Enhancing Outcomes of Low-Intensity Parenting Groups Through Sufficient Exemplar Training: A Randomized Control Trial.

Low-intensity parenting groups, such as the Triple P-Positive Parenting Program Discussion Groups, appear to be a cost-effective intervention for child conduct problems. Several studies evaluating a Triple P Discussion Group on disobedience found promising results for improving child and parent outcomes. However, a sufficient exemplar training approach that incorporates generalization promotion strategies may assist parents to more flexibly apply positive parenting principles to a broader range of child target behaviors and settings, leading to greater change. We compared the effects of sufficient exemplar training to an existing narrowly focused low-intensity intervention. Participants were 78 families with a 5-8 year-old child. Sufficient exemplar training resulted in more robust changes in child behavior and superior outcomes for mothers on measures of parenting behavior, parenting self-efficacy, mental health, and perceptions of partner support at post-intervention and 6-month follow-up. These results indicate that teaching sufficient exemplars may promote generalization leading to enhanced intervention outcomes.

Effectiveness of CenteringPregnancy on Breastfeeding Initiation Among African Americans: A Systematic Review and Meta-analysis.

While breastfeeding initiation rates for African American mothers are low, an innovative model of group prenatal care, CenteringPregnancy, holds promise to increase breastfeeding rates. The aim of this systematic review and meta-analysis was to examine the effects of CenteringPregnancy versus individual prenatal care on breastfeeding initiation among African American mothers. Using a systematic approach and PRISMA guidelines, 4 electronic databases were used to search the literature. English-language studies, comparing CenteringPregnancy and individual prenatal care, including African American participants, and specifying breastfeeding initiation as an outcome were screened for inclusion. Study strength and quality were assessed and 7 studies were systematically reviewed and meta-analyzed. Participation in CenteringPregnancy increased the probability of breastfeeding initiation by 53% (95% confidence interval = 29%-81%) (n = 8047). A subgroup analysis of breastfeeding initiation among only African American participants was performed on 4 studies where data were available. Participation in CenteringPregnancy increased the probability of breastfeeding initiation by 71% (95% confidence interval = 27%-131%) (n = 1458) for African American participants. CenteringPregnancy is an effective intervention to increase breastfeeding initiation for participants, especially for African Americans. To close the racial gap in breastfeeding initiation, high-quality research providing specific outcomes for African American participants in CenteringPregnancy are needed.

[BALINT GROUP AS A-MEANS FOR BURNOUT PREVENTION AND IMPROVEMENT OF THERAPIST-PATIENT RELATIONSHIP IN A GENERAL HOSPITAL - THE SOROKA EXPERIENCE].

Balint group (BG) is an experiential discussion group which deals with the various aspects of the therapist-patient relationship. BG was found to be effective for stress and burnout prevention among medical professionals. Burnout is expressed by emotional fatigue, de-personalization and sense of failure. Recent articles found connections between burnout and personal and systemic factors such as: workload, work conflicts, and work-life conflicts. Burnout can lead to medical mistakes, loss of empathy for the patient, coronary disease, and leaving work. Until now, BGs were held in community settings. We first describe organizing and leading BG for physicians and nurses in the Nephrology-Dialysis department. We present the process of group setting and leading as a procedure that also takes into consideration the organizational limits of the hospital setting. Conclusions and future suggestions will be presented.

[Development and evaluation of a therapeutic community model in Japan: Use of an encounter group method].

The purpose of the present study was to develop a therapeutic community (TC) model in the Drug Addiction Rehabilitation Center (DARC), the rehabilitation facility group managed by recovered drug users in Japan, and to evaluate the effectiveness of the model. The TC model is a drug-free self-help program that is significant for its use of the peer community to facilitate social and psychological change in individuals. Although the TC model has been developed around the world in a variety of settings, its use in Japan is not well known. We introduced the therapy group with an encounter group method representing the TC model at the Kawasaki DARC, and conducted pre- and post-evaluations using the modified Self-Actualization Scale (SEAS2000). Results showed that the scores of the subscale "sobering of self-affirmation" were remarkably high among those who experienced encounter groups for six months. However, the scores of the subscale "release from biased view" declined among the users at the DARC who have experienced encounter group. for a short-term, while .the scores increased among those who have a medium-term and a long-term experience. These results suggest that the encounter group may be effective especially for the medium- and long-term users in the DARC. The development of a more effective TC model is required.

