Introduction to the special section on Resources for Enhancing Alzheimer's Caregiver Health (REACH).

This article provides background information and an overview on Resources for Enhancing Alzheimer's Caregiver Health (REACH) a multisite intervention trial for caregivers of persons with Alzheimer's disease designed to reduce caregiver burden and depression. REACH is the largest randomized controlled clinical trial to date, involving 1,222 caregiver and care recipient dyads recruited from 6 different sites in the United States. The authors describe the design of the study, summarize the interventions implemented at each site, and provide an overview of the 4 articles in this special section. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effect of multicomponent interventions on caregiver burden and depression: The REACH multisite initiative at 6-month follow-up.

Meta-analysis was used to examine pooled parameter estimates of 9 active compared with 6 control conditions of the Resources for Enhancing Alzheimer's Caregiver Health (REACH) project at 6 months on caregiver burden and depressive symptoms. Associations of caregiver characteristics and outcomes were examined. For burden, active interventions were superior to control conditions (p=.022). Also, active interventions were superior to control conditions for women versus men and for caregivers with lower education versus those with higher education. For depressive symptoms, a statistically significant association of group assignment was found for Miami's family therapy and computer technology intervention (p=.034). Also, active interventions were superior to control conditions for Hispanics, nonspouses, and caregivers with lower education. Results suggest interventions should be multicomponent and tailored. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Using a new taxonomy to combine the uncombinable: integrating results across diverse interventions

Researchers have examined numerous psychosocial and behavioral interventions intended to alleviate distress among family caregivers of persons with dementia. Many of these interventions are complex, combining numerous treatment components. Although some multicomponent interventions have been successful in reducing caregiver distress, the impact of specific elements of these interventions on outcomes is not known. The article presents results of an analytic approach that allows researchers to describe the individual elements of multicomponent interventions and to examine the relationships between those components and outcomes. This approach is successfully applied to interventions being evaluated in the Resources for Enhancing Alzheimer's Caregiver Health (REACH) program. The results indicate that actively targeting caregiver behavior is effective in achieving positive outcomes with respect to caregiver depression.     

Effects of occupational stress management intervention programs: A meta-analysis.

A meta-analysis was conducted to determine the effectiveness of stress management interventions in occupational settings. Thirty-six experimental studies were included, representing 55 interventions. Total sample size was 2,847. Of the participants, 59% were female, mean age was 35.4, and average length of intervention was 7.4 weeks. The overall weighted effect size (Cohen's d) for all studies was 0.526 (95% confidence interval = 0.364, 0.687), a significant medium to large effect. Interventions were coded as cognitive-behavioral, relaxation, organizational, multimodal, or alternative. Analyses based on these subgroups suggested that intervention type played a moderating role. Cognitive-behavioral programs consistently produced larger effects than other types of interventions, but if additional treatment components were added the effect was reduced. Within the sample of studies, relaxation interventions were most frequently used, and organizational interventions continued to be scarce. Effects were based mainly on psychological outcome variables, as opposed to physiological or organizational measures. The examination of additional moderators such as treatment length, outcome variable, and occupation did not reveal significant variations in effect size by intervention type. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychological treatment of late-life anxiety: An empirical review.

This study provides a meta-analytic review of nonpharmacological interventions for late-life anxiety, focusing on treatment efficacy. Included in the analysis are studies in which a comparison was made either to a control condition or to another treatment. A total of 15 outcome studies, published or reported between January 1975 and January 2002, were identified involving 495 participants (mean age exceeding 55.0 years and a grand mean of 69.5 years) and providing 20 separate treatment interventions. The analysis indicated that psychological interventions were reliably more effective than no treatment on self-rated and clinician-rated measures of anxiety, yielding an effect size of .55. Maintenance of treatment gains (a minimum of 6 months follow-up) was insufficiently reported across studies to allow for a reliable demonstration of an overall estimate of long-term efficacy. It is concluded that psychological interventions produce significant improvements, but the analyses must be qualified by data limitations in the research synthesis. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A strategy for identifying biomarkers of aging: further evaluation of hematology and blood chemistry data from a calorie restriction study in rhesus monkeys

