结核患者服药依从性的研究现状

结核病控制是全球卫生工作的一个重点,服药依从性则是其中关键的一环。本文对结核患者服药依从性的重要性、影响因素及提高依从性的措施进行综述,认为实施直接督导短程化疗（DOTS）、强化督导、改善患者对服药依从性的认识、简化给药方案、减轻患者经济负担、设置患者提醒物等可提高服药依从性。     

Impact of Teachers' Language Expression and Message Valence when Conveying Classroom-Compliance Instructions1

This study examines how the types of language expression and message valence used by teachers to convey classroom-compliance instructions affect elementary-school children's psychological reactance and their intention to follow instructions. Altogether, 178 elementary-school children (54% girls) participated in a mixed-design experiment. Participants read four self-developed cartoons, where a hypothetical teacher conveyed classroom-compliance instructions through four expressions, and responded to questions measuring psychological reactance and the intention to follow instructions based on the cartoons. The results showed that psychological reactance was relatively significant in the high-controlling language condition. In the low-controlling language condition, the approach evoked less psychological reactance and enhanced the intention to follow instructions, whereas avoidance did so in the high-controlling language condition. Our findings offer suggestions on how teachers can improve classroom management by altering their messages in accordance with the motivation characteristics of their students.     

USING DIFFERENTIAL REINFORCEMENT TO DECREASE ACADEMIC RESPONSE LATENCIES OF AN ADOLESCENT WITH ACQUIRED BRAIN INJURY

The present study investigated the effects of contingency‐specifying rules and a token economy to decrease the latency to comply with academic instructions by a 16‐year‐old girl with acquired brain injury. Results showed that treatment was successful in reducing academic response latencies. These results replicate previous research in which differential reinforcement was used to decrease slow responding to academic tasks.     

Cognitive epidemiology: With emphasis on untangling cognitive ability and socioeconomic status

This commentary touches on practical, public policy, and social science domains informed by cognitive epidemiology while pulling together common themes running through this important special issue. As is made clear in the contributions assembled here, and others (Deary, Whalley, & Starr, 2009; Gottfredson, 2004; Lubinski & Humphreys, 1992, 1997), social scientists and practitioners cannot afford to neglect cognitive ability when modeling epidemiological and health care phenomena. However, given the dominant concern about the confounding of general cognitive ability (GCA) and socioeconomic status (SES), and the extent to which SES is frequently seen as the primary cause of health disparities (while GCA is neglected as a possible influence in epidemiology and health psychology), some methodological applications for untangling the relative influences of GCA and SES are reviewed. In addition, cognitive epidemiology is placed in a broader context: Just as cognitive epidemiology facilitates an understanding of pathology (“at risk” populations, and ways to attenuate undesirable personal and social conditions), it may also enrich our understanding of optimal functioning (“at promise” populations, and ways to identify and nurture the human and social capital needed to develop innovations for saving lives, economies, and perhaps even our planet). Finally, while GCA is likely the most important dimension in the study of individual differences for modeling healthy behaviors and outcomes, other relatively independent dimensions of psychological diversity do add value (Krueger, Caspi, & Moffitt, 2000). For example, compliance has at least two psychological components: a “can do” competency component (ability) and a “will do” motivational component (conscientiousness). Ultimately, developing and modeling healthy behaviors, interpersonal environments, and medical maladies are best accomplished by teaming multiple dimensions of human individuality.     

USING PARENTS TO MAINTAIN IMPROVED DENTAL FLOSSING SKILLS IN CHILDREN

An experimenter-administered intervention involving prompts, self-monitoring, permanent product collection, rewards for plaque reduction, and corrective feedback was used to improve the flossing skills of four 7- to 11-year-old children. Parents were subsequently trained in the reward and feedback procedures to facilitate maintenance. In a multiple baseline across subjects design, all four subjects snowed improvement in plaque between teeth during experimenter-administered intervention. Three subjects maintained low plaque levels during the 3- to 4-month parent-administered rewards and feedback follow-up condition. Improved plaque levels on nontargeted tooth surfaces also were observed. Pediatric dentistry applications are discussed.     

SEPARATE AND COMBINED EFFECTS OF METHYLPHENIDATE AND A BEHAVIORAL INTERVENTION ON DISRUPTIVE BEHAVIOR IN CHILDREN WITH MENTAL RETARDATION

We investigated the separate and combined effects of a behavioral intervention and methylphenidate (Ritalin®) on disruptive behavior and task engagement in 3 children with severe to profound mental retardation. The behavioral intervention involved differential reinforcement of appropriate behavior and guided compliance. All 3 children demonstrated decreased disruptive behavior and improved task engagement in response to the behavioral intervention. Two of the 3 children demonstrated similar improvement in response to methylphenidate. Although both interventions were highly effective for these 2 participants, the relative efficacy of the interventions varied between the 2 children. There was no evidence of an additive or synergistic effect of the two interventions, but the high efficacy of each intervention alone limited our ability to detect such effects.     

Teacher Use Of Interventions In General Education Settings: Measurement And Analysis Of The Independent Variable

This study examined the integrity with which 4 general education teachers implemented an intervention designed to improve the academic performance of elementary school students. Treatment integrity was measured daily using permanent products. The results showed that the 4 teachers markedly increased the integrity of the delivered treatment when they were provided with performance feedback. The results suggest that academic performance improved for the group of students as integrity improved.     

The relaxation word of the day: A simple technique to measure adherence to relaxation

A new procedure of assessing adherence to home practice of relaxation is presented. The technique involved the subject identifying one of four possible relaxation words of the day at the end of a taped relaxation session. The method was employed to assess the relationship between adherence to relaxation and decline of blood pressure during a 10-session/8-week relaxation program involving 17 hypertensive subjects. No statistically significant relationship was found on either a short-term or a long-term basis. An advantage of the assessment technique is that it appears easily integrated into the overall therapeutic objective for relaxation therapy; a disadvantage is that the subject needs to comply not only with the relaxation schedule but also with the monitoring procedure.This research study was funded by NIH Grant HL27159.     

Discrimination theory of rule-governed behavior

In rule-governed behavior, previously established elementary discriminations are combined in complex instructions and thus result in complex behavior. Discriminative combining and recombining of responses produce behavior with characteristics differing from those of behavior that is established through the effects of its direct consequences. For example, responding in instructed discrimination may be occasioned by discriminative stimuli that are temporally and situationally removed from the circumstances under which the discrimination is instructed. The present account illustrates properties of rule-governed behavior with examples from research in instructional control and imitation learning. Units of instructed behavior, circumstances controlling compliance with instructions, and rule-governed problem solving are considered.     

Assessing compliance to home relaxation: A simple technology for a critical problem

A simple, low-cost, and reliable technology for assessing compliance with relaxation practice in the natural environment is presented. Brief, audible cue tones are overdubbed onto selected client relaxation tapes, which are ordered by the therapist and then played in sequence by the client. The presence/absence or number of cue tones on each tape in the sequence is self-monitored, thereby providing the therapist with a record for objectively assessing whether or not the tapes were used as instructed. A clinical case example is presented to illustrate use of the procedure. Finally, advantages and limitations of the procedure are discussed.A portion of this paper (clinical case study) was presented at the meeting of the Association for Advancement of Behavior Therapy, November 1980, New York. This research was partly supported by the Medical Research Service of the Veterans Administration. The authors wish to express their appreciation to Leonard H. Epstein for his support and stimulation in the early development of this and related projects.