Showing papers on "Psychological intervention published in 2003"

Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence

Abstract: In this article the author reviews research evidence on the prevalence of mental disorders in lesbians, gay men, and bisexuals (LGBs) and shows, using meta-analyses, that LGBs have a higher prevalence of mental disorders than heterosexuals. The author offers a conceptual framework for understanding this excess in prevalence of disorder in terms of minority stress— explaining that stigma, prejudice, and discrimination create a hostile and stressful social environment that causes mental health problems. The model describes stress processes, including the experience of prejudice events, expectations of rejection, hiding and concealing, internalized homophobia, and ameliorative coping processes. This conceptual framework is the basis for the review of research evidence, suggestions for future research directions, and exploration of public policy implications. The study of mental health of lesbian, gay, and bisexual (LGB) populations has been complicated by the debate on the classification of homosexuality as a mental disorder during the 1960s and early 1970s. That debate posited a gay-affirmative perspective, which sought to declassify homosexuality, against a conservative perspective, which sought to retain the classification of homosexuality as a mental disorder (Bayer, 1981). Although the debate on classification ended in 1973 with the removal of homosexuality from the second edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM; American Psychiatric Association, 1973), its heritage has lasted. This heritage has tainted discussion on mental health of lesbians and gay men by associating— even equating— claims that LGB people have higher prevalences of mental disorders than heterosexual people with the historical antigay stance and the stigmatization of LGB persons (Bailey, 1999). However, a fresh look at the issues should make it clear that whether LGB populations have higher prevalences of mental disorders is unrelated to the classification of homosexuality as a mental disorder. A retrospective analysis would suggest that the attempt to find a scientific answer in that debate rested on flawed logic. The debated scientific question was, Is homosexuality a mental disorder? The operationalized research question that pervaded the debate was, Do homosexuals have high prevalences of mental disorders? But the research did not accurately operationalize the scientific question. The question of whether homosexuality should be considered a mental disorder is a question about classification. It can be answered by debating which behaviors, cognitions, or emotions should be considered indicators of a mental

2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference

Abstract: Objective: In 1991, the American College of Chest Physicians (ACCP) and the Society of Critical Care Medicine (SCCM) convened a "Consensus Conference", the goals of which were to provide a conceptual and a practical framework to define the systemic inflammatory response to infection, which is a progressive inju- rious process that falls under the gen- eralized term 'sepsis' and includes sepsis-associated organ dysfunction as well. The general definitions intro- duced as a result of that conference have been widely used in practice, and have served as the foundation for in- clusion criteria for numerous clinical trials of therapeutic interventions. Nevertheless, there has been an impe- tus from experts in the field to modify these definitions to reflect our current understanding of the pathophysiology of these syndromes. Design: Several North American and European inten- sive care societies agreed to revisit the definitions for sepsis and related con- ditions. This conference was spon- sored by the Society of Critical Care Medicine (SCCM), The European So-

Mindfulness Training as a Clinical Intervention: A Conceptual and Empirical Review

Abstract: Interventions based on training in mindfulness skills are becoming increasingly popular. Mindfulness involves intentionally bringing one's attention to the internal and external experiences occurring in the present moment, and is often taught through a variety of meditation exercises. This review summarizes conceptual approaches to mind-fulness and empirical research on the utility of mindfulness-based interventions. Meta-analytic techniques were incorporated to facilitate quantification of findings and comparison across studies. Although the current empirical literature includes many methodological flaws, findings suggest that mindfulness-based interventions may be helpful in the treatment of several disorders. Methodologically sound investigations are recommended in order to clarify the utility of these interventions.

Self-management education: history, definition, outcomes, and mechanisms.

Abstract: Self-management has become a popular term for behavioral interventions as well as for healthful behaviors. This is especially true for the management of chronic conditions. This article offers a short history of self-management. It presents three self-management tasks—medical management, role management, and emotional management—and six self-management skills—problem solving, decision making, resource utilization, the formation of a patient-provider partnership, action planning, and self-tailoring. In addition, the article presents evidence of the effectiveness of self-management interventions and posits a possible mechanism, self-efficacy, through which these interventions work. In conclusion the article discusses problems and solutions for integrating self-management education into the mainstream health care systems.