We examined a dataset derived from a battery of hematology and blood chemistry tests to identify candidate biomarkers of aging in a sample of 33 male rhesus monkeys (Macaca mulatta) ranging in age from 4-27 years. About half this sample comprised an experimental group subjected to 30% calorie restriction for six to seven years compared to the control group fed the same nutritionally fortified diet to approximate ad lib levels. Variables that met the following criteria were selected: (1) longitudinal change within the cohorts of control monkeys; (2) cross-sectional correlation with age across the adult lifespan in the control group; (3) stability of individual differences within all groups; and (4) no obvious redundancy with other selected variables. Five variables emerged from this step-wise selection, including the percentage lymphocytes, and serum levels of alkaline phosphatase, albumin, creatinine, and calcium. These variables were then submitted to a principal component analysis, which yielded a single component accounting for about 58% of the total variance. Based on this marked degree of covariance, these candidate biomarkers of aging could be combined into a biological age score (BAS) for the control and experimental groups. When chronological age was regressed onto BAS, the slopes of the control and experimental groups could be compared. Although a trend toward a slower aging rate in calorie-restricted monkeys was apparent, this analysis did not detect a statistically significant difference in the rate of aging between these groups estimated by this index. Despite this result, a logical strategy was confirmed for expanding the search for candidate biomarkers of aging to apply to this and to other studies assessing interventions that purport to affect the rate of aging in long-lived species.     

Nonpharmacological interventions for insomnia in older adults: A meta-analysis of treatment efficacy.

The benefit of nonpharmacological interventions for insomnia in old age was investigated. A total of 13 single-outcome studies from 1966–1998 involving 388 patients (mean age exceeding 60 years, minimum age in sample, 50 years) were included in a meta-analysis of treatment efficacy. This analysis demonstrated that behavioral interventions produce improvements in sleep parameters of older insomniacs, measured in terms of sleep-onset latency, number of nocturnal awakenings, time awake after sleep onset, and total sleep time. Clinical improvements seen at posttreatment were maintained at followups (averaging 6 months). It is concluded that behavioral treatments produce significant and long-lasting improvements in the sleep pattern of older insomniacs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Matching preparatory intervention to coping style: The effects on children's distress in the dental setting

OBJECTIVE: Investigate the effects of matching preparatory interventions to patient's coping styles. METHODS: Participants were 61 children, with a restricted age range of 6 through 9 years old (mean age was 7.9 years), who underwent dental restoration. Participants were randomly assigned to an information intervention, a relaxation intervention, or a control condition. Play and parent-report of sensitization/repression were indices of coping style. The first hypothesis, that play would relate to sensitization/repression, was tested using Pearson correlations. The second hypothesis, that interventions that were congruent with patients' coping styles would be more effective than incongruent interventions, was tested using MANCOVAs. RESULTS: No relation was found between play and coping style. The "congruency hypothesis" was supported for self-reported distress immediately following the intervention. On behavioral distress variables, the interaction between sensitization/repression and condition was contrary to the congruency hypothesis. CONCLUSIONS: Implications for future research and clinical intervention with pediatric populations were discussed.     

Multisystemic therapy for child abuse and neglect: A randomized effectiveness trial.

The primary purpose of this study was to conduct a randomized effectiveness trial of Multisystemic Therapy for Child Abuse and Neglect (MST-CAN) for physically abused youth (mean age = 13.88 years, 55.8% female, 68.6% Black) and their families. Eighty-six families being followed by Child Protective Services due to physical abuse were randomly assigned to MST-CAN or Enhanced Outpatient Treatment (EOT), with both interventions delivered by therapists employed at a community mental health center. Across five assessments extending 16 months post baseline, intent-to-treat analyses showed that MST-CAN was significantly more effective than EOT in reducing youth mental health symptoms, parent psychiatric distress, parenting behaviors associated with maltreatment, youth out-of-home placements, and changes in youth placement. Also, MST-CAN was significantly more effective at improving natural social support for parents. Effect sizes were in the medium to large range for most outcomes examined. Although fewer children in the MST-CAN condition experienced an incident of reabuse than did counterparts in the EOT condition, base rates were low and this difference was not statistically significant. The findings of this study demonstrate the potential for broad-based treatments of child physical abuse to be effectively transported and implemented in community treatment settings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relative risk and timing of divorce in families of children with an autism spectrum disorder.

