to rates found in younger postinstitutionalized adopted children. The association between duration of…

Cognitive-Behavioral Treatment of Depressed Affect among Epileptics: Preliminary Findings.

ERIC Educational Resources Information Center

Davis, Gay R.; And Others

1984-01-01

Evaluated a program where cognitive-behavioral methods were utilized in a structured learning format with clinically depressed epileptics (N=13). Results indicated that cognitive behavioral interventions result in significant decreases in depression and increases in related areas of psychosocial functioning that are maintained over time. (LLL)

A Comparison of Pharmacological (Amitriptyline HCL) and Nonpharmacological (Cognitive-Behavioral) Therapies for Chronic Tension Headaches.

ERIC Educational Resources Information Center

Holroyd, Kenneth A.; And Others

1991-01-01

Randomly assigned 41 recurrent tension headache sufferers to either cognitive-behavioral therapy or to amitriptyline therapy. Both therapies yielded clinically significant improvements in headache activity. In instances where differences in treatment effectiveness were observed, cognitive-behavioral therapy yielded somewhat more positive outcomes…

A Comparative Effectiveness Education Trial for Lifestyle Health Behavior Change in African Americans

ERIC Educational Resources Information Center

Halbert, Chanita Hughes; Bellamy, Scarlett; Briggs, Vanessa; Delmoor, Ernestine; Purnell, Joseph; Rogers, Rodney; Weathers, Benita; Johnson, Jerry C.

2017-01-01

Obesity and excess weight are significant clinical and public health issues that disproportionately affect African Americans because of physical inactivity and unhealthy eating. We compared the effects of alternate behavioral interventions on obesity-related health behaviors. We conducted a comparative effectiveness education trial in a…

Traditional Versus Integrative Behavioral Couple Therapy for Significantly and Chronically Distressed Married Couples.

ERIC Educational Resources Information Center

Christensen, Andrew; Atkins, David C.; Berns, Sara; Wheeler, Jennifer; Baucom, Donald H.; Simpson, Lorelei E.

2004-01-01

A randomized clinical trial compared the effects of traditional behavioral couple therapy (TBCT) and integrative behavioral couple therapy (IBCT) on 134 seriously and chronically distressed married couples, stratified into moderately and severely distressed groups. Couples in IBCT made steady improvements in satisfaction throughout the course of…

Associations between dental knowledge, source of dental knowledge and oral health behavior in Japanese university students: A cross-sectional study

PubMed Central

Taniguchi-Tabata, Ayano; Mizutani, Shinsuke; Yamane-Takeuchi, Mayu; Kataoka, Kota; Azuma, Tetsuji; Tomofuji, Takaaki; Iwasaki, Yoshiaki; Morita, Manabu

2017-01-01

The aim of this study was to investigate the associations between dental knowledge, the source of dental knowledge and oral health behavior in a group of students at a university in Japan. A total of 2,220 university students (1,276 males, 944 females) volunteered to undergo an oral examination and answer a questionnaire. The questionnaire assessed dental knowledge, the source of dental knowledge and oral health behavior (e.g., daily frequency of tooth brushing, use of dental floss and regular dental checkups). The odds ratio and 95% confidence interval for oral health behavior based on dental knowledge and source of dental knowledge were calculated using logistic regression models. Of the participants, 1,266 (57.0%) students obtained dental knowledge from dental clinics, followed by school (39.2%) and television (29.1%). Logistic regression analyses indicated that use of dental floss was significantly associated with source of dental knowledge from dental clinics (P = 0.006). Receiving regular dental checkups was significantly associated with source of dental knowledge; the positive source was dental clinic (P < 0.001) and the negative sources were school (P = 0.004) and television (P = 0.018). Dental clinic was the most common source of dental knowledge and associated with better oral health behavior among the Japanese university students in this study. PMID:28594914

The impact of failing to identify suspect effort in patients undergoing adult attention-deficit/hyperactivity disorder (ADHD) assessment.

PubMed

Marshall, Paul S; Hoelzle, James B; Heyerdahl, Danielle; Nelson, Nathaniel W

2016-10-01

[Correction Notice: An Erratum for this article was reported in Vol 28(10) of Psychological Assessment (see record 2016-22725-001). In the article, the penultimate sentence of the abstract should read “These results suggest that a significant percentage of those making a suspect effort will be diagnosed with ADHD using the most commonly employed assessment methods: an interview alone (71%); an interview and ADHD behavior rating scales combined (65%); and an interview, behavior rating scales, and most continuous performance tests combined (62%).” All versions of this article have been corrected.] This retrospective study examines how many adult patients would plausibly receive a diagnosis of attention-deficit/hyperactivity disorder (ADHD) if performance and symptom validity measures were not administered during neuropsychological evaluations. Five hundred fifty-four patients were extracted from an archival clinical dataset. A total of 102 were diagnosed with ADHD based on cognitive testing, behavior rating scales, effort testing, and clinical interview; 115 were identified as putting forth suspect effort in accordance with the Slick, Sherman, and Iverson (1999) criteria. From a clinical decision-making perspective, suspect effort and ADHD groups were nearly indistinguishable on ADHD behavior, executive function, and functional impairment rating scales, as well as on cognitive testing and key clinical interview questions. These results suggest that a significant percentage of those making a suspect effort will be diagnosed with ADHD using the most commonly employed assessment methods: an interview alone (71%); an interview and ADHD behavior rating scales combined (65%); and an interview, behavior rating scales, and most continuous performance tests combined (62%) [corrected]. This research makes clear that it is essential to evaluate task engagement and possible symptom amplification during clinical evaluations. PsycINFO Database Record (c) 2016 APA, all rights reserved

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.

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.

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

Karolinska Interpersonal Violence Scale predicts suicide in suicide attempters.

PubMed

Jokinen, Jussi; Forslund, Kaj; Ahnemark, Ewa; Gustavsson, J Petter; Nordström, Peter; Asberg, Marie

2010-08-01

Both childhood trauma and violent behavior are important risk factors for suicidal behavior. The aim of the present study was to construct and validate a clinical rating scale that could measure both the exposure to and the expression of violence in childhood and during adult life and to study the ability of the Karolinska Interpersonal Violence Scale (KIVS) to predict ultimate suicide in suicide attempters. A total of 161 suicide attempters and 95 healthy volunteers were assessed with the KIVS measuring exposure to violence and expressed violent behavior in childhood (between 6-14 years of age) and during adult life (15 years or older). The Buss-Durkee Hostility Inventory (BDHI), "Urge to act out hostility" subscale from the Hostility and Direction of Hostility Questionnaire (HDHQ), and the Early Experience Questionnaire (EEQ) were used for validation. All patients were followed up for cause of death and a minimum of 4 years from entering in the study. Five patients who committed suicide within 4 years had significantly higher scores in exposure to violence as a child, in expressed violent behavior as an adult, and in KIVS total score compared to survivors. Suicide attempters scored significantly higher compared to healthy volunteers in 3 of the 4 KIVS subscales. There were significant correlations between the subscales measuring exposure to and expression of violent behavior during the life cycle. BDHI, Urge to act out hostility, and EEQ validated the KIVS. Exposure to violence in childhood and violent behavior in adulthood are risk factors for completed suicide in suicide attempters. Behavioral dysregulation of aggression is important to assess in clinical work. The KIVS is a valuable new tool for case detection and long-term clinical suicide prevention. Copyright 2010 Physicians Postgraduate Press, Inc.

Longitudinal investigation of the relationship between family history of psychosis and affective disorders and Child Behavior Checklist ratings in clinical high-risk adolescents.

PubMed

Simeonova, Diana I; Lee, Frances J; Walker, Elaine F

2015-08-01

This is the first study to investigate whether positive family history (FH) of psychosis and affective disorders moderates the relationship between child diagnostic status and parent-reported social and behavioral problems on the Child Behavior Checklist (CBCL) in clinical high-risk adolescents. This longitudinal investigation assessed 122 participants (mean age=14.25±1.8years) from three groups (at-risk, other personality disorders, non-psychiatric controls) at baseline and one year follow-up. As predicted, there was a main effect of FH for a number of CBCL scales indicating higher scores for adolescents with positive FH. The findings also demonstrate a significant Diagnostic Status×Family History interaction for several behavioral scales providing support for FH as a concurrent and longitudinal moderator of the relationship between diagnostic status and CBCL scales. The moderating effect is present for areas of functioning associated with depression, anxiety, social adjustment, thought problems, attention problems, and aggressive behavior. The findings also indicate that both positive and negative symptoms are related to the genetic vulnerability for developing psychosis in clinical high-risk individuals, particularly those symptoms reflective of emotional, attentional, and interpersonal functioning. The present findings are novel and have significant clinical and research implications. This investigation provides a platform for future studies to clarify further the role of FH in clinical high-risk individuals and contributes to integration of this knowledge in the development of early intervention and prevention approaches in at-risk populations for the emergence of severe mental illness. Copyright © 2015 Elsevier B.V. All rights reserved.

Maladaptive and Repetitive Behaviors in Children with Down Syndrome and Autism Spectrum Disorders: Implications for Screening

ERIC Educational Resources Information Center

Hepburn, Susan L.; MacLean, William E.

2009-01-01

Researchers and clinicians are recognizing that a subgroup of children with Down syndrome (DS) also present with clinically significant impairments in social-communication and restricted patterns of behavior, such as those that characterize autism spectrum disorders (ASD). Efforts to better describe the behavioral presentation of children with…

PTSD's risky behavior criterion: Relation with DSM-5 PTSD symptom clusters and psychopathology.

PubMed

Contractor, Ateka A; Weiss, Nicole H; Dranger, Paula; Ruggero, Camilo; Armour, Cherie

2017-06-01

A new symptom criterion of reckless and self-destructive behaviors (E2) was recently added to posttraumatic stress disorder's (PTSD) diagnostic criteria in DSM-5, which is unsurprising given the well-established relation between PTSD and risky behaviors. Researchers have questioned the significance and incremental validity of this symptom criterion within PTSD's symptomatology. Unprecedented to our knowledge, we aim to compare trauma-exposed groups differing on their endorsement status of the risky behavior symptom on several psychopathology constructs (PTSD, depression, distress tolerance, rumination, anger). The sample included 123 trauma-exposed participants seeking mental health treatment (M age=35.70; 68.30% female) who completed self-report questionnaires assessing PTSD symptoms, depression, rumination, distress tolerance, and anger. Results of independent samples t-tests indicated that participants who endorsed the E2 criterion at a clinically significant level reported significantly greater PTSD subscale severity; depression severity; rumination facets of repetitive thoughts, counterfactual thinking, and problem-focused thinking; and anger reactions; and significantly less absorption and regulation (distress tolerance facets) compared to participants who did not endorse the E2 criterion at a clinically significant level. Results indicate the utility of the E2 criterion in identifying trauma-exposed individual with greater posttraumatic distress, and emphasize the importance of targeting such behaviors in treatment. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

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.

An exploratory investigation of purging disorder.

PubMed

Smith, Kathryn E; Crowther, Janis H

2013-01-01

Purging Disorder (PD) is an understudied pattern of behaviors within the Eating Disorder Not Otherwise Specified (EDNOS) category. Such categorization may suggest that PD is not clinically significant as other eating disorders. However, evidence has suggested that PD is associated with significant impairments in psychosocial functioning and well-being. Despite the apparent clinical significance of PD, it remains to be determined if PD is distinct from other clinically significant eating disorders. The present study sought to assess the phenomenology, clinical significance, and distinctiveness of PD. Group scores on measures of eating pathology, body image disturbance, and psychological correlates were compared using MANOVA among a female undergraduate sample (N=94) meeting diagnostic criteria for PD (n=20), Bulimia Nervosa (BN; n=35), restrained eating (n=18), and healthy controls (n=21). Overall, results indicated the PD group reported less severe symptoms than BN but more severe symptoms than controls. The PD and restraint groups were similar on most variables (including subjective binge behavior), with the exception of perfectionism and hunger. Findings support the conceptualization of PD as existing along a spectrum of bulimic spectrum disorders rather than as a distinct diagnostic category. Copyright © 2012 Elsevier Ltd. All rights reserved.

Behavioral health referrals in pediatric epilepsy.

PubMed

Wagner, Janelle L; Ferguson, Pamela L; Kellermann, Tanja; Smith, Gigi; Brooks, Byron

2016-11-01

The purpose of this study was to examine the feasibility of a behavioral health referral protocol and barriers to behavioral health care in a pediatric epilepsy clinic. A sample of 93 youth with epilepsy ages 10-17 and caregivers completed behavioral health and seizure severity measures during a routine epilepsy clinic visit. Key findings are that 47 (50.5%) of the youth screened positive for a behavioral health referral, and 35 of these youth were referred for behavioral health services. However, only 20% made and presented for the behavioral health appointment. The most commonly cited barrier for accessing and utilizing behavioral health care was stigma related- a mental health label for the child. The significance of this study lies in the revelation that solely screening for and educating caregivers about behavioral health symptoms and providing behavioral health referral information is not an ideal model. Instead, stigma related barriers point to the necessity of continued integrated physical and behavioral health care within the pediatric epilepsy visit. Copyright © 2016 Elsevier B.V. All rights reserved.

Psychometric appraisal of the Scale for Interpersonal Behavior (SIB) in France.

PubMed

Bouvard, M; Arrindell, W A; Guérin, J; Bouchard, C; Rion, A C; Ducottet, E; Séchaud, M; Mollard, E; Grillet, P R; Dang, C; Cottraux, J

1999-08-01

The present study was carried out in France to evaluate the reliability and validity of the Scale for Interpersonal Behavior (SIB), a multidimensional measure of difficulty and distress in assertiveness that was originally developed in The Netherlands. This appraisal was conducted with a clinical sample (N = 166) and a general population sample (N = 150). The clinical series comprised 115 patients with social phobia and 51 patients with personality disorder, 28 of whom were of the avoidant type. Support was found for internal consistency and test-retest reliability of the French SIB. Compared to controls, both social phobics and patients with an avoidant personality disorder had significantly lower mean scores on all performance scales and significantly higher ones on all distress scales, with the social phobics occupying a position in between. Findings in relation to convergent and divergent validity were quite satisfactory. Sensitivity of the French SIB for detecting change was demonstrated in a subgroup of the clinical Ss who had undergone 15 sessions of cognitive-behavioral group therapy for underassertiveness.

Parental Ratings of Children and Adolescents with Prader-Willi Syndrome on the Behavior Rating Inventory of Executive Function (BRIEF)

ERIC Educational Resources Information Center

Hutchison, Marnie; Pei, Jacqueline; Leung, Wing Sze Wence; Mackenzie, Michelle; Hicks, Melanie D.; Thurm, Audrey E.; Han, Joan C.; Haqq, Andrea M.

2015-01-01

We investigated executive functioning in 25 children and adolescents with Prader-Willi syndrome (PWS) on the Behavior Rating Inventory of Executive Function (BRIEF). Significant deficits emerged, with mean scores on all but two scales reaching levels of clinical significance (T score = 65). Older children tended to have higher scores than younger…

Cybercycling Effects on Classroom Behavior in Children With Behavioral Health Disorders: An RCT.

PubMed

Bowling, April; Slavet, James; Miller, Daniel P; Haneuse, Sebastien; Beardslee, William; Davison, Kirsten

2017-02-01

Exercise is linked with improved cognition and behavior in children in clinical and experimental settings. This translational study examined if an aerobic cybercycling intervention integrated into physical education (PE) resulted in improvements in behavioral self-regulation and classroom functioning among children with mental health disabilities attending a therapeutic day school. Using a 14-week crossover design, students (N = 103) were randomly assigned by classroom (k = 14) to receive the 7-week aerobic cybercycling PE curriculum during fall 2014 or spring 2015. During the intervention, children used the bikes 2 times per week during 30- to 40-minute PE classes. During the control period, children participated in standard nonaerobic PE. Mixed effects logistic regression was used to assess relationships between intervention exposures and clinical thresholds of behavioral outcomes, accounting for both individual and classroom random effects. Children experienced 32% to 51% lower odds of poor self-regulation and learning-inhibiting disciplinary time out of class when participating in the intervention; this result is both clinically and statistically significant. Effects were appreciably more pronounced on days that children participated in the aerobic exercise, but carryover effects were also observed. Aerobic cybercycling PE shows promise for improving self-regulation and classroom functioning among children with complex behavioral health disorders. This school-based exercise intervention may significantly improve child behavioral health without increasing parental burden or health care costs, or disrupting academic schedules. Copyright © 2017 by the American Academy of Pediatrics.

Psychophysiological Outcome of Behavioral and Pharmacological Treatments of Agoraphobia.

ERIC Educational Resources Information Center

Michelson, Larry; Mavissakalian, Matig

1985-01-01

Examined relative and combined effectiveness of behavior therapy and pharmacotherapy in 62 severe, chronic agoraphobics. Identified differential temporal response and treatment patterns across psychophysiological domains. Synchrony/desynchrony phenomena yielded significant findings with regard to process and clinical outcome status. Exploratory…

Investigating Habituation to Premonitory Urges in Behavior Therapy for Tic Disorders.

PubMed

Houghton, David C; Capriotti, Matthew R; Scahill, Lawrence D; Wilhelm, Sabine; Peterson, Alan L; Walkup, John T; Piacentini, John; Woods, Douglas W

2017-11-01

Behavior therapy is effective for Persistent Tic Disorders (PTDs), but behavioral processes facilitating tic reduction are not well understood. One process, habituation, is thought to create tic reduction through decreases in premonitory urge severity. The current study tested whether premonitory urges decreased in youth with PTDs (N = 126) and adults with PTDs (N = 122) who participated in parallel randomized clinical trials comparing behavior therapy to psychoeducation and supportive therapy (PST). Trends in premonitory urges, tic severity, and treatment outcome were analyzed according to the predictions of a habituation model, whereby urge severity would be expected to decrease in those who responded to behavior therapy. Although adults who responded to behavior therapy showed a significant trend of declining premonitory urge severity across treatment, results failed to demonstrate that behavior therapy specifically caused changes in premonitory urge severity. In addition, reductions in premonitory urge severity in those who responded to behavior therapy were significant greater than those who did not respond to behavior therapy but no different than those who responded or did not respond to PST. Children with PTDs failed to show any significant changes in premonitory urges. Reductions in premonitory urge severity did not mediate the relationship between treatment and outcome in either adults or children. These results cast doubt on the notion that habituation is the therapeutic process underlying the effectiveness of behavior therapy, which has immediate implications for the psychoeducation and therapeutic rationale presented in clinical practice. Moreover, there may be important developmental changes in premonitory urges in PTDs, and alternative models of therapeutic change warrant investigation. Copyright © 2017. Published by Elsevier Ltd.

Clinical profile of depressive disorder in children.

PubMed

Krishnakumar, P; Geeta, M G

2006-06-01

The aim of this retrospective study was to evaluate the risk factors, clinical features and co-morbid disorders of depressive disorder in children below the age of 12 years. Children who attended the child guidance clinic between January 2000 and December 2003 formed the subjects for the study. The diagnosis of depressive disorder was based on DSMIV diagnostic criteria for Major Depressive Disorder, Single episode. There were 26 boys and 19 girls. Stress at school and in the family was significantly associated with depressive disorder. Children with depressive disorder had significantly more family members affected with mental illnesses. The clinical features included diminished interest in play and activities, excessive tiredness, low self- esteem, problems with concentration, multiple somatic complaints, behavior symptoms like anger and aggression, recent deterioration in school performance and suicidal behavior. Majority of children had other associated psychiatric disorders which included dysthymic disorder, anxiety disorders, conduct disorder and conversion disorder.

Behavioral Management of Exercise Training in Vascular Headache Patients: An Investigation of Exercise Adherence and Headache Activity.

ERIC Educational Resources Information Center

Fitterling, James M.; And Others

1988-01-01

A behavioral package was used to shape and maintain adherence of five adult females with recurring vascular headache to a program of aerobic exercise training. Results demonstrated a functional relationship between the behavioral package and exercise adherence, as well as clinically significant collateral reductions in vascular headache activity…

Impact of Maternal Posttraumatic Stress Disorder and Depression Following Exposure to the September 11 Attacks on Preschool Children's Behavior

ERIC Educational Resources Information Center

Chemtob, Claude M.; Nomura, Yoko; Rajendran, Khushmand; Yehuda, Rachel; Schwartz, Deena; Abramovitz, Robert

2010-01-01

To evaluate whether conjoined maternal posttraumatic stress disorder (PTSD) and depression are associated with increased behavioral problems among terrorism-exposed preschool children (N = 116; 18-54 months), this study compared clinically significant child behavioral problem rates among the preschool children of mothers with PTSD and depression,…

The Treatment of Recurrent Abdominal Pain in Children: A Controlled Comparison of Cognitive-Behavioral Family Intervention and Standard Pediatric Care.

ERIC Educational Resources Information Center

Sanders, Matthew R.; And Others

1994-01-01

Conducted controlled clinical trial involving 44 children with recurrent abdominal pain randomly assigned to cognitive-behavioral family intervention (CBFI) or standard pediatric care (SPC). Both treatments resulted in significant improvements on measures of pain intensity and pain behavior. CBFI group had higher rate of complete elimination of…

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'…

Physician Satisfaction With Integrated Behavioral Health in Pediatric Primary Care.

PubMed

Hine, Jeffrey F; Grennan, Allison Q; Menousek, Kathryn M; Robertson, Gail; Valleley, Rachel J; Evans, Joseph H

2017-04-01

As the benefits of integrated behavioral health care services are becoming more widely recognized, this study investigated physician satisfaction with ongoing integrated psychology services in pediatric primary care clinics. Data were collected across 5 urban and 6 rural clinics and demonstrated the specific factors that physicians view as assets to having efficient access to a pediatric behavioral health practitioner. Results indicated significant satisfaction related to quality and continuity of care and improved access to services. Such models of care may increase access to care and reduce other service barriers encountered by individuals and their families with behavioral health concerns (ie, those who otherwise would seek services through referrals to traditional tertiary care facilities).

Amotivation in Schizophrenia: Integrated Assessment With Behavioral, Clinical, and Imaging Measures

PubMed Central

Wolf, Daniel H.; Satterthwaite, Theodore D.; Kantrowitz, Jacob J.; Katchmar, Natalie; Vandekar, Lillie; Elliott, Mark A.; Ruparel, Kosha

2014-01-01

Motivational deficits play a central role in disability caused by schizophrenia and constitute a major unmet therapeutic need. Negative symptoms have previously been linked to hypofunction in ventral striatum (VS), a core component of brain motivation circuitry. However, it remains unclear to what extent this relationship holds for specific negative symptoms such as amotivation, and this question has not been addressed with integrated behavioral, clinical, and imaging measures. Here, 41 individuals with schizophrenia and 37 controls performed a brief, computerized progressive ratio task (PRT) that quantifies effort exerted in pursuit of monetary reward. Clinical amotivation was assessed using the recently validated Clinical Assessment Interview for Negative Symptoms (CAINS). VS function was probed during functional magnetic resonance imaging using a monetary guessing paradigm. We found that individuals with schizophrenia had diminished motivation as measured by the PRT, which significantly and selectively related to clinical amotivation as measured by the CAINS. Critically, lower PRT motivation in schizophrenia was also dimensionally related to VS hypofunction. Our results demonstrate robust dimensional associations between behavioral amotivation, clinical amotivation, and VS hypofunction in schizophrenia. Integrating behavioral measures such as the PRT will facilitate translational efforts to identify biomarkers of amotivation and to assess response to novel therapeutic interventions. PMID:24657876

Does the Primary Care Behavioral Health Model Reduce Emergency Department Visits?

PubMed

Serrano, Neftali; Prince, Ronald; Fondow, Meghan; Kushner, Kenneth

2018-04-16

To examine the impact of integrating behavioral health services using the primary care behavioral health (PCBH) model on emergency department (ED) utilization. Utilization data from three Dane County, Wisconsin hospitals and four primary care clinics from 2003 to 2011. We used a retrospective, quasi-experimental, controlled, pre-post study design. Starting in 2007, two clinics began integrating behavioral health into their primary care practices with a third starting in 2010. A fourth, nonimplementing, community clinic served as control. Change in emergency department and primary care utilization (number of visits) for patients diagnosed with mood and anxiety disorders was the outcomes of interest. Retrospective data were obtained from electronic patient records from the three main area hospitals along with primary care data from participating clinics. Following the introduction of the PCBH model, one clinic experienced a statistically significant (p < .01, 95 percent CI 6.3-16.3 percent), 11.3 percent decrease in the ratio of ED visits to primary care encounters, relative to a control site, but two other intervention clinics did not. The PCBH model may be associated with a reduction in ED utilization, but better-controlled studies are needed to confirm this result. © Health Research and Educational Trust.

Gynecologic issues of adolescents with Down syndrome, autism, and cerebral palsy.

PubMed

Burke, Lori M; Kalpakjian, Claire Z; Smith, Yolanda R; Quint, Elisabeth H

2010-02-01

The gynecologic issues of adolescents with disabilities are understudied. The purpose of this study was to identify and compare the presenting complaints, treatments, and follow-up of adolescent girls with Down syndrome (DS), autism, and cerebral palsy (CP) presenting to a specialized gynecologic clinic for women with developmental disabilities. Outpatient gynecology clinic. Forty four adolescents (<21 y); 13 with DS, 14 with autism, and 17 with CP who presented to the clinic from 1999 to 2006. None. A retrospective review of the electronic medical records to collect data on age at presentation to clinic, ethnicity, menstrual history, chief complaint, treatment, and follow-up. Mean age at presentation to clinic was 15+/-3.5 years, and age of menarche was 12.5+/-2 years; age at menarche did not significantly differ between groups. The most frequent complaints were irregular bleeding (n=10) and mood/behavioral changes (n=6). Girls with autism were significantly (chi(2)=8.89, P=.012) more likely to present with behavioral issues than the other 2 groups. Initial management for the behavior issues in the autism group included nonsteroidal anti-inflammatory drugs (NSAID), oral contraceptives, and education. The most common gynecologic complaints of adolescent girls with DS, autism, and CP centered on menstruation and mood disorders. Patients with autism were more likely to present with behavioral issues related to the onset of periods. Copyright 2010 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

Confidence and Information Access in Clinical Decision-Making: An Examination of the Cognitive Processes that affect the Information-seeking Behavior of Physicians.

PubMed

Uy, Raymonde Charles; Sarmiento, Raymond Francis; Gavino, Alex; Fontelo, Paul

2014-01-01

Clinical decision-making involves the interplay between cognitive processes and physicians' perceptions of confidence in the context of their information-seeking behavior. The objectives of the study are: to examine how these concepts interact, to determine whether physician confidence, defined in relation to information need, affects clinical decision-making, and if information access improves decision accuracy. We analyzed previously collected data about resident physicians' perceptions of information need from a study comparing abstracts and full-text articles in clinical decision accuracy. We found that there is a significant relation between confidence and accuracy (φ=0.164, p<0.01). We also found various differences in the alignment of confidence and accuracy, demonstrating the concepts of underconfidence and overconfidence across years of clinical experience. Access to online literature also has a significant effect on accuracy (p<0.001). These results highlight possible CDSS strategies to reduce medical errors.

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

From Ideas to Efficacy: The ORBIT Model for Developing Behavioral Treatments for Chronic Diseases

PubMed Central

Czajkowski, Susan M.; Powell, Lynda H.; Adler, Nancy; Naar-King, Sylvie; Reynolds, Kim D.; Hunter, Christine M.; Laraia, Barbara; Olster, Deborah H.; Perna, Frank M.; Peterson, Janey C.; Epel, Elissa; Boyington, Josephine E.; Charlson, Mary E.

2015-01-01

Objective Given the critical role of behavior in preventing and treating chronic diseases, it is important to accelerate the development of behavioral treatments that can improve chronic disease prevention and outcomes. Findings from basic behavioral and social science research hold great promise for addressing behaviorally-based clinical health problems, yet there is currently no established pathway for translating fundamental behavioral science discoveries into health-related treatments ready for Phase III efficacy testing. This article provides a systematic framework for guiding efforts to translate basic behavioral science findings into behavioral treatments for preventing and treating chronic illness. Methods The ORBIT model for behavioral treatment development is described as involving a flexible and progressive process, pre-specified clinically significant milestones for forward movement, and return to earlier stages for refinement and optimization. Results This article presents the background and rationale for the ORBIT model, a summary of key questions for each phase, a selection of study designs and methodologies well-suited to answering these questions, and pre-specified milestones for forward or backward movement across phases. Conclusions The ORBIT model provides a progressive, clinically-relevant approach to increasing the number of evidence-based behavioral treatments available to prevent and treat chronic diseases. PMID:25642841

Emerging treatments for the behavioral and psychological symptoms of dementia.

PubMed

Anand, Abhinav; Khurana, Puneet; Chawla, Jasneet; Sharma, Neha; Khurana, Navneet

2017-09-15

Dementia is referred to a loss of memory and decline in other mental abilities at levels critical enough to hinder performance of daily activities. It can be of several types, depending on the underlying pathophysiology. The behavioral and psychological symptoms of dementia (BPSD) are various, but the most clinically significant are depression, apathy, and anxiety. Other BPSD include agitation, aberrant motor behavior, elation, hallucinations, and alterations in sleep and appetite. About 90% of sufferers of dementia are affected by BPSD during the course of the illness. These symptoms occur in demented patients irrespective of the dementia subtype. However, there has not been significant development in the areas of disease-modifying pharmacotherapeutics for dementia. Therefore, tackling BPSD has emerged as a research avenue in the recent past. Existing antidepressants, antipsychotics, and cholinergic agents have been extensively used in the treatment of BPSD, independently and in different combinations. However, these agents have not successful in completely alleviating such symptoms. Research in this field is going on globally, but it is still limited by various factors. There is a strong need to develop new entities and test them clinically. This review focuses on emerging treatments for the management of clinically significant BPSD.

[Assessment of parental stress using the "Eltern-Belastungs-Screening zur Kindeswohlgefährdung" (EBSK) - association with emotional and behavioral problems in children].

PubMed

Eichler, Anna K; Glaubitz, Katharina A; Hartmann, Luisa C; Spangler, Gottfried

2014-07-01

Parental stress is increased in clinical contexts (e.g., child psychiatry) and correlates with behavioral and emotional problems of children. In addition, parental stress can result in a biased parental perception of child's behavior and emotions. These interrelations were examined in a normal (N = 320) and a clinical (N = 75) sample. The "Eltern-Belastungs-Screening zur Kindeswohlgefährdung" (EBSK; Deegener, Spangler, Körner & Becker, 2009) was used for the assessment of parental stress. As expected, increased EBSK scores were overrepresented in the clinical sample. In both samples stressed parents reported having children with more behavioral and emotional problems. Children of stressed parents in turn reported significantly less problems than their parents did. The rating of independent third persons, e.g. teachers, was not available and should be added in future research. Restrictions in methodology and conclusions for practice are discussed.

Behavior of stabled horses provided continuous or intermittent access to drinking water.

PubMed

McDonnell, S M; Freeman, D A; Cymbaluk, N F; Schott, H C; Hinchcliff, K; Kyle, B

1999-11-01

To compare quantitative measures and clinical assessments of behavior as an indication of psychologic well-being of stabled horses provided drinking water continuously or via 1 of 3 intermittent delivery systems. 22 Quarter Horse (QH) or QH-crossbred mares and 17 Belgian or Belgian-crossbred mares (study 1) and 24 QH or QH-crossbred mares and 18 Belgian or Belgian-crossbred mares (study 2). Stabled horses were provided water continuously or via 1 of 3 intermittent water delivery systems in 2 study periods during a 2-year period. Continuous 24-hour videotaped samples were used to compare quantitative measures and clinical assessments of behavior among groups provided water by the various water delivery systems. All horses had clinically normal behavior. Significant differences in well being were not detected among groups provided water by the various delivery systems. Various continuous and intermittent water delivery systems can provide adequately for the psychologic well-being of stabled horses.

How to tell a patient's story? Influence of the case narrative design on the clinical reasoning process in virtual patients.

PubMed

Hege, Inga; Dietl, Anita; Kiesewetter, Jan; Schelling, Jörg; Kiesewetter, Isabel

2018-02-28

Virtual patients (VPs) are narrative-based educational activities to train clinical reasoning in a safe environment. Our aim was to explore the influence of the design of the narrative and level of difficulty on the clinical reasoning process, diagnostic accuracy and time-on-task. In a randomized controlled trial, we analyzed the clinical reasoning process of 46 medical students with six VPs in three different variations: (1) patients showing a friendly behavior, (2) patients showing a disruptive behavior and (3) a version without a patient story. For easy VPs, we did not see a significant difference in diagnostic accuracy. For difficult VPs, the diagnostic accuracy was significantly higher for participants who worked on the friendly VPs compared to the other two groups. Independent from VP difficulty, participants identified significantly more problems and tests for disruptive than for friendly VPs; time on task was comparable for these two groups. The extrinsic motivation of participants working on the VPs without a patient story was significantly lower than for the students working on the friendly VPs. Our results indicate that the measured VP difficulty has a higher influence on the clinical reasoning process and diagnostic accuracy than the variations in the narratives.

The effectiveness of the Stop Now and Plan (SNAP) program for boys at risk for violence and delinquency.

PubMed

Burke, Jeffrey D; Loeber, Rolf

2015-02-01

Among the available treatments for disruptive behavior problems, a need remains for additional service options to reduce antisocial behavior and prevent further development along delinquent and violent pathways. The Stop Now and Plan (SNAP) Program is an intervention for antisocial behavior among boys between 6 and 11. This paper describes a randomized controlled treatment effectiveness study of SNAP versus standard behavioral health services. The treatment program was delivered to youth with aggressive, rule-breaking, or antisocial behavior in excess of clinical criterion levels. Outcomes were measured at 3, 9, and 15 months from baseline. Youth in the SNAP condition showed significantly greater reduction in aggression, conduct problems, and overall externalizing behavior, as well as counts of oppositional defiant disorder and attention deficit hyperactivity disorder symptoms. Additional benefits for SNAP were observed on measures of depression and anxiety. Further analyses indicated that the SNAP program was more effective among those with a higher severity of initial behavioral problems. At 1 year follow-up, treatment benefits for SNAP were maintained on some outcome measures (aggression, ADHD and ODD, depression and anxiety) but not others. Although overall juvenile justice system contact was not significantly different, youth in SNAP had significantly fewer charges against them relative to those standard services. The SNAP Program, when contrasted with standard services alone, was associated with greater, clinically meaningful, reductions in targeted behaviors. It may be particularly effective for youth with more severe behavioral problems and may result in improvements in internalizing problems as well.

Suicide attempts and self-harm behaviors in psychiatric sex offenders.

PubMed

Stinson, Jill D; Gonsalves, Valerie

2014-06-01

Suicidality and self-harm behaviors among sex offenders remain underreported in the clinical literature and are often misunderstood in this complex population. The present study aims to identify rates of suicide attempts and self-injurious behaviors in a sample of 1,184 psychiatric inpatients, 462 of whom are sexual offenders. Between-group comparisons revealed significant differences in history of suicide attempts and self-harm behaviors, with sexual offenders evidencing greater rates of both. Significant psychiatric correlates of suicide attempts and self-harm behaviors among sex offenders varied by group and included a variety of psychiatric symptom presentations. These are compared with the general literature on suicide risk and the sex offender population. Implications for treatment of these behaviors in a sex offender population are discussed.

Appointment-keeping behavior of Medicaid-enrolled pediatric dental patients in eastern Iowa.

PubMed

Iben, P; Kanellis, M J; Warren, J

2000-01-01

The purpose of this prospective study was to assess the appointment-keeping behavior of Medicaid-enrolled pediatric dental patients in three Eastern Iowa practices. During the month of October 1998, a tally was kept of all patient appointments at a private pediatric dental office, a public health dental clinic, and a university-based pediatric dentistry clinic. Patients were categorized as either Medicaid or non-Medicaid. Appointment behavior categories were defined as: On time; Failure; Late-notice Cancellation (less than 24 hours notice); and Tardy (greater than 10 minutes). The data was entered in SPSS and analyzed using the chi square statistic. Statistical significance was P < 0.05. A total of 1,406 appointments were recorded for all three sites. Overall, patients on Iowa Medicaid had higher appointment failure, late-notice cancellation, and tardiness rates than non-Medicaid patients at all three clinics. However, these differences were only statistically significant for the private office and the university-based clinic. Failed appointment rates for Medicaid patients were much higher at the private office (38%) than at the other two sites. Consistent with anecdotal reports from dentists, Medicaid patients had higher rates of broken appointments than did non-Medicaid patients, particularly in a private practice setting.

A Quasi-Experimental Study Examining New York State's Tobacco-Free Regulation: Effects on Clinical Practice Behaviors

PubMed Central

Laschober, Tanja C.

2013-01-01

Background On July 24, 2008, New York State (NYS) became the first state to require all state-funded or state-certified substance use disorder (SUD) treatment organizations to be 100% tobacco-free and offer tobacco cessation (TC) treatment. Methods The current study used a quasi-experimental, non-equivalent control group design with a pretest and posttest to examine the effect of the NYS tobacco-free regulation on three clinical practice behaviors (use of TC-related intake procedures, use of guideline recommended counseling for TC, and pharmacotherapy availability) in a diverse sample of SUD treatment programs. Repeated cross-sectional data were collected from NYS counselors (experimental group) and non-NYS counselors (control group) approximately 4 months pre-regulation (N = 282 and 659, respectively) and 10-12 months post-regulation (N = 364 and 733, respectively). Results Using mixed-effects models, results at pre-regulation indicate no group differences in the three clinical practice behaviors. However, significant post-regulation effects were found such that the experimental group reports greater use of TC-related intake procedures, guideline recommended counseling, and availability of pharmacotherapy than the control group. Additionally, the experimental but not the control group shows increases in all three clinical practice behaviors from pre-regulation to post-regulation. Conclusions We conclude that the NYS tobacco-free regulation had a significant and positive effect on promoting patient TC efforts among counselors. PMID:23428317

Effects of a Family-Implemented Treatment on the Repetitive Behaviors of Children with Autism

PubMed Central

McDonough, Stephen G.; Rupp, Betty; Khan, Faraaz; Bodfish, James W.

2013-01-01

The restricted and repetitive behaviors of children with autism can interfere with family functioning as well as learning and socialization opportunities for the child. To date, neither pharmacological nor comprehensive behavioral treatments have been found to be consistently effective at significantly reducing children’s engagement in repetitive behaviors. We developed Family-Implemented Treatment for Behavioral Inflexibility (FITBI) to target the full variety of repetitive behaviors found in autism. For the current study, a therapist and parents of five children with autism (mean age = 48 months) co-implemented FITBI in a clinic setting over a 12-week treatment period. Using single case design methodology, significant reductions in repetitive behaviors were found for all participants and maintenance of treatment effects for 4 of 5 participants. PMID:21161576

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.

Adolescents with vascular frontal lesion: A neuropsychological follow up case study.

PubMed

Chávez, Clara L; Yáñez, Guillermina; Catroppa, Cathy; Rojas, Sulema; Escartin, Erick; Hearps, Stephen J C; García, Antonio

2016-01-01

The objective of this research was to identify clinically significant changes in cognitive functions in three adolescents who underwent surgery for resection of a focal vascular lesion in the frontal lobe. Cognitive functions, executive function, behavior regulation, emotion regulation, and social abilities were assessed prior to surgery, six and 24 months post-discharge. Significant clinical changes were observed during all the assessments. Cognitive changes after surgery are not homogeneous. Most of the significant clinical changes were improvements. Especially the significant clinical changes presented in EF domains were only improvements; these results suggest that EF were affected by the vascular lesion and benefitted by the surgery. After resection of a vascular lesion between 15 and 16 years of age the affected executive functions can continue the maturation process. Our results highlight the importance that assessments must include emotional aspects, even if deficits in these domains are not presented in the acute phase. Rehabilitation methods should promote the development of skills that help patients and their families to manage the emotional and behavioral changes that emerge once they are discharged from the hospital. Copyright © 2015 Sociedad Española de Neurocirugía. Published by Elsevier España. All rights reserved.

Light Treatment for Neuropsychiatric Behaviors in Alzheimer’s Disease

PubMed Central

Dowling, Glenna A.; Graf, Carla; Hubbard, Erin M.; Luxenberg, Jay S.

2008-01-01

Neuropsychiatric behaviors are common in people with Alzheimer’s disease (AD) and make both professional and lay caregiving difficult. Light therapy has been somewhat successful in ameliorating disruptive behaviors. This randomized trial tested the effects of morning or afternoon bright light exposure compared with usual indoor light on the presence, frequency, severity, and occupational disruptiveness of neuropsychiatric behaviors in nursing home residents with AD. Light was administered for 1 hr daily (Monday–Friday) for 10 weeks. The Neuropsychiatric Inventory–Nursing Home was used to assess behavior at baseline and end of the intervention. Analyses revealed statistically significant differences between groups on agitation/aggression, depression/dysphoria, aberrant motor behavior, and appetite/eating disorders. The magnitude of change was small and may not represent clinically significant findings. Agitation/aggression and nighttime behaviors commonly occurred and were highly correlated with occupational disruptiveness. Interventions that decrease the presence and/or severity of neuropsychiatric behaviors have the potential to significantly decrease caregiver burden. PMID:17596638

Premarital Sexual Guilt and Contraceptive Attitudes and Behavior.

ERIC Educational Resources Information Center

Herold, Edward S.; Goodwin, Marilyn Shirley

1981-01-01

Studied the relationship between premarital sexual guilt and contraceptive attitudes and behavior among young single women. High-guilt subjects were significantly more embarrassed about coming to the birth control clinics and were more likely to believe that it was difficult to obtain birth control. (Author)

[Usefulness of galectin-3 expression in the clinical behavior of differentiated thyroid carcinoma].

PubMed

López Mondéjar, Pedro; Picó, Antonio; Seguí, Javier; López Maciá, Alicia

2008-02-16

Our objective was to quantify the galectin-3 (gal-3) expression in differentiated thyroid carcinoma and study its relation with the clinical behavior of these tumors. We investigated the immunohistochemical reaction of gal-3 in patients with papillary thyroid carcinoma (PTC) and follicular thyroid carcinoma (FTC) and performed a retrospective study in order to find correlations with clinical features. Gal-3 expression was studied in 53 differentiated tyroid carcinomas (42 PTC and 11 FTC), and was related with clinical features: metastases, extrathyroid invasion and initial stage in the diagnosis and persistence disease and relapses in the follow up. Gal-3 expression positivity in PTC had a median of 60% (percentil 25 [p25], 17.5%; percentil 75 [p75], 100%), and was significantly higher (p < 0.0001) than in FTC (median, 0%; p25, 0%; p75, 15%). In PTC, gal-3 expression was significantly higher in advanced stages at the time of initial diagnosis (p = 0.014), persistent disease (p = 0.012) and relapses (p = 0.012) during the follow up. We did not find any significant association between gal-3 expression and clinical features of FTC. Gal-3 is a negative prognosis marker in PTC but not in FTC.

Parenting stress and child behavior problems among clinic-referred youth: cross-cultural differences across the US and Korea.

PubMed

Chung, Kyong-Mee; Ebesutani, Chad; Bang, Hye Min; Kim, Joohee; Chorpita, Bruce F; Weisz, John R; Suh, Dongsoo; Byun, Heejung

2013-06-01

Due to increased multiculturalism in the US and abroad, there is a need for increased understanding of the different ways in which parenting stress is related to child problems across cultures. In the present study, we investigated (a) differences in reported parenting stress and childhood problem behaviors across a Korean (n = 71) and US (n = 71) sample, as well as (b) differences in the ways in which parenting stress and childhood problems were related across Korean and US children based on mothers' reports. Results revealed that Korean mothers reported significantly higher parenting stress yet significantly lower childhood problem behaviors compared to US mothers. In addition, mother-based reports of child problems were significantly associated with parenting stress in the US sample, but not in the Korean sample. Clinical implications and culturally-relevant issues relevant to these findings are addressed, including a potential under-reporting bias of child problems among Asian parents.

Methadone Maintenance: The Addict's Family Recreated.

ERIC Educational Resources Information Center

Schwartzman, John; Bokos, Peter

1979-01-01

A study of four methadone clinics, the addicts treated at these clinics, and their families, reveals basic dissonances in treatment ideology and professional-paraprofessional relationships which, combined with the addict's particular mode of functioning, make significant change in his behavior improbable. (Author)

Autism: Clinical and Research Issues.

ERIC Educational Resources Information Center

Accardo, Pasquale J., Ed.; Magnusen, Christy, Ed.; Capute, Arnold J., Ed.

This text examines the characteristics that define autism: impairments in communication; abnormal social development; and clinically significant odd behaviors. Specific chapters include: (1) Neural Mechanisms in Autism (Andrew W. Zimmerman and Barry Gordon); (2) Epidemiology of Autism and Other Pervasive Developmental Disorders: Current…

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

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

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.

Leadership behaviors of frontline staff nurses.

PubMed

Fardellone, Christine; Musil, Carol M; Smith, Elaine; Click, Elizabeth R

2014-11-01

A recommendation in the Institute of Medicine's report, The Future of Nursing: Leading Change, Advancing Health, challenges the nursing profession to enhance nursing's leadership role in health care redesign. This descriptive, correlational, cross-sectional study examined the self-perceived leadership behaviors of RNs enrolled in a clinical ladder career pathway. A self-report survey was conducted using the Leadership Practice Inventory and a demographic questionnaire. Significant associations between continuous and categorical demographic factors and ladder levels were reported. Nurses with more experience showed fewer leadership behaviors. Leadership development is necessary for nurses in all areas of practice. The findings from this study provide evidence of the strengths and weaknesses in leadership behaviors of staff clinical RNs who often make frontline decisions for patients. Copyright 2014, SLACK Incorporated.

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.

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.

Impact of Eating Attitude and Impairment of Physical Quality of Life Between Tertiary Clinic and Primary Clinic Functional Dyspepsia Outpatients in Japan

PubMed Central

Shimpuku, Mayumi; Futagami, Seiji; Tajima, Natsuki; Yamawaki, Hiroshi; Maruki, Yuuta; Kodaka, Yasuhiro; Nagoya, Hiroyuki; Gudis, Katya; Kawagoe, Tetsuro; Sakamoto, Choitsu

2014-01-01

Background/Aims There is no available data on factors associated with healthcare-seeking behavior for functional dyspepsia (FD) symptoms at either tertiary or primary clinics in Japan. Therefore, we aimed to compare clinical symptoms and life styles such as sleep disorders and eating attitude in FD patients visiting general practitioners at primary clinics with those consulting gastroenterologists at tertiary clinics to clarify healthcare-seeking patterns in Japanese patients. Methods Fifty-one FD outpatients in a tertiary clinic (college hospital), 50 FD outpatients visiting primary clinics and 50 healthy volunteers were enrolled. Clinical symptoms, quality of life, sleep disorders, eating attitude and anxiety were estimated using the Gastrointestinal Symptom Rating Scale (GSRS), Social Functioning-8 (SF-8) test, Pittsburg Sleep Quality Index (PSQI) test and State-Trait Anxiety Inventory (STAI) for FD outpatients and healthy volunteers. Results FD outpatients exhibited higher mean scores of GSRS than healthy volunteers. The SF-8 physical component summary scores in the tertiary clinic group were significantly lower than those in the primary clinic group. GSRS scores were significantly (P < 0.001, P = 0.002) associated with global PSQI scores in FD outpatients as well as with STAI-trait scores (P = 0.006, P = 0.001) compared to healthy volunteers. The frequency of eating between meals in the primary clinic group was significantly (P < 0.05) higher than that in the tertiary clinic group. Conclusions It may be important for clarification of healthcare-seeking behavior to determine the difference in both impairment of physical quality of life and eating attitudes between tertiary clinic and primary clinic FD outpatients in Japan. PMID:25273121

Computer-supported feedback message tailoring: theory-informed adaptation of clinical audit and feedback for learning and behavior change.

PubMed

Landis-Lewis, Zach; Brehaut, Jamie C; Hochheiser, Harry; Douglas, Gerald P; Jacobson, Rebecca S

2015-01-21

Evidence shows that clinical audit and feedback can significantly improve compliance with desired practice, but it is unclear when and how it is effective. Audit and feedback is likely to be more effective when feedback messages can influence barriers to behavior change, but barriers to change differ across individual health-care providers, stemming from differences in providers' individual characteristics. The purpose of this article is to invite debate and direct research attention towards a novel audit and feedback component that could enable interventions to adapt to barriers to behavior change for individual health-care providers: computer-supported tailoring of feedback messages. We argue that, by leveraging available clinical data, theory-informed knowledge about behavior change, and the knowledge of clinical supervisors or peers who deliver feedback messages, a software application that supports feedback message tailoring could improve feedback message relevance for barriers to behavior change, thereby increasing the effectiveness of audit and feedback interventions. We describe a prototype system that supports the provision of tailored feedback messages by generating a menu of graphical and textual messages with associated descriptions of targeted barriers to behavior change. Supervisors could use the menu to select messages based on their awareness of each feedback recipient's specific barriers to behavior change. We anticipate that such a system, if designed appropriately, could guide supervisors towards giving more effective feedback for health-care providers. A foundation of evidence and knowledge in related health research domains supports the development of feedback message tailoring systems for clinical audit and feedback. Creating and evaluating computer-supported feedback tailoring tools is a promising approach to improving the effectiveness of clinical audit and feedback.

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.

The Effect of Cognitive Behavior Therapy in Insomnia due to Methadone Maintenance Therapy: A Randomized Clinical Trial

PubMed Central

Soleimani, Robabeh; Modabbernia, Mohammad Jafar; Habibi, Sharareh; Roudsary, Maryam Habibi; Elahi, Masoumeh

2015-01-01

Background: Sleep disturbance is a common complaint of patients undergoing methadone maintenance therapy (MMT). There are limited studies about the effect of different treatments on insomnia due to MMT. In this study, we evaluated the effect of cognitive-behavioral treatment for insomnia (CBTI) on sleep disorders in patients undergoing MMT. Methods: Twenty-two patients with insomnia due to MMT (aged 18-60 years) participated in this randomized double-blind clinical trial. The intervention group received CBTI from a clinical psychologist for 8 weeks, whereas the control group received behavioral placebo therapy (BPT). The duration of individual sessions was 45 minutes, which was conducted once a week. The primary outcome was sleep disturbance assessed with Pittsburgh Sleep Quality Index (PSQI). Data were analyzed using SPSS software version 19. Results: Eleven patients were assigned to each group. Two groups were matched according to demographic characteristics (age, marital status, education, and daily methadone doses). Although PSQI score was significantly reduced during weeks 5 and 8 after both interventions, there was a significant difference in intervention versus time interaction (P<0.02). The effects of CBTI versus placebo were significantly different (P<0.001). The time course was also significant (P<0.001). Conclusion: This study showed that CBTI is more effective than BPT in overall sleep quality. We recommend further studies, with a larger sample, on CBTI in patients undergoing MMT. PMID:26379345

An acceptance-oriented cognitive-behavioral therapy in multimodal rehabilitation: a pre-post test evaluation in highly distressed patients with rheumatic diseases.

PubMed

Vriezekolk, Johanna E; Eijsbouts, Agnes M M; van Lankveld, Wim G J M; Beenackers, Hanneke; Geenen, Rinie; van den Ende, Cornelia H M

2013-06-01

To examine the potential effectiveness of a multimodal rehabilitation program including an acceptance-oriented cognitive-behavioral therapy for highly distressed patients with rheumatic diseases. An observational study employing a one-group pre-post test design (N=25). The primary outcome was psychological distress. Secondary outcomes were quality of life, illness acceptance, and coping flexibility. Group pre-to-post and pre-to-12 months follow-up treatment changes were evaluated by paired-samples t-tests and Cohen's effect sizes (d). Individual changes were evaluated by the reliable change index (RCI) and clinically significant change (CSC) parameters. Significant effects were found post-treatment and maintained at 12 months in psychological distress (d>0.80), illness acceptance (d=1.48) and the SF-36 subscales role physical, vitality, and mental health (d ≥ 0.65). No significant effects were found for coping flexibility and the SF-36 subscales physical functioning, bodily pain, social functioning, and role emotional. Both a reliable (RCI) and clinically significant (CSC) improvement was observed for almost half of the highly distressed patients. The patients enrolled in the multimodal rehabilitation program showed improved psychological health status from pre to post-treatment. A randomized clinical trial is needed to confirm or refute the added value of an acceptance-oriented cognitive-behavioral therapy for highly distressed patients in rehabilitation. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Body dysmorphic symptoms: phenomenology and ethnicity.

PubMed

Marques, Luana; LeBlanc, Nicole; Weingarden, Hilary; Greenberg, Jennifer L; Traeger, Lara N; Keshaviah, Aparna; Wilhelm, Sabine

2011-03-01

Differences in the presentation of clinical features of body dysmorphic disorder (BDD) across ethnic groups have received little investigation. The current study assessed BDD symptoms in an ethnically diverse sample of adults (n=401) using an online survey. Participants completed self-report measures assessing BDD symptoms, body parts of concern and BDD behaviors. Compared to Caucasian participants, no significant differences were found in body parts or behaviors reported by Latino or African American participants. Significant group differences did emerge between Asian and Caucasian participants. Specifically, Asians reported more concern with straight hair and dark skin and fewer body shape concerns than Caucasians. Asians also endorsed lower rates of grooming, touching body parts, and camouflaging and higher rates of exercise compared to Caucasians. Although most clinical features of BDD appear similar across ethnic groups, results showed some differences in body parts and behaviors between Caucasians and Asian Americans with BDD symptoms. Copyright © 2011 Elsevier Ltd. All rights reserved.

Effects of cognitive-behavioral conjoint therapy for PTSD on partners' psychological functioning.

PubMed

Shnaider, Philippe; Pukay-Martin, Nicole D; Fredman, Steffany J; Macdonald, Alexandra; Monson, Candice M

2014-04-01

A number of studies have documented that posttraumatic stress disorder (PTSD) symptoms in "one" partner are negatively associated with their intimate partner's psychological functioning. The present study investigated intimate partners' mental health outcomes (i.e., depression, anxiety, and anger) in a sample of 40 partners of individuals with PTSD within a randomized waitlist controlled trial of cognitive-behavioral conjoint therapy for PTSD (Monson & Fredman, 2012). There were no significant differences between active treatment and waitlist in intimate partners' psychological functioning at posttreatment. Subgroup analyses, however, of partners exhibiting clinical levels of distress at pretreatment on several measures showed reliable and clinically significant improvements in their psychological functioning at posttreatment and no evidence of worsening. Results suggest that cognitive-behavioral conjoint therapy for PTSD may have additional benefits for partners presenting with psychological distress. Copyright © 2014 International Society for Traumatic Stress Studies.

Fetal alcohol spectrum disorders--a case-control study from India.

PubMed

Nayak, Raghavendra; Murthy, Pratima; Girimaji, Satish; Navaneetham, Jamuna

2012-02-01

Maternal alcohol abuse during pregnancy can lead to fetal neurotoxicity and fetal alcohol spectrum disorder (FASD). To compare the clinical features and neurobehavioral profiles of children exposed to alcohol during pregnancy with controls. Children exposed to alcohol in utero (n = 26) and 27-years age- and sex-matched controls were compared on FAS facial features, minor physical anomalies (MPAs), anthropometric measures, behavioral problems and intellectual functioning. MPAs were more common in cases (p = 0.001). Among FAS facial features, only philtrum smoothness varied significantly between the groups (p = 0.001). Behavioral problems (on Childhood Behavior Check List) were more pronounced (p = 0.001) and intellectual functioning significantly poorer in cases (p = 0.001) compared to controls. Children prenatally exposed to alcohol manifest several neurobehavioral problems compared to controls. Underlying malnutrition may have altered some of the clinical findings.

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.

Effects of Psilocybe argentipes on marble-burying behavior in mice.

PubMed

Matsushima, Yoshihiro; Shirota, Osamu; Kikura-Hanajiri, Ruri; Goda, Yukihiro; Eguchi, Fumio

2009-08-01

Psilocybe argentipes is a hallucinogenic mushroom. The present study examined the effects of P. argentipes on marble-burying behavior, which is considered an animal model of obsessive-compulsive disorder. P. argentipes significantly inhibited marble-burying behavior without affecting locomotor activity as compared with the same dose of authentic psilocybin. These findings suggest that P. argentipes would be efficient in clinical obsessive-compulsive disorder therapy.