Provision of group psychoeducation for relatives of persons in inpatient depression treatment--a cross-sectional survey of acute care hospitals in Germany.

BACKGROUND: Depressive disorders are often recurrent and place a high burden on patients and their relatives. Psychoeducational groups for relatives may reduce relatives' burden, help prevent relapses in patients, and are recommended by the German "National Disease Management Guideline Unipolar Depression". Since there is limited knowledge on the provision of psychoeducational groups for relatives of persons in inpatient depression treatment, we conducted a survey among acute care hospitals in Germany. METHODS: We conducted a two-step cross-sectional survey. Step I consisted of a questionnaire asking the heads of all psychiatric/psychosomatic acute care hospitals in Germany (N = 512) whether psychoeducational groups for relatives were provided within depression treatment, and if not, the reasons for not implementing them. In group offering hospitals the person responsible for conducting psychoeducational groups received a detailed questionnaire on intervention characteristics (step II). We performed descriptive data analysis. RESULTS: The response rate was 50.2% (N = 257) in step I and 58.4% in step II (N = 45). 35.4% of the responding hospitals offered psychoeducational groups for relatives of patients with depressive disorders. According to the estimates of the respondents, relatives of about one in five patients took part in psychoeducational groups in 2011. Groups were mostly provided by two moderators (62.2%) as continuous groups (77.8%), without patients' participation (77.8%), with up to ten participants (65.9%), consisting of four or fewer sessions (51.5%) which lasted between one and one and a half hours each (77.8%). The moderators in charge were mostly psychologists (43.9%) or physicians (26.8%). Approximately one third used published manuals. Reasons for not conducting such psychoeducational groups were lack of manpower (60.1%), time (44.9%) and financial constraints (24.1%). 25.3% mentioned adequate concepts of intervention as a required condition for initiating such groups. CONCLUSIONS: Only a small proportion of relatives of patients with depressive disorders participated in psychoeducational groups in 2011 in Germany. Mostly short interventions were favoured and main implementation barriers were scarce resources. Brief interventions that fit with healthcare routine should be developed and tested within randomised controlled trials. This could promote the provision of psychoeducational groups for relatives as evidence-based practice in inpatient depression treatment in Germany.

Longitudinal relationships between subjective fatigue, cognitive function, and everyday functioning in old age.

BACKGROUND: The present study examined the prospective relationships between subjective fatigue, cognitive function, and everyday functioning. METHODS: A cohort study with secondary data analysis was conducted using data from 2,781 community-dwelling older adults without dementia who were enrolled to participate in the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) randomized intervention trial. Measures included demographic and health information at baseline, and annual assessments of subjective fatigue, cognitive function (i.e. speed of processing, memory, and reasoning), and everyday functioning (i.e. everyday speed and everyday problem-solving) over five years. RESULTS: Four distinct classes of subjective fatigue were identified using growth mixture modeling: one group complaining fatigue "some of the time" at baseline but "most of the time" at five-year follow-up (increased fatigue), one complaining fatigue "a good bit of the time" constantly over time (persistent fatigue), one complaining fatigue "most of the time" at baseline but "some of the time" at five-year follow-up (decreased fatigue), and the fourth complaining fatigue "some of the time" constantly over time (persistent energy). All domains of cognitive function and everyday functioning declined significantly over five years; and the decline rates, but not the baseline levels, differed by the latent class of subjective fatigue. Except for the decreased fatigue class, there were different degrees of significant associations between the decline rates of subjective fatigue and all domains of cognitive function and everyday functioning in other classes of subjective fatigue. CONCLUSION: Future interventions should address subjective fatigue when managing cognitive and functional abilities in community-dwelling older adults.

"Balint group" meetings for oncology residents as a tool to improve therapeutic communication skills and reduce burnout level.