Incidence and Preventability of Adverse Drug Events Among Older Persons in the Ambulatory Setting

Abstract: ContextAdverse drug events, especially those that may be preventable, are among the most serious concerns about medication use in older persons cared for in the ambulatory clinical setting.ObjectiveTo assess the incidence and preventability of adverse drug events among older persons in the ambulatory clinical setting.Design, Setting, and PatientsCohort study of all Medicare enrollees (30 397 person-years of observation) cared for by a multispecialty group practice during a 12-month study period (July 1, 1999, through June 30, 2000), in which possible drug-related incidents occurring in the ambulatory clinical setting were detected using multiple methods, including reports from health care providers; review of hospital discharge summaries; review of emergency department notes; computer-generated signals; automated free-text review of electronic clinic notes; and review of administrative incident reports concerning medication errors.Main Outcome MeasuresNumber of adverse drug events, severity of the events (classified as significant, serious, life-threatening, or fatal), and whether the events were preventable.ResultsThere were 1523 identified adverse drug events, of which 27.6% (421) were considered preventable. The overall rate of adverse drug events was 50.1 per 1000 person-years, with a rate of 13.8 preventable adverse drug events per 1000 person-years. Of the adverse drug events, 578 (38.0%) were categorized as serious, life-threatening, or fatal; 244 (42.2%) of these more severe events were deemed preventable compared with 177 (18.7%) of the 945 significant adverse drug events. Errors associated with preventable adverse drug events occurred most often at the stages of prescribing (n = 246, 58.4%) and monitoring (n = 256, 60.8%), and errors involving patient adherence (n = 89, 21.1%) also were common. Cardiovascular medications (24.5%), followed by diuretics (22.1%), nonopioid analgesics (15.4%), hypoglycemics (10.9%), and anticoagulants (10.2%) were the most common medication categories associated with preventable adverse drug events. Electrolyte/renal (26.6%), gastrointestinal tract (21.1%), hemorrhagic (15.9%), metabolic/endocrine (13.8%), and neuropsychiatric (8.6%) events were the most common types of preventable adverse drug events.ConclusionsAdverse drug events are common and often preventable among older persons in the ambulatory clinical setting. More serious adverse drug events are more likely to be preventable. Prevention strategies should target the prescribing and monitoring stages of pharmaceutical care. Interventions focused on improving patient adherence with prescribed regimens and monitoring of prescribed medications also may be beneficial.

Less is more: Meta-analyses of sensitivity and attachment interventions in early childhood.

Abstract: Is early preventive intervention effective in enhancing parental sensitivity and infant attachment security, and if so, what type of intervention is most successful? Seventy studies were traced, producing 88 intervention effects on sensitivity (n = 7,636) and/or attachment (n = 1,503). Randomized interventions appeared rather effective in changing insensitive parenting (d = 0.33) and infant attachment insecurity (d = 0.20). The most effective interventions used a moderate number of sessions and a clear-cut behavioral focus in families with, as well as without, multiple problems. Interventions that were more effective in enhancing parental sensitivity were also more effective in enhancing attachment security, which supports the notion of a causal role of sensitivity in shaping attachment.

The immediate psychological and occupational impact of the 2003 SARS outbreak in a teaching hospital