Severely Aggressive Children Receiving Stimulant Medication Versus Stimulant and Risperidone: 12-Month Follow-Up of the TOSCA Trial

PubMed Central

Gadow, Kenneth D.; Brown, Nicole V.; Arnold, L. Eugene; Buchan-Page, Kristin A.; Bukstein, Oscar G.; Butter, Eric; Farmer, Cristan A.; Findling, Robert L.; Kolko, David J.; Molina, Brooke S.G.; Rice, Robert R.; Schneider, Jayne; Aman, Michael G.

2016-01-01

Objective To evaluate 52-week clinical outcomes of children with co-occurring attention-deficit/hyperactivity disorder (ADHD), disruptive behavior disorder, and serious physical aggression who participated in a prospective, longitudinal study that began with a controlled, 9-week clinical trial comparing the relative efficacy of parent training + stimulant medication + placebo (Basic; n=84) versus parent training + stimulant + risperidone (Augmented; n=84). Method Almost two-thirds (n=108; 64%) of families in the 9-week study participated in Week 52 follow-ups (Basic, n=55; Augmented, n=53), and they were representative of the initial study sample. The assessment battery included caregiver and clinician ratings and laboratory tests. Results Only 43% of Augmented and 36% of Basic still adhered to their assigned regimen (not significant [ns]); 23% of Augmented and 11% of Basic were taking no medication (ns). Both randomized groups improved baseline to follow-up, but the three primary parent-reported behavioral outcomes showed no significant between-group differences. Exploratory analyses indicated Augmented (65%) was more likely (p=.02) to have a Clinical Global Impressions (CGI) severity score of 1-3 (normal to mildly ill) at follow-up than Basic (42%). Parents rated 45% of children as impaired often or very often from ADHD, noncompliant, or aggressive behavior. Augmented had elevated prolactin levels, and Basic decreased in weight over time. Findings were generally similar whether groups were defined by randomized assignment or follow-up treatment status. Conclusion Both treatment strategies were associated with clinical improvement at follow-up, and primary behavioral outcomes did not differ significantly. Many children evidenced lingering mental health concerns, suggesting the need for additional research into more effective interventions. PMID:27238065

Effect of Dose of Behavioral Treatment for Obesity on Binge Eating Severity

PubMed Central

Ariel, Aviva H.; Perri, Michael G.

2016-01-01

Objectives We evaluated the effects of three doses of a behavioral intervention for obesity (High dose = 24 sessions, Moderate = 16 sessions, Low = 8 sessions) compared with a nutrition education control group (Control) on binge eating. We also examined whether participants with clinically significant improvements in binge eating had better treatment adherence and weight-loss outcomes than those who did not experience clinically significant improvements in binge eating. Finally, we examined the relation of pretreatment binge eating severity to changes at six months. Methods Participants included 572 adults (female = 78.7%; baseline mean ±SD: age = 52.7 ±11.2 years, BMI = 36.4 ±3.9 kg/m2) who provided binge eating data at baseline. We evaluated binge eating severity (assessed via the Binge Eating Scale) and weight status at baseline and six months, as well as treatment adherence over six months. Results At six months, participants in the Moderate and High treatment conditions reported greater reductions in binge eating severity than participants in the Low and Control conditions, ps < .02. Participants who demonstrated improvements in binge eating severity reported greater dietary self-monitoring adherence and attained larger weight losses than those who did not experience clinically significant reductions, ps < .001. Pretreatment binge eating severity predicted less improvement in binge eating severity over six months and fewer days with dietary self-monitoring records completed, ps ≤ .002. Conclusion A moderate or high dose of behavioral weight-loss treatment may be required to produce clinically significant reductions in binge eating severity in adults with obesity. PMID:27086049

Acute risk factors for suicide attempts and death: prospective findings from the STEP-BD study

PubMed Central

Ballard, Elizabeth D; Vande Voort, Jennifer L; Luckenbaugh, David A; Machado-Vieira, Rodrigo; Tohen, Mauricio; Zarate, Carlos A

2016-01-01

Objectives Suicide is unfortunately common in psychiatric practice, but difficult to predict. This study sought to assess which clinical symptoms increase in the months before suicidal behavior in a sample of psychiatric outpatients with bipolar disorder. Methods Data from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) trial were used. A total pf 103 participants who attempted suicide or died by suicide during the trial were included; a 15% random sample of the remaining participants (n = 427) was used as a comparison sample. Linear mixed models in the six months before suicidal behavior were conducted for each of five proposed acute risk factors for suicidal behavior. Participants were assessed using the Clinical Monitoring Form (CMF) at each visit for the following potential acute risk factors for suicidal behavior: suicidal ideation, loss of interest, anxiety, psychomotor agitation, and high-risk behavior. Results Each of the five symptoms was elevated overall in individuals who engaged in suicidal behavior (p < 0.05). The severity of both suicidal ideation and loss of interest significantly increased in the months before suicidal behavior (p < 0.001). Anxiety demonstrated comparable effect sizes across multiple models. Psychomotor agitation and high-risk behavior were not significantly elevated before suicidal behavior. Conclusions Suicidal ideation, loss of interest and, to a lesser extent, anxiety may represent acute suicide risk factors up to four months before suicidal behavior in outpatients with bipolar disorder. Further investigation of these potential acute risk factors in prospective analyses is warranted. PMID:27233466

A Clinical Application of Applied Humanism for Young Adults with Severe and Profound Retardation.

ERIC Educational Resources Information Center

Mazzelli, AnnaMaria; Polirstok, Susan Rovet; Dana, Lawrence; Buono, Serafina; Mongelli, Vita; Trubia, Grazia; Ayala, Giovanni

2000-01-01

Describes an intensive habilitation program in Sicily for young adults with severe and profound retardation. Participants in the program showed significant improvement in functional skills and an accompanying reduction in maladaptive and stereotypic behaviors, without complex behavior plans; punishing contingencies; or high dose neuroleptic,…

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…

Reduced gamma-aminobutyric acid is associated with emotional and behavioral problems in Prader-Willi syndrome.

PubMed

Rice, Lauren J; Lagopoulos, Jim; Brammer, Michael; Einfeld, Stewart L

2016-12-01

Prader-Willi syndrome (PWS) is characterized by infantile hypotonia, hypogonadism, small hands and feet, distinct facial features and usually intellectual impairment. The disorder is associated with severe behavioral disturbances which include hyperphagia leading to morbid obesity, temper outbursts, skin-picking, and compulsive behaviors. While the brain mechanisms that underpin these disturbances are unknown these behaviors suggest a lack of inhibition and thus gamma-aminobutyric acid (GABA), the main inhibitory neurotransmitter may be implicated. In the present study, we investigated in vivo brain GABA and its relationship with emotion and behavior in individuals with PWS. Single voxel proton magnetic resonance spectroscopy (1H-MRS) was performed on 15 individuals with PWS and 15 age- and gender-matched typically developing controls. GABA levels were measured in the parieto-occipital lobe. All other metabolite levels (N-acetyl aspartate, myo-Inositol, glutathione, glutamate, and glutamine + glutamate) were measured in the anterior cingulate cortex (ACC). GABA levels were significantly lower in the participants with PWS who had clinically significant emotional and behavioral problems relative to typically developing control participants and participants with PWS who did not have emotional and behavioral problems within the clinically significant range. GABA levels were negatively correlated with total behavioral problem scores as well as temper outbursts, skin-picking, depression, social relating difficulties, and a tendency to be self-absorbed. Our data suggests that alterations of the GABAergic system may play an important role in aspects of the pathophysiology of PWS. Pathological mechanism found in PWS may be relevant to understanding the control of similar behaviors in the general population. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Defining the developmental parameters of temper loss in early childhood: implications for developmental psychopathology

PubMed Central

Wakschlag, Lauren S.; Choi, Seung W.; Carter, Alice S.; Hullsiek, Heide; Burns, James; McCarthy, Kimberly; Leibenluft, Ellen; Briggs-Gowan, Margaret J.

2013-01-01

Background Temper modulation problems are both a hallmark of early childhood and a common mental health concern. Thus, characterizing specific behavioral manifestations of temper loss along a dimension from normative misbehaviors to clinically significant problems is an important step toward identifying clinical thresholds. Methods Parent-reported patterns of temper loss were delineated in a diverse community sample of preschoolers (n = 1,490). A developmentally sensitive questionnaire, the Multidimensional Assessment of Preschool Disruptive Behavior (MAP-DB), was used to assess temper loss in terms of tantrum features and anger regulation. Specific aims were: (a) document the normative distribution of temper loss in preschoolers from normative misbehaviors to clinically concerning temper loss behaviors, and test for sociodemographic differences; (b) use Item Response Theory (IRT) to model a Temper Loss dimension; and (c) examine associations of temper loss and concurrent emotional and behavioral problems. Results Across sociodemographic subgroups, a unidimensional Temper Loss model fit the data well. Nearly all (83.7%) preschoolers had tantrums sometimes but only 8.6% had daily tantrums. Normative misbehaviors occurred more frequently than clinically concerning temper loss behaviors. Milder behaviors tended to reflect frustration in expectable contexts, whereas clinically concerning problem indicators were unpredictable, prolonged, and/or destructive. In multivariate models, Temper Loss was associated with emotional and behavioral problems. Conclusions Parent reports on a developmentally informed questionnaire, administered to a large and diverse sample, distinguished normative and problematic manifestations of preschool temper loss. A developmental, dimensional approach shows promise for elucidating the boundaries between normative early childhood temper loss and emergent psychopathology. PMID:22928674

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.

Doctor-office collaborative care for pediatric behavioral problems: a preliminary clinical trial.

PubMed

Kolko, David J; Campo, John V; Kilbourne, Amy M; Kelleher, Kelly

2012-03-01

To evaluate the feasibility and clinical benefits of an integrated mental health intervention (doctor-office collaborative care [DOCC]) vs enhanced usual care (EUC) for children with behavioral problems. Cases were assigned to DOCC and EUC using a 2:1 randomization schedule that resulted in 55 DOCC and 23 EUC cases. Preassessment was conducted in 4 pediatric primary care practices. Postassessment was conducted in the pediatric or research office. Doctor-office collaborative care was provided in the practice; EUC was initiated in the office but involved a facilitated referral to a local mental health specialist. Of 125 referrals (age range, 5-12 years), 78 children participated. Children and their parents were assigned to receive DOCC or EUC. Preassessment diagnostic status was evaluated using the Schedule for Affective Disorders and Schizophrenia for School-aged Children. Preassessment and 6-month postassessment ratings of behavioral and emotional problems were collected from parents using the Vanderbilt Attention-Deficit/Hyperactivity Disorder Diagnostic Parent Rating Scale, as well as individualized goal achievement ratings forms. At discharge, care managers and a diagnostic evaluator completed the Clinical Global Impression Scale, and pediatricians and parents completed satisfaction and study feedback measures. Group comparisons found significant improvements for DOCC over EUC in service use and completion, behavioral and emotional problems, individualized behavioral goals, and overall clinical response. Pediatricians and parents were highly satisfied with DOCC. The feasibility and clinical benefits of DOCC for behavioral problems support the integration of collaborative mental health services for common mental disorders in primary care.

Sub-clinical Alcohol Consumption and Gambling Disorder

PubMed Central

Harries, Michael D.; Redden, Sarah A.; Leppink, Eric W.; Chamberlain, Samuel R.; Grant, Jon E.

2017-01-01

While it is well established that gambling disorder is associated with alcohol use disorder, less is known regarding whether sub-clinical alcohol consumption increases gambling behavior. This study examined the effects of varying levels of alcohol consumption on clinical and cognitive measures. The sample consisted of 572 non-treatment seeking gamblers age 18-29 who were divided into three groups: non-current drinkers, current drinkers who did not qualify for an alcohol use disorder, and those with an alcohol use disorder (AUD). All subjects were assessed on gambling pathology, severity and impulsivity using the Structured Clinical Interview for Gambling Disorder, Yale Brown Obsessive Compulsive Scale for Pathologic Gambling and the Barratt Impulsive Scale-11 and select cognitive tests. In all of the clinical measures, controlling for age, gender and education, the AUD group was significantly more likely than the non-current and current drinkers to be a pathologic gambler and to be impulsive, compulsive and depressed. On cognitive tasks, controlling for age, gender and education, the AUD group had significantly worse strategy use on a spatial working memory task than both other groups. This study suggests that the relationship between alcohol and gambling may only exist when pathology in both alcohol consumption and gambling behavior is present. Examining this relationship with alcohol consumption as a continuous variable would provide additional insight into the potential effects alcohol consumption has on gambling behavior. PMID:27826730

Sub-clinical Alcohol Consumption and Gambling Disorder.

PubMed

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

2017-06-01

While it is well established that gambling disorder is associated with alcohol use disorder, less is known regarding whether sub-clinical alcohol consumption increases gambling behavior. This study examined the effects of varying levels of alcohol consumption on clinical and cognitive measures. The sample consisted of 572 non-treatment seeking gamblers age 18-29 who were divided into three groups: non-current drinkers, current drinkers who did not qualify for an alcohol use disorder, and those with an alcohol use disorder (AUD). All subjects were assessed on gambling pathology, severity and impulsivity using the Structured Clinical Interview for Gambling Disorder, Yale Brown Obsessive Compulsive Scale for Pathologic Gambling and the Barratt Impulsive Scale-11 and select cognitive tests. In all of the clinical measures, controlling for age, gender and education, the AUD group was significantly more likely than the non-current and current drinkers to be a pathologic gambler and to be impulsive, compulsive and depressed. On cognitive tasks, controlling for age, gender and education, the AUD group had significantly worse strategy use on a spatial working memory task than both other groups. This study suggests that the relationship between alcohol and gambling may only exist when pathology in both alcohol consumption and gambling behavior is present. Examining this relationship with alcohol consumption as a continuous variable would provide additional insight into the potential effects alcohol consumption has on gambling behavior.

Aggression in children with autism spectrum disorders and a clinic-referred comparison group

PubMed Central

Farmer, Cristan; Butter, Eric; Mazurek, Micah O.; Cowan, Charles; Lainhart, Janet; Cook, Edwin H.; DeWitt, Mary Beth; Aman, Michael

2015-01-01

A gap exists in the literature regarding aggression in autism spectrum disorders (ASD) and how this behavior compares to other groups. In this multisite study, the Children’s Scale for Hostility and Aggression: Reactive/Proactive (C-SHARP) and the Aggression subscale of the Child Behavior Checklist (CBCL) were rated for 414 children with ASD (Autistic Disorder, 69%; PDD-NOS, 24%; Asperger’s Disorder, 7%) and 243 clinic-referred children without ASD, aged 1-21 years (mean age about 7). Participants were not selected for aggressive behavior. Relative to the comparison group, children with ASD were reported to have less aggression and were more likely to be rated as reactive rather than proactive. Among all subjects, sex was not associated with aggression; higher IQ/adaptive behavior and older age were associated with more sophisticated types of aggression while lower scores on IQ, adaptive behavior, and communication measures were associated with more physical aggression. The interaction between demographic variables and diagnosis was significant only for age: younger but not older children with ASD showed less aggression than clinic-referred controls. PMID:24497627

A quasi-experimental study examining New York State's tobacco-free regulation: effects on clinical practice behaviors.

PubMed

Eby, Lillian T; Laschober, Tanja C

2013-09-01

On July 24, 2008, New York State (NYS) became the first state to require all state-funded or state-certified substance use disorder (SUD) treatment organizations to be 100% tobacco-free and offer tobacco cessation (TC) treatment. The current study used a quasi-experimental, non-equivalent control group design with a pretest and posttest to examine the effect of the NYS tobacco-free regulation on three clinical practice behaviors (use of TC-related intake procedures, use of guideline recommended counseling for TC, and pharmacotherapy availability) in a diverse sample of SUD treatment programs. Repeated cross-sectional data were collected from NYS counselors (experimental group) and non-NYS counselors (control group) approximately 4 months pre-regulation (N=282 and 659, respectively) and 10-12 months post-regulation (N=364 and 733, respectively). Using mixed-effects models, results at pre-regulation indicate no group differences in the three clinical practice behaviors. However, significant post-regulation effects were found such that the experimental group reports greater use of TC-related intake procedures, guideline recommended counseling, and availability of pharmacotherapy than the control group. Additionally, the experimental but not the control group shows increases in all three clinical practice behaviors from pre-regulation to post-regulation. We conclude that the NYS tobacco-free regulation had a significant and positive effect on promoting patient TC efforts among counselors. Copyright © 2013 Elsevier Ireland Ltd. 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.

Mid-Treatment Sleep Duration Predicts Clinically Significant Knee Osteoarthritis Pain reduction at 6 months: Effects From a Behavioral Sleep Medicine Clinical Trial.

PubMed

Salwen, Jessica K; Smith, Michael T; Finan, Patrick H

2017-02-01

To determine the relative influence of sleep continuity (sleep efficiency, sleep onset latency, total sleep time [TST], and wake after sleep onset) on clinical pain outcomes within a trial of cognitive behavioral therapy for insomnia (CBT-I) for patients with comorbid knee osteoarthritis and insomnia. Secondary analyses were performed on data from 74 patients with comorbid insomnia and knee osteoarthritis who completed a randomized clinical trial of 8-session multicomponent CBT-I versus an active behavioral desensitization control condition (BD), including a 6-month follow-up assessment. Data used herein include daily diaries of sleep parameters, actigraphy data, and self-report questionnaires administered at specific time points. Patients who reported at least 30% improvement in self-reported pain from baseline to 6-month follow-up were considered responders (N = 31). Pain responders and nonresponders did not differ significantly at baseline across any sleep continuity measures. At mid-treatment, only TST predicted pain response via t tests and logistic regression, whereas other measures of sleep continuity were nonsignificant. Recursive partitioning analyses identified a minimum cut-point of 382 min of TST achieved at mid-treatment in order to best predict pain improvements 6-month posttreatment. Actigraphy results followed the same pattern as daily diary-based results. Clinically significant pain reductions in response to both CBT-I and BD were optimally predicted by achieving approximately 6.5 hr sleep duration by mid-treatment. Thus, tailoring interventions to increase TST early in treatment may be an effective strategy to promote long-term pain reductions. More comprehensive research on components of behavioral sleep medicine treatments that contribute to pain response is warranted. © Sleep Research Society 2016. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved. For permissions, please e-mail journals.permissions@oup.com.

Theory of mind in schizophrenia: correlation with clinical symptomatology, emotional recognition and ward behavior.

PubMed

Lee, Woo Kyeong; Kim, Yong Kyu

2013-09-01

Several studies have suggested the presence of a theory of mind (ToM) deficit in schizophrenic disorders. This study examined the relationship of emotion recognition, theory of mind, and ward behavior in patients with schizophrenia. Fifty-five patients with chronic schizophrenia completed measures of emotion recognition, ToM, intelligence, Positive and Negative Syndrome Scale (PANSS) and Nurse's Observation Scale for Inpatient Evaluation (NOSIE). Theory of mind sum score correlated significantly with IQ, emotion recognition, and ward behavior. Ward behavior was linked to the duration of the illness, and even more so to theory of mind deficits. Theory of mind contributed a significant proportion of the amount of variance to explain social behavior on the ward. Considering our study results, impaired theory of mind contributes significantly to the understanding of social competence in patients with schizophrenia. Copyright © 2012 Wiley Publishing Asia Pty Ltd.

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.

A Longitudinal Study of Violent Behavior in a Psychosis-Risk Cohort.

PubMed

Brucato, Gary; Appelbaum, Paul S; Lieberman, Jeffrey A; Wall, Melanie M; Feng, Tianshu; Masucci, Michael D; Altschuler, Rebecca; Girgis, Ragy R

2018-01-01

There is a lack of insight into the relationships between violent ideation, violent behavior, and early, particularly attenuated, psychosis. Our aims were to examine the relationships between baseline violent behavior and violent ideation and outcome violent behavior and conversion to psychosis in at-risk individuals. We longitudinally assessed 200 individuals at clinical high risk for psychosis for violent ideation and violent behavior using the Structured Interview for Psychosis-Risk Syndromes (SIPS), and rated these according to MacArthur Community Violence categories. Fifty-six individuals (28%) reported violent ideation at baseline, 12 (6%) reported violent behavior within 6 months pre-baseline, and 8 (4%) committed acts of violence during the follow-up time period. Information about violent ideation was obtained only by indirect, but not direct, inquiry about violent ideation. Both violent ideation and violent behavior at baseline significantly predicted violent behavior (RR=13.9, p=0.001; RR=8.3, p=0.003, respectively) during follow-up, as well as a diagnosis of psychosis (RR=2.3 and 2.4, respectively; both p<0.001), independent of more than 40 clinical and demographic variables. The targets of the subjects' violent ideation at baseline were completely different than their subsequent targets of violent behavior. Violent behavior occurred within 7 days (SD 35 days) of a diagnosis of syndromal psychosis. These data suggest that checking carefully for violent ideation and behavior in clinical high-risk patients is essential, as these have predictive value for conversion to psychosis and likelihood of violence in the future.

Body focused repetitive behavior disorders: Significance of family history.

PubMed

Redden, Sarah A; Leppink, Eric W; Grant, Jon E

2016-04-01

The significance of family history in body-focused repetitive behavior disorders (BFRBs) (i.e. trichotillomania and skin picking) has received scant research attention. We sought to understand the clinical and cognitive impact of having a first-degree relative with a BFRB or a substance use disorder (SUD). 265 participants with BFRBs undertook clinical and neurocognitive evaluations. Those with a first-degree relative with a BFRB or an SUD were compared to those without on a number of clinical and cognitive measures. 77 (29.1%) participants had a first-degree family member with a BFRB and 59 (22.2%) had a first-degree family member with an SUD. In terms of clinical severity, the amount of time spent picking or pulling per day in the past week was higher among those with a first-degree relative with an SUD. There were a higher rate of ADHD and higher HAM-D scores among those with a positive family history of an SUD. There were no significant cognitive differences based on family history. These results indicate that among those with BFRBs, having a first-degree family member with an SUD may be associated with a unique clinical and cognitive presentation. Whether family history also is associated with differential response to treatments awaits further research. Copyright © 2016 Elsevier Inc. All rights reserved.

Bullying in the clinical training of pharmacy students.

PubMed

Knapp, Katherine; Shane, Patricia; Sasaki-Hill, Debra; Yoshizuka, Keith; Chan, Paul; Vo, Thuy

2014-08-15

To determine whether bullying is a significant factor in the clinical training of pharmacy students. The literature as well as the Accreditation Council for Pharmacy Education (ACPE) Standards and American Association of Colleges of Pharmacy (AACP) surveys were reviewed for mention and/or measurement of bullying behaviors in the clinical training of pharmacy students. The authors used a Delphi process to define bullying behavior. The consensus definition was used to analyze 2,087 in-house student evaluations of preceptors for evidence of bullying behaviors. The authors mapped strings of text from in-house student comments to different, established categories of bullying behaviors. The ACPE Standards and AACP surveys contained no mention or measures of bullying. The 2013 AACP survey data reported overwhelmingly positive preceptor ratings. Of the 2,087 student evaluations of preceptors, 119 (5.7%) had at least 1 low rating. Within those 119 survey instruments, 34 comments were found describing bullying behaviors. Students' responses to the AACP survey were similar to data from the national cohort. Given the evidence that bullying behaviors occur in pharmacy education and that bullying has long-term and short-term damaging effects, more attention should be focused on this problem. Efforts should include addressing bullying in ACPE Standards and AACP survey tools developing a consensus definition for bullying and conducting more research into bullying in the clinical training of pharmacy students.

Bullying in the Clinical Training of Pharmacy Students

PubMed Central

Shane, Patricia; Sasaki-Hill, Debra; Yoshizuka, Keith; Chan, Paul; Vo, Thuy

2014-01-01

Objective. To determine whether bullying is a significant factor in the clinical training of pharmacy students. Methods. The literature as well as the Accreditation Council for Pharmacy Education (ACPE) Standards and American Association of Colleges of Pharmacy (AACP) surveys were reviewed for mention and/or measurement of bullying behaviors in the clinical training of pharmacy students. The authors used a Delphi process to define bullying behavior. The consensus definition was used to analyze 2,087 in-house student evaluations of preceptors for evidence of bullying behaviors. The authors mapped strings of text from in-house student comments to different, established categories of bullying behaviors. Results. The ACPE Standards and AACP surveys contained no mention or measures of bullying. The 2013 AACP survey data reported overwhelmingly positive preceptor ratings. Of the 2,087 student evaluations of preceptors, 119 (5.7%) had at least 1 low rating. Within those 119 survey instruments, 34 comments were found describing bullying behaviors. Students’ responses to the AACP survey were similar to data from the national cohort. Conclusions. Given the evidence that bullying behaviors occur in pharmacy education and that bullying has long-term and short-term damaging effects, more attention should be focused on this problem. Efforts should include addressing bullying in ACPE Standards and AACP survey tools developing a consensus definition for bullying and conducting more research into bullying in the clinical training of pharmacy students. PMID:25147389

Behavioral Problems in Indian Children with Epilepsy.

PubMed

Mishra, Om P; Upadhyay, Aishvarya; Prasad, Rajniti; Upadhyay, Shashi K; Piplani, Satya K

2017-02-15

To assess prevalence of behavioral problems in children with epilepsy. This was a cross-sectional study of children with epilepsy, and normal controls enrolled between July 2013 to June 2015. Child Behavior Checklist (CBCL) was used as a tool to assess the behavior based on parents reported observation. There were 60 children with epilepsy in 2-5 years and 80 in 6-14 years age groups, and 74 and 83 unaffected controls, respectively. Mean CBCL scores for most of the domains in children of both age groups were significantly higher than controls. Clinical range abnormalities were mainly detected in externalizing domain (23.3%) in 2-5 years, and in both internalizing (21.2%) and externalizing (45%) domains in children of 6-14 years. Younger age of onset, frequency of seizures and duration of disease had significant correlation with behavioral problems in both the age groups. Antiepileptic drug polytherapy was significantly associated with internalizing problems in older children. Age at onset, frequency of seizures and duration of disease were found to be significantly associated with occurrence of behavioral problems.

Evaluation of the significance of radiographic density and size of calculi in the incidence and clinical manifestations of postlithotripsy renal hematomas.

PubMed

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

2011-01-01

The present study is a continuation of an earlier article published on the incidence, clinical manifestations, treatment and risk factors associated with postlithotripsy renal hematomas (1). To assess the possible influence of the size and radiodensity of kidney stones on the incidence and clinical behavior of renal postlithotripsy hematomas. Observational prospective study of 324 renal units in the same number of patients undergoing extracorporeal renal lithotripsy. The variables "calculus size" and "radiographic calculus density" were evaluaArch. ted statistically by means of the IPSS 0.15 program on the basis of 42 postlithotripsy hematomas diagnosed and grouped according to their clinical behavior. Higher incidence of hematomas was observed in hiperdense calculi (25%) versus medium density calculi (7,4%), this difference was significant in the asymptomatic hematoma group. Calculus size was unrelated to the incidence of renal hematoma, but there was a significant association between renal hematoma and radiographic calculus density, probably due to the relation of radiographic density to chemical composition and, ultimately, to hardness and ultrastructure. Ultrastructure is yet another factor, among others, to be taken into account as a potential conditioning factor for this complication.

Longitudinal Impact of a Randomized Clinical Trial to Improve Family Function, Reduce Maternal Stress and Improve Child Outcomes in Families of Children with ADHD.

PubMed

Churchill, Shervin S; Leo, Michael C; Brennan, Eileen M; Sellmaier, Claudia; Kendall, Judy; Houck, Gail M

2018-02-23

Objective Evaluate the efficacy of a 12 month nursing case-management intervention over a period of 18 months, 6 months after the end of intervention, for families of children attention deficit hyperactivity disorder (ADHD). Methods Mother and child dyads were enrolled to participate in a randomized controlled clinical trial. Children were 4-18 years old. Data were collected at baseline, 6, 12, and 18 months or 6 months after the termination of direct intervention. Longitudinal analyses, using generalized estimating equations, were conducted to assess change in study outcomes relating to family function, maternal stress, and child behavior over the 18 month period. Results Compared to control families, some family function outcomes were moderately improved in the intervention group. In particular, intervention families demonstrated substantial improvement in implementing family behavior controls (p value = 0.038) and improvement in family satisfaction (not statistically significant p = 0.062). Although there was improvement in the overall family function measure there was not a statistically significant difference between groups. Maternal stress and child behavior outcomes were not significantly different between control and intervention groups by the end of the intervention. Conclusions for Practice Addressing ADHD is complex and requires the assessment of comorbidities that might exacerbate negative behavior. Our findings support the latest American Academy of Pediatrics guidelines to use behavioral therapy as the first line of treatment in young children. Nursing case-management interventions that provide direct family education and improve family function, especially with respect to providing structure and behavior control, may complement and facilitate behavioral therapy for treatment of ADHD and improving child behavior.

Use of Accelerometer Activity Monitors to Detect Changes in Pruritic Behaviors: Interim Clinical Data on 6 Dogs

PubMed Central

Thompson, Robin J.; Mickelsen, Scott L.; Smith, Spencer C.; Alvarenga, Isabella C.; Gross, Kathy L.

2018-01-01

Veterinarians and pet owners have limited ability to assess pruritic behaviors in dogs. This pilot study assessed the capacity of the Vetrax® triaxial accelerometer to measure these behaviors in six dogs with pruritus likely due to environmental allergens. Dogs wore the activity monitor for two weeks while consuming their usual pet food (baseline), then for eight weeks while consuming a veterinary-exclusive pet food for dogs with suspected non-food-related skin conditions (Hill’s Prescription Diet® Derm DefenseTM Canine dry food). Veterinarians and owners completed questionnaires during baseline, phase 1 (days 1–28) and phase 2 (days 29–56) without knowledge of the activity data. Continuous 3-axis accelerometer data was processed using proprietary behavior recognition algorithms and analyzed using general linear mixed models with false discovery rate-adjusted p values. Veterinarian-assessed overall clinical signs of pruritus were significantly predicted by scratching (β 0.176, p = 0.008), head shaking (β 0.197, p < 0.001) and sleep quality (β −0.154, p < 0.001), while owner-assessed quality of life was significantly predicted by scratching (β −0.103, p = 0.013) and head shaking (β −0.146, p < 0.001). Among dogs exhibiting pruritus signs eating the veterinary-exclusive food, the Vetrax® sensor provided an objective assessment of clinically relevant pruritic behaviors that agreed with owner and veterinarian reports. PMID:29337903

Evaluating Video Self-Modeling Treatment Outcomes: Differentiating between Statistically and Clinically Significant Change

ERIC Educational Resources Information Center

La Spata, Michelle G.; Carter, Christopher W.; Johnson, Wendi L.; McGill, Ryan J.

2016-01-01

The present study examined the utility of video self-modeling (VSM) for reducing externalizing behaviors (e.g., aggression, conduct problems, hyperactivity, and impulsivity) observed within the classroom environment. After identification of relevant target behaviors, VSM interventions were developed for first and second grade students (N = 4),…

Behavioral Problems and Reading Difficulties among Language Minority and Monolingual Urban Elementary School Students

ERIC Educational Resources Information Center

Pierce, Margaret E.; Wechsler-Zimring, Adrianna; Noam, Gil; Wolf, Maryanne; Katzir, Tami

2013-01-01

This study examined the potentially compounding effect of language minority (LM) status on problem behaviors among urban second and third grade-level poor readers. Univariate analyses showed that a disproportionate percentage of both LM and English monolingual (L1) poor readers already displayed clinically significant levels of anxiety, social…

Clinical Effects of Fenfluramine in Ten Autistic Subjects. Brief Report.

ERIC Educational Resources Information Center

Klykylo, William M.; And Others

1985-01-01

Use of the drug Fenfluramine, which reduces blood serotonin levels and possible problem behaviors, was evaluated. Nine of 10 Ss showed reduced serotonin; none showed significant differences on intelligence tests; and at least two Ss showed marked behavioral changes in less echolalia, perseveration, and motoric disturbance and more increases in…

Childhood Developmental Disorders: An Academic and Clinical Convergence Point for Psychiatry, Neurology, Psychology and Pediatrics

ERIC Educational Resources Information Center

Reiss, Allan L.

2009-01-01

Background: Significant advances in understanding brain development and behavior have not been accompanied by revisions of traditional academic structure. Disciplinary isolation and a lack of meaningful interdisciplinary opportunities are persistent barriers in academic medicine. To enhance clinical practice, research, and training for the next…

Developing Clinically Practicable Biomarkers for Autism Spectrum Disorder

ERIC Educational Resources Information Center

McPartland, James C.

2017-01-01

Despite significant advances in understanding the biological bases of autism spectrum disorder (ASD), the field remains primarily reliant on observational and parent report measures of behavior to guide clinical practice, conduct research, and evaluate intervention outcomes. There is a critical need for objective measures to more sensitively and…

Defining the Developmental Parameters of Temper Loss in Early Childhood: Implications for Developmental Psychopathology

ERIC Educational Resources Information Center

Wakschlag, Lauren S.; Choi, Seung W.; Carter, Alice S.; Hullsiek, Heide; Burns, James; McCarthy, Kimberly; Leibenluft, Ellen; Briggs-Gowan, Margaret J.

2012-01-01

Background: Temper modulation problems are both a hallmark of early childhood and a common mental health concern. Thus, characterizing specific behavioral manifestations of temper loss along a dimension from normative misbehaviors to clinically significant problems is an important step toward identifying clinical thresholds. Methods:…

REDUCING AMBIGUITY IN THE FUNCTIONAL ASSESSMENT OF PROBLEM BEHAVIOR

PubMed Central

Rooker, Griffin W.; DeLeon, Iser G.; Borrero, Carrie S. W.; Frank-Crawford, Michelle A.; Roscoe, Eileen M.

2015-01-01

Severe problem behavior (e.g., self-injury and aggression) remains among the most serious challenges for the habilitation of persons with intellectual disabilities and is a significant obstacle to community integration. The current standard of behavior analytic treatment for problem behavior in this population consists of a functional assessment and treatment model. Within that model, the first step is to assess the behavior–environment relations that give rise to and maintain problem behavior, a functional behavioral assessment. Conventional methods of assessing behavioral function include indirect, descriptive, and experimental assessments of problem behavior. Clinical investigators have produced a rich literature demonstrating the relative effectiveness for each method, but in clinical practice, each can produce ambiguous or difficult-to-interpret outcomes that may impede treatment development. This paper outlines potential sources of variability in assessment outcomes and then reviews the evidence on strategies for avoiding ambiguous outcomes and/or clarifying initially ambiguous results. The end result for each assessment method is a set of best practice guidelines, given the available evidence, for conducting the initial assessment. PMID:26236145

Translational science matters: forging partnerships between biomedical and behavioral science to advance the public's health.

PubMed

Mensah, George A; Czajkowski, Susan M

2018-03-29

The prevention and effective treatment of many chronic diseases such as cardiovascular disease, cancer and diabetes are dependent on behaviors such as not smoking, adopting a physically-active lifestyle, eating a healthy diet, and adhering to prescribed medical and behavioral regimens. Yet adoption and maintenance of these behaviors pose major challenges for individuals, their families and communities, as well as clinicians and health care systems. These challenges can best be met through the integration of the biomedical and behavioral sciences that is achieved by the formation of strategic partnerships between researchers and practitioners in these disciplines to address pressing clinical and public health problems. The National Institutes of Health has supported a number of clinical trials and research initiatives that demonstrate the value of biomedical and behavioral science partnerships in translating fundamental discoveries into significant improvements in health outcomes. We review several such examples of collaborations between biomedical and behavioral researchers, describe key initiatives focused on advancing a transdisciplinary translational perspective, and outline areas which require insights, tools and findings from both the biomedical and behavioral sciences to advance the public's health.

Are autistic traits associated with suicidality? A test of the interpersonal-psychological theory of suicide in a non-clinical young adult sample.

PubMed

Pelton, M K; Cassidy, S A

2017-11-01

Autism spectrum conditions (ASC) has recently been associated with increased risk of suicidality. However, no studies have explored how autistic traits may interact with current models of suicidal behavior in a non-clinical population. The current study therefore explored how self-reported autistic traits interact with perceived burdensomeness and thwarted belongingness in predicting suicidal behavior, in the context of the Interpersonal-Psychological Theory of Suicide (IPTS). 163 young adults (aged 18-30 years) completed an online survey including measures of thwarted belonging and perceived burdensomeness (Interpersonal Needs Questionnaire), self-reported autistic traits (Autism Spectrum Quotient), current depression (Centre for Epidemiological Studies Depression Scale), and lifetime suicidality (Suicide Behavior Questionnaire-Revised). Results showed that burdensomeness and thwarted belonging significantly mediated the relationship between autistic traits and suicidal behavior. Both depression and autistic traits significantly predicted thwarted belonging and perceived burdensomeness. Autistic traits did not significantly moderate the relationship between suicidal behavior and thwarted belonging or perceived burdensomeness. Results suggest that the IPTS provides a useful framework for understanding the influence of autistic traits on suicidal behavior. However, the psychometric properties of these measures need be explored in those with clinically confirmed diagnosis of ASC. Autism Res 2017, 10: 1891-1904. © 2017 The Authors Autism Research published by International Society for Autism Research and Wiley Periodicals, Inc. Recent research has shown that people with high autistic traits are more likely to attempt suicide. However, no studies have explored why. We found that people with high autistic traits were more likely to experience feelings that they do not belong in the world, are a burden on others, and depression, which may increase their likelihood of attempting suicide. These results suggest that promoting inclusion and independence in those with high autistic traits could help prevent people attempting suicide. © 2017 The Authors Autism Research published by International Society for Autism Research and Wiley Periodicals, Inc.

Are autistic traits associated with suicidality? A test of the interpersonal‐psychological theory of suicide in a non‐clinical young adult sample

PubMed Central

Pelton, M. K.

2017-01-01

Autism spectrum conditions (ASC) has recently been associated with increased risk of suicidality. However, no studies have explored how autistic traits may interact with current models of suicidal behavior in a non‐clinical population. The current study therefore explored how self‐reported autistic traits interact with perceived burdensomeness and thwarted belongingness in predicting suicidal behavior, in the context of the Interpersonal‐Psychological Theory of Suicide (IPTS). 163 young adults (aged 18–30 years) completed an online survey including measures of thwarted belonging and perceived burdensomeness (Interpersonal Needs Questionnaire), self‐reported autistic traits (Autism Spectrum Quotient), current depression (Centre for Epidemiological Studies Depression Scale), and lifetime suicidality (Suicide Behavior Questionnaire‐Revised). Results showed that burdensomeness and thwarted belonging significantly mediated the relationship between autistic traits and suicidal behavior. Both depression and autistic traits significantly predicted thwarted belonging and perceived burdensomeness. Autistic traits did not significantly moderate the relationship between suicidal behavior and thwarted belonging or perceived burdensomeness. Results suggest that the IPTS provides a useful framework for understanding the influence of autistic traits on suicidal behavior. However, the psychometric properties of these measures need be explored in those with clinically confirmed diagnosis of ASC. Autism Res 2017, 10: 1891–1904. © 2017 The Authors Autism Research published by International Society for Autism Research and Wiley Periodicals, Inc. Lay Summary Recent research has shown that people with high autistic traits are more likely to attempt suicide. However, no studies have explored why. We found that people with high autistic traits were more likely to experience feelings that they do not belong in the world, are a burden on others, and depression, which may increase their likelihood of attempting suicide. These results suggest that promoting inclusion and independence in those with high autistic traits could help prevent people attempting suicide. PMID:28685996

Amotivation in schizophrenia: integrated assessment with behavioral, clinical, and imaging measures.

PubMed

Wolf, Daniel H; Satterthwaite, Theodore D; Kantrowitz, Jacob J; Katchmar, Natalie; Vandekar, Lillie; Elliott, Mark A; Ruparel, Kosha

2014-11-01

Motivational deficits play a central role in disability caused by schizophrenia and constitute a major unmet therapeutic need. Negative symptoms have previously been linked to hypofunction in ventral striatum (VS), a core component of brain motivation circuitry. However, it remains unclear to what extent this relationship holds for specific negative symptoms such as amotivation, and this question has not been addressed with integrated behavioral, clinical, and imaging measures. Here, 41 individuals with schizophrenia and 37 controls performed a brief, computerized progressive ratio task (PRT) that quantifies effort exerted in pursuit of monetary reward. Clinical amotivation was assessed using the recently validated Clinical Assessment Interview for Negative Symptoms (CAINS). VS function was probed during functional magnetic resonance imaging using a monetary guessing paradigm. We found that individuals with schizophrenia had diminished motivation as measured by the PRT, which significantly and selectively related to clinical amotivation as measured by the CAINS. Critically, lower PRT motivation in schizophrenia was also dimensionally related to VS hypofunction. Our results demonstrate robust dimensional associations between behavioral amotivation, clinical amotivation, and VS hypofunction in schizophrenia. Integrating behavioral measures such as the PRT will facilitate translational efforts to identify biomarkers of amotivation and to assess response to novel therapeutic interventions. © The Author 2014. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Age- and sex-related emotional and behavioral problems in children with autism spectrum disorders: comparison with control children.

PubMed

Horiuchi, Fumie; Oka, Yasunori; Uno, Hiroyuki; Kawabe, Kentaro; Okada, Fumi; Saito, Isao; Tanigawa, Takeshi; Ueno, Shu-ichi

2014-07-01

Children with autism spectrum disorders (ASD) often present with emotional and behavioral problems, which could change the clinical course, especially during childhood, and affect future quality of life. The aim of this study was to clarify the age- and sex-related differences of these problems in ASD. The study subjects were 173 patients with ASD (age: 4-16 years) and 173 age- and sex-matched community children (control group). The parent version of the Strengths and Difficulties Questionnaire was used for comparison of the emotional and behavioral problems between the two groups. The Strengths and Difficulties Questionnaire scores were significantly higher in children with ASD than controls at all ages. The score of total difficulties was significantly higher in girls with ASD than in boys, while the score in male controls was significantly higher than in female controls. Age-related differences in emotional and behavioral problems were observed both in children with ASD and controls, but the characteristics were different: in children with ASD, emotional symptoms and peer problems in both sexes and conduct problems in girls increased significantly with age, while none of the problems in the controls changed with age except for a decrease in the score of hyperactivity/inattention developmentally in both sexes. Prosocial behaviors of children with ASD and controls showed small changes with age. Emotional and behavioral problems are common in children with ASD and showed age- and sex-related differences. Our study emphasizes the importance of recognizing those differences among children with ASD for early intervention. © 2014 The Authors. Psychiatry and Clinical Neurosciences © 2014 Japanese Society of Psychiatry and Neurology.

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.

A Single Question to Examine the Prevalence and Protective Effect of Seroadaptive Strategies Among Men Who Have Sex With Men.

PubMed

Khosropour, Christine M; Dombrowski, Julia C; Katz, David A; Golden, Matthew R

2017-11-01

Seroadaptive behaviors among men who have sex with men (MSM) are common, but ascertaining behavioral information is challenging in clinical settings. To address this, we developed a single seroadaptive behavior question. Men who have sex with men 18 years or older attending a sexually transmitted disease clinic in Seattle, WA, from 2013 to 2015, were eligible for this cross-sectional study. Respondents completed a comprehensive seroadaptive behavior questionnaire which included a single question that asked HIV-negative MSM to indicate which of 12 strategies they used in the past year to reduce their HIV risk. HIV testing was performed per routine clinical care. We used the κ statistic to examine agreement between the comprehensive questionnaire and the single question. We enrolled HIV-negative MSM at 3341 (55%) of 6105 eligible visits. The agreement between the full questionnaire and single question for 5 behaviors was fair to moderate (κ values of 0.34-0.59). From the single question, the most commonly reported behaviors were as follows: avoiding sex with HIV-positive (66%) or unknown-status (52%) men and using condoms with unknown-status partners (53%); 8% of men reported no seroadaptive behavior. Men tested newly HIV positive at 38 (1.4%) of 2741 visits. HIV test positivity for the most commonly reported behaviors ranged from 0.8% to 1.3%. Men reporting no seroadaptive strategy had a significantly higher HIV test positivity (3.5%) compared with men who reported at least 1 strategy (1.3%; P = 0.02). The single question performed relatively well against a comprehensive seroadaptive behaviors assessment and may be useful in clinical settings to identify men at greatest risk for HIV.

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.

Evaluation of the DSM-5 severity indicator for bulimia nervosa.

PubMed

Grilo, Carlos M; Ivezaj, Valentina; White, Marney A

2015-04-01

This study examined the DSM-5 severity criterion for bulimia nervosa (BN) based on the frequency of inappropriate weight compensatory behaviors. 199 community volunteers classified with BN were categorized using DSM-5 severity levels and compared on demographic and clinical variables. 77 (39%) participants were categorized as mild, 68 (34%) as moderate, 32 (16%) as severe, and 22 (11%) as extreme. The severity groups did not differ significantly in demographic variables or body mass index. Shape and Weight concerns did not differ significantly across severity groups. Binge eating differed with the extreme group having significantly higher frequency than the severe, moderate, and mild groups, which did not differ from each other. Restraint differed with the extreme group having significantly higher levels than the mild group. Eating concerns differed with the extreme group having significantly higher levels than moderate and mild groups. Depression differed with the extreme group having significantly higher levels than severe, moderate, and mild groups, which did not differ from each other. Findings from this non-clinical group provide new, albeit modest, support for DSM-5 severity rating for BN based on frequency of inappropriate weight compensatory behaviors. Statistical findings indicate that differences in collateral clinical variables associated with the DSM-5 severity ratings reflect small effect sizes. Further research is needed with treatment-seeking patient groups with BN to establish the validity of the DSM-5 severity specifier and should include broader clinical and functional validators. Copyright © 2015 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.

Are Low Patient Satisfaction Scores Always Due to the Provider?: Determinants of Patient Satisfaction Scores During Spine Clinic Visits.

PubMed

Bible, Jesse E; Shau, David N; Kay, Harrison F; Cheng, Joseph S; Aaronson, Oran S; Devin, Clinton J

2018-01-01

A prospective study. The aim of this study was to investigate the impact of various components on patient satisfaction scores SUMMARY OF BACKGROUND DATA.: Patient satisfaction has become an important component of quality assessments. However, with many of these sources collecting satisfaction data reluctant to disclose detailed information, little remains known about the potential determinants of patient satisfaction. Two hundred patients were contacted via phone within 3 weeks of new patient encounter with 11 spine providers. Standardized patient satisfaction phone survey consisting of 25 questions (1-10 rating scale) was administered. Questions inquired about scheduling, parking, office staff, teamwork, wait-time, radiology, provider interactions/behavior, treatment, and follow-up communication. Potential associations between these factors and three main outcome measures were investigated: (1) provider satisfaction, (2) overall clinic visit satisfaction, and (3) quality of care. Significant associations (P < 0.0001) with provider satisfaction, overall clinic visit satisfaction, and perceived overall quality of care were found with appointment scheduling, parking, office staff, teamwork, wait time, radiology, provider interactions/behavior, treatment, and follow-up communication. Nurse-practitioner/resident involvement was positively associated with scores (P ≤ 0.03). A "candy-man" effect was not noted, as pain medication prescribing did not play a significant role in satisfaction (P > 0.05).In multivariate regression analysis, explanation of medical condition/treatment (P = 0.002) and provider empathy (P = 0.04) were significantly associated with provider satisfaction scores, while the amount of time spent with the provider was not. Conversely, teamwork of staff/provider and follow-up communication were significantly associated with both overall clinic visit satisfaction and quality of care (P ≤ 0.03), while provider behaviors or satisfaction were not. Satisfaction with the provider was associated with better explanations of the spine condition/treatment plan and provider empathy, but was not a significant factor in either overall clinic visit satisfaction or perceived quality of care. Patients' perception of teamwork between staff and providers along with reliable follow-up communication were found to be significant determinants of overall patient satisfaction and perceived quality of care. 3.

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

"The impact of failing to identify suspect effort in patients undergoing adult attention-deficit/hyperactivity disorder (ADHD) assessment": Correction to Marshall et al. (2016).

PubMed

2016-10-01

Reports an error in "The Impact of Failing to Identify Suspect Effort in Patients Undergoing Adult Attention-Deficit/Hyperactivity Disorder (ADHD) Assessment" by Paul S. Marshall, James B. Hoelzle, Danielle Heyerdahl and Nathaniel W. Nelson ( Psychological Assessment , Advanced Online Publication, Jan 11, 2016, np). In the article, the penultimate sentence of the abstract should read “These results suggest that a significant percentage of those making a suspect effort will be diagnosed with ADHD using the most commonly employed assessment methods: an interview alone (71%); an interview and ADHD behavior rating scales combined (65%); and an interview, behavior rating scales, and most continuous performance tests combined (62%).” All versions of this article have been corrected. (The following abstract of the original article appeared in record 2016-00618-001.) This retrospective study examines how many adult patients would plausibly receive a diagnosis of attention-deficit/hyperactivity disorder (ADHD) if performance and symptom validity measures were not administered during neuropsychological evaluations. Five hundred fifty-four patients were extracted from an archival clinical dataset. A total of 102 were diagnosed with ADHD based on cognitive testing, behavior rating scales, effort testing, and clinical interview; 115 were identified as putting forth suspect effort in accordance with the Slick, Sherman, and Iverson (1999) criteria. From a clinical decision-making perspective, suspect effort and ADHD groups were nearly indistinguishable on ADHD behavior, executive function, and functional impairment rating scales, as well as on cognitive testing and key clinical interview questions. These results suggest that a significant percentage of those making a suspect effort will be diagnosed with ADHD using the most commonly employed assessment methods: an interview alone (71%); an interview and ADHD behavior rating scales combined (65%); and an interview, behavior rating scales, and most continuous performance tests combined (57%). This research makes clear that it is essential to evaluate task engagement and possible symptom amplification during clinical evaluations. PsycINFO Database Record (c) 2016 APA, all rights reserved

Beliefs about appropriate pain behavior: cross-cultural and sex differences between Japanese and Euro-Americans.

PubMed

Hobara, Mieko

2005-08-01

The Appropriate Pain Behavior Questionnaire (APBQ) was employed to examine the effects of the participants' sex and culture on their beliefs regarding gender-appropriate pain behavior. The APBQ examines beliefs about the social acceptability to male and female participants of the behavioral and verbal expressions of pain by men and women (referents) in the presence of others [Nayak, S., 2000. Cross Cult Research 34, 135-151]. The participants were 18 male and 14 female Japanese, and 11 male and 21 female Euro-Americans. There was a significant effect of sex: female participants considered pain behaviors more acceptable than male participants. There was a significant effect of culture: compared to both male and female Japanese, Euro-American participants rated pain behaviors in both sexes to be more acceptable. There was also a significant effect of referent gender: for both sexes in both cultures, pain behaviors in women were rated as more acceptable than in men. Furthermore, a significant interaction was found between referent gender and sex of the participant: Male and female participants of both cultures were equally accepting of pain behaviors in women, but male participants were less accepting of pain behaviors in men than in women. There also was a significant interaction between referent gender and culture of the participant: Japanese participants considered pain behavior in both genders to be less acceptable than did Americans. The results are explained in terms of cultural traditions and social roles, and have clear implications for clinical treatment and diagnosis.

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.

Thalamic and extrathalamic mechanisms of consciousness after severe brain injury.

PubMed

Lutkenhoff, Evan S; Chiang, Jeffrey; Tshibanda, Luaba; Kamau, Evelyn; Kirsch, Murielle; Pickard, John D; Laureys, Steven; Owen, Adrian M; Monti, Martin M

2015-07-01

What mechanisms underlie the loss and recovery of consciousness after severe brain injury? We sought to establish, in the largest cohort of patients with disorders of consciousness (DOC) to date, the link between gold standard clinical measures of awareness and wakefulness, and specific patterns of local brain pathology-thereby possibly providing a mechanistic framework for patient diagnosis, prognosis, and treatment development. Structural T1-weighted magnetic resonance images were collected, in a continuous sample of 143 severely brain-injured patients with DOC (and 96 volunteers), across 2 tertiary expert centers. Brain atrophy in subcortical regions (bilateral thalamus, basal ganglia, hippocampus, basal forebrain, and brainstem) was assessed across (1) healthy volunteers and patients, (2) clinical entities (eg, vegetative state, minimally conscious state), (3) clinical measures of consciousness (Coma Recovery Scale-Revised), and (4) injury etiology. Compared to volunteers, patients exhibited significant atrophy across all structures (p < 0.05, corrected). Strikingly, we found almost no significant differences across clinical entities. Nonetheless, the clinical measures of awareness and wakefulness upon which differential diagnosis rely were systematically associated with tissue atrophy within thalamic and basal ganglia nuclei, respectively; the basal forebrain was atrophied in proportion to patients' response to sensory stimulation. In addition, nontraumatic injuries exhibited more extensive thalamic atrophy. These findings provide, for the first time, a grounding in pathology for gold standard behavior-based clinical measures of consciousness, and reframe our current models of DOC by stressing the different links tying thalamic mechanisms to willful behavior and extrathalamic mechanisms to behavioral (and electrocortical) arousal. © 2015 American Neurological Association.

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.

Parent Depression and Anger in Peer-Delivered Parent Support Services

PubMed Central

Shen, Sa; Rodriguez, James; Radigan, Marleen; Burton, Geraldine; Hoagwood, Kimberly E.

2017-01-01

Knowledge about parents who seek peer-delivered parent support services in children’s mental health is limited. In this prospective study, characteristics of 124 parents who sought peer parent advocate services related to their children’s behavioral difficulties are described. This urban sample consisted primarily of low-income mothers of color, 80% of whom were caring for children with clinically significant behavioral problems. Of these parents, 64% endorsed clinically significant levels of depressive symptoms at baseline. Linear mixed effects models were used to examine associations between parent depression and anger expression with working alliances with peer advocates. No independent or combined effects of parent depression or anger expression on working alliance were found. However, adjusting for family demographic factors, caregiver strain and child symptoms, parent depression interacted with anger expression to influence working alliances, primarily around agreement and mutual engagement on goals. Among parents who endorsed clinically significant depressive symptoms, anger expression did not influence working alliance but among non-depressed parents, anger expression was negatively associated with working alliance. Implications for training peer parent advocates to more effectively engage low income parents are discussed. PMID:28775660

Parent Depression and Anger in Peer-Delivered Parent Support Services.

PubMed

Olin, S Serene; Shen, Sa; Rodriguez, James; Radigan, Marleen; Burton, Geraldine; Hoagwood, Kimberly E

2015-11-01

Knowledge about parents who seek peer-delivered parent support services in children's mental health is limited. In this prospective study, characteristics of 124 parents who sought peer parent advocate services related to their children's behavioral difficulties are described. This urban sample consisted primarily of low-income mothers of color, 80% of whom were caring for children with clinically significant behavioral problems. Of these parents, 64% endorsed clinically significant levels of depressive symptoms at baseline. Linear mixed effects models were used to examine associations between parent depression and anger expression with working alliances with peer advocates. No independent or combined effects of parent depression or anger expression on working alliance were found. However, adjusting for family demographic factors, caregiver strain and child symptoms, parent depression interacted with anger expression to influence working alliances, primarily around agreement and mutual engagement on goals. Among parents who endorsed clinically significant depressive symptoms, anger expression did not influence working alliance but among non-depressed parents, anger expression was negatively associated with working alliance. Implications for training peer parent advocates to more effectively engage low income parents are discussed.

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

Comparing Differences in ADL Outcomes for the STOMP Intervention for Dementia in the Natural Home Environment Versus a Clinic Environment.

PubMed

Ciro, C A; Poole, J L; Skipper, B; Hershey, L A

2014-01-01

Few studies have examined structured rehabilitation techniques for improving activities of daily living in people with mild-moderate dementia. We sought to examine the advantages to delivering the Skill-building through Task-Oriented Motor Practice (STOMP) intervention in the home environment (versus the clinic), hypothesizing that ADL improvement would be significantly better, time to meeting goals would be faster and fewer displays of behavior would be noted. Compared results of two quasi-experimental studies of STOMP, one completed in the home, one completed previously in a clinic. Participants were English-speaking; community dwelling adults aged 50-90 diagnosed with mild-moderate dementia who could participate in an intensive rehabilitation program (5 days/week, 3 hours/day, for 2 weeks). Outcome measurements include examiner-observation of performance and proxy-report of performance and satisfaction with performance in patient-selected goals. No differences existed in the sociodemographic characteristics between the home and clinic groups where the groups were primarily white, married, had > high school education and had mild-moderate dementia. Results from the home group indicate that participants made significant improvement in ADL which was generally retained at the 90 day follow-up. These results were not significantly different than the clinic group. No significant advantages were noted for the home group in terms of time to meeting goals or exhibition of fewer behaviors. The STOMP intervention appeared to work equally as well in the home and in the clinic. Future studies should continue to examine the benefits of massed practice using high-dose regimens.

