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1.
Trials ; 20(1): 397, 2019 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-31272487

RESUMO

BACKGROUND: Vaccination is a cost-effective strategy for reducing morbidity and mortality among children under 5 years old. To be fully protected from diseases such as tuberculosis, diphtheria, pertussis, and polio, children must receive all recommended vaccinations in a timely manner. In many countries, including Tanzania, high overall vaccination rates mask substantial regional variation in vaccination coverage and low rates of vaccination timeliness. This study evaluates the efficacy of mobile phone-based (mHealth) reminders and incentives for improving vaccination timeliness in the first year of life. METHODS: The study, conducted in Mtwara Region in Tanzania, includes 400 late-stage pregnant women enrolled from rural and urban health facilities and surrounding communities. The primary outcome is timeliness of vaccinations among their children at 6, 10, and 14 weeks after birth. Timeliness is defined as vaccination receipt within 28 days after the vaccination due date. The quasi-randomized controlled trial includes three arms: (1) standard of care (no reminders or incentives), (2) mobile phone-based reminders, and (3) mobile phone-based reminders and incentives in the form of conditional financial transfers. Assignment into study arms is based on scheduled vaccination dates. Reminder messages are sent to arms 2 and 3 participants via mobile phones 1 week and 1 day prior to each scheduled vaccination. For arm 3 participants, reminder messages offer an incentive that is provided in the form of a mobile phone airtime recharge voucher code for each timely vaccination. Vaccination dates are recorded via participant contact with an mHealth system, phone calls with mothers, and a review of government-issued vaccination cards during an end-line survey. Random effects logistic regression models will be used to estimate the effects of reminders and incentives on the timeliness of vaccinations. DISCUSSION: The results will inform implementation science research on the effectiveness of reminders and incentives as a means of improving vaccination timeliness. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03252288 . Registered on 17 August 2017 (retrospectively registered).


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Esquemas de Imunização , Mães/psicologia , Motivação , Sistemas de Alerta , Telemedicina/métodos , Mensagem de Texto , Reforço por Recompensa , Vacinação , Fatores Etários , Feminino , Humanos , Lactente , Masculino , Tanzânia , Fatores de Tempo
2.
Trials ; 19(1): 646, 2018 Nov 21.
Artigo em Inglês | MEDLINE | ID: mdl-30463608

RESUMO

BACKGROUND: Smoking is the leading preventable cause of death in the United States, but evidence-based smoking cessation therapy is underutilized. Financial incentive strategies represent an innovative approach for increasing the use of counseling and pharmacotherapy. If effective, they could supplement or supplant resource-intensive policy options, particularly in populations for whom smoking has substantial societal costs. FIESTA (Financial IncEntives for Smoking TreAtment) will randomize hospitalized smokers to receive usual smoking cessation care alone or usual smoking care augmented with financial incentives. We aim to compare the impact of these two strategies on 1) smoking abstinence, 2) use of counseling and nicotine replacement therapy, and 3) quality of life of participants. We also will evaluate the short-term and long-term return on the investment of incentives. The FIESTA Oral Microbiome Substudy will compare the oral microbiome of smokers and nonsmokers to longitudinally assess whether smoking cessation changes oral microbiome composition. METHODS: We will enroll 182 inpatient participants from the Manhattan campus of the Veterans Affairs New York Harbor Healthcare System. All participants receive enhanced usual care, including screening for tobacco use, counseling while hospitalized, access to nicotine replacement therapy, and referral to a state Quitline. Patients in the financial incentive arm receive enhanced usual care and up to $550 for participating in the New York Smoker's Quitline, using nicotine replacement therapy (NRT), and achieving biochemically confirmed smoking cessation at 2 months and 6 months. In the microbiome substudy, we enroll nonsmoking control participants matched to each recruited smoker's hospital ward, sex, age, diabetes status, and antibiotic use. After discharge, participants are asked to complete periodic phone interviews at 2 weeks, 2 months, 6 months, and 12 months and provide expired carbon monoxide and saliva samples at 2 months, 6 months, and 12 months for cotinine testing and oral microbiome analysis. DISCUSSION: The incentive interventions of FIESTA may benefit hospitalized smokers, an objective made all the more critical because smoking rates among hospitalized patients are higher than those in the general population. Moreover, the focus of FIESTA on evidence-based therapy and bioconfirmed smoking cessation can help guide policy efforts to reduce smoking-related healthcare costs in populations with high rates of tobacco use and costly illnesses. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02506829 . Registered on 1 July 2014.