We compared the occurrence and timing of divorce in 391 parents of children with an autism spectrum disorder (ASD) and a matched representative sample of parents of children without disabilities using a survival analysis. Parents of children with an ASD had a higher rate of divorce than the comparison group (23.5% vs. 13.8%). The rate of divorce remained high throughout the son's or daughter's childhood, adolescence, and early adulthood for parents of children with an ASD, whereas it decreased following the son's or daughter's childhood (after about age 8 years) in the comparison group. Younger maternal age when the child with ASD was born and having the child born later in the birth order were positively predictive of divorce for parents of children with an ASD. Findings have implications for interventions focused on ameliorating ongoing and long-term marital strains for parents of children with an ASD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Patterns of sedentary behavior among adolescents.

Objective: Reducing certain sedentary behaviors (e.g., watching television, using a computer) can be an effective weight loss strategy for youth. Knowledge about whether behaviors cluster together could inform interventions. Study Design: Estimates of time spent in 6 sedentary behaviors (watching television, talking on the telephone, using a computer, listening to music, doing homework, reading) were cluster analyzed for a sample of 878 adolescents (52% girls, mean age = 12.7 years, 58% Caucasian). Main Outcome Measures: The clusters were based on the sedentary behaviors listed above and compared on environmental variables (e.g., household rules), psychosocial variables (e.g., self-efficacy, enjoyment), and health behaviors (e.g., physical activity, diet). Results: Four clusters emerged: low sedentary, medium sedentary, selective high sedentary, and high sedentary. Analyses revealed significant cluster differences for gender (p     

Medication Adherence and Diabetes Control in Urban African Americans With Type 2 Diabetes.

In 181 urban African Americans with Type 2 diabetes, medication adherence was assessed using a measure designed specifically for an urban, impoverished sociodemographic population. Hemoglobin A1c, blood pressure and cholesterol levels, medication-related beliefs, and depression were assessed. Seventy-four percent of the sample reported adherence to diabetes medication. Adherence, adjusted for age, was associated with lower hemoglobin A1c. The specific behaviors associated with poorer diabetes control were forgetting to take medications and running out of medications. Knowledge of blood glucose goals differed for adherers and nonadherers. Blood pressure and cholesterol medication adherence rates were not associated with actual levels of blood pressure or lipids, respectively. These data suggest that specific medication-taking behaviors are important to diabetes control and constitute logical targets for interventions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Profile of pediatric bicycle injuries

BACKGROUND: Bicycle injury data from local communities are important for developing injury prevention and control programs. This study represents the efforts of one community trauma center to describe bicycle injuries. METHODS: We conducted a retrospective analysis of bicycle injury data from hospital charts, emergency medical services reports, and medical examiner reports. The review encompassed a 4-year period. The study sample included 211 trauma alert patients, ages 1 through 15 years, who were treated for bicycle-related injuries at our level II pediatric trauma center. RESULTS: Bicycle injuries accounted for 18% of all pediatric trauma alert patients. The mean age of injured children was 10 years, and 79% were males. Bicycle-motor vehicle collisions caused 84% of injuries. Only 3 children (1.4%) wore bicycle helmets. Resulting injuries included external wounds (86%), head injuries (47%), fractures (29%), and internal organs (9%). Six children died. CONCLUSIONS: Bicycle injuries are a significant cause of mortality and morbidity for children in our community. Use of safety helmets by child bicyclists is inadequate. The data from this study can be used as a baseline in testing the effectiveness of local and state interventions, including new legislation mandating helmet use by children in our state.     

Young women's condom use: The influence of acceptance of sexuality, control over the sexual encounter, and perceived susceptibility to common STDs.

