Effects of Social Demand on Reports of Self-Monitored Blood Glucose in Adolescents with Type 1 Diabetes Mellitus

The purpose of this study was to test the hypothesis that social demand could substantially affect reports of self-monitored blood glucose (BG) in adolescents with insulin-dependent diabetes mellitus. Of 34 patients initially enrolled in the study, 10 were excluded because they did not bring any BG records with them to an outpatient clinic appointment. The remaining 24 patients were randomly assigned to either a low or high social demand condition that provided instructions for monitoring of BG for the week following the appointment. The subjects' BG records were quantified to provide frequency of measurement and mean reported BG for the week prior to and after the clinic visit. Five subjects did not return their BG records for the week following the intervention. The analyses were therefore based on the 19 subjects from whom complete records were obtained. The 12 subjects in the low social demand group and 7 subjects in the high social demand group were equivalent with regard to age, duration of diabetes, socioeconomic status, and glycosylated hemoglobin. Frequency of BG measurement was similar in both groups during both weeks. The mean BG value reported in the week prior to intervention was similar for the groups. However, analyses of the post-intervention BGs revealed that subjects in the low-demand group reported significantly higher BGs compared to pre-intervention and to subjects in the high-demand group. These findings suggest that self-monitoring and reporting of BG is a social behavior that is affected by the demand characteristics of the interpersonal patient-health provider relationship. Because optimal treatment planning for individuals with diabetes requires accurate BG records, care must be taken to interpret them in light of the social demand characteristics associated with clinical assessment.     

A survey of celiac-sprue patients: effect of dietary restrictions on religious practices

Celiac-Sprue Disease, also referred to as Non-Tropical Sprue, is a dietary disease. Celiac-Sprue patients were asked to complete a questionnaire regarding the effect of dietary restrictions on participation in the Passover meal and reception of Communion. A pilot study suggested that subjects made changes in their religious practices because of dietary restrictions. A second, more detailed survey, was performed in which 58 subjects participated and 14 religions were represented. The results indicated that many subjects made changes in their religious practices (p less than .01), made changes on their own initiative (p less than .01), or violated diet prescribed for the disease under the religious setting versus other settings (p less than .05).     

Encoding and retrieval processes in learning-disabled, head-injured, and nondisabled young adults

Using a multi-trial, free-recall paradigm (Rey Auditory-Verbal Learning Test; Lezak, 1983), the acquisition and retention by learning disabled (LD) young adults with a Halstead Impairment Index less than or equal to 0.3 (low LD) or greater than or equal to 0.4 (high LD) was compared with that of nondisabled and head-injured (HI) young adults. Significant group differences, particularly during the last three acquisition trials, confirmed the effectiveness of this method in revealing subtle learning and retention deficits. Analyses of Trial 1 recall showed group differences in the prerecency but not the recency portion of the serial position curve, thus implicating long-term but not short-term memory differences between the groups. Analyses of pair frequency (Sternberg & Tulving, 1977) data showed that the three clinical groups had difficulty organizing the to-be-learned material for effective retrieval. Following an interpolated task, retention was poorer for the clinical groups than for the nondisabled and varied inversely with the degree of neuropsychological impairment. Finally, during retention, the nondisabled and low LD groups retained and used the list organization established during acquisition whereas the high LD and HI groups did not.     

The impact of the therapeutic environment

This paper emphasizes the impact of the setting, space, and general physical properties of the clinic upon the difficult patient's profound neediness and absence of inner regulatory structure. Moreover, the clinic's administrative style and requirements often related to fiscal restraints, demands for accountability for both how funds are spent and treatment outcome, all impinge upon the patient. Humanizing clinics so they have the capacity for psychotherapeutic holding and provision of safety for difficult patients are discussed in detail in this contribution.     

Systemic crisis intervention as a response to adolescent crises: an outcome study

The present study demonstrates the safety and effectiveness of an outpatient program designed to respond to adolescent-precipitated crises by mobilizing and restructuring the family's kinship system. Families of 75 adolescents at risk for hospitalization were followed up to 24 months after treatment with Systemic Crisis Intervention. Measures of offspring and family functioning, suicidal behavior, institutional use, and treatment costs are presented. Results clearly demonstrate the safety, effectiveness, and economic viability of Systemic Crisis Intervention.