Assuntos
Aconselhamento/economia , Microbiota , Motivação , Boca/microbiologia , Abandono do Hábito de Fumar/economia , Abandono do Hábito de Fumar/métodos , Fumar/economia , Dispositivos para o Abandono do Uso de Tabaco/economia , Reforço por Recompensa , Ensaios Clínicos como Assunto , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Qualidade de Vida , Recidiva , Fumar/efeitos adversos , Fumar/psicologia , Abandono do Hábito de Fumar/psicologia , Fatores de Tempo , Resultado do Tratamento , Estados Unidos , United States Department of Veterans Affairs , Veteranos/psicologia
3.
Trials ; 19(1): 540, 2018 Oct 05.
Artigo em Inglês | MEDLINE | ID: mdl-30290851

RESUMO

BACKGROUND: Mobile Technology and Incentives (MOTIVES) is a randomized pilot study of a mobile technology-based and behavioral economics-supported HIV prevention intervention. Behavioral economics (BE) uses financial incentives in a way that departs from the traditional focus on large monetary payments. Instead, BE suggests that relatively small "nudges" can effectively initiate and sustain behavior change. This pilot study examines the feasibility and acceptability of an HIV prevention intervention that uses text messages in combination with BE incentives to improve retention of HIV prevention information and increase frequency of HIV testing among Latino/a men who have sex with men (MSM) and transgender women (TGW). The pilot will also estimate mission-critical design parameters with point and confidence interval estimates of the intervention to inform a future, fully powered effectiveness study. METHODS: The project will be conducted in collaboration with Bienestar Human Services, Inc. (Bienestar), a non-profit community-based service organization. The intervention is being tested in a small, randomized controlled trial to pilot the intervention's feasibility and acceptability among 200 Latino/a MSM and TGW from Bienestar's HIV testing sites. Information on feasibility will include recruitment, refusal, and retention rates as well as message sending success rates; acceptability will include perceived appropriateness based on responses to the intervention. Participants will be randomized into either the "information only" control group (e.g. receiving text messages with HIV prevention information) or the "information plus" intervention group (e.g. additionally receiving quiz questions that provide the possibility of winning prizes). Participants will be followed for 12 months from enrollment. In addition to using data abstracted from Bienestar's routine data collection mechanisms, we will also collect survey data (blinded outcome assessment) from participants at 0, 6, and 12 months to provide an initial assessment of whether incentives affect their level of HIV knowledge and testing frequency. DISCUSSION: If shown to be acceptable, feasible, and resource-efficient, MOTIVES will provide an innovative way to communicate the latest HIV prevention information and support trimestral HIV screening among Latino/a MSM and TGW. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03144336 . Registered on 5 May 2017.


Assuntos
Economia Comportamental , Infecções por HIV/diagnóstico , Infecções por HIV/prevenção & controle , Hispano-Americanos/psicologia , Homossexualidade Masculina/psicologia , Programas de Rastreamento/métodos , Sexo Seguro/psicologia , Mensagem de Texto , Pessoas Transgênero/psicologia , Sexo sem Proteção/prevenção & controle , California/epidemiologia , Estudos de Viabilidade , Feminino , Infecções por HIV/psicologia , Infecções por HIV/transmissão , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Homossexualidade Masculina/etnologia , Humanos , Masculino , Motivação , Projetos Piloto , Ensaios Clínicos Controlados Aleatórios como Assunto , Sexo Seguro/etnologia , Reforço por Recompensa , Sexo sem Proteção/etnologia , Sexo sem Proteção/psicologia
4.
Hear Res ; 367: 106-112, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30096490

RESUMO

Listening to speech in noise can be effortful but when motivated people seem to be more persevering. Previous research showed effects of monetary reward on autonomic responses like cardiovascular reactivity and pupil dilation while participants processed auditory information. The current study examined the effects of monetary reward on the processing of speech in noise and related listening effort as reflected by the pupil dilation response. Twenty-four participants (median age 21 yrs) performed two speech reception threshold (SRT) tasks, one tracking 50% correct (hard) and one tracking 85% correct (easy), both of which they listened to and repeated sentences uttered by a female talker. The sentences were presented with a single male talker or, in a control condition, in quiet. Participants were told that they could earn a high (5 euros) or low (0.20 euro) reward when repeating 70% or more of the sentences correctly. Conditions were presented in a blocked fashion and during each trial, pupil diameter was recorded. At the end of each block, participants rated the effort they had experienced, their performance, and their tendency to quit listening. Additionally, participants performed a working memory capacity task and filled in a need-for-recovery questionnaire as these tap into factors that influence the pupil dilation response. The results showed no effect of reward on speech perception performance as reflected by the SRT. The peak pupil dilation showed a significantly larger response for high than for low reward, for the easy and hard conditions, but not the control condition. Higher need for recovery was associated with a higher subjective tendency to quit listening. Consistent with the Framework for Understanding Effortful Listening, we conclude that listening effort as reflected by the peak pupil dilation is sensitive to the amount of monetary reward.


