Acute Stabilization in an Inpatient Trauma Program

Abstract

The author presents an evidence-based psychological theory which is derived from clinical observations, a review of the literature, especially the split-brain literature, and experimentation with lateral visual field stimulation which has been found to induce changes in patients' cognitive and emotional status thought to be associated with the relative activation of one cerebral hemisphere or the other. The evidence from lateral visual field stimulation suggests that often each hemisphere can have distinct psychological perspectives differing especially in their level of neuroticism with one visual field evoking a more immature perspective than the other. One of the central tenets of the hypothesis is that psychological traumas are associated more with one cerebral hemisphere and than the other, and that the ultimate aim of psychiatric care then becomes the teaching of the mental entity associated with this troubled hemisphere that it is now safer and more valued than it had been at the time of the trauma.     

健康行为改变干预本体的构建与应用

生活方式干预是慢病管理的重要环节,随着互联网的发展,基于移动医疗技术的综合干预方案成为慢病管理模式研究的新趋势。面对干预复杂性和综合性越来越强的挑战,一个标准、细致、综合的框架有利于对干预方案进行解构分析,从而促进干预的质量和效果提升。本研究提出健康行为改变干预本体,通过内容分析法对干预内容进行分类提取,得到行为改变技术及其属性的重要术语集合,通过七步法结合OWL建模语言完成本体构建;并以面向高血压院外管理的干预方案为例进行验证,评估其干预方案。所得术语集合包括22个适用于基于移动医疗技术的慢病管理饮食和运动场景的行为改变技术,以及102个行为改变技术实施过程属性,健康行为改变干预本体共有128个类,51个数据属性,16个对象属性。基于本体将高血压干预方案转换为层次清晰、过程明确的干预单元组合,对其评估结果表明方案使用行为改变技术共14种,覆盖率为63.64%。该本体能够应用于慢病管理相关场景的干预设计、描述和分析评估等环节,有利于知识的组织与共享。     

Fit and Motivated: Outcome Predictors in Patients Starting a Program for Lifestyle Change

Background:In previous pilot studies we have demonstrated that the Treatment Motivation and Readiness Test (TRE-MORE) is capable of predicting the outcome of obesity therapy and that a higher muscle mass (MM) is associated with a greater weight loss. Purposes of the present study were: to confirm the predictive value of TRE-MORE scores and MM, using a standardized non-pharmacologic intervention for weight loss; to explore the relationship between TRE-MORE and MM; to discriminate predictors of attendance from predictors of final therapeutic success.Methods:A consecutive series of 331 patients was enrolled and addressed to a standardized treatment protocol.Results:Mean weight loss at 6 months was −5.03%. Among participants, 48.7% lost at least 5% initial body weight after 6 months and had significantly higher TRE-MORE total scores and MM. Weight loss was significantly associated with baseline MM, TRE-MORE-3, and a lower number of previous diets. Significantly lower TRE-MORE-3 scores were associated with drop-out.Conclusion:The present study confirms that therapeutic success is predicted by TRE-MORE scores and, independently from these, by estimated MM (after adjustment for BMI). TRE-MORE total score is a predictor of failure, but not of attendance, whereas drop-out patients showed a lower score only in TREMORE-3 subscale which investigates lifestyle habits.Key Words: Obesity, Motivation, Muscle mass, Weight loss     

Predictors of Outcome for Children With Behavior Problems Served in Public Mental Health

This study investigated whether pervasiveness of problems across settings predicted successful reduction of impairment in school, home, and interactions with others after controlling for other variables that may be stronger predictors. The data of 4,434 youths between the ages of 7 and 17 years in public mental health services in Michigan were examined employing logistic regressions, with 4 sets of predictors, as follows: demographic characteristics, risk factors, therapist's perception of impairment in the youth's caregiving environment, and pervasiveness of the youth's problems. The results indicated that pervasiveness of problems was the strongest predictor of poor outcomes for each domain. In addition, impaired caregiving environment, previous hospitalization for psychiatric or substance use problems, and placement out-of-home were also negatively associated with successful outcome. The implications of the findings for practice and research are discussed.     

