Long-term comparison of brief versus unlimited psychodynamic treatments with children and their parents.

30 children and their parents were assigned randomly to either time-unlimited or time-limited (12 sessions) psychodynamically oriented treatments or to a minimal-contact control group. All groups showed significant improvements from pretest to posttest. Comparisons between groups at posttest on parental measures of family functioning showed that changes reported by the minimal contact control group were significantly greater than those of the time-unlimited group. When assessments from pretest to 4-yr follow-up were compared, all groups improved significantly on therapist measures of goal attainment, but only the minimal-contact control group reported significant improvements on severity of target problems and measures of family functioning. The results of this study suggest that long-term therapy does not necessarily provide more effective therapy. These findings have important implications for clinical practice, service delivery, and research, particularly in the present climate of financial restraint in health care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Parents and procedures: a randomized controlled trial

INTRODUCTION: Previous work has shown that parents prefer to be present when their children undergo common invasive procedures, although physicians are ambivalent about parental presence. PURPOSE: To determine the effect of a parent-focused intervention on the pain and performance of the procedure, anxiety of parents and clinicians, and parental satisfaction with care. POPULATION: Children younger than 3 years old undergoing venipuncture, intravenous cannulation, or uretheral catheterization. SETTING: Pediatric emergency department of Boston City Hospital. DESIGN: Randomized controlled trial with three groups; parents present and given instructions on how to help their children; parents present, but no instructions given; and parents not present. INTERVENTION: The parents were instructed to touch, talk to, and maintain eye contact during the procedure. RESULTS: A total of 431 parents was randomized to the intervention (N = 153), present (N = 147), and not present (N = 131) groups. The groups were equivalent with respect to measured sociodemographic variables and parents' previous experience in the pediatric emergency department. No differences emerged with respect to pain (3-point scale measured by parent and clinician, and analysis of cry); performance of the procedure (number of attempts, completion of procedure by first clinician, time); clinician anxiety; or parental satisfaction with care. Parents who were present were more likely to rate the pain of the children as extreme/severe (52%) in comparison to clinicians (15%, kappa .07, poor agreement) and were significantly less anxious than parents who were not present. CONCLUSION: Overall, the intervention was not effective in reducing the pain of routine procedures. Parental presence did not negatively affect performance of the procedure or increase clinician anxiety. Parents who were present were less anxious than those who were not present. CLINICAL IMPLICATION: In general, parents have indicated that they want to be present when their children undergo procedures. The results of this study challenge the traditional belief that parental presence negatively affects our ability to successfully complete procedures. We should encourage parents who want to be present to stay during procedures.     

Outpatient behavioral treatment for cocaine dependence: One-year outcome.

This article describes outcomes observed during the year after treatment entry from two controlled trials in which cocaine-dependent outpatients were randomly assigned to either a multicomponent behavioral treatment or to one of two control treatments. The behavioral treatment integrated the community reinforcement approach (CRA) with an incentive program in which cocaine abstinence was reinforced with vouchers exchangeable for retail items. The two control treatments were drug abuse counseling and CRA without the incentive program. All treatment groups improved significantly compared to intake, and those changes were maintained through the follow-up period. When efficacy differences were observed during treatment and follow-up, they supported CRA with vouchers over control treatments. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effects of visual surround eccentricity and size on manual and postural control

The aim of this study was to compare two different modes of behaviorally-oriented therapies for dental fear. The subjects were chosen consecutively from the waiting-list of a Dental Fears Research and Treatment Clinic. In addition, a control group was selected from patients treated under general anesthesia to compare levels of dental and general fear with the experimental groups. Twenty-two women, with a mean age of 31.8 yr, were included and randomly assigned to two groups. The median time of avoidance of dental care was 9.5 yr. One group received hypnotherapy (HT) and one group a behavioral treatment based on psychophysiological principles (PP). Both therapies included eight sessions followed by standardized conventional dental test treatments. Pre- and posttreatment measures were dental fear, general fear, mood, and patient behavior. Nine patients were not able to conclude the treatment sessions (6 HT and 3 PP); these patients did not differ significantly from the remaining patients before treatment. The PP group reported a statistically significant decrease in dental fear as well as a rise in mood during dental situations, as opposed to the HT group. General fear levels decreased but not significantly. Eleven patients completed conventional dental treatment according to a dentist's behavioral rating scale, indicating that they were relaxed, and no problems occurred during the treatments. These patients were referred to general practitioners within the community dental service. In conclusion, this small size study showed that a majority of the patients, who accomplished the behavioral therapy and the dental test treatments, became less fearful of dental care and were able to manage conventional dental care, including changing dentist.     

Parent training of toddlers in day care in low-income urban communities.

