Determinants of participation in an epidemiological study of preterm delivery

We describe the study design and patterns of participation for a cohort study of preterm delivery, focused on genital tract infections, nutrition, tobacco use, illicit drugs and psychosocial stress. Women are recruited at 24-29 weeks' gestation from prenatal clinics at a teaching hospital and a county health department. We recruited 57% of the first 1843 eligible women; 29% refused and 8% could not be contacted. White women were somewhat more likely to participate than African-American women (61% vs. 54% respectively). More notable differences were found comparing teaching hospital and health department clinics (71% vs. 47% participation respectively), with the health department clinic having a greater proportion refuse (24% vs. 33%) and more women who could not be contacted (4% vs. 11%). Participation was affected only minimally by day or timing of recruitment, but inability to contact diminished substantially as the study continued (13-0%). Refusals were largely unrelated to patient attributes. Lower education predicted inability to contact. Risk of preterm delivery was 14% among recruited women, 10% among women who refused, and 15% among women whom we were not able to contact, demonstrating that, overall, risk status was not lower among recruited women.     

Predictive factors for outcome of treatment for alcohol problems

Two samples of problem drinkers were followed up 2 and 4 years after they completed treatment. The first consisted of 72 men and 16 women admitted to a program for alcoholics (the inpatient sample), and the second, of 57 men and 35 women who participated in a program of outpatient treatment (the outpatient sample). At start of treatment, the outpatient sample, was generally characterized by a higher degree of social integration and more moderate alcohol problems than those found in the inpatient sample. These differences were sustained during the part of the follow-up period for which comparative data existed. In both samples it was possible to identify subgroups whose alcohol consumption throughout the observation period did not exceed average consumption in a comparative group of the Norwegian population. The most important predictive factors for alcohol consumption in the inpatient sample were degree of social integration, consumption before start of treatment, and sex. In the outpatient sample the most important factors were level of consumption and relative contribution of heavy drinking to the drinking pattern before start of treatment and the client's own goals as regards to alcohol. In both samples there was a close connection between alcohol consumed, total situation, and individual degree of satisfaction. For both groups, less frequent drinking and reduction of heavy drinking were most important for feeling satisfied with the drinking outcome. The therapeutic implications of the qualitative changes in drinking patterns are discussed.     

Impact of motivational interviewing on participation and outcome in residential alcoholism treatment.

Tested motivational interviewing (a strategy to increase motivation for change) as a preparation for residential alcoholism treatment. 28 consecutive alcoholism admissions to a psychiatric hospital were assigned alternately to receive or not to receive a 2-session motivational assessment and interview shortly after intake, in addition to standard evaluation and treatment procedures. Patients who received the motivational interview participated more fully in treatment (as evidenced by therapist ratings) and showed significantly lower alcohol consumption at a 3-mo follow-up interview. The beneficial effects of motivational interviewing on outcome were mediated by increased participation in treatment. The extent to which the received treatment outcome conformed to patients' pretreatment expectations was predictive of outcome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A controlled trial of cue exposure treatment in alcohol dependence.

The clinical effectiveness of cue exposure (CE) treatment in alcohol dependence was evaluated in a controlled trial. 35 men who were detoxified and severely alcohol dependent received either CE or relaxation control (RC) treatment. CE Ss had 400 min exposure to the sight and smell of preferred drinks over 10 days in a laboratory setting. RC Ss spent identical time in the laboratory but had relaxation therapy and only 20 min exposure to alcohol cues. During 6-mo follow-up, personal interview was achieved with 91% of Ss. CE Ss had a more favorable outcome than the RC Ss in terms of latency (length of time) to relapse of heavy drinking (p?     

Nonspecific treatment factors in psychotherapy outcome research.

Discusses salient issues raised by W. Wilkins (see record 1980-01498-001). The term nonspecific treatment factors usually refers to several, often unspecified, variables that may influence therapy outcome. The word nonspecific denotes that these factors may extend to many different techniques. Recent research has demonstrated that treatment and control conditions differing from each other in overall efficacy may also differ in such factors as their credibility to the client and in the expectancies for improvement they generate. Relatively high levels of credibility and expectancies for improvement may be inherent in most, if not all, treatments. The task for therapy research is not to demonstrate that treatment operates free from such factors. Rather, the task is to demonstrate that specific treatment techniques considered to carry the burden of client change go beyond the results that can be obtained by implementing procedures that produce change merely because of their relatively high levels of credibility and treatment-generated expectancies. The present article briefly examines the conceptual and methodological issues raised by nonspecific treatment factors and the interpretive problems these factors pose for selected outcome questions. (27 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Methodological considerations in treatment outcome research on obesity.

