Preventing Peer Violence Against Children: Methods and Baseline Data of a Cluster Randomized Controlled Trial in Pakistan.

BACKGROUND: Violence against and among children is a global public health problem that annually affects 50% of youth worldwide with major impacts on child development, education, and health including increased probability of major causes of morbidity and mortality in adulthood. It is also associated with the experience of and perpetration of later violence against women. The aim of this article is to describe the intervention, study design, methods, and baseline findings of a cluster randomized controlled trial underway in Pakistan to evaluate a school-based play intervention aiming to reduce peer violence and enhance mental health. METHODS: A cluster randomized controlled design is being conducted with boys and girls in grade 6 in 40 schools in Hyderabad, Pakistan, over a period of 2 years. The Multidimensional Peer-Victimization and Peer Perpetration Scales and the Children's Depression Inventory 2 (CDI 2) are being used to measure the primary outcomes while investigator-derived scales are being used to assess domestic violence within the family. Specifics of the intervention, field logistics, ethical, and fidelity management issues employed to test the program's impact on school age youth in a volatile and politically unstable country form this report. BASELINE RESULTS: A total of 1,752 school-age youth were enrolled and interviewed at baseline. Over the preceding 4 weeks, 94% of the boys and 85% of the girls reported 1 or more occurrences of victimization, and 85% of the boys and 66% of the girls reported 1 or more acts of perpetration. Boys reported more depression compared with girls, as well as higher negative mood and self-esteem scores and more interpersonal and emotional problems. INTERPRETATION: Globally, prevalence of youth violence perpetration and victimization is high and associated with poor physical and emotional health. Applying a randomized controlled design to evaluate a peer violence prevention program built on a firm infrastructure and that is ready for scale-up and sustainability will make an important contribution to identifying evidence-informed interventions that can reduce youth victimization and perpetration.

Expressive writing in early breast cancer survivors.

AIMS: This article is the report of a study aimed at determining whether or not expressive writing improves the quality-of-life of early breast cancer survivors. An additional aim is the investigation of whether or not the type of writing prompt makes a difference in results. BACKGROUND: The risk of distress can extend well beyond the time of a breast cancer diagnosis. Emotional expression may assist in dealing with this. DESIGN: Randomized controlled study. METHODS: Participants (n = 120) were randomized into one of four groups: a control group (no writing) or one of three expressive writing groups: breast cancer trauma, any self-selected trauma and facts related to breast cancer. Participants wrote 20 minutes a day for 4 consecutive days. Their quality-of-life was measured, using the 'Functional Assessment of Cancer Therapy-Breast Cancer Version', at baseline and at 1 month and 6 months after writing. Paired t-tests, multivariate analysis of variance and multiple regression were used to analyse the data of the 97 participants who completed the journaling assignment and at least the first assessment, collected in 2006. Intention-to-treat analysis was used. RESULTS/FINDINGS: Expressive writing about one's breast cancer, breast cancer trauma and facts related to breast cancer, significantly improved the quality-of-life outcome. CONCLUSION: Expressive writing, focusing the instructions on writing about one's living and dealing with a diagnosis of breast cancer, is recommended for early breast cancer survivors as a feasible and easily implemented treatment approach to improve quality-of-life.

Clinical and ethical considerations in pharmacogenetic testing: views of physicians in 3 "early adopting" departments of psychiatry.

OBJECTIVE: Pharmacogenetic testing for polymorphisms affecting drug response and metabolism is now clinically available, and its use in psychiatry is expected to become more widespread. Currently, few clinical and ethical standards exist for the use of these new tests. As a step toward building consensus about testing, we assessed the attitudes and practices of psychiatrists at 3 academic departments of psychiatry where pharmacogenetic testing is clinically available. We hypothesized that testing would be used primarily in treatment-resistant illness and that clinicians would believe such tests carried little risk. METHOD: Residents and faculty at 3 departments of psychiatry considered to be "early adopters" of pharmacogenetic testing were invited during the academic year 2006-2007 to complete an Internet-based survey, including questions regarding clinical practices and opinions about testing utility, risks, and necessary safeguards. RESULTS: The 75 respondents had ordered pharmacogenetic testing a mean of 20.86 times in the previous 12 months. Testing was judged most useful in cases of treatment-resistant depression and medication intolerance. There was a lack of consensus about the risks of testing, particularly the risk of secondary information about disease susceptibility. Respondents endorsed the use of several safeguards, including confidentiality, pretest and posttest counseling, and informed consent, but consensus about other safeguards was lacking. Women and those who had not ordered testing in the prior year were more concerned about risks and need for safeguards than were men and those who had recently ordered testing. CONCLUSIONS: Physicians at early adopting departments of psychiatry endorsed the clinical utility of pharmacogenetic testing and the use of some patient safeguards, but showed a lack of consensus about other safeguards and risks.

Effect of patient adherence to antiretroviral therapy on the progression of cervical dysplasia among HIV-infected women.

A case-control study was conducted that involved a retrospective chart review of 181 HIV-infected women in whom cervical dysplasia had been diagnosed to examine the association between patient adherence to highly active antiretroviral therapy and the regression or stabilization of cervical dysplasia. Patient adherence to the medical regimen was evaluated using prescription refill data. Analyses of 154 case patients and 27 control patients showed that adherence to antiretroviral therapy was associated with changes in cervical dysplasia. Patients who were more adherent to treatment showed the greatest regression and the least progression of dysplasia, while those who were least adherent to treatment showed the greatest amount of progression and the least regression.

Houses built on sand: effects of exemplar stability on susceptibility to attitude change.

Attitude representation theory (C. G. Lord & M. R. Lepper, 1999) explains both attitude-behavior consistency and attitude change with the same principles. When individuals respond evaluatively to an attitude object, they activate and combine assumptions about the attitude object with perceptions of the immediate situation. The assumptions activated can vary across time, even without additional information. Previous research has shown that individuals activate exemplars when answering attitude questions, attitude reports vary with the valence of the assumptions activated, and activating differently liked exemplars reduces attitude-behavior consistency. The present research completed study of the theoretical implications of exemplar stability by showing that individuals with temporally unstable exemplars, whether spontaneous (Experiment 1) or manipulated (Experiments 2 and 3), are more susceptible to subsequent attitude change than are individuals with stable exemplars.

Effects of attitude action identification on congruence between attitudes and behavioral intentions toward social groups.

Attitude Representation Theory (ART) holds that attitude-relevant responses are informed by mental representations of the attitude object, which include the individual's actions toward that object. Action Identification Theory (AIT) holds that the same action can be identified at multiple levels. Individuals who identify their actions at lower levels have less flexibility in how they perform the action, and thus enact the action less consistently. An integration of ART and AIT suggested that individuals who spontaneously (Experiment 1) or through manipulation (Experiments 2 and 3) identify their attitude-relevant actions toward a social group at lower levels might display less attitude-intention congruence than would individuals who identify their attitude-relevant actions at higher levels. ART and AIT are discussed as having links with each other and with other theories of attitude and judgment processes.