Abstract: Background: The outbreak of severe acute respiratory syndrome (SARS) in Toronto, which began on Mar. 7, 2003, resulted in extraordinary public health and infection control measures. We aimed to describe the psychological and occupational impact of this event within a large hospital in the first 4 weeks of the outbreak and the subsequent administrative and mental health response. Methods: Two principal authors met with core team members and mental health care providers at Mount Sinai Hospital, Toronto, to compile retrospectively descriptions of the experiences of staff and patients based on informal observation. All authors reviewed and analyzed the descriptions in an iterative process between Apr. 3 and Apr. 13, 2003. Results: In a 4-week period, 19 individuals developed SARS, including 11 health care workers. The hospital’s response included establishing a leadership command team and a SARS isolation unit, implementing mental health support interventions for patients and staff, overcoming problems with logistics and communication, and overcoming resistance to directives. Patients with SARS reported fear, loneliness, boredom and anger, and they worried about the effects of quarantine and contagion on family members and friends. They experienced anxiety about fever and the effects of insomnia. Staff were adversely affected by fear of contagion and of infecting family, friends and colleagues. Caring for health care workers as patients and colleagues was emotionally difficult. Uncertainty and stigmatization were prominent themes for both staff and patients. Interpretation: The hospital’s response required clear communication, sensitivity to individual responses to stress, collaboration between disciplines, authoritative leadership and provision of relevant support. The emotional and behavioural reactions of patients and staff are understood to be a normal, adaptive response to stress in the face of an overwhelming event.

Evidence-based psychotherapies for children and adolescents

Abstract: Part I: Foundations of Child and Adolescent Psychotherapy Research. Kazdin, Weisz, Introduction: Context, Background, and Goals. Hoagwood, Cavaleri, Ethical Issues in Child and Adolescent Psychosocial Treatment Research. Holmbeck, Devine, Bruno, Developmental Issues and Considerations in Research and Practice. Part II: Treatments and Problems. A: Internalizing Disorders and Problems. Kendall, Furr, Podell, Child-focused Treatment of Anxiety. Pahl, Barrett, Interventions for Anxiety Disorders in Children Using Group Cognitive-Behavioral Therapy with Family Involvement. Franklin, Freeman, March, Treating Pediatric Obsessive-Compulsive Disorder Using Exposure-based Cognitive-Behavioral Therapy. Stark, Streusand, Krumholz, Patel, Cognitive-Behavioral Therapy for Depression: The ACTION Treatment Program for Girls. Clarke, DeBar, Group Cognitive-Behavioral Treatment for Adolescent Depression. Weersing, Brent, Treating Depression in Adolescents Using Individual Cognitive-Behavioral Therapy. Jacobson, Mufson, Treating Adolescent Depression Using Interpersonal Psychotherapy. B: Externalizing Disorders and Problems. Forgatch, Patterson, The Oregon Model of Parent Management Training: An Intervention for Antisocial Behavior in Children and Adolescents. Zisser, Eyberg, Parent-child Interaction Therapy and the Treatment of Disruptive Behavior Disorders. Webster-Stratton, Reid, The Incredible Years Parents, Teachers, and Children Training Series: A Multifaceted Treatment Approach for Young Children with Conduct Problems. Kazdin, Problem-solving Skills Training and Parent Management Training for Oppositional Defiant Disorder and Conduct Disorder. Lochman, Boxmeyer, Powell, Barry, Pardini, Anger Control Training for Aggressive Youths. Smith, Chamberlain, Multidimensional Treatment Foster Care for Adolescents: Processes and Outcomes. Henggeler, Schaeffer, Treating Serious Antisocial Behavior Using Multisystemic Therapy. Pelham, Jr., Gnagy, Greiner, Waschbusch, Fabiano, Burrows-MacLean, Summer Treatment Programs for Attention-Deficit/Hyperactivity Disorder. C: Other Disorders and Special Applications. Cohen, Mannarino, Deblinger, Trauma-focused Cognitive-Behavioral Therapy for Traumatized Children. Smith, Early and Intensive Behavioral Intervention in Autism. R. L. Koegel, L. K. Koegel, Vernon, Brookman-Frazee, Empirically Supported Pivotal Response Treatment for Children with Autism Spectrum Disorders. Robin, le Grange, Family Therapy for Adolescents with Anorexia Nervosa. Houts, Behavioral Treatment for Enuresis. Robbins, Horigian, Szapocznik, Ucha, Treating Hispanic Youths Using Brief Strategic Family Therapy. Malgady, Treating Hispanic Children and Adolescents Using Narrative Therapy. Waldron, Brody, Functional Family Therapy for Adolescent Substance Use Disorders. Liddle, Treating Adolescent Substance Abuse Using Multidimensional Family Therapy. Part III: Implementation and Dissemination: Extending Treatments to New Populations and New Settings. Fixsen, Blase, Duda, Naoom, Dyke, Implementation of Evidence-based Treatments for Children and Adolescents: Research Findings and Their Implications for the Future. Huey, Jr., Polo, Assessing the Effects of Evidence-based Psychotherapies with Ethnic-minority Youths. Bearman, Ugueto, Alleyne, Weisz, Adapting Cognitive-Behavioral Therapy for Depression to Fit Diverse Youths and Contexts: Applying the Deployment-focused Model of Treatment Development and Testing. Chorpita, Daleiden, Building Evidence-based Systems in Children's Mental Health. Scott, Nationwide Dissemination of Effective Parenting Interventions: Building a Parenting Academy for England. Sanders, Murphy-Brennan, The International Dissemination of the Triple P - Positive Parenting Program. Schoenwald, From Policy Pinball to Purposeful Partnership: The Policy Contexts of Multisystemic Therapy Transport and Dissemination. Part IV: Conclusions and Future Directions. Weisz, Kazdin, The Present and Future of Evidence-based Psychotherapies for Children and Adolescents.

