Pre-screening education in multiple marker screening programs: The effect on patient anxiety and knowledge

Previous studies have shown that unexplained deviations in maternal serum multiple marker screening (MMS) generate considerable anxiety during the remainder of pregnancy. While the role of education in decreasing anxiety is documented, to date there has been no prospective evaluation of which educational practices might minimize this emotional stress. In a pilot study, we prospectively examined the effects on anxiety and knowledge by providing information about MMS (1) by genetic counselor, (2) by pamphlet, and (3) by primary physician. Women randomized to one of these three modalities were administered the Spielberger State- Trait Anxiety Inventory [STAI] and knowledge questionnaires at their initial obstetrics visit, at their second visit after educational intervention and 1–2 weeks after MMS results were provided to patients. Education resulted in an increase in knowledge and post-education knowledge was different between educational modalities. Anxiety declined in patients educated through genetic counseling or a pamphlet.     

Stress,coping resources,and injury risk

Over the last two and a half decades, researchers have tried to determine if psychological variables predispose or buffer athletes from injury. They have found that sport participants who experience many recent stressors, and who do not have the resources and skills to cope with the stress, seem most at risk for injury. This article reviews that research as well as efforts to identify mechanisms that might explain why the stress-injury relationship occurs and interventions that will hopefully reduce the injury risk. Because the multicomponent stress-injury model of Andersen and Williams (1988) helped provide the impetus and theoretical base for much of that research, it serves as the foundation for organizing and summarizing the findings. Although the research has focused largely on sport injuries, the findings have relevance for understanding and potentially preventing many accidents and injuries that occur outside the realm of sport participation.     

Behavioral assessment and treatment of acquired visuoperceptual disorders

Visuoperceptual deficits are common sequelae of damage to either hemisphere of the brain, but are typically more pronounced following injuries involving the right cerebral hemisphere. Common visuoperceptual disorders include visual field cuts, hemi-inattention and hemi-spatial neglect, hemi-perceptual deficits, and gaze and visual pursuit disturbances. A number of behavioral interventions have been developed to teach patients to compensate for acquired visual deficits. Studies addressing assessment and treatment issues in this area are reviewed, and future directions for research are outlined.     

BEHAVIORAL ASSESSMENT FOR PEDIATRIC INTENSIVE CARE UNITS1

Two studies were conducted to analyze behaviors of staff and patients on a Pediatric Intensive Care Unit (PICU). In the first study, behavioral observation procedures were employed to assess patient state, physical position, affect, verbal behaviors, visual attention and activity engagement, and staff verbal behavior. On the average, one-third of the patients were judged to be conscious and alert but markedly nonengaged with their environment. In the second study, a member of the hospital staff provided alert patients with individual activities to determine whether a simple environmental manipulation could positively affect behavior of children in intensive care. Employing a reversal design, the activity intervention was found to increase attention and engagement and positive affect, and to decrease inappropriate behavior. Both studies demonstrate that behavioral assessment procedures can provide an empirical basis for designing PICU routines affecting children's psychosocial status, and, thus, complement current procedures designed to provide quality medical care.     

Community applications of instructional technology: teaching writers of instructional packages

A community education program, to develop a variety of performance competencies in large numbers of neighborhood residents, requires a technology for preparing learning units administerable by community members themselves. The effects of a writing manual, designed to teach nonprofessionals to prepare such instructional packages, were analyzed in two experiments. Experiment I employed a multiple-baseline design across three university student trainees. The results showed that appropriate program writing increased by 75% after completion of the manual. The results of Experiment II, with two low-income neighborhood residents serving as trainees, showed that packages produced by trained writers resulted in a greater increase in skill activities than sets of training stimuli produced by untrained writers.     

Be a Mom,a Web-Based Intervention to Prevent Postpartum Depression: Results From a Pilot Randomized Controlled Trial

Be a Mom is a self-guided web-based intervention, grounded in cognitive behavioral therapy, delivered to postpartum women to prevent persistent postpartum depression [PPD] symptoms. We aimed to evaluate Be a Mom in terms of its preliminary efficacy, feasibility, and acceptability. A pilot randomized, two-arm controlled trial was conducted. Eligible women (presenting PPD risk-factors and/or early-onset PPD symptoms) were enrolled in the study and were randomly assigned to the intervention (Be a Mom) or to the waiting-list control group. Participants in both groups completed baseline (T1) and postintervention (T2) assessments. The 194 women presenting risk factors/early-onset PPD symptoms were allocated to the intervention (n = 98) or to the control (n = 96) group. A significant Time × Group interaction effect was found for both depressive and anxiety symptoms, with women in the intervention group presenting a larger decrease in symptoms from T1 to T2 (p < .05). Less than half of the women (41.8%) completed Be a Mom. Most women (71.4%) would use Be a Mom again if needed. Results provide preliminary evidence of the Be a Mom’s efficacy, acceptability and feasibility, although further research is needed to establish Be a Mom as a selective/indicative preventive intervention for persistent PPD.     

Enhancing young people's social competence and health behavior: An important challenge for educators, scientists, policymakers, and funders

Large numbers of America's young people engage in multiple high-risk behaviors that may jeopardize their health and social development. Given the gravity of this situation, many federal agencies and national organizations have called for the implementation of school-based K-12 social competence and health promotion programs. Unfortunately, there is a gap between the comprehensive programs that policymakers are asking educators to implement and the limited scope, duration, and intensity of state-of-the-art health promotion programs that scientists have developed and evaluated. As a result, most schools currently adopt well-marketed programs that lack documented effectiveness. Although current research indicates that brief, well-designed, theory-driven competence promotion and health education programs produce short-term benefits, there have been no controlled, longitudinal field studies to evaluate the long-term effects of K-12 efforts. This paper proposes that policymakers and funding agencies support long-term collaborations among educators and scientists to develop and evaluate K-12 comprehensive social competence and health education programs and identifies critical issues that funded projects should address.     

Perception of genetic risk among genetic counselors

A mailed survey of female prenatal genetic counselors, obstetric nurses, and high school biology teachers was conducted to determine if these groups hold different attitudes toward genetic risk and to investigate the extent to which any differences result from the effect of different professional experiences. In this study, the participants were 166 genetic counselors, 116 obstetric nurses, and 78 biology teachers (n = 360). Survey participants completed a written questionnaire designed to assess their numeric estimate of the empiric risk for birth defects/genetic problems, their subjective perception of this risk, and their personal use of prenatal diagnosis. Genetic counselors were found to be less likely than the other groups to consider the frequency of birth defects/genetic problems as rare and were 10 times more likely than nurses and 8 times more likely than teachers to have had prenatal diagnosis. Furthermore, more than half of the prenatal diagnosis procedures had by genetic counselors were not medically indicated. These results suggest that genetic counselors have an increased perception of genetic risks relative to nurses or teachers. Possible explanations for this finding are discussed, and the potential role of discordant risk perception in creating biases in the genetic counseling process is explored.