Assuntos
Atenção , Ruído/efeitos adversos , Mascaramento Perceptivo , Pupila/fisiologia , Reflexo , Percepção da Fala , Reforço por Recompensa , Estimulação Acústica , Adolescente , Adulto , Limiar Auditivo , Compreensão , Feminino , Humanos , Masculino , Memória de Curto Prazo , Pessoa de Meia-Idade , Tempo de Reação , Inteligibilidade da Fala , Teste do Limiar de Recepção da Fala , Fatores de Tempo , Adulto Jovem
5.
Pediatr Blood Cancer ; 65(11): e27387, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30051581

RESUMO

BACKGROUND: Participation in key activities of daily living (ADL), including daily bathing, physical activity, and oral hygiene, can decrease the risk of bloodstream infections, oral complications, and deconditioning in pediatric patients undergoing hematopoietic stem cell transplant (HSCT). However, many patients fail to perform ADL during their inpatient stay. To improve inpatient adherence to ADL, we tested a token economy to engage patients, families, and the clinical team in improving adherence to these important health behaviors during this critical time. METHODS: We used a controlled before-after study design to test our hypothesis. All patients were prescribed three ADL. We used an "all or none" measurement for each component of the ADL 1-2-3 initiative to measure adherence. HSCT patients with poor ADL adherence (<20%) were eligible to receive the intervention, which consisted of rewarding patients through an ADL via a token economy. RESULTS: Twenty-one patients participated in the study. ADL adherence for the 14 days prior to intervention in study subjects (n = 294 inpatient days) averaged 0.51 ADL per day (95% CI 0.45-0.57). In the 14 days postinitiation of the token economy intervention (n = 294 inpatient days), the average adherence was 2.5 ADL per day (95% CI 2.4-2.5; P = <0.001). DISCUSSION: Positive reinforcement through a token economy system is associated with improved adherence to ADL in hospitalized pediatric patients who demonstrated poor ADL adherence at baseline. We believe this intervention can positively impact adherence to targeted health behaviors with the ability to correlate with improved health outcomes.


Assuntos
Atividades Cotidianas , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Cooperação do Paciente , Educação de Pacientes como Assunto/métodos , Complicações Pós-Operatórias/prevenção & controle , Reforço por Recompensa , Criança , Pré-Escolar , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Masculino
6.
J Am Heart Assoc ; 7(12)2018 06 13.
Artigo em Inglês | MEDLINE | ID: mdl-29899015

RESUMO

BACKGROUND: Regular physical activity reduces the risk of cardiovascular events, but most ischemic heart disease (IHD) patients do not obtain enough. METHODS AND RESULTS: ACTIVE REWARD (A Clinical Trial Investigating Effects of a Randomized Evaluation of Wearable Activity Trackers with Financial Rewards) was a 24-week home-based, remotely monitored, randomized trial with a 16-week intervention (8-week ramp-up incentive phase and 8-week maintenance incentive phase) and an 8-week follow-up. Patients used wearable devices to track step counts and establish a baseline. Patients in control received no other interventions. Patients in the incentive arm received personalized step goals and daily feedback for all 24 weeks. In the ramp-up incentive phase, daily step goals increased weekly by 15% from baseline with a maximum of 10 000 steps and then remained fixed. Each week, $14 was allocated to a virtual account; $2 could be lost per day for not achieving step goals. The primary outcome was change in mean daily steps from baseline to the maintenance incentive phase. Ischemic heart disease patients had a mean (SD) age of 60 (11) years and 70% were male. Compared with control, patients in the incentive arm had a significantly greater increase in mean daily steps from baseline during ramp-up (1388 versus 385; adjusted difference, 1061 [95% confidence interval, 386-1736]; P<0.01), maintenance (1501 versus 264; adjusted difference, 1368 [95% confidence interval, 571-2164]; P<0.001), and follow-up (1066 versus 92; adjusted difference, 1154 [95% confidence interval, 282-2027]; P<0.01). CONCLUSIONS: Loss-framed financial incentives with personalized goal setting significantly increased physical activity among ischemic heart disease patients using wearable devices during the 16-week intervention, and effects were sustained during the 8-week follow-up. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02531022.


Assuntos
Actigrafia/instrumentação , Tolerância ao Exercício , Exercício , Monitores de Aptidão Física , Metas , Comportamentos Relacionados com a Saúde , Conhecimentos, Atitudes e Prática em Saúde , Isquemia Miocárdica/terapia , Reforço por Recompensa , Idoso , Aptidão Cardiorrespiratória , Feminino , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/fisiopatologia , Pennsylvania , Fatores de Tempo , Resultado do Tratamento
7.
BMC Psychiatry ; 18(1): 144, 2018 05 24.
Artigo em Inglês | MEDLINE | ID: mdl-29793451