Medical training, particularly residency, may pose many challenges and may lead to burnout. Oncology training may be more stressful, given the prolonged exposure to death and dying. Balint group is an intervention method common in medical training, aimed at improving communication skills and strengthening doctor-patient relationships. We arranged for our oncology residents, guided by a senior oncologist and a clinical psychologist, to meet monthly for a discussion of personal cases from the residents' experiences. At the beginning of the year, higher measures in two burnout parameters were found in junior residents compared to senior residents. At the end of the year, the gap in Maslach Burnout Inventory scores between junior and senior residents had decreased, while burnout level decreased slightly during the year in junior residents. It was felt that participation in a Balint group could improve communication abilities of residents and contribute to their feelings of self-accomplishment as doctors.

Addressing patient health care demands in systemic sclerosis: pre-post assessment of a psycho-educational group programme.

OBJECTIVES: Patients diagnosed with systemic sclerosis (SSc) report a high need for education and support. To address these needs, a short, group-based psycho-educational programme for patients with SSc was developed and evaluated. METHODS: A pre-post test design was utilised. Participants completed questionnaires on physical and psychological functioning. Furthermore, patients were asked to evaluate the content of the programme by questionnaire. RESULTS: Data from 41 patients were available for analysis. Patients reported less helplessness after the intervention, and higher acceptance of their limitations. However, no difference in depressed mood and physical functioning was observed. Patients reported high satisfaction with the content of the programme. CONCLUSIONS: Despite the limited changes in psychological and physical functioning, this psycho-educational programme addresses patients' needs reported in previous study and therefore contributes to the improvement of care for patients with SSc.

Recommending encounters according to the sociodemographic characteristics of patient strata can reduce risks from type 2 diabetes.

OBJECTIVES: Physician encounters with patients with type 2 diabetes act as motivation for self-management and lifestyle adjustments that are indispensable for diabetes treatment. We elucidate the sociodemographic sources of variation in encounter usage and the impact of encounter usage on glucose control, which can be used to recommend encounter usage for different sociodemographic strata of patients to reduce risks from Type 2 diabetes. DATA AND METHODS: We analyzed data from a multi-facility clinic in the Midwestern United States on 2124 patients with type 2 diabetes, from 95 ZIP codes. A zero-inflated Poisson model was used to estimate the effects of various ZIP-code level sociodemographic variables on the encounter usage. A multinomial logistic regression model was built to estimate the effects of physical and telephonic encounters on patients' glucose level transitions. Results from the two models were combined in marginal effect analyses. RESULTS AND CONCLUSIONS: Conditional on patients' clinical status, demographics, and insurance status, significant inequality in patient encounters exists across ZIP codes with varying sociodemographic characteristics. One additional physical encounter in a six-month period marginally increases the probability of transition from a diabetic state to a pre-diabetic state by 4.3% and from pre-diabetic to the non-diabetic state by 3.2%. Combined marginal effect analyses illustrate that a ZIP code in the lower quartile of high school graduate percentage among all ZIP codes has 1 fewer physical encounter per six months marginally compared to a ZIP code at the upper quartile, which gives 5.4% average increase in the probability of transitioning from pre-diabetic to diabetic. Our results suggest that policymakers can target particular patient groups who may have inadequate encounters to engage in diabetes care, based on their immediate environmental sociodemographic characteristics, and design programs to increase their encounters to achieve better care outcomes.

Sensitivity to violence measured by ratings of severity increases after nonviolence training.

It was hypothesized that training in nonviolence would increase participants' sensitivity to violence because such training emphasizes both the harm and the avoidability of many kinds of violence. This research built upon earlier studies, which had proposed that ratings of the severity of violent behaviors (e.g., murder, bullying, cursing) can be interpreted as measuring sensitivity to violence. Two quasi-experiments examined changes in ratings of severity obtained before and after nonviolence training. In Study 1, 28 college-age traffic offenders who received nonviolence training judged stimulus behaviors ranging from life-threatening physical harm to verbal disrespect as more violent after their training. An untrained comparison group did not show this change. In Study 2, 30 student teachers who received instruction in nonviolence also rated behaviors as more violent after training; an untrained comparison group did not. Results are interpreted as showing increased sensitivity to violence following exposure to nonviolence.

The impact and utility of encounter patient decision aids: Systematic review, meta-analysis and narrative synthesis.

