Physician and patient communication training in primary care: effects on participation and satisfaction

OBJECTIVE: To assess the effects of a communication skills training program for physicians and patients. DESIGN: A randomized experiment to improve physician communication skills was assessed 1 and 6 months after a training intervention; patient training to be active participants was assessed after 1 month. Across three primary medical care settings, 156 physicians treating 2,196 patients were randomly assigned to control group or one of three conditions (physician, patient, or both trained). MAIN OUTCOME MEASURES: Patient satisfaction and perceptions of choice, decision-making, information, and lifestyle counseling; physicians' satisfaction and stress; and global ratings of the communication process. RESULTS: The following significant (p < .05) effects emerged: physician training improved patients' satisfaction with information and overall care; increased willingness to recommend the physician; increased physicians' counseling (as reported by patients) about weight loss, exercise, and quitting smoking and alcohol; increased physician satisfaction with physical exam detail; increased independent ratings of physicians' sensitive, connected communication with their patients, and decreased physician satisfaction with interpersonal aspects of professional life. Patient training improved physicians' satisfaction with data collection; if only physician or patient was trained, physician stress increased and physician satisfaction decreased. CONCLUSION: Implications for improving physician-patient relationship outcomes through communication skills training are discussed.     

Accelerated relearning after retrieval-induced forgetting: the benefit of being forgotten

Research on retrieval-induced forgetting has demonstrated that retrieving some information from memory can cause the forgetting of other information in memory. Here, the authors report research on the relearning of items that have been subjected to retrieval-induced forgetting. Participants studied a list of category- exemplar pairs, underwent a series of retrieval-practice and relearning trials, and, finally, were tested on the initially studied pairs. The final recall of non-relearned items exhibited a cumulative effect of retrieval-induced forgetting such that the size of the effect increased with each block of retrieval practice. Of most interest, and very surprising from a common-sense standpoint, items that were relearned benefited more from that relearning if they had previously been forgotten. The results offer insights into the nature and durability of retrieval-induced forgetting and provide additional evidence that forgetting is an enabler--rather than a disabler--of future learning.     

Primacy or recency effects in forming inductive categories

Five experiments provide evidence for a primacy effect in the formation of inductive categories. Participants completed a category induction task in which they observed and reproduced a set of lines that varied in length but were serially ordered so that they increased or decreased in length. Subsequent estimates of the average of the distribution were systematically biased in the direction of stimuli encountered at the beginning of the induction task, suggesting that initially encountered stimuli exert greater weight in a category representation than do subsequent stimuli. We offer possible explanations for why this primacy effect might arise.     

Variability in Adaptive Behavior in Autism: Evidence for the Importance of Family History

Adaptive behavior in autism is highly variable and strongly related to prognosis. This study explored family history as a potential source of variability in adaptive behavior in autism. Participants included 77 individuals (mean age = 18) with average or better intellectual ability and autism. Parents completed the Family History Interview about the presence of broader autism phenotype symptoms and major psychiatric disorders in first degree relatives. Adaptive behavior was assessed via the Vineland Adaptive Behavior Scales (VABS). Based on family history variables, age, and intelligence quotient (IQ), 87% of participants were correctly classified as having impaired or average VABS scores. Family history of depression and shyness accounted for the most variance in VABS scores, and they had the greatest influence on VABS Socialization scores in particular. Possible underlying mechanisms include genetics, psychosocial factors, and social resources. This study provides initial evidence of the importance of family history to adaptive behavior in autism and has implications for genetics and treatment.     

Distressed Mothers and Their Infants Use a Less Efficient Timing Mechanism in Creating Expectancies of Each Other’s Looking Patterns

The prediction of events and the creation of expectancies about their time course is a crucial aspect of an infant's mental life, but temporal mechanisms underlying these predictions are obscure. Scalar timing, in which the ratio of mean durations to their standard deviations is held constant, enables a person to use an estimate of the mean for its standard deviation. It is one efficient mechanism that may facilitate predictability and the creation of expectancies in mother-infant interaction. We illustrate this mechanism with the dyadic gaze rhythm of mother and infant looking at and looking away from each other's faces. Two groups of Hi- and Lo-Distress mothers were created using self-reported depression, anxiety, self-criticism and childhood experiences. Lo-Distress infants (controls) used scalar timing 100% of the time, about double that of Hi-Distress infants. Lo-Distress mothers used scalar timing about nine times as much as Hi-Distress mothers. The diminished use of scalar timing patterns in Hi-Distress mothers and infants may make the anticipation of each other's gaze patterns more difficult for both partners.     