RESUMO

BACKGROUND: Offering financial incentives is an effective intervention for improving adherence in patients taking antipsychotic depot medication. We assessed whether patients' motivation for treatment might be reduced after receiving financial rewards. METHODS: This study was part of Money for Medication, a multicentre, open-label, randomised controlled trial, which demonstrated the positive effects of financial incentives on antipsychotic depot compliance. Three mental healthcare institutions in Dutch secondary psychiatric care services participated. Eligible patients were aged 18-65 years, had been diagnosed with schizophrenia or another psychotic disorder, had been prescribed antipsychotic depot medication or had an indication to start using depot medication, and were participating in outpatient treatment. For 12 months, patients were randomly assigned either to treatment as usual (control group) or to treatment as usual plus a financial reward for each depot of medication received (€30 per month if fully compliant; intervention group). They were followed up for 6 months, during which time no monetary rewards were offered for taking antipsychotic medication. To assess treatment motivation after 0, 12 and 18 months, interviews were conducted using a supplement to the Health of the Nation Outcome Scales (HoNOS) and the Treatment Entry Questionnaire (TEQ). RESULTS: Patients were randomly assigned to the intervention (n = 84) or the control group (n = 85). After 12 months, HoNOS motivation scores were available for 131 patients (78%). Ninety-one percent of the patients had no or mild motivational problems for overall treatment; over time, there were no significant differences between the intervention and control groups. TEQ data was available for a subgroup of patients (n = 61), and showed no significant differences over time between the intervention and control groups for external motivation (ß = 0.37 95% CI: -2.49 - 3.23, p = 0.799); introjected motivation (ß = - 2.39 95% CI: -6.22 - 1.44, p = 0.222); and identified motivation (ß = - 0.91 95% CI: -4.42 - 2.61, p = 0.613). After the 6-month follow-up period, results for the HoNOS and TEQ scores remained comparable. CONCLUSIONS: Offering financial incentives for taking antipsychotic depot medication does not reduce patients' motivation for treatment. TRIAL REGISTRATION: Netherlands Trial registration, number NTR2350 .


Assuntos
Assistência Ambulatorial/métodos , Antipsicóticos , Adesão à Medicação/psicologia , Motivação , Transtornos Psicóticos , Esquizofrenia/tratamento farmacológico , Reforço por Recompensa , Adulto , Antipsicóticos/economia , Antipsicóticos/uso terapêutico , Preparações de Ação Retardada/economia , Preparações de Ação Retardada/uso terapêutico , Feminino , Apoio Financeiro , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos , Transtornos Psicóticos/tratamento farmacológico , Transtornos Psicóticos/psicologia , Inquéritos e Questionários
8.
J Appl Behav Anal ; 51(2): 393-435, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29468686

RESUMO

The present paper provides an integrative review of research on token reinforcement systems, organized in relation to basic behavioral functions and economic variables. This type of functional taxonomy provides a useful way to organize the literature, bringing order to a wide range of findings across species and settings, and revealing gaps in the research and areas especially ripe for analysis and application. Unlike standard translational research, based on a unidirectional model in which the analysis moves from laboratory to the applied realm, work in the area of token systems is best served by a bidirectional interplay between laboratory and applied research, where applied questions inspire research on basic mechanisms. When based on and contributing to an analysis, applied research on token economies can be on the leading edge of theoretical advances, helping set the scientific research agenda.


Assuntos
Terapia Comportamental/métodos , Reforço por Recompensa , Pesquisa Médica Translacional/métodos , Humanos
9.
J Appl Behav Anal ; 51(1): 40-52, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-29193060

RESUMO

The properties of operant reinforcers are dynamic and dependent on a number of variables, such as schedule and effort. There has been sparse research on the generalized conditioned properties of token reinforcement. We evaluated leisure items, edible items, and tokens using a progressive ratio schedule with three children with diagnoses of ASD and developmental delays. The highest break points occurred during the token reinforcement condition for two out of three participants, but response rates tended to be higher with edibles. We then evaluated the effects of presession access to edibles on the break points of edible items and tokens with two participants. Break points decreased only in the edible reinforcement condition, and the participants chose to work for leisure items rather than edibles when presession access to edibles was in place. These findings suggest that the tokens functioned as generalized conditioned reinforcers.


Assuntos
Deficiências do Desenvolvimento/psicologia , Deficiências do Desenvolvimento/reabilitação , Esquema de Reforço , Reforço por Recompensa , Criança , Condicionamento Operante/fisiologia , Feminino , Humanos , Atividades de Lazer/psicologia , Masculino
10.
Healthc Manage Forum ; 30(6): 289-292, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29061074

RESUMO

Smoking has a tremendous negative impact on the Canadian economy and contributes to growing costs in the healthcare system. Efforts to reduce smoking rates may therefore reduce strain on the healthcare system and free up scarce resources. Academic literature on economic smoking cessation incentives presents a countless variety of interventions that have met with varying degrees of success. This study reviews six different variables used in the design of incentives in smoking cessation interventions: direction, form, magnitude, certainty, recipient grouping, and target demographic. The purpose of this study is to provide analysis and recommendations about the contribution of each variable into the overall effectiveness of smoking cessation programs and help health leaders design better interventions according to their specific needs.