Poverty and common mental disorders in developing countries

Abstract: A review of English-language journals published since 1990 and three global mental health reports identified 11 community studies on the association between poverty and common mental disorders in six low- and middle-income countries. Most studies showed an association between indicators of poverty and the risk of mental disorders, the most consistent association being with low levels of education. A review of articles exploring the mechanism of the relationship suggested weak evidence to support a specific association with income levels. Factors such as the experience of insecurity and hopelessness, rapid social change and the risks of violence and physical ill-health may explain the greater vulnerability of the poor to common mental disorders. The direct and indirect costs of mental ill-health worsen the economic condition, setting up a vicious cycle of poverty and mental disorder. Common mental disorders need to be placed alongside other diseases associated with poverty by policy-makers and donors. Programmes such as investment in education and provision of microcredit may have unanticipated benefits in reducing the risk of mental disorders. Secondary prevention must focus on strengthening the ability of primary care services to provide effective treatment.

The built environment and mental health.

Abstract: The built environment has direct and indirect effects on mental health. High-rise housing is inimical to the psychological well-being of women with young children. Poor-quality housing appears to increase psychological distress, but methodological issues make it difficult to draw clear conclusions. Mental health of psychiatric patients has been linked to design elements that affect their ability to regulate social interaction (e.g., furniture configuration, privacy). Alzheimer's patients adjust better to small-scale, homier facilities that also have lower levels of stimulation. They are also better adjusted in buildings that accommodate physical wandering. Residential crowding (number of people per room) and loud exterior noise sources (e.g., airports) elevate psychological distress but do not produce serious mental illness. Malodorous air pollutants heighten negative affect, and some toxins (e.g., lead, solvents) cause behavioral disturbances (e.g., self-regulatory ability, aggression). Insufficient daylight is reliably associated with increased depressive symptoms. Indirectly, the physical environment may influence mental health by altering psychosocial processes with known mental health sequelae. Personal control, socially supportive relationships, and restoration from stress and fatigue are all affected by properties of the built environment. More prospective, longitudinal studies and, where feasible, randomized experiments are needed to examine the potential role of the physical environment in mental health. Even more challenging is the task of developing underlying models of how the built environment can affect mental health. It is also likely that some individuals may be more vulnerable to mental health impacts of the built environment. Because exposure to poor environmental conditions is not randomly distributed and tends to concentrate among the poor and ethnic minorities, we also need to focus more attention on the health implications of multiple environmental risk exposure.

Interventions to reduce HIV/AIDS stigma: what have we learned?

Abstract: This article reviews 22 studies that test a variety of interventions to decrease AIDS stigma in developed and developing countries. This article assesses published studies that met stringent evaluation criteria in order to draw lessons for future development of interventions to combat stigma. The target group, setting, type of intervention, measures, and scale of these studies varied tremendously. The majority (14) of the studies aimed to increase tolerance of persons living with HIV/AIDS (PLHA) among the general population. The remaining studies tested interventions to increase willingness to treat PLHA among health care providers or improve coping strategies for dealing with AIDS stigma among PLHA or at-risk groups. Results suggest some stigma reduction interventions appear to work, at least on a small scale and in the short term, but many gaps remain especially in relation to scale and duration of impact and in terms of gendered impact of stigma reduction interventions.

