Predictors of outcome in patients consulting their general practitioners for headache: a prospective study

Headache is the most common neurological symptom presenting to general practitioners (GPs). Identifying factors predicting outcome in patients consulting their GPs for headache may help GPs with prognosis and choose management strategies which would improve patient care. We followed up a cohort of patients receiving standard medical care, recruited from 18 general practices in the South Thames region of England, approximately 9 months after their initial participation in the study. Of the baseline sample (N=255), 134 provided both full baseline and follow-up data on measures of interest. We determined associations between patients' follow-up scores on the Headache Impact Test-6 and baseline characteristics (including headache impact and frequency scores, mood, attributions about psychological/medical causes of their headaches, satisfaction with GP care and illness perceptions). Greater impact and stronger beliefs about the negative consequences of headaches at baseline were the strongest predictors of poor outcome at follow-up.     

Psychometric properties of the Miranda Rights Comprehension Instruments with a juvenile justice sample

This article describes the psychometric properties of the Miranda Rights Comprehension Instruments, the revised version of Grisso's Miranda instruments. The original instruments demonstrated good reliability and validity in a normative sample. The revised instruments updated the content of the original instruments and were administered to a sample of 183 youth in pre- and postadjudication facilities. Analyses were conducted to establish the psychometric properties of the revised instruments and included similar analyses to those conducted by Grisso, as well as additional calculations (e.g., standard errors of measurement, intraclass correlation coefficients, Kappa coefficients). Results revealed sound psychometric properties, similar to those observed for the original instruments.     

Adolescents’ Social Reasoning About Relational Aggression

We examined early adolescents’ reasoning about relational aggression, and the links that their reasoning has to their own relationally aggressive behavior. Thinking about relational aggression was compared to thinking about physical aggression, conventional violations, and personal behavior. In individual interviews, adolescents (N = 103) rated the acceptability of relational aggression, physical aggression, conventional violations, and personal behavior, and justified their ratings. Results indicated that adolescents’ views about relational aggression are complex. Although gossip was viewed as very wrong (comparable to beliefs about physical aggression), exclusion was perceived to be somewhat acceptable (less wrong than conventional violations, but more wrong than personal behaviors). With regard to associations between beliefs about aggression and aggressive behavior, the results indicated that beliefs about gossip were associated with gossiping behavior, and that beliefs about physical aggression were associated with physically aggressive behavior. No links emerged between beliefs about exclusion and exclusionary behavior. Implications and suggestions for future research are discussed within the frameworks of social domain theory and social information processing models of aggressive behavior.     

Personal, Medical, and Healthcare Utilization Among Homeless Veterans Served by Metropolitan and Nonmetropolitan Veteran Facilities

This study assessed differences in personal, medical, and health care utilization characteristics of homeless veterans living in metropolitan versus nonmetropolitan environments. Data were obtained from a Veterans Health Administration (VHA) network sample of homeless veterans. Chi-square tests were used to assess differences in demographics, military history, living situation, medical history, employment status, and health care utilization. Moderator analyses determined whether predictors of health care utilization varied by metropolitan status. Of 3,595 respondents, 60% were residing in metropolitan areas. Age, sex, and marital status were similar between metropolitan and nonmetropolitan homeless. Metropolitan homeless were less likely to receive public financial support or to be employed, to have at least one medical problem, one psychiatric problem, or current alcohol dependency, but more likely to be homeless longer. Of the 52% of the sample who used VHA care in the last 6 months, 53% were metropolitan versus 49% nonmetropolitan (p = .01). Metropolitan status predicted at least one VHA visit within the prior 6 months (OR:1.3, CI:1.1, 1.6). Significant differences occur in the personal, medical, and health care utilization characteristics of homeless veterans in metropolitan versus nonmetropolitan areas.     

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.     

Relational Aggression in Mothers and Children: Links with Psychological Control and Child Adjustment

This study assesses associations between mothers’ use of relational aggression with their peers and psychological control with their children, and child adjustment in a sample of fifty U.S. mothers of elementary and middle school children. Mothers completed surveys assessing their relational aggression and psychological control. Teachers completed surveys assessing children’s externalizing behavior, internalizing symptoms, and relational aggression. Results suggest that mothers who are relationally aggressive with their peers are more likely to be psychologically controlling with their children. Results also showed that relational aggression predicted adjustment problems in youth. Relational aggression was associated with externalizing problems among boys and girls, and with internalizing problems among boys. Few gender differences in mean levels of maternal or child behaviors emerged.     

Social feedback to infants' babbling facilitates rapid phonological learning

Infants' prelinguistic vocalizations are rarely considered relevant for communicative development. As a result, there are few studies of mechanisms underlying developmental changes in prelinguistic vocal production. Here we report the first evidence that caregivers' speech to babbling infants provides crucial, real-time guidance to the development of prelinguistic vocalizations. Mothers of 9.5-month-old infants were instructed to provide models of vocal production timed to be either contingent or noncontingent on their infants' babbling. Infants given contingent feedback rapidly restructured their babbling, incorporating phonological patterns from caregivers' speech, but infants given noncontingent feedback did not. The new vocalizations of the infants in the contingent condition shared phonological form but not phonetic content with their mothers' speech. Thus, prelinguistic infants learned new vocal forms by discovering phonological patterns in their mothers' contingent speech and then generalizing from these patterns.     

Neuropsychologic functioning in children with autism: further evidence for disordered complex information-processing.

A wide range of abilities was assessed in 56 high-functioning children with autism and 56 age- and IQ-matched controls. Stepwise discriminant analyses produced good group discrimination for sensory-perceptual, motor, complex language, and complex memory domains but lower agreement for the reasoning domain than previously obtained for adults. Group discrimination did not occur for attention, simple language, simple memory, and visuospatial domains. Findings provide additional support for a complex information-processing model for autism, previously based on adult data, demonstrating a pattern across domains of selective impairments on measures with high demands for integration of information and sparing when demands were low. Children as compared to adults with autism exhibited more prominent sensory-perceptual symptoms and less pronounced reasoning deficits reflecting brain maturation.