OBJECTIVE: To determine the effect of encounter patient decision aids (PDAs) as evaluated in randomized controlled trials (RCTs) and conduct a narrative synthesis of non-randomized studies assessing feasibility, utility and their integration into clinical workflows. METHODS: Databases were systematically searched for RCTs of encounter PDAs to enable the conduct of a meta-analysis. We used a framework analysis approach to conduct a narrative synthesis of non-randomized studies. RESULTS: We included 23 RCTs and 30 non-randomized studies. Encounter PDAs significantly increased knowledge (SMD = 0.42; 95% CI 0.30, 0.55), lowered decisional conflict (SMD= -0.33; 95% CI -0.56, -0.09), increased observational-based assessment of shared decision making (SMD = 0.94; 95% CI 0.40, 1.48) and satisfaction with the decision-making process (OR = 1.78; 95% CI 1.19, 2.66) without increasing visit durations (SMD= -0.06; 95% CI -0.29, 0.16). The narrative synthesis showed that encounter tools have high utility for patients and clinicians, yet important barriers to implementation exist (i.e. time constraints) at the clinical and organizational level. CONCLUSION: Encounter PDAs have a positive impact on patient-clinician collaboration, despite facing implementation barriers. PRACTICAL IMPLICATIONS: The potential utility of encounter PDAs requires addressing the systemic and structural barriers that prevent adoption in clinical practice.

[Effect observation of cleaning up the external auditory canal by otoendoscope combined with Clotrimazole Ointment in the treatment of pregnancy with otitis externa mycotica].

Objective:To investigate the clinical effect of cleaning up the external auditory canal under otoendoscope combined with Clotrimazole Ointment in the treatment of pregnancy with otitis externa mycotica.Method:From May 2015 to May 2017,16 cases of pregnant patients(19 ears)with otitis externa mycotica were divided into two groups:pure cleaning up group and cleaning up combined with medication group.In the pure cleaning up group,external auditory canal were only cleaned up under otoendoscope conventionally in 9 patients(11 ears),while in the cleaning up combined with medication group,Clotrimazole Ointment was topically applied after cleaning up the external auditory canal under otoendoscope in 7 patients(8 ears).After treatment of 2 weeks,the clinical curative effect,adverse reaction and average time interval to take effect were compared at the end of treatment.Result:The total effective rate(100%)in cleaning up combined with medication group's was significantly better than that in pure cleaning up group's(81.81%)(P<0.05);The average time interval to take effect in cleaning up combined with medication groupwas significantly shorter than that in pure cleaning up group's[(2.71±0.70)d vs(5.40±1.96)d,P<0.05].After the two-week treatment,there was a four-week follow-up.Only one patient in pure cleaning up group relapsed.After two-week treatment by Clotrimazole Ointment,this patient was cured.Conclusion:Cleaning up the external auditory canal under otoendoscope combined with Clotrimazole Ointment is effective and safe for the treatment of otitis externa mycotica in pregnant women.The addition of topical application of Clotrimazole Ointment further improve the therapeutic efficacy,as compared to the conventional method of cleaning up the external auditory canal under otoendoscope.We suggest clinical application of this method.

Hepatitis B virus contact disclosure and testing in Lusaka, Zambia: a mixed-methods study.

OBJECTIVES: The aim of this study was to estimate the frequency of disclosure to and testing of contacts of patients with hepatitis B virus (HBV) in Zambia. DESIGN: We used a convergent parallel mixed-method research design including a quantitative survey and focus group discussions with patients with HBV. SETTING: A university hospital in Lusaka, Zambia. PARTICIPANTS: 79 hepatitis B surface antigen (HBsAg)-positive, HIV-negative, adults (18+ years) receiving HBV care completed a quantitative survey and 32 also participated in a focus group discussion. OUTCOMES AND ANALYSIS: Contacts of patients with HBV were enumerated and patient-reported disclosure, contact testing and contact HBV test results were used to develop a testing cascade. Using multivariable logistic regression, we identified factors associated with disclosure of HBV status. In focus groups, we explored how index patient knowledge and awareness of their condition shaped perspectives on contact disclosure and testing. Focus groups coding and analysis followed a thematic analysis approach. RESULTS: Among 79 patients with HBV (median age 35 years; 26.6% women), the majority reported disclosure to ≥1 contact. According to the index patients' knowledge, of 776 contacts enumerated, 326 (42.1%) were disclosed to, 77 (9.9%) were tested, 67 (8.6%) received results and 8 (11.9%) were HBsAg-positive. Increased stigma score was associated with reduced disclosure. In focus groups, HBV awareness, knowledge and stigma emerged as barriers to disclosure and referral of contacts for testing. Association of HBV with HIV-related stigma was also reported as a strong barrier to contact disclosure and testing and to taking antivirals for HBV monoinfection. CONCLUSIONS: HBV contact disclosure and testing were feasible and yielded new diagnoses in Zambia. A better understanding of barriers to seeking HBV testing and treatment is needed to scale-up this important intervention in Africa. TRIALS REGISTRATION NUMBER: NCT03158818.

