Advising parents of asthmatic children on passive smoking: randomised controlled trial.
(17/4618)
OBJECTIVE: To investigate whether parents of asthmatic children would stop smoking or alter their smoking habits to protect their children from environmental tobacco smoke. DESIGN: Randomised controlled trial. SETTING: Tayside and Fife, Scotland. PARTICIPANTS: 501 families with an asthmatic child aged 2-12 years living with a parent who smoked. INTERVENTION: Parents were told about the impact of passive smoking on asthma and were advised to stop smoking or change their smoking habits to protect their child's health. MAIN OUTCOME MEASURES: Salivary cotinine concentrations in children, and changes in reported smoking habits of the parents 1 year after the intervention. RESULTS: At the second visit, about 1 year after the baseline visit, a small decrease in salivary cotinine concentrations was found in both groups of children: the mean decrease in the intervention group (0.70 ng/ml) was slightly smaller than that of the control group (0.88 ng/ml), but the net difference of 0.19 ng/ml had a wide 95% confidence interval (-0.86 to 0.48). Overall, 98% of parents in both groups still smoked at follow up. However, there was a non-significant tendency for parents in the intervention group to report smoking more at follow up and to having a reduced desire to stop smoking. CONCLUSIONS: A brief intervention to advise parents of asthmatic children about the risks from passive smoking was ineffective in reducing their children's exposure to environmental tobacco smoke. The intervention may have made some parents less inclined to stop smoking. If a clinician believes that a child's health is being affected by parental smoking, the parent's smoking needs to be addressed as a separate issue from the child's health. (+info)
The development of a structured rating schedule (the BAS) to assess skills in breaking bad news.
(18/4618)
There has been considerable interest in how doctors break bad news, with calls from within the profession and from patients for doctors to improve their communication skills. In order to aid clinical training and assessment of the skills used in breaking bad news there is a need for a reliable, practical and valid, structured rating schedule. Such a rating schedule was compiled from agreed criteria in the literature. Video-taped recordings of simulated consultations breaking bad news were independently assessed by three raters using the schedule and compared to three experts who gave global ratings. The primary outcome measures were internal consistency of the schedule and level of agreement between raters. The internal consistency was high with a Cronbach's alpha of 0.93. Agreement between raters using the schedule was moderate to good. The majority of the variation in scores was due to the differences in skills demonstrated in the interviews. The agreement between raters not using the schedule was poor. The BAS provides a simple to use, reliable, and consistent rating schedule for assessing skills used in breaking bad news. It could be a valuable aid to teaching this difficult task. (+info)
Communication and interpretation of risk.
(19/4618)
The 'new genetics' enables people's risk status for many diseases and disorders to be assessed much more accurately than before, yet considerable uncertainty remains over how risk information will be evaluated and acted upon. This paper summarises some of the main themes of psychological research on risk. Risk is traditionally defined in terms of probability. However, people often have difficulty in processing statistical information and may rely instead on simplified decision rules. Decision making under risk is also critically affected by people's subjective assessments of benefits and costs. In the field of genetic risk, such assessments may vary greatly between individuals, reflecting personal and cultural preferences and ethical concerns. The goals of risk communication should, therefore, not be merely the imparting of statistical 'facts' or the reduction of anxiety, but also enabling individuals and their families to make important decisions under conditions of uncertainty. (+info)
Teenage partners' communication about sexual risk and condom use: the importance of parent-teenager discussions.
(20/4618)
CONTEXT: Teenagers' communication with their partners about sex and their use of condoms may be influenced by the discussions teenagers have with their parents about sex. However, little is known about the process of parent-teenager communication on this topic. Understanding both what parents discuss with their children and how they discuss it may lead to a greater understanding of teenagers' sexual behavior. METHODS: Interviews were conducted with 372 sexually active black and Hispanic youth aged 14-17 from Alabama, New York and Puerto Rico. Regression analyses were used to examine parent-teenager discussions about sexuality and about sexual risk, and parental communication skills as predictors of teenagers' discussions about sexual risk with a partner and teenagers' condom use. RESULTS: Parent-teenager discussions about sexuality and sexual risk were associated with an increased likelihood of teenager-partner discussions about sexual risk and of teenagers' condom use, but only if parents were open, skilled and comfortable in having those discussions. Teenagers' communication with their partner about sexual risk also was associated with greater condom use, but the relationship between parent-teenager communication and teenagers' condom use was independent of this association. CONCLUSIONS: The influence on teenagers of parent-teenager discussions about sexuality and sexual risk depends on both what parents say and how they say it. Programs that foster parent-teenager communication about sexuality and sexual risk must emphasize both of these aspects. (+info)
Reducing indices of unhappiness among individuals with profound multiple disabilities during therapeutic exercise routines.
