The accuracy of patient-reported measures for GI symptoms: a comparison of real time and retrospective reports.

BACKGROUND: Obtaining accurate information about gastrointestinal (GI) symptoms is critical to achieving the goals of clinical research and practice. The accuracy of patient data is especially important for functional GI disorders (e.g., IBS) whose symptoms lack a biomarker and index illness severity and treatment response. Retrospective patient-reported data are vulnerable to forgetting and various cognitive biases whose impact has not been systematically studied in patients with GI disorders. The aim of this study was to document the accuracy of patient-reported GI symptoms over a reporting period (1 week) most representative of the time frame used in research and clinical care. METHODS: Subjects were 273 Rome III-diagnosed IBS patients (mean age = 39 years, 89% F) who completed end of day GI symptom ratings for 7 days using an electronic diary. On Day 8, Subjects recalled the frequency and/or intensity of IBS symptoms over the past 7 days. Reports were then compared against a validation criterion based on aggregated end of day ratings. KEY RESULTS: At the group level, subjects recalled most accurately abdominal pain and urgency intensity at their worst, urgency days, and stool frequency. When data were analyzed at the individual level, a subgroup of subjects had difficulty recalling accurately symptoms that showed convergence between recall and real time reports at the group level. CONCLUSIONS & INFERENCES: Although many patients' recollection for specific GI symptoms (e.g., worst pain, stool frequency) is reasonably accurate, a non-trivial number of other symptoms (e.g., typical pain) are vulnerable to distortion from recall biases that can reduce sensitivity of detecting treatment effects in clinical and research settings.

Examination of the short-term efficacy of a parent intervention to reduce college student drinking tendencies.

The research evaluated the efficacy of an intervention to reduce the onset and extent of binge drinking during the 1st year of college. The approach was on influencing the students before they start college, through their parents, during the critical time between high school graduation and the beginning of college. Specifically, parents were educated about binge drinking and how to convey information to their teens, and then encouraged to talk with their teens just before their teens embarked on their college education. Teens whose parents implemented the intervention materials were compared with a control sample during their 1st semester on drinking outcomes, perceptions about drinking activities, perceived parental and peer approval of drinking, and drinking-related consequences. As anticipated, teens in the treatment condition were significantly different (p < .05) on nearly all outcomes in the predicted directions (e.g., lower drinking tendencies, drinking consequences). The benefits of a parent-based intervention to prevent college drinking are discussed.

Adolescent perceptions of maternal approval of birth control and sexual risk behavior.

OBJECTIVES: This study examined the relationship between adolescent perceptions of maternal approval of the use of birth control and sexual outcomes across a 12-month period. METHODS: A subsample of the Longitudinal Study of Adolescent Health database was used in the context of a prospective design. Approximately 10,000 students in grades 7 to 11 were interviewed twice, 1 year apart. RESULTS: Adolescent perceptions of maternal approval of birth control were associated with an increased likelihood of sexual intercourse over the next 12 months for virgins at wave 1. The perceptions also were related to an increase in birth control use but showed an ambiguous relation to the probability of pregnancy. High relationship satisfaction between adolescents and mothers was associated with a higher probability of birth control use and a lower probability of both sexual intercourse and pregnancy. CONCLUSIONS: The results suggest that perceived parental approval of birth control may increase the probability of sexual activity in some adolescents. "Safer sex" messages must be conveyed by parents with thought and care.

Adolescents' perceptions of maternal disapproval of sex: relationship to sexual outcomes.

