Cultural Sensitivity and Adaptation in Family-Based Prevention Interventions

Because of the substantial impact of families on the developmental trajectories of children, family interventions should be a critical ingredient in comprehensive prevention programs. Very few family interventions have been adapted to be culturally sensitive for different ethnic groups. This paper examines the research literature on whether culturally adapting family interventions improves retention and outcome effectiveness. Because of limited research on the topic, the prevention research field is divided on the issue. Factors to consider for cultural adaptations of family-focused prevention are presented. Five research studies testing the effectiveness of the generic version of the Strengthening Families Program (SFP) compared to culturally-adapted versions for African Americans, Hispanic, Asian/Pacific Islander, and American Indian families suggest that cultural adaptations made by practitioners that reduce dosage or eliminate critical core content can increase retention by up to 40%, but reduce positive outcomes. Recommendations include the need for additional research on culturally-sensitive family interventions.     

Updating evidence-based clinical guidelines

OBJECTIVES: To report on the updating of two evidence-based guidelines. METHODS: Development of multi-disciplinary evidence-based guidelines within the North of England Evidence Based Guideline Development Programme. RESULTS: The guideline updating groups were multi-disciplinary although the balance of disciplines was different from the original development groups; the convening of the updating groups allowed refinement of both the skills within the groups and the overall size of the groups. As both groups were starting with a previous version of the guideline, defining the scope of the guideline was more straightforward and faster than when developing the guideline de novo. The process of evidence identification for both guidelines was again by systematic review. Updating the guidelines influenced recommendations in two ways: new evidence required new recommendations; and supplementary evidence in an existing area allowed refinement of recommendations. Overall savings within the guideline updating process (compared with initial development) were modest. The major costs of both the initial guideline development and the updating process were staff costs, which were identical for the two processes. CONCLUSIONS: There is little other experience to set alongside this paper. There is a need for further sharing of experiences and the development of explicit methods for informing decisions on when and how to update evidence-based guidelines.     

High dose rate brachytherapy source measurement intercomparison

This work presents a comparison of air kerma rate (AKR) measurements performed by multiple radiotherapy centres for a single HDR ¹⁹²Ir source. Two separate groups (consisting of 15 centres) performed AKR measurements at one of two host centres in Australia. Each group travelled to one of the host centres and measured the AKR of a single ¹⁹²Ir source using their own equipment and local protocols. Results were compared to the ¹⁹²Ir source calibration certificate provided by the manufacturer by means of a ratio of measured to certified AKR. The comparisons showed remarkably consistent results with the maximum deviation in measurement from the decay-corrected source certificate value being 1.1%. The maximum percentage difference between any two measurements was less than 2%. The comparisons demonstrated the consistency of well-chambers used for ¹⁹²Ir AKR measurements in Australia, despite the lack of a local calibration service, and served as a valuable focal point for the exchange of ideas and dosimetry methods.     

A Study of Expectations and the Marital Quality of Participants of a Marital Enrichment Seminar

This longitudinal study investigated the effects of expectations of effort of self and spouse on the marital quality of marital enrichment seminar participants. Self‐report measures of marital quality, expectations regarding effort put into implementing what was learned during the seminar, amount of perceived effort, and satisfaction with effort were administered before and after the seminar, as well as at a 2‐month follow‐up. Participants (147 women, 95 men) attended community‐based marital enrichment seminars in 12 U.S. cities. Multivariate path models indicated that larger discrepancies between expectations of effort postseminar and perceived effort at 2‐month follow‐up were associated with less satisfaction with perceived effort. Furthermore, participants' dissatisfaction in their spouses' effort had a negative effect on marital quality while controlling for initial marital quality, whereas dissatisfaction in their own effort did not. These findings highlight the possible detrimental effect that unmet spousal expectations can have. Implications for marital enrichment programs and couples therapy are discussed.     

Ruptured tuboovarian abscess in early gestation. A case report

A woman with a ruptured tuboovarian abscess was treated surgically at nine weeks' gestation. She subsequently had an uneventful pregnancy and delivery.     

Psychiatry and the skin

Many patients with emotional, psychological and frank psychiatric problems present in disguise to the dermatologist. It is important that the dermatologist recognizes such patients and institutes appropriate therapy. A liaison clinic is particularly helpful in the management of more difficult patients, such as those with delusional disease or profound depression.     

Use of a lignocaine-prilocaine cream as an analgesic in dye laser treatment of port-wine stains

A eutectic mixture of two local anaesthetics—prilocaine and lignocaine (EMLA cream)—has been investigated for its usefulness as an analgesic in the treatment of facial port-wine stains with the tunable dye laser. The cream provided adequate analgesia in eight of 10 patients assessed and was well tolerated. The results of treatment after use of EMLA cream were no different from those where conventional analgesia had been used, and EMLA cream can be recommended for analgesia during laser treatment of port-wine stains.