Do adjunctive flap-monitoring technologies impact clinical decision making? An analysis of microsurgeon preferences and behavior by body region.

PubMed

Bellamy, Justin L; Mundinger, Gerhard S; Flores, José M; Wimmers, Eric G; Yalanis, Georgia C; Rodriguez, Eduardo D; Sacks, Justin M

2015-03-01

Multiple perfusion assessment technologies exist to identify compromised microvascular free flaps. The effectiveness, operability, and cost of each technology vary. The authors investigated surgeon preference and clinical behavior with several perfusion assessment technologies. A questionnaire was sent to members of the American Society for Reconstructive Microsurgery concerning perceptions and frequency of use of several technologies in varied clinical situations. Demographic information was also collected. Adjusted odds ratios were calculated using multinomial logistic regression accounting for clustering of similar practices within institutions/regions. The questionnaire was completed by 157 of 389 participants (40.4 percent response rate). Handheld Doppler was the most commonly preferred free flap-monitoring technology (56.1 percent), followed by implantable Doppler (22.9 percent) and cutaneous tissue oximetry (16.6 percent). Surgeons were significantly more likely to opt for immediate take-back to the operating room when presented with a concerning tissue oximetry readout compared with a concerning handheld Doppler signal (OR, 2.82; p < 0.01), whereas other technologies did not significantly alter postoperative management more than simple handheld Doppler. Clinical decision making did not significantly differ by demographics, training, or practice setup. Although most surgeons still prefer to use standard handheld Doppler for free flap assessment, respondents were significantly more likely to opt for immediate return to the operating room for a concerning tissue oximetry reading than an abnormal Doppler signal. This suggests that tissue oximetry may have the greatest impact on clinical decision making in the postoperative period.

Impact of non-medical switching on clinical and economic outcomes, resource utilization and medication-taking behavior: a systematic literature review.

PubMed

Nguyen, Elaine; Weeda, Erin R; Sobieraj, Diana M; Bookhart, Brahim K; Piech, Catherine Tak; Coleman, Craig I

2016-07-01

To evaluate current knowledge of the impact of non-medical switching on clinical and economic outcomes, resource utilization and medication-taking behavior. The literature was searched (Medline and Web of Science, January 2000-November 2015) to identify United States' studies evaluating ≥25 patients and measuring the impact of non-medical switching of drugs (switching to a chemically distinct but similar medication for reasons other than lack of clinical efficacy/response, side effects or poor adherence) on ≥1 clinical, economic, resource utilization or medication-taking behavior outcome. The direction of association between non-medical switching and outcomes was classified as negative or positive if a statistically significant worsening or improvement was reported, or neutral if no significant difference was observed. Twenty-nine studies contributed 96 outcomes (60.4% clinical; 21.9% resource utilization; 13.5% economic; 4.2% medication-taking behavior) within six disease categories (cardio-metabolic, immune-mediated, acid suppression, psychiatric, hormone replacement therapy and pain). The direction of association was more frequently negative (33.3%) or neutral (55.2%) than it was positive (11.5%). Stratified by outcome type, non-medical switching was negatively associated with clinical, economic, healthcare utilization and medication-taking behavior outcomes in 20.7%, 69.2%, 38.1% and 75.0% of cases, respectively; and positively in only 4.8%-17.2% of outcomes subgroups. Of 32 outcomes in patients demonstrating stable/well controlled disease, 68.8% and 31.3% had a negative and neutral direction of association. In patients without demonstrated disease stability, outcomes were negatively, neutrally and positively impacted by non-medical switching in 15.6%, 67.2% and 17.2% of 64 outcomes. Our inability to evaluate specific disease state categories and studies/outcomes received equal weight regardless of sample size or magnitude of effect. Non-medical switching was more often associated with negative or neutral effects than positive effects on an array of important outcomes. Among patients with stable/well controlled disease, non-medical switching was associated with mostly negative effects.

Neuropsychological Profiles Correlated with Clinical and Behavioral Impairments in a Sample of Brazilian Children with Attention-Deficit Hyperactivity Disorder

PubMed Central

Rizzutti, Sueli; Schuch, Viviane; Augusto, Bruno Muszkat; Coimbra, Caio Colturato; Pereira, João Pedro Cabrera; Bueno, Orlando Francisco Amodeo

2015-01-01

Attention-deficit hyperactivity disorder (ADHD) is a complex neurodevelopmental disorder that implies several-step process, and there is no single test to diagnose both ADHD and associated comorbidities, such as oppositional-defiant disorder (ODD), anxiety disorder, depression, and certain types of learning disabilities. The purpose of the present study was to examine correlations between behavioral and clinical symptoms by administering an extensive neuropsychological battery to a sample of children and adolescents from a developing country. The sample was divided into three groups: non-ADHD, ADHD-non-comorbid, and ADHD + comorbidity. A full neuropsychological battery and clinical assessment found that 105 children met DSM-5 criteria, of whom 46.6% had the predominantly inattentive presentation, 37.3% had combined presentation, and 16% were predominantly hyperactive/impulsive presentation. The internal correlation between neuropsychological tests did not reach statistical significance in the comparison between ADHD and non-ADHD cases (p < 0.17). Clinical ADHD cases, including both + comorbidity and non-comorbid groups, performed substantially worse on continuous performance test (CPT), working memory. Comparing ADHD-non-comorbid and ADHD + comorbidity groups, the latter did significantly worse on inhibitory control, time processing, and the level of perseveration response on CPT indexes, as well as on working memory performance and child behavior checklist (CBCL) tests particularly the CBCL-deficient emotional self-regulation test in the ADHD + comorbidity group. Children diagnosed as ODD or with conduct disorder showed close correlations between clinical CBCL profiles and externalized symptoms. Our findings suggest that ADHD + comorbidity and ADHD non-comorbid cases may be differentiated by a number of neuropsychological measures, such as processing speed, inhibitory control, and working memory, that may reflect different levels of involvement of the hot and cool executive domains, which are more impaired in cases of severe symptomatic-externalized behavior and emotional regulation problems. Therefore, profiles based on clinical and behavioral findings can help clinicians select better strategies for detecting neuropsychological impairment in Brazilian children with ADHD. PMID:26635638

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.

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…

Treatment Effects of a Modular Intervention for Early-Onset Child Behavior Problems on Family Contextual Outcomes

ERIC Educational Resources Information Center

Shaffer, Anne; Lindhiem, Oliver; Kolko, David J.

2013-01-01

The overall aim of this multi-informant study was to examine pre-post treatment changes, and maintenance at 3-year follow-up, for multiple dimensions of the family context, for a modular intervention that has previously demonstrated significant clinical improvements in child behavior and maintenance of these effects. Family outcomes included…

Social Functioning in Youth with Anxiety Disorders: Association with Anxiety Severity and Outcomes from Cognitive-Behavioral Therapy

ERIC Educational Resources Information Center

Settipani, Cara A.; Kendall, Philip C.

2013-01-01

Social functioning was assessed using the Child Behavior Checklist and Teacher Report Form for children with anxiety disorders who participated in a randomized clinical trial (N = 161, aged 7-14). Significant relationships were found between severity of children's principal anxiety disorder and most measures of social functioning, such that poorer…

Behavioral problems in children with epilepsy in rural Kenya

PubMed Central

Kariuki, Symon M.; Abubakar, Amina; Holding, Penny A.; Mung'ala-Odera, Victor; Chengo, Eddie; Kihara, Michael; Neville, Brian G.; Newton, Charles R.J.C.

2012-01-01

The aims of this study were to record behavioral problems in children with epilepsy (CWE), compare the prevalence with that reported among healthy children without epilepsy, and investigate the risk factors. A child behavioral questionnaire for parents comprising 15 items was administered to the main caregiver of 108 CWE and 108 controls matched for age in Kilifi, Kenya. CWE had a higher mean score for reported behavioral problems than controls (6.9 vs 4.9, t = 4.7, P < 0.001). CWE with active epilepsy also recorded more behavioral problems than those with inactive epilepsy (8.2 vs 6.2, t = − 2.9, P = 0.005). A significantly greater proportion of CWE (49% vs 26% of controls) were reported to have behavioral problems. Active epilepsy, cognitive impairment, and focal seizures were the most significant independent covariates of behavioral problems. Behavioral problems in African CWE are common and need to be taken into consideration in planning comprehensive clinical services in this region. PMID:22119107

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.

Behavior within fortuitous environments: The entwined history of Division 28 and the fields of behavioral pharmacology and toxicology.

PubMed

Campbell, Nancy D

2016-08-01

Behavioral pharmacology emerged in the early to mid-20th century as an experimental and observational science, helping to consolidate an empirically based psychological science of behavior. Behavioral psychologists came to play significant roles in toxicology, neuropharmacology, and psychopharmacology. This article traces the first 3 decades of American Psychological Association Division 28. Sources include the Division 28 Oral History Project; formal interviews conducted by the author in the early 2000s with behavioral, experimental, and clinical pharmacologists; and the archived newsletters of Division 28. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

The virtual child: evaluation of an internet-based pediatric behavior management simulation.

PubMed

Boynton, James R; Green, Thomas G; Johnson, Lynn A; Nainar, S M Hashim; Straffon, Lloyd H

2007-09-01

This article describes an Internet-based instructional tool designed to give predoctoral dental students a virtual simulation of clinical pediatric dentistry to develop their pediatric behavior management knowledge. Effectiveness of this tool was evaluated using two consecutive classes of junior dental students. The control group was exposed to the traditional behavior management curriculum (two lectures) in a spring term course. The next class of dental students was exposed to the two lectures and, in addition, completed the behavior management simulation during the following spring term. Both groups completed a two-part examination (objective section=18 questions; open-ended section=responses to a clinical situation) designed to test their behavior management knowledge. The simulation group performed significantly better in both parts of the examination (objective section: p=.028; open-ended section: p=.012). The simulation was evaluated by students and perceived by most to be an effective addition to the curriculum. It was concluded that the experimental behavior management simulation, when added to the traditional lecture curriculum, improved pediatric behavior management knowledge in predoctoral dental students.

Hoarding in Youth with Autism Spectrum Disorders and Anxiety: Incidence, Clinical Correlates, and Behavioral Treatment Response.

PubMed

Storch, Eric A; Nadeau, Joshua M; Johnco, Carly; Timpano, Kiara; McBride, Nicole; Jane Mutch, P; Lewin, Adam B; Murphy, Tanya K

2016-05-01

This study examined the nature and correlates of hoarding among youth with autism spectrum disorders (ASD). Forty children with ASD and a comorbid anxiety disorder were administered a battery of clinician-administered measures assessing presence of psychiatric disorders and anxiety severity. Parents completed questionnaires related to child hoarding behaviors, social responsiveness, internalizing and externalizing behaviors, and functional impairment. We examined the impact of hoarding behaviors on treatment response in a subsample of twenty-six youth who completed a course of personalized cognitive-behavioral therapy targeting anxiety symptoms. Hoarding symptoms were common and occurred in a clinically significant manner in approximately 25 % of cases. Overall hoarding severity was associated with increased internalizing and anxiety/depressive symptoms, externalizing behavior, and attention problems. Discarding items was associated with internalizing and anxious/depressive symptoms, but acquisition was not. Hoarding decreased following cognitive-behavioral therapy but did not differ between treatment responders and non-responders. These data are among the first to examine hoarding among youth with ASD; implications of study findings and future directions are highlighted.

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.

Clinical trials attitudes and practices of Latino physicians.

PubMed

Ramirez, Amelie G; Wildes, Kimberly; Talavera, Greg; Nápoles-Springer, Anna; Gallion, Kipling; Pérez-Stable, Eliseo J

2008-07-01

Ethnic differences in physicians' attitudes and behaviors related to clinical trials might partially account for disparities in clinical trial participation among Latino patients. Literature regarding Latino physicians' clinical trials attitudes and practices, in comparison to White physicians, was lacking. Cross-sectional data from randomly selected physicians (N=695), stratified by ethnicity, were analyzed to test associations of ethnicity with physicians' participation in and attitudes toward referral of patients to clinical trials. Chi-square analyses showed significant (p<0.05) associations of physician race/ethnicity and clinical trials involvement, type of trial for which the physician is likely to recommend a patient, belief in scientific value, and factors that would influence recommendation for a patient to participate. Multivariate analyses resulted in several significant (p<0.05) predictors of clinical trials outcomes, including physician race/ethnicity. Latino physicians were significantly less involved in clinical trials than White physicians and found less scientific value in them, highlighting areas for future education and intervention.

Self-care behavior when suffering from the common cold and health-related quality of life in individuals attending an annual checkup in Japan: a cross-sectional study.

PubMed

Shaku, Fumio; Tsutsumi, Madoka; Miyazawa, Asako; Takagi, Hiroshi; Maeno, Tetsuhiro

2015-07-29

The World Health Organization and several governments encourage medical self-care (including self-medication) for minor illnesses. Accordingly, the factors that influence self-care have received research attention, with socioeconomic status identified as one such predictor. Although studies have examined the relationship between socioeconomic status and quality of life (QOL) in patients suffering from respiratory allergies or chronic illnesses, the relationship between QOL and self-care behavior for the common cold, the most common illness seen in primary care, has not been examined. Therefore, we investigated the relationship between QOL and self-care behavior in individuals suffering from the common cold. We distributed questionnaires to 499 people who attended an annual public health checkup in Kasama city, Japan. Valid questionnaires were received from 398 participants (mean age = 59.0, SD = 15.8, range = 24-87 years; 61.4 % women). The materials included a question relating to typical actions taken when treating a common cold (self-care or visiting a health clinic), demographics, and the Short Form-8™ (SF-8™)-an 8-item survey that assesses health-related quality of life (HRQOL). The association of care action and HRQOL were investigated using Mann-Whitney U tests with a significance level of p < 0.05. The mean scores for the Physical Functioning, Role-Physical, Bodily Pain, Social Functioning, Role-Emotional, and Physical Component Summary score of the SF-8™ were significantly higher among the self-care group than the group that preferred visiting a clinic. HRQOL among individuals who engage in self-care when treating the common cold was observed to be significantly higher than among individuals who preferred to attend a health clinic. It is unclear whether self-care behavior affects QOL, or whether QOL affects self-care behavior; however, this finding highlights the importance of the relationship between QOL and self-care behavior. Additional studies should be conducted in order to investigate the direction of causality between self-care behaviors and QOL further.

Practitioner review: maternal mood in pregnancy and child development--implications for child psychology and psychiatry.

PubMed

O'Connor, Thomas G; Monk, Catherine; Fitelson, Elizabeth M

2014-01-01

The empirical base suggesting a link between prenatal maternal anxiety, stress or depression and cognitive, behavioral, and biological outcomes in the infant and child has increased dramatically in the past 10 years. In this review, we consider the relevance of prenatal maternal mood for child mental health practitioners; the empirical base for a likely causal impact of the link between prenatal anxiety, depression, or stress and child outcomes; the degree to which the available evidence is sufficient for informing or altering clinical practice; and the possible role of prenatal interventions for promoting child health and development. A selective review of PubMed, Cochrane Library and other sources was undertaken. Clinically significant links between maternal prenatal distress and child behavioral and cognitive outcomes have been reported; predictions to stress physiology, immunology, and neurodevelopment have been reported but the effect sizes and clinical significance is less clear. Several candidate mechanisms have been proposed, with some supporting evidence. Many behavioral treatments for prenatal maternal distress exist, but their application to promoting child health is largely unknown. Research on maternal prenatal distress is a good example of translational research and offers a strong paradigm for promoting interdisciplinary clinical research on child health and development. © 2013 The Authors. Journal of Child Psychology and Psychiatry © 2013 Association for Child and Adolescent Mental Health.

Changing personnel behavior to promote quality care practices in an intensive care unit

PubMed Central

Cooper, Dominic; Farmery, Keith; Johnson, Martin; Harper, Christine; Clarke, Fiona L; Holton, Phillip; Wilson, Susan; Rayson, Paul; Bence, Hugh

2005-01-01

The delivery of safe high quality patient care is a major issue in clinical settings. However, the implementation of evidence-based practice and educational interventions are not always effective at improving performance. A staff-led behavioral management process was implemented in a large single-site acute (secondary and tertiary) hospital in the North of England for 26 weeks. A quasi-experimental, repeated-measures, within-groups design was used. Measurement focused on quality care behaviors (ie, documentation, charting, hand washing). The results demonstrate the efficacy of a staff-led behavioral management approach for improving quality-care practices. Significant behavioral change (F [6, 19] = 5.37, p < 0.01) was observed. Correspondingly, statistically significant (t-test [t] = 3.49, df = 25, p < 0.01) reductions in methicillin-resistant Staphylococcus aureus (MRSA) were obtained. Discussion focuses on implementation issues. PMID:18360574

The frequency and behavioral outcomes of goal choices in the self-management of diabetes.

PubMed

Estabrooks, Paul A; Nelson, Candace C; Xu, Stanley; King, Diane; Bayliss, Elizabeth A; Gaglio, Bridget; Nutting, Paul A; Glasgow, Russell E

2005-01-01

The purpose of this study was to determine the frequency and effectiveness of behavioral goal choices in the self-management of diabetes and to test goal-setting theory hypotheses that self-selection and behavioral specificity of goals are key to enhancing persistence. Participants with type 2 diabetes in a randomized controlled trial (n = 422) completed baseline behavioral assessments using a clinic-based, interactive, self-management CD-ROM that allowed them to select a behavioral goal and receive mail and telephone support for the initial 6 months of the trial followed by additional behavioral assessments. Frequency of behavioral goal selection and 6-month behavioral data were collected. Approximately 49%, 27%, and 24% of the participants, respectively, set goals to increase physical activity (PA), reduce fat intake, or increase fruits and vegetables (F&V) consumed. At baseline, participants who selected PA, reduced fat consumption, or F&V were significantly, and respectively, less active, consumed more dietary fat, and ate fewer F&V regardless of demographic characteristics. Participants who selected a reduced-fat goal showed a significantly larger decrease than did those that selected PA or F&V goals. Participants who selected an F&V goal showed significant changes in F&V consumption. Participants who selected a PA goal demonstrated significant changes in days of moderate and vigorous physical activity. When participants are provided with information on health behavior status and an option of behavioral goals for managing type 2 diabetes, they will select personally appropriate goals, resulting in significant behavioral changes over a 6-month period.

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.

The Autism Diagnosis in Translation: Shared Affect in Children and Mouse Models of ASD

PubMed Central

Bishop, Somer L.; Lahvis, Garet P.

2013-01-01

In recent years, there have been significant improvements in assessment and diagnostic procedures for autism spectrum disorders (ASD). Standardized diagnostic instruments have been developed, promoting consistent diagnostic practices among clinicians. For clinical researchers, these instruments have facilitated collaborations across different sites by providing standardized metrics with which to evaluate ASD symptoms. Nevertheless, because ASD remains a diagnosis that is defined on the basis of behavior, there are significant challenges associated with modeling ASD social behaviors in laboratory animals. In order to more effectively study the causes of ASD symptoms and behaviors, there is a need to develop new ways of measuring social behaviors that can be applied to non-human species. Critically, while verbal dialogue between the clinician and patient is integral to clinical diagnoses, it cannot be employed for studies of animal models. However, observations of autistic-like social interactions can be modeled in animals. In this regard, communication between professionals in the clinical and basic sciences is necessary to break down the complex diagnosis into units of social impairment that can be more feasibly measured in different species. This paper presents a discussion between an animal researcher and a clinical psychologist. Using shared affect as an example, we explore potential avenues for increasing the utility of animal models to move us toward a better understanding of the mechanisms underlying social impairments in ASD. In the absence of molecular biomarkers that can be used to diagnose ASD, current diagnostic tools depend upon clinical assessments of behavior. Research efforts with human subjects have successfully utilized standardized diagnostic instruments, which include clinician interviews with parents and direct observation of the children themselves (Risi et al., 2006). However, because clinical instruments are semi-structured and rely heavily on dynamic social processes and clinical skill, scores from these measures do not necessarily lend themselves directly to experimental investigations into the causes of ASD. Studies of the neurobiology of autism require experimental animal models. Mice are particularly useful, in this regard, for elucidating genetic and toxicologjcal contributions to impairments in social function (Halladay et al., 2009). Behavioral tests have been developed that are relevant to autism (Crawley, 2004, 2007), including measures of repetitive behaviors (Lewis, Tanimura, Lee, & Bodfish, 2007; Moy et al., 2008), social behavior (Brodkin, 2007; Lijam et al., 1997; Moretti, Bouwknecht, Teague, Paylor, & Zoghbi, 2005), and vocal communication (Panksepp et al., 2007). Advances also include development of high-throughput measures of mouse sociability that can be used to reliably compare inbred mouse strains (Moy, et al., 2008; Nadler et al., 2004), as well as measures of social reward (Panksepp & Lahvis, 2007) and empathy (Chen, Panksepp, & Lahvis, 2009; Langford et al., 2006). With continued generation of mouse gene-targeted mice that are directly relevant to genetic linkages in ASD, there remains an urgent need to utilize a full suite of mouse behavioral tests that allows for a comprehensive assessment of the spectrum of social difficulties relevant to ASD. Using impairments in shared affect as an example, this paper explores potential avenues for collaboration between clinical and basic scientists, within an amply considered translational framework. PMID:21882361

Brief Report: Developmental Trajectories of Adaptive Behavior in Children and Adolescents with ASD.

PubMed

Meyer, Allison T; Powell, Patrick S; Butera, Nicole; Klinger, Mark R; Klinger, Laura G

2018-03-17

Research suggests that individuals with autism spectrum disorder (ASD) have significant difficulties with adaptive behavior skills including daily living and functional communication skills. Few studies have examined the developmental trajectory of adaptive behavior across childhood and adolescence. The present study examined longitudinal trajectories of adaptive behavior in a community-based clinic sample of 186 individuals with ASD. The overall pattern indicated an initial increase in adaptive behavior during early childhood followed by a plateau in skills during adolescence for individuals of all IQ groups. Given the importance of adaptive behavior for employment and quality of life, this study emphasizes the importance of targeting adaptive behavior during adolescence to insure continued gains.

Can Cognitive Behavioral Therapy for Insomnia also treat fatigue, pain, and mood symptoms in individuals with traumatic brain injury? - A multiple case report.

PubMed

Lu, William; Krellman, Jason W; Dijkers, Marcel P

2016-01-01

Individuals with traumatic brain injury (TBI) often develop sleep disorders post-injury. The most common one is insomnia, which can exacerbate other post-injury symptoms, including fatigue, impaired cognition, depression, anxiety, and pain. Cognitive Behavioral Therapy for Insomnia (CBT-I) is a manualized treatment that effectively treats insomnia with secondary effects on cognition, mood, and pain in various populations. This paper reviews the use of CBT-I for three participants with TBI of different severities. Pre- and post-treatment assessments of insomnia, fatigue, depression, anxiety, and pain were conducted. Mood was further assessed at follow-up. Minimal clinically important difference (MCID) scores derived from the research literature were used to establish clinically meaningful symptom improvement on self-report questionnaires. The reduction in insomnia severity scores for all three participants were not large enough to be considered a clinically significant improvement following CBT-I, although trends toward improvement were observed. However, all participants showed clinically significant reductions in anxiety at post-treatment; the effects persisted for 2 participants at follow-up. Reductions in depression symptoms were observed for 2 participants at post-treatment, and treatment effects persisted for 1 participant at follow-up. One participant endorsed clinically significant improvements in fatigue and pain severity. We conclude that CBT-I may provide secondary benefits for symptoms commonly experienced by individuals with TBI, especially mood disturbances.

Health Behavior Changes After Genetic Risk Assessment for Alzheimer Disease: The REVEAL Study

PubMed Central

Chao, Serena; Roberts, J. Scott; Marteau, Theresa M.; Silliman, Rebecca; Cupples, L. Adrienne; Green, Robert C.

2008-01-01

Risk information for Alzheimer disease (AD) may be communicated through susceptibility gene disclosure, even though this is not currently in clinical use. The REVEAL Study is the first randomized clinical trial of risk assessment for AD with apolipoprotein E (APOE) genotype and numerical risk estimate disclosure. We examined whether APOE genotype and numerical risk disclosure to asymptomatic individuals at high risk for AD alters health behaviors. One hundred sixty-two participants were randomized to either intervention (APOE disclosure) or control (no genotype disclosure) groups. Subjects in both groups received numerical lifetime risk estimates of future AD development based on sex and family history of AD. The intervention group received their APOE genotype. Subjects were informed that no proven preventive measures for AD existed and given an information sheet on preventative therapies under investigation. Participants who learned they were ε4 positive were significantly more likely than ε4 negative participants to report AD-specific health behavior change 1 year after disclosure (adjusted odds ratio: 2.73; 95% confidence interval: 1.14, 6.54; P = 0.02). Post hoc analyses revealed similar significant associations between numerical lifetime risk estimates and self-report of AD-specific health behavior change. Despite lack of preventive measures for AD, knowledge of APOE genotype, numerical lifetime risk, or both, influences health behavior. PMID:18317253

Health behavior changes after genetic risk assessment for Alzheimer disease: The REVEAL Study.

PubMed

Chao, Serena; Roberts, J Scott; Marteau, Theresa M; Silliman, Rebecca; Cupples, L Adrienne; Green, Robert C

2008-01-01

Risk information for Alzheimer disease (AD) may be communicated through susceptibility gene disclosure, even though this is not currently in clinical use. The REVEAL Study is the first randomized clinical trial of risk assessment for AD with apolipoprotein E (APOE) genotype and numerical risk estimate disclosure. We examined whether APOE genotype and numerical risk disclosure to asymptomatic individuals at high risk for AD alters health behaviors. One hundred sixty-two participants were randomized to either intervention (APOE disclosure) or control (no genotype disclosure) groups. Subjects in both groups received numerical lifetime risk estimates of future AD development based on sex and family history of AD. The intervention group received their APOE genotype. Subjects were informed that no proven preventive measures for AD existed and given an information sheet on preventative therapies under investigation. Participants who learned they were epsilon 4 positive were significantly more likely than epsilon 4 negative participants to report AD-specific health behavior change 1 year after disclosure (adjusted odds ratio: 2.73; 95% confidence interval: 1.14, 6.54; P=0.02). Post hoc analyses revealed similar significant associations between numerical lifetime risk estimates and self-report of AD-specific health behavior change. Despite lack of preventive measures for AD, knowledge of APOE genotype, numerical lifetime risk, or both, influences health behavior.

Relationship between dietary intake and behaviors with oxytocin: a systematic review of studies in adults.

PubMed

Skinner, Janelle A; Garg, Manohar L; Dayas, Christopher V; Fenton, Sasha; Burrows, Tracy L

2018-05-01

Oxytocin plays an important hormonal role in the regulation of feeding and energy intake. The aims of this review were to 1) determine the effects of dietary intake/behaviors on endogenous oxytocin and 2) examine the effect of exogenous oxytocin on dietary intake/behaviors. Published studies up to December 2016 were identified through searches of 5 electronic databases. Eligible studies included those in adults that included a measure related to an individual's diet and a measure of oxytocin and the relationship between the 2 outcomes. Twenty-six studies (n = 912 participants; 77% female) were included. The most common dietary outcomes assessed were alcohol, caffeine, calcium, sodium, fat, and calorie intake. It was found that endogenous oxytocin (n = 13) in nonclinical samples did not change significantly (P > 0.05) through altered diet or behaviors (neutral effect); in contrast, significant (P < 0.05) differences (increases and decreases) were identified in clinical samples. Exogenous oxytocin studies (n = 13) found reduced indices of food intake (positive effect) in clinical and nonclinical samples. Overall, few studies included comprehensive investigation of dietary intakes through the use of validated assessment tools. Dietary intake and behaviors appear to have some influence on oxytocin, with more pronounced effects found with exogenously administered oxytocin.

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.

The burden of insomnia in Japan

PubMed Central

Mishima, Kazuo; DiBonaventura, Marco daCosta; Gross, Hillary

2015-01-01

Objectives Several studies have suggested that patients who experience insomnia report a number of significant impairments. However, despite this literature, fewer studies have focused on the burden of insomnia among patients in Japan. The objective of the current study is to extend this work in Japan to further understand the effect of insomnia on health-related quality of life (hrQOL). Further, another objective is to understand general predictors of hrQOL among patients with insomnia. Methods Data from the 2012 Japan National Health and Wellness Survey, an annual, cross-sectional study of adults aged 18 years or older, were used (N=30,000). All National Health and Wellness Survey respondents were categorized based on the incidence of self-reported insomnia diagnosis and prescription medication usage (clinical insomniacs under treatment versus [vs] good sleepers without insomnia or insomnia symptoms). Comparisons among different groups were made using multiple regression models controlling for demographics and health history. Results Clinical insomniacs (n=1,018; 3.4%) reported significantly worse hrQOL compared with good sleepers (n=20,542) (mental component summary: 34.2 vs 48.0; physical component summary: 48.0 vs 52.8; health utilities: 0.61 vs 0.76; all P<0.05). Health behaviors (smoking, exercise, alcohol use) and comorbidities were the strongest predictors of health utilities for clinical insomniacs. For all three clinical insomniac subgroups of interest, those with a physical comorbidity but not a psychiatric one, those with a psychiatric comorbidity but not a physical one, and those without either a physical or psychiatric comorbidity, large decrements in health utilities were observed for respondents who did not engage in any positive health behaviors (0.61, 0.57, 0.64, respectively) relative to good sleepers (0.78). However, the gap in health utility scores between these subgroups and good sleepers diminishes with an increasing number of positive health behaviors (eg, clinical insomniacs with a physical comorbidity but not a psychiatric comorbidity performing all three positive health behaviors =0.67 vs good sleepers =0.78). Discussion A significant burden remains for those with insomnia who are treated. Given the particularly low levels of hrQOL among treated insomnia patients who have poor health behavior profiles and have psychiatric comorbidities, physicians should place particular emphasis on these patients who are most in need of intervention. Improved treatments may help to address the unmet needs of these patient populations. PMID:25610008

Predisposing characteristics, enabling resources and need as predictors of utilization and clinical outcomes for veterans receiving mental health services.

PubMed

Fasoli, DiJon R; Glickman, Mark E; Eisen, Susan V

2010-04-01

Though demand for mental health services (MHS) among US veterans is increasing, MHS utilization per veteran is decreasing. With health and social service needs competing for limited resources, it is important to understand the association between patient factors, MHS utilization, and clinical outcomes. We use a framework based on Andersen's behavioral model of health service utilization to examine predisposing characteristics, enabling resources, and clinical need as predictors of MHS utilization and clinical outcomes. This was a prospective observational study of veterans receiving inpatient or outpatient MHS through Veterans Administration programs. Clinician ratings (Global Assessment of Functioning [GAF]) and self-report assessments (Behavior and Symptom Identification Scale-24) were completed for 421 veterans at enrollment and 3 months later. Linear and logistic regression analyses were conducted to examine: (1) predisposing characteristics, enabling resources, and need as predictors of MHS inpatient, residential, and outpatient utilization and (2) the association between individual characteristics, utilization, and clinical outcomes. Being older, female, having greater clinical need, lack of enabling resources (employment, stable housing, and social support), and easy access to treatment significantly predicted greater MHS utilization at 3-month follow-up. Less clinical need and no inpatient psychiatric hospitalization predicted better GAF and Behavior and Symptom Identification Scale-24 scores. White race and residential treatment also predicted better GAF scores. Neither enabling resources, nor number of outpatient mental health visits predicted clinical outcomes. This application of Andersen's behavioral model of health service utilization confirmed associations between some predisposing characteristics, need, and enabling resources on MHS utilization but only predisposing characteristics, need, and utilization were associated with clinical outcomes.

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.

Skittish, shielded, and scared: relations among behavioral inhibition, overprotective parenting, and anxiety in native and non-native Dutch preschool children.

PubMed

Vreeke, Leonie J; Muris, Peter; Mayer, Birgit; Huijding, Jorg; Rapee, Ronald M

2013-10-01

This study examined behavioral inhibition and overprotective parenting as correlates and predictors of anxiety disorder symptoms in preschoolers with a multi-cultural background (N=168). Parents of 3- to 6-year-old children completed a set of questionnaires twice, 12 months apart. Parents were also interviewed with the Anxiety Disorders Interview Schedule for DSM-IV at the 12-month point to assess the clinical severity of children's anxiety symptoms. Behavioral inhibition consistently emerged as a significant concurrent correlate of anxiety symptoms and this was particularly true for social anxiety symptoms. Overprotective parenting also emerged as a significant correlate of anxiety, but only in the case of non-social anxiety symptoms and mainly in non-native Dutch children. Prospective analyses revealed that behavioral inhibition was a significant predictor of social anxiety symptoms, while overprotective parenting did not explain significant variance in the development of children's anxiety over time. The support for an interactive effect of behavioral inhibition and overprotective parenting was unconvincing. Finally, it was found that children who exhibited stable high levels of behavioral inhibition throughout the study ran the greatest risk for developing an anxiety disorder. Copyright © 2013 Elsevier Ltd. All rights reserved.

Heart failure patient adherence: epidemiology, cause, and treatment.

PubMed

Corotto, Paul S; McCarey, Melissa M; Adams, Suzanne; Khazanie, Prateeti; Whellan, David J

2013-01-01

Poor adherence to therapeutic regimens is a significant impediment to improving clinical outcomes in the HF population. Typical rates of adherence to prescribed medications, low-sodium diets, and aerobic exercise programs remain lower than that needed to decrease morbidity and mortality associated with HF. Factors contributing to poor adherence include multiple comorbidities, clinical depression, and decreased cognitive functioning. HF education and programs to enhance self-management skills have improved patient quality of life but have yet to decrease mortality or rehospitalization rates significantly. Telemonitoring to improve adherence behaviors and self-management interventions within broader HF management programs have demonstrated significant clinical improvements in this population. Copyright © 2013 Elsevier Inc. All rights reserved.

Investigation of Nutritional Behaviors in the First and Second Trimesters in Pregnant Women Referring to Clinics in Hamadan, Iran, in 2013.

PubMed

Masoumi, Seyedeh Zahra; Parsa, Parisa; Kazemi, Farideh; Soltanian, Ali Reza; Dadvand, Gissoo; Habib, Shabnam

2016-09-01

Pregnancy is a particular period in women's life that is accompanied by an increase in nutritional needs. Having a normal pregnancy period and successful pregnancy outcomes depends on the intake of sufficient amount of food. The present study aimed to determine nutritional behaviors in pregnant women in the first and second trimesters referring to clinics in Hamadan, Iran. This cross-sectional study was conducted on 170 women referred to health and treatment centers of Hamadan in 2013. Among Hamadan's health and treatment centers, 10 were selected as the research setting through cluster sampling. Then, the pregnant women at 8-24 weeks of gestation were randomly entered into the study. The data were collected using nutritional behaviors questionnaire in three months. Accordingly, mean scores below 50, between 50 and 75, and above 75 were considered as weak, moderate, and perfect nutritional behaviors, respectively. The data were analyzed using the SPSS statistical software, version 21 and P<0.05 was considered as statistically significant. The results showed that more than three fourths of the study participants had moderate nutritional behaviors. Insufficient intake of fruit, vegetables, and cereals was detected in 80.6%, 54.1%, and 47.1% of the participants, respectively. Besides, 30% of the women had not used folic acid supplement during their pregnancy period or were not aware of its necessity. The results of multivariate analysis indicated that age was only significantly associated with pregnant women's score of nutritional behaviors (P=0.010). Additionally, no significant relationship was found between the women's nutritional behaviors and their strategies for elimination of common pregnancy complications, such as constipation, heartburn, urinary tract infection, and anemia. Considering the participants' moderate nutritional behaviors, health and treatment centers are recommended to provide the necessary training for improving pregnant women's nutritional behaviors and supervise and follow their execution and evaluation.

Investigation of Nutritional Behaviors in the First and Second Trimesters in Pregnant Women Referring to Clinics in Hamadan, Iran, in 2013

PubMed Central

Masoumi, Seyedeh Zahra; Parsa, Parisa; Kazemi, Farideh; Soltanian, Ali Reza; Dadvand, Gissoo; Habib, Shabnam

2016-01-01

Background: Pregnancy is a particular period in women’s life that is accompanied by an increase in nutritional needs. Having a normal pregnancy period and successful pregnancy outcomes depends on the intake of sufficient amount of food. The present study aimed to determine nutritional behaviors in pregnant women in the first and second trimesters referring to clinics in Hamadan, Iran. Methods: This cross-sectional study was conducted on 170 women referred to health and treatment centers of Hamadan in 2013. Among Hamadan’s health and treatment centers, 10 were selected as the research setting through cluster sampling. Then, the pregnant women at 8-24 weeks of gestation were randomly entered into the study. The data were collected using nutritional behaviors questionnaire in three months. Accordingly, mean scores below 50, between 50 and 75, and above 75 were considered as weak, moderate, and perfect nutritional behaviors, respectively. The data were analyzed using the SPSS statistical software, version 21 and P<0.05 was considered as statistically significant. Results: The results showed that more than three fourths of the study participants had moderate nutritional behaviors. Insufficient intake of fruit, vegetables, and cereals was detected in 80.6%, 54.1%, and 47.1% of the participants, respectively. Besides, 30% of the women had not used folic acid supplement during their pregnancy period or were not aware of its necessity. The results of multivariate analysis indicated that age was only significantly associated with pregnant women’s score of nutritional behaviors (P=0.010). Additionally, no significant relationship was found between the women’s nutritional behaviors and their strategies for elimination of common pregnancy complications, such as constipation, heartburn, urinary tract infection, and anemia. Discussion and Conclusion: Considering the participants’ moderate nutritional behaviors, health and treatment centers are recommended to provide the necessary training for improving pregnant women’s nutritional behaviors and supervise and follow their execution and evaluation. PMID:27157177

Antiepileptic drug behavioral side effects and baseline hyperactivity in children and adolescents with new onset epilepsy.

PubMed

Guilfoyle, Shanna M; Follansbee-Junger, Katherine; Smith, Aimee W; Combs, Angela; Ollier, Shannon; Hater, Brooke; Modi, Avani C

2018-01-01

To examine baseline psychological functioning and antiepileptic drug (AED) behavioral side effects in new onset epilepsy and determine, by age, whether baseline psychological functioning predicts AED behavioral side effects 1 month following AED initiation. A retrospective chart review was conducted between July 2011 and December 2014 that included youths with new onset epilepsy. As part of routine interdisciplinary care, caregivers completed the Behavior Assessment System for Children, 2nd Edition: Parent Rating Scale to report on baseline psychological functioning at the diagnostic visit and the Pediatric Epilepsy Side Effects Questionnaire to identify AED behavioral side effects at the 1-month follow-up clinic visit following AED initiation. Children (age = 2-11 years) and adolescents (age = 12-18 years) were examined separately. A total of 380 youths with new onset epilepsy (M age  = 8.9 ± 4.3 years; 83.4% Caucasian; 34.8% focal epilepsy, 41.1% generalized epilepsy, 23.7% unclassified epilepsy) were included. Seventy percent of youths had at-risk or clinically elevated baseline psychological symptoms. Children had significantly greater AED behavioral side effects (M = 25.08 ± 26.36) compared to adolescents (M = 12.36 ± 17.73), regardless of AED. Valproic acid demonstrated significantly greater behavioral side effects compared to all other AEDs, with the exception of levetiracetam. Higher hyperactivity/impulsivity at baseline significantly predicted higher AED behavioral side effects 1 month after AED initiation in both age groups. Younger children seem to be more prone to experience behavioral side effects, and these are likely to be higher if youths with epilepsy have baseline hyperactivity/impulsivity. Baseline psychological screening, specifically hyperactivity, can be used as a precision medicine tool for AED selection. Wiley Periodicals, Inc. © 2017 International League Against Epilepsy.

An exploratory study of the effectiveness of group narrative therapy on the school behavior of girls with attention-deficit/hyperactivity symptoms.

PubMed

Looyeh, Majid Yoosefi; Kamali, Khosrow; Shafieian, Roya

2012-10-01

This study explored the effectiveness of group narrative therapy for improving the school behavior of a small sample of girls with attention-deficit/hyperactivity disorder (ADHD). Fourteen clinics referred 9- to 11-year-old girls with a clinical diagnosis of ADHD were randomly assigned to treatment and wait-list control groups. Posttreatment ratings by teachers showed that narrative therapy had a significant effect on reducing ADHD symptoms 1 week after completion of treatment and sustained after 30 days. Copyright © 2012 Elsevier Inc. All rights reserved.

Associations between body mass index, weight control concerns and behaviors, and eating disorder symptoms among non-clinical Chinese adolescents

PubMed Central

2010-01-01

Background Previous research with adolescents has shown associations of body weight, weight control concerns and behaviors with eating disorder symptoms, but it is unclear whether these associations are direct or whether a mediating effect exists. This study was conducted to investigate the prevalence of overweight and obesity, weight control concerns and behaviors, and eating disorder symptoms and to examine the mediating function of weight control concerns and behaviors on the relationship between body mass index (BMI) and eating disorder symptoms among non-clinical adolescents in China. Methods A cross-sectional survey among 2019 adolescent girls and 1525 adolescent boys in the 7th, 8th, 10th and 11th grades from seven cities in China was conducted. Information on weight control concerns and behaviors, and eating disorder symptoms (Eating Disorder Inventory-3) were collected from the adolescents using a self-administrated questionnaire. Results Weight control concerns and behaviors, and eating disorder symptoms were prevalent among the study population. A high proportion of adolescents scored at or above the threshold on the eating disorder inventory (EDI) subscale such as bulimia, interoceptive deficits, perfectionism, and maturity fears, which indicated eating disorder symptoms. High BMI was significantly associated with high score of drive for thinness, body dissatisfaction, bulimia, low self-esteem, interceptive deficits and maturity fears, so do perceived body weight status. Almost all weight control concerns and behaviors we investigated were significantly associated with high EDI subscale scores. When weight control concerns were added to the model, as shown in the model, the association between BMI and tendency of drive to thinness and bulimia was attenuated but still kept significant. The association between BMI and body dissatisfaction were no further significant. The association of BMI and drive for thinness, body dissatisfaction and bulimia was considerably weaker than when weight control behaviors were not included. Conclusions Weight control concerns and behaviors may be mediators of the association between BMI and eating disorder symptoms. Interpretation of these weight control problems is crucial to develop culturally appropriate educational and intervention programs for adolescents. PMID:20525394

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.

Clinical, morphological, and biochemical correlates of head circumference in autism.

PubMed

Sacco, Roberto; Militerni, Roberto; Frolli, Alessandro; Bravaccio, Carmela; Gritti, Antonella; Elia, Maurizio; Curatolo, Paolo; Manzi, Barbara; Trillo, Simona; Lenti, Carlo; Saccani, Monica; Schneider, Cindy; Melmed, Raun; Reichelt, Karl-Ludvig; Pascucci, Tiziana; Puglisi-Allegra, Stefano; Persico, Antonio M

2007-11-01

Head growth rates are often accelerated in autism. This study is aimed at defining the clinical, morphological, and biochemical correlates of head circumference in autistic patients. Fronto-occipital head circumference was measured in 241 nonsyndromic autistic patients, 3 to 16 years old, diagnosed according to DSM-IV criteria. We assessed 1) clinical parameters using the Autism Diagnostic Observation Schedule, Autism Diagnostic Interview-Revised, Vineland Adaptive Behavioral Scales, intelligence quotient measures, and an ad hoc clinical history questionnaire; 2) height and weight; 3) serotonin (5-HT) blood levels and peptiduria. The distribution of cranial circumference is significantly skewed toward larger head sizes (p < .00001). Macrocephaly (i.e., head circumference >97th percentile) is generally part of a broader macrosomic endophenotype, characterized by highly significant correlations between head circumference, weight, and height (p < .001). A head circumference >75th percentile is associated with more impaired adaptive behaviors and with less impairment in IQ measures and motor and verbal language development. Surprisingly, larger head sizes are significantly associated with a positive history of allergic/immune disorders both in the patient and in his/her first-degree relatives. Our study demonstrates the existence of a macrosomic endophenotype in autism and points toward pathogenetic links with immune dysfunctions that we speculate either lead to or are associated with increased cell cycle progression and/or decreased apoptosis.

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.

Are Borderline Personality Symptoms Associated With Compulsive Sexual Behaviors Among Women in Treatment for Substance Use Disorders? An Exploratory Study

PubMed Central

Elmquist, JoAnna; Shorey, Ryan C.; Anderson, Scott; Stuart, Gregory L.

2016-01-01

Objective Extant literature has documented a significant relationship between borderline symptoms and substance use disorders. As supported in past work, there is a significant theoretical relationship between borderline symptoms and compulsive sexual behaviors because both disorders share common underlying behaviors and traits. There is no known research that has examined the empirical relationship between borderline symptoms and compulsive sexual behaviors in a population with substance use disorders. To fill this important gap in the literature, this relationship was examined in the current study. Method Medical records from 120 women admitted to a private, residential treatment program for substance use disorders were reviewed for the current study. Results Hierarchical multiple regression analysis demonstrated that borderline symptoms were significantly associated with compulsive sexual behaviors after controlling for alcohol use and problems, drug use and problems, age, and positive impression management. Conclusion Results from this study provide potentially important research and clinical implications, which could ultimately aid treatment and reduce relapse. However, continued research is needed to further examine the relationship between symptoms and compulsive sexual behaviors. PMID:27059090

Are Borderline Personality Symptoms Associated With Compulsive Sexual Behaviors Among Women in Treatment for Substance Use Disorders? An Exploratory Study.

PubMed

Elmquist, JoAnna; Shorey, Ryan C; Anderson, Scott; Stuart, Gregory L

2016-10-01

Extant literature has documented a significant relationship between borderline symptoms and substance use disorders. As supported in past work, there is a significant theoretical relationship between borderline symptoms and compulsive sexual behaviors because both disorders share common underlying behaviors and traits. There is no known research that has examined the empirical relationship between borderline symptoms and compulsive sexual behaviors in a population with substance use disorders. To fill this important gap in the literature, this relationship was examined in the current study. Medical records from 120 women admitted to a private, residential treatment program for substance use disorders were reviewed for the current study. Hierarchical multiple regression analysis demonstrated that borderline symptoms were significantly associated with compulsive sexual behaviors after controlling for alcohol use and problems, drug use and problems, age, and positive impression management. Results from this study provide potentially important research and clinical implications, which could ultimately aid treatment and reduce relapse. However, continued research is needed to further examine the relationship between symptoms and compulsive sexual behaviors. © 2016 Wiley Periodicals, Inc.

Demographic and clinical correlates of autism symptom domains and autism spectrum diagnosis.

PubMed

Frazier, Thomas W; Youngstrom, Eric A; Embacher, Rebecca; Hardan, Antonio Y; Constantino, John N; Law, Paul; Findling, Robert L; Eng, Charis

2014-07-01

Demographic and clinical factors may influence assessment of autism symptoms. This study evaluated these correlates and also examined whether social communication and interaction and restricted/repetitive behavior provided unique prediction of autism spectrum disorder diagnosis. We analyzed data from 7352 siblings included in the Interactive Autism Network registry. Social communication and interaction and restricted/repetitive behavior symptoms were obtained using caregiver-reports on the Social Responsiveness Scale. Demographic and clinical correlates were covariates in regression models predicting social communication and interaction and restricted/repetitive behavior symptoms. Logistic regression and receiver operating characteristic curve analyses evaluated the incremental validity of social communication and interaction and restricted/repetitive behavior domains over and above global autism symptoms. Autism spectrum disorder diagnosis was the strongest correlate of caregiver-reported social communication and interaction and restricted/repetitive behavior symptoms. The presence of comorbid diagnoses also increased symptom levels. Social communication and interaction and restricted/repetitive behavior symptoms provided significant, but modest, incremental validity in predicting diagnosis beyond global autism symptoms. These findings suggest that autism spectrum disorder diagnosis is by far the largest determinant of quantitatively measured autism symptoms. Externalizing (attention deficit hyperactivity disorder) and internalizing (anxiety) behavior, low cognitive ability, and demographic factors may confound caregiver-report of autism symptoms, potentially necessitating a continuous norming approach to the revision of symptom measures. Social communication and interaction and restricted/repetitive behavior symptoms may provide incremental validity in the diagnosis of autism spectrum disorder. © The Author(s) 2013.

Predictors of violent behavior among acute psychiatric patients: clinical study.

PubMed

Amore, Mario; Menchetti, Marco; Tonti, Cristina; Scarlatti, Fabiano; Lundgren, Eva; Esposito, William; Berardi, Domenico

2008-06-01

Violence risk prediction is a priority issue for clinicians working with mentally disordered offenders. The aim of the present study was to determine violence risk factors in acute psychiatric inpatients. The study was conducted in a locked, short-term psychiatric inpatient unit and involved 374 patients consecutively admitted in a 1-year period. Sociodemographic and clinical data were obtained through a review of the medical records and patient interviews. Psychiatric symptoms at admission were assessed using the Brief Psychiatric Rating Scale (BPRS). Psychiatric diagnosis was formulated using the Structured Clinical Interview for DSM-IV. Past aggressive behavior was evaluated by interviewing patients, caregivers or other collateral informants. Aggressive behaviors in the ward were assessed using the Overt Aggression Scale. Patients who perpetrated verbal and against-object aggression or physical aggression in the month before admission were compared to non-aggressive patients, moreover, aggressive behavior during hospitalization and persistence of physical violence after admission were evaluated. Violent behavior in the month before admission was associated with male sex, substance abuse and positive symptoms. The most significant risk factor for physical violence was a past history of physically aggressive behavior. The persistent physical assaultiveness before and during hospitalization was related to higher BPRS total scores and to more severe thought disturbances. Higher levels of hostility-suspiciousness BPRS scores predicted a change for the worse in violent behavior, from verbal to physical. A comprehensive evaluation of the history of past aggressive behavior and psychopathological variables has important implications for the prediction of violence in psychiatric settings.

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.

Demographic and clinical correlates of autism symptom domains and autism spectrum diagnosis

PubMed Central

Frazier, Thomas W; Youngstrom, Eric A; Embacher, Rebecca; Hardan, Antonio Y; Constantino, John N; Law, Paul; Findling, Robert L; Eng, Charis

2014-01-01

Demographic and clinical factors may influence assessment of autism symptoms. This study evaluated these correlates and also examined whether social communication and interaction and restricted/repetitive behavior provided unique prediction of autism spectrum disorder diagnosis. We analyzed data from 7352 siblings included in the Interactive Autism Network registry. Social communication and interaction and restricted/repetitive behavior symptoms were obtained using caregiver-reports on the Social Responsiveness Scale. Demographic and clinical correlates were covariates in regression models predicting social communication and interaction and restricted/repetitive behavior symptoms. Logistic regression and receiver operating characteristic curve analyses evaluated the incremental validity of social communication and interaction and restricted/repetitive behavior domains over and above global autism symptoms. Autism spectrum disorder diagnosis was the strongest correlate of caregiver-reported social communication and interaction and restricted/repetitive behavior symptoms. The presence of comorbid diagnoses also increased symptom levels. Social communication and interaction and restricted/repetitive behavior symptoms provided significant, but modest, incremental validity in predicting diagnosis beyond global autism symptoms. These findings suggest that autism spectrum disorder diagnosis is by far the largest determinant of quantitatively measured autism symptoms. Externalizing (attention deficit hyperactivity disorder) and internalizing (anxiety) behavior, low cognitive ability, and demographic factors may confound caregiver-report of autism symptoms, potentially necessitating a continuous norming approach to the revision of symptom measures. Social communication and interaction and restricted/repetitive behavior symptoms may provide incremental validity in the diagnosis of autism spectrum disorder. PMID:24104512

REM sleep behavior disorder in Parkinson's disease and dementia with Lewy bodies.

PubMed

Boeve, Bradley F; Silber, Michael H; Ferman, Tanis J

2004-09-01

Rapid eye movement (REM) sleep behavior disorder (RBD) is a parasomnia manifested by vivid, often frightening dreams associated with simple or complex motor behavior during REM sleep. Patients appear to "act out their dreams," in which the exhibited behaviors mirror the content of the dreams. Management of RBD involves counseling about safety measures in the sleep environment; in those at risk for injury, clonazepam and/or melatonin is usually effective. In this article, the authors present a detailed review of the clinical and polysomnographic features, differential diagnosis, diagnostic criteria, management strategies, and pathophysiologic mechanisms of RBD. They then review the literature and their institutional experience of RBD associated with neurodegenerative disease, particularly Parkinson's disease and dementia with Lewy bodies. The evolving data suggests that RBD may have clinical diagnostic and pathophysiologic significance in isolation and when associated with neurodegenerative disease.

Cardiovascular self-management support program for preventing cardiovascular complication behaviors and clinical outcomes in the elderly with poorly controlled type 2 diabetes mellitus in Indonesia: A pilot study.

PubMed

Hisni, Dayan; Rukmaini, Rukmaini; Saryono, Saryono; Chinnawong, Tippamas; Thaniwattananon, Ploenpit

2018-03-06

The aim of the study was to determine the feasibility, and to evaluate the effect of, a cardiovascular self-management support program by applying the 5A's self-management support program on preventing cardiovascular complication behaviors and to assess the clinical outcomes in the elderly with poorly controlled type 2 diabetes mellitus (DM). This pilot study used a quasi-experimental study design. Twelve elderly persons with poorly controlled type 2 DM were assigned into either a control or experimental group, with six participants in each group. The Preventing Cardiovascular Complication Behaviors (PCCB) was measured by the Preventing Cardiovascular Complication Behaviors Questionnaire, while the clinical outcomes were measured by clinical devices that were provided. These measurements were conducted and compared at baseline and 6 weeks after the completion of the program. The self-management support program was a 6 week program with several implementation methods, based on the 5A's self-management support program. The participants who received the cardiovascular self-management support program reported a significant improvement in their PCCB and clinical outcomes, compared to those receiving the usual care. This study revealed that a cardiovascular self-management support program that applies the 5A's self-management support program is feasible for implementation. © 2018 Japan Academy of Nursing Science.

Problem-solving and mental health outcomes of women and children in the wake of intimate partner violence.

PubMed

Maddoux, John; Symes, Lene; McFarlane, Judith; Koci, Anne; Gilroy, Heidi; Fredland, Nina

2014-01-01

The environmental stress of intimate partner violence is common and often results in mental health problems of depression, anxiety, and PTSD for women and behavioral dysfunctions for their children. Problem-solving skills can serve to mitigate or accentuate the environmental stress of violence and associated impact on mental health. To better understand the relationship between problem-solving skills and mental health of abused women with children, a cross-sectional predictive analysis of 285 abused women who used justice or shelter services was completed. The women were asked about social problem-solving, and mental health symptoms of depression, anxiety, and PTSD as well as behavioral functioning of their children. Higher negative problem-solving scores were associated with significantly (P < 0.001) greater odds of having clinically significant levels of PTSD, anxiety, depression, and somatization for the woman and significantly (P < 0.001) greater odds of her child having borderline or clinically significant levels of both internalizing and externalizing behaviors. A predominately negative problem-solving approach was strongly associated with poorer outcomes for both mothers and children in the aftermath of the environmental stress of abuse. Interventions addressing problem-solving ability may be beneficial in increasing abused women's abilities to navigate the daily stressors of life following abuse.

Suicidal Behavior and Associations with Quality of Life among HIV-Infected Patients in Ibadan, Nigeria.