Few Preschool Boys and Girls with ADHD are Well-Adjusted During Adolescence

To estimate the prevalence of being well-adjusted in adolescence, boys and girls with (n = 96) and without (n = 126) attention-deficit/hyperactivity disorder (ADHD) were assessed seven times in eight years starting when they were 4–6 years of age. Symptoms of ADHD, ODD/CD, and depression/anxiety in addition to social skills and social preference were gathered using multiple methods and informants. Being well-adjusted was defined by surpassing thresholds in at least four of the five domains. At the 7- and 8-year follow-up, when youth were 11–14 years old, probands were significantly less likely to be well-adjusted relative to age- and ethnicity-matched control children. Only a minority of children with ADHD was well-adjusted in adolescence when emotional, behavioral, and social domains were considered simultaneously. Even when their ADHD symptoms improved over time, most probands exhibited significant impairment 7–8 years after their initial assessment.     

Trajectories of Parenting Processes and Adolescent Substance Use: Reciprocal Effects

Drawing on transactional theories of child development, we assessed bidirectional links between trajectories of adolescent substance use and parenting processes from early through mid adolescence. Hierarchical generalized models estimated trajectories for 3,317 adolescents from the National Longitudinal Survey of Youth 1997, exploring both between- and within-individual effects. Between individuals, adolescents reporting more regular family activities and greater father and mother knowledge of friends and teachers experienced lower levels of substance use through mid adolescence. Similarly, adolescents with more frequent substance use reported lower family activities, father knowledge, and mother knowledge, though these differences dissipated over time. More conservative within-individual differences indicated a prospective protective effect of family activities, with increases in adolescent participation in family activities predicting later declines in substance use. Results support the central importance of engagement in regular family activities, and suggest the need for further exploration of transactional processes between parents and children in the development of risk behaviors.     

Response Style Differences in the Inattentive and Combined Subtypes of Attention-Deficit/Hyperactivity Disorder

This study examined potential differences between the inattentive and combined ADHD subtypes using laboratory tasks assessing behavioral inhibitory processes. Seventy-five children completed two tasks of behavioral inhibition believed to isolate different processes: the cued reaction time task (CRT), a basic inhibition task, and the go/no-go task (GNG), a complex inhibition task that incorporates motivational contingencies. Three groups of participants were identified, including ADHD/Inattentive (n = 17), ADHD/Combined (n = 37), and comparison (n = 21). Results indicated that rather than showing behavioral inhibition deficits, the ADHD/I children appeared overly inhibited, as evidenced by slower reaction times across the two tasks and significantly higher errors of omission in the GNG task. Additionally, the ADHD/I children did not demonstrate cue dependency effects on the CRT task, suggesting that they were failing to incorporate relevant information before making a response. The sluggish and inhibited performance of the ADHD/I group challenges the idea that it is a subtype of ADHD.     

Overconcern with weight and shape is not the same as body dissatisfaction: evidence from a prospective study of pre-adolescent boys and girls

Overconcern with weight and shape and body dissatisfaction have both emerged as significant predictors of disordered eating. However, it is unclear how these constructs relate to each other, and if each has different antecedents and consequences. This study aimed to identify prospective predictors of each construct and to determine their relative importance in predicting dietary restraint and binge eating. Eight- to 13-year-old boys and girls (N = 259) were assessed at baseline and one-year follow-up, using a range of measures that included the Child Eating Disorder Examination. Psychosocial variables predicted overconcern with weight and shape whilst objective weight predicted body dissatisfaction. Body dissatisfaction and weight and shape concern predicted restraint, and weight and shape concern and restraint predicted binge eating. Findings provide support for the theoretical differences between body dissatisfaction and overconcern with weight and shape, and highlight the importance of focusing on specific body image variables.     

Cyber sexy: electronic game play and perceptions of attractiveness among college-aged men

The current study was conducted to determine if electronic gaming among males is related to body image, formation of body ideals, and appraisals of female attractiveness. A sample of 219 college-aged men (age 18-32) completed a variety of measures that assessed their game play habits, their perceptions of their own attractiveness, and perceptions of women's attractiveness. Results indicated that participants' ratings of women's attractiveness varied across the genres of game most frequently played but was not related to age of commencement or frequency of electronic game play. Additionally, frequency of play and age of commencement of game play were not related to self-perceptions of physical attractiveness, the association of positive attributes with muscularity, or the drive to become more muscular. Men's appearance satisfaction and valuation of muscularity was related to the extent to which they compare their own appearance to that of the characters featured in their electronic games. The results indicate that, unlike other forms of media, electronic gaming may have a weaker relationship to decreased appearance satisfaction or the formation of unrealistic standards of attractiveness.