Physiological and perceptual responses to affect-regulated exercise in healthy young women

The purpose of the study was to objectively measure the exercise intensity associated with affective responses of “good” and “fairly good.” In Study 1, 8 active females completed 20 min of affect‐regulated exercise to feel “good” or “fairly good” (order counterbalanced) followed by an intensity replication session. On‐line gas analysis was used during the replication session to measure the physiological cost of exercising. In Study 2, 10 females completed either 3 trials of exercise to feel “good” (n = 5) or 3 trials to feel “fairly good” (n = 5). Each trial consisted of an affect‐regulated session followed by a replication session. Across studies, the intensity to feel “fairly good” was significantly higher than to feel “good.” Both intensities lay close to ventilatory threshold. The results add to evidence that women can use affect to regulate intensity and exercise at an intensity that would confer fitness and health benefits if maintained.     

Process evaluation of community coalitions for alcohol and other drug abuse prevention: A case study comparison of researcher- and community-initiated models

During the past decade, coalitions have been assumed to be central to the structure and functioning of community health promotion and disease prevention projects. However, there has been little empirical evaluation of community coalitions. The present paper presents case studies of two different coalition models, one a coalition developed to support a community-based drug abuse prevention trial, and the other, a CSAP Community Partnership Demonstration Program site. Comparison of the two coalitions on key characteristics indicated that they were similar except for their impetus for initiation (researcher versus community-initiated) and primary purpose (to support experimental program components versus to coordinate prevention programming and develop new prevention services). Members of the two coalitions (n = 51 in the researcher-initiated, and n = 49 in the community-initiated coalition) responded to a written survey that assessed immediate coalition process and activity outcomes, including perceptions of coalition efficiency, outcome efficacy, interagency coordination, and benefits of involvement. After controlling for demographic differences, the two groups of coalition members were similar, overall, on the measures of immediate outcomes. Univariate analyses indicated only one difference: members of the researcher-initiated coalition had higher ratings of perceived action committee effectiveness than did members of the community-initiated coalition. The results suggest that the impetus for initiation and primary purpose of a coalition may not be as important as other factors in influencing immediate process and activity outcomes. © 1996 John Wiley & Sons, Inc.     

A cost-benefit analysis of prenatal diagnosis by amniocentesis in Denmark

A cost-benefit analysis of amniocentesis has been performed using both the excess-cost- and the replacement methods and several replacement and discount rates. In Denmark, amniocentesis is offered free of charge to various groups of pregnant women at risk for genetic disorders of the foetus. Most important is age greater than or equal to 35 years. The analysis is based on incidence and survival rates for Down syndrome (trisomy 21), Patau's syndrome (trisomy 13) and Edward's syndrome (trisomy 18), and on incidence and survival rates of children with neural tube defects. If amniocentesis were offered to all pregnant women independent of age, with a supposed participation rate of 75% and if only tangible costs and benefits were included, the analysis shows a benefit:cost ratio greater than 1.0 using discount rates of 4% and 7% (both for the excess-cost- and replacement method); a benefit:cost ratio less than 1.0 is found using 10%. The ratio is approximately 1.0, if pregnant women aged 15-19 and 20-24 years are excluded, using the discount rate 10%. Calculations for other participation rates have also been performed. If intangible costs and benefit are included, the results are uncertain.     

Feasibility of a pancreatic cancer surveillance program from a psychological point of view

PurposeThe success of any surveillance program depends not solely on its technological aspects but also on the commitment of participants to adhere to follow-up investigations, which is influenced by the psychological impact of surveillance. This study investigates the psychological impact of participating in a pancreatic cancer surveillance program.MethodsHigh-risk individuals participating in an endoscopic ultrasonography-magnetic resonance imaging-based pancreatic cancer surveillance program received a questionnaire assessing experiences with endoscopic ultrasonography and magnetic resonance imaging, reasons to participate, psychological distress, and benefits and barriers of surveillance. High-risk individuals were individuals with a strong family history of pancreatic cancer or carriers of pancreatic cancer-prone gene mutations.ResultsSixty-nine participants (85%) completed the questionnaire. Surveillance was reported as “very to extremely uncomfortable” by 15% for magnetic resonance imaging and 14% for endoscopic ultrasonography. Most reported reason to participate was that pancreatic cancer might be detected in a curable stage. Abnormalities were detected in 27 respondents, resulting in surgical resection in one individual and a shorter follow-up interval in five individuals. Surveillance outcomes did not influence cancer worries. Overall, 29% was “often” or “almost always” concerned about developing cancer. Six respondents (9%) had clinical levels of depression and/or anxiety. According to 88% of respondents, advantages of surveillance outweighed disadvantages.ConclusionsAlthough endoscopic ultrasonography is more invasive than magnetic resonance imaging, endoscopic ultrasonography was not perceived as more burdensome. Despite one third of respondents worrying frequently about cancer, this was not related to the surveillance outcomes. Anxiety and depression levels were comparable with the general population norms. Advantages of participation outweighed disadvantages according to the majority of respondents. From a psychological point of view, pancreatic cancer surveillance in high-risk individuals is feasible and justified.     

