Extinction of responding maintained by timeout from avoidance.
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The resistance to extinction of lever pressing maintained by timeout from avoidance was examined. Rats were trained under a concurrent schedule in which responses on one lever postponed shock on a free-operant avoidance (Sidman) schedule (response-shock interval = 30 s) and responses on another lever produced 2 min of signaled timeout from avoidance on a variable-ratio 15 schedule. Following extended training (106 to 363 2-hr sessions), two experiments were conducted. In Experiment 1 two different methods of extinction were compared. In one session, all shocks were omitted, and there was some weakening of avoidance but little change in timeout responding. In another session, responding on the timeout lever was ineffective, and under these conditions timeout responding showed rapid extinction. The within-session patterns produced by extinction manipulations were different than the effects of drugs such as morphine, which also reduces timeout responding. In Experiment 2 shock was omitted for many consecutive sessions. Response rates on the avoidance lever declined relatively rapidly, with noticeable reductions within 5 to 10 sessions. Extinction of the timeout lever response was much slower than extinction of avoidance in all 4 rats, and 2 rats continued responding at baseline levels for more than 20 extinction sessions. These results show that lever pressing maintained by negative reinforcement can be highly resistant to extinction. The persistence of responding on the timeout lever after avoidance extinction is not readily explained by current theories. (+info)
Relationships between various attitudes towards self-determination in health care with special reference to an advance directive.
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OBJECTIVES: The subject of patient self-determination in health care has gained broad interest because of the increasing number of incompetent patients. In an attempt to solve the problems related to doctors' decision making in such circumstances, advance directives have been developed. The purpose of this study was to examine relationships between public attitudes towards patient autonomy and advance directives. SUBJECTS AND MAIN OUTCOME MEASURES: A stratified random sample of 600 adults in northern Sweden was surveyed by a questionnaire with a response rate of 78.2%. The subjects were asked about their wish for control of their health care, their concerns about health care, their treatment preferences in a life-threatening situation (both reversible and irreversible), and their attitudes towards the application of advance directives. RESULTS: Numerous relationships between various aspects of self-determination in health care (desire for control, fears of over-treatment, and choice of treatment level) in general and advance directives, in particular, were found. Those who wanted to have a say in their health care (about 94%) also mainly supported the use of an advance directive. CONCLUSIONS: The fact that almost 30% of the respondents were undecided concerning their personal use of advance directives points to a lack of knowledge and to the necessity of education of the public on these issues. (+info)
Changing trends in barriers to cataract surgery in India.
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Cataract is a major cause of blindness in Asia. Efforts in India to provide cataract surgical services have had limited success in reaching the cataract-blind population. Earlier studies identified the major barriers to cataract surgery as poverty, lack of transportation or felt need, or sex related; and the critical barriers in rural areas as lack of awareness, difficult access, and cost. Compared with these earlier data, the results of the present study in Karnataka State indicate a shift in the character of the barriers. They now appear to be more related to case selection and service provision. These shifts are analysed and alternative strategies to increase the uptake to cataract surgery are recommended. (+info)
Factors associated with refusal to treat HIV-infected patients: the results of a national survey of dentists in Canada.
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OBJECTIVES: This study investigated dentists refusal to treat patients who have HIV. METHODS: A survey was mailed to a random sample of all licensed dentists in Canada, with 3 follow-up attempts (n = 6444). Data were weighted to allow for probability of selection and nonresponse and analyzed with Pearson's chi 2 and multiple logistic regression. RESULTS: The response rate was 66%. Of the respondents, 32% had knowingly treated HIV-infected patients in the last year; 16% would refuse to treat HIV-infected patients. Respondents reported willingness to treat HIV-infected patients (81%), injection drug users (86%), hepatitis B virus-infected patients (87%), homosexual and bisexual persons (94%), individuals with sexually transmitted disease(s) (94%), and recipients of blood and blood products (97%). The best predictors of refusal to treat patients with HIV were lack of ethical responsibility (odds ratio = 9.0) and items related to fear of cross-infection or lack of knowledge of HIV. CONCLUSIONS: One in 6 dentists reported refusal to treat HIV-infected patients, which was associated primarily with respondents' lack of belief in an ethical responsibility to treat patients with HIV and fears related to cross-infection. These results have implications for undergraduate, postgraduate, and continuing education. (+info)
Effect of butorphanol tartrate on shock-related discomfort during internal atrial defibrillation.
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BACKGROUND: In patients with atrial fibrillation, intracardiac atrial defibrillation causes discomfort. An easily applicable, short-acting analgesic and anxiolytic drug would increase acceptability of this new treatment mode. METHODS AND RESULTS: In a double-blind, placebo-controlled manner, the effect of intranasal butorphanol, an opioid, was evaluated in 47 patients with the use of a step-up internal atrial defibrillation protocol (stage I). On request, additional butorphanol was administered and the step-up protocol continued (stage II). Thereafter, if necessary, patients were intravenously sedated (stage III). After each shock, the McGill Pain Questionnaire was used to obtain a sensory (S), affective (A), evaluative (E), and total (T) pain rating index (PRI) and a visual analogue scale analyzing pain (VAS-P) and fear (VAS-F). For every patient, the slope of each pain or fear parameter against the shock number was calculated and individual slopes were averaged for the placebo and butorphanol group. All patients were cardioverted at a mean threshold of 4.4+/-3.3 J. Comparing both patient groups for stage II, the mean slopes for PRI-T (P=0.0099), PRI-S (P=0.019), and PRI-E (P=0.015) became significantly lower in the butorphanol group than in the placebo group. Comparing patients who received the same shock intensity ending stage I and going to stage II, in those patients randomized to placebo the mean VAS-P (P=0.023), PRI-T (P=0. 029), PRI-S (P=0.030), and PRI-E (P=0.023) became significantly lower after butorphanol administration. CONCLUSIONS: During a step-up internal atrial defibrillation protocol, intranasal butorphanol decreased or stabilized the value of several pain variables and did not affect fear. Of the 3 qualitative components of pain, only the affective component was not influenced by butorphanol. The PRI evaluated pain more accurately than the VAS. (+info)
Attitudes toward colon cancer gene testing: survey of relatives of colon cancer patients.