Anxiety Sensitivity Amelioration Training (ASAT): a longitudinal primary prevention program targeting cognitive vulnerability.

Fear of arousal symptoms, often referred to as anxiety sensitivity (AS) appears to be associated with risk for anxiety pathology and other Axis I conditions. Findings from a longitudinal prevention program targeting AS are reported. Participants (n=404) scoring high on the Anxiety Sensitivity Index (ASI) were randomly assigned to receive a brief intervention designed to reduce AS (Anxiety Sensitivity Amelioration Training (ASAT)) or a control condition. Participants were followed for up to 24 months. Findings indicate that ASAT produced greater reductions in ASI levels compared with the control condition. Moreover, reductions were specific to anxiety sensitivity relative to related cognitive risk factors for anxiety. ASAT also produced decreased subjective fear responding to a 20% CO(2) challenge delivered postintervention. Data from the follow-up period show a lower incidence of Axis I diagnoses in the treated condition though the overall group difference was not statistically different at all follow-up intervals. Overall, findings are promising for the preventative efficacy of a brief, computer-based intervention designed to decrease anxiety sensitivity.

"Rare place where I feel normal": Perceptions of a social support conference among parents of and people with Moebius syndrome.

BACKGROUND: Moebius syndrome is a rare congenital disorder resulting in impaired facial and eye movement. People with rare diseases like Moebius syndrome experience stigma and a lack of specialized information. Support conferences may provide important forms of social support for people with rare disorders. AIMS: To examine reasons for attending, benefits, and limitations of support conferences. METHODS AND PROCEDURES: 50 adults with Moebius syndrome and 57 parents of people with Moebius syndrome completed open-ended items in an online study. OUTCOMES AND RESULTS: Mixed- methods content analysis revealed that companionship and informational support were most frequently mentioned as reasons for and benefits of attending. Finances were the most frequently mentioned reason for not attending. Parents were more likely than people with Moebius to describe instrumental support as a conference benefit. When describing conference limitations, parents were significantly more concerned by lack of information relevance, while people with Moebius noted more often that conference attributes were not relevant to their age. CONCLUSIONS AND IMPLICATIONS: Being surrounded by others who share one's condition offers a unique opportunity for destigmatizing companionship support, which normalizes, reduces isolation, and promotes solidarity. Ways to increase facilitators and decrease barriers to accessing support for rare disorders should be investigated.

Oficina de linguagem na atenção psicossocial: vez e voz do sujeito / Language workshop in the psychosocial care: the subject's turn and voice / Taller de lenguaje en la atención psicosocial: vez y voz del sujeto

Introdução: A oficina de linguagem, tecnologia, por excelência, de trabalho com a saúde mental, é constituída por três pilares: protagonismo, potência criadora e a própria linguagem, como espaço de empoderamento. Objetivo Verificar a percepção dos participantes sobre os efeitos da oficina de linguagem, objeto deste estudo. Método: Foi feito um estudo transversal, descritivo, por meio da introdução de uma temática específica nas rodas de conversa da oficina em questão durante o período do recorte. As sessões foram filmadas por doze semanas, e as rodas de conversa foram transcritas. Utilizou-se a análise de conteúdo do tipo temática para análise e interpretação dos dados obtidos dos discursos dos seus participantes que exibiam a diversidade postulada em termos de idade, gênero, condição social e saúde. Resultados: Três categorias temáticas foram identificadas e selecionadas por sua relevância: enlaçamento social, protagonismo subjetivo e circulação discursiva. Conclusões: Os resultados apontam narrativas de empoderamento que as vivências da oficina proporcionam, com clara expressão de reconhecimento da assunção ao lugar de falante por todos, posicionamento fundamental para a possibilidade de alcançar vez e voz nas suas relações sociais.