Assuntos
Motivação , Abandono do Hábito de Fumar/economia , Abandono do Hábito de Fumar/métodos , Reforço por Recompensa , Canadá , Medicina Baseada em Evidências , Humanos
11.
Trials ; 18(1): 349, 2017 07 24.
Artigo em Inglês | MEDLINE | ID: mdl-28738857

RESUMO

BACKGROUND: Despite large-scale efforts to diagnose people living with HIV, 54% remain undiagnosed in sub-Saharan Africa. The gap in knowledge of HIV status and uptake of follow-on services remains wide with much lower rates of HIV testing among men compared to women. Here, we design a study to investigate the effect on uptake of HIV testing and linkage into care or prevention of partner-delivered HIV self-testing alone or with an additional intervention among male partners of pregnant women. METHODS: A phase II, adaptive, multi-arm, multi-stage cluster randomised trial, randomising antenatal clinic (ANC) days to six different trial arms. Pregnant women accessing ANC in urban Malawi for the first time will be recruited into either the standard of care (SOC) arm (invitation letter to the male partner offering HIV testing) or one of five intervention arms offering oral HIV self-test kits. Three of the five intervention arms will additionally offer the male partner a financial incentive (fixed or lottery amount) conditional on linkage after self-testing with one arm testing phone call reminders. Assuming that 25% of male partners link to care or prevention in the SOC arm, six clinic days, with a harmonic mean of 21 eligible participants, per arm will provide 80% power to detect a 0.15 absolute difference in the primary outcome. Cluster proportions will be analysed by a cluster summaries approach with adjustment for clustering and multiplicity. DISCUSSION: This trial applies adaptive methods which are novel and efficient designs. The methodology and lessons learned here will be important as proof of concept of how to design and conduct similar studies in the future. Although small, this trial will potentially present good evidence on the type of effective interventions for improving linkage into ART or prevention. The trial results will also have important policy implications on how to implement HIVST targeting male partners of pregnant women who are accessing ANC for the first time while paying particular attention to safety concerns. Contamination may occur if women in the intervention arms share their self-test kits with women in the SOC arm. TRIAL REGISTRATION: ISRCTN, ID: 18421340 . Registered on 31 March 2016.


Assuntos
Infecções por HIV/diagnóstico , Programas de Rastreamento/métodos , Aceitação pelo Paciente de Cuidados de Saúde , Cuidado Pré-Natal , Kit de Reagentes para Diagnóstico , Autocuidado/métodos , Parceiros Sexuais , Cônjuges , Protocolos Clínicos , Feminino , Infecções por HIV/economia , Infecções por HIV/prevenção & controle , Infecções por HIV/transmissão , Humanos , Malaui , Masculino , Programas de Rastreamento/economia , Motivação , Valor Preditivo dos Testes , Gravidez , Kit de Reagentes para Diagnóstico/economia , Sistemas de Alerta , Projetos de Pesquisa , Autocuidado/economia , Telefone , Reforço por Recompensa
12.
Trials ; 18(1): 337, 2017 07 20.
Artigo em Inglês | MEDLINE | ID: mdl-28728583

RESUMO

BACKGROUND: The Cessation in Pregnancy Incentives Trial (CPIT), which offered financial incentives for smoking cessation during pregnancy showed a clinically and statistically significant improvement in cessation. However, infant birth weight was not seen to be affected. This study re-examines birth weight using an intuitive and a complier average causal effects (CACE) method to uncover important information missed by intention-to-treat analysis. METHODS: CPIT offered financial incentives up to £400 to pregnant smokers to quit. With incentives, 68 women (23.1%) were confirmed non-smokers at primary outcome, compared to 25 (8.7%) without incentives, a difference of 14.3% (Fisher test, p < 0.0001). For this analysis, randomised groups were split into three theoretical sub-groups: independent quitters - quit without incentives, hardened smokers - could not quit even with incentives and potential quitters - required the addition of financial incentives to quit. Viewed in this way, the overall birth weight gain with incentives is attributable only to potential quitters. We compared an intuitive approach to a CACE analysis. RESULTS: Mean birth weight of potential quitters in the incentives intervention group (who therefore quit) was 3338 g compared with potential quitters in the control group (who did not quit) 3193 g. The difference attributable to incentives, was 3338 - 3193 = 145 g (95% CI -617, +803). The mean difference in birth weight between the intervention and control groups was 21 g, and the difference in the proportion who managed to quit was 14.3%. Since the intervention consisted of the offer of incentives to quit smoking, the intervention was received by all women in the intervention group. However, "compliance" was successfully quitting with incentives, and the CACE analysis yielded an identical result, causal birth weight increase 21 g ÷ 0.143 = 145 g. CONCLUSIONS: Policy makers have great difficulty giving pregnant women money to stop smoking. This study indicates that a small clinically insignificant improvement in average birth weight is likely to hide an important clinically significant increase in infants born to pregnant smokers who want to stop but cannot achieve smoking cessation without the addition of financial voucher incentives. TRIAL REGISTRATION: ISRCTN Registry, ISRCTN87508788 . Registered on 1 September 2011.