Identifies methodological problems in treatment research on obesity. The importance of multiple measurement of outcome, including appropriate assessment of weight, activity, and relevant physical, emotional, and social indices of adjustment, is emphasized. Traditional evaluation criteria need to be broadened to encompass factors such as cost effectiveness of treatment. The relative merits of alternative single-S and between-groups experimental designs are discussed, the latter including the treatment package, constructive, dismantling, and comparative research strategies. Ways of controlling for non-specific treatment influences are reviewed, and the contribution of client and therapist variables to outcome are mentioned. The reasons for conspicuous lack of long-term follow-ups are analyzed, and recommendations for reducing S attrition during treatment and follow-up are advanced. (80 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Determinants of outcome after carotid endarterectomy

BACKGROUND: The efficacy of carotid endarterectomy for selected patients has been evaluated with randomized controlled clinical trials. The generalizability of these studies to average surgical practice remains an important public health concern. OBJECTIVE: The objective of the study was to determine the predictors of outcome after carotid endarterectomy on a regional basis. Patients and Methods: The study was designed as a retrospective cohort study and included all consecutive patients presented for carotid endarterectomy at the 8 University of Toronto-affiliated hospitals in the period from January 1, 1994, to December 31, 1996. The main outcome measure was 30-day postoperative stroke or death rate. RESULTS: During the study interval, 1280 primary carotid endarterectomies were performed. The overall combined stroke and death rate was 6.3% for all patients who underwent endarterectomy (4.0% for patients who were asymptomatic). The significant predictors of poor outcome were the following: presenting symptoms (odds ratio, 1.74; 95% confidence interval [CI], 0.96, 3.12), low surgeon volume (<6 cases per year; odds ratio, 3.98; 95% CI, 1.65, 9.58), and left-sided surgery (odds ratio, 1.72; 95% CI, 1.07, 2.76). CONCLUSION: These data suggest that adoption of the recommendations of the symptomatic carotid endarterectomy trials is appropriate. However, endarterectomy for asymptomatic lesions remains of uncertain benefit on a regional basis and must be individualized to the experience of the specific surgeon. The surgeon volume/outcome relationship that is identified in this study suggests a need for a minimum volume threshold for this procedure.     

Changes in activation of alcohol expectancies in memory in relation to changes in alcohol use after participation in an expectancy challenge program.

Memory model-based expectancy studies have shed light on the process by which expectancies may influence drinking but have not related changes in expectancy activation to drinking changes. In the present study, 38 undergraduates completed a drinking measure and factor-based and memory model-based expectancy measures, before and after an expectancy challenge intervention designed to alter expectancies. Expectancies were mapped into memory network format with individual differences scaling and likely paths of activation were modeled with preference mapping. Results indicated that exposure to the expectancy challenge led to a change in likely activation of expectancies for men, but not for women. In the 30 days after the intervention, alcohol use among men decreased significantly but did not change among women. Therefore, changes in likely activation corresponded to changes in drinking. These findings support a memory model conceptualization of expectancy influence on drinking. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The therapeutic alliance and its relationship to alcoholism treatment participation and outcome.

The relationship between the therapeutic alliance and treatment participation and drinking outcomes during and after treatment was evaluated among alcoholic outpatient and aftercare clients. In the outpatient sample, ratings of the working alliance, whether provided by the client or therapist, were significant predictors of treatment participation and drinking behavior during the treatment and 12-month posttreatment periods, after a variety of other sources of variance were controlled. Ratings of the alliance by the aftercare clients did not predict treatment participation or drinking outcomes. Therapists ratings of the alliance in the aftercare sample predicted only percentage of days abstinent during treatment and follow-up. The results document the independent contribution of the therapeutic alliance to treatment participation and outcomes among alcoholic outpatients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Depression among cocaine abusers in treatment: relation to cocaine and alcohol use and treatment outcome

Recent studies indicate that immature B cells compete with recirculating B cells for survival signals. The signals, delivered through the B-cell receptor for antigen, induce immature cells to differentiate into recirculating cells and maintain the survival of recirculating cells. They do not induce proliferation or differentiation to antibody-producing cells.     

Therapist's style of participation and case outcome.

The purpose of this study was to develop and test a system for classifying some aspects of the therapist's behavior during the interview. The focus was on process rather than on content and involved both vocal and lexical aspects of the therapist's style of participation. 30 therapist responses were sampled from the 2nd and from the next-to-last interviews of each of 20 cases and were classified on each of 3 aspects. The behavior thus coded was vector analyzed by columns, thereby yielding factor loadings for interviews. Loadings on 2 of the resultant 3 factors were found to be related to case outcome as viewed by client and therapist. The findings for late interviews were more clear-cut than those for early interviews. Loadings on the same 2 factors were found to be related to the therapist's level of experience. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A randomized trial of individual and couple behavioral alcohol treatment for women.