PubMed

Oladeji, Bibilola Damilola; Taiwo, Babafemi; Mosuro, Olushola; Fayemiwo, Samuel A; Abiona, Taiwo; Fought, Angela J; Robertson, Kevin; Ogunniyi, Adesola; Adewole, Isaac F

Suicidality has rarely been studied in HIV-infected patients in sub-Saharan Africa. This study explored suicidal behavior in a clinic sample of people living with HIV, in Nigeria. Consecutive patients were interviewed using the Composite International Diagnostic Interview (CIDI-10.0) and the World Health Organization Quality of Life (WHO-QOL-HIV-BREF). Associations of suicidal behavior were explored using logistic regression models. In this sample of 828 patients (71% female, mean age 41.3 ± 10 years), prevalence of suicidal behaviors were 15.1%, 5.8%, and 3.9% for suicidal ideation, plans, and attempts, respectively. Women were more likely than men to report suicidal ideation (odds ratio 1.7; 95% confidence interval 1.05-2.64). Depression and/or anxiety disorder was associated with increased odds of all suicidal behaviors. Suicidal behavior was associated with significantly lower overall and domain scores on the WHO-QOL. Suicidal behaviors were common and significantly associated with the presence of mental disorders and lower quality of life.

Cognitive behavior therapy-based psychoeducational groups for adults with ADHD and their significant others (PEGASUS): an open clinical feasibility trial.

PubMed

Hirvikoski, T; Waaler, E; Lindström, T; Bölte, S; Jokinen, J

2015-03-01

The aim of this pilot study was to investigate the feasibility and effectiveness of a new psychoeducative intervention program (PEGASUS) for adults with ADHD and their significant others in a psychiatric outpatient context. At three outpatient psychiatric clinics, adults with ADHD and their significant others took part in PEGASUS, a psychoeducational program based on theories from cognitive behavioral therapy, neuropsychology, and cross-disciplinary evidence regarding ADHD. In total, 108 adults were allocated to treatment (51 with ADHD and their 57 significant others). Feasibility was evaluated regarding suitability of the intervention at a psychiatric outpatient clinic and treatment completion. Preliminary efficacy was evaluated per protocol from baseline to post-intervention (n = 41 adults with ADHD and 40 significant others). In a feasibility analysis, the intervention was judged to be a suitable treatment option for 94.5 % of all individuals with a primary diagnosis of ADHD at an outpatient psychiatric clinic. In total, 43 out of 51 allocated individuals with ADHD (84.3 %) completed the intervention. The corresponding figures for their significant others were 42 out of 57 (73.7 %). Knowledge about ADHD increased, and both the quality of relationships and psychological well-being improved from baseline to post-intervention in all participants. The significant others reported a reduction in the subjective burden of care, such as worry and guilt. The objective burden of care (such as financial problems) did not change. The findings support the potential value of psychoeducation for adults with ADHD and their significant others. An ongoing randomized controlled trial will generate further evidence concerning the PEGASUS program.

An Exploratory Study of Psychosocial Risk Behaviors of Adolescents Who Are Deaf or Hard of Hearing: Comparisons and Recommendations

ERIC Educational Resources Information Center

Coll, Kenneth M.; Cutler, Martin M.; Thobro, Patti; Haas, Robin; Powell, Stephanie

2009-01-01

The study compared psychosocial risk behaviors of adolescents who were deaf or hard of hearing with those of their hearing peers in a residential treatment facility. Statistically significant differences emerged between groups. The adolescents who were deaf or hard of hearing demonstrated clinically higher scores than those of their hearing peers…

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.

Obsessive-compulsive symptoms in Prader-Willi and "Prader-Willi-Like" patients.

PubMed

State, M W; Dykens, E M; Rosner, B; Martin, A; King, B H

1999-03-01

To compare obsessive-compulsive (OC) symptoms in patients with Prader-Willi syndrome (PWS) and symptoms in a group of patients presenting with "Prader-Willi-like" features but without the genetic abnormalities associated with PWS. 16 patients aged 4 through 20 years were evaluated in a clinic specializing in the assessment and management of behavioral and food-related problems in PWS. Eight patients were found to have key features of the syndrome but did not have a PWS genotype. These PWS-like subjects were matched to 8 clinic patients with a confirmed deletion of the PWS critical region of the paternally derived chromosome 15. All subjects were evaluated for obesity, IQ, food-related problems, maladaptive behaviors, and non-food-related OC symptoms. There were no differences between the 2 groups with respect to measures of obesity, IQ, food-related difficulties, or overall maladaptive behaviors. The PWS group showed significantly greater numbers of OC symptoms and greater symptom severity. Patients with PWS have elevated numbers of OC symptoms and significant symptom-related impairment which are not explained by developmental delay, food-related difficulties, or obesity. OC symptoms are part of a behavioral phenotype that accompanies deletions on the proximal long arm of chromosome 15 in PWS.

Severely Aggressive Children Receiving Stimulant Medication Versus Stimulant and Risperidone: 12-Month Follow-Up of the TOSCA Trial.

PubMed

Gadow, Kenneth D; Brown, Nicole V; Arnold, L Eugene; Buchan-Page, Kristin A; Bukstein, Oscar G; Butter, Eric; Farmer, Cristan A; Findling, Robert L; Kolko, David J; Molina, Brooke S G; Rice, Robert R; Schneider, Jayne; Aman, Michael G

2016-06-01

The objective of this study was to evaluate 52-week clinical outcomes of children with co-occurring attention-deficit/hyperactivity disorder (ADHD), disruptive behavior disorder, and serious physical aggression who participated in a prospective, longitudinal study that began with a controlled, 9-week clinical trial comparing the relative efficacy of parent training + stimulant medication + placebo (Basic; n = 84) versus parent training + stimulant + risperidone (Augmented; n = 84). Almost two-thirds (n = 108; 64%) of families in the 9-week study participated in week 52 follow-ups (Basic, n = 55; Augmented, n = 53) and were representative of the initial study sample. The assessment battery included caregiver and clinician ratings and laboratory tests. Only 43% of participants in the Augmented group and 36% in the Basic group still adhered to their assigned regimen (not significant [NS]); 23% of those in the Augmented group and 11% in the Basic group were taking no medication (NS). Both randomized groups improved baseline to follow-up, but the 3 primary parent-reported behavioral outcomes showed no significant between-group differences. Exploratory analyses indicated that participants in the Augmented group (65%) were more likely (p = .02) to have a Clinical Global Impressions (CGI) severity score of 1 to 3 (i.e., normal to mildly ill) at follow-up than those in the Basic group (42%). Parents rated 45% of children as impaired often or very often from ADHD, noncompliant, or aggressive behavior. The Augmented group had elevated prolactin levels, and the Basic group had decreased weight over time. Findings were generally similar whether groups were defined by randomized assignment or follow-up treatment status. Both treatment strategies were associated with clinical improvement at follow-up, and primary behavioral outcomes did not differ significantly. Many children evidenced lingering mental health concerns, suggesting the need for additional research into more effective interventions. Clinical trial registration information-Treatment of Severe Childhood Aggression (the TOSCA Study); http://clinicaltrials.gov/; NCT00796302. Published by Elsevier Inc.

Corticosteroid therapy in regressive autism: a retrospective study of effects on the Frequency Modulated Auditory Evoked Response (FMAER), language, and behavior

PubMed Central

2014-01-01

Background Up to a third of children with Autism Spectrum Disorder (ASD) manifest regressive autism (R-ASD).They show normal early development followed by loss of language and social skills. Absent evidence-based therapies, anecdotal evidence suggests improvement following use of corticosteroids. This study examined the effects of corticosteroids for R-ASD children upon the 4 Hz frequency modulated evoked response (FMAER) arising from language cortex of the superior temporal gyrus (STG) and upon EEG background activity, language, and behavior. An untreated clinical convenience sample of ASD children served as control sample. Methods Twenty steroid-treated R-ASD (STAR) and 24 not-treated ASD patients (NSA), aged 3 - 5 years, were retrospectively identified from a large database. All study participants had two sequential FMAER and EEG studies;Landau-Kleffner syndrome diagnosis was excluded. All subjects’ records contained clinical receptive and expressive language ratings based upon a priori developed metrics. The STAR group additionally was scored behaviorally regarding symptom severity as based on the Diagnostic and Statistical Manual IV (DSM-IV) ASD criteria list. EEGs were visually scored for abnormalities. FMAER responses were assessed quantitatively by spectral analysis. Treated and untreated group means and standard deviations for the FMAER, EEG, language, and behavior, were compared by paired t-test and Fisher’s exact tests. Results The STAR group showed a significant increase in the 4 Hz FMAER spectral response and a significant reduction in response distortion compared to the NSA group. Star group subjects’ language ratings were significantly improved and more STAR than NSA group subjects showed significant language improvement. Most STAR group children showed significant behavioral improvement after treatment. STAR group language and behavior improvement was retained one year after treatment. Groups did not differ in terms of minor EEG abnormalities. Steroid treatment produced no lasting morbidity. Conclusions Steroid treatment was associated with a significantly increased FMAER response magnitude, reduction of FMAER response distortion, and improvement in language and behavior scores. This was not observed in the non-treated group. These pilot findings warrant a prospective randomized validation trial of steroid treatment for R-ASD utilizing FMAER, EEG, and standardized ASD, language and behavior measures, and a longer follow-up period. Please see related article http://www.biomedcentral.com/1741-7015/12/79 PMID:24885033

Family behavior, adaptation, and treatment adherence of pediatric nephrology patients.

PubMed

Davis, M C; Tucker, C M; Fennell, R S

1996-04-01

In this exploratory study we investigated the relationships among family behavior variables (e.g., family expressiveness), adaptive functioning skills, maladaptive behavior, and adherence to treatment in pediatric renal failure patients. The study included 22 pediatric outpatients with renal failure who had not yet received dialysis or transplantation (RF) and their parents, and 12 pediatric outpatients with kidney transplants (TX) and their parents. For the RF patients, significant correlations were found between some of their adaptive functioning skills and measures of their medication adherence, diet adherence, and clinic appointment adherence; however, for the TX patients significant correlations were found only between some of their adaptive functioning skills and measures of their medication adherence. For the RF patients only, some measures of their family behavior were significantly correlated with measures of their medication adherence and diet adherence. Additionally, some measures of the RF patients' family behavior were significantly related to their communication skills, socialization skills, overall adaptive functioning skills, and maladaptive behavior. For the TX patients, only their socialization skill level was significantly correlated with one measure of their family behavior. It is concluded that facilitation of adaptive and physical functioning among renal pediatric patients likely requires multidimensional training and/or counselling interventions with the children and their families, and that some of the content and/or emphasis of this training likely needs to differ for RF patients versus TX patients.

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

Predictors of aggression on the psychiatric inpatient service: self-esteem, narcissism, and theory of mind deficits.

PubMed

Goldberg, Brett R; Serper, Mark R; Sheets, Michelle; Beech, Danielle; Dill, Charles; Duffy, Kristine G

2007-05-01

Aggressive behavior committed by inpatients has significant negative effects on patients, clinical staff, the therapeutic milieu, and inpatient community as whole. Past research examining nonpsychiatric patient groups has suggested that elevated self-esteem and narcissism levels as well as self-serving theory of mind (ToM) biases may be robust predictors of aggressive behavior. In the present study, we examined whether these constructs were useful in predicting aggressive acts committed by psychiatric inpatients. Severity of psychiatric symptoms, demographic variables and patients' anger, and hostility severity were also examined. We found patients who committed acts of aggression were differentiated from their nonaggressive counterparts by exhibiting significantly higher levels of self-esteem and narcissistic superiority. In addition, aggressors demonstrated self-serving ToM biases, attributing more positive attributes to themselves, relative to their perceptions of how others viewed them. Aggressors also showed increased psychosis, fewer depressive symptoms, and had significantly fewer years of formal education than their nonaggressive peers. These results support and extend the view that in addition to clinical variables, specific personality traits and self-serving attributions are linked to aggressive behavior in acutely ill psychiatric patients.

Yohimbine Increases Opioid-Seeking Behavior in Heroin-Dependent, Buprenorphine-Maintained Individuals

PubMed Central

Greenwald, Mark K.; Lundahl, Leslie H.; Steinmiller, Caren L.

2012-01-01

Rationale In laboratory animals, the biological stressor yohimbine (α2-noradrenergic autoreceptor antagonist) promotes drug seeking. Human laboratory studies have demonstrated that psychological stressors can increase drug craving but not that stressors alter drug seeking. Objectives This clinical study tested whether yohimbine increases opioid seeking behavior. Methods Ten heroin-dependent, buprenorphine (8-mg/day) stabilized volunteers, sampled two doses of hydromorphone (12 and 24 mg IM in counterbalanced order, labeled Drug A [session 1] and Drug B [session 2]). During each of six later sessions (within-subject, double blind, randomized crossover design), volunteers could respond on a 12-trial choice progressive ratio task to earn units (1 or 2 mg) of the sampled hydromorphone dose (Drug A or B) vs. money ($2) following different oral yohimbine pretreatment doses (0, 16.2 and 32.4 mg). Results Behavioral economic demand intensity and peak responding (Omax) were significantly higher for hydromorphone 2-mg than 1-mg. Relative to placebo, yohimbine significantly increased hydromorphone demand inelasticity, more so for hydromorphone 1-mg units (Pmax = 909, 3647 and 3225 for placebo, 16.2 and 32.4 mg yohimbine doses, respectively) than hydromorphone 2-mg units (Pmax = 2656, 3193 and 3615, respectively). Yohimbine produced significant but clinically modest dose-dependent increases in blood pressure (systolic ≈15 and diastolic ≈10 mmHg) and opioid withdrawal symptoms, and decreased opioid agonist symptoms and elated mood. Conclusions These findings concur with preclinical data by demonstrating that yohimbine increases drug seeking; in this study, these effects occurred without clinically significant subjective distress or elevated craving, and partly depended on opioid unit dose. PMID:23161001

Prevalence and associated behavioral symptoms of depression in mild cognitive impairment and dementia due to Alzheimer's disease.

PubMed

Van der Mussele, Stefan; Bekelaar, Kim; Le Bastard, Nathalie; Vermeiren, Yannick; Saerens, Jos; Somers, Nore; Mariën, Peter; Goeman, Johan; De Deyn, Peter P; Engelborghs, Sebastiaan

2013-09-01

Mild cognitive impairment (MCI) is a clinical concept that categorizes subjects who are in an intermediate cognitive state between normal aging and dementia. The aims of this study are to determine the prevalence of significant depressive symptoms in MCI and Alzheimer's disease (AD) patients and to characterize the behavior associated with significant depressive symptoms in MCI and AD patients. A cross-sectional analysis of baseline data from a prospective, longitudinal study on behavioral symptoms of dementia and MCI was performed. The study population consisted of 270 MCI and 402 AD patients. Behavioral assessment was performed by means of Middelheim Frontality Score, Behavioral Pathology in Alzheimer's Disease Rating Scale (Behave-AD) and Cohen-Mansfield Agitation Inventory. The presence of significant depressive symptoms was defined as a Cornell Scale for Depression in Dementia total score >7. The prevalence of significant depressive symptoms in AD patients (25%) was higher compared with MCI patients (16%) (p = 0.005). Patients with significant depressive symptoms showed an increased severity of frontal lobe symptoms, behavioral symptoms and agitation (Middelheim Frontality Score, Behave-AD and Cohen-Mansfield Agitation Inventory total scores; p < 0.001). Also, most of the individual frontal lobe and behavioral symptoms were more prevalent and severe, resulting in higher Behave-AD global scores. Mild cognitive impairment patients with depressive symptoms showed more severe behavioral symptoms and more severe verbally agitated behavior than AD patients without depressive symptoms (p < 0.001). Frontal lobe and behavioral symptoms are more prevalent and severe in MCI and AD patients with significant depressive symptoms as compared with patients without depressive symptoms. Copyright © 2012 John Wiley & Sons, Ltd.

Problem solving moderates the effects of life event stress and chronic stress on suicidal behaviors in adolescence.

PubMed

Grover, Kelly E; Green, Kelly L; Pettit, Jeremy W; Monteith, Lindsey L; Garza, Monica J; Venta, Amanda

2009-12-01

The present study examined the unique and interactive effects of stress and problem-solving skills on suicidal behaviors among 102 inpatient adolescents. As expected, life event stress and chronic stress each significantly predicted suicidal ideation and suicide attempt. Problem solving significantly predicted suicidal ideation, but not suicide attempt. Problem solving moderated the associations between life event stress and suicidal behaviors, as well as between chronic stress and suicidal ideation, but not chronic stress and suicide attempt. At high levels of stress, adolescents with poor problem-solving skills experienced elevated suicidal ideation and were at greater risk of making a nonfatal suicide attempt. The interactive effects decreased to non-significance after controlling for depressive symptoms and hopelessness. Clinical implications are discussed.

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.

Effects of a synthetic facial pheromone on behavior of cats.

PubMed

Griffith, C A; Steigerwald, E S; Buffington, C A

2000-10-15

TO evaluate the effects of a synthetic feline facial pheromone (FFP) on behavior and food intake of healthy versus clinically ill cats. Original study. 20 cats were used in each of 2 studies. In each study, 7 cats were considered healthy, and 13 cats were determined to be clinically ill. In study 1, cats were assigned either to exposure to FFP (treated group; 4 healthy, 6 ill cats) or to exposure to the vehicle (70% ethanol solution; control group; 3 healthy, 7 ill cats). Cats were placed in a cage containing a small cotton towel that had been sprayed with FFP or vehicle 30 minutes previously. Cats were then videotaped for 125 minutes, and food intake was measured during this period. Videotapes were scored at 5-minute intervals for various behaviors. In study 2, cats were categorized in 1 of 2 groups; group 1 (2 healthy, 8 ill cats) had a cat carrier placed in their cages, and group 2 (5 healthy, 5 ill cats) did not. All cats were exposed to FFP, and 24-hour food intake was measured. Differences between behaviors of healthy versus clinically ill cats were not identified. In the first study, significant increases in grooming and interest in food were found in cats exposed to FFP compared with vehicle. For all cats, significant positive correlations were detected between grooming and facial rubbing, walking and facial rubbing, interest in food and facial rubbing, eating and facial rubbing, grooming and interest in food, and grooming and eating. In the second study, 24-hour food intake was significantly greater in cats exposed to FFP and the cat carrier, compared with cats exposed to FFP alone. Results suggest that exposure to FFP may be useful to increase food intake of hospitalized cats.

Assessing MSW Students' Integrated Behavioral Health Skills Using an Objective Structured Clinical Examination

ERIC Educational Resources Information Center

Sampson, McClain; Parrish, Danielle E.; Washburn, Micki

2018-01-01

Within the last decade, there has been a significant shift in the field of social work toward competency-based education. This article details the use of the Objective Structured Clinical Examination (OSCE) Adapted for Social Work Performance Rating Scale. We used the measure to evaluate specific practice competencies among students (n = 33)…

U.S. health professionals' views on obesity care, training, and self-efficacy.

PubMed

Bleich, Sara N; Bandara, Sachini; Bennett, Wendy L; Cooper, Lisa A; Gudzune, Kimberly A

2015-04-01

Despite emphasis of recent guidelines on multidisciplinary teams for collaborative weight management, little is known about non-physician health professionals' perspectives on obesity, their weight management training, and self-efficacy for obesity care. To evaluate differences in health professionals' perspectives on (1) the causes of obesity; (2) training in weight management; and (3) self-efficacy for providing obesity care. Data were obtained from a cross-sectional Internet-based survey of 500 U.S. health professionals from nutrition, nursing, behavioral/mental health, exercise, and pharmacy (collected from January 20 through February 5, 2014). Inferences were derived using logistic regression adjusting for age and education (analyzed in 2014). Nearly all non-physician health professionals, regardless of specialty, cited individual-level factors, such as overconsumption of food (97%), as important causes of obesity. Nutrition professionals were significantly more likely to report high-quality training in weight management (78%) than the other professionals (nursing, 53%; behavioral/mental health, 32%; exercise, 50%; pharmacy, 47%; p<0.05). Nutrition professionals were significantly more likely to report high confidence in helping obese patients achieve clinically significant weight loss (88%) than the other professionals (nursing, 61%; behavioral/mental health, 51%; exercise, 52%; pharmacy, 61%; p<0.05), and more likely to perceive success in helping patients with obesity achieve clinically significant weight loss (nutrition, 81%; nursing, behavioral/mental health, exercise, and pharmacy, all <50%; p<0.05). Nursing, behavioral/mental health, exercise, and pharmacy professionals may need additional training in weight management and obesity care to effectively participate in collaborative weight management models. Copyright © 2015 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Effect of parent training vs parent education on behavioral problems in children with autism spectrum disorder: a randomized clinical trial.

PubMed

Bearss, Karen; Johnson, Cynthia; Smith, Tristram; Lecavalier, Luc; Swiezy, Naomi; Aman, Michael; McAdam, David B; Butter, Eric; Stillitano, Charmaine; Minshawi, Noha; Sukhodolsky, Denis G; Mruzek, Daniel W; Turner, Kylan; Neal, Tiffany; Hallett, Victoria; Mulick, James A; Green, Bryson; Handen, Benjamin; Deng, Yanhong; Dziura, James; Scahill, Lawrence

2015-04-21

Disruptive behavior is common in children with autism spectrum disorder. Behavioral interventions are used to treat disruptive behavior but have not been evaluated in large-scale randomized trials. To evaluate the efficacy of parent training for children with autism spectrum disorder and disruptive behavior. This 24-week randomized trial compared parent training (n = 89) to parent education (n = 91) at 6 centers (Emory University, Indiana University, Ohio State University, University of Pittsburgh, University of Rochester, Yale University). We screened 267 children; 180 children (aged 3-7 years) with autism spectrum disorder and disruptive behaviors were randomly assigned (86% white, 88% male) between September 2010 and February 2014. Parent training (11 core, 2 optional sessions; 2 telephone boosters; 2 home visits) provided specific strategies to manage disruptive behavior. Parent education (12 core sessions, 1 home visit) provided information about autism but no behavior management strategies. Parents rated disruptive behavior and noncompliance on co-primary outcomes: the Aberrant Behavior Checklist-Irritability subscale (range, 0-45) and the Home Situations Questionnaire-Autism Spectrum Disorder (range, 0-9). On both measures, higher scores indicate greater severity and a 25% reduction indicates clinical improvement. A clinician blind to treatment assignment rated the Improvement scale of the Clinical Global Impression (range, 1-7), a secondary outcome, with a positive response less than 3. At week 24, the Aberrant Behavior Checklist-Irritability subscale declined 47.7% in parent training (from 23.7 to 12.4) compared with 31.8% for parent education (23.9 to 16.3) (treatment effect, -3.9; 95% CI, -6.2 to -1.7; P < .001, standardized effect size = 0.62). The Home Situations Questionnaire-Autism Spectrum Disorder declined 55% (from 4.0 to 1.8) compared with 34.2% in parent education (3.8 to 2.5) (treatment effect, -0.7; 95% CI, -1.1 to -0.3; P < .001, standardized effect size = 0.45). Neither measure met the prespecified minimal clinically important difference. The proportions with a positive response on the Clinical Global Impression-Improvement scale were 68.5% for parent training vs 39.6% for parent education (P < .001). For children with autism spectrum disorder, a 24-week parent training program was superior to parent education for reducing disruptive behavior on parent-reported outcomes, although the clinical significance of the improvement is unclear. The rate of positive response judged by a blinded clinician was greater for parent training vs parent education. clinicaltrials.gov Identifier: NCT01233414.

Guanfacine Use in Children With Down Syndrome and Comorbid Attention-Deficit Hyperactivity Disorder (ADHD) With Disruptive Behaviors.

PubMed

Capone, George T; Brecher, Liza; Bay, Mihee

2016-07-01

The purpose of this study was to characterize children with Down syndrome and attention-deficit hyperactivity disorder (ADHD) with disruptive behaviors using the Aberrant Behavior Checklist (ABC), and to measure the treatment effects of guanfacine on maladaptive behaviors. Subjects were enrolled from a group of outpatients who visited our clinic between 2002 and 2007. Subjects (N = 23) were children with Down syndrome ages 4 to 12 years (mean 7.4 ± 4.1), who met criteria for ADHD according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition The Aberrant Behavior Checklist Irritability and Hyperactivity subscales each showed a significant decrease (P < .0001) at follow-up. The mean decline on Hyperactivity was 25% (-7.8 points), and for Irritability, 25% (-3.5 points). The mean composite score also declined by 24% (-12 points). Effect size differences on Irritability were moderate, whereas differences on Hyperactivity and composite score appeared large. Clinically important target behaviors were reduced. Medication was generally well tolerated and the incidence of treatment emergent side effects remained low. © The Author(s) 2016.

Externalizing behavior from early childhood to adolescence: Prediction from inhibition, language, parenting, and attachment.

PubMed

Roskam, Isabelle

2018-03-22

The aim of the current research was to disentangle four theoretically sound models of externalizing behavior etiology (i.e., attachment, language, inhibition, and parenting) by testing their relation with behavioral trajectories from early childhood to adolescence. The aim was achieved through a 10-year prospective longitudinal study conducted over five waves with 111 referred children aged 3 to 5 years at the onset of the study. Clinical referral was primarily based on externalizing behavior. A multimethod (questionnaires, testing, and observations) approach was used to estimate the four predictors in early childhood. In line with previous studies, the results show a significant decrease of externalizing behavior from early childhood to adolescence. The decline was negatively related to mothers' coercive parenting and positively related to attachment security in early childhood, but not related to inhibition and language. The study has implications for research into externalizing behavior etiology recommending to gather hypotheses from various theoretically sound models to put them into competition with one another. The study also has implications for clinical practice by providing clear indications for prevention and early intervention.

Parenting Latino Toddlers and Preschoolers: Clinical and Nonclinical Samples

ERIC Educational Resources Information Center

Perez, Maria E.; Fox, Robert A.

2008-01-01

Parenting practices contribute significantly to the social-emotional development of young children. There is limited literature that addresses the role of culture in parenting, particularly among Latino families who have very young children with significant behavior problems. The current study compared the parenting practices of 30 low-income…

Evaluating outpatient behavior therapy of sex offenders. A pretest-posttest study.

PubMed

Crolley, J; Roys, D; Thyer, B A; Bordnick, P S

1998-10-01

This study compared the entrance and exit scores of 16 patients completing treatment at the Highland Institute for Behavioral Change (HIBC), an outpatient program specializing in the behavioral treatment of sex offenders. Outcome measures included the Minnesota Multiphasic Personality Inventory (MMPI), the Multiphasic Sexual Inventory, and recidivism (rearrest record) posttreatment. Statistically significant and clinical improvements were obtained on a number of these measures. One of the 16 graduates reoffended during the average follow-up period of 26 months (he is now incarcerated). These data are supportive of the contention that outpatient behavior therapy can be effective in reducing deviant sexual arousal and in enhancing appropriate consensual sexual behavior.

Psychological Well-Being and Family Environment of Siblings of Children with Life Threatening Illness.

PubMed

Humphrey, Lisa M; Hill, Douglas L; Carroll, Karen W; Rourke, Mary; Kang, Tammy I; Feudtner, Chris

2015-11-01

The psychological well-being of siblings of children with life threatening illness remains largely uncharted. Pediatric cancer research suggests that a supportive family environment may protect the psychological well-being of siblings. We hypothesized that (1) siblings of pediatric palliative care patients would show clinical/behavioral scores that were elevated but that rates of serious psychopathology would be comparable to the general population of children their age; and (2) higher family functioning scores would be associated with lower clinical scores and higher adaptive scores for these siblings. We conducted an observational study with families in which a patient receiving palliative care had one or more siblings between the ages of 6 and 11. Parents completed the Behavioral Assessment System for Children, Second Edition (BASC-2) to assess the siblings' psychological well-being and the Family Assessment Device (FAD) to assess the family environment. Twenty-four parents reported data for 30 siblings. Only three siblings scored in the clinical range on a BASC-2 composite clinical scale, and 11 siblings scored in the at-risk range on one or more composite scales. Higher FAD scores predicted significantly higher externalization composite clinical scores (7.54, 95% CI: 1.12, 13.97, p < 0.05) and significantly higher behavioral composite scores (7.88, 95% CI: 1.55, 14.21, p < 0.05). Siblings of pediatric palliative care patients are not experiencing lower psychological well-being than the general population. The prediction that a positive family environment would be associated with higher levels of psychological health was supported.

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.

Antisocial Behavioral Syndromes and DSM-IV Drug Use Disorders in the United States: Results from the National Epidemiologic Survey on Alcohol and Related Conditions

PubMed Central

Goldstein, Risë B.; Compton, Wilson M.; Pulay, Attila J.; Ruan, W. June; Pickering, Roger P.; Stinson, Frederick S.; Grant, Bridget F.

2008-01-01

Background Antisocial behavioral syndromes, including antisocial personality disorder (ASPD), syndromal adult antisocial behavior (AABS) without conduct disorder (CD) before age 15, and CD without progression to ASPD (“CD only”) are highly comorbid with drug use disorders (DUDs). Among patients in DUD treatment, antisocial syndromes are associated with greater severity and poorer outcomes. Comparative data concerning associations of antisocial syndromes with clinical characteristics of DUDs among general population adults have not previously been available. This study describes associations of antisocial syndromes with clinical characteristics of lifetime Diagnostic and Statistical Manual – Version IV DUDs in the general U.S. adult population. Methods This report is based on the 2001–2002 National Epidemiologic Survey on Alcohol and Related Conditions (n=43,093, response rate=81%). Respondents (n=4,068) with lifetime DUDs were classified according to whether they met criteria for ASPD, AABS, “CD only,” or no antisocial syndrome. Associations of antisocial syndromes with clinical characteristics of DUDs were examined using logistic regression. Results Antisocial syndromes were significantly associated with the phenomenology of DUDs, particularly ASPD with the most severe clinical presentations. Associations with AABS were similar to those with ASPD; those with “CD only” were weak, inconsistent, and not statistically significant. Patterns of associations differed little between men and women. Conclusions Both ASPD and AABS, but not “CD only,” appear to identify greater clinical severity of DUDs among adults in the general U.S. population. PMID:17433571

Sex addiction and gambling disorder: similarities and differences.

PubMed

Farré, J M; Fernández-Aranda, F; Granero, R; Aragay, N; Mallorquí-Bague, N; Ferrer, V; More, A; Bouman, W P; Arcelus, J; Savvidou, L G; Penelo, E; Aymamí, M N; Gómez-Peña, M; Gunnard, K; Romaguera, A; Menchón, J M; Vallès, V; Jiménez-Murcia, S

2015-01-01

Recently, the DSM-5 has developed a new diagnostic category named "Substance-related and Addictive Disorders". This category includes gambling disorder (GD) as the sole behavioral addiction, but does not include sex addiction (SA). The aim of this study is to investigate whether SA should be classified more closely to other behavioral addictions, via a comparison of the personality characteristics and comorbid psychopathology of individuals with SA with those of individuals with GD, which comes under the category of addiction and related disorders. The sample included 59 patients diagnosed with SA, who were compared to 2190 individuals diagnosed with GD and to 93 healthy controls. Assessment measures included the Diagnostic Questionnaire for Pathological Gambling, the South Oaks Gambling Screen, the Symptom CheckList-90 Items-Revised and the Temperament and Character Inventory-Revised. No statistically significant differences were found between the two clinical groups, except for socio-economic status. Although statistically significant differences were found between both clinical groups and controls for all scales on the SCL-90, no differences were found between the two clinical groups. The results were different for personality characteristics: logistic regression models showed that sex addictive behavior was predicted by a higher education level and by lower scores for TCI-R novelty-seeking, harm avoidance, persistence and self-transcendence. Being employed and lower scores in cooperativeness also tended to predict the presence of sex addiction. While SA and GD share some psychopathological and personality traits that are not present in healthy controls, there are also some diagnostic-specific characteristics that differentiate between the two clinical groups. These findings may help to increase our knowledge of phenotypes existing in behavioral addictions. Copyright © 2014 Elsevier Inc. All rights reserved.

Differential Contributions of Selective Attention and Sensory Integration to Driving Performance in Healthy Aging and Alzheimer's Disease.

PubMed

Venkatesan, Umesh M; Festa, Elena K; Ott, Brian R; Heindel, William C

2018-05-01

Patients with Alzheimer's disease (AD) demonstrate deficits in cross-cortical feature binding distinct from age-related changes in selective attention. This may have consequences for driving performance given its demands on multisensory integration. We examined the relationship of visuospatial search and binding to driving in patients with early AD and elderly controls (EC). Participants (42 AD; 37 EC) completed search tasks requiring either luminance-motion (L-M) or color-motion (C-M) binding, analogs of within and across visual processing stream binding, respectively. Standardized road test (RIRT) and naturalistic driving data (CDAS) were collected alongside clinical screening measures. Patients performed worse than controls on most cognitive and driving indices. Visual search and clinical measures were differentially related to driving behavior across groups. L-M search and Trail Making Test (TMT-B) were associated with RIRT performance in controls, while C-M binding, TMT-B errors, and Clock Drawing correlated with CDAS performance in patients. After controlling for demographic and clinical predictors, L-M reaction time significantly predicted RIRT performance in controls. In patients, C-M binding made significant contributions to CDAS above and beyond demographic and clinical predictors. RIRT and C-M binding measures accounted for 51% of variance in CDAS performance in patients. Whereas selective attention is associated with driving behavior in EC, cross-cortical binding appears most sensitive to driving in AD. This latter relationship may emerge only in naturalistic settings, which better reflect patients' driving behavior. Visual integration may offer distinct insights into driving behavior, and thus has important implications for assessing driving competency in early AD. (JINS, 2018, 24, 486-497).

Does the therapy manual or the therapist matter most in treatment of obsessive-compulsive disorder? A randomized controlled trial of exposure with response or ritual prevention in 118 patients.

PubMed

van Oppen, Patricia; van Balkom, Anton J L M; Smit, Johannes H; Schuurmans, Josien; van Dyck, Richard; Emmelkamp, Paul M G

2010-09-01

The importance of the therapist's education and experience for the successful behavior treatment of obsessive-compulsive disorder (OCD) has not been investigated. Data on the relative effectiveness of self-controlled versus therapist-controlled in vivo exposure with response or ritual prevention (ERP) have yielded conflicting results. The present study compared the effectiveness of 4 different modes of delivery of ERP in a referred sample of OCD patients. Of the 146 eligible OCD outpatients, 118 patients enrolled in this randomized controlled trial and were randomly assigned to (1) therapist-controlled ERP performed by experienced behavior therapists; (2) therapist-controlled ERP performed by master's students of clinical psychology; (3) self-controlled ERP performed by experienced behavior therapists; and (4) self-controlled ERP performed by master's students of clinical psychology. This trial was performed from January 1999 to January 2005. Our analyses revealed no significant differences in clinical outcome between any of the different modes of delivery of ERP at posttreatment. The different ERP modes of delivery were associated with significant pretreatment to posttreatment improvement on all measurements, with large effect sizes on the primary outcome measure, the Yale-Brown Obsessive Compulsive Scale. Our results indicate that clinically inexperienced master's students with no postgraduate training can be as capable as experienced and certified behavior therapists in treating OCD patients, as long as therapists adhere to a standardized treatment manual and adequate training and supervision is provided. In contrast to other studies, we did not find a supposed benefit of therapist-controlled ERP versus self-controlled ERP in patients with OCD. www.trialregister.nl Identifier: NTR1444. © Copyright 2010 Physicians Postgraduate Press, Inc.

The Effectiveness of Ultra-Low Magnitude Reinforcers: Findings From a "Real-World" Application of Contingency Management.

PubMed

Kropp, Frankie; Lewis, Daniel; Winhusen, Theresa

2017-01-01

Research has consistently found contingency management (CM) to be an effective tool in increasing desired patient behaviors in substance use disorder (SUD) treatment. Despite the strong evidence for the effectiveness of this intervention, practical issues and the cost of implementing CM in treatment programs have been significant barriers to adoption. To evaluate the impact of a CM program designed and implemented by university-affiliated methadone clinic staff to increase patient group attendance. The CM program consisted of a weekly raffle for patients attending clinician-led group counseling and/or in-clinic Methadone Anonymous (MA) groups in which slips with patient ID#s were entered and one ID slip was drawn per week with a fee credit for a dose of methadone ($15) as the prize. The CM program continued for 12 months. Group attendance was tracked before, during, and after CM implementation as part of ongoing clinic service utilization monitoring. Following the implementation of CM, attendance at any clinician-led or MA groups increased significantly from baseline to month 1 (X 2 =5.78, p<0.05) but this increase was not sustained beyond month 6. Analysis of attendance by type of group revealed that clinician-led group attendance did not increase significantly but there was a significant increase in in-clinic MA group attendance from baseline to month 1 (X 2 =20.27, p<0.001), which was sustained through the 12-month implementation period (X 2 =11.21, p<0.001) and through 3 months post-implementation (X 2 =14.73; p<0.001). A low-cost, simple CM intervention implemented by clinic staff was associated with significant increases in the target behavior of increasing group attendance. Copyright © 2016 Elsevier Inc. All rights reserved.

A Case of Mental Retardation with Paraphilia Treated with Depot Leuprorelin

PubMed Central

Park, Woo Sung; Kim, Kyung Min; Jung, Yong Woo

2014-01-01

Paraphilia is a psychiatric disease that has been difficult to cure. However, recently developed therapeutic methods hold promise. The patient was a 20-yr-old male with chief complaints of continuous masturbation, genital exposure, and aggressive behavior that started 2 yr ago. We administered leuprorelin 3.6 mg intramuscular injection per month, a depot gonadotrophin-releasing hormone analogue, to this patient who a severe mentally retardation with paraphilia. The clinical global impression (CGI)-severity, CGI-improvement and aberrant behavior checklist were performed. After one month, we observed significant improvement in symptoms, such as decreases of abnormal sexual behavior and sexual desire. The GnRH analogues are suggested to be used as an alternative or supplementary therapeutic method for sexual offenders after clinical studies. Graphical Abstract PMID:25246754

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.

How to influence patient oral hygiene behavior effectively.

PubMed

Clarkson, J E; Young, L; Ramsay, C R; Bonner, B C; Bonetti, D

2009-10-01

Considerable resources are expended in dealing with dental disease easily prevented with better oral hygiene. The study hypothesis was that an evidence-based intervention, framed with psychological theory, would improve patients' oral hygiene behavior. The impact of trial methodology on trial outcomes was also explored by the conducting of two independent trials, one randomized by patient and one by dentist. The study included 87 dental practices and 778 patients (Patient RCT = 37 dentists/300 patients; Cluster RCT = 50 dentists/478 patients). Controlled for baseline differences, pooled results showed that patients who experienced the intervention had better behavioral (timing, duration, method), cognitive (confidence, planning), and clinical (plaque, gingival bleeding) outcomes. However, clinical outcomes were significantly better only in the Cluster RCT, suggesting that the impact of trial design on results needs to be further explored.

Overprotective parenting and child anxiety: the role of co-occurring child behavior problems.

PubMed

Gere, Martina K; Villabø, Marianne A; Torgersen, Svenn; Kendall, Philip C

2012-08-01

The relationship between overprotective parenting and child anxiety has been examined repeatedly because theories emphasize its role in the maintenance of child anxiety. No study has yet tested whether this relationship is unique to child anxiety, by controlling for commonly co-occurring behavior problems within the same children. The current study examined 190 children (age 7-13, 118 [corrected] boys) referred to mental health clinics and their parents. Results revealed that significant correlations between overprotective parenting and child anxiety symptoms disappear after controlling for co-occurring child behavior symptoms. It appears that overprotection is not uniquely related to child anxiety. Furthermore, overprotective parenting was significantly and uniquely related to child behavior symptoms. Researchers and practitioners need to consider co-occurring child behavior problems when working with the parents of anxious children. Copyright © 2012 Elsevier Ltd. All rights reserved.

Increased cooperative behavior across remitted bipolar I disorder and major depression: Insights utilizing a behavioral economic trust game.

PubMed

Ong, Desmond C; Zaki, Jamil; Gruber, June

2017-01-01

Mood disorders impact social functioning, but might contribute to experiences-like affective distress-that might result in increased cooperative behavior under certain circumstances. We recruited participants with a history of bipolar I disorder (n = 28), major depressive disorder (n = 30), and healthy controls (n = 27)-to play a well-validated behavioral economic Trust Game, a task that provides a well-controlled experimental scenario, to measure cooperative behavior for the first time across both groups. Both remitted mood-disordered groups cooperated significantly more than the control group, but did not differ from one another. These results suggest that, in some contexts, a history of mood disturbance can produce enhanced cooperation, even in the absence of current mood symptoms. We discuss the clinical significance of enhanced cooperation in mood disorders and point to key directions for future research. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Feasibility of Conducting Autism Biomarker Research in the Clinical Setting.

PubMed

Sices, Laura; Pawlowski, Katherine; Farfel, Laura; Phillips, Deirdre; Howe, Yamini; Cochran, David M; Choueiri, Roula; Forbes, Peter W; Brewster, Stephanie J; Frazier, Jean A; Neumeyer, Ann; Bridgemohan, Carolyn

2017-09-01

Recruitment and completion of research activities during regular clinical care has the potential to increase research participation in complex neurodevelopmental disorders. We evaluated the feasibility, and effect on clinical care, of conducting biomarker research within a subspecialty clinical visit for autism spectrum disorder (ASD). Children, aged 5 to 10 years, were recruited by providers in ASD clinics at 5 institutions. Biomarkers collected were growth measurements, head circumference, neurologic and dysmorphology examinations, digit ratio (2D:4D) measurement, and platelet serotonin and urinary melatonin sulfate excretion levels. Parents completed the Aberrant Behavior Checklist-Community and a medical/demographic questionnaire. Cognitive level was abstracted from the medical record. Parents and clinicians completed surveys on the effect of the study on the clinical visit. Eighty-three children and their caregivers participated. Factors limiting participation included difficulty reaching families by phone and parent concern about the study blood draw requirement. All children completed at least 4 of 7 planned research activities. Demographic factors, educational placement, and child behavior were not associated with completion of study activities. Lower nonverbal cognitive function was weakly associated with fewer activities completed. Forty-four percent of clinicians reported an effect of the research study on the clinical visit. However, neither parent-reported nor clinician-reported effect was associated with the degree of study activity completion. Recruiting study participants in the context of scheduled ASD clinical visits required significant effort. However, once recruited, participants completed most study activities, regardless of behavioral symptom severity. Research activities did not adversely affect the clinical visit.

Cannabinoid type 1 receptor ligands WIN 55,212-2 and AM 251 alter anxiety-like behaviors of marmoset monkeys in an open-field test.

PubMed

Cagni, Priscila; Barros, Marilia

2013-03-01

Cannabinoid type 1 receptors (CB1r) are an important modulatory site for emotional behavior. However, little is known on the effects of CB1r ligands on emotionality aspects of primates, even with their highly similar behavioral response and receptor density/distribution as humans. Thus, we analyzed the effects of the CB1r agonist WIN 55,212-2 (WIN; 1mg/kg) and the antagonist AM 251 (AM; 2mg/kg), systemically administered prior to a single brief (15 min) exposure to a novel open-field (OF) environment, on the behavior of individually tested adult black tufted-ear marmosets. Both WIN- and AM-treated subjects, compared to vehicle controls, had significantly lower rates of long (contact) calls and exploration, while higher levels of vigilance-related behaviors (scan/glance); these are indicators of anxiolysis in this setup. Changes in locomotion were not detected. However, in the vehicle and AM-groups, sojourn in the peripheral zone of the OF was significantly higher than in its central region. WIN-treated marmosets spent an equivalent amount of time in both zones. Therefore, activation or blockade CB1r function prior to a short and individual exposure to an unfamiliar environment exerted a significant and complex influence on different behavioral indicators of anxiety in these monkeys (i.e., a partially overlapping anxiolytic-like profile). AM 251, however, has no anxiolytic effect when the time spent in the center of the OF is considered. This is a major difference when compared to the WIN-treated group. Data were compared to the response profile reported in other pre-clinical (rodent) and clinical studies. Copyright © 2012 Elsevier B.V. All rights reserved.

Centers of Excellence on Environmental Health Disparities Research

EPA Pesticide Factsheets

collaborative effort that encourages basic, biological, clinical, epidemiological, behavioral, and/or social scientific investigations of disease conditions that are known to be a significant burden in low socioeconomic and health disparate populations

Predicting outcome of Internet-based treatment for depressive symptoms.

PubMed

Warmerdam, Lisanne; Van Straten, Annemieke; Twisk, Jos; Cuijpers, Pim

2013-01-01

In this study we explored predictors and moderators of response to Internet-based cognitive behavioral therapy (CBT) and Internet-based problem-solving therapy (PST) for depressive symptoms. The sample consisted of 263 participants with moderate to severe depressive symptoms. Of those, 88 were randomized to CBT, 88 to PST and 87 to a waiting list control condition. Outcomes were improvement and clinically significant change in depressive symptoms after 8 weeks. Higher baseline depression and higher education predicted improvement, while higher education, less avoidance behavior and decreased rational problem-solving skills predicted clinically significant change across all groups. No variables were found that differentially predicted outcome between Internet-based CBT and Internet-based PST. More research is needed with sufficient power to investigate predictors and moderators of response to reveal for whom Internet-based therapy is best suited.

Early-Onset Bipolar Disorder: Characteristics and Outcomes in the Clinic.

PubMed

Connor, Daniel F; Ford, Julian D; Pearson, Geraldine S; Scranton, Victoria L; Dusad, Asha

2017-12-01

To assess patient characteristics and clinician-rated outcomes for children diagnosed with early-onset bipolar disorder in comparison to a depressive disorders cohort from a single clinic site. To assess predictors of bipolar treatment response. Medical records from 714 consecutive pediatric patients evaluated and treated at an academic tertiary child and adolescent psychiatry clinic between 2006 and 2012 were reviewed. Charts of bipolar children (n = 49) and children with depressive disorders (n = 58) meeting study inclusion/exclusion criteria were compared on variables assessing clinical characteristics, treatments, and outcomes. Outcomes were assessed by using pre- and post-Clinical Global Impressions (CGI)-Severity and Children's Global Assessment Scale (CGAS) scores, and a CGI-Improvement score ≤2 at final visit determined responder status. Bipolar outcome predictors were assessed by using multiple linear regression. Clinic prevalence rates were 6.9% for early-onset bipolar disorder and 1.5% for very early-onset bipolar disorder. High rates of comorbid diagnoses, symptom severity, parental stress, and child high-risk behaviors were found in both groups. The bipolar cohort had higher rates of aggression and higher lifetime systems of care utilization. The final CGI and CGAS outcomes for unipolar depression patients differed statistically significantly from those for the bipolar cohort, reflecting better clinical status and more improvement at outcome for the depression patients. Both parent-reported Child Behavior Checklist total T-score at clinic admission and the number of lifetime systems-of-care for the child were significantly and inversely associated with improvement for the bipolar cohort. Early-onset bipolar disorder is a complex and heterogeneous psychiatric disorder. Evidence-based treatment should emphasize psychopharmacology with adjunctive family and individual psychotherapy. Strategies to improve engagement in treatment may be especially important. Given high rates of high-risk behaviors in these youth, regular mental health follow-up to assess safety is important. Additional evidence-based treatments for pediatric bipolar disorder are needed.

Impulse control disorders in advanced Parkinson's disease with dyskinesia: The ALTHEA study.

PubMed

Biundo, Roberta; Weis, Luca; Abbruzzese, Giovanni; Calandra-Buonaura, Giovanna; Cortelli, Pietro; Jori, Maria Cristina; Lopiano, Leonardo; Marconi, Roberto; Matinella, Angela; Morgante, Francesca; Nicoletti, Alessandra; Tamburini, Tiziano; Tinazzi, Michele; Zappia, Mario; Vorovenci, Ruxandra Julia; Antonini, Angelo

2017-11-01

Impulse control disorders and dyskinesia are common and disabling complications of dopaminergic treatment in Parkinson's disease. They may coexist and are possibly related. The objectives of this study were to assess the frequency and severity of impulse control disorders in Parkinson's disease patients with dyskinesia. The ALTHEA study enrolled 251 Parkinson's disease patients with various degrees of dyskinesia severity from 11 movement disorders centers in Italy. Each patient underwent a comprehensive assessment including Unified Dyskinesia Rating Scale and the Questionnaire for Impulsive Compulsive Disorders in Parkinson Disease-Rating Scale. There was an overall 55% frequency of impulse control disorder and related behaviors (36% were clinically significant). The positive patients were younger at disease diagnosis and onset and had higher Unified Dyskinesia Rating Scale historical and total score (P = 0.001 and P = 0.02, respectively, vs negative). There was an increased frequency of clinically significant impulse control disorders in patients with severe dyskinesia (P = 0.013), a positive correlation between the questionnaire total score and dopamine agonist dose (P = 0.018), and a trend with levodopa dose. More than half of Parkinson's disease patients with dyskinesia have impulse control disorders and related behaviors, which are frequently clinically significant. Dopaminergic therapy total dose is associated with their severity. Clinicians should carefully assess patients with maladaptive behaviors and dyskinesia because they do not properly evaluate their motor and nonmotor status. © 2017 International Parkinson and Movement Disorder Society. © 2017 International Parkinson and Movement Disorder Society.

A partner-related risk behavior index to identify people at elevated risk for sexually transmitted infections.

PubMed

Crosby, Richard; Shrier, Lydia A

2013-04-01

The purpose of this study was to develop and test a sexual-partner-related risk behavior index to identify high-risk individuals most likely to have a sexually transmitted infection (STI). Patients from five STI and adolescent medical clinics in three US cities were recruited (N = 928; M age = 29.2 years). Data were collected using audio-computer-assisted self-interviewing. Of seven sexual-partner-related variables, those that were significantly associated with the outcomes were combined into a partner-related risk behavior index. The dependent variables were laboratory-confirmed infection with Chlamydia trachomatis, Neisseria gonorrhoeae, and/or Trichomonas vaginalis. Nearly one-fifth of the sample (169/928; 18.4%) tested positive for an STI. Three of the seven items were significantly associated with having one or more STIs: sex with a newly released prisoner, sex with a person known or suspected of having an STI, and sexual concurrency. In combined form, this three-item index was significantly associated with STI prevalence (p < .001). In the presence of three covariates (gender, race, and age), those classified as being at-risk by the index were 1.8 times more likely than those not classified as such to test positive for an STI (p < .001). Among individuals at risk for STIs, a three-item index predicted testing positive for one or more of three STIs. This index could be used to prioritize and guide intensified clinic-based counseling for high-risk patients of STI and other clinics.

Parents who hit and scream: interactive effects of verbal and severe physical aggression on clinic-referred adolescents' adjustment.

PubMed

LeRoy, Michelle; Mahoney, Annette; Boxer, Paul; Gullan, Rebecca Lakin; Fang, Qijuan

2014-05-01

The goals of this study were first, to delineate the co-occurrence of parental severe physical aggression and verbal aggression toward clinic-referred adolescents, and second, to examine the interactive effects of parental severe physical aggression and verbal aggression on adolescent externalizing and internalizing behavior problems. This research involved 239 referrals of 11- to 18-year-old youth and their dual-parent families to a non-profit, private community mental health center in a semi-rural Midwest community. Multiple informants (i.e., adolescents and mothers) were used to assess parental aggression and adolescent behavior problems. More than half of clinic-referred adolescents (51%) experienced severe physical aggression and/or high verbal aggression from one or both parents. A pattern of interactive effects of mother-to-adolescent severe physical aggression and verbal aggression on adolescent behavior problems emerged, indicating that when severe physical aggression was present, mother-to-adolescent verbal aggression was positively associated with greater adolescent behavior problems whereas when severe physical aggression was not present, the links between verbal aggression and behavior problems was no longer significant. No interactive effects were found for father-to-adolescent severe physical aggression and verbal aggression on adolescent adjustment; however, higher father-to-adolescent verbal aggression was consistently linked to behavior problems above and beyond the influence of severe physical aggression. The results of this study should promote the practice of routinely assessing clinic-referred adolescents and their parents about their experiences of verbal aggression in addition to severe physical aggression and other forms of abuse. Copyright © 2013 Elsevier Ltd. All rights reserved.

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.

Clinic Design as Placebo—Using Design to Promote Healing and Support Treatments

PubMed Central

Schuster, Kai

2017-01-01

Analogously to the medical placebo effect, people seem to anticipate the quality of treatments based on external stimuli. In order to gain insights on the effect the built environment can have on a person’s judgments and behavior with a particular focus on health related issues, a quantitative survey (N = 851) with four groups before and after the renovation of a rehabilitation clinic has been conducted. In line with an overall modernization of the clinic, the entrance, the lobby, and some patient rooms have been changed. In the lobby, a service counter and coffee bar have been added as well as light colors and new flooring material to achieve a more modern and clean atmosphere in the sense of aesthetical appearance of the space. The outcome revealed that patients rate the intention to change their health behavior as well as the quality of food or significantly higher in a modernized clinic. These differences cannot be directly attributed solely to the changes in the building. Analogously to the medical placebo, an effect referred to as design placebo effect is, therefore, proposed to explain improved ratings of aspects that have not directly been changed due to the intervention. Other significant effects are attributable to winter and summer climate. During summer time, ratings for waiting area, atmosphere, patient rooms, as well as for staff were significantly higher. It is, therefore, assumed that aesthetic attributes, such as architectural design, or friendliness of the weather, exert their effects as perceptual placebos that directly influence judgment outcomes and behavioral intentions. Further research is needed to match certain design and general environmental features to their effects on patients and investigate their effect strength. PMID:29120378

Clinic Design as Placebo-Using Design to Promote Healing and Support Treatments.

PubMed

Rehn, Jonas; Schuster, Kai

2017-11-09

Analogously to the medical placebo effect, people seem to anticipate the quality of treatments based on external stimuli. In order to gain insights on the effect the built environment can have on a person's judgments and behavior with a particular focus on health related issues, a quantitative survey ( N = 851) with four groups before and after the renovation of a rehabilitation clinic has been conducted. In line with an overall modernization of the clinic, the entrance, the lobby, and some patient rooms have been changed. In the lobby, a service counter and coffee bar have been added as well as light colors and new flooring material to achieve a more modern and clean atmosphere in the sense of aesthetical appearance of the space. The outcome revealed that patients rate the intention to change their health behavior as well as the quality of food or significantly higher in a modernized clinic. These differences cannot be directly attributed solely to the changes in the building. Analogously to the medical placebo, an effect referred to as design placebo effect is, therefore, proposed to explain improved ratings of aspects that have not directly been changed due to the intervention. Other significant effects are attributable to winter and summer climate. During summer time, ratings for waiting area, atmosphere, patient rooms, as well as for staff were significantly higher. It is, therefore, assumed that aesthetic attributes, such as architectural design, or friendliness of the weather, exert their effects as perceptual placebos that directly influence judgment outcomes and behavioral intentions. Further research is needed to match certain design and general environmental features to their effects on patients and investigate their effect strength.

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.

Antianxiety effect of cannabis: involvement of central benzodiazepine receptors.

PubMed

Sethi, B B; Trivedi, J K; Kumar, P; Gulati, A; Agarwal, A K; Sethi, N

1986-01-01

The present work, involving clinical, behavioral, and biochemical studies, was undertaken to elucidate the probable mechanism of the observed antianxiety effects of cannabis. The population for the clinical study consisted of 50 male chronic cannabis users who were otherwise healthy and 50 matched controls. When evaluated on Taylor's Manifest Anxiety Scale (TMA), these subjects had low anxiety scores as compared with the controls. To explore the possible interaction of cannabis with the benzodiazepine receptors, behavioral and biochemical studies in mice were devised, involving acute and chronic cannabis administration. Behavioral study revealed that mice under chronic cannabis treatment scored significantly higher on foot shock-induced aggression, but this was significantly blocked by benzodiazepine receptor antagonist. Furthermore, chronic cannabis treatment significantly (p less than 0.001) increased the frequency of licking response periodically punished by shocks. This confirms the antianxiety effect of cannabis, which also appears to be mediated through a benzodiazepine receptor, as it was reduced significantly (p less than 0.001) by a benzodiazepine receptor blocker. Specific 3H-diazepam binding was carried out in frontal cortex to assess both the population and affinity of benzodiazepine receptors. Our results indicate that acute cannabis treatment has no significant effect, whereas chronic cannabis treatment significantly increased 3H-diazepam binding as compared with controls. Scatchard analysis further reveals that increased affinity is responsible for increased binding to these receptors. It is therefore our contention that the antianxiety effect of cannabis is mediated through central benzodiazepine receptors.

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.

Compliance with behavioral guidelines for diet, physical activity and sedentary behaviors is related to insulin resistance among overweight and obese youth.