Roles assumed by a community coalition when creating environmental and policy‐level changes

A significant amount of federal, state, and local resources are spent organizing large‐scale community coalitions designed to address the issues of alcohol, tobacco, and other drug (ATOD) use in communities. Thus far, results regarding the effectiveness of community coalitions in reducing ATOD rates are mixed. This article discusses the importance of strategies designed to impact environmental‐level changes (e.g., policies, laws), which, in turn, can impact individual use. The development of prevention structures that consistently and continuously promote prevention efforts must be established before significant change in use rates can occur and be sustained. In order to identify the roles assumed by a coalition in order to affect policy‐level changes, this article examines the specific efforts of the Lexington/Richland Drug and Alcohol Abuse Coalition in Columbia, South Carolina. Review of meeting minutes and interviews with staff and coalition members suggest that the coalition assumed three central roles: developer, facilitator, and arbitrator. The coalition's success in influencing community policies and sanctions is attributed to its responsiveness and ability to assume diverse roles, depending on the specific needs of the community. Changes in policies/laws and sanctions are presented as evidence of the coalition's success in impacting and reinforcing community‐wide prevention structures thought to reduce the abuse of alcohol and other drugs. © 2003 Wiley Periodicals, Inc. J Comm Psychol 31: 661–670, 2003.     

The emerging role of genetics professionals in forensic kinship DNA identification after a mass fatality: lessons learned from Hurricane Katrina volunteers

PurposeTo explore the experience of medical genetics professionals who volunteered in the DNA identification efforts after Hurricane Katrina to identify “lessons learned” and plan for future recovery efforts.MethodsA web-based survey was administered to volunteers in the Fall of 2007.ResultsSixty-six individuals (75%) completed the survey. Eighty-six percent volunteered because they felt their skills as genetics professional were needed and 46% desired additional training on the molecular aspects of kinship analysis. Most (97%) reported that they would like to see the genetics community become actively involved in further developing the role of genetics professionals in mass fatality response. All respondents (100%) would volunteer again.ConclusionDeveloping a registry of volunteers and educational materials tailored to the needs of genetics professionals should be explored as a mechanism to prepare the genetics community to play an active role in future mass fatality response.     

Temporal self-regulation theory: A model for individual health behavior

Abstract

Human behavior often seems “maladaptive”, “self-defeating”, or “dysfunctional” to the observer. Upon closer examination, the rationality of human behavior largely depends on the temporal frame adopted; behaviors judged to be maladaptive in the long-run are usually driven by a strongly favorable balance of immediate costs and benefits. That is, many ‘‘maladaptive’’ behaviors are associated with substantial long-term costs and few (if any) long-term benefits; however, these same behaviors are frequently associated with many benefits and few costs for the individual at the time of action. In contrast, many avoided behaviors that seem ‘‘adaptive’’ to the outside observer, are in fact associated with substantial costs (and few benefits) at the time of action, leading to the perplexing but common state of affairs where individuals know ‘‘what is good for them’’, but do not do it. We present a new theoretical framework—Temporal Self-Regulation Theory—as a way of understanding human behavior in general, and those special instances of seemingly ‘‘self-defeating’’ behavior that have important implications for physical health. This theoretical framework incorporates thinking about temporal aspects of behavioral contingencies and the biological roots of self-regulation to make sense of human behavioral patterns that seem to represent, on the surface, significant deviations from rationality.     