PURPOSE: To examine the relationship between adolescents' perceptions of maternal abstinence attitudes, adolescent-maternal relationship satisfaction, and the occurrence in the ensuing 12 months of: (a) sexual intercourse, (b) the use of birth control at intercourse, and (c) the occurrence of pregnancy. We also examined the accuracy of adolescents in perceiving the attitudes of their mothers as well as factors that predicted underestimations of these attitudes. Finally, the study evaluated the relative predictive power of adolescent perceptions of maternal abstinence attitudes and the actual maternal abstinence attitudes. METHODS: This was a prospective study using a subsample of the Longitudinal Study of Adolescent Health database, which is a nationally representative school-based sample. The sample for the present study was approximately 10,000 adolescents in grades 7 to 11 who completed 2 interviews in their homes at a 1-year interval. Mothers of the adolescents were interviewed only during Wave 1. Interviews covered a variety of topics, including adolescent risk behaviors and family relationships. Measures at Wave 1 were used to predict outcomes at Wave 2, employing logistic and multiple regression techniques. RESULTS: Adolescents' perceptions of maternal attitudes toward the adolescents' engaging in sexual intercourse, and adolescent satisfaction with the maternal relationship were predictive of the occurrence of sexual intercourse between Wave 1 and Wave 2, as well as the occurrence of pregnancy. The more disapproving adolescents perceived their mothers to be toward their engaging in sexual intercourse and the more satisfied adolescents were with their relationship with their mothers, the less likely adolescents were to initiate sexual activity or to become pregnant. Only relationship satisfaction was predictive of the use of birth control, such that more satisfied adolescents were more likely to use birth control at their most recent intercourse. The correlation between adolescent perceptions of maternal abstinence attitudes and actual maternal attitudes was .26. Adolescent perceptions of maternal attitudes tended to be a more consistent predictor of outcomes than actual maternal attitudes. CONCLUSIONS: The results are consistent with a growing body of literature that suggests the importance of adolescents' perceptions of maternal attitudes in determining sexual risk behaviors. Adolescents may misperceive the attitudes of parents, suggesting the need for communication between parent and teen.

PIP: This prospective study examined the relationship between adolescents' perceptions of maternal abstinence attitude, adolescent-maternal relationship satisfaction, and the occurrence in the ensuing 12 months of sexual intercourse, the use of birth control during intercourse, and the occurrence of pregnancy. It further examined the accuracy of adolescents in perceiving the attitudes of their mothers as well as factors that predicted underestimations of these attitudes. The study also evaluated the relative predictive power of adolescent perceptions of maternal abstinence attitude and the actual maternal abstinence attitude. Included in the study were approximately 10,000 adolescents in grades 7-11 who completed 2 interviews in their homes at a 1-year interval. The analysis showed that perceived maternal opposition to sex and relationship satisfaction, as well as the occurrence of pregnancy was predictive of sexual intercourse. The more adolescents perceived disapproval from their mothers and the more satisfied they were in their maternal-adolescent relationship, the less likely adolescents were to initiate sexual activity or to become pregnant. In addition, only relationship satisfaction was noted to be predictive of the use of birth control. Overall, the results highlight the importance of adolescents' perceptions of maternal attitudes in determining sexual risk behaviors. Since adolescents may misperceive the attitudes of parents, communication between parent and teen should be enforced.

Parent-based intervention strategies to reduce adolescent alcohol-impaired driving.

OBJECTIVE: To review selected issues to consider when designing parent-based interventions for reducing alcohol-impaired driving in adolescent populations and to present a theoretical framework for analyzing such behavior. METHOD: The existing literature on alcohol-impaired driving and parent influences is considered based on a literature review of contemporary social science journals. Data also are presented from a survey of junior and senior high school students in the Capitol District of New York. CONCLUSIONS: Parent-based approaches are promising and represent an additional tool in the armament of strategies to reduce alcohol-impaired driving. Programs should focus on variables that are amenable to change (cognitions and attitudes), conduct preliminary studies to isolate relevant attitudes and cognitions for the target population of interest, formulate strategies that recognize the numerous demands in a parent's life and take into account existing theoretical frameworks on alcohol-impaired driving in adolescents.

A cognitive analysis of server intervention policies: perceptions of bar owners and servers.

OBJECTIVE: The present study examined the underlying psychological variables relevant to alcohol server intervention policies. The focus of the research was the theoretical examination of college bar owners' and servers' attitudes and beliefs about server intervention policies. METHOD: Owners (n = 185) and servers (n = 185) of college bars were asked about their attitudes and perceived cognitive outcomes regarding server intervention policies. RESULTS: Although the findings revealed no statistical differences between owners and servers on their attitudes toward the different server intervention policies, statistical differences were found between the different policies (p < .05). Favorable policies focused on providing services to customers, whereas unfavorable policies focused on limiting the sales of alcohol. Finally, structural equation modeling revealed perceived cognitive outcomes related to the attitudes toward different server intervention policies. CONCLUSIONS: According to the present study's theoretical orientation, the attitudes are likely to have a direct influence on the adoption of policies or, on the part of the server, compliance with the policies. These attitudes toward the policies were found to be a function of the perceived hassle of implementing the policies and how effective the policy was in preventing driving under the influence.

Parent-adolescent congruency in reports of adolescent sexual behavior and in communications about sexual behavior.