Meta-analysis of psychosocial interventions for caregivers of people with dementia.

Abstract: OBJECTIVES: To review published reports of interventions for caregivers (CGs) of persons with dementia, excluding respite care, and provide recommendations to clinicians. DESIGN: Meta-analytical review. Electronic databases and key articles were searched for controlled trials, preferably randomized, published in English from 1985 to 2001 inclusive. Thirty studies were located and scored according to set criteria, and the interventions' research quality and clinical significance were judged. SETTING: Home or noninstitutional environment. PARTICIPANTS: Informal CGs-persons providing unpaid care at home or in a noninstitutional setting. MEASUREMENTS: The primary measures were psychological morbidity and burden. Other varied outcome measures such as CG coping skills and social support were combined with measures of psychological distress and burden to form a main outcome measure. RESULTS: The quality of research increased over the 17 years. Results from 30 studies (34 interventions) indicated, at most-current follow-up, significant benefits in caregiver psychological distress (random effect size (ES) = 0.31; 95% confidence interval (CI) = 0.13-0.50), caregiver knowledge (ES = 0.51; CI = 0.05-0.98), any main caregiver outcome measure (ES = 0.32; CI = 0.15-0.48), and patient mood (ES = 0.68; CI = 0.30-1.06), but not caregiver burden (ES = 0.09; CI = -0.09-0.26). There was considerable variability in outcome, partly because of differences in methodology and intervention technique. Elements of successful interventions could be identified. Success was more likely if, in addition to CGs, patients were involved. Four of seven studies indicated delayed nursing home admission. CONCLUSION: Some CG interventions can reduce CG psychological morbidity and help people with dementia stay at home longer. Programs that involve the patients and their families and are more intensive and modified to CGs' needs may be more successful. Future research should try to improve clinicians' abilities to prescribe interventions.

Reducing work related psychological ill health and sickness absence: a systematic literature review

Abstract: A literature review revealed the following: key work factors associated with psychological ill health and sickness absence in staff were long hours worked, work overload and pressure, and the effects of these on personal lives; lack of control over work; lack of participation in decision making; poor social support; and unclear management and work role. There was some evidence that sickness absence was associated with poor management style. Successful interventions that improved psychological health and levels of sickness absence used training and organisational approaches to increase participation in decision making and problem solving, increase support and feedback, and improve communication. It is concluded that many of the work related variables associated with high levels of psychological ill health are potentially amenable to change. This is shown in intervention studies that have successfully improved psychological health and reduced sickness absence.

Cancer Survivors in the United States: Age, Health, and Disability

Abstract: Background Relatively little is known about the health and disability of adult cancer survivors. As a way to explore these issues, data from the National Health Interview Survey (years 1998-2000) were analyzed. Methods Comparisons were made between cancer survivors (n = 4878) and those without a history of cancer (n = 90,737), using both descriptive statistics and logistic-regression models on general health status, psychological disability, limitations in activities of daily living, physical function, and health-related ability to work. Among cancer survivors, health and disability status were assessed by cancer site or type, age at diagnosis, and years since cancer diagnosis. Results Compared with individuals without a history of cancer or other chronic disease, cancer survivors without other chronic diseases were significantly more likely to report being in fair or poor health (odds ratio, or OR, 2.97), a psychological disability (OR 2.18), limitations of activities of daily living or instrumental activities of daily living (OR 2.22), functional limitations (OR 1.74), and, among those under the age of 65, being unable to work because of a health condition (OR 3.22). The likelihood of poor health and disability was much higher among cancer survivors who also reported comorbid chronic conditions. Conclusions Providers caring for cancer survivors should be made aware of the long-term health consequences of cancer and consider appropriate supportive care for their patients. The identification of long-term effects of cancer that contribute to disability and the interventions needed to ameliorate these and their consequences should become a more prominent aspect of the research agenda.

