Using motivational interviewing as a supplement to obesity treatment: a stepped-care approach.

OBJECTIVE: This investigation was designed to improve behavioral weight loss program (BWLP) treatment outcomes by providing stepped care (SC) to individuals experiencing difficulties with weight loss during treatment. SC entails transition to more intensive treatments when less intensive treatments fail to meet treatment goals. In a BWLP, motivational interviewing (MI) may increase participants' motivation toward behavioral change and thus complement the acquisition of behavioral change skills. It was hypothesized that BWLP+SC (MI) participants (i.e., participants who failed to meet weight loss goals and received MI) would demonstrate superior treatment outcomes when compared with BWLP (SC matched) participants (i.e., participants who failed to meet weight loss goals but did not receive MI). DESIGN: Fifty-five obese, sedentary adults were randomly assigned to a BWLP+SC or a BWLP. MAIN OUTCOME MEASURES: Changes in weight, cardiorespiratory fitness, self-reported physical activity, and diet (i.e., calories, percentage daily intake of fat, protein, and carbohydrates) in response to treatment were assessed. RESULTS: Participants significantly decreased their weight, increased physical activity/fitness, and improved dietary intake (ps<.05). BWLP+SC (MI) participants lost more weight and engaged in greater weekly exercise than BWLP (SC matched) participants who did not receive MI (ps<.05). CONCLUSION: For individuals experiencing weight loss difficulties during a BWLP, MI may have considerable promise.     

Elimination of position-biased responding in individuals with autism and intellectual disabilities

Five individuals with autism or other developmental disabilities participated in paired-stimulus preference assessments during repeated baseline probes. All subjects initially showed a pronounced bias by typically selecting the stimulus placed in either the left or right position. Biased responding for 3 subjects was eliminated when training trials were conducted in which a stimulus of known lesser quality was presented as one of the choices. Reinforcer-quality training was unsuccessful for 2 subjects, as was a condition in which reinforcer magnitude was modified to favor unbiased responding. These subjects' biased responding was eliminated only when a correction procedure (repetition of error trials) was implemented.     

Bayesian chance

This paper explores how the Bayesian program benefits from allowing for objective chance as well as subjective degree of belief. It applies David Lewis??s Principal Principle and David Christensen??s principle of informed preference to defend Howard Raiffa??s appeal to preferences between reference lotteries and scaling lotteries to represent degrees of belief. It goes on to outline the role of objective lotteries in an application of rationality axioms equivalent to the existence of a utility assignment to represent preferences in Savage??s famous omelet example of a rational choice problem. An example motivating causal decision theory illustrates the need for representing subjunctive dependencies to do justice to intuitive examples where epistemic and causal independence come apart. We argue to extend Lewis??s account of chance as a guide to epistemic probability to include De Finetti??s convergence results. We explore Diachronic Dutch book arguments as illustrating commitments for treating transitions as learning experiences. Finally, we explore implications for Martingale convergence results for motivating commitment to objective chances.     

Neuroanatomy and Neuropathology Associated with Korsakoff’s Syndrome

Although the neuropathology of Korsakoff's syndrome (KS) was first described well over a century ago and the characteristic brain pathology does not pose a diagnostic challenge to pathologists, there is still controversy over the neuroanatomical substrate of the distinctive memory impairment in these patients. Cohort studies of KS suggest a central role for the mammillary bodies and mediodorsal thalamus, and quantitative studies suggest additional damage to the anterior thalamus is required. Rare cases of KS caused by pathologies other than those of nutritional origin provide support for the role of the anterior thalamus and mammillary bodies. Taken together the evidence to date shows that damage to the thalamus and hypothalamus is required, in particular the anterior thalamic nucleus and the medial mammillary nucleus of the hypothalamus. As these nuclei form part of wider memory circuits, damage to the inter-connecting white matter tracts can also result in a similar deficit as direct damage to the nuclei. Although these nuclei and their connections appear to be the primary site of damage, input from other brain regions within the circuits, such as the frontal cortex and hippocampus, or more distant regions, including the cerebellum and amygdala, may have a modulatory role on memory function. Further studies to confirm the precise site(s) and extend of brain damage necessary for the memory impairment of KS are required.     

Testing Effects of Community Collaboration on Rates of Low Infant Birthweight at the County Level

Interorganizational collaboration has become a popular strategy for addressing population health and well-being. However, evidence for its effectiveness in achieving outcomes at the population level is limited, at least in part due to a variety of methodological challenges such as reduced sample size at the population level, the availability of suitable comparison groups of communities, and study durations that are too short to detect slowly emerging outcomes. The present study addresses these challenges by retrospectively examining the effectiveness of a mature network of community collaboratives, using latent growth modeling of longitudinal change in an archival community-level outcome, low infant birthweight, and propensity score matching of comparison communities. A group of 25 Georgia counties with collaboratives targeting low infant birthweight was compared to a weighted comparison group of counties from other southeastern states, using propensity score matching. We report results of full matching methods and outcome analyses examining differences in change in county rates of low infant birthweight from 1997 to 2004 between intervention and comparison counties. Results indicated significantly smaller increases in low weight birth rates in intervention counties than in comparison counties.     

Daily Hassles,Intimacy, and Marital Quality in Later Life Marriages

This study addressed the relationship between daily stress, intimacy, and marital quality in mature marriages in which the ages of husbands and wives ranged from 55 to 75 years. Four hundred and seventy-two individuals married to each other and randomly sampled from all fifty states completed the Kansas Marital Satisfaction Scale, the Personal Assessment of Intimacy in Relationships, and the Hassles and Uplifts Scale. Findings indicated that daily stress was negatively related to marital quality for both wives and husbands, and that intimacy mediated the relationship between stress and marital quality for both husbands and wives. Implications for marriage and family therapy practice are explored.