A comprehensive model of the determinants of condom use among young women was developed, tested, and replicated, with longitudinal follow-up to assess predictive utility of the model for condom use over time. Participants in Study 1 and Study 2 were 198 female undergraduates (mean age, 18.6 years) and 238 female undergraduates (mean age, 19.1 years), respectively. Acceptance of sexuality and control over the sexual encounter were related to a multidimensional measure of condom use self-efficacy, which predicted condom use intentions. Perceived susceptibility to STDs was both directly related to intentions and indirectly related through perceived benefits and attitudes about condom use. Intentions predicted subsequent reports of condom use. The model suggests foci for condom use interventions for young women. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of psychotherapy training and intervention use on session outcome.

Objective: This study was an investigation of the relationships among therapist training variables, psychotherapy process, and session outcome in a psychotherapy training clinic. The aims were to assess the relationship between “training as usual” and intervention use in individual psychotherapy, to investigate the relationship between therapist intervention use and session outcome, and to test whether training variables moderate this relationship. Method: Graduate student therapists (n = 19; mean age = 27 years; 79% women; 84% White) provided information about their training and completed a measure of intervention use (Multitheoretical List of Therapeutic Interventions; McCarthy & Barber, 2009) and clients (n = 42; mean age = 33 years; 64% women; 95% White) completed a measure of session outcome (Session Progress Scale; Kolden, 1991) after each session of individual psychotherapy. Results: With regard to intervention use and session outcome, no main effects were found for the training variables. Consequently, tests of moderation were not performed. The final model for intervention use and session outcome yielded main effects for time-varying interpersonal therapy and time-varying common factor use, and a 3-way interaction among time-varying cognitive–behavioral (CBT) intervention use, between-patient common factor use, and between-therapist common factor use. Patients who received more common factor interventions on average rated sessions as less helpful when more CBT interventions were employed; this finding was stronger for patients who were being treated by therapists with higher average levels of common factor use. Conclusions: Implications for training are discussed, with particular attention paid to the importance of clinical decision making and the complex interaction between common and unique technical factors in practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Differentiation of abilities, socioeconomic status, and the WISC.

The study investigated the effect of an increase in age on the factor structures of the subtests of the WISC, and the relationship between subtest scores and socioeconomic status (SES). The scores of 70 Ss, tested at ages 10 and 12, were factor analyzed and structures at the 2 age levels compared. The sample was also divided into high and low SES groups, and subtest means calculated for each group. At both age levels, between-group mean differences were significant at or beyond the .05 level of confidence in the case of verbal subtests, while factor structures, which were similar, indicated a trend towards integration of abilities. The structures defined 2 main factors, identified as verbal and performance IQ, respectively. (31 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Activity Counseling Trial (ACT): rationale, design, and methods. Activity Counseling Trial Research Group

The Activity Counseling Trial (ACT) is a multicenter, randomized controlled trial to evaluate the effectiveness of interventions to promote physical activity in the primary health care setting. ACT has recruited, evaluated, and randomized 874 men and women 35-75 yr of age who are patients of primary care physicians. Participants were assigned to one of three educational interventions that differ in amount of interpersonal contact and resources required: standard care control, staff-assisted intervention, or staff-counseling intervention. The study is designed to provide 90% power in both men and women to detect a 1.1 kcal.kg-1.day-1 difference in total daily energy expenditure between any two treatment groups, and over 90% power to detect a 7% increase in maximal oxygen uptake, the two primary outcomes. Primary analyses will compare study groups on mean outcome measures at 24 months post-randomization, be adjusted for the baseline value of the outcome measure and for multiple comparisons, and be conducted separately for men and women. Secondary outcomes include comparisons between interventions at 24 months of factors related to cardiovascular disease (blood lipids/lipoproteins, blood pressure, body composition, plasma insulin, fibrinogen, dietary intake, smoking, heart rate variability), psychosocial effect, and cost-effectiveness, and at 6 months for primary outcome measures. ACT is the first large-scale behavioral intervention study of physical activity counseling in a clinical setting, includes a generalizable sample of adult men and women and of clinical setting, and examines long-term (24 months) effects. ACT has the potential to make substantial contributions to the understanding of how to promote physical activity in the primary health care setting.     