Agreement between mothers' and adolescents' reports of communication about sex, satisfaction with the parent-child relationship, maternal disapproval of adolescent sexual activity, and adolescent sexual behavior was investigated in a sample of 745 African American adolescents (ages 14-17) and their mothers. Congruence between the 2 sets of reports tended to be low. Adolescent perceptions and reports were found to be more predictive of adolescent sexual behavior than maternal reports. Mothers tended to underestimate the sexual activity of their teens and teens tended to underestimate their mother's level of disapproval of their engaging in sexual activity. Reasons for these misperceptions were explored.

Prediction of remission of acute posttraumatic stress disorder in motor vehicle accident victims.

One hundred forty five individuals who sought medical attention as a result of a motor vehicle accident (MVA), and who were initially assessed 1 to 4 months post-MVA, were followed up prospectively for 6 months to determine how many of the 55 with posttraumatic stress disorder (PTSD) and the 43 with sub-syndromal PTSD would remit and what variables would predict remission. Thirty (55%) of those with initial PTSD had remitted at least in part by 6 months while 67% of those with sub-syndromal PTSD had remitted (and 5% had worsened). Four variables, including severity of initial symptoms, degree of initial physical injury, relative degree of physical recovery by 4 months and whether a close family member suffered a trauma during the follow-up interval, combined to classify 6-month clinical status of 84% of those with initial PTSD secondary to MVAs.

Psychological aspects of organ donation: a critical review and synthesis of individual and next-of-kin donation decisions.

This article presents a critical review of psychological perspectives on organ donation. The review considers individual decisions to donate organs posthumously and next-of-kin consent decisions. A theoretical analysis of intention to donate is presented for both types of donation decisions, and the literature is reviewed within the context of the proposed framework. Donation decisions are examined as a function of attitude toward donation and the religious, cultural, altruistic, normative, and knowledge-based beliefs that comprise the attitude. Consent decisions are primarily influenced by prior knowledge of the deceased individual's wishes. An alternative conceptual model is offered to explain the basis of consent decisions in the absence of this knowledge. Suggestions are offered to improve measurement strategy and to guide theoretically based organ donation research within selected disciplines of psychology.

Psychiatric morbidity in medical and surgical patients evacuated from the Persian Gulf War.

Acute treatment records of all medical and surgical patients evacuated to Walter Reed Army Medical Center in Washington, D.C., from the Persian Gulf theater (N = 161) were examined to better understand the relationship of injury to psychiatric symptoms. A total of 110 (68 percent) sustained a traumatic injury. They were significantly more likely to have an axis I disorder or psychiatric symptoms of concern than participants in the Persian Gulf War who did not sustain traumatic injuries but who were evacuated for medical conditions. The results indicate that traumatically injured veterans are at greater risk of psychiatric symptoms than veterans who are not injured and that they should be referred for psychiatric evaluation.

Adolescent contraceptive behavior: the impact of the provider and the structure of clinic-based programs.

OBJECTIVE: To characterize general trends in research on the impact of provider variables on adolescent contraceptive behavior and to identify useful frameworks for designing clinic-based programs aimed at reducing unintended adolescent pregnancy. DATA SOURCES: A computerized search of Psychological Abstracts, Sociological Abstracts, and MEDLINE identified English-language articles from 1990 to 1995 on adolescent contraceptive behavior in the United States. All relevant citations within these articles also were examined. METHODS OF STUDY SELECTION: Studies were selected that focused on any aspect of provider characteristics as they relate to adolescent contraceptive behavior. TABULATION, INTEGRATION, AND RESULTS: Based on a conceptual integration of the articles, three general research issues on provider characteristics were identified; 1) the effectiveness of adolescent-based clinic programs and provider variables that discriminate successful versus unsuccessful programs, 2) the effects of parental notification policies on adolescent clinic use, and 3) whether the presence of clinics promotes sexual activity on the part of adolescents. Issues that must be considered in the structuring of provider-based programs include the strategic focus of the program, the target behaviors, the target population, and the structuring of educational materials. CONCLUSION: The effectiveness of adolescent-based clinic programs is mixed. Parental notification of adolescent use of a clinic can, in some cases, decrease the likelihood of clinic use. There is little convincing evidence that the presence of adolescent clinics promotes sexual activity.

Testing for HIV and other sexually transmitted diseases: implications for risk behavior in women.