The authors tested a 12-week parent training program with parents (n=208) and teachers (n=77) of 2-3-year-olds in day care centers serving low-income families of color in Chicago. Eleven centers were randomly assigned to 1 of 4 conditions: (a) parent and teacher training (PT + TT), (b) parent training (PT), (c) teacher training (TT), and (d) waiting list control (C). After controlling for parent stress, PT and PT + TT parents reported higher self-efficacy and less coercive discipline and were observed to have more positive behaviors than C and TT parents. Among toddlers in high-risk behavior problem groups, toddlers in the experimental conditions showed greater improvement than controls. Most effects were retained 1 year later. Benefits were greatest when parents directly received training. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attrition in worksite weight-loss interventions: The effects of an incentive procedure.

48 20–69 yr old hospital employees were randomly assigned to either an incentive or control group and completed a 14-session behavioral weight-loss program. Results indicate that the incentive procedure significantly decreased attrition. More Ss in the incentive condition completed treatment (60 vs 20%) and attended significantly more of the sessions than did Ss in the control group. Results are discussed with reference to cost effectiveness of behavioral worksite weight-loss interventions. (2 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Monetary incentives improve recall of research consent information: It pays to remember.

Research participants often fail to recall substantial amounts of informed consent information after delays of only a few days. Numerous interventions have proven effective at improving consent recall; however, virtually all have focused on compensating for potential cognitive deficits and have ignored motivational factors. In this pilot study, the authors randomly assigned 31 drug court clients participating in a clinical research trial to a control group that received a standard informed consent procedure or to a group that received the same procedure plus incentives for correctly recalling consent information. The incentive group was told they would receive $5 for each of the 15 consent items they could answer correctly 1 week later. At the follow-up, the incentive group recalled a significantly greater percentage of consent information overall than the control group (65% vs. 42%, p     

The Youth-Nominated Support Team–Version II for suicidal adolescents: A randomized controlled intervention trial.

The purpose of this study was to examine the efficacy of the Youth-Nominated Support Team–Version II (YST-II) for suicidal adolescents, an intervention based on social support and health behavior models, which was designed to supplement standard treatments. Psychiatrically hospitalized and suicidal adolescents, 13–17 years of age, were randomly assigned to treatment-as-usual (TAU) + YST-II (n = 223) or TAU only (n = 225). YST-II provided tailored psychoeducation to youth-nominated adults in addition to weekly check-ins for 3 months following hospitalization. In turn, these adults had regular supportive contact with adolescents. Adolescents assigned to TAU + YST-II had an average of 3.43 (SD = 0.83) nominated adults. Measures included the Suicidal Ideation Questionnaire–Junior (SIQ-JR; W. M. Reynolds, 1988), Children’s Depression Rating Scale–Revised (E. O. Poznanski & H. B. Mokros, 1996), Beck Hopelessness Scale (A. T. Beck & R. A. Steer, 1993), and Child and Adolescent Functional Assessment Scale (CAFAS; K. Hodges, 1996). YST-II had very limited positive effects, which were moderated by history of multiple suicide attempts, and no negative effects. It resulted in more rapid decreases in suicidal ideation (SIQ-JR) for multiple suicide attempters during the initial 6 weeks after hospitalization (small-to-moderate effect size). For nonmultiple attempters, it was associated with greater declines in functional impairment (CAFAS) at 3 and 12 months (small effect sizes). YST-II had no effects on suicide attempts and no enduring effects on SIQ-JR scores. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Potential role of the peroxynitrate-poly(ADP-ribose) synthetase pathway in a rat model of severe hemorrhagic shock

PURPOSE: The purpose of this study was to assess the performance of sealants placed by senior dental students as part of a comprehensive dental care program that included periodic patient recall. METHODS: The dental records of 100 patients ranging in age from 6 to 13 years were selected for review to determine the treatments provided for first permanent molars over time. Criteria for inclusion were: 1) at least five documented recall examinations and 2) all four first permanent molars had to have been treated with an occlusal pit and fissure sealant. The data collected included: 1) the age of the patient at the time of initial sealant placement; 2) the subsequent treatment provided to the first permanent molars, including retreatment with sealant or restoration and the date the services were provided; 3) the last date of follow-up examination in the pediatric dental program. RESULTS: A total of 400 molars were followed for an average of 54 months. Fifty-two percent of all molars received no further treatment after initial placement of sealant. Approximately 35% received retreatment with sealant only. The total number of molars receiving sealant material only was 343 (86%). The total number of teeth that were judged to require restoration was 57 (14%). No relationship was noted between the patient's age at placement of the occlusal sealant and sealant performance. CONCLUSION: In a dental school clinic, occlusal sealants were effective at preventing caries in a comprehensive care program that included periodic recall.     