PubMed

Huang, Jeannie S; Gottschalk, Michael; Norman, Gregory J; Calfas, Karen J; Sallis, James F; Patrick, Kevin

2011-02-01

Overweight and obesity are established risk factors for insulin resistance in youth. A number of behavioral recommendations have been publicized with the goal of improving glycemic control. However, there is limited information about whether meeting these behavioral recommendations actually reduces insulin resistance. 92 youths 11 - 16 years with BMI ≥ 85% underwent oral glucose tolerance testing. HOMA-IR and AUCInsulin/AUCGlucose were calculated as measures of insulin resistance. Dietary and physical activity (PA) measures were performed. Assessments included whether or not participants met recommended levels of diet, PA and sedentary behaviors.62% youths met criteria for insulin resistance. 82% (75/92) met at least one behavioral recommendation. Participants who met ≥ 1 dietary, sedentary, or PA recommendations had significantly reduced insulin resistance as compared with youth who did not. This relationship remained significant in multivariate modeling of insulin resistance adjusting for age, sex, and BMI. Even relatively minor behavior change may reduce insulin resistance in youth at risk for diabetes. Our findings support the relevance of current behavioral interventions for glycemic control. Clinical Trials #NCT00412165.

Complex PTSD as Proposed for ICD-11: Validation of a New Disorder in Children and Adolescents and Their Response to Trauma-Focused Cognitive Behavioral Therapy

ERIC Educational Resources Information Center

Sachser, Cedric; Keller, Ferdinand; Goldbeck, Lutz

2017-01-01

Background: To evaluate whether the symptoms of children and adolescents with clinically significant posttraumatic stress symptoms (PTSS) form classes consistent with the diagnostic criteria of complex PTSD (CPTSD) as proposed for the ICD-11, and to relate the emerging classes with treatment outcome of Trauma-Focused Cognitive Behavioral Therapy…

Emotional Triggers and Psychopathology Associated with Suicidal Ideation in Urban Children with Elevated Aggressive-Disruptive Behavior

ERIC Educational Resources Information Center

Wyman, Peter A.; Gaudieri, Patricia A.; Schmeelk-Cone, Karen; Cross, Wendi; Brown, C. Hendricks; Sworts, Luke; West, Jennifer; Burke, Katharine C.; Nathan, Janaki

2009-01-01

8.6% suicidal ideation (SI) was found among 349 urban 6-9 year olds in the top tercile of aggressive-disruptive behavior. SI was associated with more self-reported depression, ODD, conduct problems, and ADHD symptoms (ES 0.70-0.97) and 3.5-5 times more clinically significant symptoms. Parents rated more symptoms in older children associated with…

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.

Integration of Motor Learning Principles Into Real-Time Ambulatory Voice Biofeedback and Example Implementation Via a Clinical Case Study With Vocal Fold Nodules.

PubMed

Van Stan, Jarrad H; Mehta, Daryush D; Petit, Robert J; Sternad, Dagmar; Muise, Jason; Burns, James A; Hillman, Robert E

2017-02-01

Ambulatory voice biofeedback (AVB) has the potential to significantly improve voice therapy effectiveness by targeting one of the most challenging aspects of rehabilitation: carryover of desired behaviors outside of the therapy session. Although initial evidence indicates that AVB can alter vocal behavior in daily life, retention of the new behavior after biofeedback has not been demonstrated. Motor learning studies repeatedly have shown retention-related benefits when reducing feedback frequency or providing summary statistics. Therefore, novel AVB settings that are based on these concepts are developed and implemented. The underlying theoretical framework and resultant implementation of innovative AVB settings on a smartphone-based voice monitor are described. A clinical case study demonstrates the functionality of the new relative frequency feedback capabilities. With new technical capabilities, 2 aspects of feedback are directly modifiable for AVB: relative frequency and summary feedback. Although reduced-frequency AVB was associated with improved carryover of a therapeutic vocal behavior (i.e., reduced vocal intensity) in a patient post-excision of vocal fold nodules, causation cannot be assumed. Timing and frequency of AVB schedules can be manipulated to empirically assess generalization of motor learning principles to vocal behavior modification and test the clinical effectiveness of AVB with various feedback schedules.

Integration of Motor Learning Principles Into Real-Time Ambulatory Voice Biofeedback and Example Implementation Via a Clinical Case Study With Vocal Fold Nodules

PubMed Central

Mehta, Daryush D.; Petit, Robert J.; Sternad, Dagmar; Muise, Jason; Burns, James A.; Hillman, Robert E.

2017-01-01

Purpose Ambulatory voice biofeedback (AVB) has the potential to significantly improve voice therapy effectiveness by targeting one of the most challenging aspects of rehabilitation: carryover of desired behaviors outside of the therapy session. Although initial evidence indicates that AVB can alter vocal behavior in daily life, retention of the new behavior after biofeedback has not been demonstrated. Motor learning studies repeatedly have shown retention-related benefits when reducing feedback frequency or providing summary statistics. Therefore, novel AVB settings that are based on these concepts are developed and implemented. Method The underlying theoretical framework and resultant implementation of innovative AVB settings on a smartphone-based voice monitor are described. A clinical case study demonstrates the functionality of the new relative frequency feedback capabilities. Results With new technical capabilities, 2 aspects of feedback are directly modifiable for AVB: relative frequency and summary feedback. Although reduced-frequency AVB was associated with improved carryover of a therapeutic vocal behavior (i.e., reduced vocal intensity) in a patient post-excision of vocal fold nodules, causation cannot be assumed. Conclusions Timing and frequency of AVB schedules can be manipulated to empirically assess generalization of motor learning principles to vocal behavior modification and test the clinical effectiveness of AVB with various feedback schedules. PMID:28124070

Negative affect, interpersonal perception, and binge eating behavior: An experience sampling study.

PubMed

Ambwani, Suman; Roche, Michael J; Minnick, Alyssa M; Pincus, Aaron L

2015-09-01

Etiological and maintenance models for disordered eating highlight the salience of negative affect and interpersonal dysfunction. This study employed a 14-day experience sampling procedure to assess the impact of negative affect and interpersonal perceptions on binge eating behavior. Young adult women (N = 40) with recurrent binge eating and significant clinical impairment recorded their mood, interpersonal behavior, and eating behaviors at six stratified semirandom intervals daily through the use of personal digital assistants. Although momentary negative affect was associated with binge eating behavior, average levels of negative affect over the experience sampling period were not, and interpersonal problems moderated the relationship between negative affect and binge eating. Interpersonal problems also intensified the association between momentary interpersonal perceptions and binge eating behavior. Lagged analyses indicated that previous levels of negative affect and interpersonal style also influence binge eating. The study findings suggest there may be important differences in how dispositional versus momentary experiences of negative affect are associated with binge eating. Results also highlight the importance of interpersonal problems for understanding relationships among negative affect, interpersonal perception, and binge eating behavior. These results offer several possibilities for attending to affective and interpersonal functioning in clinical practice. © 2015 Wiley Periodicals, Inc.

The assessment of recalled parental rearing behavior and its relationship to life satisfaction and interpersonal problems: a general population study

PubMed Central

2009-01-01

Background Parental rearing behavior is a significant etiological factor for the vulnerability of psychopathology and has been an issue of clinical research for a long time. For this scope instruments are important who asses economically recalled parental rearing behavior in a clinical practice. Therefore, a short German instrument for the assessment of the recalled parental rearing behavior Fragebogen zum erinnerten elterlichen Erziehungsverhalten (FEE) was psychometrically evaluated [Recalled Parental Rearing Behavior]. Methods This questionnaire was evaluated in a representative population sample (N = 2.948) in Germany which included 44.2% male and 55.8% female persons with a mean age of M = 47.35 (SD = 17.10, range = 18–92). For the content evaluation of the FEE the Life Satisfaction Questionnaire (FLZ) and the Inventory of Interpersonal Problems (IIP) was filled out by the participants. Results The FEE scales yielded a good to satisfactory internal consistency and split-half reliability. Its three factors (rejection/punishment, emotional warmth, control/overprotection) correlated positively with most of the areas of life satisfaction. Furthermore, positive associations between interpersonal problems and parental rejection and control could be identified. Conclusion The FEE is a short, reliable and valid instrument that can be applied in the clinical practice. In addition, the data proved an association between recalled parental rearing behavior, life satisfaction and interpersonal problems conform to the literature. Finally, specific problems with the retrospective assessment of parental rearing behavior were addressed as well. PMID:19267894

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.

[HIV/STD prevalence and related behaviors among male STD clinic attendees in Xi'an and Xianyang cities, Shaanxi province].

PubMed

Hu, T; Dong, L F; Ding, Z W; Jia, H; Li, X; Zhang, J S; Song, Y L; Chang, W H

2017-12-10

Objective: To compare the prevalence of HIV/STD and related health care seeking behaviors among male STD clinic attendees between Xi'an and Xianyang cities. Methods: During June and July 2016, 206 male STD clinic attendees were studied in Xi'an city, with another 221 male STD clinic attendees in Xianyang city. Cross-sectional questionnaire survey was used to collect attendees'behavioral information. Blood samples were collected via HIV/HCV/Syphilis testing. Results: The prevalence rate of HIV infection was 2.4% (5/206) in Xi'an and 0.9% (2/221) in Xianyang, with no statistical significant difference between the two cities. The prevalence rate of syphilis was 4.9% (10/206) in Xi'an, which was significantly lower than 13.6% (30/221) in Xianyang. The proportion of respondents, diagnosed with other sexually transmitted diseases, in Xi'an was higher than that of Xianyang. The proportions of commercial heterosexual sex and sex with temporary sexual partners in the past 3 months were 18.0% (37/206) and 15.5% (32/206) in Xi'an, lower than 46.6% (103/221) and 15.8% (35/221) in Xianyang ( χ (2)=39.70, Р <0.01; χ (2)=0.01, P =0.93) . The proportions of condom use with commercial sex workers or temporary sexual partners in the past 3 months among Xi'an were 37.8% (14/37) and 6.3% (2/32) , lower than 93.1% (95/102) and 57.1% (20/35) in Xianyang ( χ (2)=49.06, Р <0.01; χ (2)=19.63, Р <0.01) . Conclusion: Differences were noticed between Xi'an and Xianyang city in terms of STD and HIV prevalences, behaviors related to commercial sex and use of condoms among the male STD clinic attendees that calling for targeted actions in control of high risk behavlors in both HIV/AIDS and STDs transmission.

Repetitive traumatic brain injury, psychological symptoms, and suicide risk in a clinical sample of deployed military personnel.

PubMed

Bryan, Craig J; Clemans, Tracy A

2013-07-01

Traumatic brain injury (TBI) is believed to be one factor contributing to rising suicide rates among military personnel and veterans. This study investigated the association of cumulative TBIs with suicide risk in a clinical sample of deployed military personnel referred for a TBI evaluation. To determine whether suicide risk is more frequent and heightened among military personnel with multiple lifetime TBIs than among those with no TBIs or a single TBI. Patients completed standardized self-report measures of depression, posttraumatic stress disorder (PTSD), and suicidal thoughts and behaviors; clinical interview; and physical examination. Group comparisons of symptom scores according to number of lifetime TBIs were made, and generalized regression analyses were used to determine the association of cumulative TBIs with suicide risk. Patients included 161 military personnel referred for evaluation and treatment of suspected head injury at a military hospital's TBI clinic in Iraq. Behavioral Health Measure depression subscale, PTSD Checklist-Military Version, concussion symptoms, and Suicide Behaviors Questionnaire-Revised. Depression, PTSD, and TBI symptom severity significantly increased with the number of TBIs. An increased incidence of lifetime suicidal thoughts or behaviors was associated with the number of TBIs (no TBIs, 0%; single TBI, 6.9%; and multiple TBIs, 21.7%; P = .009), as was suicidal ideation within the past year (0%, 3.4%, and 12.0%, respectively; P = .04). The number of TBIs was associated with greater suicide risk (β [SE] = .214 [.098]; P = .03) when the effects of depression, PTSD, and TBI symptom severity were controlled for. A significant interaction between depression and cumulative TBIs was also found (β  = .580 [.283]; P = .04). Suicide risk is higher among military personnel with more lifetime TBIs, even after controlling for clinical symptom severity. Results suggest that multiple TBIs, which are common among military personnel, may contribute to increased risk for suicide.

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.

Behavioral activation and inhibition system's role in predicting addictive behaviors of patients with bipolar disorder of Roozbeh Psychiatric Hospital

PubMed Central

Abbasi, Moslem; Sadeghi, Hasan; Pirani, Zabih; Vatandoust, Leyla

2016-01-01

Background: Nowadays, prevalence of addictive behaviors among bipolar patients is considered to be a serious health threat by the World Health Organization. The aim of this study is to investigate the role of behavioral activation and inhibition systems in predicting addictive behaviors of male patients with bipolar disorder at the Roozbeh Psychiatric Hospital. Materials and Methods: The research method used in this study is correlation. The study population consisted of 80 male patients with bipolar disorder referring to the psychiatrics clinics of Tehran city in 2014 who were referred to the Roozbeh Psychiatric Hospital. To collect data, the international and comprehensive inventory diagnostic interview, behavioral activation and inhibition systems scale, and addictive behaviors scale were used. Results: The results showed that there is a positive and significant relationship between behavioral activation systems and addictive behaviors (addictive eating, alcohol addiction, television addiction, cigarette addiction, mobile addiction, etc.). In addition, correlation between behavioral inhibition systems and addictive behaviors (addictive eating, alcohol addiction, TV addiction, cigarette addiction, mobile addiction) is significantly negative. Finally, regression analysis showed that behavioral activation and inhibition systems could significantly predict 47% of addictive behaviors in patients with bipolar disorder. Conclusions: It can be said that the patients with bipolar disorder use substance and addictive behaviors for enjoyment and as pleasure stimulants; they also use substances to suppress unpleasant stimulants and negative emotions. These results indicate that behavioral activation and inhibition systems have an important role in the incidence and exacerbation of addictive behaviors. Therefore, preventive interventions in this direction seem to be necessary. PMID:28194203

Comparison of behavioral profiles for anxiety-related comorbidities including ADHD and selective mutism in children.

PubMed

Levin-Decanini, Tal; Connolly, Sucheta D; Simpson, David; Suarez, Liza; Jacob, Suma

2013-09-01

Elucidating differences in social-behavioral profiles of children with comorbid presentations, utilizing caregiver as well as teacher reports, will refine our understanding of how contextual symptoms vary across anxiety-related disorders. In our pediatric anxiety clinic, the most frequent diagnoses and comorbidities were mixed anxiety (MA; ≥ 1 anxiety disorder; N = 155), anxiety with comorbid attention-deficit hyperactivity disorder (MA/ADHD, N = 47) and selective mutism (SM, N = 48). Behavioral measures (CPRS, CTRS) were analyzed using multiple one-way multivariate analyses of covariance tests. Differences between the three diagnostic groups were examined using completed parent and teacher reports (N = 135, 46, and 48 for MA, MA/ADHD, and SM groups, respectively). Comparisons across the MA, MA/ADHD, and SM groups indicate a significant multivariate main effect of group for caregiver and teacher responses (P < 0.01). Caregivers reported that children with SM are similar in profile to those with MA, and both groups were significantly different from the MA/ADHD group. Teachers reported that children with SM had more problems with social behaviors than with the MA or MA/ADHD groups. Further comparison indicates a significant main effect of group (P < 0.001), such that children with SM have the greatest differences in behavior observed by teachers versus caregivers. Clinical profiles between MA/ADHD, MA, and SM groups varied, illustrating the importance of multi-rater assessment scales to capture subtle distinctions and to inform treatment planning given that comorbidities occur frequently in children who present with anxiety. © 2013 Wiley Periodicals, Inc.

Comparison of Behavioral Profiles for Anxiety-Related Comorbidities including ADHD and Selective Mutism in Children

PubMed Central

Levin-Decanini, Tal; Connolly, Sucheta D.; Simpson, David; Suarez, Liza; Jacob, Suma

2013-01-01

Background Elucidating differences in social-behavioral profiles of children with comorbid presentations, utilizing caregiver as well as teacher reports, will refine our understanding of how contextual symptoms vary across anxiety-related disorders. Methods In our pediatric anxiety clinic, the most frequent diagnoses and comorbidities were mixed anxiety (MA; ≥ 1 anxiety disorder; N = 155), anxiety with comorbid attention-deficit hyperactivity disorder (MA/ADHD, N = 47) and selective mutism (SM, N = 48). Behavioral measures (CPRS, CTRS) were analyzed using multiple one-way multivariate analyses of covariance tests. Differences between the three diagnostic groups were examined using completed parent and teacher reports (N = 135, 46 and 48 for MA, MA/ADHD and SM groups, respectively). Results Comparisons across the MA, MA/ADHD and SM groups indicate a significant multivariate main effect of group for caregiver and teacher responses (p < 0.01). Caregivers reported that children with SM are similar in profile to those with MA, and both groups were significantly different from the MA/ADHD group. Teachers reported that children with SM had more problem social behaviors than either the MA or MA/ADHD groups. Further comparison indicates a significant main effect of group (p < 0.001), such that children with SM have the greatest differences in behavior observed by teachers versus caregivers. Conclusions Clinical profiles between MA/ADHD, MA and SM groups varied, illustrating the importance of multi-rater assessment scales to capture subtle distinctions and to inform treatment planning given that comorbidities occur frequently in children who present with anxiety. PMID:23526795

COMT genotype, gambling activity, and cognition.

PubMed

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

2015-09-01

Neuropsychological studies of adults with problem gambling indicate impairments across multiple cognitive domains. Catechol-O-methyltransferase (COMT) plays a unique role in the regulation of dopamine in the prefrontal cortex, and has been implicated in the cognitive dysfunction evident in problem gambling. This study examined adults with varying levels of gambling behavior to determine whether COMT genotype was associated with differences in gambling symptoms and cognitive functioning. 260 non-treatment-seeking adults aged 18-29 years with varying degrees of gambling behavior provided saliva samples for genotyping COMT val158met (rs4680). All subjects underwent clinical evaluations and neurocognitive assessment of decision-making, working memory, and impulsivity. The Val/Val COMT genotype was associated with the largest percentage of subjects with gambling disorder (31.8%), a rate significantly different from the Val/Met (13.2%) group (p = 0.001). The Val/Val COMT group was also associated with significantly more gambling disorder diagnostic criteria being met, greater frequency of gambling behavior, and significantly worse cognitive performance on the Cambridge Gamble Task (risk adjustment and delay aversion) and the Spatial Working Memory task (total errors). This study adds to the growing literature on the role of COMT in impulsive behaviors by showing that the Val/Val genotype was associated with specific clinical and cognitive elements among young adults who gamble, in the absence of differences on demographic measures and other cognitive domains. Future work should consider using genotyping to explore whether certain polymorphisms predict subsequent development of impulsive behaviors including gambling disorder, and treatment outcomes. Copyright © 2015 Elsevier Ltd. All rights reserved.

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

Psychosocial and Clinical Outcomes of a Cognitive Behavioral Therapy for Asians and Pacific Islanders with Type 2 Diabetes: A Randomized Clinical Trial.

PubMed

Inouye, Jillian; Li, Dongmei; Davis, James; Arakaki, Richard

2015-11-01

Asian Americans and Pacific Islanders are twice as likely to be diagnosed with type 2 diabetes compared to Caucasians. The objective was to determine the effect of cognitive behavioral therapy on quality of life, general health perceptions, depressive symptoms, and glycemia in Asians and Pacific Islanders with type 2 diabetes. The design was a randomized controlled clinical trial comparing cognitive behavioral therapy to diabetes education and support for six weekly sessions. Participants were recruited from two endocrinology practices; 207 were enrolled. The cognitive behavioral therapy group was provided self-management tools which included biofeedback, breathing exercises, and stress relievers, while the diabetes education and support group included diabetes education and group discussions. Assessments of psychosocial and clinical outcomes were obtained before and after sessions and 12 months PostSession. Differences between the two groups were examined using linear mixed-effects models with linear contrasts. The cognitive behavioral therapy group had improved depressive symptom scores from PreSession to EndSession compared to the diabetes education and support group (P < .03), but the improvement did not extend to 12 months PostSession. Similar results were observed with misguided support scores in the Multidimensional Diabetes Questionnaire (P < .03) and susceptibility in health beliefs (P < .01), but no significant differences in HbA1c improvement were found between the two groups. Both interventions improved outcomes from baseline but were not sustained for 1 year.

The role of health behavior in preventing dental caries in resource-poor adults: a pilot intervention.

PubMed

Wu, Andrew; Switzer-Nadasdi, Rhonda

2014-01-01

Dental caries is a highly prevalent, yet preventable disease that is commonly overlooked in the adult population. It is strongly related to health-related behaviors and knowledge, and therefore, is potentially receptive to a behavioral health intervention. However, prevention strategies that target health behaviors in adults are fundamentally different from those in children, whom most current intervention strategies for dental caries target. This study attempts to pilot design, implement, and assess health behavior intervention tools for adults, in order to improve their oral health. To increase knowledge about dental caries by 80% and increase positive self-reported oral hygiene behaviors by 80% in low-income adult participants at Interfaith Dental Clinic by piloting novel interventional and educational tools based on the Transtheoretical Model of Health Behavior. A convenience sample of newly registered participants to the Interfaith Dental Clinic between August 2011 and May 2013, were interviewed on each participant's first appointment, exposed to the interventional tools, and subsequently interviewed at their next appointment. A control group, comprised of participants who had completed their caries care as deemed by the clinic and had not been exposed to the interventional tools, were also interviewed on their last appointment before graduating the clinic's program. A total of 112 participants were exposed to the intervention, and forty-two participants comprised the control group. Follow-up for the intervention group was 20.5% (n = 23). Knowledge about the cause of caries increased by 29.9%, and positive self-reported oral hygiene behaviors increased by 25.4%. A Wilcoxon rank sum test showed no significance between the interview scores of the post-intervention group and that of the control group (p = 0.18 for knowledge, p = 0.284 for behaviors). Qualitative results show the vast majority of participants blamed diet for cause of caries, that this participant population prioritized practical advice over factual education, and that flossing was perceived to be the largest barrier to proper oral care, citing pain, lack of time, and technique as common reasons. Educational tools based on current models of health behavior theory have the potential to improve participant knowledge and health behaviors, while also remaining low-cost and convenient for clinical use.

Factors that impact clinical laboratory scientists' commitment to their work organizations.

PubMed

Bamberg, Richard; Akroyd, Duane; Moore, Ti'eshia M

2008-01-01

To assess the predictive ability of various aspects of the work environment for organizational commitment. A questionnaire measuring three dimensions of organizational commitment along with five aspects of work environment and 10 demographic and work setting characteristics was sent to a national, convenience sample of clinical laboratory professionals. All persons obtaining the CLS certification by NCA from January 1, 1997 to December 31, 2006. Only respondents who worked full-time in a clinical laboratory setting were included in the database. Levels of affective, normative, and continuance organizational commitment, organizational support, role clarity, role conflict, transformational leadership behavior of supervisor, and organizational type, total years work experience in clinical laboratories, and educational level of respondents. Questionnaire items used either a 7-point or 5-point Likert response scale. Based on multiple regression analysis for the 427 respondents, organizational support and transformational leadership behavior were found to be significant positive predictors of affective and normative organizational commitment. Work setting (non-hospital laboratory) and total years of work experience in clinical laboratories were found to be significant positive predictors of continuance organizational commitment. Overall the organizational commitment levels for all three dimensions were at the neutral rating or below in the slightly disagree range. The results indicate a less than optimal level of organizational commitment to employers, which were predominantly hospitals, by CLS practitioners. This may result in continuing retention problems for hospital laboratories. The results offer strategies for improving organizational commitment via the significant predictors.

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

Family Functioning and Predictors of Runaway Behavior Among At-Risk Youth.

PubMed

Holliday, Stephanie Brooks; Edelen, Maria Orlando; Tucker, Joan S

2017-06-01

Adolescent runaway behavior is associated with a host of negative outcomes in young adulthood. Therefore, it is important to understand the factors that predict running away in youth. Longitudinal data from 111 at-risk families were used to identify proximal predictors of runaway behavior over a 12-week period. On average, youth were 14.96 years old, and 45% were female. Ten percent of youth ran away during the 12-week follow-up period. In bivariate analyses, running away was predicted by poorer youth- and parent-rated family functioning, past runaway behavior, and other problem behaviors (e.g., substance use, delinquency), but not poorer perceived academic functioning. Results of a hierarchical logistic regression revealed a relationship between youth-rated family functioning and runaway behavior. However, this effect became non-significant after accounting for past runaway behavior and other problem behaviors, both of which remained significant predictors in the multivariable model. These findings suggest that youth who run away may be engaged in a more pervasive pattern of problematic behavior, and that screening and prevention programs need to address the cycle of adolescent defiant behavior associated with running away. Recommendations for clinical practice with this at-risk population are discussed.

Using the Behavior Change Technique Taxonomy v1 to conceptualize the clinical content of Breaking Free Online: a computer-assisted therapy program for substance use disorders.

PubMed

Dugdale, Stephanie; Ward, Jonathan; Hernen, Jan; Elison, Sarah; Davies, Glyn; Donkor, Daniel

2016-07-22

In recent years, research within the field of health psychology has made significant progress in terms of advancing and standardizing the science of developing, evaluating and reporting complex behavioral change interventions. A major part of this work has involved the development of an evidence-based Behavior Change Technique Taxonomy v1 (BCTTv1), as a means of describing the active components contained within such complex interventions. To date, however, this standardized approach derived from health psychology research has not been applied to the development of complex interventions for the treatment of substance use disorders (SUD). Therefore, this paper uses Breaking Free Online (BFO), a computer-assisted therapy program for SUD, as an example of how the clinical techniques contained within such an intervention might be mapped onto the BCTTv1. The developers of BFO were able to produce a full list of the clinical techniques contained within BFO. Exploratory mapping of the BCTTv1 onto the clinical content of the BFO program was conducted separately by the authors of the paper. This included the developers of the BFO program and psychology professionals working within the SUD field. These coded techniques were reviewed by the authors and any discrepancies in the coding were discussed between all authors until an agreement was reached. The BCTTv1 was mapped onto the clinical content of the BFO program. At least one behavioral change technique was found in 12 out of 16 grouping categories within the BCTTv1. A total of 26 out of 93 behavior change techniques were identified across the clinical content of the program. This exploratory mapping exercise has identified the specific behavior change techniques contained within BFO, and has provided a means of describing these techniques in a standardized way using the BCTTv1 terminology. It has also provided an opportunity for the BCTTv1 mapping process to be reported to the wider SUD treatment community, as it may have real utility in the development and evaluation of other psychosocial and behavioral change interventions within this field.

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.

Stories and Music for Adolescent/Young Adult Resilience During Transplant Partnerships: Strategies to Support Academic-Clinical Nurse Collaborations in Behavioral Intervention Studies.

PubMed

Hendricks-Ferguson, Verna L; Barnes, Yvonne J; Cherven, Brooke; Stegenga, Kristin; Roll, Lona; Docherty, Sharon L; Haase, Joan E

Evidence-based nursing is in the forefront of healthcare delivery systems. Federal and state agencies, academic institutions, and healthcare delivery systems recognize the importance of nursing research. This article describes the mechanisms that facilitate nursing partnerships yielding high-level research outcomes in a clinical setting. A phase-II multicenter behavioral intervention study with pediatric stem cell transplant patients was the context of this academic/clinical research partnership. Strategies to develop and maintain this partnership involved a thorough understanding of each nurse's focus and barriers. A variety of communication plans and training events maximized preexisting professional networks. Academic/clinical nurses' discussions identified barriers to the research process, the most significant being role conflict. Communication and validation of benefits to each individual and institution facilitated the research process during challenging times. Establishing strong academic/clinical partnerships should lead to evidence-based research outcomes for the nursing profession, healthcare delivery systems, and patients and families.

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.

Practitioner Review: Bridging the Gap between Research and Clinical Practice in Pediatric Obesity

ERIC Educational Resources Information Center

Jelalian, Elissa; Wember, Yana Markov; Bungeroth, Heidi; Birmaher, Vered

2007-01-01

Background: Pediatric obesity is a significant public health concern, with rising prevalence rates in both developed and developing countries. This is of particular significance given that overweight children and adolescents are at increased risk for multiple medical comorbidities, as well as psychosocial and behavioral difficulties. The current…

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.

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.

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

Early intervention and recovery among children with failure to thrive: follow-up at age 8.

PubMed

Black, Maureen M; Dubowitz, Howard; Krishnakumar, Ambika; Starr, Raymond H

2007-07-01

We sought to examine the impact of a randomized, controlled trial of home visiting among infants with failure to thrive on growth, academic/cognitive performance, and home/classroom behavior at age 8. Infants with failure to thrive (N = 130) or adequate growth (N = 119) were recruited from pediatric primary care clinics serving low-income, urban communities. Eligibility criteria included age <25 months, gestational age >36 weeks, birth weight >2500 g, and no significant medical conditions. Evaluation included anthropometries, Bayley scales, maternal anthropometries, demographics, negative affect, IQ, and the Home Observation for Measurement of the Environment scale. Infants with failure to thrive were treated in an interdisciplinary growth and nutrition clinic and randomized into clinical-intervention-plus-home-intervention or clinical-care-only groups. The home-visiting curriculum promoted maternal sensitivity, parent-infant relationships, and child development. Follow-up visits were conducted by evaluators who were unaware of the children's growth or intervention history. At age 8, the evaluation included anthropometries, the Wechsler Intelligence Scale for Children III, and the Wide Range Achievement Test, Revised. Mothers completed the Child Behavior Checklist and teachers completed the Teacher Report Form. Multivariate analyses of variance were used to examine differences in growth, cognitive/academic performance, and home/school behavior, adjusted by maternal education, public assistance, and, when appropriate, infant Bayley score, maternal BMI, height, negative affect, IQ, and Home Observation for Measurement of the Environment scores. Retention was 74% to 78%. Children in the adequate-growth group were significantly taller, heavier, and had better arithmetic scores than the clinical-intervention-only group, with the clinical-intervention-plus-home-intervention group intermediate. There were no group differences in IQ, reading, or mother-reported behavior problems. Children in the clinical-intervention-plus-home-intervention group had fewer teacher-reported internalizing problems and better work habits than the clinical-intervention-only group. Early failure to thrive increased children's vulnerability to short stature, poor arithmetic performance, and poor work habits. Home visiting attenuated some of the negative effects of early failure to thrive, possibly by promoting maternal sensitivity and helping children build strong work habits that enabled them to benefit from school. Findings provide evidence for early intervention programs for vulnerable infants.

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.

Testing the theory of reasoned action in explaining sexual behavior among African American young teen girls.

PubMed

Doswell, Willa M; Braxter, Betty J; Cha, Eunseok; Kim, Kevin H

2011-12-01

This study tested the Theory of Reasoned Action to examine the prediction of early sexual behavior among African American young teen girls. Baseline data from a longitudinal randomized clinical trial were used. Between 2001 and 2005, 198 middle-school girls aged 11 to 14 years were recruited. As girls aged, they held more permissive attitudes toward engaging in early sexual behavior and had a higher intention to engage in early sexual behavior. Intention was a significant predictor to explain sexual behavior among the girls. There is a need to develop strategies that promote intention related to delay and prevention of early sexual behavior. Copyright © 2011 Elsevier Inc. All rights reserved.

Assessment of low-dose cisplatin as a model of nausea and emesis in beagle dogs, potential for repeated administration.

PubMed

Kenward, Hannah; Pelligand, Ludovic; Elliott, Jonathan

2014-08-01

Cisplatin is a highly emetogenic cancer chemotherapy agent, which is often used to induce nausea and emesis in animal models. The cytotoxic properties of cisplatin also cause adverse events that negatively impact on animal welfare preventing repeated administration of cisplatin. In this study, we assessed whether a low (subclinical) dose of cisplatin could be utilized as a model of nausea and emesis in the dog while decreasing the severity of adverse events to allow repeated administration. The emetic, nausea-like behavior and potential biomarker response to both the clinical dose (70 mg/m2) and low dose (15 mg/m2) of cisplatin was assessed. Plasma creatinine concentrations and granulocyte counts were used to assess adverse effects on the kidneys and bone marrow, respectively. Nausea-like behavior and emesis was induced by both doses of cisplatin, but the latency to onset was greater in the low-dose group. No significant change in plasma creatinine was detected for either dose groups. Granulocytes were significantly reduced compared with baseline (P = 0.000) following the clinical, but not the low-dose cisplatin group. Tolerability of repeated administration was assessed with 4 administrations of an 18 mg/m2 dose cisplatin. Plasma creatinine did not change significantly. Cumulative effects on the granulocytes occurred, they were significantly decreased (P = 0.03) from baseline at 3 weeks following cisplatin for the 4th administration only. Our results suggest that subclinical doses (15 and 18 mg/m2) of cisplatin induce nausea-like behavior and emesis but have reduced adverse effects compared with the clinical dose allowing for repeated administration in crossover studies.

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.

Differences in misreporting of sexual behavior over time: implications for HIV trials.

PubMed

Gallo, Maria F; Warner, Lee; Hobbs, Marcia M; Jamieson, Denise J; Hylton-Kong, Tina; Steiner, Markus J

2015-03-01

We used data from a prospective study of 300 women attending a sexually transmitted infection clinic in Kingston, Jamaica, to compare participant self-report of recent semen exposure to actual semen exposure measured by prostate-specific antigen in vaginal swabs. Underreporting of semen exposure was significantly more frequent at follow-up than baseline, suggesting that the accuracy of reports of sexual behavior may vary over time.

DoD Alcohol and Substance Abuse Consortium Award

DTIC Science & Technology

2016-10-01

opiate use disorder (OUD) also has developed significant clinical importance due to prolonged pain treatments with opiates. FDA approved...2) behaviors other than amount of alcohol consumed will be examined, such as anxiety-like behavior, sensitivity to pain and avoidance of an...The prospectus will be reviewed by the entire SRPP Committee and a subset of applications will be approved to develop a 10- to 20-page mini -protocol

Challenging behavior and co-morbid psychopathology in adults with intellectual disability and autism spectrum disorders.

PubMed

McCarthy, Jane; Hemmings, Colin; Kravariti, Eugenia; Dworzynski, Katharina; Holt, Geraldine; Bouras, Nick; Tsakanikos, Elias

2010-01-01

We investigated the relationship between challenging behavior and co-morbid psychopathology in adults with intellectual disability (ID) and autism spectrum disorders (ASDs) (N=124) as compared to adults with ID only (N=562). All participants were first time referrals to specialist mental health services and were living in community settings. Clinical diagnoses were based on ICD-10 criteria and presence of challenging behavior was assessed with the Disability Assessment Schedule (DAS-B). The analyses showed that ASD diagnosis was significantly associated with male gender, younger age and lower level of ID. Challenging behavior was about four times more likely in adults with ASD as compared to non-ASD adults. In those with challenging behavior, there were significant differences in co-morbid psychopathology between ASD and non-ASD adults. However, after controlling for level of ID, gender and age, there was no association between co-morbid psychopathology and presence of challenging behavior. Overall, the results suggest that presence of challenging behavior is independent from co-morbid psychopathology in adults with ID and ASD. Copyright 2009 Elsevier Ltd. All rights reserved.

Externalizing behaviors and television viewing in children of low-income minority parents.

PubMed

Gupta, V B; Nwosa, N M; Nadel, T A; Inamdar, S

2001-06-01

The parents of 151 children, ages 4-16 years, attending the pediatric outpatient clinic of an urban hospital were surveyed to determine if aggressive behavior among children of low literacy and low-income parents is related to excessive television viewing or to sociological variables such as ethnicity/race, education, occupation, and parents' marital status. The survey consisted of 22 questions about the ethnicity, marital status, education, and occupation of the parent, the television viewing behavior of the child, and the externalizing behavior scale of the Child Behavior Checklist of Achenbach (CBC). The television viewing habits of children in this study were not significantly different from viewing habits reported in national surveys of the US population. T scores in the aggression scale of CBC were unrelated to the hours of television watched by children and the control of viewing by the parent but were significantly associated with the employment and marital status of the mother. Children of unemployed and single mothers had higher externalizing-behavior scores, suggesting that family ecological variables may have more influence on children's behavior than the duration of television viewing.

Using GPS-enabled cell phones to track the travel patterns of adolescents.

PubMed

Wiehe, Sarah E; Carroll, Aaron E; Liu, Gilbert C; Haberkorn, Kelly L; Hoch, Shawn C; Wilson, Jeffery S; Fortenberry, J Dennis

2008-05-21

Few tools exist to directly measure the microsocial and physical environments of adolescents in circumstances where participatory observation is not practical or ethical. Yet measuring these environments is important as they are significantly associated with adolescent health-risk. For example, health-related behaviors such as cigarette smoking often occur in specific places where smoking may be relatively surreptitious. We assessed the feasibility of using GPS-enabled cell phones to track adolescent travel patterns and gather daily diary data. We enrolled 15 adolescent women from a clinic-based setting and asked them to carry the phones for 1 week. We found that these phones can accurately and reliably track participant locations, as well as record diary information on adolescent behaviors. Participants had variable paths extending beyond their immediate neighborhoods, and denied that GPS-tracking influenced their activity. GPS-enabled cell phones offer a feasible and, in many ways, ideal modality of monitoring the location and travel patterns of adolescents. In addition, cell phones allow space- and time-specific interaction, probing, and intervention which significantly extends both research and health promotion beyond a clinical setting. Future studies can employ GPS-enabled cell phones to better understand adolescent environments, how they are associated with health-risk behaviors, and perhaps intervene to change health behavior.

Using GPS-enabled cell phones to track the travel patterns of adolescents

PubMed Central

Wiehe, Sarah E; Carroll, Aaron E; Liu, Gilbert C; Haberkorn, Kelly L; Hoch, Shawn C; Wilson, Jeffery S; Fortenberry, J Dennis

2008-01-01

Background Few tools exist to directly measure the microsocial and physical environments of adolescents in circumstances where participatory observation is not practical or ethical. Yet measuring these environments is important as they are significantly associated with adolescent health-risk. For example, health-related behaviors such as cigarette smoking often occur in specific places where smoking may be relatively surreptitious. Results We assessed the feasibility of using GPS-enabled cell phones to track adolescent travel patterns and gather daily diary data. We enrolled 15 adolescent women from a clinic-based setting and asked them to carry the phones for 1 week. We found that these phones can accurately and reliably track participant locations, as well as record diary information on adolescent behaviors. Participants had variable paths extending beyond their immediate neighborhoods, and denied that GPS-tracking influenced their activity. Conclusion GPS-enabled cell phones offer a feasible and, in many ways, ideal modality of monitoring the location and travel patterns of adolescents. In addition, cell phones allow space- and time-specific interaction, probing, and intervention which significantly extends both research and health promotion beyond a clinical setting. Future studies can employ GPS-enabled cell phones to better understand adolescent environments, how they are associated with health-risk behaviors, and perhaps intervene to change health behavior. PMID:18495025

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.

Sleep in children with autism spectrum disorder.

PubMed

Kotagal, Suresh; Broomall, Eileen

2012-10-01

Children with autism spectrum disorder demonstrate an increased prevalence of difficulties with sleep initiation and maintenance. The consequences may include alterations in daytime behavior, memory, and learning in patients, and significant stress in caretakers. The dysregulation of melatonin synthesis, sensitization to environmental stimuli, behavioral insomnia syndromes, delayed sleep phase syndrome, rapid eye movement sleep behavior disorder, and comorbid anxiety, depression, and epilepsy comprise common etiologic factors. The clinical assessment of sleep problems in this population and a management algorithm are presented. Copyright © 2012 Elsevier Inc. All rights reserved.

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.

Positive and Negative Peer Influence in Residential Care.

PubMed

Huefner, Jonathan C; Smith, Gail L; Stevens, Amy L

2017-10-13

The potential for negative peer influence has been well established in research, and there is a growing interest in how positive peer influence also impacts youth. No research, however, has concurrently examined positive and negative peer influence in the context of residential care. Clinical records for 886 residential care youth were used in a Hierarchical Linear Model analysis to examine the impact of negative and positive peer influence on naturally occurring patterns of serious problem behavior over time. Negative peer influence, where the majority of youth in a home manifested above the average number of serious behavior problems, occurred 13.7% of the time. Positive peer influence, where the majority of youth manifested no serious problem behaviors for the month, occurred 47.7% of the time. Overall, youth problem behavior improved over time. There were significantly lower rates of serious problem behavior in target youth during positive peer influence months. Conversely, there were significantly higher rates of serious problem behaviors in target youth during negative peer influence months. Negative peer influence had a relatively greater impact on target peers' serious behavior problems than did positive peer influence. Caregiver experience significantly reduced the impact of negative peer influence, but did not significantly augment positive peer influence. Months where negative peer influence was combined with inexperienced caregivers produced the highest rates of serious problem behavior. Our results support the view that residential programs for troubled youth need to create circumstances that promote positive and control for negative peer influence.

Human papillomavirus vaccination and sexual behavior in young women.

PubMed

Rysavy, Mary B; Kresowik, Jessica D K; Liu, Dawei; Mains, Lindsay; Lessard, Megan; Ryan, Ginny L

2014-04-01

To compare sexual attitudes and behaviors of young women who have received or declined the HPV vaccine. Cross-sectional survey. Obstetrics and gynecology and pediatrics clinics at a large, Midwestern, academic health center. 223 young women (ages 13-24): 153 who had received HPV vaccination and 70 with no prior HPV vaccination. Sexual behaviors; attitudes toward sexual activity. Vaccinated young women were slightly but significantly younger than unvaccinated (mean age 19.2 vs 20.0). Both groups showed a large percentage of participants engaging in high-risk sexual behavior (75% vs 77%). The mean age at sexual debut was not significantly different between the groups (16.8 vs 17.0) nor was the average number of sexual partners (6.6 for both). Unvaccinated participants were more likely to have been pregnant (20% vs 8.6%, P = .016), although this difference was not significant in multivariate analysis CI [0.902-5.177]. Specific questions regarding high-risk sexual behaviors and attitudes revealed no significant differences between the groups. We found that sexual behaviors, including high-risk behaviors, were similar between young women who had and had not received HPV vaccination. Our findings provide no support for suggestions that the vaccine is associated with increased sexual activity. Importantly, we found that young women in our population are sexually active at a young age and are engaged in high-risk behaviors, affirming the importance of early vaccination. Copyright © 2014 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

Application of Attachment Theory in Clinical Social Work.

PubMed

Blakely, Thomas Joseph; Dziadosz, Gregory M

2015-11-01

This article proposes the use of attachment theory in clinical social work practice. This theory is very appropriate in this context because of its fit with social work concepts of person-in-situation, the significance of developmental history in the emergence of psychosocial problems, and the content of human behavior in the social environment. A literature review supports the significance of the theory. Included are ideas about how attachment styles and working models may be used in assessment and treatment to help clients achieve a secure attachment style.

Food insecurity and effectiveness of behavioral interventions to reduce blood pressure, New York City, 2012-2013.

PubMed

Grilo, Stephanie A; Shallcross, Amanda J; Ogedegbe, Gbenga; Odedosu, Taiye; Levy, Natalie; Lehrer, Susan; Chaplin, William; Spruill, Tanya M

2015-02-12

Food insecurity is associated with diet-sensitive diseases and may be a barrier to successful chronic disease self-management. To evaluate the impact of food insecurity on blood pressure reduction in a pilot clinical trial, we tested the effectiveness of 2 behavioral interventions for hypertension in people with and without food security. A group of 28 men and women with type 2 diabetes and uncontrolled hypertension were randomized to either 1) home blood pressure telemonitoring alone or 2) home blood pressure telemonitoring plus telephone-based nurse case management. The primary outcome was 6-month change in systolic blood pressure. The 2 interventions resulted in modest, nonsignificant blood pressure reductions. Food-secure patients experienced clinically and statistically significant reductions in blood pressure, whereas no significant change was seen among food-insecure patients. Screening for food insecurity may help identify patients in need of tailored disease management interventions.

Unmet clinical needs and burden in Angelman syndrome: a review of the literature.

PubMed

Wheeler, Anne C; Sacco, Patricia; Cabo, Raquel

2017-10-16

Angelman syndrome (AS) is a rare disorder with a relatively well-defined phenotype. Despite this, very little is known regarding the unmet clinical needs and burden of this condition, especially with regard to some of the most prevalent clinical features-movement disorders, communication impairments, behavior, and sleep. A targeted literature review using electronic medical databases (e.g., PubMed) was conducted to identify recent studies focused on specific areas of the AS phenotype (motor, communication, behavior, sleep) as well as epidemiology, diagnostic processes, treatment, and burden. 142 articles were reviewed and summarized. Findings suggest significant impairment across the life span in all areas of function. While some issues may resolve as individuals get older (e.g., hyperactivity), others become worse (e.g., movement disorders, aggression, anxiety). There are no treatments focused on the underlying etiology, and the symptom-based therapies currently prescribed do not have much, if any, empirical support. The lack of standardized treatment protocols or approved therapies, combined with the severity of the condition, results in high unmet clinical needs in the areas of motor functioning, communication, behavior, and sleep for individuals with AS and their families.

Patient safety climate and worker safety behaviours in acute hospitals in Scotland.

PubMed

Agnew, Cakil; Flin, Rhona; Mearns, Kathryn

2013-06-01

To obtain a measure of hospital safety climate from a sample of National Health Service (NHS) acute hospitals in Scotland and to test whether these scores were associated with worker safety behaviors, and patient and worker injuries. Data were from 1,866 NHS clinical staff in six Scottish acute hospitals. A Scottish Hospital Safety Questionnaire measured hospital safety climate (Hospital Survey on Patient Safety Culture), worker safety behaviors, and worker and patient injuries. The associations between the hospital safety climate scores and the outcome measures (safety behaviors, worker and patient injury rates) were examined. Hospital safety climate scores were significantly correlated with clinical workers' safety behavior and patient and worker injury measures, although the effect sizes were smaller for the latter. Regression analyses revealed that perceptions of staffing levels and managerial commitment were significant predictors for all the safety outcome measures. Both patient-specific and more generic safety climate items were found to have significant impacts on safety outcome measures. This study demonstrated the influences of different aspects of hospital safety climate on both patient and worker safety outcomes. Moreover, it has been shown that in a hospital setting, a safety climate supporting safer patient care would also help to ensure worker safety. The Scottish Hospital Safety Questionnaire has proved to be a usable method of measuring both hospital safety climate as well as patient and worker safety outcomes. Copyright © 2013 National Safety Council and Elsevier Ltd. Published by Elsevier Ltd. All rights reserved.

The relationship of seizure focus with depression, anxiety, and health-related quality of life in children and adolescents with epilepsy.

PubMed

Schraegle, William A; Titus, Jeffrey B

2017-03-01

For youth with epilepsy, comorbid psychiatric conditions, such as depression and anxiety, require further examination as they carry increased risk for reduced health-related quality of life (HRQOL). The current study assessed whether rates of depression, anxiety, and withdrawal behaviors differed based on seizure location. Data included parental ratings on the Behavior Assessment System for Children (BASC-2) and the Quality of Life in Childhood Epilepsy (QOLCE) questionnaire for 132 children and adolescents (mean age=11.34, SD=3.95) with generalized or partial (i.e., frontal [FLE] or temporal lobe epilepsy [TLE]) epilepsy. Our results identified clinically significant internalizing psychopathology in nearly half of our sample (41%). Although rates of internalizing behavior were similar between generalized and partial groups, children and adolescents with TLE demonstrated higher rates of depression compared to youth with FLE. No effects of laterality on internalizing behaviors were identified between TLE and FLE groups. Finally, for youth with TLE, parental depression ratings along with current number of antiepileptic medications (AEDs) were found to be significant barriers to HRQOL above and beyond anxiety, withdrawal, and epilepsy-specific variables. Temporal lobe epilepsy was associated with a two-fold risk of clinically significant depression ratings. These findings highlight the high prevalence of internalizing psychopathology features in pediatric epilepsy and offer further support for the relationship between depression and TLE in children and adolescents with epilepsy. Copyright © 2016 Elsevier Inc. All rights reserved.

The Implications of Endoscopic Ulcer in Early Gastric Cancer: Can We Predict Clinical Behaviors from Endoscopy?

PubMed

Lee, Yoo Jin; Kim, Jie-Hyun; Park, Jae Jun; Youn, Young Hoon; Park, Hyojin; Kim, Jong Won; Choi, Seung Ho; Noh, Sung Hoon

2016-01-01

The presence of ulcer in early gastric cancer (EGC) is important for the feasibility of endoscopic resection, only a few studies have examined the clinicopathological implications of endoscopic ulcer in EGC. To determine the role of endoscopic ulcer as a predictor of clinical behaviors in EGC. Data of 3,270 patients with EGC who underwent surgery between January 2005 and December 2012 were reviewed. Clinicopathological characteristics were analyzed in relation to the presence and stage of ulcer in EGC. Based on endoscopic findings, the stage of ulcer was categorized as active, healing, or scar. Logistic regression analysis was performed to analyze factors associated with lymph node metastasis (LNM). 2,343 (71.7%) patients had endoscopic findings of ulceration in EGC. Submucosal (SM) invasion, LNM, lymphovascular invasion (LVI), perineural invasion, and undifferentiated-type histology were significantly higher in ulcerative than non-ulcerative EGC. Comparison across different stages of ulcer revealed that SM invasion, LNM, and LVI were significantly associated with the active stage, and that these features exhibited significant stage-based differences, being most common at the active stage, and least common at the scar stage. The presence of endoscopic ulcer and active status of the ulcer were identified as independent risk factors for LNM. Ulcerative EGC detected by endoscopy exhibited more aggressive behaviors than non-ulcerative EGC. Additionally, the endoscopic stage of ulcer may predict the clinicopathological behaviors of EGC. Therefore, the appearance of ulcers should be carefully evaluated to determine an adequate treatment strategy for EGC.

Failure to replicate the deleterious effects of safety behaviors in exposure therapy.

PubMed

Sy, Jennifer T; Dixon, Laura J; Lickel, James J; Nelson, Elizabeth A; Deacon, Brett J

2011-05-01

The current study attempted to replicate the finding obtained by Powers, Smits, and Telch (2004; Journal of Consulting and Clinical Psychology, 72, 448-545) that both the availability and utilization of safety behaviors interfere with the efficacy of exposure therapy. An additional goal of the study was to evaluate which explanatory theories about the detrimental effects of safety behaviors best account for this phenomenon. Undergraduate students (N=58) with high claustrophobic fear were assigned to one of three treatment conditions: (a) exposure only, (b) exposure with safety behavior availability, and (c) exposure with safety behavior utilization. Participants in each condition improved substantially, and there were no significant between-group differences in fear reduction. Unexpectedly, exposure with safety behavior utilization led to significantly greater improvement in self-efficacy and claustrophobic cognitions than exposure only. The extent to which participants inferred danger from the presence of safety aids during treatment was associated with significantly less improvement on all outcome measures. The findings call into question the hypothesized deleterious effects of safety behaviors on the outcome of exposure therapy and highlight a possible mechanism through which the mere presence of safety cues during exposure trials might affect treatment outcomes depending on participants' perceptions of the dangerousness of exposure stimuli. Published by Elsevier Ltd.

A clinical interpretation of attitudes and behaviors associated with celebrity worship.

PubMed

Maltby, John; Houran, James; McCutcheon, Lynn E

2003-01-01

The phenomenon of celebrity worship is currently conceptualized as an abnormal type of parasocial relationship, driven by absorption and addictive elements and which potentially has significant clinical sequelae. The authors hypothesize that the three increasingly extreme sets of attitudes and behaviors associated with celebrity worship also partly reflect the three domains of personality discussed in Eysenckian theory. Specifically, celebrity worship for entertainment-social reasons may reflect extraversion personality traits; intense-personal attitudes and behaviors toward celebrities may reflect neuroticism traits; and celebrity worship of a borderline-pathological nature may reflect psychoticism traits. To test this idea, the authors administered the Celebrity Attitude Scale and the Abbreviated Form of the Revised Eysenck Personality Questionnaire to large convenience samples of students (N = 317) and community (N = 290) respondents. Results indicate that celebrity worship is not an uncommon phenomenon. Further, correlational analyses supported predictions and suggest that Eysenckian domains of personality may promote or hinder a person's progression along the continuum of behaviors associated with celebrity worship.

Command hallucinations and clinical characteristics of suicidality in patients with psychotic spectrum disorders.

PubMed

Wong, Zerlina; Öngür, Dost; Cohen, Bruce; Ravichandran, Caitlin; Noam, Gil; Murphy, Beth

2013-08-01

Suicide is a leading cause of death among patients with psychotic illnesses. Several researchers have suggested that specific illness symptoms may better predict suicide risk. An ability to identify high-risk patients would aid clinicians in instituting risk-reduction measures to decrease suicidal behavior in this population. We examined the association between psychotic symptoms and suicidal behavior among 148 inpatients with psychosis using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), the Scale for the Assessment of Positive Symptoms, and the Positive and Negative Syndrome Scale. Measures of suicidality were obtained from risk assessment clinical data routinely collected during intake. For individuals with a DSM-IV diagnosed psychotic spectrum disorder, 40% (n=57) endorsed suicidal ideation on admission and 23% (n=33) endorsed a recent suicide attempt. The presence of command auditory hallucinations was significantly associated with active suicidal ideation across diagnostic categories. Similarly, a greater percentage of patients endorsed a recent suicide attempt in the presence of command hallucinations. These correlations with CAH are noteworthy, as we found no significant difference in the prevalence of SI among those with and without general auditory hallucinations (42.5% and 37.7%). The presence of command auditory hallucinations, in particular, but not auditory hallucinations, in general, was associated with suicidal behavior. These results indicate that command auditory hallucinations may identify or even place psychotic individuals at greater risk for acute, suicidal behavior--these symptoms should be the target of immediate and aggressive characterization and treatment. Copyright © 2013 Elsevier Inc. All rights reserved.

Fathers and mothers with eating-disorder psychopathology: Associations with child eating-disorder behaviors.

PubMed

Lydecker, Janet A; Grilo, Carlos M

2016-07-01

A limited literature suggests an association between maternal eating disorders and child feeding difficulties, and notes maternal concern about inadvertently transmitting eating disorders. Thus, parents may be an important target for eating-disorder research to guide the development of clinical programs. The current study examined differences in child eating-disorder behaviors and parental feeding practices between a sample of parents (42 fathers, 130 mothers) exhibiting core features of anorexia nervosa, bulimia nervosa, binge-eating disorder, or purging disorder, and a matched sample of parents (n=172) reporting no eating-disorder characteristics. Parents with eating-disorder psychopathology were significantly more likely than parents without eating-disorder characteristics to report child binge-eating and compulsive exercise. Parents with eating-disorder psychopathology reported greater perceived feeding responsibility, greater concern about their child's weight, and more monitoring of their child's eating than parents without eating-disorder characteristics; however, they did not differ significantly in restriction of their child's diet and pressure-to-eat. Child body mass index z-scores did not differ between parents with versus without eating-disorder characteristics. Our findings suggest some important differences between parents with and without core eating-disorder psychopathology, which could augment clinical interventions for patients with eating disorders who are parents, or could guide pediatric eating-disorder prevention efforts. However, because our study was cross-sectional, findings could indicate increased awareness of or sensitivity to eating-disorder behaviors rather than a psychosocial cause of those behaviors. Longitudinal research and controlled trials examining prevention and intervention can clarify and address these clinical concerns. Copyright © 2016 Elsevier Inc. All rights reserved.

Fathers and mothers with eating-disorder psychopathology: Associations with child eating-disorder behaviors

PubMed Central

Lydecker, Janet A.; Grilo, Carlos M.

2016-01-01

Objective A limited literature suggests an association between maternal eating disorders and child feeding difficulties, and notes maternal concern about inadvertently transmitting eating disorders. Thus, parents may be an important target for eating-disorder research to guide the development of clinical programs. Methods The current study examined differences in child eating-disorder behaviors and parental feeding practices between a sample of parents (42 fathers, 130 mothers) exhibiting core features of anorexia nervosa, bulimia nervosa, binge-eating disorder, or purging disorder, and a matched sample of parents (n=172) reporting no eating-disorder characteristics. Results Parents with eating-disorder psychopathology were significantly more likely than parents without eating-disorder characteristics to report child binge-eating and compulsive exercise. Parents with eating-disorder psychopathology reported greater perceived feeding responsibility, greater concern about their child’s weight, and more monitoring of their child’s eating than parents without eating-disorder characteristics; however, they did not differ significantly in restriction of their child’s diet and pressure-to-eat. Child body mass index z-scores did not differ between parents with versus without eating-disorder characteristics. Conclusion Our findings suggest some important differences between parents with and without core eating-disorder psychopathology, which could augment clinical interventions for patients with eating disorders who are parents, or could guide pediatric eating-disorder prevention efforts. However, because our study was cross-sectional, findings could indicate increased awareness of or sensitivity to eating-disorder behaviors rather than a psychosocial cause of those behaviors. Longitudinal research and controlled trials examining prevention and intervention can clarify and address these clinical concerns. PMID:27302549

Echothymia: environmental dependency in the affective domain.

