Testing practices and knowledge of HIV among prenatal care providers in a low seroprevalence state

As the prevalence of heterosexually transmitted HIV increases among women of childbearing age in the United States, so too does the potential for vertical transmission from mother to child. Early maternal diagnosis and appropriate management are critical to minimizing the risk of perinatal infection. We designed a study to evaluate current prenatal care provider testing practices and knowledge of HIV as it relates to pregnancy in a low seroprevalence state. A written questionnaire was mailed to 642 prenatal care providers in Kentucky. Responses were compared to a similar survey conducted in 1998 and to current federal guidelines for HIV management. Nearly all respondents reported to offer HIV testing to all prenatal patients, demonstrating a marked improvement since 1998 (p < 0.001). However, clinicians did not report adequate follow-up when testing is refused and appear to have limited knowledge of the disease as it relates to pregnancy. Only 9.3% of respondents demonstrated proficiency on two knowledge assessment questions. Those with previous experience treating prenatal patients with HIV were more likely to respond correctly (odds ratio [OR] 3.03; 95% confidence interval [CI] 1.08-8.50). Providers with little experience treating patients with HIV may not possess the basic knowledge required to manage the disease during pregnancy. Additional educational interventions are needed in low seroprevalence areas to ensure the appropriate treatment of all HIV-positive pregnant patients and to minimize the risk of preventable perinatal transmission.     

Patterns of self-disclosure in psychotherapy and marriage

This study compared patterns of self-disclosure in psychotherapy and marriage. Participants (48 married, current psychotherapy patients, mean age = 42) completed a 101-item Disclosure to Therapist Inventory and a companion measure, a 101-item Disclosure to Spouse Inventory. Results indicated a pattern of greater disclosure to one's therapist in regard to issues involving despair (e.g., feelings of depression), and to one's spouse in regard to procreation and body concerns (e.g., birth control) and values (e.g., feelings about religion, race, or politics). Issues involving sex were infrequently discussed in either context. Discrepancy scores (differences between extent of disclosure and perceived importance) were greater in the spouse condition. Outcome predictors varied by situation, with overall disclosure predicting therapeutic outcome and both overall disclosure and discrepancy scores predicting marital satisfaction. Findings suggest that although there is substantial overlap in issues discussed in these two contexts, certain intimate disclosures are perceived as situation-specific. (PsycINFO Database Record (c) 2010 APA, all rights reserved).     

Enhanced stimulus strength improves visual cognition in aging and Alzheimer's disease

Deficits in visual cognition in Alzheimer's disease (AD) arise from neuropathological changes in higher-order association areas of the cortex and from defective input from lower-level visual processing areas. We investigated whether enhanced signal strength may lead to improvement of visual cognition in AD. We tested 35 individuals with probable AD, 35 age-matched elderly control (EC) and 58 young control (YC) adults on letter identification, word reading, picture naming, discrimination of unfamiliar faces, and pattern completion. The contrast sensitivity step-difference across an independent sample of AD and EC groups was used in calculating an image filter, from which we produced stimulus-strength conditions of low-degraded, medium-normal, and high-enhanced. Using this filter we created a hypothetical proximal-strength equivalence between AD at medium strength and EC at low strength, and between AD at high strength and EC at medium strength. For letter identification, word reading, picture naming, and face discrimination, medium strength elicited AD accuracy levels and reaction times that were similar to those of EC at low strength. On picture naming, increased strength reduced perceptual-type errors for EC and AD and random errors for AD. For word reading, high strength elicited AD accuracy levels and reaction times that were equivalent to those of EC at medium strength. We saw no effect of signal-strength manipulation on performance of pattern completion, possibly owing to the complex cognitive demands of that task or to the inadequacy of the filter for its images. The results indicate that putative AD-EC differences in cognition directly reflect contrast sensitivity differences between the groups. Enhancement of stimulus strength can ameliorate vision-based deficits and lead to improvement in some aspects of cognitive performance. These results suggest new non-pharmacological avenues to explore in the attempt to improve cognition in elderly adults and especially in individuals with AD.     

A 15-year national follow-up: legislation is not enough to reduce the use of seclusion and restraint

BACKGROUND: Seclusion and restraint are frequent but controversial coercive measures used in psychiatric treatment. Legislative efforts have started to emerge to control the use of these measures in many countries. In the present study, the nationwide trends in the use of seclusion and restraint were investigated in Finland over a 15-year span which was characterised by legislative changes aiming to clarify and restrict the use of these measures. METHOD: The data were collected during a predetermined week in 1990, 1991, 1994, 1998 and 2004, using a structured postal survey of Finnish psychiatric hospitals. The numbers of inpatients during the study weeks were obtained from the National Hospital Discharge Register. RESULTS: The total number of the secluded and restrained patients declined as did the number of all inpatients during the study weeks, but the risk of being secluded or restrained remained the same over time when compared to the first study year. The duration of the restraint incidents did not change, but the duration of seclusion increased. A regional variation was found in the use of coercive measures. CONCLUSION: Legislative changes solely cannot reduce the use of seclusion and restraint or change the prevailing treatment cultures connected with these measures. The use of seclusion and restraint should be vigilantly monitored and ethical questions should be under continuous scrutiny.     

Reduction in midthigh low-density muscle with aerobic exercise training and weight loss impacts glucose tolerance in older men

CONTEXT: Intramuscular lipid content increases with aging and obesity and is directly related to impaired glucose tolerance and insulin resistance. OBJECTIVE: Our purpose was to determine the effects of aerobic exercise training (AEX) with and without weight loss (WL) on midthigh low-density muscle (LDM; a measure of im lipid) and whether changes in LDM impact glucose tolerance in sedentary older men. DESIGN: Forty-six men (60.4 +/- 1.1 yr) completed 6 months of AEX (n = 34) or AEX + WL (n = 12) and had oral glucose tolerance tests (OGTTs) and computed tomography measures of LDM and regional abdominal and thigh fat depot areas. RESULTS: At baseline, LDM area directly correlated with fasting plasma glucose (FPG), 120-min glucose (G(120)), and glucose area under the curve (G(AUC)) during an OGTT (r = 0.44, r = 0.51, and r = 0.54, respectively, P < 0.01). After the interventions, the AEX + WL group had greater decreases in LDM (-13.5 vs. +1.3%, respectively), FPG (-8.3 vs. +2.1%, respectively), G(120) (-22.5 vs. -3.6%, respectively), and G(AUC) (-17.3 vs. - 3.1%, respectively) than the AEX group. In the entire sample, the decreases in LDM correlated with reductions in FPG, G(120), and G(AUC) during an OGTT (r = 0.31, r = 0.34, and r = 0.41, P < 0.05). Changes in other regional fat depots did not independently correlate with glucose tolerance or insulin responses. CONCLUSION: AEX + WL is more efficacious than AEX for reducing LDM and glucose tolerance. The improvement in glucose tolerance may be partially mediated by decreases in LDM in older men.