Today's minimal requirements for a practical dental office infection control and exposure control program

The current climate in society regarding infectious diseases in general, and herpes, hepatitis, and HIV infections in particular, dictates that today's dental practices must use effective infection control techniques. The Occupational Safety and Health Administration continues to inspect, cite, and fine health care facilities. More states are implementing regulations concerning the operation of health care facilities. Patients are becoming more sophisticated in their scrutinizing of the dental and medical professions' approach to asepsis. Media coverage of exposure incidents is becoming more intense. All these factors leave dentists no choice; they must implement appropriate infection control techniques. The life-time cost of effective infection control is far less than one malpractice settlement. Implementation of an effective infection control program to promote dental asepsis can be cost-effective. In addition, it can be a practice builder.     

Biofeedback and relaxation training for chronic headache: A controlled comparison of booster treatments and regular contacts for long-term maintenance.

Assigned 55 adult Ss, successfully treated by 2 of the present authors in behavioral treatment for chronic headaches, to 1 of 2 follow-up conditions: (1) regular contact or (2) booster treatment. Ss assigned to regular contact were asked to continue daily monitoring of headache activity and home practice and were seen for a brief visit (10–25 min) on a monthly basis for 6 mo. Ss assigned to booster treatments received full sessions during their 6 monthly visits. Results show that at 1-yr follow-up diary records and interviews with Ss and significant others revealed no major differences between groups. Although Ss attributed a number of positive side effects to treatment, it is suggested that regular contact may be an efficient procedure for maintaining treatment gains. (21 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of parent training on infant sleeping patterns, parents' stress, and perceived parental competence.

First-time parent couples from childbirth classes were randomly assigned to a 4-session training group (n?=?29) or a control group (n?=?31). Members of the training group were taught behavioral strategies to promote healthy, self-sufficient sleep patterns in their infants, whereas the control group received the same amount of personal contact without the behavioral training. Six sleep variables were derived from a daily infant sleep diary completed by parents at 2 time points. Results show that at age 6–9 wks, infants in the training group displayed significantly better sleeping patterns than did control infants. Training group parents awakened and responded less often to infant signaling and reported greater parental competence. By contrast, control group parents indicated increased stress over time. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Correction to Gross et al. (2003).

Reports an error in the original article by D. Gross et al (Journal of Consulting and Clinical Psychology, 2003[Apr], Vol 71[2], pp. 261-278). The article was mistitled. The correct title is "Parent Training with Multi-Ethnic Families of Toddlers in Day Care in Low-Income Urban Communities". (The following abstract of the article originally appeared in record 2003-02091-006.) The authors tested a 12-week parent training program with parents (n=208) and teachers (n=77) of 2-3-year-olds in day care centers serving low-income families of color in Chicago. Eleven centers were randomly assigned to 1 of 4 conditions: (a) parent and teacher training (PT + TT), (b) parent training (PT), (c) teacher training (TT), and (d) waiting list control (C). After controlling for parent stress, PT and PT + TT parents reported higher self-efficacy and less coercive discipline and were observed to have more positive behaviors than C and TT parents. Among toddlers in high-risk behavior problem groups, toddlers in the experimental conditions showed greater improvement than controls. Most effects were retained 1 year later. Benefits were greatest when parents directly received training. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pediatric dentists' attitudes regarding parental presence during dental procedures

A controversial aspect of pediatric dentistry today is parental presence. A number of authors report an increase in the number of parents who wish to accompany their children throughout the dental appointment. Dentists historically have excluded parents from the treatment area, while pediatricians routinely keep the parent and child together. The purpose of this survey was to determine the frequency that Florida pediatric dentists permit parental presence during children's dental visits and to relate the influence of patient age, dentist's years in practice, procedure type, and practitioner attitudes on parental presence. A high return rate (98.9%) was obtained, and results indicated a significant increase in parental presence in the dental operatory and that further increases in parental presence are expected. Younger children were more likely to be accompanied by a parent for each procedure. Parental presence for examination was more likely than for restorative or extraction. Analysis of variance (ANOVA) indicated that the most frequent attitudes influencing the pediatric dentist's choice to exclude parents were that their presence: wastes time (P < 0.001); disrupts the child (P < 0.05); and makes the dentist uncomfortable (P < 0.05).     

A multiple comparison procedure to control the strong stagewise family error rate in comparing test treatments and a control

Multiple comparisons are commonly seen in clinical trials and many other fields. An example, which is the focus of this paper, is the comparison of several test treatments (possibly different doses of a compound) with placebo (control). It is well known that steps must be taken to control the type I error rate when multiple testing is performed. We introduce the concept of the strong stagewise family error rate and propose a multiple comparison procedure to control this error rate. The proposed procedure is compared to Dunnett's step-down procedure when there are two test treatment groups and a placebo group.     

Using behavioral interventions to assist children with type 1 diabetes manage blood glucose levels.

