Predicting outcome of chronic pain treatment via a modified self-efficacy scale

This study utilized a modified self-efficacy scale and examined the relationship of perceived self-efficacy to treatment outcome in a chronic, intractable, benign pain population (N = 62). In two separate studies a self-efficacy scale was given to inpatients in a combined cognitive-behavioral and medical treatment program. The scale categories consisted of (1) walking distance, (2) lifting ability, (3) pain coping, (4) working ability, and (5) social and recreational engagement. Self-efficacy beliefs were found to be associated with the level of functioning of these patients and their response to treatment. Patients with higher self-efficacy scores following treatment rated themselves as more improved and demonstrated better overall functioning with greater reductions in chronic illness behavior at followup. These observations support the merits of self-efficacy measures as predictors of treatment outcome in chronic pain patients.     

Clamped Corticosterone (B) Reveals the Effect of Endogenous B on Both Facilitated Responsivity to Acute Restraint and Metabolic Responses to Chronic Stress

To determine the effects of both corticosterone (B) and chronic stressors on acute ACTH responses to restraint, young male rats were exposed to streptozotocin-induced diabetes, cold (5-7 degreesC) or intracerebroventricular (icv) neuropeptide Y (NPY) for 5 d and then exposed to restraint within 2 h after lights on. Two groups of rats were studied: intact and adrenalectomized replaced with B pellets that maintained plasma B in the normal mean 24-h range of intact rats. In addition to ACTH and B responses to restraint on d 5, body weight, food intake, fat depots, glucose and other hormones were measured to determine the role of stress-induced elevations in B on energy balance. ACTH responses to restraint were normal in intact rats subjected to diabetes or cold. By contrast, there was no ACTH or B response to restraint in NPY-infused intact rats. All 3 groups of chronically stimulated adrenalectomized rats with clamped B had facilitated ACTH responses to restraint compared to their treatment controls. Overall food intake increased in all groups of stressed rats; however, augmented intake occurred only during the light in intact rats and equally in the light and dark in B-clamped rats. White adipose depot weights were decreased by both diabetes and cold and increased by NPY in intact rats; the decreases with cold and increases with NPY were both blunted and changes in fat stores were not significant in adrenalectomized, B-clamped rats. We conclude that: 1. diabetes- and cold-induced facilitation of restraint-induced afferent input to hypothalamic control of the hypothalamo-pituitary-adrenal (HPA) axis is opposed in intact rats by the elevated feedback signal of B secretion; 2. NPY does not induce facilitation of afferent stress pathways; 3. chronic stimulation of the HPA axis induces acute hyperresponsiveness of hypothalamic neurons to restraint provided that the afferent input of this acute stimulus is not prevented by B feedback; 4. stimulus-induced elevations in B secretion result in day-time feeding; 5. insensitivity of both caloric efficiency and white fat stores to chronic stress in adrenalectomized, B-clamped rats results from loss of normally variable B levels.     

The curfew bill as it relates to the juvenile and his family

Curfew laws have been instituted in cities across the United States in an attempt to control the rise in juvenile crime. This article discusses the advantages and disadvantages of a curfew law for Baltimore City based on interviews with city officals and concludes that the law in its present form will not bring about any significant change in the rate of delinquency. Alternative are suggested that might better get to the source of the problem. These include more youth and family counseling services, rehabilitative facilities, work study programs and shelter areas.     

What do Patients Prefer: Informed Consent Models for Genetic Carrier Testing

The recent increased number of conditions for which patients can undergo genetic carrier testing raises the question of how best to obtain pre-test informed consent. Clinical approaches vary from a minimalist model to a model where patients are given detailed information about all conditions to be screened for. Few data exist as to patient preferences, or how information impacts decision-making. Eight high-literacy focus groups were conducted to assess the knowledge and preferences of pregnant patients and their male partners. Most groups indicated that some balance between details and brevity was optimal, recognizing that anxiety can occur when patients are provided with too much information and that the wide range of tests offered during pregnancy often led to confusion. Critical areas for the informed consent process included (1) details about the conditions and risk of being a carrier, (2) logistics of testing, (3) next steps if the test is positive, and (4) prognosis, options and resources if the child were to be affected with a disorder. It will be useful to develop model consent programs and prospectively assess their impact on informed consent and patient satisfaction, both when positive and negative results are received.     

Who is umuntu in Umuntu ngumuntu ngabantu? Interrogating moral issues facing Ndau women in polygyny

Discussions on the African communitarian idea of personhood have generated several debates among African philosophers about how it is conceived and perceived. While scholars like Wiredu and Gyekye maintain that personhood is gender-neutral, others such as Oyowe suggest that personhood is gendered. The position that African communitarian personhood is gendered is the basis for the argument in this article. Defenders of this notion argue that the gender-neutral conception of personhood has created situations where gender issues have been glossed over, thereby perpetuating gender inequality in African communities. It is within this context that we take the argument further by interrogating the word umuntu in the popular southern African maxim on personhood, Umuntu ngumuntu ngabantu. We ask the question: if personhood is gendered, then who is umuntu in this aphorism? In an attempt to answer this question, we advance two important claims. First, we claim that umuntu refers to a person whose interest is upheld in the community as well as those who are able to determine their own interest. Second, we also say that this concept of umuntu has perpetuated cultural practices that adversely impact women and girls in most African rural communities. Although some scholars might object to these claims, in this article we will not be addressing those objections, but rather we argue that umuntu is gendered male in the aphorism.