Children's Adjustment Following Divorce: Risk and Resilience Perspectives

Abstract: The empirical literature on the longer-term adjustment of children of divorce is reviewed from the perspective of (a) the stressors and elevated risks that divorce presents for children and (b) protective factors associated with better adjustment. The resiliency demonstrated by the majority of children is discussed, as are controversies regarding the adjustment of adult children of divorce. A third dimension of children's responses to divorce, that of lingering painful memories, is distinguished from pathology in order to add a useful complement to risk and resilience perspectives. The potential benefits of using an increasingly differentiated body of divorce research to shape the content of interventions, such as divorce education, by designing programs that focus on known risk factors for children and that assist parents to institute more protective behaviors that may enhance children's longer-term adjustment is discussed.

A mental health Intervention for schoolchildren exposed to violence: A randomized controlled trial

Abstract: ContextNo randomized controlled studies have been conducted to date on the effectiveness of psychological interventions for children with symptoms of posttraumatic stress disorder (PTSD) that has resulted from personally witnessing or being personally exposed to violenceObjectiveTo evaluate the effectiveness of a collaboratively designed school-based intervention for reducing children's symptoms of PTSD and depression that has resulted from exposure to violenceDesignA randomized controlled trial conducted during the 2001-2002 academic yearSetting and ParticipantsSixth-grade students at 2 large middle schools in Los Angeles who reported exposure to violence and had clinical levels of symptoms of PTSDInterventionStudents were randomly assigned to a 10-session standardized cognitive-behavioral therapy (the Cognitive-Behavioral Intervention for Trauma in Schools) early intervention group (n = 61) or to a wait-list delayed intervention comparison group (n = 65) conducted by trained school mental health cliniciansMain Outcome MeasuresStudents were assessed before the intervention and 3 months after the intervention on measures assessing child-reported symptoms of PTSD (Child PTSD Symptom Scale; range, 0-51 points) and depression (Child Depression Inventory; range, 0-52 points), parent-reported psychosocial dysfunction (Pediatric Symptom Checklist; range, 0-70 points), and teacher-reported classroom problems using the Teacher-Child Rating Scale (acting out, shyness/anxiousness, and learning problems; range of subscales, 6-30 points)ResultsCompared with the wait-list delayed intervention group (no intervention), after 3 months of intervention students who were randomly assigned to the early intervention group had significantly lower scores on symptoms of PTSD (89 vs 155, adjusted mean difference, − 70; 95% confidence interval [CI], − 108 to − 32), depression (94 vs 127, adjusted mean difference, − 34; 95% CI, − 65 to − 04), and psychosocial dysfunction (125 vs 165, adjusted mean difference, − 64; 95% CI, –104 to –23) Adjusted mean differences between the 2 groups at 3 months did not show significant differences for teacher-reported classroom problems in acting out (−10; 95% CI, –25 to 05), shyness/anxiousness (01; 95% CI, –15 to 17), and learning (−11, 95% CI, –29 to 08) At 6 months, after both groups had received the intervention, the differences between the 2 groups were not significantly different for symptoms of PTSD and depression; showed similar ratings for psychosocial function; and teachers did not report significant differences in classroom behaviorsConclusionA standardized 10-session cognitive-behavioral group intervention can significantly decrease symptoms of PTSD and depression in students who are exposed to violence and can be effectively delivered on school campuses by trained school-based mental health clinicians

Research designs for studies evaluating the effectiveness of change and improvement strategies

Abstract: The methods of evaluating change and improvement strategies are not well described. The design and conduct of a range of experimental and non-experimental quantitative designs are considered. Such study designs should usually be used in a context where they build on appropriate theoretical, qualitative and modelling work, particularly in the development of appropriate interventions. A range of experimental designs are discussed including single and multiple arm randomised controlled trials and the use of more complex factorial and block designs. The impact of randomisation at both group and individual levels and three non-experimental designs (uncontrolled before and after, controlled before and after, and time series analysis) are also considered. The design chosen will reflect both the needs (and resources) in any particular circumstances and also the purpose of the evaluation. The general principle underlying the choice of evaluative design is, however, simple-those conducting such evaluations should use the most robust design possible to minimise bias and maximise generalisability.