North Wales randomized controlled trial of cognitive behaviour therapy for acute schizophrenia spectrum disorders: two-year follow-up and economic evaluation

BACKGROUND: There is good evidence now that cognitive behaviour therapy (CBT) is effective in the treatment of people suffering from schizophrenia. There is also some evidence that the benefits of CBT persist after the end of treatment and that the direct costs of providing CBT as an adjunct to standard care are no higher than the direct costs of standard care alone. The aims of the present study were to discover if the benefits of CBT for acute schizophrenia which were found 1 year after index admission persist for another year, and to evaluate the comparative costs of providing CBT. METHOD: Consecutive admissions meeting criteria were recruited. After screening, 43 were assigned at random to a treatment-as-usual (TAU) control group and 47 were assigned to TAU plus CBT. Patients (73% of original) were rated on symptoms and social functioning 2 years after index admission. An evaluation of the direct costs of services was also completed. RESULTS: The CBT group had maintained its advantage over the TAU group on negative symptoms and social functioning but had lost the advantage it previously enjoyed in positive symptoms. The difference between groups in total direct costs over the 2 years was not statistically significant despite the cost of providing CBT. CONCLUSIONS: Some of the benefits of CBT for patients suffering acute psychotic episodes persist for 2 years. After the end of regular treatment, CBT should probably be targeted on the appearance of early signs of relapse to forestall the re-emergence of positive symptoms.     

Better together? The cognitive advantages of synaesthesia for time,numbers, and space

Synaesthesia for time, numbers, and space (TNS synaesthesia) is thought to have costs and benefits for recalling and manipulating time and number. There are two competing theories about how TNS synaesthesia affects cognition. The “magnitude” account predicts that TNS synaesthesia may affect cardinal magnitude judgements, whereas the “sequence” account suggests that it may affect ordinal sequence judgements and could rely on visuospatial working memory. We aimed to comprehensively assess the cognitive consequences of TNS synaesthesia and distinguish between these two accounts. TNS synaesthetes, grapheme–colour synaesthetes, and nonsynaesthetes completed a behavioural task battery. Three tasks involved cardinal and ordinal comparisons of temporal, numerical, and spatial stimuli; we also examined visuospatial working memory. TNS synaesthetes were significantly more accurate than nonsynaesthetes in making ordinal judgements about space. This difference was explained by significantly higher visuospatial working memory accuracy. Our findings demonstrate an advantage of TNS synaesthesia that is more in line with the sequence account.     

Increasing inclusivity in precision medicine research: Views of deaf and hard of hearing individuals

PurposeDeaf/hard of hearing (HoH) individuals can benefit from precision medicine research (PMR) but are underrepresented in mainstream health research and may experience barriers to participation. Understanding their views and concerns about PMR can inform processes to foster inclusion in future studies and reduce health disparities.MethodsWe administered an online disability-accessible survey to explore perceptions of PMR among, inter alia, deaf/HoH individuals. Questions included willingness to participate, interest in results, and barriers and facilitators to participation. Analyses describe results for participants who self-identified their primary condition as being deaf/HoH and compared results for key demographic characteristics.ResultsA total of 267 deaf/HoH participants completed the survey. Interest in PMR was high, although many reported inaccessible facilities and information about medical research; 51% reported that communication with health professionals is a barrier. Concerns about harm, lack of access to benefits, misinformed allocation decisions, and limited disability-relevant knowledge among researchers and health care providers were significant. Differences across racial, ethnic, and sex groups were observed and are discussed.ConclusionStrategies to remove barriers to participation of deaf/HoH individuals in PMR are suggested. Distrust is a major challenge for cohort diversity, and research is needed to identify measures to increase the trustworthiness of PMR endeavors.     

Factors contributing to the variability of direct costs for graduate medical education in teaching hospitals.

Medicare's support of graduate medical education includes funds allocated to the direct costs of graduate medical education: housestaff stipends and benefits, faculty costs, and related educational costs such as classroom space. As reimbursed through the mechanism called the direct graduate medical education (DGME) pass-through, these direct costs have been reported to vary widely from one teaching hospital to another, with little explanation for this variation being available. Based on a national survey of 69 teaching hospitals--principally affiliated community teaching hospitals--the author suggests that a major cause for the variation in these costs might be found in their faculty-expenses component. It is further suggested that economies of scale may provide some clue as to the variability of these costs. The author also reports lower DGME costs for the survey sample than for the national sample, and suggests that the fact that community teaching hospital faculties include a significant volunteer component may account for some of these savings.     