A sample of 808 nonpregnant women residing in an area of high prevalence of sexually transmitted diseases (STDs) was studied with respect to sexual risk behaviors in the 4-month period before and after testing for a series of STDs. All women were tested for both Chlamydia trachomatis and Trichomonas vaginalis and were given the option of also taking a test for the HIV antibody. Neither the experience of receiving a negative HIV test result nor that of receiving a positive versus a negative diagnosis for STDs resulted in significant mean changes in self-reports of STD or HIV susceptibility, condom use consistency, or number of sexual partners during the 4 months following testing. However, perceived susceptibility was found to predict when women would decrease the consistency with which they used condoms as a function of HIV testing.

Maternal correlates of adolescent sexual and contraceptive behavior.

Maternal disapproval of premarital sex, maternal discussions about birth control and the quality of the parent-child relationship may have an important influence on adolescents' sexual activity and the consistency of their contraceptive use. Findings from a survey of 751 black youths showed that adolescent perceptions of maternal disapproval of premarital sex and satisfaction with the mother-child relationship were significantly related to abstinence from adolescent sexual activity and to less-frequent sexual intercourse and more consistent use of contraceptives among sexually active youths. Teenagers who reported a low level of satisfaction with their mother were more than twice as likely as those highly satisfied with their relationship to be having sexual intercourse. Discussions about birth control were associated with an increased likelihood that adolescents were sexually active. Such discussions were not significantly related to consistent contraceptive use for female adolescents, but were associated with increased contraceptive use for male teenagers.

The relationship between pregnancy and sexual risk taking.

OBJECTIVES: We attempted to determine whether risks of acquiring sexually transmitted diseases differ between pregnant and nonpregnant women. STUDY DESIGN: Women attending clinics in Brooklyn (332 pregnant and 1069 nonpregnant) were interviewed and tested for Trichomonas vaginalis and Chlamydia trachomatis. Independent-sample t tests were conducted via SPSSX (SPSS Inc., Chicago) to assess differences in risk behavior across pregnancy status. RESULTS: In the pregnant sample 17.2% had positive test results for chlamydia and 23.4% had T vaginalis. In the nonpregnant women the rates were 10.9% and 17.7%, respectively (p<0.01). Pregnant respondents used condoms less consistently than nonpregnant women (p<0.01). Although nonpregnant women reported a higher frequency of sexual activity and more sexual partners in the previous month, the strength of those relationships was weak. CONCLUSION: We have found that pregnancy does not represent a time of reduced sexual risks. The differences in self-reported risk, with the exception of consistency of condom use, all showed very weak indexes of strength. Providers of obstetric services should incorporate "safer sex" messages into routine prenatal care.

The prediction of accurate contraceptive use from attitudes and knowledge.

A framework of the relationship between knowledge, attitudes, and behavior was described in the context of couple's use of birth control. It was hypothesized that when knowledge of behavioral enactment is present, attitudes and beliefs about susceptibility to pregnancy will be predictive of accurate use of the diaphragm. Respondents were 111 women who participated in a three-wave panel design focusing on diaphragm use. Analyses indicated that the level of knowledge about what a woman should do to use the diaphragm correctly was high. Correct knowledge, however, did not translate into accurate behavior. Motivational factors focusing on attitudes, perceived susceptibility to pregnancy, and normative factors were also relevant.

PIP: This study sought to predict and understand the behavioral criterion for accurate contraceptive usage using knowledge and attitudinal variables as major predictors. Building on the research of Fishbein into the prediction of aggregated behaviors over time (multiple act criteria), accurate use of contraception is conceptualized as an aggregation of many acts over time. Fishbein's framework is also extended to include the variables of perceived susceptibility to pregnancy and the influence of the male partner's attitude toward contraception. The subjects of the study were 111 family planning (FP) clients who identified the diaphragm as their major contraceptive during the eight-month test period. The sample was approximately divided between new users, restarters, and continuing users. Two follow-up interviews were used to measure accuracy of use, attitude toward method, attitude toward becoming pregnant, perceived susceptibility to pregnancy, partner attitude, and knowledge. Analyses were performed to detect the presence of selection, retention, and testing biases (nothing of significance was found). It was found that the women had high and persistent knowledge about proper use of a diaphragm. This knowledge did not ensure accurate behavior, however. Women were influenced by motivational factors such as relative contraceptive utility (attitude toward the diaphragm and toward becoming pregnant), perceived pregnancy susceptibility, and perceived partner attitude. This latter affected accuracy through its intermediate effects on relative contraceptive utility. Inaccurate use was most often associated with failure to check for holes and failure to apply additional spermicide if intercourse was repeated. These behavioral failures are less likely to result in contraceptive failure than other factors for which high accuracy was observed (length of time inserted or use of spermicide). These findings suggest that motivational and knowledge factors play a role in ensuring correct contraceptive usage and should receive the attention of FP counselors.