Does Early Psychological Intervention Promote Recovery From Posttraumatic Stress

Abstract: In the wake of the terrorist attacks at the World Trade Center, more than 9,000 counselors went to New York City to offer aid to rescue workers, families, and direct victims of the violence of September 11, 2001. These mental health professionals assumed that many New Yorkers were at high risk for developing posttraumatic stress disorder (PTSD), and they hoped that their interventions would mitigate psychological distress and prevent the emergence of this syndrome. Typically developing in response to horrific, life-threatening events, such as combat, rape, and earthquakes, PTSD is characterized by reexperiencing symptoms (e.g., intrusive recollections of the trauma, nightmares), emotional numbing and avoidance of reminders of the trauma, and hyperarousal (e.g., exaggerated startle, difficulty sleeping). People vary widely in their vulnerability for developing PTSD in the wake of trauma. For example, higher cognitive ability and strong social support buffer people against PTSD, whereas a family or personal...

Peer-assisted learning interventions with elementary school students: A meta-analytic review.

Abstract: A meta-analytic review of group comparison design studies evaluating peer-assisted learning (PAL) interventions with elementary school students produced positive effect sizes (ESs) indicating increases in achievement (unweighted mean ES = 0.59, SD = 0.90; weighted ES, d = 0.33, p < .0001, 95% confidence interval = 0.29-0.37). PAL interventions were most effective with younger, urban, low-income, and minority students. Interventions that used interdependent reward contingencies, ipsative evaluation procedures, and provided students with more autonomy had higher ESs. Adequate descriptive information was missing in many studies. Researchers are encouraged to develop PAL interventions in collaboration with practitioners to maximize those interventions' use and effectiveness and to include more detailed information about students, schools, and intervention components in their reports. (PsycINFO Database Record (c) 2016 APA, all rights reserved)

Healing traditions: culture, community and mental health promotion with Canadian Aboriginal peoples

Abstract: Objective: To identify issues and concepts to guide the development of culturally appropriate mental health promotion strategies with Aboriginal populations and communities in Canada.Methods: We review recent literature examining the links between the history of colonialism and government interventions (including the residential school system, out-adoption, and centralised bureaucratic control) and the mental health of Canadian Aboriginal peoples.Results: There are high rates of social problems, demoralisation, depression, substance abuse, suicide and other mental health problems in many, though not all, Aboriginal communities. Although direct causal links are difficult to demonstrate with quantitative methods, there is clear and compelling evidence that the long history of cultural oppression and marginalisation has contributed to the high levels of mental health problems found in many communities. There is evidence that strengthening ethnocultural identity, community integration and political empowermen...

Interventions for Violence Against Women: Scientific Review

Abstract: ContextIntimate partner violence is prevalent and is associated with significant impairment, yet it remains unclear which interventions, if any, reduce rates of abuse and reabuse.ObjectiveTo systematically review, from the perspective of primary health care, the available evidence on interventions aimed at preventing abuse or reabuse of women.Data SourcesMEDLINE, PsycINFO, CINAHL, HealthStar, and Sociological Abstracts were searched from the database start dates to March 2001 using database-specific key words such as domestic violence, spouse abuse, partner abuse, shelters, and battered women. References of key articles were hand searched. The search was updated in December 2002.Study SelectionBoth authors reviewed all titles and abstracts using established inclusion/exclusion criteria. Twenty-two articles met the inclusion criteria for critical appraisal.Data ExtractionFollowing the evidence-based methods of the Canadian Task Force on Preventive Health Care, both authors independently reviewed the 22 included studies using an established hierarchy of study designs and criteria for rating internal validity. Quality ratings of individual studies—good, fair, or poor—were determined based on a set of operational parameters specific to each design category developed with the US Preventive Services Task Force.Data SynthesisScreening instruments exist that can identify women who are experiencing intimate partner violence. No study has examined, in a comparative design, the effectiveness of screening when the end point is improved outcomes for women (as opposed to identification of abuse). No high-quality evidence exists to evaluate the effectiveness of shelter stays to reduce violence. Among women who have spent at least 1 night in a shelter, there is fair evidence that those who received a specific program of advocacy and counseling services reported a decreased rate of reabuse and an improved quality of life. The benefits of several other intervention strategies in treating both women and men are unclear, primarily because of a lack of suitably designed research measuring appropriate outcomes. In most cases, the potential harms of interventions are not assessed within the studies reviewed.ConclusionsMuch has been learned in recent years about the epidemiology of violence against women, yet information about evidence-based approaches in the primary care setting for preventing intimate partner violence is seriously lacking. The evaluation of interventions to improve the health and well-being of abused women remains a key research priority.