PubMed

Marin, Robert S; Gorovoy, Ian R

2014-01-01

Echothymia is stimulus-bound affective behavior, an echophenomenon in the domain of affect. Like echolalia and echopraxia, it is a concomitant of the environmental dependency associated with dysfunction of the frontal-striatal systems that mediate so-called frontal lobe functions. The authors introduce the definition and phenomenology of echothymia, overview its differential diagnosis and clinical significance, and suggest ways in which understanding echothymia may contribute to clinical management.

Kleptomania and Co-morbid addictive disorders.

PubMed

Kim, Hyoun S; Christianini, Aparecida Rangon; Bertoni, Daniela; de Oliveira, Maria do Carmo Medeiros; Hodgins, David C; Tavares, Hermano

2017-04-01

We examined the association between kleptomania and addictive disorders, including behavioral addictions. Fifty-three individuals with a diagnosis of kleptomania completed measures of kleptomania severity, semi-structured clinical interviews to assess co-morbid diagnosis of addictive disorders, and the Shorter PROMIS Questionnaire (SPQ) assessing an array of addictive behaviors. 20.75% of the sample met criteria for an addictive disorder; four for a substance use disorder and four for a behavioral addiction. Kleptomania severity was significantly associated with compulsive work and shopping measured by the SPQ. The results suggest the need to assess a wide array of addictive behaviors in individuals with kleptomania. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

The Co-occurrence of Gambling with Substance Use and Conduct Disorder among Youth in the U.S

PubMed Central

Barnes, Grace M.; Welte, John W.; Hoffman, Joseph H.; Tidwell, Marie-Cecile O.

2013-01-01

The co-occurrence of gambling with substance use and conduct disorder was examined in a representative U.S. household sample of 2,274 youth 14 to 21 years old. The findings show that problem gambling occurs within a problem behavior syndrome with other substance use behaviors and conduct disorder. Male gender, being black, and being Hispanic were found to be significant in predicting problem gambling over and above the effects of all four substance use and conduct disorder variables. Clinical interventions for one specific problem behavior in youth should consider assessing the other problem behaviors as well. PMID:21314760

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

Association between regression and self injury among children with autism.

PubMed

Lance, Eboni I; York, Janet M; Lee, Li-Ching; Zimmerman, Andrew W

2014-02-01

Self injurious behaviors (SIBs) are challenging clinical problems in individuals with autism spectrum disorders (ASDs). This study is one of the first and largest to utilize inpatient data to examine the associations between autism, developmental regression, and SIBs. Medical records of 125 neurobehavioral hospitalized patients with diagnoses of ASDs and SIBs between 4 and 17 years of age were reviewed. Data were collected from medical records on the type and frequency of SIBs and a history of language, social, or behavioral regression during development. The children with a history of any type of developmental regression (social, behavioral, or language) were more likely to have a diagnosis of autistic disorder than other ASD diagnoses. There were no significant differences in the occurrence of self injurious or other problem behaviors (such as aggression or disruption) between children with and without regression. Regression may influence the diagnostic considerations in ASDs but does not seem to influence the clinical phenotype with regard to behavioral issues. Additional data analyses explored the frequencies and subtypes of SIBs and other medical diagnoses in ASDs, with intellectual disability and disruptive behavior disorder found most commonly. Copyright © 2013 Elsevier Ltd. All rights reserved.

Self-harm and suicidal behavior in borderline personality disorder with and without bulimia nervosa.

PubMed

Reas, Deborah L; Pedersen, Geir; Karterud, Sigmund; Rø, Øyvind

2015-06-01

Few studies have investigated whether a diagnosis of Bulimia nervosa (BN) confers additional risk of life-threatening behaviors such as self-harm and suicidal behavior in borderline personality disorder (BPD). Participants were 483 treatment-seeking women diagnosed with BPD according to the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II; First, Gibbon, Spitzer, Williams, & Benjamin, 1997; Diagnostic and Statistical Manual of Mental Disorders, 4th ed.; APA, 1994) and admitted to the Norwegian Network of Psychotherapeutic Day Hospitals between 1996 and 2009. Of these, 57 (11.8%) women met DSM-IV diagnostic criteria for BN according to the Mini-International Neuropsychiatric Interview (M.I.N.I.; Sheehan et al., 1998) and they were compared with women with BPD and other Axis I disorders. We found that comorbid BN is uniquely and significantly associated with increased risk of suicidal behavior among women being treated for BPD. Findings underscore the importance of routinely screening for BN among women seeking treatment for BPD, as co-occurring bulimia appears to be a significant marker for immediate life-threatening behaviors in this already high-risk population, which is a significant public health issue. A significantly greater proportion of women with BPD-BN reported suicidal ideation at intake (past 7 days), engaged in self-harm behavior during treatment, and attempted suicide during treatment. All bivariate associations remained significant in the logistic regression models after controlling for mood, anxiety, and substance-related disorders. The presence of a concurrent diagnosis of BN among women with BPD is significantly and uniquely associated with recent suicidal ideation, and self-harm behavior and suicide attempts during treatment after controlling for major classes of mental disorders. Co-occurring BN appears to represent a significant marker for immediate life-threatening behaviors in women seeking treatment for BPD. Extra vigilance and careful monitoring of suicidal behavior during treatment is important for these individuals, and routine screening for BN is warranted. (c) 2015 APA, all rights reserved).

Prevalence of pica and rumination behaviors in German children aged 7-14 and their associations with feeding, eating, and general psychopathology: a population-based study.

PubMed

Hartmann, Andrea S; Poulain, Tanja; Vogel, Mandy; Hiemisch, Andreas; Kiess, Wieland; Hilbert, Anja

2018-04-19

Despite potentially severe medical consequences of pica and rumination disorder (RD), little is known about their prevalence and association with other psychopathology in childhood. As a part of a larger population-based study, 804 children aged 7-14 years and their parents were asked about their experience of pica and RD behaviors, and associated eating, feeding and general psychopathology. A total of 12.31 and 11.49% of the participants reported having engaged in pica or RD behaviors, respectively, at least once. Recurring pica or RD behaviors had been experienced by 4.98 and 1.49% of the participants, respectively. The behaviors showed a significant but small correlation with one another (r = 0.28, p < 0.01). Correlations with symptoms of avoidant/restrictive food intake disorder (ARFID) were significant but small (pica: r = 0.18, RD: r = 0.27, both p < 0.01). Prevalence rates of recurring pica behavior were significantly increased if recurring RD was present (58.33%), and also vice versa (17.50%). The prevalence rates of recurrent pica and RD behaviors were also increased in the presence of an ARFID diagnosis (both behaviors 12.0%). However, correlations with restraint and eating, weight, and shape concern were non-significant (all p > 0.05). Additionally, RD behavior was positively correlated with emotional and conduct problems (r = 0.15 and 0.22, both p < 0.01), and both behaviors were negatively correlated with prosocial behavior (r = -  0.10 and - 0.09, both p < 0.05). Our findings underscore the clinical significance of pica and RD behaviors. More research is warranted on both disorders and their association and relation with ARFID to deepen the understanding of their presentation and to ascertain diagnostic validity.

Social network composition of vascular patients and its associations with health behavior and clinical risk factors.

PubMed

Heijmans, Naomi; van Lieshout, Jan; Wensing, Michel

2017-01-01

This study aimed to explore linkages of patients' social network composition with health behaviors and clinical risk factors. This observational study was embedded in a project aimed at improving cardiovascular risk management (CRVM) in primary care. 657 vascular patients (227 with cardiovascular disease, 380 at high vascular risk), mean age 72.4 (SD 9.4) years, were recruited as were individuals patients considered important for dealing with their disease, so called alters (n = 487). Network composition was measured with structured patient questionnaires. Both patients and alters completed questionnaires to measure health behavior (habits for physical activity, diet, and smoking). Clinical risk factors (systolic blood pressure, LDL cholesterol level, and body mass index) were extracted from patients' medical records. Six logistic regression analyses, using generalized estimating equations, were used to test three hypothesized effects of network composition (having alters with healthful behaviors, without depression, and with specialized knowledge) on six outcomes, adjusted for demographic, personal and psychological characteristics. Having alters with overall healthful behavior was related to healthful patient diet (OR 2.14, 95%CI: 1.52-3.02). Having non-smoking alters in networks was related to reduced odds for patient smoking (OR 0.17, 95%CI: 0.05-0.60). No effects of presence of non-depressed alters were found. Presence of alters with specialized knowledge on CVRM was inversely related to healthful diet habits of patients (OR 0.47, 95%CI 0.24-0.89). No significant associations between social network composition and clinical risk factors were found. Diet and smoking, but not physical exercise and clinical risk factors, were associated with social network composition of patients with vascular conditions. In this study of vascular patients, controlling for both personal and psychological factors, fewer network influences were found compared to previous research. Further research is needed to examine network structure characteristics as well as the role of psychological factors to enhance understanding health behavior of patients involved in CVRM.

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

Behavior Problems and Psychiatric Diagnoses in Girls with Gender Identity Disorder: A Follow-Up Study.

PubMed

Drummond, Kelley D; Bradley, Susan J; Peterson-Badali, Michele; VanderLaan, Doug P; Zucker, Kenneth J

2018-02-17

This study evaluated the presence of clinical range behavior problems and psychiatric diagnoses in 25 girls referred for gender identity disorder (GID) in childhood (mean age: 8.88 years) at the time of follow-up in adolescence or adulthood (mean age: 23.2 years). At follow-up, three (12%) of the girls were judged to have persistent GID based on DSM-IV criteria. With regard to behavior problems at follow-up, 39.1% of the girls had a clinical range score on either the Child Behavior Checklist or Adult Behavior Checklist as rated by their mothers, and 33.3% had a clinical range score on either the Youth Self-Report or the Adult Self-Report. On either the Diagnostic Interview for Children and Adolescents or the Diagnostic Interview Schedule, the girls had, on average, 2.67 diagnoses (range: 0-10); 46% met criteria for three or more diagnoses. From the childhood assessment, five variables were significantly associated with a composite Psychopathology Index (PI) at follow-up: a lower IQ, living in a non-two-parent or reconstituted family, a composite behavior problem index, and poor peer relations. At follow-up, degree of concurrent homoeroticism and a composite index of gender dysphoria were both associated with the composite PI. Girls with GID show a psychiatric vulnerability at the time of follow-up in late adolescence or adulthood, although there was considerable variation in their general well-being.

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.

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.

Predictors of healthcare seeking delays among children with chronic musculoskeletal disorders in Nepal.

PubMed

LeBrun, Drake G; Talwar, Divya; Pham, Tuyetnhi A; Banskota, Bibek; Spiegel, David A

2017-12-01

Healthcare seeking behaviors among children with musculoskeletal disorders are poorly understood. We sought to analyze healthcare seeking delays among children with chronic musculoskeletal conditions in Nepal and identify predictors of clinically significant delays. A cross-sectional study was conducted at a large pediatric musculoskeletal rehabilitation center in Nepal. Baseline sociodemographic data and healthcare seeking behaviors were assessed via interviews with 75 randomly selected caregivers. Delays of at least 3 months between disease recognition and presentation to a health worker were considered clinically significant. Predictors of significant delay were assessed via multivariable logistic regression. Clubfoot was the most common condition seen in the study sample (N = 33; 37%). Mean and median presentation delays were 33 months and 14 months, respectively. Sixty-seven percent of children were delayed at least 3 months and 40% were delayed at least 2 years. Caregiver occupation in agriculture or unskilled labor was associated with an increased risk of delayed presentation (adjusted OR = 4.05; 95% CI: 1.36-12.09). Children with chronic musculoskeletal disorders in Nepal face significant delays in accessing healthcare. This poses a major clinical problem as the delayed diagnosis and treatment of childhood musculoskeletal disorders can complicate management options and decrease long-term quality of life. Copyright © 2017 Ministry of Health, Saudi Arabia. Published by Elsevier Ltd. All rights reserved.

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.

Virtual reality cognitive behavior therapy for public speaking anxiety: a randomized clinical trial.

PubMed

Wallach, Helene S; Safir, Marilyn P; Bar-Zvi, Margalit

2009-05-01

Public speaking anxiety (PSA) is a common phobia. Although cognitive behavior therapy (CBT) is preferred, difficulties arise with the exposure component (lack of therapist control, patient's inability to imagine, self-flooding, loss of confidentiality resulting from public exposure). Virtual reality CBT (VRCBT) enables a high degree of therapist control, thus overcoming these difficulties. This study examined whether VRCBT is an alternative to CBT. Participants with PSA were randomly assigned to VRCBT (28 participants), CBT (30 participants), and wait list control (WLC; 30 participants). VRCBT and CBT were significantly more effective than WLC in anxiety reduction on four of five anxiety measures, and on subject's self-rating of anxiety during a behavioral task. No significant differences were found on observer ratings of the behavioral task. However, twice as many participants dropped out from CBT than from VRCBT. Our results demonstrated that VRCBT is an effective and brief treatment regimen, equal to CBT.

Effect of Race and Marital Status on Mothers’ Observed Parenting and Adolescent Adjustment in Youth With Type 1 Diabetes

PubMed Central

Young, Mackenzie T.; Gruhn, Meredith A.; Grey, Margaret; Delamater, Alan M.; Jaser, Sarah S.

2015-01-01

Objective To examine demographic differences in parenting behaviors and adjustment in youth with type 1 diabetes. Methods Adolescents’ psychosocial adjustment was assessed via self-reports and parent reports, and clinical data were obtained from adolescents’ medical records. Mother–adolescent dyads (N = 93) engaged in a videotaped discussion task, which was coded for observed parenting behaviors. Results Single and non-White mothers exhibited significantly more overinvolved and less collaborative parenting behaviors. Higher levels of overinvolved parenting and lower levels of collaborative parenting were associated with poorer adolescent adjustment (i.e., higher levels of externalizing problems). Observed parenting was not significantly associated with glycemic control. There was an indirect effect of marital status and race/ethnicity on externalizing behaviors through parenting. Conclusions The current study highlights parenting as a potential target for interventions, especially in single and minority mothers, to improve adjustment in this population. PMID:25248850

The Centers for Disease Control and Prevention: Findings From The National Healthy Worksite Program

PubMed Central

Lang, Jason; Cluff, Laurie; Payne, Julianne; Matson-Koffman, Dyann; Hampton, Joel

2017-01-01

Objective To evaluate employers’ implementation of evidence-based interventions, and changes in employees’ behaviors associated with participating in the national healthy worksite program (NHWP). Methods NHWP recruited 100 small and mid-sized employers and provided training and support for 18 months. Outcome measures were collected with an employer questionnaire, an employee survey, and biometric data at baseline and 18 months later. Results The 41 employers who completed the NHWP implemented significantly more evidence-based interventions and had more comprehensive worksite health promotion programs after participating. Employees made significant improvements in physical activity and nutritional behaviors, but did not significantly improve employee weight. Conclusions Training and technical support can help small and mid-sized employers implement evidence-based health interventions to promote positive employee behavior changes. A longer follow up period may be needed to assess whether NHWP led to improvements in clinical outcomes. PMID:28594703

The Centers for Disease Control and Prevention: Findings From The National Healthy Worksite Program.

PubMed

Lang, Jason; Cluff, Laurie; Payne, Julianne; Matson-Koffman, Dyann; Hampton, Joel

2017-07-01

To evaluate employers' implementation of evidence-based interventions, and changes in employees' behaviors associated with participating in the national healthy worksite program (NHWP). NHWP recruited 100 small and mid-sized employers and provided training and support for 18 months. Outcome measures were collected with an employer questionnaire, an employee survey, and biometric data at baseline and 18 months later. The 41 employers who completed the NHWP implemented significantly more evidence-based interventions and had more comprehensive worksite health promotion programs after participating. Employees made significant improvements in physical activity and nutritional behaviors, but did not significantly improve employee weight. Training and technical support can help small and mid-sized employers implement evidence-based health interventions to promote positive employee behavior changes. A longer follow up period may be needed to assess whether NHWP led to improvements in clinical outcomes.

Countering workplace aggression: an urban tertiary care institutional exemplar.

PubMed

Phillips, Susan

2007-01-01

The purpose of this process improvement project was to provide nursing staff with evidence-based knowledge and skills to manage patients and/or visitors with the potential for violence. Current statistics describing workplace violence in healthcare settings are alarming. Workplace violence significantly impacts nursing practice and may contribute to physical injuries, psychological trauma, decreased productivity, and low morale among nurses. This is particularly germane to those nurses who have been inadequately trained to manage aggressive patients and/or family behaviors. Following a series of disruptive episodes on the pulmonary-medical service that occurred at our facility in the winter of 2006, an employee safety team was formed to address the issue of workplace violence. Around this same time frame, a team comprising system hospital representatives was also initiated to globally address workplace violence. A Workplace Violence Education Program was devised to equip nurses with information, skills, and practical tools that will empower them when encountering clinical situations characterized by disruptive or abusive patient and/or family behaviors. The ultimate goal was to diffuse progressive, escalating aggressive behaviors in the clinical setting. FINDINGS/OUTCOMES: Evidence-based approaches formed the basis of an educational offering focusing on workplace violence prevention and management. This informational intervention was devised to empower clinical nursing staff with knowledge to enhance judgment, decision making, and implementation of behavioral strategies to reduce the likelihood of patient/family behaviors escalating to aggression. Interdisciplinary collaboration that included clinical experience, expertise, and knowledge generated from current literature reviews contributed to a successful educational program for nurses focusing on a historically neglected topic--workplace violence.

[DAILY AND ABNORMAL EATING BEHAVIORS IN A COMMUNITY SAMPLE OF CHILEAN ADULTS].

PubMed

Oda-Montecinos, Camila; Saldaña, Carmina; Andrés Valle, Ana

2015-08-01

this research aimed to characterize the daily eating behavior in a sample of Chilean adults according to their Body Mass Index (BMI) and gender and to analyze the possible links between these variables and abnormal eating behaviors. 657 participants (437 women and 220 men, age range 18-64 years) were evaluated with a battery of self-administered questionnaires. Mean BMI was 25.50 kg/m2 (women 24.96 kg/m2, men 26.58 kg/m2), being significantly higher the mean of BMI in the men group, being the BMI mean of the total sample and that of the male group in the overweight range. participants with overweight (BMI ≥ 25 kg/m2), in contrast with normal-weight group, tended to do more frequently the following behaviors: skip meals, follow a diet, eat less homemade food, eat faster and in greater quantities, in addition to do a greater number of abnormal eating behaviors of various kinds and to rate significantly higher in clinical scales that evaluated eating restraint and overeating. Men showed significantly more eating behaviors linked with overeating, and women performed more behaviors related with eating restraint and emotional eating. the results suggest that, besides "what" people eat, "how" people eat, in terms of specific behaviors, may contribute to the rapid increase of overweight in Chilean population. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

Predicting Treatment Success in Child and Parent Therapy Among Families in Poverty.

PubMed

Mattek, Ryan J; Harris, Sara E; Fox, Robert A

2016-01-01

Behavior problems are prevalent in young children and those living in poverty are at increased risk for stable, high-intensity behavioral problems. Research has demonstrated that participation in child and parent therapy (CPT) programs significantly reduces problematic child behaviors while increasing positive behaviors. However, CPT programs, particularly those implemented with low-income populations, frequently report high rates of attrition (over 50%). Parental attributional style has shown some promise as a contributing factor to treatment attendance and termination in previous research. The authors examined if parental attributional style could predict treatment success in a CPT program, specifically targeting low-income urban children with behavior problems. A hierarchical logistic regression was used with a sample of 425 families to assess if parent- and child-referent attributions variables predicted treatment success over and above demographic variables and symptom severity. Parent-referent attributions, child-referent attributions, and child symptom severity were found to be significant predictors of treatment success. Results indicated that caregivers who viewed themselves as a contributing factor for their child's behavior problems were significantly more likely to demonstrate treatment success. Alternatively, caregivers who viewed their child as more responsible for their own behavior problems were less likely to demonstrate treatment success. Additionally, more severe behavior problems were also predictive of treatment success. Clinical and research implications of these results are discussed.

Individual cognitive-behavioral therapy and behavioral couples therapy in alcohol use disorder: a comparative evaluation in community-based addiction treatment centers.

PubMed

Vedel, Ellen; Emmelkamp, Paul M G; Schippers, Gerard M

2008-01-01

Alcohol abuse serves as a chronic stressor between partners and has a deleterious effect on relationship functioning. Behavioral Couples Therapy (BCT) for alcohol dependence, studied as an adjunct to individual outpatient counseling, has shown to be effective in decreasing alcohol consumption and enhancing marital functioning, but no study has directly tested the comparative effectiveness of stand-alone BCT versus an individually focused cognitive-behavioral therapy (CBT) in a clinical community sample. The present study is a randomized clinical trial evaluating the effectiveness of stand-alone BCT (n = 30) compared to individual CBT (n = 34) in the treatment of alcohol use disorders in community treatment centers in Dutch male and female alcoholics and their partners. Results show both BCT and CBT to be effective in changing drinking behavior after treatment. BCT was not found to be superior to CBT. Marital satisfaction of the spouse increased significantly in the BCT condition but not in the CBT condition, the differences being significant at the post-test. Patients' self-efficacy to withstand alcohol-related high-risk situations increased significantly in both treatment conditions, but more so in CBT than in BCT after treatment. Treatment involvement of the spouse did not increase retention. Regular practitioners in community treatment centers can effectively deliver both treatments. Stand-alone BCT is as effective as CBT in terms of reduced drinking and to some extent more effective in terms of enhancing relationship satisfaction. However, BCT is a more costly intervention, given that treatment sessions lasted almost twice as long as individual CBT sessions. Copyright 2008 S. Karger AG, Basel.

School-based intervention for childhood disruptive behavior in disadvantaged settings: a randomized controlled trial with and without active teacher support.

PubMed

Liber, Juliette M; De Boo, Gerly M; Huizenga, Hilde; Prins, Pier J M

2013-12-01

In this randomized controlled trial, we investigated the effectiveness of a school-based targeted intervention program for disruptive behavior. A child-focused cognitive behavioral therapy (CBT) program was introduced at schools in disadvantaged settings and with active teacher support (ATS) versus educational teacher support (ETS) (CBT + ATS vs. CBT + ETS). Screening (n = 1,929) and assessment (n = 224) led to the inclusion of 173 children ages 8-12 years from 17 elementary schools. Most of the children were boys (n = 136, 79%) of low or low-to-middle class socioeconomic status (87%); the sample was ethnically diverse (63% of non-Western origin). Children received CBT + ATS (n = 29) or CBT + ETS (n = 41) or were entered into a waitlist control condition (n = 103) to be treated afterward (CBT + ATS, n = 39, and CBT + ETS, n = 64). Effect sizes (ES), clinical significance (reliable change), and the results of multilevel modeling are reported. Ninety-seven percent of children completed treatment. Teachers and parents reported positive posttreatment effects (mean ES = .31) for CBT compared with the waitlist control condition on disruptive behavior. Multilevel modeling showed similar results. Clinical significance was modest. Changes had remained stable or had increased at 3-months follow-up (mean ES = .39). No consistent effect of teacher condition was found at posttreatment; however, at follow-up, children who received ETS fared significantly better. This study shows that a school-based CBT program is beneficial for difficult-to-reach children with disruptive behavior: The completion rate was remarkably high, ESs (mean ES = .31) matched those of previous studies with targeted intervention, and effects were maintained or had increased at follow-up.

Driven exercise in the absence of binge eating: Implications for purging disorder.

PubMed

Lydecker, Janet A; Shea, Megan; Grilo, Carlos M

2018-02-01

Purging disorder (PD) is characterized by recurrent purging without objectively large binge-eating episodes. PD has received relatively little attention, and questions remain about the clinical significance of "purging" by exercise that is driven or compulsive (i.e., as extreme compensatory or weight-control behavior). The little available research suggests that individuals who use exercise as a compensatory behavior might have less eating-disorder psychopathology than those who purge by vomiting or laxatives, but those studies have had smaller sample sizes, defined PD using low-frequency thresholds, and defined exercise without weight-compensatory or driven elements. Participants (N = 2,017) completed a web-based survey with established measures of eating-disorder psychopathology, depression, and physical activity. Participants were categorized (regular compensatory driven exercise, PD-E, n = 297; regular compensatory vomiting/laxatives, PD-VL, n = 59; broadly defined anorexia nervosa, AN, n = 20; and no eating-disordered behaviors, NED, n = 1,658) and compared. PD-E, PD-VL, and AN had higher eating-disorder psychopathology and physical activity than NED but did not significantly differ from each other on most domains. PD-VL and AN had higher depression than PD-E, which was higher than NED. Findings suggest that among participants with regularly compensatory behaviors without binge eating, those who use exercise alone have similar levels of associated eating-disorder psychopathology as those who use vomiting/laxatives, although they have lower depression levels and overall frequency of purging. Findings provide further support for the clinical significance of PD. Clinicians and researchers should recognize the severity of driven exercise as a compensatory behavior, and the need for further epidemiological and treatment research. © 2017 Wiley Periodicals, Inc.

Aggression in pigtailed macaque (Macaca nemestrina) breeding groups affects pregnancy outcome

PubMed Central

Ha, James; Alloway, Hayley; Sussman, Adrienne

2011-01-01

Past research has shown that aggressive behaviors can affect female reproductive outcome in non-human primate captive breeding programs. In this study, aggressive behaviors were recorded in a colony of pigtailed macaque monkeys (Macaca nemestrina) and related to pregnancy outcome. For twenty-two weeks, behavioral data were collected from nine breeding groups, consisting of zero to one male (some males were removed after a cycle of conceptions for husbandry reasons) and four to eight females. Observations included all occurrences of eleven aggressive behaviors during 15-minute observation sessions, one to three times a week. Mean weekly aggression levels during the study period were determined for each group, as well as for each pregnancy. Aggression data were summarized with Principal Components Analyses (PCA). Results indicate that pigtailed macaque aggression falls into five distinctive categories: warn, engage, threaten, pursue, and attack. Breeding groups differed in their levels of aggression, even after controlling for group size, presence of a sire, and group stability. Levels of the five aggression categories were found to affect the probability that a pregnancy ended in either a natural birth of a live infant, a clinical intervention producing a live infant, or a nonviable outcome. The predictive value of aggression was significant when clinical interventions were included as possible reproductive outcomes, Behavioral observation of captive groups could identify “risk” conditions affecting pregnancy outcome and the requirement for clinical intervention. PMID:21898511

[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.

Suicide, hopelessness, and social desirability: a test of an interactive model.

PubMed

Holden, R R; Mendonca, J D; Serin, R C

1989-08-01

We examined the relationships among suicidal indices, hopelessness, and social desirability. Both hopelessness and a measure of social desirability that reflected a sense of general capability were significant indicators of suicidal manifestations. In particular, hierarchical multiple regression procedures demonstrated that hopelessness and social desirability interacted in the prediction of suicide variables. Results generalized across various clinical diagnostic subgroups of psychiatric patients and a sample of prisoners and across different clinically evaluated and self-reported indices of suicidal behavior. Findings are interpreted to mean that a sense of general capability buffers the link of hopelessness to suicidal behavior. Implications for understanding the cognitions associated with suicide and for improving prediction of persons at risk are discussed.

[Evaluation of the treatment with fenfluramine of autism in children].

PubMed

de Villard, R; Ceillier-Hoppenot, B; Flachaire, E; Dalery, J; Rebaud, B; Maillet, J; Revol, O; Mamelle, J C; Quincy, C

1988-01-01

The effects of fenfluramine were studied in a group of 44 children with the autistic syndrome and in 26 non autistic children with behavior abnormalities, mostly hyperkinetic children, as a control group. The mean daily dosage was 0.65 mg/kg/day. There were 75% positive results in the autistic children and 77% in the control group. The clinical improvement appears to be mainly related to the control of the hyperactive behavior in the autistic children. Platelet serotonin levels were studied in both groups, showing a clear cut decrease during fenfluramine therapy with no significant differences between the 2 groups and no correlation between the clinical effects and the magnitude of the decrease.

Parental posttraumatic stress and child behavioral problems in world trade center responders.

PubMed

Uchida, Mai; Feng, Huifen; Feder, Adriana; Mota, Natalie; Schechter, Clyde B; Woodworth, Hilary D; Kelberman, Caroline G; Crane, Michael; Landrigan, Philip; Moline, Jacqueline; Udasin, Iris; Harrison, Denise; Luft, Benjamin J; Katz, Craig; Southwick, Steven M; Pietrzak, Robert H

2018-06-01

We investigated trans-generational associations between Post Traumatic Stress Disorder (PTSD) symptoms in World Trade Center (WTC) responders and behavioral problems in their children. Participants were WTC responders-8034 police and 8352 non-traditional (eg, construction workers)-with one or more children at the time of their first visit to the World Trade Center Health Program (WTC-HP). Self-report questionnaires were administered approximately 4 years after the 9/11 WTC attack. A total of 31.4% of non-traditional and 20.0% of police responders reported behavioral problems in their children. Non-traditional responder status, female sex, Hispanic ethnicity, more life stressors, more WTC-related PTSD symptoms, and dysphoric arousal symptoms were significant correlates of behavioral problems in responders' children. Specific parental sociodemographic, psychosocial and clinical characteristics, as well as PTSD symptom severity, were significant correlates of child behavior problems. Findings encourage monitoring and early intervention for children of disaster responders, particularly those at highest risk. © 2018 Wiley Periodicals, Inc.

Reaction Time is a Marker of Early Cognitive and Behavioral Alterations in Pure Cerebral Small Vessel Disease.

PubMed

Jouvent, Eric; Reyes, Sonia; De Guio, François; Chabriat, Hugues

2015-01-01

The assessment of early and subtle cognitive and behavioral effects of cerebral small vessel disease (SVD) requires specific and long-lasting evaluations performed by experienced neuropsychologists. Simpler tools would be helpful for daily clinical practice. To determine whether a simple reaction time task that lasts 5 minutes and can be performed without external supervision on any tablet or laptop can be used as a proxy of early cognitive and behavioral alterations in CADASIL (Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy), a monogenic form of pure SVD related to NOTCH3 mutations. Twenty-two genetically confirmed patients with CADASIL having preserved global cognitive abilities and without disability (MMSE >24 and modified Rankin's scale ≤1) were compared to 29 age-and-gender matched controls to determine group differences according to: 1) conventional neuropsychological and behavioral testing; 2) a computerized battery evaluating reaction time, processing speed, and executive functions. In a second step, correlations between reaction time and cognitive and behavioral alterations detected using both conventional and computerized testing were tested in patients. Reaction time was significantly higher in patients than in controls (mean in patients: 283 ms - in controls: 254 ms, p = 0.03). In patients, reaction time was significantly associated with conventional and chronometric tests of executive functions, working memory, and apathy. Reaction time obtained using a very simple task may serve as a proxy of early cognitive and behavioral alterations in SVD and could be easily used in daily clinical practice.

The Modified Frontal Behavioral Inventory (FBI-mod) for Patients with Frontotemporal Lobar Degeneration, Alzheimer's Disease, and Mild Cognitive Impairment.

PubMed

Suhonen, Noora-Maria; Hallikainen, Ilona; Hänninen, Tuomo; Jokelainen, Jari; Krüger, Johanna; Hall, Anette; Pikkarainen, Maria; Soininen, Hilkka; Remes, Anne M

2017-01-01

While behavioral symptoms are both early and prevalent features of behavioral variant frontotemporal dementia (bvFTD), they can be present in other types of dementia as well, including Alzheimer's disease (AD) and even mild cognitive impairment (MCI). The Frontal Behavioral Inventory (FBI) was specifically developed to capture the behavioral and personality changes in bvFTD; it has also been modified into a self-administered caregiver questionnaire (FBI-mod). We examined the utility of the FBI-mod in differentiating bvFTD (n = 26), primary progressive aphasia (PPA) (n = 7), AD (n = 53), and MCI (n = 50) patients, and investigated how the FBI-mod may be associated with neuropsychological measures. The bvFTD patients scored significantly higher as compared to all other patient groups on the FBI-mod Total (p < 0.005), Negative (p < 0.005), and Positive (p < 0.01) scores. The cut-off point for the FBI-mod Total score that best discriminated the bvFTD and AD patients in our sample was 16, thus substantially lower than reported for the original FBI. For the bvFTD group, only mild correlations emerged between the FBI-mod and the cognitive measures. However, significant correlations between the FBI-mod and depressive symptoms as measured by the BDI-II were found for bvFTD. This suggests that while behavioral symptoms appear independent from cognitive deficits in bvFTD, they may nevertheless be interrelated with depressive symptoms. We conclude that the FBI-mod is an easily administered behavioral scale that can aid in differential diagnosis of bvFTD and should be used in clinical practice. The FBI-mod may further be considered as an outcome measure in clinical trials.

Resilience in physically abused children: protective factors for aggression.

PubMed

Holmes, Megan R; Yoon, Susan; Voith, Laura A; Kobulsky, Julia M; Steigerwald, Stacey

2015-04-27

Aggression continues to be a serious problem among children, especially those children who have experienced adverse life events such as maltreatment. However, there are many maltreated children who show resilient functioning. This study investigated potential protective factors (i.e., child prosocial skills, child internalizing well-being, and caregiver well-being) that promoted positive adaptation and increased the likelihood of a child engaging in the healthy, normative range of aggressive behavior, despite experiencing physical maltreatment. Logistic regression analyses were conducted using two waves of data from the National Survey of Child and Adolescent Well-Being (NSCAW-I). Children who were physically maltreated were more likely to exhibit clinical levels of aggressive behavior at Time 1 than children who were not physically maltreated. Children's internalizing well-being, children's prosocial behavior, and caregivers' well-being were associated with lower likelihood of clinical levels of aggressive behavior at Time 1. Children's internalizing well-being and children's prosocial behavior remained significantly associated with nonclinical aggression 18 months later. These findings highlight the role of protective factors in fostering positive and adaptive behaviors in maltreated children. Interventions focusing on preventing early aggression and reinforcing child prosocial skills, child internalizing well-being, and caregiver well-being may be promising in promoting healthy positive behavioral adjustment.

[Organizational ethics: a study in ophthalmologic clinics].

PubMed

Sanches, Maria Aparecida; Scarpi, Marinho Jorge

2005-01-01

Research on the field of organizational ethics to investigate to which extent ophthalmologic clinics, inserted in the competitive atmosphere, in the condition of organizations in search of survival, subordinate ethics to competitiveness in the managerial praxis, that is, in the administrative sphere. Kohlberg is taken as theoretical reference, approaching the theme of ethical subordination to competitiveness. The instrument to evaluate moral behaviors of organizations, elaborated by Licht, is applied. The quantitative method is used, adopting analytic instruments, such as Q of Yule and non parametric tests, when dealing with the data of 41 ophthalmologic clinics. The results of the research seem to indicate that administrators of ophthalmologic clinics of greater performance subordinate ethical principles to competitiveness, seeking to assure the survival of the company and, when confronted with the instrument to evaluate their moral behavior, proposed by Kohlberg, have a significantly smaller presence in the postconventional stage than administrators of ophthalmologic clinics with a smaller performance. One may affirm, according to non parametric tests, at the level of significance of 0.05, that the levels of moral development of the two groups differ significantly. The obtained results are according to the literature, especially concerning the "paradox of the ethical subordination and competitiveness". They also suggest that the warrant of the survival of the company tends to reduce the perception of the groups in power regarding the problems that happen in the community, and that a reduction of the ethical values subordinated to competition occurs, and such reduction provokes growing feelings of economical disputes in the social sphere.

Multi-site randomized trial of behavioral interventions for women with co-occurring PTSD and substance use disorders

PubMed Central

Hien, Denise A.; Wells, Elizabeth A.; Jiang, Huiping; Suarez-Morales, Lourdes; Campbell, Aimee N. C.; Cohen, Lisa R.; Miele, Gloria M.; Killeen, Therese; Brigham, Gregory S.; Zhang, Yulei; Hansen, Cheri; Hodgkins, Candace; Hatch-Maillette, Mary; Brown, Chanda; Kulaga, Agatha; Kristman-Valente, Allison; Chu, Melissa; Sage, Robert; Robinson, James A.; Liu, David; Nunes, Edward V.

2009-01-01

We compared the effectiveness of Seeking Safety (SS), an integrated cognitive behavioral treatment for substance use disorder (SUD) and post-traumatic stress disorder (PTSD), to an active comparison health education group (Women’s Health Education [WHE]) within NIDA’s Clinical Trials Network. We randomized 353 women to receive 12 sessions of SS (M = 6.2 sessions) or WHE (M = 6.0 sessions) with follow-up assessment at post-treatment and 3-, 6-, and 12-months post-treatment. Primary outcomes were the Clinician Administered PTSD Scale (CAPS) and PTSD Symptom Scale-Self Report (PSS-SR), and substance use (self-reported abstinence in the prior 7 days and days per week of any substance use). Intention-to-treat analysis showed large, clinically significant reductions in CAPS and PSS-SR symptoms (d = 1.94 and 1.12, respectively), but no reliable difference between conditions. Substance use outcomes were not significantly different over time between the two treatments and at follow-up showed no significant change from baseline, when 46% of participants were abstinent. Study results do not favor SS over WHE as an adjunct to SUD treatment for women with PTSD and reflect considerable opportunity to improve clinical outcomes in community-based treatments for these co-occurring conditions. PMID:19634955

Enzyme potentiated hyposensitization: IV. effect of protamine on the immunological behavior of beta glucuronidase in mice and patients with hay fever.

PubMed

McEwen, L M; Nicholson, M; Kitchen, I; O'Gorman, J; White, S

1975-05-01

The ability of beta glucuronidase and a small dose of antigen to modify the anaphylactic reaction of previously sensitized mice has been further investigated. Protamine has an important effect on the immunological behavior of the enzyme. A trial on hay fever patients shows that the results in mice are relevant and that the method can produce significant clinical hyposensitization.

Evaluation of Internet-Based Clinical Decision Support Systems

PubMed Central

Thomas, Karl W; Dayton, Charles S

1999-01-01

Background Scientifically based clinical guidelines have become increasingly used to educate physicians and improve quality of care. While individual guidelines are potentially useful, repeated studies have shown that guidelines are ineffective in changing physician behavior. The Internet has evolved as a potentially useful tool for guideline education, dissemination, and implementation because of its open standards and its ability to provide concise, relevant clinical information at the location and time of need. Objective Our objective was to develop and test decision support systems (DSS) based on clinical guidelines which could be delivered over the Internet for two disease models: asthma and tuberculosis (TB) preventive therapy. Methods Using open standards of HTML and CGI, we developed an acute asthma severity assessment DSS and a preventative tuberculosis treatment DSS based on content from national guidelines that are recognized as standards of care. Both DSS's are published on the Internet and operate through a decision algorithm developed from the parent guidelines with clinical information provided by the user at the point of clinical care. We tested the effectiveness of each DSS in influencing physician decisions using clinical scenario testing. Results We first validated the asthma algorithm by comparing asthma experts' decisions with the decisions reached by nonpulmonary nurses using the computerized DSS. Using the DSS, nurses scored the same as experts (89% vs. 88%; p = NS). Using the same scenario test instrument, we next compared internal medicine residents using the DSS with residents using a printed version of the National Asthma Education Program-2 guidelines. Residents using the computerized DSS scored significantly better than residents using the paper-based guidelines (92% vs. 84%; p <0.002). We similarly compared residents using the computerized TB DSS to residents using a printed reference card; the residents using the computerized DSS scored significantly better (95.8% vs. 56.6% correct; p<0.001). Conclusions Previous work has shown that guidelines disseminated through traditional educational interventions have minimal impact on physician behavior. Although computerized DSS have been effective in altering physician behavior, many of these systems are not widely available. We have developed two clinical DSS's based on national guidelines and published them on the Internet. Both systems improved physician compliance with national guidelines when tested in clinical scenarios. By providing information that is coupled to relevant activity, we expect that these widely available DSS's will serve as effective educational tools to positively impact physician behavior. PMID:11720915

Disrupting the downward spiral of chronic pain and opioid addiction with mindfulness-oriented recovery enhancement: a review of clinical outcomes and neurocognitive targets.

PubMed

Garland, Eric L

2014-06-01

Prescription opioid misuse and addiction among chronic pain patients are problems of growing medical and social significance. Chronic pain patients often require intervention to improve their well-being and functioning, and yet, the most commonly available form of pharmacotherapy for chronic pain is centered on opioid analgesics--drugs that have high abuse liability. Consequently, health care and legal systems are often stymied in their attempts to intervene with individuals who suffer from both pain and addiction. As such, novel, nonpharmacologic interventions are needed to complement pharmacotherapy and interrupt the cycle of behavioral escalation. The purpose of this paper is to describe how the downward spiral of chronic pain and prescription opioid misuse may be targeted by one such intervention, Mindfulness-Oriented Recovery Enhancement (MORE), a new behavioral treatment that integrates elements from mindfulness training, cognitive-behavioral therapy, and positive psychology. The clinical outcomes and neurocognitive mechanisms of this intervention are reviewed with respect to their effects on the risk chain linking chronic pain and prescription opioid misuse. Future directions for clinical and pharmacologic research are discussed.

A Closer Look at Racism and Heterosexism in Medical Students' Clinical Decision-Making Related to HIV Pre-Exposure Prophylaxis (PrEP): Implications for PrEP Education.

PubMed

Calabrese, Sarah K; Earnshaw, Valerie A; Krakower, Douglas S; Underhill, Kristen; Vincent, Wilson; Magnus, Manya; Hansen, Nathan B; Kershaw, Trace S; Mayer, Kenneth H; Betancourt, Joseph R; Dovidio, John F

2018-04-01

Social biases among healthcare providers could limit PrEP access. In this survey study of 115 US medical students, we examined associations between biases (racism and heterosexism) and PrEP clinical decision-making and explored prior PrEP education as a potential buffer. After viewing a vignette about a PrEP-seeking MSM patient, participants reported anticipated patient behavior (condomless sex, extra-relational sex, and adherence), intention to prescribe PrEP to the patient, biases, and background characteristics. Minimal evidence for racism affecting clinical decision-making emerged. In unadjusted analyses, heterosexism indirectly affected prescribing intention via all anticipated behaviors, tested as parallel mediators. Participants expressing greater heterosexism more strongly anticipated increased risk behavior and adherence problems, which were associated with lower prescribing intention. The indirect effect via condomless sex remained significant adjusting for background characteristics. Prior PrEP education did not buffer any indirect effects. Heterosexism may compromise PrEP provision to MSM and should be addressed in PrEP-related medical education.

Randomized Clinical Trial of Brief Risk Reduction Counseling for Sexually Transmitted Infection Clinic Patients in Cape Town, South Africa

PubMed Central

Cain, Demetria; Eaton, Lisa; Jooste, Sean; Simbayi, Leickness C.

2011-01-01

Objectives. We examined the effects of a brief counseling intervention designed to reduce HIV risk behaviors and sexually transmitted infections (STIs) among patients receiving STI services in Cape Town, South Africa. Methods. After randomization to either a 60-minute risk reduction counseling session or a 20-minute HIV–STI educational session, patients completed computerized sexual behavior assessments. More than 85% of the participants were retained at the 12-month follow-up. Results. There were 24% fewer incident STIs and significant reductions in unprotected vaginal and anal intercourse among participants who received risk reduction counseling relative to members of the control condition. Moderator analyses showed shorter lived outcomes for heavy alcohol drinkers than for lighter drinkers. The results were not moderated by gender. Conclusions. Brief single-session HIV prevention counseling delivered to STI clinic patients has the potential to reduce HIV infections. Counseling should be enhanced for heavier drinkers, and sustained outcomes will require relapse prevention techniques. Disseminating effective, brief, and feasible behavioral interventions to those at highest risk for HIV infection should remain a public health priority. PMID:21778486

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.

Suicide and Suicidal Behavior

PubMed Central

Nock, Matthew K.; Borges, Guilherme; Bromet, Evelyn J.; Cha, Christine B.; Kessler, Ronald C.; Lee, Sing

2008-01-01

Suicidal behavior is a leading cause of injury and death worldwide. Information about the epidemiology of such behavior is important for policy-making and prevention. The authors reviewed government data on suicide and suicidal behavior and conducted a systematic review of studies on the epidemiology of suicide published from 1997 to 2007. The authors' aims were to examine the prevalence of, trends in, and risk and protective factors for suicidal behavior in the United States and cross-nationally. The data revealed significant cross-national variability in the prevalence of suicidal behavior but consistency in age of onset, transition probabilities, and key risk factors. Suicide is more prevalent among men, whereas nonfatal suicidal behaviors are more prevalent among women and persons who are young, are unmarried, or have a psychiatric disorder. Despite an increase in the treatment of suicidal persons over the past decade, incidence rates of suicidal behavior have remained largely unchanged. Most epidemiologic research on suicidal behavior has focused on patterns and correlates of prevalence. The next generation of studies must examine synergistic effects among modifiable risk and protective factors. New studies must incorporate recent advances in survey methods and clinical assessment. Results should be used in ongoing efforts to decrease the significant loss of life caused by suicidal behavior. PMID:18653727

Family Functioning and Predictors of Runaway Behavior Among At-Risk Youth

PubMed Central

Holliday, Stephanie Brooks; Edelen, Maria Orlando; Tucker, Joan S.

2016-01-01

Purpose Adolescent runaway behavior is associated with a host of negative outcomes in young adulthood. Therefore, it is important to understand the factors that predict running away in youth. Methods Longitudinal data from 111 at-risk families were used to identify proximal predictors of runaway behavior over a 12-week period. On average, youth were 14.96 years old, and 45% were female. Ten percent of youth ran away during the 12-week follow-up period. Results In bivariate analyses, running away was predicted by poorer youth- and parent-rated family functioning, past runaway behavior, and other problem behaviors (e.g., substance use, delinquency), but not poorer perceived academic functioning. Results of a hierarchical logistic regression revealed a relationship between youth-rated family functioning and runaway behavior. However, this effect became non-significant after accounting for past runaway behavior and other problem behaviors, both of which remained significant predictors in the multivariable model. Conclusion These findings suggest that youth who run away may be engaged in a more pervasive pattern of problematic behavior, and that screening and prevention programs need to address the cycle of adolescent defiant behavior associated with running away. Recommendations for clinical practice with this at-risk population are discussed. PMID:28496291

Longitudinal Trajectories of Aberrant Behavior in Fragile X Syndrome

PubMed Central

Hustyi, Kristin M.; Hall, Scott S.; Jo, Booil; Lightbody, Amy A.; Reiss, Allan L.

2016-01-01

The Aberrant Behavior Checklist—Community (ABC-C; Aman, Burrow, & Wolford, 1995) has been increasingly adopted as a primary tool for measuring behavioral change in clinical trials for individuals with fragile X syndrome (FXS). To our knowledge, however, no study has documented the longitudinal trajectory of aberrant behaviors in individuals with FXS using the ABC-C. As part of a larger longitudinal study, we examined scores obtained on the ABC-C subscales for 124 children and adolescents (64 males, 60 females) with FXS who had two or more assessments (average interval between assessments was approximately 4 years). Concomitant changes in age-equivalent scores on the Vineland Adaptive Behavior Scales (VABS) were also examined. As expected for an X-linked genetic disorder, males with FXS obtained significantly higher scores on all subscales of the ABC-C and significantly lower age-equivalent scores on the VABS than females with FXS. In both males and females with FXS, scores on the Irritability/Agitation and Hyperactivity/Noncompliance subscales of the ABC-C decreased significantly with age, with little to no change occurring over time on the Lethargy/Social Withdrawal, Stereotypic Behavior, and Inappropriate Speech subscales. The decrease in scores on the Hyperactivity/Noncompliance domain was significantly greater for males than for females. In both males and females, age-equivalent scores on the VABS increased significantly over this developmental period. These results establish a basis upon which to evaluate long-term outcomes from intervention-based research. However, longitudinal direct observational studies are needed to establish whether the severity of problem behavior actually decreases over time in this population. PMID:25129200

Creating a firestorm: a review of children who deliberately light fires.

PubMed

Lambie, Ian; Randell, Isabel

2011-04-01

Deliberate firesetting is a significant social problem that causes millions of dollars of property damage each year. Of particular concern is that a high proportion of these arson offences are committed by children and adolescents. Youth firesetters are a unique and diverse group, variant in their motivations, needs and behavior and distinct from their adult counterparts. The study of firesetting has been approached in a number of ways and thus the existing body of research lacks a coherent, consistent and comprehensive set of empirical findings. In synthesizing the literature on child and adolescent firesetting, this review considers the potential relationships between firesetting typologies, risk factors, development and treatment. It considers the extent to which firesetting can be considered within the framework of antisocial behavior and what implications such a relationship may have for clinical practice. The review concludes that despite a number of risk factors being repeatedly identified, an understanding of the etiology behind firesetting behavior and potential developmental trajectories remains theoretically rather than empirically based. Existing typological theories do not take sufficient account of the complexities of firesetting behavior and there is not yet a typology and accompanying assessment that has undergone thorough empirical testing and is of significant clinical utility. Despite indications that the relationship between firesetting and antisocial behavior is of a serious nature, there has been a general lack of attention to this in literature and practice. Attention to this relationship is necessary not just in the area of firesetting research and practice, but also amongst those working with youth with behavioral difficulties and conduct problems, as for these individuals firesetting is likely to indicate particularly high risk for severity of behavior and future offending. Because of this relationship and the diversity of firesetting populations there is a need for collaborative intervention for firesetters that includes thorough assessment and provides an individualized, and developmentally appropriate approach best suited to the needs of the individual. This review reflects on the methodological limitations as well as clinical implications of existing studies and suggests necessary directions for future research. Copyright © 2011 Elsevier Ltd. All rights reserved.

Effectiveness of teaching cognitive-behavioral techniques on locus of control in hemodialysis patients.

PubMed

Mehrtak, Mohammad; Habibzadeh, Shahram; Farzaneh, Esmaeil; Rjaei-Khiavi, Abdollah

2017-10-01

Many of the cognitive behavioral models and therapeutic protocols developed so far for psychological disorders and chronic diseases have proved effective through clinical research. This study aimed to determine the effectiveness of teaching cognitive-behavioral techniques on locus of control in hemodialysis patients. This controlled clinical trial study was conducted in 2015 with 76 patients selected by census and treated with a hemodialysis machine in the dialysis department of Vali-Asr Hospital in the city of Meshkinshahr. A total of four patients were excluded because of their critical conditions while the rest, who were recruited, were randomly divided into two equal groups of 36 patients as the intervention and control groups. First, the locus of control was measured in both groups through a pretest, and cognitive-behavioral techniques were then taught to the intervention group during eight 45 to 90-minute sessions. The locus of control in patients of both groups was finally re-measured through a posttest. Data were collected using Rotter's Locus of Control Inventory. The Wilcoxon test and Mann-Whitney U test were respectively used in SPSS18 for data analysis. In the pretest and posttest stages respectively, 4.8% and 14.3% of samples in the control group as well as 14.3% and 33.3% of samples in the intervention group enjoyed internal locus of control. The difference between the pretest and posttest scores of internal locus of control in the intervention group was significant (p=0.004), which indicates the positive effect of cognitive-behavioral psychotherapeutic intervention on internalization of locus of control in this group. Given the external locus of control in most of the study patients and also the positive significant effect of cognitive-behavioral psychotherapy on internalization of locus of control in this group of patients, it appears necessary to have a psychology resident present in the hemodialysis department to teach the necessary cognitive-behavioral techniques to internalize the locus of control. The trial was registered at the Thai Clinical Trial Registry (http://www.clinicaltrials.in.th) with the TCTID: TCTR20170707003. The authors received no financial support for the research, authorship, and/or publication of this article.

The self-reported clinical practice behaviors of Australian optometrists as related to smoking, diet and nutritional supplementation.

PubMed

Downie, Laura Elizabeth; Keller, Peter Richard

2015-01-01

The primary aim of this study was to examine the self-reported, routine clinical practice behaviors of Australian optometrists with respect to advice regarding smoking, diet and nutritional supplementation. The study also sought to assess the potential influence of practitioner age, gender, practice location (major city versus regional), therapeutic-endorsement status and personal nutritional supplementation habits upon management practices in these areas. A survey was electronically distributed to Australian optometrists (n = 4,242). Respondents anonymously provided information about their personal demographics and lifestyle behaviors (i.e., age, gender, practice location, therapeutic-endorsement status, smoking status, nutritional supplement intake) and routine patient management practices with respect to advice across three domains: smoking, diet and nutritional supplementation. Multivariate logistic regression analyses were performed to assess for potential effects of the listed factors on practitioner behavior. A total of 283 completed surveys were received (completed survey response rate: 6.7%). Fewer than half of respondents indicated routinely asking their patients about smoking status. Younger practitioners were significantly (p < 0.05) less likely to enquire about patients' smoking behaviors, but this did not extend to counseling for smoking cessation. Almost two-thirds of respondents indicated routinely counseling patients about diet. About half of practitioners specified routinely asking their patients about nutritional supplement intake; this form of questioning was significantly more likely if the respondent was female (p < 0.05). Practitioners who recommended nutritional supplements most commonly did so for age-related macular degeneration (91.2%) and dry eye disease (63.9%). The primary source of evidence used to guide practitioners' nutrition-related patient management was reported to be peer-reviewed publications. These findings demonstrate that there are no clear predictors of practitioner behavior across the three domains. Overall, this study suggests that there is scope for Australian optometrists to improve their routine engagement by questioning patients, as well as providing evidence-based clinical advice, about smoking status, diet and nutritional supplement behaviors, being key modifiable lifestyle risk factors with long-term implications for eye health.

The Self-Reported Clinical Practice Behaviors of Australian Optometrists as Related to Smoking, Diet and Nutritional Supplementation

PubMed Central

Downie, Laura Elizabeth; Keller, Peter Richard

2015-01-01

Objective The primary aim of this study was to examine the self-reported, routine clinical practice behaviors of Australian optometrists with respect to advice regarding smoking, diet and nutritional supplementation. The study also sought to assess the potential influence of practitioner age, gender, practice location (major city versus regional), therapeutic-endorsement status and personal nutritional supplementation habits upon management practices in these areas. Methods A survey was electronically distributed to Australian optometrists (n = 4,242). Respondents anonymously provided information about their personal demographics and lifestyle behaviors (i.e., age, gender, practice location, therapeutic-endorsement status, smoking status, nutritional supplement intake) and routine patient management practices with respect to advice across three domains: smoking, diet and nutritional supplementation. Multivariate logistic regression analyses were performed to assess for potential effects of the listed factors on practitioner behavior. Results A total of 283 completed surveys were received (completed survey response rate: 6.7%). Fewer than half of respondents indicated routinely asking their patients about smoking status. Younger practitioners were significantly (p < 0.05) less likely to enquire about patients’ smoking behaviors, but this did not extend to counseling for smoking cessation. Almost two-thirds of respondents indicated routinely counseling patients about diet. About half of practitioners specified routinely asking their patients about nutritional supplement intake; this form of questioning was significantly more likely if the respondent was female (p < 0.05). Practitioners who recommended nutritional supplements most commonly did so for age-related macular degeneration (91.2%) and dry eye disease (63.9%). The primary source of evidence used to guide practitioners’ nutrition-related patient management was reported to be peer-reviewed publications. Conclusions These findings demonstrate that there are no clear predictors of practitioner behavior across the three domains. Overall, this study suggests that there is scope for Australian optometrists to improve their routine engagement by questioning patients, as well as providing evidence-based clinical advice, about smoking status, diet and nutritional supplement behaviors, being key modifiable lifestyle risk factors with long-term implications for eye health. PMID:25886641

Basing assessment and treatment of problem behavior on behavioral momentum theory: Analyses of behavioral persistence.