(21/4618)
A program was developed to reduce indices of unhappiness that accompanied therapeutic exercise routines among people with profound multiple disabilities. Indices of unhappiness were recorded, using an observation system that had been validated through previous research involving happiness-related variables, while support personnel conducted exercises with 3 participants. A multicomponent program was then implemented that involved presenting highly preferred stimuli before, during, and after each exercise session. Results indicated that the program was accompanied by reduced indices of unhappiness for each participant relative to the traditional method of conducting the exercises, although changes in the preferred stimuli used with 1 participant were required before consistent reductions occurred. Results are discussed regarding the importance of reducing unhappiness indices as a means of enhancing aspects of the daily quality of life for people with profound multiple disabilities. Areas for future research are also discussed, focusing on expanding the unhappiness-reduction procedures to other routine events that may occasion indices of unhappiness. (+info)
The impact of functional analysis methodology on treatment choice for self-injurious and aggressive behavior.
(22/4618)
Self-injurious behavior (SIB) and aggression have been the concern of researchers because of the serious impact these behaviors have on individuals' lives. Despite the plethora of research on the treatment of SIB and aggressive behavior, the reported findings have been inconsistent regarding the effectiveness of reinforcement-based versus punishment-based procedures. We conducted a literature review to determine whether a trend could be detected in researchers' selection of reinforcement-based procedures versus punishment-based procedures, particularly since the introduction of functional analysis to behavioral assessment. The data are consistent with predictions made in the past regarding the potential impact of functional analysis methodology. Specifically, the findings indicate that, once maintaining variables for problem behavior are identified, experimenters tend to choose reinforcement-based procedures rather than punishment-based procedures as treatment for both SIB and aggressive behavior. Results indicated an increased interest in studies on the treatment of SIB and aggressive behavior, particularly since 1988. (+info)
Building peace from scratch: some theoretical and technological aspects.
(23/4618)
A peace-building process is based on activity, acceptance, understanding of political reality, communication, and empowerment. Acceptance means accepting everybody as he or she is and let each know it. This is at the heart of peace work, it is the prerequisite for effective communication, and includes accepting other even in cases of severe disagreement. Peace work requires both an understanding of political reality and the expression of one's own political opinion. Acceptance and the expression of political opinion are not at variance but complementary. Combining acceptance and understanding of the political context provides hope for real communication in which messages are both sent and received, with appreciation and interest. Empowerment implies overcoming of the feeling of powerlessness, often present in conflict by all sides and in all social groups. It includes recovery of self-respect and respect for others. Education and economic independence are important facets of the empowerment concept. Essential principles of peace-building process are responsibility, solidarity, cooperation, and nonviolence. Responsibility encompasses caring for human rights, the suffering of others, and for consequences of our own intended and unintended actions. Solidarity allows learning through listening and understanding. Even with the best intentions on both sides, cooperation may be difficult and painful. Nonviolence is a way of life. (+info)
Identifying appropriate tasks for the preregistration year: modified Delphi technique.
(24/4618)
OBJECTIVES: To identify the tasks that should constitute the work of preregistration house officers to provide the basis for the development of a self evaluation instrument. DESIGN: Literature review and modified Delphi technique. SETTING: Northern Deanery within the Northern and Yorkshire office NHS executive. SUBJECTS: 67 educational supervisors of preregistration house officers. MAIN OUTCOME MEASURES: Percentage of agreement by educational supervisors to tasks identified from the literature. RESULTS: Over 61% of communication items, 70% of on call patient care items, 75% of routine patient care items, 45% of practical procedure items, and over 63% of self management items achieved over 95% agreement that they should be part of the house job of preregistration house officers. Poor agreement was found for the laboratory and clinical investigations that house officers could perform with or without supervision. CONCLUSIONS: The tasks of house officers were identified but issues in using this method and in devising a universally acceptable list of tasks for preregistration house officers were apparent. (+info)