Bioavailability of rifampicin, isoniazid and pyrazinamide from fixed-dose combination capsules

Due to the observation of severe neurological symptoms in single patients as well as brain imaging, neuropsychological and neurophysiological abnormalities, the long-term prognosis of treated phenylketonuria is still under discussion. We investigated the neurological outcome of 57 (24 male, 33 female) patients with phenylketonuria (diet onset < 3 months) at a mean age of 23.6 (17-33) years in comparison to control subjects. Methods used were a clinical-neurological examination, tests for fine motor abilities, IQ test (WAIS-R), a neuropsychological attention task and MRI (30 patients only). Tremor was increased in the patients (28%) compared to controls (15%). Fine motor abilities were significantly reduced in three areas: hand-wrist steadiness, finger-hand dexterity and hand-wrist speed. Tremor as well as reduced fine motor skills were not associated with treatment-related variables, e.g. diet onset, strictness of biochemical control or amount of MRI white matter change. IQ was lower in patients (mean 97.6) compared to matched control subjects (mean 105.5). IQ at 12 years was correlated with biochemical control from birth up to the age of 12 and remained stable up to adult age, independent of biochemical control after 12 years of age. In contrast to the other outcome parameters, the performance in a neuropsychological attention task was influenced by the concurrent plasma phenylalanine concentration. Specific late-onset neurological impairment was not identified in this sample of early-treated adults with phenylketonuria. CONCLUSION: Careful neurological investigation revealed subtle symptoms of brain damage even after early-initiated treatment in adult patients with phenylketonuria. At present it cannot be excluded that further neurological deterioration could emerge later in life. Thus, patients with phenylketonuria - either on or off diet - should be monitored throughout life.     

Behavior Therapists' Professional Behaviors: A Survey Study.

Behavior therapy is often associated with an empirical-clinical methodology (Goldfried & Davison, 1976) and utilization of clinical interventions that have received research validation. Yet the extent to which self-defined behavior therapists follow these guidelines is not known. To initiate the present study, a survey was made of a random sample of 250 members of the Association for Advancement of Behavior Therapy, with a 64% return rate. The results suggest that behavior therapists do not operationalize their theoretical guidelines in many of their actual clinical cases. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A prospective study of the efficacy of the physician order form for life-sustaining treatment

OBJECTIVES: The Physician Orders for Life-Sustaining Treatment (POLST), a comprehensive, one-page order form, was developed to convey preferences for life-sustaining treatments during transfer from one care site to another. This study examined the extent to which the POLST form ensured that nursing home residents' wishes were honored for Do Not Resuscitate (DNR) and requests for transfer only if comfort measures fail. DESIGN: The study used chart record data to follow prospectively a sample of nursing home residents with the POLST. SETTING: Eight geographically diverse, long-term, adult-care facilities in Oregon in which the POLST was in use. PARTICIPANTS: Nursing home residents (n = 180), who had a POLST recording DNR designation and who indicated a desire for transfer only if comfort measures failed, were followed for 1 year. MEASUREMENTS: For all subjects: treatment and disposition after significant health status changes; orders for narcotics and for provision or limitation of aggressive interventions. For hospitalized subjects: diagnosis, medical interventions, and DNR orders. For those who died: cause and location of death, life-sustaining treatments attempted, and comfort measures provided. RESULTS: No study subject received CPR, ICU care, or ventilator support, and only 2% were hospitalized to extend life. Of the 38 subjects who died during the study year, 63% had an order for narcotics, and only two (5%) died in an acute care hospital. A total of 24 subjects (13%) were hospitalized during the year. Hospitalized subjects' mean length of stay was 4.9 days, and the mean rate of hospitalizations for all subjects was 174 per 1000 resident years. In 85% of all hospitalizations, patients were transferred because the nursing home could not control suffering. In 15% of hospitalizations (n = 4), the transfer was to extend life, overriding POLST orders. CONCLUSIONS: POLST orders regarding CPR in nursing home residents in this study were universally respected. Study subjects received remarkably high levels of comfort care and low rates of transfer for aggressive life-extending treatments.