PubMed

Schieltz, Kelly M; Wacker, David P; Ringdahl, Joel E; Berg, Wendy K

2017-08-01

The connection, or bridge, between applied and basic behavior analysis has been long-established (Hake, 1982; Mace & Critchfield, 2010). In this article, we describe how clinical decisions can be based more directly on behavioral processes and how basing clinical procedures on behavioral processes can lead to improved clinical outcomes. As a case in point, we describe how applied behavior analyses of maintenance, and specifically the long-term maintenance of treatment effects related to problem behavior, can be adjusted and potentially enhanced by basing treatment on Behavioral Momentum Theory. We provide a brief review of the literature including descriptions of two translational studies that proposed changes in how differential reinforcement of alternative behavior treatments are conducted based on Behavioral Momentum Theory. We then describe current clinical examples of how these translations are continuing to impact the definitions, designs, analyses, and treatment procedures used in our clinical practice. Copyright © 2017 Elsevier B.V. All rights reserved.

Efficacy of a specific model for cognitive-behavioral therapy among panic disorder patients with agoraphobia: a randomized clinical trial.

PubMed

King, Anna Lucia Spear; Valença, Alexandre Martins; de Melo-Neto, Valfrido Leão; Freire, Rafael Christophe; Mezzasalma, Marco André; Silva, Adriana Cardoso de Oliveira e; Nardi, Antonio Egidio

2011-01-01

Cognitive-behavioral therapy is frequently indicated for panic disorder. The aim here was to evaluate the efficacy of a model for cognitive-behavioral therapy for treating panic disorder with agoraphobia. Randomized clinical trial at Instituto de Psiquiatria da Universidade Federal do Rio de Janeiro. A group of 50 patients with a diagnosis of panic disorder with agoraphobia was randomized into two groups to receive: a) cognitive-behavioral therapy with medication; or b) medication (tricyclic antidepressants or selective serotonin reuptake inhibitors). Although there was no difference between the groups after the treatment in relation to almost all variables with the exception of some items of the Sheehan disability scale and the psychosocial and environmental problems scale, the patients who received the specific therapy presented significant reductions in panic attacks, anticipatory anxiety, agoraphobia avoidance and fear of body sensations at the end of the study, in relation to the group without the therapy. On the overall functioning assessment scale, overall wellbeing increased from 60.8% to 72.5% among the patients in the group with therapy, thus differing from the group without therapy. Although both groups responded to the treatment and improved, we only observed significant differences between the interventions on some scales. The association between specific cognitive-behavioral therapy focusing on somatic complaints and pharmacological treatment was effective among this sample of patients with panic disorder and the response was similar in the group with pharmacological treatment alone.

Mother-child interactions in young children with excessive physical aggression and in typically developing young children.

PubMed

Urbain-Gauthier, Nadine; Wendland, Jaqueline

2017-07-01

Among the multiple risk factors, the emergence of conduct problems in young children may be linked to harsh parenting and child's temperamental difficulties, leading to a reciprocal early discordant relationship. Little is known about the characteristics of early parent-child interactions in young children with physical aggression. The purpose of the current study was to evaluate the characteristics of mother-child interactions in dyads referred for excessive physical aggression in young children under 5 years of age compared to mother-child interactions in typically developing young children. Mother-child interactions were assessed during a free-play session in both a clinical sample ( N = 70, child mean age  = 3.5 years) and a nonclinical sample ( N = 80, child mean age  = 3.5 years) by using the Rating Scale of Interaction Style (Clark and Seifer, adapted by Molitor and Mayes). Significant differences were found between several interactive features in clinical and nonclinical dyads. In clinical dyads, mothers' behaviors were often characterized by intrusiveness and criticism toward children, and poor facilitative positioning. Children with excessive aggressive behavior often displayed poor communication, initiation of bids, and poor responsiveness toward the mother. They displayed fewer sustained bouts of play than typically developing children did. In clinical dyads, strong positive correlations were found between child responsiveness and maternal interest in engagement ( r = .41, p < .001), while the child displaying sustained bouts of play was negatively correlated with the mother's attempts to intrude on the child's activity ( r = .64, p < .05). These data show that children with excessive aggressive behavior develop disrupted mother-infant interactions from a very young age. Several negative interactive features and correlations between child behavior and maternal behavior were found in clinical samples. The effects of these features add up and probably strengthen each other, thus leading to interactive difficulties from a very young age. More attention should be paid to early parent-child interactions in case of child behavioral problems. The recognition of these interactive dysfunctions is discussed in terms of clinical implications for therapeutic interventions.

Sociodemographic and Substance Use Disorder Determinants of HIV Sexual Risk Behavior in Men and Women in Outpatient Drug Treatment in the NIDA National Drug Abuse Treatment Clinical Trials Network.

PubMed

Kidd, Jeremy D; Tross, Susan; Pavlicova, Martina; Hu, Mei-Chen; Campbell, Aimee N C; Nunes, Edward V

2017-06-07

Sexual risk behavior is now the primary vector of HIV transmission among substance users in the United States with gender as a crucial moderator of risk behavior. The purpose of this study was to examine gender differences in factors (age, race/ethnicity, education) that predict main-partner unprotected sexual occasions (USO) using the unique platform of two parallel NIDA National Drug Abuse Treatment Clinical Trials Network gender-specific safer sex intervention trials. Baseline assessments of male (N = 430) and female (N = 377) participants included demographic characteristics; past 3-month sexual activity; and a diagnostic assessment for alcohol, cocaine/stimulant, and opioid use disorders. Using mixed effects generalized linear modeling of the main outcome USO, two-way interactions of gender with age, race/ethnicity, and education were evaluated and adjusted by alcohol, cocaine/stimulant, or opioid use disorder. When adjusted for alcohol use disorder, the interaction of education and gender was significant. For men, a high school or greater education was significantly associated with more USO compared to men with less than high school. For women, greater than high school education was significantly associated with less USO compared to women with a high school education. None of the other interactions were significant when adjusted for cocaine/stimulant or opioid use disorder. Conclusions/Importance: This study demonstrates gender differences in the relationship of education, alcohol use disorder, and main-partner USO in individuals in substance abuse treatment. This underscores the importance of considering demographic and substance use factors in HIV sexual risk behavior and in crafting prevention messages for this population.

Impact evaluation of a healthy lifestyle intervention to reduce cardiovascular disease risk in health centers in San José, Costa Rica and Chiapas, Mexico.

PubMed

Fort, Meredith P; Murillo, Sandra; López, Erika; Dengo, Ana Laura; Alvarado-Molina, Nadia; de Beausset, Indira; Castro, Maricruz; Peña, Liz; Ramírez-Zea, Manuel; Martínez, Homero

2015-12-28

Previous healthy lifestyle interventions based on the Salud para Su Corazón curriculum for Latinos in the United States, and a pilot study in Guatemala, demonstrated improvements in patient knowledge, behavior, and clinical outcomes for adults with hypertension. This article describes the implementation of a healthy lifestyle group education intervention at the primary care health center level in the capital cities of Costa Rica and Chiapas, Mexico for patients with hypertension and/or type 2 diabetes and presents impact evaluation results. Six group education sessions were offered to participants at intervention health centers from November 2011 to December 2012 and participants were followed up for 8 months. The study used a prospective, longitudinal, nonequivalent pretest-posttest comparison group design, and was conducted in parallel in the two countries. Cognitive and behavioral outcome measures were knowledge, self-efficacy, stage-of-change, dietary behavior and physical activity. Clinical outcomes were: body mass index, systolic and diastolic blood pressure, and fasting blood glucose. Group by time differences were assessed using generalized estimating equation models, and a dose-response analysis was conducted for the intervention group. The average number of group education sessions attended in Chiapas was 4 (SD: 2.2) and in Costa Rica, 1.8 (SD: 2.0). In both settings, participation in the study declined by 8-month follow-up. In Costa Rica, intervention group participants showed significant improvements in systolic and diastolic blood pressure and borderline significant improvement for fasting glucose, and significant improvement in the stages-of-change measure vs. the comparison group. In Chiapas, the intervention group showed significant improvement in the stages-of-change measure in relation to the comparison group. Significant improvements were not observed for knowledge, self-efficacy, dietary behavior or physical activity. In Chiapas only, a significant dose-response relationship was observed for systolic and diastolic blood pressure. Group education interventions at health centers have the potential to improve stage-of-change activation, and may also improve clinical outcomes. In the future, it will be essential to dedicate resources to understand ways to reach a representative group of the patient population, tailor the intervention so that patients are engaged to participate, and consider the broader family and community context that influences patients' capacity to manage their condition.

Sexual Minority Stressors, Internalizing Symptoms, and Unhealthy Eating Behaviors in Sexual Minority Youth

PubMed Central

Katz-Wise, Sabra L.; Calzo, Jerel P.; Scherer, Emily A.; Sarda, Vishnudas; Jackson, Benita; Haines, Jess; Austin, S. Bryn

2015-01-01

Background Sexual minorities are more likely than heterosexuals to engage in unhealthy eating behaviors. Purpose To examine sexual minority stressors and internalizing symptoms as predictors of unhealthy eating behaviors among sexual minority youth. Methods We used longitudinal data from 1461 sexual minority youth in the Growing Up Today Study, across ages 14-28 years. We hypothesized that sexual minority stressors would predict unhealthy eating behaviors, in part due to internalizing symptoms. Linear regression models fit via generalized estimating equations were stratified by gender and sexual orientation. Results Significant positive and inverse associations between stressors and eating behaviors were detected among females and males, with more significant associations among females. Associations were attenuated by up to 71% for females and 12% for males when internalizing symptoms were added to the models. Conclusions Sexual minority stressors predicted unhealthy eating behaviors overall and more so for some sexual orientation and gender groups; associations were partially explained by internalizing symptoms. The conceptual model appears to best describe the experiences of bisexual females. Findings have clinical implications for adolescent health. PMID:26156678

Psychopathology and behavior problems in children and adolescents with Williams syndrome: Distinctive relationships with cognition.

PubMed

Osório, Ana A C; Rossi, Natália F; Gonçalves, Óscar F; Sampaio, Adriana; Giacheti, Célia M

2017-08-01

Several studies have documented the high prevalence of psychopathology and behavior problems in Williams syndrome (WS). However, the links between cognitive development and such symptoms need further clarification. Our study aims to expand current knowledge on levels of behavior problems and its links to cognition in a sample of Brazilian individuals with WS. A total of 25 children and adolescents with WS and their parents participated in this study. The participants' IQs were assessed with the Wechsler Scales of Intelligence (for children or adults) and parental reports of psychopathology/behavior problems were collected using the Child Behavior Checklist (CBCL). The presence of clinically significant attention problems was a main feature in our sample of children and adolescents with WS. In the children, higher IQ scores were found to be significantly associated with less externalizing problems, while in the adolescents cognitive abilities were found to be associated with less internalizing symptoms. These results provide further insight into the links between psychopathology and behavior problems and cognitive abilities in WS, and suggest the need to take age into consideration when analyzing such relationships.

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

Construct validation of the hybrid model of posttraumatic stress disorder: Distinctiveness of the new symptom clusters.

PubMed

Silverstein, Madison W; Dieujuste, Nathalie; Kramer, Lindsay B; Lee, Daniel J; Weathers, Frank W

2018-03-01

Despite the factor analytic support for the seven-factor hybrid model (Armour et al., 2015) of posttraumatic stress disorder (PTSD), little research has examined the degree to which newly established symptom clusters (i.e., negative affect, anhedonia, dysphoric arousal, anxious arousal, externalizing behavior) functionally and meaningfully differ in their associations with other clinical phenomena. The aim of the current study was to examine the degree to which newly established PTSD symptom clusters differentially relate to co-occurring psychopathology and related clinical phenomena through Wald testing using latent variable modeling. Participants were 535 trauma-exposed undergraduates who completed the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5; Weathers et al., 2013) and Personality Assessment Inventory (PAI; Morey, 1991). As expected and in line with results from previous studies, significant heterogeneity emerged for dysphoric arousal, anxious arousal, and externalizing behavior. However, there was less evidence for the distinctiveness of negative affect and anhedonia. Results indicate that only some of the newly established symptom clusters significantly differ in their associations with related clinical phenomena and that the hybrid model might not provide a meaningful framework for understanding which PTSD symptoms relate to associated features. Limitations include a non-clinical sample and reliance on retrospective self-report assessment measures. Copyright © 2017 Elsevier Ltd. All rights reserved.

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

Impact and implications of disruptive behavior in the perioperative arena.

PubMed

Rosenstein, Alan H; O'Daniel, Michelle

2006-07-01

There is a growing concern about the role of human factor issues and their effect on patient safety and clinical outcomes of care. Problems with disruptive behaviors negatively affect communication flow and team dynamics, which can lead to adverse events and poor quality outcomes. A 25-question survey tool was used to assess the status and significance of disruptive behaviors around perioperative services in a large metropolitan academic medical center. Results were analyzed and compared with those from a national databank to identify areas of concern and opportunities for improvement. Disruptive behaviors were a common occurrence in the perioperative setting. These types of behaviors were most prevalent in attending surgeons. Disruptive behaviors increased levels of stress and frustration, which impaired concentration, impeded communication flow, and adversely affected staff relationships and team collaboration. These events were perceived to increase the likelihood of medical errors and adverse events and to compromise patient safety and quality of care. Disruptive behaviors in the perioperative arena have a significant impact on team dynamics and communication flow, which can have a negative impact on patient care. Organizations need to recognize the prevalence and significance of disruptive behaviors and develop policies and processes to address the issue. Key areas of focus include recognition and awareness, organizational and cultural commitment, implementation of appropriate codes of behavior policies and procedures, and provision of education and training programs to discuss contributing factors and tools to build effective communication and team collaboration skills.

Intergenerational Transmission of Internalizing Behavior: The Role of Maternal Psychopathology, Child Responsiveness and Maternal Attachment Style Insecurity.

PubMed

Reck, Corinna; Nonnenmacher, Nora; Zietlow, Anna-Lena

Maternal depression and anxiety disorders are risk factors for the development of internalizing disorders in offspring. Maternal attachment has been discussed as one factor accounting for transmission. The aim of this study was to investigate child internalizing behavior at preschool age on a symptomatic and behavioral level and possible links to maternal mental health over time and maternal attachment style insecurity in a sample of postpartum depressed and anxious mothers. Child internalizing behavior at preschool age was rated by the Child Behavior Checklist (CBCL), the Caregiver-Teacher Report Form (C-TRF), and during a mother-child free-play situation. We focused on child responsiveness as it has been linked to child internalizing behavior. Maternal attachment style insecurity was tested to mediate the link between maternal mental health (assessed postpartum and at preschool age with the Structured Clinical Interview for DSM-IV Axis-I Disorders, SCID-I) and child internalizing behavior/child responsiveness. Of the overall sample (n = 58), 28 women were diagnosed with postpartum depression and/or anxiety disorders according to DSM-IV, and 30 were healthy controls. Data were collected 3-9 months after delivery and at preschool age (mean = 4.6 years). At preschool age, children of postpartum depressed and anxious mothers were rated significantly higher on child internalizing behavior by mothers, fathers, and additional caregivers compared to the control group. Child internalizing behavior rated by mothers was influenced by current psychiatric symptoms; maternal attachment style insecurity did not mediate this link. During interaction, children in the clinical group displayed significantly less child responsiveness compared to the control group. Maternal attachment style insecurity mediated the relationship between maternal mental health over time and child responsiveness. The results emphasize the need for interventions focusing on mother-child interaction and maternal attachment. © 2016 S. Karger AG, Basel.

A pilot study of high-dose intravenous immunoglobulin 5% for autism: Impact on autism spectrum and markers of neuroinflammation.

PubMed

Melamed, Isaac R; Heffron, Melinda; Testori, Alessandro; Lipe, Kellie

2018-03-01

Research has shown that a subset of the autism spectrum disorder (ASD) population presents with immune dysregulation. To explore this topic further, we investigated the efficacy and tolerability of intravenous immunoglobulin (IVIG) infusion in children with ASD. In this study, participants were recruited based on a diagnosis of autistic disorder, Asperger's disorder, or pervasive developmental disorder not otherwise specified. Participants also showed evidence of immune dysfunction based on abnormal levels of specific biomarkers, including CD40 ligand (CD154), lymphocyte stimulation, and T or B cell dysfunction. Of 17 screened patients, 14 completed the trial and received IVIG treatment (1 g/kg dose) for ten 21-day treatment cycles. The primary endpoint was disease improvement assessed using standardized cognitive and behavioral tests (Children's Communication Checklist [CCC-2], Social Responsiveness Scale [SRS], Aberrant Behavior Checklist [ABC], Clinical Global Impressions-Severity [CGI-S] and -Improvement [CGI-I], Autism Diagnostic Observation Schedule [ADOS], and Peabody Picture Vocabulary Test [PPVT]). Secondary endpoints included experimental biomarkers such as CD154, toll-like receptor-4, memory B cells, FOXP3, and lymphocyte stimulation. Significant improvements from baseline to study endpoint were observed in several subscales of the CCC-2, SRS, CGI-I, CGI-S, and ADOS, including Associated Maladaptive Behaviors (P ≤ .043), Reciprocal Social Interaction (P = .015), Communication (P < .001), and Stereotyped Behaviors and Repetitive Interests (P ≤ .013). Statistically significant reductions were also seen in numerous secondary outcomes of immunological biomarkers indicative of neuroinflammation. IVIG was well tolerated; no subjects withdrew due to an adverse event, and clinical data showed no evidence of thromboembolic events. Autism Res 2018, 11: 421-433. © 2018 International Society for Autism Research, Wiley Periodicals, Inc. Since research has demonstrated a link between autism spectrum disorder (ASD) and immune dysfunction, this study investigated the efficacy and tolerability of intravenous immunoglobulin (IVIG) infusion in children with ASD. Fourteen patients received IVIG treatment and were assessed using standardized cognitive and behavioral tests. Following treatment with IVIG, significant improvement was observed across several subscales of the clinical tests and significant reductions were seen in the markers of neuroinflammation. These data suggest that inflammatory etiologies may play a role in select cases of autism, and IVIG treatment may exert a positive impact on behaviors and markers of inflammation in ASD. © 2018 International Society for Autism Research, Wiley Periodicals, Inc.

Goal setting in diabetes self-management: taking the baby steps to success.

PubMed

DeWalt, Darren A; Davis, Terry C; Wallace, Andrea S; Seligman, Hilary K; Bryant-Shilliday, Betsy; Arnold, Connie L; Freburger, Janet; Schillinger, Dean

2009-11-01

To evaluate the usefulness of a diabetes self-management guide and a brief counseling intervention in helping patients set and achieve their behavioral goals. We conducted a quasi-experimental study using a one group pretest posttest design to assess the effectiveness of a goal setting intervention along with a self-management guide. English- and Spanish-speaking patients with diabetes had one in-person session and two telephone follow-up calls with a non-clinical provider over a 12-16-week period. At each call and at the end of the study, we assessed success in achieving behavioral goals and problem solving toward those goals. Satisfaction with the self-management guide was assessed at the end of the study. We enrolled 250 patients across three sites and 229 patients completed the study. Most patients chose to set goals in diet and exercise domains. 93% of patients achieved at least one behavioral goal during the study and 73% achieved at least two behavioral goals. Many patients exhibited problem solving behavior to achieve their goals. We found no significant differences in reported achievement of behavior goals by literacy or language. Patients were very satisfied with the guide. A brief goal setting intervention along with a diabetes self-management guide helped patients set and achieve healthy behavioral goals. Non-clinical providers can successfully help a diverse range of patients with diabetes set and achieve behavioral goals.

Evaluation of the DSM-5 Severity Indicator for Bulimia Nervosa

PubMed Central

Grilo, Carlos M.; Ivezaj, Valentina; White, Marney A.

2015-01-01

This study examined the DSM-5 severity criterion for bulimia nervosa (BN) based on the frequency of inappropriate weight compensatory behaviors. 199 community volunteers classified with BN were categorized using DSM-5 severity levels and compared on demographic and clinical variables. 77 (39%) participants were categorized as mild, 68 (34%) as moderate, 32 (16%) as severe, and 22 (11%) as extreme. The severity groups did not differ significantly in demographic variables or body mass index. Shape and Weight concerns did not differ significantly across severity groups. Binge eating differed with the extreme group having higher frequency than the severe, moderate, and mild groups, which did not differ from each other. Restraint differed with the extreme group having significantly higher levels than the mild group. Eating concerns differed with the extreme group having higher levels than moderate and mild groups. Depression differed with the extreme group having higher levels than severe, moderate, and mild groups, which did not differ from each other. Findings from this non-clinical group provide new, albeit modest, support for DSM-5 severity rating for BN based on frequency of inappropriate weight compensatory behaviors. Statistical findings indicate that differences in collateral clinical variables associated with the DSM-5 severity ratings reflect small effect sizes. Further research is needed with treatment-seeking patient groups with BN to establish the validity of the DSM-5 severity specifier and should include broader clinical and functional validators. PMID:25744910

Risky Sexual Behavior, Bleeding Caused by Intimate Partner Violence, and Hepatitis C Virus Infection in Patients of a Sexually Transmitted Disease Clinic

PubMed Central

Chen, Meng-Jinn; Nochajski, Thomas H.; Testa, Maria; Zimmerman, Scott J.; Hughes, Patricia S.

2009-01-01

Objectives. We sought to investigate independent contributions of risky sexual behaviors and bleeding caused by intimate partner violence to prediction of HCV infection. Methods. We conducted a case–control study of risk factors among patients of a sexually transmitted disease clinic with and without HCV antibodies, group-matched by age. Results. Multivariate analyses indicated that Black race (odds ratio [OR] = 2.4; 95% confidence interval [CI] = 1.3, 4.4), injection drug use (OR = 20.3; 95% CI = 10.8, 37.8), sharing straws to snort drugs (OR = 1.8; 95% CI = 1.01, 3.0), sharing razors (OR = 7.8; 95% CI = 2.0, 31.0), and exposure to bleeding caused by intimate partner violence (OR = 5.5; 95% CI = 1.4, 22.8) contributed significantly to the prediction of HCV infection; risky sexual behavior and exposure to blood or sores during sexual intercourse did not. Conclusions. HCV risk among patients of a sexually transmitted disease clinic can be explained by direct blood exposure, primarily through injection drug use. Exposure to bleeding caused by intimate partner violence may be a previously unrecognized mechanism for HCV transmission associated with risky sexual behavior. PMID:19218181

Just a scary dream? A brief review of sleep terrors, nightmares, and rapid eye movement sleep behavior disorder.

PubMed

Haupt, Mark; Sheldon, Stephen H; Loghmanee, Darius

2013-10-01

The clinical spectrum of sleep disorders in children is broad, ranging from primary snoring and obstructive sleep apnea (OSA) syndrome to complex sleep-related behaviors and movement disorders. Although snoring and OSA typically receive significant attention and discussion, other biologically based sleep disorders are as common, if not more common, in children. A general pediatrician is frequently presented with the complaint of sleep talking, sleep walking, or abnormal movements during sleep. Even more alarming is the presentation of the child suddenly and explosively screaming during sleep. Such complaints fall under the category of parasomnias. Exclusive to sleep and wake-to-sleep transitions, these parasomnias include arousals with abnormal motor, behavioral, autonomic, or sensory symptoms. Parasomnias can be noticeably dissimilar in clinical manifestations, but most share biologic characteristics. Three parasomnias associated with loud vocalizations associated with sleep that can present to general practitioners include sleep terrors, nightmares, and rapid eye movement sleep behavior disorder (RBD). Although usually benign, these sleep disorders can be disruptive and even potentially dangerous to the patient and can often be threatening to quality of life. In this article, we describe the clinical features of some of these disorders and how to differentiate between their alarming presentations. Copyright 2013, SLACK Incorporated.

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.

School-Based Educational Intervention to Improve Children's Oral Health-Related Knowledge.

PubMed

Blake, Holly; Dawett, Bhupinder; Leighton, Paul; Rose-Brady, Laura; Deery, Chris

2015-07-01

To evaluate a brief oral health promotion intervention delivered in schools by a primary care dental practice, aimed at changing oral health care knowledge and oral health-related behaviors in children. Cohort study with pretest-posttest design. Three primary schools. One hundred and fifty children (aged 9-12 years). Children received a 60-minute theory-driven classroom-based interactive educational session delivered by a dental care professional and received take-home literature on oral health. All children completed a questionnaire on oral health-related knowledge and self-reported oral health-related behaviors before, immediately after, and 6 weeks following the intervention. Children's dental knowledge significantly improved following the intervention, with improvement evident at immediate follow-up and maintained 6 weeks later. Significantly more children reported using dental floss 6 weeks after the intervention compared with baseline. No significant differences were detected in toothbrushing or dietary behaviors. School-based preventative oral health education delivered by primary care dental practices can generate short-term improvements in children's knowledge of oral health and some aspects of oral hygiene behavior. Future research should engage parents/carers and include objective clinical and behavioral outcomes in controlled study designs. © 2014 Society for Public Health Education.

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…

Comorbidity of functional urinary incontinence and encopresis: somatic and behavioral associations.

PubMed

Von Gontard, Alexander; Hollmann, Elke

2004-06-01

Functional urinary incontinence and encopresis are common comorbid disorders in childhood. We analyze the specific somatic and behavioral symptoms associated with functional enuresis/urinary incontinence and encopresis when they occur together. A total of 167 consecutive children 5 to 10 year olds, with day and/or night wetting were examined prospectively with ultrasound, uroflowmetry, electroencephalography, the Child Behavior Checklist, Culture Fair Intelligence Test and ICD-10 child psychiatric diagnoses. The main findings for the comorbid group (20 patients) with wetting and soiling were a significantly higher rate of daytime incontinence and micturition problems, thickened bladder walls and pathological electroencephalography. There were higher, although not significant, rates of previous urinary tract infections, antibiotic prophylaxis, residual volume and abnormal uroflow curves in this group. Behaviorally, hyperkinetic syndromes, and emotional and conduct disorders (according to ICD-10) were more common. Of the 20 patients 65% had a Child Behavior Checklist total score (greater than 90th percentile) in the clinical range. The externalizing, internalizing, delinquent and anxious/depressed problem scales were also significantly higher. This risk group requires detailed assessment and specific treatment. In addition to the symptomatic treatment of the wetting and soiling, many of these children are in need of specific behavioral, psychotherapeutic and pharmacological treatment.

Hypnosis, behavioral theory, and smoking cessation.

PubMed

Covino, N A; Bottari, M

2001-04-01

Although nicotine replacement and other pharmacological treatments head the list of popular interventions for smoking cessation, approaches based on psychology can also assist smokers. Hypnosis, suggestion, and behavior therapies have been offered to patients and studied experimentally for several decades. Although no single psychological approach has been found to be superior to others, psychological interventions contribute significantly to successful treatment outcome in smoking cessation. This article describes common hypnotic and behavioral approaches to smoking cessation and critically reviews some of the findings from clinical and experimental research studies. The authors also offer suggestions regarding treatment and future research.

Gender Differences in Treatment-Seeking British Pathological Gamblers

PubMed Central

Ronzitti, Silvia; Lutri, Vittorio; Smith, Neil; Clerici, Massimo; Bowden-Jones, Henrietta

2016-01-01

Background and aim Gambling is a widespread recreational activity in the UK. A significant percentage of gamblers develop subclinical or clinically relevant problem gambling issues, but only a low percentage of them seek treatment. Although characteristics of pathological gamblers from treatment-seeking population have been examined in some research, only a few studies have explored the differences between females and males. This study aimed to examine the gender-related differences in demographics, gambling measures, and clinical variables in an outpatient sample of pathological gamblers seeking treatment. Methods A total of 1,178 treatment-seeking individuals with gambling disorder were assessed at the National Problem Gambling Clinic in London. Sociodemographic characteristics, clinical variables, and gambling behavior habits were obtained during the assessment evaluation. Of the total sample, 92.5% were males and 7.5% were females. Results Males were more likely to be younger, white, and employed than females. In addition, compared to women, men showed a lower PGSI score, an earlier age of onset of gambling behavior, a higher gambling involvement, and preferred specific forms gambling. Female gamblers were more anxious and depressed, while men were more likely to use alcohol and illicit drugs. Conclusions Our findings support the importance of gender differences in a treatment-seeking population of pathological gamblers both in sociodemographic characteristics, gambling behavior variables, and clinical variables. Males and females might benefit from group-specific treatment. PMID:27348561

Effectiveness of a Psychoeducational Parenting Group on Child, Parent and Family Behavior: A Pilot Study in a Family Practice Clinic with an Underserved Population

PubMed Central

Berge, Jerica M.; Law, David D.; Johnson, Jennifer; Wells, M. Gawain

2013-01-01

Background Although integrated care for adults in primary care has steadily increased over the last several decades, there remains a paucity of research regarding integrated care for children in primary care. Purpose To report results of a pilot study testing initial feasibility of a parenting psychoeducational group targeting child behavioral problems within a primary care clinic. Method The participants (n = 35) were parents representing an underserved population from an inner-city primary care clinic. Participants attended a 12-week psychoeducational parenting group and reported pre- and post-measures of family functioning, child misbehavior and dyadic functioning. Paired t-tests and effects sizes are reported. Results Participants reported statistically significant improvement in family functioning, child misbehavior and couple functioning after participating in the parenting psychoeducational group. Conclusions Results suggest initial feasibility of a parenting psychoeducational group within a primary care clinic with an underserved population. This intervention may be useful for other primary care clinics seeking to offer more integrative care options for children and their families. PMID:20939627

Low-shrink composite resins: a review of their history, strategies for managing shrinkage, and clinical significance.

PubMed

Pitel, Mark L

2013-09-01

Despite numerous advances in composite resin technology over the course of many decades, shrinkage behavior and the resultant stresses inherent to direct placed composite restorations continue to challenge clinicians. This overview of composite resins includes a review of their history and development along with a discussion of strategies for reducing polymerization shrinkage. An assessment of the clinical significance of these materials is also provided, including a discussion of the differences between polymerization shrinkage and stress, incremental layering versus bulk placement, and the emergence of lower shrinkage stress monomer chemistry.

Increasing confidence and changing behaviors in primary care providers engaged in genetic counselling.

PubMed

Wilkes, Michael S; Day, Frank C; Fancher, Tonya L; McDermott, Haley; Lehman, Erik; Bell, Robert A; Green, Michael J

2017-09-13

Screening and counseling for genetic conditions is an increasingly important part of primary care practice, particularly given the paucity of genetic counselors in the United States. However, primary care physicians (PCPs) often have an inadequate understanding of evidence-based screening; communication approaches that encourage shared decision-making; ethical, legal, and social implication (ELSI) issues related to screening for genetic mutations; and the basics of clinical genetics. This study explored whether an interactive, web-based genetics curriculum directed at PCPs in non-academic primary care settings was superior at changing practice knowledge, attitudes, and behaviors when compared to a traditional educational approach, particularly when discussing common genetic conditions. One hundred twenty one PCPs in California and Pennsylvania physician practices were randomized to either an Intervention Group (IG) or Control Group (CG). IG physicians completed a 6 h interactive web-based curriculum covering communication skills, basics of genetic testing, risk assessment, ELSI issues and practice behaviors. CG physicians were provided with a traditional approach to Continuing Medical Education (CME) (clinical review articles) offering equivalent information. PCPs in the Intervention Group showed greater increases in knowledge compared to the Control Group. Intervention PCPs were also more satisfied with the educational materials, and more confident in their genetics knowledge and skills compared to those receiving traditional CME materials. Intervention PCPs felt that the web-based curriculum covered medical management, genetics, and ELSI issues significantly better than did the Control Group, and in comparison with traditional curricula. The Intervention Group felt the online tools offered several advantages, and engaged in better shared decision making with standardized patients, however, there was no difference in behavior change between groups with regard to increases in ELSI discussions between PCPs and patients. While our intervention was deemed more enjoyable, demonstrated significant factual learning and retention, and increased shared decision making practices, there were few differences in behavior changes around ELSI discussions. Unfortunately, barriers to implementing behavior change in clinical genetics is not unique to our intervention. Perhaps the missing element is that busy physicians need systems-level support to engage in meaningful discussions around genetics issues. The next step in promoting active engagement between doctors and patients may be to put into place the tools needed for PCPs to easily access the materials they need at the point-of-care to engage in joint discussions around clinical genetics.

Understanding Research Gaps and Priorities for Improving Behavioral Counseling Interventions: Lessons Learned From the U.S. Preventive Services Task Force.

PubMed

Kurth, Ann E; Miller, Therese L; Woo, Meghan; Davidson, Karina W

2015-09-01

Behavioral counseling interventions can address significant causes of preventable morbidity and mortality. However, despite a growing evidence base for behavioral counseling interventions, there remain significant research gaps that limit translating the evidence into clinical practice. Using U.S. Preventive Services Task Force (USPSTF) examples, we address how researchers and funders can move the research portfolio forward to achieve better application of behavioral counseling interventions to address substantial health burdens in the U.S. This paper describes the types of gaps that the USPSTF encounters across its behavioral counseling intervention topics and provides suggestions for opportunities to address these gaps to enhance the evidence base for primary care-based behavioral counseling recommendations. To accomplish this, we draw from both the USPSTF experience and issues identified by researchers and clinicians during the USPSTF-sponsored Behavioral Counseling Intervention Forum. We also discuss the dilemma posed by having "insufficient" evidence with which to make a behavioral counseling intervention-related recommendation, and describe two case examples (screening for alcohol misuse in adolescence and screening for child maltreatment), detailing the research gaps that remain. Recommendations are outlined for researchers, funders, and practice implementers to improve behavioral counseling intervention research and application. Copyright © 2015 American Journal of Preventive Medicine. All rights reserved.

Evidence-Informed, Individual Treatment of a Child with Sexual Behavior Problems: A Case Study.

PubMed

Allen, Brian; Berliner, Lucy

2015-11-01

Children with sexual behavior problems pose a significant challenge for community-based mental health clinicians. Very few clinical trials are available to guide intervention and those interventions that are available are based in a group format. The current case study demonstrates the application of evidence-informed treatment techniques during the individual treatment of a 10-year-old boy displaying interpersonal sexual behavior problems. Specifically, the clinician adapts and implements a group-based model developed and tested by Bonner et al. (1999) for use with an individual child and his caregivers. Key points of the case study are discussed within the context of implementing evidence-informed treatments for children with sexual behavior problems.

Functional hypothalamic amenorrhea is associated with elevated ghrelin and disordered eating.

PubMed

Schneider, Lisa F; Warren, Michelle P

2006-12-01

To determine whether ghrelin, an orexigen released by the stomach, is elevated in women with hypothalamic amenorrhea who are of normal weight and whether this is associated with abnormal eating behaviors. Controlled clinical study. Healthy volunteers in an academic research environment. Twenty-seven women with functional hypothalamic amenorrhea (FHA) and 42 normally menstruating women. None. Ghrelin and eating behavior. Ghrelin was significantly elevated in FHA (648.4 +/- 92.0 pg/mL vs. controls 596.7 +/- 79.0 pg/mL), while leptin, although lower, was not significantly so (FHA 5.4 +/- 2.8 ng/mL vs. controls 6.4 +/- 3 ng/mL). Eating Attitudes Test (EAT) scores were also significantly elevated in FHA (15.3 +/- 10.6 vs. controls 10.3 +/- 8.4), particularly on the subscale that measured bulimic behaviors. However, FHA patients consumed significantly more kilocalories (1,930 kcal/day vs. 1,588 kcal/day). High ghrelin in women with FHA may be linked to abnormal dietary behaviors, as reflected in high EAT scores yet characterized by normal caloric intake. Ghrelin may act as a restraining metabolic signal preventing a return to cyclicity in women with both disordered eating and FHA, prolonging amenorrhea when leptin has returned to normal.

Examination of a board game approach to children's involvement in family-based weight management vs. traditional family-based behavioral counseling in primary care.

PubMed

Sen, Merve; Uzuner, Arzu; Akman, Mehmet; Bahadir, Aliye Tugba; Borekci, Nazire Oncul; Viggiano, Emanuela

2018-05-29

The most effective intervention model for childhood obesity is known as family-based behavioral group treatments. There are also studies that investigate the effects of educational games for children to gain healthy eating and physical exercise habits. The aim of this study was to compare the efficacy of a family-based group treatment with an educational game (Kaledo) intervention in childhood obesity. Kaledo is a board game that was designed to improve nutritional knowledge and healthy life style habits. It is played with nutrition and activity cards that players can select from, and a total score is calculated in the end of the game according to energy intake and expenditure. Obese children between 9 and 12 ages were involved in this study. Participants randomly divided into behavioral and game intervention groups. Clinical evaluation was performed in the first and second counseling in both groups. Marmara University Family Medicine Department Obese Children and Adolescents Interview Form, Physical Activity Evaluation Form, and Three-day Food Record Form were used for this purpose. Strengths and Difficulties Questionnaire-Parent Report Version and Children's Depression Inventory were used for the assessment of psychiatric symptoms. After the clinical evaluation, an education session about healthy eating and physical activity was attended by both groups. After that, for the behavioral groups, parents and children were assigned to different groups, while for the game intervention group, parents were assigned to behavioral sessions and children were assigned to game (Kaledo) sessions. A total of six sessions with 1-h duration and 2-week interval were performed in both groups. Height and weight were measured in each session and analysis was performed on the data of the children who participated in all of the sessions. Although a total of 108 children were clinically evaluated, 52 children and their parents, 26 in the behavioral group and 26 in the game intervention group, participated in two or more sessions. Twenty-four participants, 12 in behavioral and 12 in the game intervention group, finished the study by participating in all of the six sessions. Thus, dropout rate was 74%. BMI and BMI z-scores decreased in both groups compared with the initial measures and these changes were statistically significant. For the behavioral group, these changes were - 1.01 (25.44 to 24.43, p = 0.03) and - 0.17 (2.07 to 1.90, p = 0.000) and for the game group, - 0.74 (26.98 to 26.24, p = 0.007) and - 0.09 (2.07 to 1.98, p = 0.003). There were no significant differences between behavioral and game intervention groups in point of BMI and BMI z-scores (p = 0.130 and p = 0.706). Family-based behavioral group treatment and game (Kaledo) intervention were found to be effective in childhood obesity management in this research. There was no significant difference between the two interventions. According to this study, these intervention models can be advised to primary care physicians to be used in the management of childhood obesity. What is Known: - Family-based behavioral group treatment is known as the most efficient model for childhood obesity management. What is New: - In this study, for the first time, a game (Kaledo) intervention was found to be effective in childhood obesity management. - Compared with family-based behavioral group treatment, there was no significant difference between the two interventions.

Current Enlightenment About Etiology and Pharmacological Treatment of Autism Spectrum Disorder

PubMed Central

Eissa, Nermin; Al-Houqani, Mohammed; Sadeq, Adel; Ojha, Shreesh K.; Sasse, Astrid; Sadek, Bassem

2018-01-01

Autistic Spectrum Disorder (ASD) is a complex neurodevelopmental brain disorder characterized by two core behavioral symptoms, namely impairments in social communication and restricted/repetitive behavior. The molecular mechanisms underlying ASD are not well understood. Recent genetic as well as non-genetic animal models contributed significantly in understanding the pathophysiology of ASD, as they establish autism-like behavior in mice and rats. Among the genetic causes, several chromosomal mutations including duplications or deletions could be possible causative factors of ASD. In addition, the biochemical basis suggests that several brain neurotransmitters, e.g., dopamine (DA), serotonin (5-HT), gamma-amino butyric acid (GABA), acetylcholine (ACh), glutamate (Glu) and histamine (HA) participate in the onset and progression of ASD. Despite of convincible understanding, risperidone and aripiprazole are the only two drugs available clinically for improving behavioral symptoms of ASD following approval by Food and Drug Administration (FDA). Till date, up to our knowledge there is no other drug approved for clinical usage specifically for ASD symptoms. However, many novel drug candidates and classes of compounds are underway for ASD at different phases of preclinical and clinical drug development. In this review, the diversity of numerous aetiological factors and the alterations in variety of neurotransmitter generation, release and function linked to ASD are discussed with focus on drugs currently used to manage neuropsychiatric symptoms related to ASD. The review also highlights the clinical development of drugs with emphasis on their pharmacological targets aiming at improving core symptoms in ASD. PMID:29867317

Current Enlightenment About Etiology and Pharmacological Treatment of Autism Spectrum Disorder.

PubMed

Eissa, Nermin; Al-Houqani, Mohammed; Sadeq, Adel; Ojha, Shreesh K; Sasse, Astrid; Sadek, Bassem

2018-01-01

Autistic Spectrum Disorder (ASD) is a complex neurodevelopmental brain disorder characterized by two core behavioral symptoms, namely impairments in social communication and restricted/repetitive behavior. The molecular mechanisms underlying ASD are not well understood. Recent genetic as well as non-genetic animal models contributed significantly in understanding the pathophysiology of ASD, as they establish autism-like behavior in mice and rats. Among the genetic causes, several chromosomal mutations including duplications or deletions could be possible causative factors of ASD. In addition, the biochemical basis suggests that several brain neurotransmitters, e.g., dopamine (DA), serotonin (5-HT), gamma-amino butyric acid (GABA), acetylcholine (ACh), glutamate (Glu) and histamine (HA) participate in the onset and progression of ASD. Despite of convincible understanding, risperidone and aripiprazole are the only two drugs available clinically for improving behavioral symptoms of ASD following approval by Food and Drug Administration (FDA). Till date, up to our knowledge there is no other drug approved for clinical usage specifically for ASD symptoms. However, many novel drug candidates and classes of compounds are underway for ASD at different phases of preclinical and clinical drug development. In this review, the diversity of numerous aetiological factors and the alterations in variety of neurotransmitter generation, release and function linked to ASD are discussed with focus on drugs currently used to manage neuropsychiatric symptoms related to ASD. The review also highlights the clinical development of drugs with emphasis on their pharmacological targets aiming at improving core symptoms in ASD.

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.

Rapid clinical deterioration in an individual with Down syndrome.

PubMed

Jacobs, Julia; Schwartz, Alison; McDougle, Christopher J; Skotko, Brian G

2016-07-01

A small percentage of adolescents and young adults with Down syndrome experience a rapid and unexplained deterioration in cognitive, adaptive, and behavioral functioning. Currently, there is no standardized work-up available to evaluate these patients or treat them. Their decline typically involves intellectual deterioration, a loss of skills of daily living, and prominent behavioral changes. Certain cases follow significant life events such as completion of secondary school with friends who proceed on to college or employment beyond the individual with DS. Others develop this condition seemingly unprovoked. Increased attention in the medical community to clinical deterioration in adolescents and young adults with Down syndrome could provide a framework for improved diagnosis, evaluation, and treatment. This report presents a young adult male with Down syndrome who experienced severe and unexplained clinical deterioration, highlighting specific challenges in the systematic evaluation and treatment of these patients. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Retaining Low-Income Minority Cancer Patients in a Depression Treatment Intervention Trial: Lessons Learned.

PubMed

Wells, Anjanette A; Palinkas, Lawrence A; Williams, Sha-Lai L; Ell, Kathleen

2015-08-01

Previously published work finds significant benefit from medical and behavioral health team care among safety-net patients with major depression. This qualitative study assessed clinical social worker, psychiatrist and patient navigator strategies to increase depression treatment among low-income minority cancer patients participating in the ADAPt-C clinical depression trial. Patient care retention strategies were elicited through in-depth, semi-structured interviews with nine behavioral health providers. Using grounded theory, concepts from the literature and dropout barriers identified by patients, guided interview prompts. Retention strategies clustered around five dropout barriers: (1) informational, (2) instrumental, (3) provider-patient therapeutic alliance, (4) clinic setting, and (5) depression treatment. All strategies emphasized the importance of communication between providers and patients. Findings suggest that strong therapeutic alliance and telephone facilitates collaborative team provider communication and depression treatment retention among patients in safety-net oncology care systems.

Culture as a variable in neuroscience and clinical neuropsychology: A comprehensive review

PubMed Central

Wajman, José Roberto; Bertolucci, Paulo Henrique Ferreira; Mansur, Letícia Lessa; Gauthier, Serge

2015-01-01

Culture is a dynamic system of bidirectional influences among individuals and their environment, including psychological and biological processes, which facilitate adaptation and social interaction. One of the main challenges in clinical neuropsychology involves cognitive, behavioral and functional assessment of people with different sociocultural backgrounds. In this review essay, examining culture from a historical perspective to ethical issues in cross-cultural research, including the latest significant and publications, the authors sought to explore the main features related to cultural variables in neuropsychological practice and to debate the challenges found regarding the operational methods currently in use. Literature findings suggest a more comprehensive approach in cognitive and behavioral neuroscience, including an interface between elementary disciplines and applied neuropsychology. Thus, as a basis for discussion on this issue, the authors analyzed key-topics related to the study of new trends in sociocultural neuroscience and the application of their concepts from a clinical perspective. PMID:29213964

Aripiprazole in the treatment of irritability in children and adolescents with autistic disorder.

PubMed

Owen, Randall; Sikich, Linmarie; Marcus, Ronald N; Corey-Lisle, Patricia; Manos, George; McQuade, Robert D; Carson, William H; Findling, Robert L

2009-12-01

The objective of this study was to evaluate short-term efficacy and safety of aripiprazole in the treatment of irritability in children and adolescents with autistic disorder who were manifesting behaviors such as tantrums, aggression, self-injurious behavior, or a combination of these. This 8-week, double-blind, randomized, placebo-controlled, parallel-group study was conducted of children and adolescents (aged 6-17 years) with autistic disorder. Patients were randomly assigned (1:1) to flexibly dosed aripiprazole (target dosage: 5, 10, or 15 mg/day) or placebo. Efficacy outcome measures included the Aberrant Behavior Checklist irritability subscale and the Clinical Global Impression-Improvement score (CGI-I). Safety and tolerability were also assessed. Ninety-eight patients were randomly assigned to receive placebo (n = 51) or aripiprazole (n = 47). Mean improvement in Aberrant Behavior Checklist irritability subscale score was significantly greater with aripiprazole than with placebo from week 1 through week 8. Aripiprazole demonstrated significantly greater global improvements than placebo, as assessed by the mean CGI-I score from week 1 through week 8; however, clinically significant residual symptoms may still persist for some patients. Discontinuation rates as a result of adverse events (AEs) were 10.6% for aripiprazole and 5.9% for placebo. Extrapyramidal symptom-related AE rates were 14.9% for aripiprazole and 8.0% for placebo. No serious AEs were reported. Mean weight gain was 2.0 kg on aripiprazole and 0.8 kg on placebo at week 8. Aripiprazole was efficacious in children and adolescents with irritability associated with autistic disorder and was generally safe and well tolerated.

The Implications of Endoscopic Ulcer in Early Gastric Cancer: Can We Predict Clinical Behaviors from Endoscopy?

PubMed Central

Lee, Yoo Jin; Kim, Jie-Hyun; Park, Jae Jun; Youn, Young Hoon; Park, Hyojin; Kim, Jong Won; Choi, Seung Ho; Noh, Sung Hoon

2016-01-01

Background The presence of ulcer in early gastric cancer (EGC) is important for the feasibility of endoscopic resection, only a few studies have examined the clinicopathological implications of endoscopic ulcer in EGC. Objectives To determine the role of endoscopic ulcer as a predictor of clinical behaviors in EGC. Methods Data of 3,270 patients with EGC who underwent surgery between January 2005 and December 2012 were reviewed. Clinicopathological characteristics were analyzed in relation to the presence and stage of ulcer in EGC. Based on endoscopic findings, the stage of ulcer was categorized as active, healing, or scar. Logistic regression analysis was performed to analyze factors associated with lymph node metastasis (LNM). Results 2,343 (71.7%) patients had endoscopic findings of ulceration in EGC. Submucosal (SM) invasion, LNM, lymphovascular invasion (LVI), perineural invasion, and undifferentiated-type histology were significantly higher in ulcerative than non-ulcerative EGC. Comparison across different stages of ulcer revealed that SM invasion, LNM, and LVI were significantly associated with the active stage, and that these features exhibited significant stage-based differences, being most common at the active stage, and least common at the scar stage. The presence of endoscopic ulcer and active status of the ulcer were identified as independent risk factors for LNM. Conclusions Ulcerative EGC detected by endoscopy exhibited more aggressive behaviors than non-ulcerative EGC. Additionally, the endoscopic stage of ulcer may predict the clinicopathological behaviors of EGC. Therefore, the appearance of ulcers should be carefully evaluated to determine an adequate treatment strategy for EGC. PMID:27741275

Effect of DECIDE (Decision-making Education for Choices In Diabetes Everyday) Program Delivery Modalities on Clinical and Behavioral Outcomes in Urban African Americans With Type 2 Diabetes: A Randomized Trial.

PubMed

Fitzpatrick, Stephanie L; Golden, Sherita Hill; Stewart, Kerry; Sutherland, June; DeGross, Sharie; Brown, Tina; Wang, Nae-Yuh; Allen, Jerilyn; Cooper, Lisa A; Hill-Briggs, Felicia

2016-12-01

To compare the effectiveness of three delivery modalities of Decision-making Education for Choices In Diabetes Everyday (DECIDE), a nine-module, literacy-adapted diabetes and cardiovascular disease (CVD) education and problem-solving training, compared with an enhanced usual care (UC), on clinical and behavioral outcomes among urban African Americans with type 2 diabetes. Eligible participants (n = 182) had a suboptimal CVD risk factor profile (A1C, blood pressure, and/or lipids). Participants were randomized to DECIDE Self-Study (n = 46), DECIDE Individual (n = 45), DECIDE Group (n = 46), or Enhanced UC (n = 45). Intervention duration was 18-20 weeks. Outcomes were A1C, blood pressure, lipids, problem-solving, disease knowledge, and self-care activities, all measured at baseline, 1 week, and 6 months after completion of the intervention. DECIDE modalities and Enhanced UC did not significantly differ in clinical outcomes at 6 months postintervention. In participants with A1C ≥7.5% (58 mmol/mol) at baseline, A1C declined in each DECIDE modality at 1 week postintervention (P < 0.05) and only in Self-Study at 6 months postintervention (b = -0.24, P < 0.05). There was significant reduction in systolic blood pressure in Self-Study (b = -4.04) and Group (b = -3.59) at 6 months postintervention. Self-Study, Individual, and Enhanced UC had significant declines in LDL and Self-Study had an increase in HDL (b = 1.76, P < 0.05) at 6 months postintervention. Self-Study and Individual had a higher increase in knowledge than Enhanced UC (P < 0.05), and all arms improved in problem-solving (P < 0.01) at 6 months postintervention. DECIDE modalities showed benefits after intervention. Self-Study demonstrated robust improvements across clinical and behavioral outcomes, suggesting program suitability for broader dissemination to populations with similar educational and literacy levels. © 2016 by the American Diabetes Association.

The attitude-behavior discrepancy in medical decision making.

PubMed

He, Fei; Li, Dongdong; Cao, Rong; Zeng, Juli; Guan, Hao

2014-12-01

In medical practice, the dissatisfaction of patients about medical decisions made by doctors is often regarded as the fuse of doctor-patient conflict. However, a few studies have looked at why there are such dissatisfactions. This experimental study aimed to explore the discrepancy between attitude and behavior within medical situations and its interaction with framing description. A total of 450 clinical undergraduates were randomly assigned to six groups and investigated using the classic medical decision making problem, which was described either in a positive or a negative frame (2) × decision making behavior\\attitude to risky plan\\attitude to conservative plan (3). A discrepancy between attitude and behavior did exist in medical situations. Regarding medical dilemmas, if the mortality rate was described, subjects had a significant tendency to choose a conservative plan (t = 3.55, P < 0.01) yet if the survival rate was described, there was no such preference (t = -1.48, P > 0.05). However, regardless of the plan chosen by the doctor, the subjects had a significant opposing attitude (P < .05). Framing description had a significant impact on both decision making behavior and attitude (t behavior = -3.24, P < 0.01；t attitude to surgery = 4.08，P < 0.01；t attitude to radiation = -2.15，P < 0.05). A discrepancy of attitude-behavior does exist in medical situations. The framing of a description has an impact on medical decision-making.

Health Blief Model-based intervention to improve nutritional behavior among elderly women.

PubMed

Iranagh, Jamileh Amirzadeh; Rahman, Hejar Abdul; Motalebi, Seyedeh Ameneh

2016-06-01

Nutrition is a determinant factor of health in elderly people. Independent living in elderly people can be maintained or enhanced by improvement of nutritional behavior. Hence, the present study was conducted to determine the impact of Health Belief Model (HBM)-based intervention on the nutritional behavior of elderly women. Cluster-random sampling was used to assess the sample of this clinical trial study. The participants of this study attended a 12-week nutrition education program consisting of two (2) sessions per week. There was also a follow-up for another three (3) months. Smart PLS 3.5 and SPSS 19 were used for structural equation modeling, determination of model fitness, and hypotheses testing. The findings indicate that intervention had a significant effect on knowledge improvement as well as the behavior of elderly women. The model explained 5 to 70% of the variance in nutritional behavior. In addition, nutritional behavior was positively affected by the HBM constructs comprised of perceived susceptibility, self-efficacy, perceived benefits, and barriers after the intervention program. The results of this study show that HBM-based educational intervention has a significant effect in improving nutritional knowledge and behavior among elderly women.

The impact of exposure to peer suicidal self-directed violence on youth suicidal behavior: a critical review of the literature.

PubMed

Crepeau-Hobson, M Franci; Leech, Nancy L

2014-02-01

There is considerable evidence that being exposed to the suicide or suicidal behavior of another can increase the risk for suicide. Significant relationships between media coverage and youth suicide have been documented in the professional literature. Exposure to familial suicidal behavior has also been established as a risk factor for youth suicidal behavior; However, peer suicide exposure is not as clear cut as research results in this area have been mixed. In the current paper the empirical literature focused on the associations between exposure to peer suicides and suicide attempts and youth suicidal behavior is critically reviewed. Effect sizes were computed for each of the 23 studies included in the review to allow for cross-study comparisons. The results demonstrate that having a friend or acquaintance attempt suicide is significantly related to risk for suicidal thoughts and behavior. However, the support for the relationship between the suicide of a peer and youth suicidal behavior was less consistent. Implications for clinical practice and suicide postvention as well as areas of future research are discussed. © 2013 The American Association of Suicidology.

Health Outcomes in Individuals with Problem and Pathological Gambling: An Analysis of the 2014 North Carolina Behavioral Risk Factor Survey System (BRFSS).

PubMed

Van Patten, Ryan; Weinstock, Jeremiah; McGrath, Andrew B

2018-03-01

Problem and pathological gambling refers to subclinical and clinical levels of maladaptive gambling, respectively, and is associated with specific sociodemographic characteristics as well as a number of poor health outcomes. We examined such demographic, physical health, mental health, and health-related behaviors in a sample of 7045 low-risk gamblers and 244 problem/pathological gamblers. Participants completed the 2014 North Carolina Behavioral Risk Factor Surveillance System telephone survey. Using the National Opinion Research Center's Diagnostic Screen for Gambling Disorders-CLiP, participants were categorized as either "problem/pathological gamblers" or "low-risk gamblers." Problem/pathological gamblers were younger, more likely to be male, of ethnic minority status, unmarried, and of lower education than low-risk gamblers. No physical health variables differentiated the groups but problem/pathological gamblers reported experiencing significantly more adverse childhood experiences and engaging in significantly more tobacco and alcohol use compared to low-risk gamblers. Moreover, gender moderated relationships between gambling group and several of the alcohol use variables such that male problem/pathological gamblers exhibited greater alcohol use behavior than male low-risk gamblers but no such relationship was present in females. Overall, this study expands the current knowledgebase on disordered gambling and highlights the need to assess disordered gambling in public health samples. Clinical implications are discussed.

Can the Theory of Planned Behavior Predict Dietary Intention and Future Dieting in an Ethnically Diverse Sample of Overweight and Obese Veterans Attending Medical Clinics?

PubMed Central

Lash, Denise N.; Smith, Jane Ellen; Rinehart, Jenny K.