Sustained effect of intensive treatment of type 1 diabetes mellitus on the development and progression of diabetic nephropathy in epidemiology of diabetes interventions and complications (EDIC) study.

Abstract: CONTEXT The Diabetes Control and Complications Trial (DCCT) demonstrated the benefits of intensive treatment of diabetes in reducing glycemic levels and slowing the progression of diabetic nephropathy. The DCCT cohort has been examined annually for another 8 years as part of the follow-up Epidemiology of Diabetes Interventions and Complications (EDIC) study. During the EDIC study, glycemic levels no longer differed substantially between the 2 original treatment groups. OBJECTIVE To determine the long-term effects of intensive vs conventional diabetes treatment during the DCCT on kidney function during the EDIC study. DESIGN, SETTING, AND PARTICIPANTS Observational study begun in 1993 (following DCCT closeout) in 28 medical centers in the United States and Canada. Participants were 1349 (of 1375) EDIC volunteers who had kidney evaluation at years 7 or 8. MAIN OUTCOME MEASURES Development of microalbuminuria, clinical-grade albuminuria, hypertension, or increase in serum creatinine level. RESULTS Results were analyzed by intention-to-treat analyses, comparing the 2 original DCCT treatment groups. New cases of microalbuminuria occurred during the EDIC study in 39 (6.8%) of the participants originally assigned to the intensive-treatment group vs 87 (15.8%) of those assigned to the conventional-treatment group, for a 59% (95% confidence interval [CI], 39%-73%) reduction in odds, adjusted for baseline values, compared with a 59% (95% CI, 36%-74%) reduction at the end of the DCCT (P<.001 for both comparisons). New cases of clinical albuminuria occurred in 9 (1.4%) of the participants in the original intensive-treatment group vs 59 (9.4%) of those in the original conventional-treatment group, representing an 84% reduction in odds (95% CI, 67%-92%), compared with a reduction of 57% (95% CI, -1% to +81%) at the end of the DCCT. Fewer cases of hypertension (prevalence at year 8, 29.9% vs 40.3%; P<.001) developed in the original intensive-treatment group. Significantly fewer participants reached a serum creatinine level of 2 mg/dL or greater in the intensive-treatment vs the conventional-treatment group (5 vs 19, P =.004), but there were no differences in mean log clearance values. Although small numbers of patients required dialysis and/or transplantation, fewer patients experienced either of these outcomes in the intensive group (4 vs 7, P =.36). CONCLUSIONS The persistent beneficial effects on albumin excretion and the reduced incidence of hypertension 7 to 8 years after the end of the DCCT suggest that previous intensive treatment of diabetes with near-normal glycemia during the DCCT has an extended benefit in delaying progression of diabetic nephropathy.

Mathematics Interventions for Children with Special Educational Needs A Meta-Analysis

Abstract: This article presents the results of a meta-analysis of 58 studies of mathematics interventions for elementary students with special needs. Interventions in three different domains were selected: preparatory mathematics, basic skills, and problem-solving strategies. The majority of the included studies described interventions in the domain of basic skills. In general, these interventions were also the most effective. Furthermore, a few specific characteristics were found to influence the outcomes of the studies. In addition to the duration of the intervention, the particular method of intervention proved important: Direct instruction and self-instruction were found to be more effective than mediated instruction. Interventions involving the use of computer-assisted instruction and peer tutoring showed smaller effects than interventions not including these supports.