Effect of Aditional Brief Counselling after Periodic Health Examination on Motivation for Health Behavior Change

This study was to evaluate the effect of additional brief counseling by a primary care physician on lifestyle modification of examinees after a periodic health examination. 1,000 participants of the 2007 Korean national health screening program were asked to note any variation in their health behavior after participating in the screening program. The degree of comprehensive motivation for lifestyle modification was assessed in terms of stages of health behavior change. We calculated odds ratio of positive change (enhanced stage of change) with multiple logistic regression analysis and age-adjusted proportion of positive changers. Of 989 respondents, 486 and 503 received the basic and additional programs, respectively. Additional group were more likely to be positive changer than basic group (adjusted OR 1.78; 95% CI 1.19-2.65), and this was more prominent in older age group (adjusted OR 2.38, 95% CI 1.23-4.58). The age-adjusted proportions of positive changers were 22.7% (95% CI, 17.9-28.3) and 36.2% (95% CI, 30.4-42.4) in the basic and additional groups, respectively (P < 0.001). The additional consultation led to improvements in the stage of health behavior change after the health examination. Thus, such a consultation should be considered when designing a health-screening program.     

Implementation and evaluation of an undergraduate Sociocultural Medicine Program.

PURPOSE: To demonstrate an effective model for designing, implementing, and evaluating the Sociocultural Medicine Program (SMP), part of a comprehensive sociocultural medicine curriculum at the University of Michigan Medical School. METHOD: This study followed a cross-sectional, pre- and post-intervention survey design. A total of 167 medical students completed a measure of attitudes toward sociocultural issues in medicine prior to and following participation in the SMP. Students' attitudes were assessed in the domains of "exposure to sociocultural issues," "sociocultural factors in clinical scenarios," and "sociocultural background in patient/physician/health status issues." RESULTS: Paired t-tests of the pre- and post-intervention responses revealed significant positive changes for items in the domain of exposure to sociocultural issues in medicine: experience with sociocultural issues in a clinical setting (p <.01), understanding of relationship among sociocultural background, health, and medicine (p <.001), and importance of sociocultural background in students' future patient populations (p <.01). Significant changes were also found for the impact of sociocultural background in patient/physician/health status issues: physician-patient relationship (p <.001) and patients' health behavior (p <.001). CONCLUSIONS: The SMP had a significant educational impact on students' attitudes towards sociocultural issues in medicine. Students reported greater exposure to these issues conceptually and clinically, and greater influence of sociocultural factors in patients' behaviors and patient- physician relationships. Critical components of this SMP were faculty development, multiple teaching approaches, and pre- and post-intervention evaluation.     

Culture Change and Ethnic-Minority Health Behavior: An Operant Theory of Acculturation

Data on acculturation and ethnic-minority health indicate that acculturation has opposite effects on the same health behavior among different ethnic groups; opposite effects on different health behaviors within an ethnic group; opposite effects on the same health behavior for the women vs. the men of most ethnic groups; and no effect whatsoever on some health behaviors for some ethnic groups. This evidence is so incoherent that it is unintelligible, and hence it continues to be largely useless to health psychology and behavioral medicine. This paper presents a new theory of acculturation that renders these confusing data coherent by predicting such changes in minority health behavior a priori. By so doing, the operant model of acculturation has the potential to improve health promotion and disease prevention and thereby reduce ethnic health disparities.     

精神分裂症治疗前后幻觉特征的比较

目的　了解住院治疗对精神分裂症幻觉特征的影响 .方法　应用自编幻觉特征调查表检查 10 4例初发精神分裂症病人治疗前后的幻觉特征 .结果　治疗 8周后仍有 46例病人存在幻觉 ,但幻觉特征与治疗前明显不同 ,幻觉出现频率和持续时间减少 ,形象模糊 ,伴随的负性情感反应和行为反应减弱 .结论　即使治疗不能消除幻觉 ,也能改变幻觉特征 ,减低幻觉所造成的负面影响 ,有着重要的临床意义 .     

