Acupuncture outcomes, expectations, patient-provider relationship, and the placebo effect: implications for health promotion.
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OBJECTIVES: To explore whether treatment outcomes are associated with a patient's degree of general hopefulness, expectations regarding treatment, attributions of health status, beliefs about mind-body dualism, and patient-provider relationship factors, I studied acupuncture patients' goal attainment. METHODS: Sixty-two acupuncture patients were interviewed before and after acupuncture regarding goal attainment, mind-body beliefs, hopefulness, and attributions of health status. Demographics, acupuncture treatment, and health care usage information was also collected. Acupuncturists provided 3 months of treatment. RESULTS: Patients reported treatment goal attainment from acupuncture. Their perceived outcomes were not associated with previous treatment, patient demographics, or the expected and actual numbers of needle insertion. Successful outcomes were related positively to number of different CAM treatments used in the past year but negatively to patients' expectations and the "Powerful Others" health locus of control dimension. CONCLUSIONS: Perceived acupuncture outcomes seem not to be related to placebo effects and patient expectations, but rather to client-practitioner relationship factors. (+info)
Effects of public posting, goal setting, and oral feedback on the skills of female soccer players.
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We evaluated the effects of public posting, goal setting, and oral feedback on the skills of 3 female high school soccer players during practice scrimmages. The dependent variables were the percentage of appropriate responses when the player (a) kept and maintained possession of the ball, (b) moved to an open position during a game restart (e.g., goal or corner kick), and (c) moved to an open position after passing the ball. We also assessed the extent to which changes in practice performances generalized to games. A social validity questionnaire was completed by both players and coaches to assess the acceptability of the intervention's goals, procedures, and outcomes. Results indicate that the intervention was effective in improving performances during practice scrimmages but produced limited generalization to game settings. (+info)
The effects of a public address system on the off-task behavior of elementary physical education students.
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The purpose of this study was to determine the effects of teacher feedback delivered via a public address system on the off-task behavior of elementary-school physical education students. A multiple baseline design across three classes was used in this investigation. Results indicated a consistent decline in off-task behavior when the public address feedback system was used. (+info)
Multi-ethnic study of atherosclerosis: objectives and design.
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The Multi-Ethnic Study of Atherosclerosis was initiated in July 2000 to investigate the prevalence, correlates, and progression of subclinical cardiovascular disease (CVD) in a population-based sample of 6,500 men and women aged 45-84 years. The cohort will be selected from six US field centers. Approximately 38% of the cohort will be White, 28% African-American, 23% Hispanic, and 11% Asian (of Chinese descent). Baseline measurements will include measurement of coronary calcium using computed tomography; measurement of ventricular mass and function using cardiac magnetic resonance imaging; measurement of flow-mediated brachial artery endothelial vasodilation, carotid intimal-medial wall thickness, and distensibility of the carotid arteries using ultrasonography; measurement of peripheral vascular disease using ankle and brachial blood pressures; electrocardiography; and assessments of microalbuminuria, standard CVD risk factors, sociodemographic factors, life habits, and psychosocial factors. Blood samples will be assayed for putative biochemical risk factors and stored for use in nested case-control studies. DNA will be extracted and lymphocytes will be immortalized for genetic studies. Measurement of selected subclinical disease indicators and risk factors will be repeated for the study of progression over 7 years. Participants will be followed through 2008 for identification and characterization of CVD events, including acute myocardial infarction and other coronary heart disease, stroke, peripheral vascular disease, and congestive heart failure; therapeutic interventions for CVD; and mortality. (+info)
Goal setting and attainment in Alzheimer's disease patients treated with donepezil.
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OBJECTIVES: To understand the treatment goals of Alzheimer's disease (AD) patients, carers, and physicians; to estimate whether clinically important goals are met during treatment with donepezil; and to compare a measure of goal attainment with standard measures used to evaluate AD treatment. METHODS: In a 12 month phase IV trial, 108 patients with mild to moderate AD, their primary carers, and treating physicians set goals assigned to five domains, using Goal Attainment Scaling (GAS) as the primary outcome. Goal attainment was assessed quarterly. GAS scores were correlated with standard outcomes, including the Alzheimer's Disease Assessment Scale-Cognitive (ADAS-cog), and the Clinician's Interview-Based Impression of Change-Plus (CIBIC-plus). RESULTS: Physicians set fewer goals (342, mean (SD) per patient=3 (1)) than patients/carers (855, mean=9 (3)), particularly in leisure (20% by physicians compared with 76% by patients/carers), and social interaction (24% versus 49%). Physicians observed statistically significant improvement in global goal attainment for six months, and patients/carers for nine months. Patients/carers described consistent goal attainment, whereas physicians observed variable effects, such as decline in cognition but improved social interaction and behaviour. Physician global GAS scores correlated highly with the CIBIC-plus at weeks 12 (r= -0.82) and 52 (r=-0.80), but not with the ADAS-cog (r=0.12 and r=-0.45, respectively). Patient/carer global GAS scores correlated moderately with the physician's CIBIC-plus (week 12 r=-0.51; week 52 r=-0.56), and nominally with the ADAS-cog. CONCLUSIONS: Patients/carers and physicians differ in their expectations and impressions of treatment effects. Clinically important changes correlated only modestly with psychometric tests. Attainment of treatment goals does not accord with a simplistic model in which successful AD treatment means that all declines uniformly improve. (+info)
The Health Intervention Project: HIV risk reduction among African American women drug users.
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OBJECTIVE: This article describes the Health Intervention Project, an intervention for African American women in Atlanta, Georgia, who are crack cocaine users. METHODS: A formative phase involved ethnographic mapping of the physical and social infrastructure of the study communities and in-depth interviews with women crack cocaine users. Key findings that were incorporated into the intervention program included the exchange of sex for money or drugs, the women's experience with trauma and abuse, the role of men and male partners, the women's roles as mothers and members of extended families, their identity as African Americans, and their desire to reduce their risk for HIV/AIDS related to their drug use and sexual behavior. Individualized intervention sessions were designed to meet the women's needs. The motivation intervention emphasized self-motivation for behavioral change with the assistance of the interventionist, who facilitated the women's goal identification, action plan, and problem-solving skills. The negotiation intervention focused on improving technical and assertive communication skills. An action plan was developed, and the women worked on negotiation skills, self-control regarding sexual and drug-use encounters, assertiveness in sexual and drug-use interactions, and conflict resolution. CONCLUSION: Effective prevention and intervention programs must be framed within an appropriate racial, ethnic, and cultural context. Future research is needed to better understand risk in its social context, including the impact of community factors. (+info)
Information model and terminology model issues related to goals.
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Goal statements are a significant component of structures that support the process of health care delivery such as practice guidelines, standards of care, critical pathways, disease management plans, patient education plans, and nursing care plans. Although these structures are increasingly computer-based, there has been little attention to the formal representation of goal statements. This is a necessary prerequisite for enabling semantic interoperability. Existing and evolving information model and terminology model standards offer some approaches that may be applicable to goal statements, however, a number of issues require resolution (+info)
The movement for universal health insurance: finding common ground.
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Before 1971, all proposals for universal health insurance were based on private sector financing and administration. After 1971, universal health insurance plans relying on the private sector complicated efforts of the universal health insurance movement. To forge as broad a movement for universal health insurance as possible, it may be worthwhile for universal health insurance advocates of different persuasions to seek common ground on the basis of a set of goals for a new health care system. The goals can serve as a measuring stick to determine which health insurance plans are worthy of support. (+info)