Although alcohol use disorders (AUDs) adversely affect women, research on efficacious treatments for women is limited. In this randomized efficacy trial of 102 heterosexual women with AUDs, the authors compared alcohol behavioral couple therapy (ABCT) and alcohol behavioral individual therapy (ABIT) on percentage of days abstinent (PDA) and percentage of days of heavy drinking (PDH) over 6 months of treatment and 12 months of posttreatment follow-up. Baseline relationship functioning and comorbid disorders were tested as moderators of outcome. Piecewise linear growth models were used to model outcomes. During treatment, women increased their PDA and decreased their PDH, with significantly greater improvements in ABCT than in ABIT (d = 0.59 for PDA; d = 0.79 for PDH). Differences favoring ABCT were maintained during follow-up. Women with poorer baseline relationship functioning improved more on PDA during treatment with ABCT than with ABIT. For PDH, results during treatment and follow-up favored ABCT for women with better baseline relationship functioning. ABCT resulted in better outcomes than ABIT for women with Axis I disorders at the end of follow-up (PDA), and for women with Axis II disorders at the end of treatment (PDA) and at the end of follow-up (PDH). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Randomized trial of treatment for children with sexual behavior problems: Ten-year follow-up.

This study prospectively follows 135 children 5-12 years of age with sexual behavior problems from a randomized trial comparing a 12-session group cognitive-behavioral therapy (CBT) with group play therapy and follows 156 general clinic children with nonsexual behavior problems. Ten-year follow-up data on future juvenile and adult arrests and child welfare perpetration reports were collected. The CBT group had significantly fewer future sex offenses than the play therapy group (2% vs. 10%) and did not differ from the general clinic comparison (3%), supporting the use of short-term CBT. There were no group differences in nonsexual offenses (21%). The findings do not support assumptions about persistent or difficult to modify risk and raise questions about policies and practices founded on this assumption. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Determinants of midterm outcome of partial left ventriculectomy in dilated cardiomyopathy

The objective of this study was to test the hypothesis that maternal CRH concentrations are elevated in women experiencing threatened preterm labor who subsequently give birth within 24 h compared to those in women who do not. We also characterized the changes in maternal plasma cortisol, ACTH, corticosteroid binding capacity (CBC), and CRH concentrations in 28 healthy pregnant women between 20-38 weeks gestation. Overall, maternal plasma CRH concentrations were significantly greater (P < 0.05) in those women giving birth within 24 h (1343.3 +/- 143.9 pg/mL; n = 81) compared to those in women who did not (714.5 +/- 64.8 pg/mL; n = 144) or those in normal subjects. This difference was present between 28-36 weeks, but not 24-28 weeks gestation. The ratio of maternal cortisol to CBC was also significantly greater (P < 0.05; 0.65 +/- 0.04; n = 82) in women giving birth within 24 h than in those who did not (0.55 +/- 0.02; n = 136). This difference was significant at all gestational ages studied. Elevated CRH concentrations and bioavailability of free cortisol may both be implicated in the pathogenesis of preterm labor in some women. Further prospective clinical trials are warranted to determine the positive and negative predictive values of maternal CRH concentrations and/or the ratio of cortisol/CBC for identifying women with threatened preterm labor destined to give birth within 24 h.     

The Thematic Apperception Test as an outcome measure in psychotherapy research.

Correlated 2 measures of the TAT—the presence of depressive themes and the ratings of story endings—with other indicators of depression (MMPI and Beck Depression Inventory) or with ratings of improvement. 129 psychiatric hospital patients, aged 20–65 yrs, served as Ss. Results support the potential use of the TAT as an outcome measure in the treatment of depressions. (18 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Education of nonscientists about new alcohol research: results of two types of presentations plus 6-month follow-up

Education of nonscientists by scientists is assumed to be beneficial for enhancing public understanding of the research process and increasing public excitement about science. However, evaluation of audience response to receiving such information has rarely been performed. In particular, the effectiveness of communicating new research on alcohol abuse and alcohol dependence has never been evaluated. Evaluation data in the present study show significant knowledge transfer, belief changes, and participant reports of possible behavioral changes in targeted audiences. These occur when alcohol researchers present basic neuropharmacological concepts and new neurobiological research to audiences consisting primarily of chemical dependency counselors, social workers, criminal justice workers, physicians, nurses, family, clergy, and others interested in alcohol-related problems (defined as "clinicians" and the "reachable public"). Together, these results suggest that it is possible to change the beliefs, knowledge, and behavior of chemical dependency clinicians and the reachable public about alcoholism, its causes, and its treatment.     

Coercion in participation as a research subject.

Reports an unsuccessful replication of a previous study by J. C. Ascough and C. N. Sipprelle (see pa, vol. 43:2682) of operant verbal cardiac conditioning. It was hypothesized that the ss of the original study were volunteers while the replication ss were coerced into participation as part of the requirements of a course. Replication was significant (p =