Client Satisfaction Survey of Inpatient Trauma and Dissociative Disorders Program

Abstract

Treatment interventions from a specialized multi-disciplinary inpatient trauma and dissociative disorders program were evaluated by 43 patients through the use of a satisfaction survey questionnaire. Interventions with the highest ranking means of usefulness, as perceived by participants, included individual therapy sessions by both the psychiatrist and the psychotherapist, trauma group, psychodrama, and goals-and-closure group. Body awareness group, led by nurses, and body movement group, led by expressive therapists, were rated the lowest. These results indicate the importance for specialized trauma programs to address body distorted perceptions of the dissociative patients while maintaining frequent individual treatment interventions that address the patients' existing problems they bring to therapy.     

Dynamic Change of Aggressive Behavior and Victimization Among Adolescents: Effectiveness of the ViSC Program

The present study reports a high-quality evaluation of the ViSC Social Competence Program, which was implemented large scale in Austria. A rigorous test of program effectiveness has been performed to investigate the dynamic change of aggressive behavior and victimization and to ensure a high level of statistical conclusion validity. A cluster randomized control study was applied to examine program effectiveness regarding aggressive behavior and victimization. In sum, 1,377 adolescents (48.5% girls, M_age = 11.7) enrolled in 13 schools participated in the program; 665 adolescents (45.2% girls, M_age = 11.6) enrolled in 5 schools were in the control group. Data were collected with Internet-based questionnaires at pre- and posttest with several validated scales to capture the full range of the two constructs. To ensure construct validity, a series of invariance tests of the second-order factor models were performed. To test program effectiveness, a multiple group bivariate latent change score model was applied. Evidence for a dynamic change of aggressive behavior and victimization was found. As predicted, the pretest levels and the change scores of aggressive behavior and victimization were associated. Moreover, higher levels of pretest values predicted more change. The program was effective in reducing victimization but not aggressive behavior. Gender did not moderate the results. Results are important for national rollout and cross-national dissemination of the program. However, further research is needed to investigate the underlying mechanisms of the intervention effects.     

Health Behavior Change Support Systems as a research discipline; A viewpoint

As research on Health Behavior Change Support Systems (HBCSS) proliferates, meaningful management of the different findings is becoming a challenge. We argue that for the field to evolve, it is important to establish the study of HBCSSs as an independent research area, which means that instead of only applying theories from related disciplines to HBCSSs, we need to significantly extend and adapt these theories, or develop new theories, to explain the phenomena that are encountered.Current research in HBCSSs is carried out in different disciplines, with a different approach in each of these disciplines. However, both the CeHRes roadmap and the Persuasive System Design Model show that HBCSSs are complex and the development and evaluation of these systems need to deal with this complexity to be successful. Therefore, an integrative approach is needed to study the combination of content, system, and context. Although research into the separate areas has yielded important findings that are discussed in this paper, we argue that an integrated approach of HBCSSs is useful. We discuss two examples to show how a truly integrative approach can be utilized to enhance the field involving tailoring, personalization, and support. In conclusion we present three practical and relatively easy–to-implement recommendations for researchers who want to contribute to this discipline: Avoid the black box, be specific about the terms used, and look past the borders of one’s own discipline.     

Psychosocial Predictors of Health Status Revisited

A one-year prospective design was used to explore health care costs, claims, and job burnout in relation to the following predictors: work and life stress, social support, exercise, Type A behavior, and personal hardiness. Nowack's (1991) model guided the study. A sample of 260 working adults from two organizations participated. Bivariate correlational results suggested that stressful work events were positively related to health care costs and the number of claims filed. With regard to job burnout, (a) stress appeared positively related to personal accomplishment and (b) Type A behavior was associated with greater emotional exhaustion. Higher job satisfaction, social support, and Type A behavior were associated with an increased sense of personal accomplishment. Findings concerning objective health indicators are discussed in relation to previous results pertaining to self-reports of health/illness.