2016-01-01

Obesity has become a world-wide epidemic; in the United States (U.S.) approximately two-thirds of adults are classified as overweight or obese. Military veterans’ numbers are even higher, with 77% of retired or discharged U.S. veterans falling in these weight categories. One of the most common methods of changing one’s weight is through dieting, yet little is known regarding the factors that facilitate successful dieting behavior. The current investigation tested the Theory of Planned Behavior’s (TPB) ability to predict dietary intention and future dieting in a sample of 84 overweight and obese patients attending medical clinics at a Veterans Affairs Hospital in the southwestern part of the U.S. Participants primarily were male (92%) and ethnic/racial minorities (58%). Perceived need and anticipated regret were added to the standard TPB model. While the TPB predicted dietary intention, it did not significantly account for improved dietary behaviors. Anticipated regret significantly enhanced the basic TPB’s ability to predict intention to diet, while perceived need did not. These findings highlight the difficulty in predicting sustained change in a complex behavior such as dieting to lose weight. The need for more work with older, overweight/obese medical patients attending veterans’ facilities is stressed, as is the need for such work with male patients and ethnic minorities in particular. PMID:26792774

Effect of gluten free diet on gastrointestinal and behavioral indices for children with autism spectrum disorders: a randomized clinical trial.

PubMed

Ghalichi, Faezeh; Ghaemmaghami, Jamal; Malek, Ayyoub; Ostadrahimi, Alireza

2016-11-01

Genetic and environmental factors are both responsible for the etiology of autism spectrum disorders (ASD). Although epidemiological studies have been conducted to clarify the association between restriction diets and ASD, the conclusion remains unclear. This study was undertaken to investigate the effect of gluten free diet (GFD) on gastrointestinal symptoms and behavioral indices in children with ASD. In this randomized clinical trial, 80 children diagnosed with ASD by the Autism Diagnostic Interview-Revised (ADI-R) were assigned into GFD (n=40) and regular diet (RD) (n=40) groups for 6 weeks. At the beginning and end of the intervention, the ROME Ш questionnaire for evaluating gastrointestinal symptoms and Gilliam Autism Rating Scale 2 questionnaire (GARS-2) for assessing psychometric properties were completed. Of the 80 children, 53.9% had gastrointestinal abnormalities. In the GFD group, the prevalence of gastrointestinal symptoms decreased significantly (P<0.05) after intake of GFD (40.57% vs. 17.10%) but increased insignificantly in the RD group (42.45% vs. 44.05%). GFD intervention resulted in a significant decrease in behavioral disorders (80.03±14.07 vs. 75.82±15.37, P<0.05) but an insignificant increase in the RD group (79.92±15.49 vs. 80.92±16.24). This study suggested that GFD may be effective in controlling gastrointestinal symptoms and ASD behaviors.

The Cardiovascular Intervention Improvement Telemedicine Study (CITIES): Rationale for a Tailored Behavioral and Educational Pharmacist-Administered Intervention for Achieving Cardiovascular Disease Risk Reduction

PubMed Central

Zullig, Leah L.; Melnyk, S. Dee; Stechuchak, Karen M.; McCant, Felicia; Danus, Susanne; Oddone, Eugene; Bastian, Lori; Olsen, Maren; Edelman, David; Rakley, Susan; Morey, Miriam

2014-01-01

Abstract Background: Hypertension, hyperlipidemia, and diabetes are significant, but often preventable, contributors to cardiovascular disease (CVD) risk. Medication and behavioral nonadherence are significant barriers to successful hypertension, hyperlidemia, and diabetes management. Our objective was to describe the theoretical framework underlying a tailored behavioral and educational pharmacist-administered intervention for achieving CVD risk reduction. Materials and Methods: Adults with poorly controlled hypertension and/or hyperlipidemia were enrolled from three outpatient primary care clinics associated with the Durham Veterans Affairs Medical Center (Durham, NC). Participants were randomly assigned to receive a pharmacist-administered, tailored, 1-year telephone-based intervention or usual care. The goal of the study was to reduce the risk for CVD through a theory-driven intervention to increase medication adherence and improve health behaviors. Results: Enrollment began in November 2011 and is ongoing. The target sample size is 500 patients. Conclusions: The Cardiovascular Intervention Improvement Telemedicine Study (CITIES) intervention has been designed with a strong theoretical underpinning. The theoretical foundation and intervention are designed to encourage patients with multiple comorbidities and poorly controlled CVD risk factors to engage in home-based monitoring and tailored telephone-based interventions. Evidence suggests that clinical pharmacist-administered telephone-based interventions may be efficiently integrated into primary care for patients with poorly controlled CVD risk factors. PMID:24303930

Applicability Evaluation of Simplified Cognitive Behavioral Therapy.

PubMed

Zhang, Li; Zhu, Zhipei; Fang, Fang; Shen, Yuan; Liu, Na; Li, Chunbo

2018-04-25

We have developed a structured cognitive behavioral therapy manual for anxiety disorder in China, and the present study evaluated the applicability of simplified cognitive behavioral therapy based on our previous research. To evaluate the applicability of simplified cognitive behavioral therapy (SCBT) on generalized anxiety disorder (GAD) by conducting a multi-center controlled clinical trial. A multi-center controlled clinical trial of SCBT was conducted on patients with GAD, including institutions specializing in mental health and psychiatry units in general hospitals. The participants were divided into 3 groups: SCBT group, SCBT with medication group and medication group. The drop-out rates of these three groups, the therapy satisfaction of patients who received SCBT and the evaluation of SCBT from therapists were compared. (1) There was no significant difference among the drop-out rates in the three groups. (2) Only the duration and times of therapy were significantly different between the two groups of patients who received the SCBT, and the therapy satisfaction of the SCBT group was higher than that of the SCBT with medication group. (3) Eighteen therapists who conducted the SCBT indicated that the manual was easy to comprehend and operate, and this therapy could achieve the therapy goals. The applicability of SCBT for patients with GAD is relatively high, and it is hopeful that SCBT can become a psychological treatment which can be applied in medical institutions of various levels.

Psychosocial impairment in DSM-5 intermittent explosive disorder.

PubMed

Rynar, Lauren; Coccaro, Emil F

2018-03-30

The purpose of this study was to document the functional severity of DSM-5 IED in a clinical research sample. IED and control groups were compared on psychosocial functioning, life satisfaction, and on a variety of cognitive and behavioral issues. IED study participants reported significantly worse psychosocial function, quality of life, and higher job dysfunction than both psychiatric and healthy control study participants. The presence of DSM-5 IED is associated with significant psychosocial and functional impairment. Early intervention may aid in minimizing the consequences of impulsive aggressive behavior, and improving psychosocial functioning and quality of life. Copyright © 2018 Elsevier B.V. All rights reserved.

Therapist Training on Cognitive Behavior Therapy for Anxiety Disorders Using Internet-Based Technologies.

PubMed

Kobak, Kenneth A; Wolitzky-Taylor, Kate; Craske, Michelle G; Rose, Raphael D

2017-04-01

This study investigated a technology-enhanced training protocol to facilitate dissemination of therapist training on cognitive behavior therapy (CBT) for anxiety disorders. Seventy community clinicians received an online tutorial followed by live remote observation of clinical skills via videoconference. Impact of training on patient outcomes was also assessed. Training resulted in a significant increase in both trainee knowledge of CBT concepts and techniques and therapist competence in applying these skills. Patients treated by trainees following training had significant reductions in anxiety and depression. Ratings of user satisfaction were high. Results provide support for the use of these technologies for therapist training in CBT.

Therapist Training on Cognitive Behavior Therapy for Anxiety Disorders Using Internet-Based Technologies

PubMed Central

Kobak, Kenneth A.; Wolitzky-Taylor, Kate; Craske, Michelle G.; Rose, Raphael D.

2016-01-01

This study investigated a technology-enhanced training protocol to facilitate dissemination of therapist training on cognitive behavior therapy (CBT) for anxiety disorders. Seventy community clinicians received an online tutorial followed by live remote observation of clinical skills via videoconference. Impact of training on patient outcomes was also assessed. Training resulted in a significant increase in both trainee knowledge of CBT concepts and techniques and therapist competence in applying these skills. Patients treated by trainees following training had significant reductions in anxiety and depression. Ratings of user satisfaction were high. Results provide support for the use of these technologies for therapist training in CBT. PMID:28435174

Change in airflow among patients with asthma discussing relationship problems with their partners.

PubMed

Schmaling, Karen B; Afari, Niloofar; Hops, Hyman; Barnhart, Scott; Buchwald, Dedra

2009-09-01

This study examined the covariation of negative emotions with airflow among 48 persons with asthma and their partners as they discussed relationship problems. Measures included self-reported questionnaires, airflow and behavior coded from videotaped discussions. Significantly increased self-reported hostility and statistically but not clinically significant declines in airflow were found post- versus pre-discussion. Self-reported responses to asthma symptoms of more anger and less loneliness predicted lower post-discussion airflow after accounting for pre-discussion airflow. The use of effort-independent measures of airflow and autonomic nervous system monitoring may inform future research regarding the physiological mechanisms through which mood and behavior affect airflow.

Predicting effective contraceptive behavior in college females.

PubMed

Hughes, C B; Torre, C

1987-09-01

This article reports the results of a preliminary research project that explored the relationship between assertiveness, cognitive development and contraceptive behavior among single young women in their freshman and senior years at college. A total of 60 college women at a university health center volunteered to participate in this pilot study. They filled out three instruments: the Galassi College Self-Expression Scale (SES), the Measure of Intellectual Development (MID) tool and an author-developed sexuality questionnaire. Although there was a significant relationship between cognitive development and assertiveness, no significant relationships were found between cognitive development, assertiveness and use of effective contraception. Interesting descriptive characteristics were identified. Clinical implications are discussed.

Exploring the interaction of patient activation and message design variables: message frame and presentation mode influence on the walking behavior of patients with type 2 diabetes.

PubMed

Ledford, Christy J W

2012-10-01

Examining interpersonal (physician-patient) communication strategies for promoting walking exercise to patients with type 2 diabetes assigned to primary care clinics, the study evaluated two message design variables--frame and presentation mode--as influencers of communication and adoption success. The single-site, four-week, prospective intervention study followed a 2×3 factorial, non-equivalent comparison group quasi-experimental design. Results showed frame was significantly related to steps walked; however, when including patient activation as an interaction, frame was non-significant. The model including patient activation interactions, however, detected significant mode effects on behavior. Results provide evidence that statistics are most effectively used with activated patients.

Information and Communication Technologies for the Dissemination of Clinical Practice Guidelines to Health Professionals: A Systematic Review.

PubMed

De Angelis, Gino; Davies, Barbara; King, Judy; McEwan, Jessica; Cavallo, Sabrina; Loew, Laurianne; Wells, George A; Brosseau, Lucie

2016-11-30

The transfer of research knowledge into clinical practice can be a continuous challenge for researchers. Information and communication technologies, such as websites and email, have emerged as popular tools for the dissemination of evidence to health professionals. The objective of this systematic review was to identify research on health professionals' perceived usability and practice behavior change of information and communication technologies for the dissemination of clinical practice guidelines. We used a systematic approach to retrieve and extract data about relevant studies. We identified 2248 citations, of which 21 studies met criteria for inclusion; 20 studies were randomized controlled trials, and 1 was a controlled clinical trial. The following information and communication technologies were evaluated: websites (5 studies), computer software (3 studies), Web-based workshops (2 studies), computerized decision support systems (2 studies), electronic educational game (1 study), email (2 studies), and multifaceted interventions that consisted of at least one information and communication technology component (6 studies). Website studies demonstrated significant improvements in perceived usefulness and perceived ease of use, but not for knowledge, reducing barriers, and intention to use clinical practice guidelines. Computer software studies demonstrated significant improvements in perceived usefulness, but not for knowledge and skills. Web-based workshop and email studies demonstrated significant improvements in knowledge, perceived usefulness, and skills. An electronic educational game intervention demonstrated a significant improvement from baseline in knowledge after 12 and 24 weeks. Computerized decision support system studies demonstrated variable findings for improvement in skills. Multifaceted interventions demonstrated significant improvements in beliefs about capabilities, perceived usefulness, and intention to use clinical practice guidelines, but variable findings for improvements in skills. Most multifaceted studies demonstrated significant improvements in knowledge. The findings suggest that health professionals' perceived usability and practice behavior change vary by type of information and communication technology. Heterogeneity and the paucity of properly conducted studies did not allow for a clear comparison between studies and a conclusion on the effectiveness of information and communication technologies as a knowledge translation strategy for the dissemination of clinical practice guidelines. ©Gino De Angelis, Barbara Davies, Judy King, Jessica McEwan, Sabrina Cavallo, Laurianne Loew, George A Wells, Lucie Brosseau. Originally published in JMIR Medical Education (http://mededu.jmir.org), 30.11.2016.

The Association Between Internet Use and Ambulatory Care-Seeking Behaviors in Taiwan: A Cross-Sectional Study

PubMed Central

Chen, Tsung-Fu; Liang, Jyh-Chong; Lin, Tzu-Bin; Tsai, Chin-Chung

2016-01-01

Background Compared with the traditional ways of gaining health-related information from newspapers, magazines, radio, and television, the Internet is inexpensive, accessible, and conveys diverse opinions. Several studies on how increasing Internet use affected outpatient clinic visits were inconclusive. Objective The objective of this study was to examine the role of Internet use on ambulatory care-seeking behaviors as indicated by the number of outpatient clinic visits after adjusting for confounding variables. Methods We conducted this study using a sample randomly selected from the general population in Taiwan. To handle the missing data, we built a multivariate logistic regression model for propensity score matching using age and sex as the independent variables. The questionnaires with no missing data were then included in a multivariate linear regression model for examining the association between Internet use and outpatient clinic visits. Results We included a sample of 293 participants who answered the questionnaire with no missing data in the multivariate linear regression model. We found that Internet use was significantly associated with more outpatient clinic visits (P=.04). The participants with chronic diseases tended to make more outpatient clinic visits (P<.01). Conclusions The inconsistent quality of health-related information obtained from the Internet may be associated with patients’ increasing need for interpreting and discussing the information with health care professionals, thus resulting in an increasing number of outpatient clinic visits. In addition, the media literacy of Web-based health-related information seekers may also affect their ambulatory care-seeking behaviors, such as outpatient clinic visits. PMID:27927606

Choice of Insulin in Type 2 Diabetes: A Southeast Asian Perspective.

PubMed

Kalra, Sanjay; Thai, Hong Quang; Deerochanawong, Chaicharn; Su-Yen, Goh; Mohamed, Mafauzy; Latt, Tint Swe; Aye, Than Than; Latif, Zafar Ahmed; Katulanda, Prasad; Khun, Touch; Satha, Sum; Vongvandy, Vadsana

2017-01-01

Southeast Asia faces a diabetes epidemic, which has created significant challenges for health care. The unique Asian diabetes phenotype, coupled with peculiar lifestyle, diet, and healthcare-seeking behavior, makes it imperative to develop clinical pathways and guidelines which address local needs and requirements. From an insulin-centric viewpoint, the preparations prescribed in such pathways should be effective, safe, well tolerated, nonintrusive, and suitable for the use in multiple clinical situations including initiation and intensification. This brief communication describes the utility of premixed or dual action insulin in such clinical pathways and guidelines.

Cortical thickness, cortico-amygdalar networks, and externalizing behaviors in healthy children.

PubMed

Ameis, Stephanie H; Ducharme, Simon; Albaugh, Matthew D; Hudziak, James J; Botteron, Kelly N; Lepage, Claude; Zhao, Lu; Khundrakpam, Budhachandra; Collins, D Louis; Lerch, Jason P; Wheeler, Anne; Schachar, Russell; Evans, Alan C; Karama, Sherif

2014-01-01

Fronto-amygdalar networks are implicated in childhood psychiatric disorders characterized by high rates of externalizing (aggressive, noncompliant, oppositional) behavior. Although externalizing behaviors are distributed continuously across clinical and nonclinical samples, little is known about how brain variations may confer risk for problematic behavior. Here, we studied cortical thickness, amygdala volume, and cortico-amygdalar network correlates of externalizing behavior in a large sample of healthy children. Two hundred ninety-seven healthy children (6-18 years; mean = 12 ± 3 years), with 517 magnetic resonance imaging scans, from the National Institutes of Health Magnetic Resonance Imaging Study of Normal Brain Development, were studied. Relationships between externalizing behaviors (measured with the Child Behavior Checklist) and cortical thickness, amygdala volume, and cortico-amygdalar structural networks were examined using first-order linear mixed-effects models, after controlling for age, sex, scanner, and total brain volume. Results significant at p ≤ .05, following multiple comparison correction, are reported. Left orbitofrontal, right retrosplenial cingulate, and medial temporal cortex thickness were negatively correlated with externalizing behaviors. Although amygdala volume alone was not correlated with externalizing behaviors, an orbitofrontal cortex-amygdala network predicted rates of externalizing behavior. Children with lower levels of externalizing behaviors exhibited positive correlations between orbitofrontal cortex and amygdala structure, while these regions were not correlated in children with higher levels of externalizing behavior. Our findings identify key cortical nodes in frontal, cingulate, and temporal cortex associated with externalizing behaviors in children; and indicate that orbitofrontal-amygdala network properties may influence externalizing behaviors, along a continuum and across healthy and clinical samples. Copyright © 2014 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.

School attendance, health-risk behaviors, and self-esteem in adolescents applying for working papers.

PubMed Central

Suss, A. L.; Tinkelman, B. K.; Freeman, K.; Friedman, S. B.

1996-01-01

Since health-risk behaviors are often encountered in clusters among adolescents, it was hypothesized that adolescents with poor school attendance would be associated with more health-risk behaviors (e.g., substance use, violence) than those who attend school regularly. This study assessed the relationship between poor school attendance and health-risk behaviors, and described health-risk behaviors and self-esteem among adolescents seeking employment. In this cross-sectional study, school attendance (poor vs. regular attendance) was related to health-risk behaviors by asking 122 subjects seen at a New York City Working Papers Clinic to complete both a 72-item questionnaire about their health-risk behaviors and the 58-item Coopersmith Self-Esteem School Form Inventory. Chi-square and Fisher's Exact Tests were performed. The poor and regular attenders of school differed significantly in only 5 out of 44 items pertaining to health-risk behaviors. Self-esteem measures for the two groups did not differ from one another or from national norms. In this sample, depression "in general" (global) and "at home," but not "at school," were associated significantly with suicidal thoughts/attempts and serious past life events (e.g. family conflict, sexual abuse). There were no significant associations between depression or self-esteem and illicit substance or alcohol use. We found few associations between poor school attendance and health-risk behaviors in this sample of employment-seeking adolescents. The poor and regular attenders of school were similar in most aspects of their health-risk behaviors and self-esteem. PMID:8982520

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…

Importance of a specialty clinic for individuals with fragile X syndrome.

PubMed

Visootsak, Jeannie; Kidd, Sharon A; Anderson, Tovi; Bassell, Julia L; Sherman, Stephanie L; Berry-Kravis, Elizabeth M

2016-12-01

Advances in human genetics have identified a significant number of genetic disorders associated with intellectual disability. As a result, appropriate clinical management of these affected individuals and their family members have become critical in addressing medical needs to improve quality of life. We examine the importance of a Fragile X Clinic for individuals with fragile X syndrome (FXS) and their family members by conducting a retrospective chart review of 123 new patients with FXS evaluated at the Fragile X Clinic at Emory University. After the initial diagnosis of a proband with FXS with cascade testing, there were 345 family members identified with a mutation (70% with premutations; 30% with full mutations). In terms of the impact of the clinic visit, males had a substantial number of new diagnoses in all behavioral disorders (P < 0.001), with anxiety (62%) being the most common. For female probands, the most frequent diagnosis was also anxiety (87%). Prior to the clinic visit, very few patients were prescribed psychotropic medications. After the clinic visit, the most frequently prescribed psychotropic medications for males were stimulants (41%; P < 0.001) and SSRIs (40%; P < 0.001). For females, only stimulants (33%; P = 0.03) and SSRIs (44%; P = 0.008) were statistically significantly prescribed. Our results revealed that there is a gap in care to address the co-morbid behavioral issues, psychopharmacologic medication management, and genetic counseling needs regarding FXS. A multidisciplinary setting and approach, such as that offered by a Fragile X Clinic, is one method of treating the complex needs of patients with FXS. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Prevalence of HIV, STIs, and risk behaviors in a cross-sectional community- and clinic-based sample of men who have sex with men (MSM) in Lima, Peru.

PubMed

Perez-Brumer, Amaya G; Konda, Kelika A; Salvatierra, H Javier; Segura, Eddy R; Hall, Eric R; Montano, Silvia M; Coates, Thomas J; Klausner, Jeff D; Caceres, Carlos F; Clark, Jesse L

2013-01-01

Further research is necessary to understand the factors contributing to the high prevalence of HIV/STIs among men who have sex with men (MSM) in Peru. We compared HIV/STI prevalence and risk factors between two non-probability samples of MSM, one passively enrolled from an STI clinic and the other actively enrolled from community venues surrounding the clinic in Lima, Peru. A total of 560 self-identified MSM were enrolled between May-December, 2007. 438 subjects enrolled from a municipal STI clinic and 122 subjects enrolled during community outreach visits. All participants underwent screening for HIV, syphilis, HSV-2, gonorrhoea, and chlamydia and completed a survey assessing their history of HIV/STIs, prior HIV testing, and sexual behavior. HIV prevalence was significantly higher among MSM enrolled from the clinic, with previously undiagnosed HIV identified in 9.1% compared with 2.6% of community participants. 15.4 % of all MSM screened were infected with ≥ 1 curable STI, 7.4% with early syphilis (RPR ≥ 1:16) and 5.5% with urethral gonorrhoea and/or chlamydia. No significant differences between populations were reported in prevalence of STIs, number of male sex partners, history of unprotected anal intercourse, or alcohol and/or drug use prior to sex. Exchange of sex for money or goods was reported by 33.5% of MSM enrolled from the clinic and 21.2% of MSM from the community (p = 0.01). Our data demonstrate that the prevalence of HIV and STIs, including syphilis, gonorrhoea, and chlamydia are extremely high among MSM enrolled from both clinic and community venues in urban Peru. New strategies are needed to address differences in HIV/STI epidemiology between clinic- and community-enrolled samples of MSM.

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

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.

The impact of length of placement on self-reported mental health problems in detained Jordanian youth.

PubMed

Schwalbe, Craig S; Gearing, Robin E; Mackenzie, Michael J; Brewer, Kathryne B; Ibrahim, Rawan W

2013-01-01

This study reports the prevalence of emotional and behavioral problems among youths placed in juvenile correctional facilities in Jordan and describes the effect of length of stay on mental health outcomes. The Youth Self Report (YSR) was administered to 187 adolescent males (mean age=16.4, SD=1.0) in all five juvenile detention facilities in Jordan in 2011. Descriptive statistics were calculated to estimate the prevalence of emotional and behavioral problems. Logistic regression models were estimated to evaluate the impact of placement length on mental health. Statistical models were weighted by the youth propensity to be 'long-stay' youths (>23 weeks) based on preplacement case characteristics. The prevalence of clinically significant emotional and behavioral problems was 84%. 46% had YSR scores above the clinical cutpoint in both the internalizing and externalizing subscales. 24% of youths reported suicidal ideation. The high prevalence of emotional and behavioral disorders was stable across placement for most YSR subscales. The prevalence of emotional and behavioral disorders among detained and incarcerated youth in Jordan mirrors the literature worldwide. These findings suggest that serious mental health problems for many youths persist throughout placement. Copyright © 2013 Elsevier Ltd. All rights reserved.

Predictive Validity of the Columbia-Suicide Severity Rating Scale for Short-Term Suicidal Behavior: A Danish Study of Adolescents at a High Risk of Suicide.

PubMed

Conway, Paul Maurice; Erlangsen, Annette; Teasdale, Thomas William; Jakobsen, Ida Skytte; Larsen, Kim Juul

2017-07-03

Using the Columbia-Suicide Severity Rating Scale (C-SSRS), we examined the predictive and incremental predictive validity of past-month suicidal behavior and ideation for short-term suicidal behavior among adolescents at high risk of suicide. The study was conducted in 2014 on a sample of 85 adolescents (90.6% females) who participated at follow-up (85.9%) out of the 99 (49.7%) baseline respondents. All adolescents were recruited from a specialized suicide-prevention clinic in Denmark. Through multivariate logistic regression analyses, we examined whether baseline suicidal behavior predicted subsequent suicidal behavior (actual attempts and suicidal behavior of any type, including preparatory acts, aborted, interrupted and actual attempts; mean follow-up of 80.8 days, SD = 52.4). Furthermore, we examined whether suicidal ideation severity and intensity incrementally predicted suicidal behavior at follow-up over and above suicidal behavior at baseline. Actual suicide attempts at baseline strongly predicted suicide attempts at follow-up. Baseline suicidal ideation severity and intensity did not significantly predict future actual attempts over and above baseline attempts. The suicidal ideation intensity items deterrents and duration were significant predictors of subsequent actual attempts after adjustment for baseline suicide attempts and suicidal behavior of any type, respectively. Suicidal ideation severity and intensity, and the intensity items frequency, duration and deterrents, all significantly predicted any type of suicidal behavior at follow-up, also after adjusting for baseline suicidal behavior. The present study points to an incremental predictive validity of the C-SSRS suicidal ideation scales for short-term suicidal behavior of any type among high-risk adolescents.

Mental and behavioral disorders among people with congenital deafblindness.

PubMed

Dammeyer, Jesper

2011-01-01

The population of people with congenital deafblindness faces challenges concerning communication and mobility. Due to the significance of the sensory loss it is difficult to diagnose mental and behavioral disorders. This article investigates the prevalence of mental and behavioral disorders among 95 congenitally deafblind adults. Seventy-four percent were found to have a mental and/or behavioral diagnose. Mental retardation was found among 34%, psychosis among 13%. Mental and behavioral disorders, especially with symptoms of psychosis and mental retardation, are common among people with congenital deafblindness. Clinical experience is needed, as well as cross-disciplinary cooperation and specialized diagnostic methods together with a observation and intervention period in order to be able to assess and differentiate mental and behavioral symptoms from sensory deprivation in people with congenital deafblindness. Copyright © 2010 Elsevier Ltd. All rights reserved.

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.

Who repeats? A follow-up study of state hospital patients' firesetting behavior.

PubMed

Geller, J L; Fisher, W H; Bertsch, G

1992-01-01

The authors report on a population of psychiatric patients who were studied over a 6.75 year period to determine the occurrences of firesetting behavior noted in their psychiatric inpatient records. Two groups of 50 patients each were drawn from an earlier study and were matched by sex, age, and diagnoses. One group of patients had prior firesetting behavior; the other did not. Firesetting behavior was found not only in patients originally identified as having previously engaged in this behavior, but also in those with no documented history of this act prior to the period of the study. Patients having firesetting behavior in their past psychiatric record set more actual fires. Total number of episodes of firesetting behavior, however, was not significantly different between the two groups. Results are discussed in terms of the communicative function of firesetting and the dilemma of clinical prediction.

Direct Care Worker Training to Respond to the Behavior of Individuals With Dementia

PubMed Central

Gaugler, Joseph E.; Hobday, John V.; Robbins, Joyce C.; Barclay, Michelle P.

2016-01-01

Only a handful of online training programs are available for direct care workers (DCWs) to acquire the strategic skills needed to improve dementia care in instances of challenging or inappropriate behavior. Utilizing pre- and post-test data from a convenience sample of 40 DCWs, the present study sought to determine (a) whether DCWs’ knowledge of responding to dementia-related behavior increased following participation in the CARES® Dementia-Related Behavior™ Online Training Program (or CARES® Behavior) and (b) if CARES® Behavior was acceptable and useful. The average number of correct scores on a dementia care knowledge measure was significantly higher among DCWs after viewing the online modules when compared with pre-test scores (p < .01). Descriptive empirical and open-ended data also suggested that the interactive, “real-world” content of CARES® Behavior was feasibly delivered online, acceptable, and may influence how DCWs deliver clinical care to individuals with dementia-related behavior. PMID:26894209

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.

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 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.

Lack of chart reminder effectiveness on family medicine resident JNC-VI and NCEP III guideline knowledge and attitudes.

PubMed

Echlin, Paul S; Upshur, Ross E G; Markova, Tsveti P

2004-07-05

The literature demonstrates that medical residents and practicing physicians have an attitudinal-behavioral discordance concerning their positive attitudes towards clinical practice guidelines (CPG), and the implementation of these guidelines into clinical practice patterns. A pilot study was performed to determine if change in a previously identified CPG compliance factor (accessibility) would produce a significant increase in family medicine resident knowledge and attitude toward the guidelines. The primary study intervention involved placing a summary of the Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI) and the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (NCEP III) CPGs in all patient (>18 yr.) charts for a period of three months. The JNC VI and NCEP III CPGs were also distributed to each Wayne State family medicine resident, and a copy of each CPG was placed in the preceptor's area of the involved clinics. Identical pre- and post- intervention questionnaires were administered to all residents concerning CPG knowledge and attitude. Post-intervention analysis failed to demonstrate a significant difference in CPG knowledge. A statistically significant post-intervention difference was found in only on attitude question. The barriers to CPG compliance were identified as 1) lack of CPG instruction; 2) lack of critical appraisal ability; 3) insufficient time; 4) lack of CPG accessibility; and 5) lack of faculty modeling. This study demonstrated no significant post intervention changes in CPG knowledge, and only one question that reflected attitude change. Wider resident access to dedicated clinic time, increased faculty modeling, and the implementation of an electronic record/reminder system that uses a team-based approach are compliance factors that should be considered for further investigation. The interpretation of CPG non-compliance will benefit from a causal matrix focused on physician knowledge, attitudes, and behavior. Recent findings in resident knowledge-behavior discordance may direct the future investigation of physician CPG non-compliance away from generalized barrier research, and toward the development of information that maximizes the sense of individual practitioner urgency and certainty.

In vivo behavior of NTBI revealed by automated quantification system.

PubMed

Ito, Satoshi; Ikuta, Katsuya; Kato, Daisuke; Lynda, Addo; Shibusa, Kotoe; Niizeki, Noriyasu; Toki, Yasumichi; Hatayama, Mayumi; Yamamoto, Masayo; Shindo, Motohiro; Iizuka, Naomi; Kohgo, Yutaka; Fujiya, Mikihiro

2016-08-01

Non-Tf-bound iron (NTBI), which appears in serum in iron overload, is thought to contribute to organ damage; the monitoring of serum NTBI levels may therefore be clinically useful in iron-overloaded patients. However, NTBI quantification methods remain complex, limiting their use in clinical practice. To overcome the technical difficulties often encountered, we recently developed a novel automated NTBI quantification system capable of measuring large numbers of samples. In the present study, we investigated the in vivo behavior of NTBI in human and animal serum using this newly established automated system. Average NTBI in healthy volunteers was 0.44 ± 0.076 μM (median 0.45 μM, range 0.28-0.66 μM), with no significant difference between sexes. Additionally, serum NTBI rapidly increased after iron loading, followed by a sudden disappearance. NTBI levels also decreased in inflammation. The results indicate that NTBI is a unique marker of iron metabolism, unlike other markers of iron metabolism, such as serum ferritin. Our new automated NTBI quantification method may help to reveal the clinical significance of NTBI and contribute to our understanding of iron overload.

Attention-Deficit/Hyperactivity Disorder Subtype Differentially Predicts Smoking Expectancies in Adolescents

PubMed Central

Foster, Ida; Racicot, Simon; McGrath, Jennifer J.

2017-01-01

Purpose Attention deficit hyperactivity disorder (ADHD) is an established risk factor for smoking; however, no studies have considered whether precursors to smoking behavior differ among adolescents with ADHD. Smoking expectancies are beliefs about the potential consequences of smoking, and they develop before smoking initiation. ADHD characteristics may contribute to the formation of expectancies and eventual smoking behavior. We evaluated whether clinical levels of ADHD subtypes differentially predicted smoking expectancies. Methods Adolescents (n = 221; age mean = 12.67 years) completed the Smoking Expectancy Scale for Adolescents, answered standardized questions about their smoking behavior, and provided expired breath samples to verify never-smoking status. Parents completed the Conners’ Parent Rating Scale for ADHD symptoms of inattention and hyperactivity/impulsivity. Results Adolescents with clinical levels of inattention were significantly less likely to endorse negative consequences, including Expected Costs (odds ratio [OR] = .16), Appearance–Presentation Costs (OR = .29), Social Costs (OR = .19), Health Costs (OR = .21), and Addiction Costs (OR = .39). Inattentive female adolescents were significantly more likely to endorse Weight Control as a consequence. Adolescents with clinical levels of hyperactivity/impulsivity were more likely to endorse positive consequences, including Expected Benefits (OR = 5.31), Affect Control (OR = 2.60), and Boredom Reduction (OR = 3.14); they were less likely to endorse Social Costs (OR = .27). Conclusions ADHD subtype differentially predicted smoking expectancies. Adolescents with ADHD may be more vulnerable to developing pro-smoking expectancies due to subtype-related deficits in neurocognitive processing. These findings have potential implications for developing targeted smoking prevention programs. PMID:22999841

Knowledge translation and implementation in spinal cord injury: a systematic review.

PubMed

Noonan, V K; Wolfe, D L; Thorogood, N P; Park, S E; Hsieh, J T; Eng, J J

2014-08-01

To conduct a systematic review examining the effectiveness of knowledge translation (KT) interventions in changing clinical practice and patient outcomes. MEDLINE/PubMed, CINAHL, EMBASE and PsycINFO were searched for studies published from January 1980 to July 2012 that reported and evaluated an implemented KT intervention in spinal cord injury (SCI) care. We reviewed and summarized results from studies that documented the implemented KT intervention, its impact on changing clinician behavior and patient outcomes as well as the facilitators and barriers encountered during the implementation. A total of 13 articles featuring 10 studies were selected and abstracted from 4650 identified articles. KT interventions included developing and implementing patient care protocols, providing clinician education and incorporating outcome measures into clinical practice. The methods (or drivers) to facilitate the implementation included organizing training sessions for clinical staff, introducing computerized reminders and involving organizational leaders. The methodological quality of studies was mostly poor. Only 3 out of 10 studies evaluated the success of the implementation using statistical analyses, and all 3 reported significant behavior change. Out of the 10 studies, 6 evaluated the effect of the implementation on patient outcomes using statistical analyses, with 4 reporting significant improvements. The commonly cited facilitators and barriers were communication and resources, respectively. The field of KT in SCI is in its infancy with only a few relevant publications. However, there is some evidence that KT interventions may change clinician behavior and improve patient outcomes. Future studies should ensure rigorous study methods are used to evaluate KT interventions.

Androgen deficiency: association with increased anxiety and depression symptom severity in anorexia nervosa.

PubMed

Miller, Karen K; Wexler, Tamara L; Zha, Alicia M; Lawson, Elizabeth A; Meenaghan, Erinne M; Misra, Madhusmita; Binstock, Anna B; Herzog, David B; Klibanski, Anne

2007-06-01

Anorexia nervosa is associated with a high prevalence of psychiatric comorbidities, including anxiety and depression, and with endocrine dysfunction, including relative androgen deficiency compared with healthy young women. Because androgens are known to affect mood and behavior, we hypothesized that low endogenous androgen production in anorexia nervosa would predict anxiety and depression severity. Serum androgen levels and severity of depression (Hamilton Rating Scale for Depression) and anxiety (Hamilton Rating Scale for Anxiety) were measured in 43 community-dwelling women with DSM-IV-defined anorexia nervosa from May 2004 to July 2006. Strong inverse associations were observed between both total and free testosterone and anxiety and depression severity, independent of weight. Free testosterone was also inversely associated with 4 eating-disordered thinking and behavior subscales of the Eating Disorder Inventory 2 (EDI-2). Mean free testosterone blood levels were lower in women with clinically significant anxiety and in women with clinically significant depression, compared with those without. In stepwise regression models, free testosterone was an important predictor of anxiety and depression severity. EDI-2 ineffectiveness, perfectionism, interpersonal distress, and social insecurity scores were also inversely associated with androgen levels, independent of weight. Our data suggest that low androgen levels may contribute to anxiety, depression, and eating-disordered thinking and behavior in women with anorexia nervosa and form the basis for future studies to investigate the effectiveness of androgen replacement therapy. ClinicalTrials.gov identifier NCT00089843.

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…

Technology-enhanced program for child disruptive behavior disorders: development and pilot randomized control trial.

PubMed

Jones, Deborah J; Forehand, Rex; Cuellar, Jessica; Parent, Justin; Honeycutt, Amanda; Khavjou, Olga; Gonzalez, Michelle; Anton, Margaret; Newey, Greg A

2014-01-01

Early onset disruptive behavior disorders are overrepresented in low-income families; yet these families are less likely to engage in behavioral parent training (BPT) than other groups. This project aimed to develop and pilot test a technology-enhanced version of one evidence-based BPT program, Helping the Noncompliant Child (HNC). The aim was to increase engagement of low-income families and, in turn, child behavior outcomes, with potential cost-savings associated with greater treatment efficiency. Low-income families of 3- to 8-year-old children with clinically significant disruptive behaviors were randomized to and completed standard HNC (n = 8) or Technology-Enhanced HNC (TE-HNC; n = 7). On average, caregivers were 37 years old; 87% were female, and 80% worked at least part-time. More than half (53%) of the youth were boys; the average age of the sample was 5.67 years. All families received the standard HNC program; however, TE-HNC also included the following smartphone enhancements: (a) skills video series, (b) brief daily surveys, (c) text message reminders, (d) video recording home practice, and (e) midweek video calls. TE-HNC yielded larger effect sizes than HNC for all engagement outcomes. Both groups yielded clinically significant improvements in disruptive behavior; however, findings suggest that the greater program engagement associated with TE-HNC boosted child treatment outcome. Further evidence for the boost afforded by the technology is revealed in family responses to postassessment interviews. Finally, cost analysis suggests that TE-HNC families also required fewer sessions than HNC families to complete the program, an efficiency that did not compromise family satisfaction. TE-HNC shows promise as an innovative approach to engaging low-income families in BPT with potential cost-savings and, therefore, merits further investigation on a larger scale.

Technology-Enhanced Program for Child Disruptive Behavior Disorders: Development and Pilot Randomized Control Trial

PubMed Central

Jones, Deborah J.; Forehand, Rex; Cuellar, Jessica; Parent, Justin; Honeycutt, Amanda; Khavjou, Olga; Gonzalez, Michelle; Anton, Margaret; Newey, Greg A.

2013-01-01

Objective Early onset Disruptive Behavior Disorders (DBDs) are overrepresented in low-income families; yet, these families are less likely to engage in Behavioral Parent Training (BPT) than other groups. This project aimed to develop and pilot test a technology-enhanced version of one evidence-based BPT program, Helping the Noncompliant Child (HNC). The aim was to increase engagement of low-income families and, in turn, child behavior outcomes, with potential cost-savings associated with greater treatment efficiency. Method Low-income families of 3-to-8 year old children with clinically-significant disruptive behaviors were randomized to and completed standard HNC (n =8) or technology-enhanced HNC (TE-HNC) (n = 7). On average, caregivers were 37 years old, female (87%), and most (80%) worked at least part-time. Half (53%) of the youth were boys, average age of the sample was 5.67 years. All families received the standard HNC program; however, TE-HNC also included the following smartphone-enhancements: (1). Skills video series; (2). Brief daily surveys; (3). Text message reminders; (4). Video recording home practice; and (5). Mid-week video calls. Results TE-HNC yielded larger effect sizes than HNC for all engagement outcomes. Both groups yielded clinically significant improvements in disruptive behavior; however, findings suggest that the greater program engagement associated with TE-HNC boosted child treatment outcome. Further evidence for the boost afforded by the technology is revealed in family responses to post-assessment interviews. Finally, cost analysis suggests that TE-HNC families also required fewer sessions than HNC families to complete the program, an efficiency that did not compromise family satisfaction. Conclusions TE-HNC shows promise as an innovative approach to engaging low-income families in BPT with potential cost-savings and, therefore, merits further investigation on a larger scale. PMID:23924046

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kimpe, T; Marchessoux, C; Rostang, J

Purpose: Use of color images in medical imaging has increased significantly the last few years. As of today there is no agreed standard on how color information needs to be visualized on medical color displays, resulting into large variability of color appearance and it making consistency and quality assurance a challenge. This paper presents a proposal for an extension of DICOM GSDF towards color. Methods: Visualization needs for several color modalities (multimodality imaging, nuclear medicine, digital pathology, quantitative imaging applications…) have been studied. On this basis a proposal was made for desired color behavior of color medical display systems andmore » its behavior and effect on color medical images was analyzed. Results: Several medical color modalities could benefit from perceptually linear color visualization for similar reasons as why GSDF was put in place for greyscale medical images. An extension of the GSDF (Greyscale Standard Display Function) to color is proposed: CSDF (color standard display function). CSDF is based on deltaE2000 and offers a perceptually linear color behavior. CSDF uses GSDF as its neutral grey behavior. A comparison between sRGB/GSDF and CSDF confirms that CSDF significantly improves perceptual color linearity. Furthermore, results also indicate that because of the improved perceptual linearity, CSDF has the potential to increase perceived contrast of clinically relevant color features. Conclusion: There is a need for an extension of GSDF towards color visualization in order to guarantee consistency and quality. A first proposal (CSDF) for such extension has been made. Behavior of a CSDF calibrated display has been characterized and compared with sRGB/GSDF behavior. First results indicate that CSDF could have a positive influence on perceived contrast of clinically relevant color features and could offer benefits for quantitative imaging applications. Authors are employees of Barco Healthcare.« less

Responsiveness of the quality of life in late-stage dementia scale to psychotropic drug treatment in late-stage dementia.

PubMed

Martin-Cook, Kristin; Hynan, Linda S; Rice-Koch, Kathleen; Svetlik, Doris A; Weiner, Myron F

2005-01-01

We report on the responsiveness of a previously validated quality-of-life scale, the Quality of Life in Late-Stage Dementia scale (QUALID), as an outcome measure in a clinical trial of two psychotropic medications. Secondary analyses were conducted comparing outcome measures used in a randomized double-blind trial of two antipsychotics (olanzapine and risperidone) for the treatment of dementia-related behavioral symptoms. The QUALID was completed for 31 of the patients in addition to several measures of behavior-related dementia symptoms including the Neuropsychiatric Inventory, the Withdrawn Behavior subscale of the Multidimensional Observation Scale for Elderly Subjects, the Mini-Mental State Examination, and the Clinical Global Impression. Measures of safety and adverse effects included the Simpson-Angus Scale and records of specific adverse events. A significant positive relationship was found between QUALID score and improvement in behavioral symptoms, and a negative association was found with adverse medication effects. The QUALID was sensitive to both the treatment effects and the adverse effects of medication in this sample of patients.

Child and Adolescent Behavior Inventory (CABI): Standardization for Age 6-17 Years and First Clinical Application

PubMed Central

Cianchetti, Carlo; Pasculli, Marcello; Pittau, Andrea; Campus, Maria Grazia; Carta, Valeria; Littarru, Roberta; Fancello, Giuseppina Sannio; Zuddas, Alessandro; Ledda, Maria Giuseppina

2017-01-01

Background: The Child and Adolescent Behavior Inventory (CABI) is a questionnaire designed to collect information from the parents of children and adolescents, both for the preparation of screening and epidemiological studies and for clinical evaluation. It has been published in CPEMH in 2013, with the first data on 8-10 years old school children. Here we report an extended standardization on a school population 6-17 years old and the first results of the application in a clinical sample. Methods: Parents, after giving their informed consent, answered to the questionnaire. Complete and reliable data were obtained from the parents of 659 school children and adolescents 6-17 y.o., with a balanced distribution of gender. Moreover, in a population of 84 patients, the results with the CABI were compared with the clinical evaluation and the CBCL. Results: In the school population, scores were different in relation to gender and age. The values of externalizing disorders were higher in males, with the highest values for ADHD in the 6-10 y.o. children. On the contrary, the scores of internalizing disorders and of eating disorders tended to be slightly higher in females. In the clinical population, scores at the CABI were in agreement with the clinical evaluation in 84% cases for depressive symptoms (compared to CBCL 66%), 53% for anxiety symptoms (CBCL 42%) and 87% for ODD (CBCL 69%), differences, however; without statistical significance (chi square). Conclusion: The study obtained normative data for the CABI and gave information of the behavioral differences in relation to age and gender of the school population as evaluated by parents/caregivers. Clinically, the CABI provided useful information for the clinical evaluation of the patient, sometimes with better agreement with the final diagnosis compared to the CBCL. PMID:28458717

Increasing referral of at-risk travelers to travel health clinics: evaluation of a health promotion intervention targeted to travel agents.

PubMed

MacDougall, L A; Gyorkos, T W; Leffondré, K; Abrahamowicz, M; Tessier, D; Ward, B J; MacLean, J D

2001-01-01

Increases in travel-related illness require new partnerships to ensure travelers are prepared for health risks abroad. The travel agent is one such partner and efforts to encourage travel agents to refer at-risk travelers to travel health clinics may help in reducing travel-attributable morbidity. A health promotion intervention encouraging travel agents to refer at-risk travelers to travel health clinics was evaluated. Information on the knowledge, attitudes, and behaviors of travel agents before and after the intervention was compared using two self-administered questionnaires. The Wilcoxon signed rank test was used to compare the mean difference in overall scores to evaluate the overall impact of the intervention and also subscores for each of the behavioral construct groupings (attitudes, barriers, intent, and subjective norms). Multiple regression techniques were used to evaluate which travel agent characteristics were independently associated with a stronger effect of the intervention. A small improvement in travel agents overall attitudes and beliefs (p =.03) was found, in particular their intention to refer (p =.01). Sixty-five percent of travel agents self-reported an increase in referral behavior; owners or managers of the agency were significantly more likely to do so than other travel agents (OR = 7.25; 95% CI: 1.64 32.06). Older travel agents, those that worked longer hours and those with some past referral experience, had significantly higher post-intervention scores. Travel agents can be willing partners in referral, and agencies should be encouraged to develop specific referral policies. Future research may be directed toward investigating the role of health education in certification curricula, the effectiveness of different types of health promotion interventions, including Internet-facilitated interventions, and the direct impact that such interventions would have on travelers attending travel health clinics.

The assessment and treatment of performance anxiety in musicians.

PubMed

Clark, D B; Agras, W S

1991-05-01

Performance anxiety in musicians may be severe enough to require intervention but has been the subject of relatively little clinical research. The authors' objectives were to describe the results of a comprehensive clinical and laboratory assessment and to perform a double-blind, placebo-controlled study comparing buspirone, cognitive-behavior therapy, and the combination of these treatments for performance anxiety. Ninety-four subjects were recruited by mass media announcements and were seen in a university-based outpatient psychiatric clinic. Assessments were 1) questionnaires for all 94 subjects, 2) diagnostic interview of 50 subjects, and 3) laboratory performance of 34 subjects. Treatment conditions were 1) 6 weeks of buspirone, 2) 6 weeks of placebo, 3) a five-session, group cognitive-behavior therapy program with buspirone, or 4) the cognitive-behavior therapy program with placebo. Treatment outcome measures included subjective anxiety ratings and heart rate measures during a laboratory performance, a questionnaire measure of performance confidence, and a blind rating of musical performance quality. All subjects fulfilled criteria for DSM-III-R social phobia. Of the 15 full-time professional musicians, ten had tried propranolol and three had stopped performing. Most of the subjects had substantial anxiety and heart rate increases during laboratory speech and musical performances. Cognitive-behavior therapy resulted in statistically significant reductions in subjective anxiety, improved quality of musical performance, and improved performance confidence. Buspirone was not an effective treatment. Cognitive-behavior therapy is a viable treatment approach for performance anxiety in musicians.

Problem and pro-social behavior among Nigerian children with intellectual disability: the implication for developing policy for school based mental health programs

PubMed Central

2010-01-01

Background School based mental health programs are absent in most educational institutions for intellectually disabled children and adolescents in Nigeria and co-morbid behavioral problems often complicate intellectual disability in children and adolescents receiving special education instructions. Little is known about prevalence and pattern of behavioral problems existing co-morbidly among sub-Saharan African children with intellectual disability. This study assessed the prevalence and pattern of behavioral problems among Nigerian children with intellectual disability and also the associated factors. Method Teachers' rated Strengths and Difficulties Questionnaire (SDQ) was used to screen for behavioral problems among children with intellectual disability in a special education facility in south eastern Nigeria. Socio-demographic questionnaire was used to obtain socio-demographic information of the children. Results A total of forty four (44) children with intellectual disability were involved in the study. Twenty one (47.7%) of the children were classified as having behavioral problems in the borderline and abnormal categories on total difficulties clinical scale of SDQ using the cut-off point recommended by Goodman. Mild mental retardation as compared to moderate, severe and profound retardation was associated with highest total difficulties mean score. Males were more likely to exhibit conduct and hyperactivity behavioral problems compared to the females. The inter-clinical scales correlations of teachers' rated SDQ in the studied population also showed good internal consistency (Cronbach Alpha = 0.63). Conclusion Significant behavioral problems occur co-morbidly among Nigerian children with intellectual disability receiving special education instructions and this could impact negatively on educational learning and other areas of functioning. There is an urgent need for establishing school-based mental health program and appropriate screening measure in this environment. These would afford early identification of intellectually disabled children with behavioral problems and appropriate referral for clinical evaluation and interventions. The need to focus policy making attention on hidden burden of intellectual disability in sub-Saharan African children is essential. PMID:20465841

The interplay between individual social behavior and clinical symptoms in small clustered groups.

PubMed

Poletti, Piero; Visintainer, Roberto; Lepri, Bruno; Merler, Stefano

2017-07-26

Mixing patterns of human populations play a crucial role in shaping the spreading paths of infectious diseases. The diffusion of mobile and wearable devices able to record close proximity interactions represents a great opportunity for gathering detailed data on social interactions and mixing patterns in human populations. The aim of this study is to investigate how social interactions are affected by the onset of symptomatic conditions and to what extent the heterogeneity in human behavior can reflect a different risk of infection. We study the relation between individuals' social behavior and the onset of different symptoms, by making use of data collected in 2009 among students sharing a dormitory in a North America university campus. The dataset combines Bluetooth proximity records between study participants with self-reported daily records on their health state. Specifically, we investigate whether individuals' social activity significantly changes during different symptomatic conditions, including those defining Influenza-like illness, and highlight to what extent possible heterogeneities in social behaviors among individuals with similar age and daily routines may be responsible for a different risk of infection for influenza. Our results suggest that symptoms associated with Influenza-like illness can be responsible of a reduction of about 40% in the average duration of contacts and of 30% in the daily time spent in social interactions, possibly driven by the onset of fever. However, differences in the number of daily contacts were found to be not statistically significant. In addition, we found that individuals who experienced clinical influenza during the study period were characterized by a significantly higher social activity. In particular, both the number of person-to-person contacts and the time spent in social interactions emerged as significant risk factors for influenza infection. Our findings highlight that Influenza-like illness can remarkably reduce the social activity of individuals and strengthen the idea that the heterogeneity in social habits among individuals can significantly contribute in shaping differences among the individuals' risk of infection.

Predicting Self-Management Behaviors in Familial Hypercholesterolemia Using an Integrated Theoretical Model: the Impact of Beliefs About Illnesses and Beliefs About Behaviors.

PubMed

Hagger, Martin S; Hardcastle, Sarah J; Hingley, Catherine; Strickland, Ella; Pang, Jing; Watts, Gerald F

2016-06-01

Patients with familial hypercholesterolemia (FH) are at markedly increased risk of coronary artery disease. Regular participation in three self-management behaviors, physical activity, healthy eating, and adherence to medication, can significantly reduce this risk in FH patients. We aimed to predict intentions to engage in these self-management behaviors in FH patients using a multi-theory, integrated model that makes the distinction between beliefs about illness and beliefs about self-management behaviors. Using a cross-sectional, correlational design, patients (N = 110) diagnosed with FH from a clinic in Perth, Western Australia, self-completed a questionnaire that measured constructs from three health behavior theories: the common sense model of illness representations (serious consequences, timeline, personal control, treatment control, illness coherence, emotional representations); theory of planned behavior (attitudes, subjective norms, perceived behavioral control); and social cognitive theory (self-efficacy). Structural equation models for each self-management behavior revealed consistent and statistically significant effects of attitudes on intentions across the three behaviors. Subjective norms predicted intentions for health eating only and self-efficacy predicted intentions for physical activity only. There were no effects for the perceived behavioral control and common sense model constructs in any model. Attitudes feature prominently in determining intentions to engage in self-management behaviors in FH patients. The prominence of these attitudinal beliefs about self-management behaviors, as opposed to illness beliefs, suggest that addressing these beliefs may be a priority in the management of FH.

Optimal neurocognitive, personality and behavioral measures for assessing impulsivity in cocaine dependence.

PubMed

LoBue, Christian; Cullum, C Munro; Braud, Jacqueline; Walker, Robrina; Winhusen, Theresa; Suderajan, Prabha; Adinoff, Bryon

2014-11-01

Impulsivity may underlie the poor treatment retention and high relapse rates observed in cocaine-dependent persons. However, observed differences in measures of impulsivity between cocaine-dependent and healthy control participants often do not reach clinical significance, suggesting that the clinical relevance of these differences may be limited. To examine which measures of impulsivity (i.e. self-report impulsivity, self-report personality, neurocognitive testing) best distinguish cocaine-dependent and healthy control participants (i.e. showing differences at least 1.5 standard deviations [SD] from controls). Optimal measures were considered to demonstrate sufficient classification accuracy. Sixty-five recently abstinent cocaine-dependent and 25 healthy control participants were assessed using select neurocognitive tests and self-report questionnaires including the NEO Personality Inventory-Revised (NEO-PI-R), Temperament and Character Inventory (TCI), Barratt Impulsiveness Scale (BIS-11a), and the Frontal Systems Behavior Scale (FrSBe). When corrected for years of education and gender, neurocognitive measures did not demonstrate clinically significant differences between cocaine-dependent and control participants. The personality measures TCI Purposefulness and Congruent Second Nature and NEO-PI-R Impulsiveness, and the self-rating measures FrSBe Disinhibition and BIS-11 Motor Impulsivity and Total successfully identified clinically meaningful elevations in impulsivity within cocaine-dependent participants (>1.5 SDs from controls). Furthermore, these measures achieved 84-93% accuracy in discriminating cocaine-dependent from control participants. Clinically significant neurocognitive impairment in cocaine-dependent participants was not observed in this sample. As the BIS-11 or FrSBe are brief to administer, accurate, and have been shown to predict treatment retention and relapse, these measures appear to be optimal, relative to the personality measures, for examining trait impulsivity in cocaine dependence.

Impact of Gender, Age at Onset, and Lifetime Tic Disorders on the Clinical Presentation and Comorbidity Pattern of Obsessive-Compulsive Disorder in Children and Adolescents

PubMed Central

Adaletli, Hilal; Gunes, Hatice; Kilicoglu, Ali Guven; Mutlu, Caner; Bahali, Mustafa Kayhan; Aytemiz, Tugce; Uneri, Ozden Sukran

2015-01-01

Abstract Background: Obsessive–compulsive disorder (OCD) is a heterogeneous disorder; therefore, there is a need for identifying more homogeneous subtypes. This study aimed to examine the clinical characteristics and comorbidity pattern of a large sample of pediatric OCD subjects, and to examine the impact of gender, age at onset, and lifetime tic disorders on the clinical presentation and comorbidity pattern. Methods: A total of 110 children and adolescents diagnosed with OCD were assessed using the Kiddle Schedule for Affective Disorders and Schizophrenia for School Age Children-Present and Lifetime Version (K-SADS-PL) for psychiatric comorbidity, and a clinical data form was filled out. The cutoff for differentiating prepubertal from adolescent onset was 11 years of age. Results: A total of 83.6% of the subjects had at least one comorbid psychiatric disorder. Oppositional defiant disorder and contamination/somatic obsessions were significantly higher in males (p=0.036 and p=0.03, respectively) than in females. Depressive disorders and religious obsessions were significantly higher in the adolescent-onset group (p=0.02, p=0.05, respectively) whereas disruptive behavior disorders were higher in the prepubertal-onset group (p=0.037). Disruptive behavior disorders were significantly more frequent in the tic (+) group than in tic (-) group (p=0.021). Conclusions: There were differences in the comorbidity pattern and clinical expression between genders and between prepubertal and adolescent-onset cases. Findings of this study supported the introduction of tic-related OCD as a specifier in Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (DSM-5), and the necessity of a detailed assessment of other psychiatric disorders in youth with OCD. PMID:26091196