Treatment and management of chronic disease processes on children occurs across multiple settings, placing demands for consultation and expertise on school personnel, including school psychologists. One such chronic condition in children is type I diabetes. Children with type I insulin dependent diabetes mellitus exhibit high rates of noncompliance to treatment, which can lead to a variety of medical problems. This study examined the effectiveness of a specific behavioral intervention using behavioral consultation (BC) and conjoint behavioral consultation (CBC) to reduce uncontrolled blood glucose levels in medically at-risk children. An intermittent reward procedure was utilized to reinforce individualized target behaviors associated with treatment noncompliance. Specific target behaviors were individually established for six patients ages 8-12 through behavioral consultation interviews. Each child was randomly assigned to a reward + BC or reward + CBC condition. Results of the study showed that all participants improved; with slightly greater gains shown in the CBC condition. Follow-up data for 3 of the 4 participants completing the study showed improved compliance and mental health status. Treatment acceptability date indicate the intervention was viewed positively by parents and school based nurses. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A meta-analysis of bibliotherapy studies

Used meta-analysis to examine the efficacy of bibliotherapy. Bibliotherapy treatments were compared to control groups and therapist-administered treatments. The mean estimated effect size (d) of the 70 samples analyzed was + 0.565. There was no significant differences between the effects of bibliotherapy and therapist-administered treatments, as well as no significant erosion of effect sizes at follow-up. Bibliotherapy did appear more effective for certain problem types (assertion training, anxiety, and sexual dysfunction) than for others (weight loss, impulse control, and studying problems). Overall the amount of therapist contact during bibliotherapy did not seem to relate to effectiveness, but there was evidence that certain problem types (weight loss and anxiety reduction) responded better with increased therapist contact. Recommendations for future research were given, especially for more research on the commonly purchased books and moderator analyses by personality type and reading ability.     

An experimental test of adolescents' compliance with dental appointments

This study assessed factors associated with adolescents' compliance with dental appointments. Patients (n = 162) attending an adolescent clinic were administered a pretest questionnaire assessing health locus of control, self-esteem, and beliefs and attitudes about dental health from the Health Belief Model. Adolescents needing dental care were randomly assigned to groups for whom their dental appointment was made by a health professional or one in which the patient made his or her own appointment and to groups receiving an appointment reminder card versus not receiving a reminder card. Dental records were then reviewed to examine previous experiences with dental treatment. Neither the method used for making the appointment nor the use of reminder cards had a significant effect on compliance with the dental appointments. Also, compliance was not associated with health locus of control, self-esteem, or variables from the Health Belief Model. Older patients were more noncompliant than younger patients (tau = 0.14). Noncompliance was negatively correlated with the number of previous dental visits and previous dental procedures, oral hygiene instruction, and x-rays. Number of previous x-rays and previous broken appointments explained 5.1% of the variation in noncompliance. The Health Belief Model was not successful in predicting compliance behavior in this sample of adolescents.     

The clinical impact of resistance in the management of pneumococcal disease

The purpose of this report was to use a particular clinical trial, the Preventive Geriatric Trial (PGT), as a starting point to discuss whether treatment efficacy can be evaluated by means of tooth mortality. In the PGT, 296 subjects were recruited and randomly assigned to five treatment groups: (1) usual procedures (UP); (2) UP + a cognitive-behavioral intervention (CB); (3) UP + CB + weekly chlorhexidine rinse (CHX); (4) UP + CB + CHX + semi-annual fluoride varnish (F); and (5) UP + CB + CHX + F + semi-annual prophylaxis, including scaling (P). Exploratory analyses revealed that tooth mortality after the 1st year was lower in treatment groups 3, 4, and 5 than in groups 1 and 2. A one-year exposure resulted in a 45% reduction in tooth mortality (p < 0.05); a two-year exposure resulted in a 59% reduction (p-value < 0.04). The PGT findings suggested that it is possible to design trials based on clinically relevant endpoints, such as tooth mortality. For the detection of moderate treatment effects, such trials could take the form of Large, Simple Trials (LST), where many subjects are recruited with minimally restrictive entry criteria, and data are collected only on essential baseline characteristics and tooth mortality. LSTs have provided "reliable answers to important clinical questions" for other chronic diseases, and several arguments suggest that they could play a similar critical role in dental research: (1) Periodontitis and caries are among the most common and costly chronic diseases affecting humans, and the identification of even moderately effective treatments by LSTs can have a large socio-economic impact; (2) the identification of low-cost widely practicable treatments that lend themselves to be investigated in LSTs is likely to benefit more people than the identification of high-cost complex treatments; and (3) tooth mortality is simple to assess and more relevant than the unvalidated surrogate endpoints that have largely failed for more than 20 years to provide reliable answers to certain controversial issues regarding treatment efficacy. The cost of not reliably establishing the safety and the efficacy of treatments may be far greater than the cost of conducting LSTs.