Who develops PTSD from motor vehicle accidents?

Within 1 to 4 months of their motor vehicle accident (MVA), we assessed 158 MVA victims who sought medical attention as a result of the MVA. Using the Clinician-Administered PTSD Scale (CAPS: Blake, Weathers, Nagy, Kaloupek, Klauminzer, Charney & Keane, 1990. National Center for Post-Traumatic Stress Disorder, Boston, MA)., we found that 62 (39%) met DSM-III-R (American Psychiatric Association, 1987. Washington, DC: American Psychiatric Press) criteria for Post-Traumatic Stress Disorder. Using variables from the victim's account of the accident and its sequelae, pre-MVA psychosocial functioning, demographic variables, pre-MVA psychopathology and degree of physical injury, we found that 70% of the subjects could be classified as PTSD or not with 4 variables: prior major depression, fear of dying in the MVA, extent of physical injury and whether litigation had been initiated. Using multiple regression to predict the continuous variable of total CAPS score, as a measure of post-traumatic stress symptoms, we found that 8 variables combined to predict 38.1% of variance (Multiple R = 0.617).

Test-retest reliability of 24-hour ambulatory blood pressures.

The test-retest reliability of 24-hour ambulatory blood pressures (ABP) was examined using correlational analyses as well as idiographic and nomothetic time-series regression analyses. Thirty normotensives (equal males and females) underwent ABP monitoring on three occasions, each of which was separated by a week. When analyzing the data, various postural positions, activities, and locations were controlled for in order to differentially assess the effects of these variables independently. Correlational analyses found the overall test-retest reliability of the ABPs to be quite good (SBP r = .84-.88, DBP r = .83-.86, HR r = .91-.95). Correlations examined within specific postural positions, activities, and locations were also significant. The time-series regression analyses used confirmed the reproducibility of the ABPs, with no greater than 20% of the subjects showing significant changes in ABPs over the three monitoring periods. Gender effects were also examined. In general, males had significantly higher systolic ABPs overall, although there was no influence of gender in terms of the test-retest reliability of the ABPs.

Short-term follow-up of post-traumatic stress symptoms in motor vehicle accident victims.

Ninety-eight victims of recent motor vehicle accidents (MVA), who sought medical attention as a result of the MVA, were followed up prospectively 6 months after the initial assessment, using Keller, Lavori, Friedman, Nielsen, Endicott, McDonald-Scott and Andreasen's (Archives of General Psychiatry, 44, 540-548, 1987) LIFE methodology so that month-by-month changes in post-traumatic stress disorder (PTSD) symptoms could be determined. For the 40 MVA victims who initially met the full criteria for PTSD, 10 no longer met the criteria 4 months after the initial assessment, a decrease significant at the P < 0.01 level, and 20 no longer met the full criteria at 6 months (P < 0.001). On a symptom-by-symptom basis, there were significant declines among the fraction of those who initially met the criteria for PTSD for all avoidance and numbing symptoms by the 6-month follow-up, whereas most of the hyperarousal symptoms did not show significant declines.

Effects of varying scoring rules of the Clinician-Administered PTSD Scale (CAPS) for the diagnosis of post-traumatic stress disorder in motor vehicle accident victims.

We examined the effects of varying the scoring rules for the CAPS (Clinician Administered PTSD Scale) on the diagnosis of PTSD in a sample of 100 victims of recent motor vehicle accidents. This was done by assessing, for each scoring rule, the rate of categorical diagnosis and the effect on group mean scores on measures of subjective distress and role impairment. Changing from the most liberal to the most conservative scoring rule results in a change in diagnosis of PTSD from 44% to 29% of the sample. Comparisons of those included as PTSD under the most conservative scoring criteria vs those excluded (who had previously been included) reveal significantly greater subjective distress and role impairment among those who continue to be included in the PTSD category. Thus, changes in scoring rules have clinically significant effects on the incidence and severity of diagnosed PTSD. This indicates that the selection of scoring rules has important implications for epidemiological estimates of the prevalence of PTSD, and that PTSD studies using different scoring rules as inclusion criteria may be using somewhat different samples.