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OBJECTIVES: Various studies have identified psychosocial factors that may influence attitudes toward colon cancer gene testing. Whereas family history of colon cancer has been associated with interest in gene testing, this has not been examined extensively. We hypothesized that the strength of family history of colon cancer is associated with risk perception and willingness to undergo gene testing. MATERIALS AND METHODS: We evaluated attitudes toward colon cancer gene testing among persons who had at least one first-degree relative with colon cancer. A total of 2680 at-risk relatives in 863 kindreds were identified and mailed an extensive survey regarding sociodemographic variables, family history, health behaviors and knowledge, and willingness to take a colon cancer gene test. A total of 56.6% of persons completed and returned surveys. We conducted a brief telephone survey of a random sample of 200 persons who did not respond to the mail survey. RESULTS: The combined study sample of 1373 people was 42% male, had a mean age of 55 +/- 15 years, was 96% white, and had moderate-to-high SES. A total of 77.4% were very likely to take the gene test, and 92.4% were somewhat or very likely to take the gene test. A total of 78% of the sample perceived a higher colon cancer risk, although patterns of risk perception and worry differed significantly between mail survey and telephone survey respondents. More of the telephone survey respondents were also somewhat unlikely or very unlikely to take the gene test compared to the mail survey respondents (13.7% versus 6.9%). In the combined sample, concern about developing colon cancer and risk perception increased with number of relatives with colon cancer (P < 0.0001). Eight percent expressed no concern about developing colon cancer; 4.8% felt their chance of developing colon cancer was lower than others of the same age, sex, and race; and 3.3% felt that they were very unlikely to develop colon cancer in their lifetime. However, there was strong interest in gene testing regardless of the number of affected relatives, and persons with more affected relatives were generally willing to pay more for the gene test (up to $1000). CONCLUSIONS: The strength of family history of colon cancer is associated with risk perception but not with willingness to undergo gene testing. (+info)
Effect of nonaversive and aversive stimulations in infancy on the acoustic startle response in adult rats.
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Two groups, each consisting of 8 three-week-old rat pups, were exposed to different behavioral treatments with the aim to determine how the experimental manipulation influenced their adult emotional reactivity. Every day for two weeks the pups from the first group received 15 min of handling whereas the animals from the second group were exposed to various aversive stimuli, differing each day. Following these manipulations, after a 5-day break the acoustic startle response (ASR) was measured in all animals and the testing was repeated after another four weeks. Statistical analysis of the data revealed significant differences between groups in the ASR parameters. Surprisingly, in the test which directly followed the treatment the mean ASR amplitudes were similar in both groups. Highly significant differences, however, were observed in the ASR amplitude four weeks later. The rats from the handling group responded with greater amplitudes. The latency of the ASR was significantly shorter in the nonaversive group compared with the second group exposed to aversive stimuli. The results suggest that early exposure to aversive stimulation significantly decreases rats emotional reactivity whereas nonaversive and impoverished stimulation clearly elevates arousal levels when the animal is placed in a novel situation. (+info)
Emotional stress and characteristics of brain noradrenaline release in the rat.
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We have investigated several characteristics of the rat brain noradrenaline (NA) release caused by various stressful situations. Stresses such as immobilization or electric foot shock, wherein the physical factors rather than emotional ones were greatly involved, caused more marked increases in NA release in the more extended brain regions, as compared to psychological stress and conditioned fear, which caused increases in NA release preferentially in the hypothalamus, amygdala and locus coeruleus (LC) region. When the electric shock stress and psychological stress for 1 hr daily were repeated for 5 consecutive days, increases in brain NA release induced by electric shock were rapidly reduced, but those caused by psychological stress were enhanced rather than reduced. Rats with no stressor controllability (uncontrollable) had more severe gastric lesions and more marked increases in NA release in such brain regions as the hypothalamus and amygdala after 21 hrs of training than controllable rats. Rats with no opportunity to predict electric shock exhibited more severe gastric lesions and more marked increases in hypothalamic NA release than the predictable rats. The rats not allowed to express their aggression had more severe gastric mucosal lesions and a more noticeable and persistent increases in extracellular NA content in the amygdala determined by intracerebral microdialysis than the rats allowed to express aggression by biting a wooden stick in front of them during stress exposure. In aged rats (12 months old), recovery from increases in NA release in the hypothalamus and amygdala and increases in plasma corticosterone were much later than in young (2-month-old) rats. When rats were exposed to a series of six 15-min stress interrupted by 18-min non-stress periods for 180 min, they had much greater increases in brain NA release than rats stressed continuously for 180 min. Based upon these findings, we suggest that such stresses might be harmful to our health as psychological, uncontrollable and unpredictable stresses, stress unable to express aggression, stress in elderly people, and stress with lack of suitable rest. (+info)