Assuntos
Peso ao Nascer , Comportamentos Relacionados com a Saúde , Recém-Nascido de Baixo Peso , Mães/psicologia , Complicações na Gravidez/prevenção & controle , Cuidado Pré-Natal/economia , Fumantes/psicologia , Abandono do Hábito de Fumar/economia , Fumar , Reforço por Recompensa , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Análise de Intenção de Tratamento , Motivação , Gravidez , Complicações na Gravidez/economia , Complicações na Gravidez/etiologia , Cuidado Pré-Natal/métodos , Projetos de Pesquisa , Fatores de Risco , Escócia , Fumar/efeitos adversos , Fumar/economia , Fumar/psicologia , Abandono do Hábito de Fumar/psicologia
13.
J Neurosci ; 37(29): 7023-7035, 2017 07 19.
Artigo em Inglês | MEDLINE | ID: mdl-28630257

RESUMO

The orbitofrontal cortex is critical for goal-directed behavior. Recent work in macaques has suggested the lateral orbitofrontal cortex (lOFC) is relatively more concerned with assignment of credit for rewards to particular choices during value-guided learning, whereas the medial orbitofrontal cortex (often referred to as ventromedial prefrontal cortex in humans; vmPFC/mOFC) is involved in constraining the decision to the relevant options. We examined whether people with damage restricted to subregions of prefrontal cortex showed the patterns of impairment observed in prior investigations of the effects of lesions to homologous regions in macaques. Groups of patients with either lOFC (predominantly right hemisphere), mOFC/vmPFC, or dorsomedial prefrontal (DMF), and a comparison group of healthy age- and education-matched controls performed a probabilistic 3-choice decision-making task. We report anatomically specific patterns of impairment. We found that credit assignment, as indexed by the normal influence of contingent relationships between choice and reward, is reduced in lOFC patients compared with Controls and mOFC/vmPFC patients. Moreover, the effects of reward contingency on choice were similar for patients with lesions in DMF or mOFC/vmPFC, compared with Controls. By contrast, mOFC/vmPFC-lesioned patients made more stochastic choices than Controls when the decision was framed by valuable distracting alternatives, suggesting that value comparisons were no longer independent of irrelevant options. Once again, there was evidence of regional specialization: patients with lOFC lesions were unimpaired relative to Controls. As in macaques, human lOFC and mOFC/vmPFC are necessary for contingent learning and value-guided decision-making, respectively.SIGNIFICANCE STATEMENT The lateral and medial regions of the orbitofrontal cortex are cytoarchitectonically distinct and have different anatomical connections. Previous investigations in macaques have shown these anatomical differences are accompanied by functional specialization for learning and decision-making. Here, for the first time, we test the predictions made by macaque studies in an experiment with humans with frontal lobe lesions, asking whether behavioral impairments can be linked to lateral or medial orbitofrontal cortex. Using equivalent tasks and computational analyses, our findings broadly replicate the pattern reported after selective lesions in monkeys. Patients with lateral orbitofrontal damage had impaired credit assignment, whereas damage to medial orbitofrontal cortex meant that patients were more likely to be distracted by irrelevant options.


Assuntos
Lesões Encefálicas/fisiopatologia , Comportamento de Escolha , Rede Nervosa/fisiologia , Rede Nervosa/fisiopatologia , Córtex Pré-Frontal/lesões , Córtex Pré-Frontal/fisiopatologia , Reforço por Recompensa , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
14.
J Neurosci ; 37(29): 6995-7007, 2017 07 19.
Artigo em Inglês | MEDLINE | ID: mdl-28634307

RESUMO

To adapt successfully to our environments, we must use the outcomes of our choices to guide future behavior. Critically, we must be able to correctly assign credit for any particular outcome to the causal features which preceded it. In some cases, the causal features may be immediately evident, whereas in others they may be separated in time or intermingled with irrelevant environmental stimuli, creating a potentially nontrivial credit-assignment problem. We examined the neuronal representation of information relevant for credit assignment in the dorsolateral prefrontal cortex (dlPFC) of two male rhesus macaques performing a task that elicited key aspects of this problem. We found that neurons conveyed the information necessary for credit assignment. Specifically, neuronal activity reflected both the relevant cues and outcomes at the time of feedback and did so in a manner that was stable over time, in contrast to prior reports of representational instability in the dlPFC. Furthermore, these representations were most stable early in learning, when credit assignment was most needed. When the same features were not needed for credit assignment, these neuronal representations were much weaker or absent. These results demonstrate that the activity of dlPFC neurons conforms to the basic requirements of a system that performs credit assignment, and that spiking activity can serve as a stable mechanism that links causes and effects.SIGNIFICANCE STATEMENT Credit assignment is the process by which we infer the causes of our successes and failures. We found that neuronal activity in the dorsolateral prefrontal cortex conveyed the necessary information for performing credit assignment. Importantly, while there are various potential mechanisms to retain a "trace" of the causal events over time, we observed that spiking activity was sufficiently stable to act as the link between causes and effects, in contrast to prior reports that suggested spiking representations were unstable over time. In addition, we observed that this stability varied as a function of learning, such that the neural code was more reliable over time during early learning, when it was most needed.