The economic burden of HIV in the United States in the era of highly active antiretroviral therapy: evidence of continuing racial and ethnic differences

BACKGROUND: Assessing the economic burden of HIV/AIDS can help to quantify the effect of the epidemic on a population and assist policy makers in allocating public health resources. OBJECTIVE: To estimate the economic burden of HIV/AIDS in the United States and provide race/ethnicity-specific estimates. METHODS: We conducted an incidence-based cost-of-illness analysis to estimate the lifetime cost of HIV/AIDS resulting from new infections diagnosed in 2002. Data from the HIV/AIDS Reporting System of the Centers for Disease Control and Prevention were used to determine stage of disease at diagnosis and proportion of cases by race/ethnicity. Lifetime direct medical costs and mortality-related productivity losses were estimated using data on cost, life expectancy, and antiretroviral therapy (ART) use from the literature. RESULTS: The cost of new HIV infections in the United States in 2002 is estimated at $36.4 billion, including $6.7 billion in direct medical costs and $29.7 billion in productivity losses. Direct medical costs per case were highest for whites ($180,900) and lowest for blacks ($160,400). Productivity losses per case were lowest for whites ($661,100) and highest for Hispanics ($838,000). In a sensitivity analysis, universal use of ART and more effective ART regimens decreased the overall cost of illness. CONCLUSION: Direct medical costs and productivity losses of HIV/AIDS resulting from infections diagnosed in 2002 are substantial. Productivity losses far surpass direct medical costs and are disproportionately borne by minority races/ethnicities. Our analysis underscores economic benefits of more effective ART regimens and universal access to ART.     

The case of Powhatan Correctional Center/Virginia Department of Corrections and Virginia Commonwealth University/Medical College of Virginia.

OBJECTIVE: To implement a cost/benefit analysis of telemedicine subspecialty care provided between the Powhatan Correctional Center (PCC) of the Virginia Department of Corrections (Corrections) and the Medical College of Virginia campus of Virginia Commonwealth University (MCV/VCU). METHODS: We evaluated the costs and benefits of the implementation of telemedicine for HIV-positive inmates. Benefits included dollar savings in transportation and medical reimbursement. Costs included those of operating the telemedicine system and of medical care. Non-dollar benefits included implementing more consistent and timely treatment of inmates and reducing security risk. RESULTS: Over the 7-month study period, the total number of HIV consults by telemedicine was 165. The Department of Corrections was able to achieve transportation and medical savings of $35,640 and $21,123, respectively. The operating costs for the telemedicine services totaled $42,277. The net benefit, which is the difference between cost savings and total operating costs, was $14,486. CONCLUSION: Telemedicine increased access to care for HIV-positive inmates and generated cost savings in transportation and care delivery.     

Including the blind community in precision medicine research: findings from a national survey and recommendations

PurposeDespite ongoing efforts to increase diversity of cohorts in precision medicine research (PMR), little is known about the obstacles to inclusion of blind people and those with low vision (“the blind community”) in PMR. The blind community comprises ~10% of the US adult population and its members commonly experience health disparities. Understanding barriers to inclusion of this community is necessary to facilitate their participation.MethodsAn online survey was developed in disability-accessible formats. Key questions included views on PMR; willingness to participate, provide data, and engage in the study; data sharing and consent; and perceived barriers to participation. Analyses describe results for all participants.ResultsTwo hundred seventy-one blind/low-vision participants completed the survey. Participants expressed strong support for PMR, and willingness to participate in PMR, to provide lifestyle, biological and medical information, to engage with the study, and to have their data shared with other researchers. Preferences for data sharing and consent models varied. Significantly, 65% identified 3–6 barriers to participation, particularly inaccessible transportation, clinics, and facilities; inaccessible information; and attitudinal and institutional barriers.ConclusionRemoving the identified barriers is key. Measures that could increase inclusivity of blind people and those with low vision in PMR are suggested.     

Counselling interventions to address the psychological consequences of screening mammography: a randomised trial

We examined the effectiveness of offering counselling to women undergoing screening mammography who are recalled for further investigations that do not lead to a diagnosis of cancer. Women were randomised to being offered either face-to-face (n = 66) or telephone counselling (n = 68) or usual care (n = 71) at the recall clinic after being told that their screen-detected abnormality was not cancer. The PCQ (a reliable and valid measure of the psychological consequences of screening mammography) measured the emotional, social and physical functioning of women at the recall clinic (Time 1) and after the counselling intervention (Time 2). Analyses of covariance (ANCOVA) showed no main effects for intervention on Time 2 levels of functioning after adjustment for the respective covariate of Time 1 functioning. Time 1 levels significantly predicted Time 2 levels of functioning. When data were analysed according to whether women actually received any type of counselling versus not receiving counselling, participation in counselling was associated with lower scores on dysfunction scales at Time 2, after adjusting for Time 1 levels.     

