Referring patients to counsellors in primary care: Qualitative investigation of general practitioners’ perceptions

Despite growing evidence of the effectiveness of counselling in primary care, questions arise concerning the role of general practitioners in the referral process. This involves both liaison with counsellors and the management of people who do not wish to see counsellors. Respondents (n=23) in this qualitative study of general practitioners’ perceptions were clear about which patients should be referred to counsellors, based on guidelines. Additionally, these doctors perceived their role and skills as negotiating with their patients about referral to a counsellor, and managing patients who are either waiting to see a counsellor or who prefer not to see a counsellor. These doctors feel inadequately trained in managing this latter group, whose outcome they perceive as unclear. Despite this, respondents accept a role in ongoing support for their patients with consequent training issues for doctors and opportunities for liaison and mentoring by counsellors.     

A MULTIPLE-BASELINE ANALYSIS OF SOCIAL-SKILLS TRAINING IN CHRONIC SCHIZOPHRENICS

Social-skills training was applied to two male chronic schizophrenics. Component behaviors of social skill requiring modification were identified for each patient by rating videotapes of role-played interactions. Training involved instructions and feedback for one subject and instructions, feedback, and modelling for the second. Target behaviors were treated sequentially and cumulatively in a multiple-baseline format. Training was applied for both positive and negative assertion and for situations involving males and females. The results were positive for all behaviors for both patients. Follow-ups at 2, 4, 6, and 8 weeks after training indicated that most effects were maintained at near-treatment levels.     

BIOFEEDBACK,AUTOGENIC TRAINING,AND PROGRESSIVE RELAXATION IN THE TREATMENT OF RAYNAUD'S DISEASE: A COMPARATIVE STUDY

Twenty-one female patients suffering from diagnosed idiopathic Raynaud's Disease were trained to raise digital skin temperature using either autogenic training, progressive muscle relaxation, or a combination of autogenic training and skin temperature feedback. Patients were instructed in the treatment procedures in three one-hour group sessions spaced one week apart. All patients were instructed to practice what they had learned twice a day at home. Patients kept records of the frequency of vasospastic attacks occurring over a four-week baseline period, and during the first four weeks and the ninth week of training. In addition, patients underwent four laboratory cold stress tests during which they were instructed to maintain digital temperature as the ambient temperature was slowly dropped from 26° to 17°C. Cold stress tests were given during week 1 of baseline and during weeks 1, 3, and 5 of training. Results indicated that all patients improved during the first four weeks of training. No significant differences between the three behavioral treatment procedures were obtained. In addition, the ability of patients to maintain digital temperature during the cold stress challenge showed significant improvement from the first to the last tests. Symptomatic improvement was maintained by all patients nine weeks after the start of the training. The implications of these findings for the behavioral treatment of Raynaud's Disease are discussed.     

The long-term outcome of a personal network-oriented HIV prevention intervention for injection drug users: The SAFE study

Social influence processes have been found to affect numerous drug and health-related behaviors. We postulated that by using a network-oriented intervention it may be possible to capitalize on social influence processes to reduce human immunodeficiency virus (HIV) risk behaviors. The present study used an experimental study design for delivering a psychoeducational acquired immunodeficiency syndrome (AIDS) preventive intervention to injection drug sharing networks. Participants were recruited from the ALIVE study, an epidemiological study in Baltimore. In the present paper we examine the self-reported behavioral outcomes of 117 injection drug users 18 months after the baseline interview. HIV seronegative experimental participants reported significantly less frequent needle sharing and less injecting of heroin and cocaine than controls. In multiple logistic regression models of HIV seronegative participants, there was a significant negative association between assignment to the experimental group and the HIV-related behaviors of needle sharing and sharing of cookers in the prior 6 months; controls were 2.8 times more likely than experimentals to report needle sharing and were 2.7 times more likely to report sharing cookers. The results of this 18-month follow-up suggest that among injection drug users network-oriented interventions may be a promising approach to HIV prevention.     