Introduction: The workshop of language, a technology par excellence, when working with mental health, consists of three pillars: protagonism, creative power and language itself as a space of empowerment. Objective: The aim of this study was to verify the perception of participants about the effects of the language workshop, object of this study. Methods: This research used the methodology of transverse, descriptive design. A specific theme was introduced in the Conversation Wheels of the workshop over a period of 12 weeks. Those sessions were filmed and the conversation wheels transcribed. "Thematic content analysis" was used to analyze and interpret the data obtained from the discourses of its participants. These participants exhibited the diversity postulated in terms of age, gender, social condition, health. Results: Three thematic categories were identified and selected for their relevance: social binding, subjective protagonism and discursive circulation. Conclusions: The results highlight narratives of empowerment that the experiences of the workshop propose, with clear expression of recognition of the occupation of the place of speaker by all, an essential prerequisite for the possibility of reaching time and voice in their social interrelations.

Introducción: El taller de lenguaje se considera la tecnología por excelencia para trabajar con la salud mental y se apoya en tres pilares básicos: el protagonismo; la capacidad creativa y el propio lenguaje en sí mismo como espacio de empoderamiento. Objetivo: Comprobar como perciben los participantes los efectos del taller de lenguaje Método: Se hizo un estudio transversal y descriptivo por medio de la introducción de una temática específica en las ruedas de conversación del taller durante su realización. Las conversaciones se fueron filmando durante las doce semanas de trabajo y se transcribieron. Se utilizó el análisis temático de contenidos para analizar e interpretar los datos obtenidos de los discursos de sus participantes que mostraron la diversidad propuesta respecto a edad, género, condición social y salud. Resultados: Se identificaron tres categorías temáticas y se seleccionaron por su importancia: las relaciones sociales, el protagonismo subjetivo y la circulación discursiva. Conclusiones: Los resultados muestran que las experiencias del taller proporcionan empoderamiento, al ir ocupando todos los participantes el puesto de hablante, siendo esto fundamental para poder tener voz y espacio en sus relaciones sociales.

Three therapeutic communities. A prospective controlled study of narcotic addiction treatment: process and two-year follow-up results.

The efficacy of three different residential therapeutic communities for male veterans addicted to heroin was studied, comparing 181 subjects who were randomly assigned to one of the communities with 166 subjects briefly hospitalized only for the treatment of withdrawal symptoms. At two-year follow-up, subjects from both a professionally staffed community and a peer confrontation community were found significantly more likely than the withdrawal-only group to be working or attending school and less likely to have been convicted of a crime. An eclectic program employing both professionals and paraprofessionals was not found to exceed the withdrawal-only group on any of the major outcome variables. The two relatively successful communities, although different in structure and style, were both perceived by their residents to have greater program clarity, order, staff control, and orientation to personal problems than the unsuccessful program.

The impact of a weekend group experience on individual therapy.

Thirty-three patients in long-term individual therapy were referred to one of three weekend groups: two experimental (affect-arousing, gestalt therapy) groups and one control (meditation-Tai Chi) group. The impact of the weekend group experience (WGE) on individual therapy was examined six and 12 weeks later. At six weeks the patients in the experimental groups showed, on some measures, a significantly greater improvement in their individual therapy than did controls. By 12 weeks, there were no demonstrable differences. The WGE was not without risk: even though the group leaders were highly trained, responsible clinicians, two patients suffered considerable psychological damage. The control (meditation-Tai Chi) group offered a relatively innocuous experience; there was no risk, but few members found the specific procedures useful in their lives. Intense affect arousal in the WGE was not related to positive change in subsequent individual therapy. Those expressing the greatest affect in either experimental group were no more likely to have had a measurable positive impact on their subsequent individual therapy than patients expressing little or no measurable affect.