Between a rock and a hard place: Associations between Mentzos' “dilemma”, self‐reported interpersonal problems,and psychosocial functioning in individuals with non‐affective psychoses

Primary aim of this study was to determine the extent and type of self‐reported interpersonal problems in patients with non‐affective psychoses and their impact on psychosocial functioning. Furthermore, we aimed to explore potential links with the psychodynamic construct of Stavros Mentzos' “psychotic dilemma”, which describes an insufferable inner tension caused by an individual's struggle of being torn between “self‐oriented” and “object‐oriented” tendencies. In a cross‐sectional study among 129 patients with non‐affective psychoses, measures of cognition, symptom load and social functioning as well as a tentative, psychodynamic assessment of Mentzos' “dilemma” were obtained during a clinical research visit. Self‐report data on interpersonal problems were gathered using the Inventory of Interpersonal Problems (IIP‐64D) and compared with a German representative standard sample. Second, IIP‐64D scores were compared between groups with or without Mentzos' “dilemma”. Hierarchical regression analyses were performed to test for the impact of interpersonal problems on psychosocial functioning, while controlling for cognitive deficits and psychopathology. Results showed that IIP‐64D scores differed significantly from healthy controls, except for “self‐centred” and “intrusive” interpersonal styles. Participants with a potential “psychotic dilemma” scored significantly higher on the subscales: “domineering”, “self‐centred”, “cold”, and “socially avoidant” than the group without a “psychotic dilemma”. The total amount of interpersonal problems, and particularly high scores on the IIP‐64D “socially avoidant” subscale, predicted psychosocial dysfunction, whereas a “cold” interpersonal style had an opposite effect. In conclusion, specific interpersonal problems may predict psychotherapeutic outcome measures like psychosocial functioning and are partly compatible with the psychodynamic construct of Stavros Mentzos' “psychotic dilemma”.     

Elementary student and teacher perceptions of a mindfulness and yoga-based program in school: A qualitative evaluation

Research questionWhat are the qualitative insights and perspectives about the implementation of a mindfulness and yoga-based program from elementary youth and teachers?ContextA mindfulness and yoga-based curriculum was implemented in 15 schools. The curriculum was taught to students during a physical education or dance class by instructors who were within each school and received training on the curriculum.Sample selectionVolunteer focus group elementary students who participated for one year and teachers who did not implement the program were qualitatively interviewed, by three trained University researchers.Data collectionNine focus groups were completed within three different elementary schools. Six focus groups were completed with 3rd and 5th grade students. Three focus groups were conducted with teachers within each school which received the program, excluding instructors.AnalysisFocus group data were coded and a thematic analysis was completed among the 40 students and 23 teachers.Interpretation and main resultsTeachers had varying degrees of involvement with the program and communication emerged as a critical theme for buy-in as communication represents the underpinnings of creating and retaining stakeholders. Most students talked about perceived improvements in focus, emotional regulation, flexibility, breathing, and school work. A common theme to describe benefits of the program emerged with the idea of “increased focus”. Conceptually, it may be that increasing mindfulness increases “focus” thus increasing positive outcomes. More research is needed to understand if “focus” may serve as a mediating variable on emotional regulation, cognitive improvements, and other health outcomes.     

Prevalence, Overlap, and Predictors of Functional Somatic Syndromes in a Student Sample

Background

Although at least 20 different functional somatic syndromes (FSS) have been described, and overlaps between individual FSS and a high comorbidity with depressive and anxiety disorders have been suggested, barely any studies have examined a broad array of FSS within one study. Moreover, information on psychosocial risk factors gained from prospective studies is scarce.

Purpose

This study aimed to determine prevalence rates, overlap, and comorbidity in 17 FSS and to estimate the influence of psychosocial risk factors on the development of FSS.

Methods

In total, 3,054 students (73.4 % women) completed a Web survey containing questions on FSS, comorbidity, and psychosocial risk factors at baseline. Of these, 429 completed the survey again 6 months later.

Results

The prevalence of any FSS was 9.5 %, with 227 (78.6 %) subjects fulfilling criteria for only one FSS, 49 (17.0 %) reporting two, and 12 (4.2 %) reporting three syndromes simultaneously. Only one person suffered from four FSS at the same time. “Major depressive syndrome” (15.6 %), “panic syndrome” (4.8 %), and “other anxiety syndromes” (19.7 %) frequently occurred among persons with FSS. Significant predictors of FSS were number of somatic symptoms (OR?=?1.15), impairment in daily activities (OR?=?3.17), depression (OR?=?1.13), and somatization (OR?=?1.15).

Conclusions

Our findings indicate that FSS are common in nonclinical samples. The frequency of overlap and comorbidity in FSS was lower compared with previous research. A consideration of psychosocial risk factors is warranted in the prevention and management of FSS.