Thinking about going to the dentist: a Contemplation Ladder to assess dentally-avoidant individuals' readiness to go to a dentist

Background  

The Transtheoretical Model suggests that individuals vary according to their readiness to change behavior. Previous work in smoking cessation and other health areas suggests that interventions are more successful when they are tailored to an individual's stage of change with regards to the specific behavior. We report on the performance of a single-item measure ("Ladder") to assess the readiness to change dental-avoidant behavior.     

Intrinsic and extrinsic barriers to mental health care among community-dwelling younger and older adults

This study examined intrinsic and extrinsic barriers to mental health care among younger (n = 76; M age = 23 years) and older adults (n = 88; M age = 71 years) using a new 56 item self-report measure, Barriers to Mental Health Services Scale (BMHSS). The BMHSS was developed to examine 10 barriers to the utilization of mental health services: help-seeking attitudes, stigma, knowledge and fear of psychotherapy, belief about inability to find a psychotherapist, belief that depressive symptoms are normal, insurance and payment concerns, ageism, concerns about psychotherapist's qualifications, physician referral, and transportation concerns. Results indicated that younger adults perceived fear of psychotherapy, belief about inability to find a psychotherapist, and insurance concerns to be greater barriers than older adults. Men perceived stigma to be a greater barrier than women whereas women perceived finding a psychotherapist to be a greater barrier than men. The rank order of the BMHSS subscales was strongly similar for younger and older adults (r = 0.90, p = 0.000). These results also provide further evidence that stigma about receiving mental health services is not a primary barrier among younger or older adults.     

Hemispheric asymmetries of affective processing as determined by the Minnesota Multiphasic Personality Inventory

Patients with left hemisphere disease have been noted to be depressed while those with right hemisphere disease appear indifferent. While patients with left hemisphere disease frequently have a greater cognitive deficit, patients with right hemisphere disease have difficulty in expressing affectively intoned speech. The Minnesota Multiphasic Personality Inventory (MMPI) can demonstrate underlying affective experience and is not dependent on affectively intoned speech. The purpose of this study was to determine whether a difference in affective moods, as assessed by the MMPI, was related to laterality of lesion in patients matched for severity of cognitive and motor dysfunction. Seven of the 16 subjects with left hemisphere dysfunction and none of the eight subjects with right hemisphere dysfunction showed an elevation on the depression scale. This observation not only confirms previous clinical observations but also demonstrates that these asymmetries cannot be ascribed completely to hemisphere-related differences in cognitive deficits or expressive abilities.     

Amoxicillin in treatment of acute uncomplicated exacerbations of chronic bronchitis. A double-blind, placebo-controlled multicentre study in general practice.

The aim of the study was to evaluate whether a broad-spectrum penicillin, amoxicillin, was superior to placebo in resolving symptoms of acute exacerbations of chronic bronchitis in patients from general practice. 131 general practitioners included 278 patients over a period of 30 months. The patients were randomly assigned to treatment with amoxicillin 750 mg b.i.d. or corresponding placebo for 7 days. Patients with pneumonia, a temperature above 38.5 degrees C or heart rate over 100 were excluded for safety reasons. The main effect parameter--the doctors' overall evaluation of the treatment--did not demonstrate any statistically significant difference between amoxicillin or placebo, 63% versus 64% of the patients. Resolution of symptoms was obtained by 19% (25/132) of the patients in the amoxicillin group compared with 10% (13/136) of the patients in the placebo group, P = 0.03. The present findings do not favour routine use of antibiotics in an attempt to improve the course of acute exacerbations as defined in this study in patients with chronic bronchitis.     

Are Personality Disorders Psychological Manifestations of Executive Function Deficits? Bivariate Heritability Evidence from a Twin Study

This study tested whether personality disorders may be the psychological manifestations of executive function deficits by examining their bivariate heritability in a community sample of 314 twins (ages 5-17 years; M age = 9.7; 96 monozygotic pairs and 61 dizygotic pairs). The parents of the twins completed the Coolidge Personality and Neuropsychological Inventory (Coolidge, 1998; Coolidge et al., 2002). Heritability was estimated by structural equation modeling. Executive function deficits and personality disorders were significantly heritable (executive function deficits,.77; 11 out of 12 personality disorders, median =.69). The proportion of the observed correlation attributable to heritable factors or bivariate heritability between executive function deficits and the personality disorder scales ranged from.27 for schizoid to.64 for histrionic. These findings may provide some insight as to why individuals diagnosed with specific personality disorders frequently exhibit chronic difficulties with everyday decisions, selective attention and inhibition, judgments, choices, planning, and flexibility.     

Psychoneurosis in the Elderly

Although psychoneurosis rarely occurs for the first time in elderly persons, psychoneurotic symptoms are very prevalent in that age group. It is essential to treatment and prognosis to determine whether organic brain disease is present and to establish the origin of the symptoms by careful history and appropriate examinations. The most important aspect of treatment is the sustained interest of one person supervising the patient's welfare on a long-term basis.     

Burkholderia cepacia lower respiratory tract infection associated with exposure to a respiratory therapist.

OBJECTIVE: To investigate and control a nosocomial outbreak of Burkholderia cepacia lower respiratory tract infection. DESIGN: Outbreak investigation and case-control study. SETTNG: A 260-bed community hospital. PATIENTS: Participants were mechanically ventilated intensive care patients without cystic fibrosis. A case was defined as a hospitalized patient with a sputum culture positive for B. cepacia between January 1 and November 6, 1998. METHODS: Respiratory therapy infection control policies and practices were reviewed; laboratory and environmental studies and a retrospective case-control study were conducted. Case-patients were matched with control-patients on age, gender, diagnosis, and type of intensive care unit. RESULTS: Nine case-patients were identified; B. cepacia likely caused pneumonia in seven and colonization in two. Two respiratory therapy practices probably contributed to the transmission of B. cepacia: multidose albuterol vials were used among several patients, and nebulizer assemblies often were not dried between uses. B. cepacia was grown from cultures of three previously opened multidose vials; pulsed-field gel electrophoresis patterns of B. cepacia from seven case-patients and two multidose vials were indistinguishable. Case-patients had longer durations of heated humidified mechanical ventilation (mean, 9.8 days vs 4.4 days; P=.03) and were more likely to have exposure to one particular respiratory therapist than controls (odds ratio, undefined; 95% confidence interval, 4.7-infinity; P=.001). The association with the respiratory therapist, a temporary employee, persisted after controlling for duration of heated humidified ventilation. No new B. cepacia infections were identified after control measures were implemented. CONCLUSIONS: B. cepacia probably was transmitted among patients through use of extrinsically contaminated multidose albuterol vials. Respiratory therapy departments must pay close attention to infection control practices, particularly among new or temporary staff.