脑外伤患者记忆功能的双重特征：损伤与保存

该研究探讨了中─重型闭合性脑外伤患者及对照被试（各１７名）在对单个汉字不同水平的加工后,其外显记忆（自由回忆、再认）和内隐记忆（汉字补笔起动效应）的若干特点。发现：患者组外显记忆受损而内隐记忆正常;两组被试在深层意义加工中的外显记忆均强于在浅层表面加工中的外显记忆,这种语义易化现象以耗费更多的认知努力为代价,其中患者组耗费的尤多,而记忆效率却不及对照组。综上,脑外伤患者记忆功能呈损伤和保存双重性。     

Safer sex: Lessons from the male sex industry

Discerning the complex factors influencing male sex work is an important element of understanding HIV transmission. The present study examines a sample of London-based masseurs and street workers' ideas concerning their sexual encounters, their partners and their role in society. Unsafe sex is associated with (1) a lack of perception of control in the sexual encounter, (2) attractive clients, and (3) loving relationships with non-clients. The ways in which personal needs and stigma influence sexual practices and the men's sense of identity are considered. For some of the men, unsafe sex demarcates a sphere containing a type of intimacy that is absent from their working life. Since working life is associated with negative social judgements, the importance of this separate sphere is heightened. The findings call into question models of health behaviour that are built on individualist, reason-based tenets and highlight the importance of social and emotional factors in safer sexual behaviour. The implications of the findings for prevention programmes and future research are discussed.     

The Development and Validation of the Multicomponent AIDS Phobia Scale

The development, reliability, and validity of a new instrument, the Multicomponent AIDS Phobia Scale (MAPS), is described. Based on a sample of 181 university students, the results indicate that the MAPS has strong internal consistency and moderate test-retest reliability. In addition, an assessment of concurrent and discriminant validity indicates statistically significant correlations with other self-report measures of anxiety, hypochondriasis, obsessive-compulsive disorder, and fear of AIDS. The results of a factor analysis indicate that the scale consists of two factors: Fear of Infection and Fear of Others/Avoidance. Although further research with the MAPS in a clinical population is warranted to investigate the generalizability of this study's results, the instrument appears to be a reliable and valid measure of AIDS Phobia and may prove useful for improving clinical assessment and documenting treatment outcome.     

Credit for discoveries: Citation data as a Basis for History of Science Analysis

Citation data have become an increasingly significant source of information for historians, sociologists, and other researchers studying the evolution of science. In the past few decades elaborate methodologies have been developed for the use of citation data in the study of the modern history of science. This article focuses on how citation indexes make it possible to trace the background and development of discoveries as well as to assess the credit that publishing scientists assign to particular discoverers. Kuhn's notion of discovery is discussed. The priority dispute over the discovery of the AIDS virus is used as an example.     

Between Addition and Difference: A Place for Religious Understanding in a World of Science

Among contemporary religious believers, some follow in the footsteps of Newton, allowing their religious understanding to fill in gaps left by the sciences. Others take a more Wittgensteinian approach, discretely separating religious from scientific ways of thinking. Because neither of these relatively irenic positions captures the important element of cultural reform that is prevalent in so much of the religious life of the past, George Lakoff's recent work in cognitive studies is used to suggest ways that religious ideas may be used to challenge and enrich scientific thought. A scrutiny of Richard Dawkins's biological analyses of human behavior reveals the distorting limitations of exclusively scientific understanding, thereby clearing conceptual space for genuinely religious values, actions, responsibilities, and forms of human life.     

The Relationship Between Health and Human Services and the Personal Goal-Directed Activities of Persons Living with AIDS

This study evaluates the relationship between the social climate from different services and the personal goal-directed activities of 224 individuals with AIDS. The study's results supported the main hypothesis that recipient and participatory service involvement uniquely influence personal goal-directed activities, even after considering individuals with AIDS' physical symptoms, psychological distress, income, and recruitment site. Income and involvement with participatory services were both positively related to the amount of personal goal-directed activity. Longitudinal analyses suggest that personal initiative contributes to the subsequent amount of personal goal-directed activities a person pursues. These results suggest further examination of factors contributing to the selection of different service types and of the processes underlying the relationship between participatory services and positive outcomes for clients with AIDS.