Assuntos
Adaptação Fisiológica/fisiologia , Comportamento de Escolha/fisiologia , Rede Nervosa/fisiologia , Neurônios/fisiologia , Córtex Pré-Frontal/fisiologia , Reforço por Recompensa , Animais , Macaca mulatta , Masculino
15.
Behav Modif ; 41(5): 708-737, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-28423911

RESUMO

The token economy is a well-established and widely used behavioral intervention. A token economy is comprised of six procedural components: the target response(s), a token that functions as a conditioned reinforcer, backup reinforcers, and three interconnected schedules of reinforcement. Despite decades of applied research, the extent to which the procedures of a token economy are described in complete and replicable detail has not been evaluated. Given the inherent complexity of a token economy, an analysis of the procedural descriptions may benefit future token economy research and practice. Articles published between 2000 and 2015 that included implementation of a token economy within an applied setting were identified and reviewed with a focus on evaluating the thoroughness of procedural descriptions. The results show that token economy components are regularly omitted or described in vague terms. Of the articles included in this analysis, only 19% (18 of 96 articles reviewed) included replicable and complete descriptions of all primary components. Missing or vague component descriptions could negatively affect future research or applied practice. Recommendations are provided to improve component descriptions.


Assuntos
Terapia Comportamental/métodos , Reforço por Recompensa , Humanos
16.
Am J Psychiatry ; 174(4): 370-377, 2017 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-28135843

RESUMO

OBJECTIVE: The authors examined whether a contingency management intervention using the ethyl glucuronide (EtG) alcohol biomarker resulted in increased alcohol abstinence in outpatients with co-occurring serious mental illnesses. Secondary objectives were to determine whether contingency management was associated with changes in heavy drinking, treatment attendance, drug use, cigarette smoking, psychiatric symptoms, and HIV-risk behavior. METHOD: Seventy-nine (37% female, 44% nonwhite) outpatients with serious mental illness and alcohol dependence receiving treatment as usual completed a 4-week observation period and were randomly assigned to 12 weeks of contingency management for EtG-negative urine samples and addiction treatment attendance, or reinforcement only for study participation. Contingency management included the variable magnitude of reinforcement "prize draw" procedure contingent on EtG-negative samples (<150 ng/mL) three times a week and weekly gift cards for outpatient treatment attendance. Urine EtG, drug test, and self-report outcomes were assessed during the 12-week intervention and 3-month follow-up periods. RESULTS: Contingency management participants were 3.1 times (95% CI=2.2-4.5) more likely to submit an EtG-negative urine test during the 12-week intervention period, attaining nearly 1.5 weeks of additional alcohol abstinence compared with controls. Contingency management participants had significantly lower mean EtG levels, reported less drinking and fewer heavy drinking episodes, and were more likely to submit stimulant-negative urine and smoking-negative breath samples, compared with controls. Differences in self-reported alcohol use were maintained at the 3-month follow-up. CONCLUSIONS: This is the first randomized trial utilizing an accurate and validated biomarker (EtG) to demonstrate the efficacy of contingency management for alcohol dependence in outpatients with serious mental illness.


Assuntos
Alcoolismo/terapia , Alcoolismo/urina , Glucuronatos/urina , Transtornos Mentais/sangue , Transtornos Mentais/terapia , Reforço por Recompensa , Adulto , Alcoolismo/epidemiologia , Alcoolismo/psicologia , Assistência Ambulatorial , Comorbidade , Diagnóstico Duplo (Psiquiatria) , Feminino , Seguimentos , Humanos , Masculino , Transtornos Mentais/epidemiologia , Transtornos Mentais/psicologia , Pessoa de Meia-Idade , Cooperação do Paciente/psicologia
17.
J Exp Anal Behav ; 107(1): 123-135, 2017 01.
Artigo em Inglês | MEDLINE | ID: mdl-28000221

RESUMO

Pigeons made repeated choices between earning and exchanging reinforcer-specific tokens (green tokens exchangeable for food, red tokens exchangeable for water) and reinforcer-general tokens (white tokens exchangeable for food or water) in a closed token economy. Food and green food tokens could be earned on one panel; water and red water tokens could be earned on a second panel; white generalized tokens could be earned on either panel. Responses on one key produced tokens according to a fixed-ratio schedule, whereas responses on a second key produced exchange periods, during which all previously earned tokens could be exchanged for the appropriate commodity. Most conditions were conducted in a closed economy, and pigeons distributed their token allocation in ways that permitted food and water consumption. When the price of all tokens was equal and low, most pigeons preferred the generalized tokens. When token-production prices were manipulated, pigeons reduced production of the tokens that increased in price while increasing production of the generalized tokens that remained at a fixed price. The latter is consistent with a substitution effect: Generalized tokens increased and were exchanged for the more expensive reinforcer. When food and water were made freely available outside the session, token production and exchange was sharply reduced but was not eliminated, even in conditions when it no longer produced tokens. The results join with other recent data in showing sustained generalized functions of token reinforcers, and demonstrate the utility of token-economic methods for assessing demand for and substitution among multiple commodities in a laboratory context.


Assuntos
Reforço por Recompensa , Animais , Columbidae , Condicionamento Operante
18.
Transl Psychiatry ; 6(11): e948, 2016 11 15.
Artigo em Inglês | MEDLINE | ID: mdl-27845779

RESUMO

Autism spectrum disorders (ASDs) are common yet complex neurodevelopmental disorders, characterized by social, communication and behavioral deficits. Behavioral interventions have shown favorable results-however, the promise of precision medicine in ASD is hampered by a lack of sensitive, objective neurobiological markers (neurobiomarkers) to identify subgroups of young children likely to respond to specific treatments. Such neurobiomarkers are essential because early childhood provides a sensitive window of opportunity for intervention, while unsuccessful intervention is costly to children, families and society. In young children with ASD, we show that functional magnetic resonance imaging-based stratification neurobiomarkers accurately predict responses to an evidence-based behavioral treatment-pivotal response treatment. Neural predictors were identified in the pretreatment levels of activity in response to biological vs scrambled motion in the neural circuits that support social information processing (superior temporal sulcus, fusiform gyrus, amygdala, inferior parietal cortex and superior parietal lobule) and social motivation/reward (orbitofrontal cortex, insula, putamen, pallidum and ventral striatum). The predictive value of our findings for individual children with ASD was supported by a multivariate pattern analysis with cross validation. Predicting who will respond to a particular treatment for ASD, we believe the current findings mark the very first evidence of prediction/stratification biomarkers in young children with ASD. The implications of the findings are far reaching and should greatly accelerate progress toward more precise and effective treatments for core deficits in ASD.


Assuntos
Transtorno do Espectro Autista/fisiopatologia , Transtorno do Espectro Autista/terapia , Terapia Comportamental/métodos , Encéfalo/fisiopatologia , Imagem por Ressonância Magnética , Percepção de Movimento/fisiologia , Percepção Social , Reforço por Recompensa , Transtorno do Espectro Autista/psicologia , Criança , Pré-Escolar , Terapia Combinada , Educação não Profissionalizante , Feminino , Humanos , Masculino , Motivação , Valor Preditivo dos Testes , Comportamento Social , Resultado do Tratamento
19.
J Appl Behav Anal ; 49(4): 745-750, 2016 12.
Artigo em Inglês | MEDLINE | ID: mdl-27287667

RESUMO

The purpose of this study was to evaluate the effectiveness of token reinforcement, using an ABAB reversal design, for increasing distance walked for adults with mild to moderate intellectual disabilities at an adult day-training center. Five participants earned tokens for walking 50-m laps and exchanged tokens for back-up reinforcers that had been identified through preference assessments. Token reinforcement resulted in a substantial increase from baseline in laps walked for 4 participants.


Assuntos
Terapia Comportamental/métodos , Deficiência Intelectual/complicações , Transtornos dos Movimentos/etiologia , Transtornos dos Movimentos/reabilitação , Reforço por Recompensa , Caminhada/fisiologia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
20.
J Appl Behav Anal ; 49(3): 639-55, 2016 09.
Artigo em Inglês | MEDLINE | ID: mdl-27174440

RESUMO

We examined the effects of delayed reinforcement on the responding of individuals with intellectual disabilities. Three conditions were evaluated: (a) food reinforcement, (b) token reinforcement with a postsession exchange opportunity, and (c) token reinforcement with a posttrial exchange opportunity. Within each condition, we assessed responding given (a) a no-reinforcement baseline, (b) immediate reinforcement, and (c) delayed reinforcement, in which responses produced a reinforcer after 1 of 6 delays. Results suggest that delayed food produced greater response persistence than did delayed tokens.


Assuntos
Condicionamento Operante/fisiologia , Deficiência Intelectual/psicologia , Deficiência Intelectual/reabilitação , Esquema de Reforço , Estatística como Assunto/métodos , Reforço por Recompensa , Adolescente , Criança , Comportamento de Escolha , Feminino , Alimentos , Humanos , Masculino
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