Follow-up care after a health fair screening in three Houston neighborhoods in 2008

Background. Each year thousands of people participate in mass health screenings for diabetes and hypertension, but little is known about whether or not those who receive higher than normal screening results obtain the recommended follow-up medical care, or what barriers they perceive to doing so. ^ Methods. Study participants were recruited from attendees at three health fairs in low-income neighborhoods in Houston, Texas Potential participants had higher than normal blood pressure (> 90/140 mgHg) or blood glucose readings (100 mm/dL fasting or 140 mm/dL random). Study participants were called at one, two, and three months and asked if they had obtained follow-up medical care; those who had not yet obtained follow-up care were asked to identify barriers. Using a modified Aday-Andersen model of health service access, the independent variables were individual and community characteristics and self-perceived need. The dependent variable was obtaining follow-up care, with barriers to care a secondary outcome. ^ Results. Eighty-two study participants completed the initial questionnaire and 59 participants completed the study protocol. Forty-eight participants (59% under an intent to treat analysis, 81% of those completing the study protocol) obtained follow-up care. Those who completed the initial questionnaire and who reported a regular source of care were significantly more likely to obtain follow-up care. For those who completed the study protocol the relationship between having a regular source of care and obtaining follow-up care approached but did not reach significance. For those who completed the initial questionnaire, self-described health status, when examined as a binary variable (good, very good, excellent, or poor, fair, not sure) was associated with obtaining follow-up care for those who rated their health as poor, fair, or not sure. While the group who completed the study protocol did not reach statistical significance, the same relationship between self-described health status of poor, fair, or not sure and obtaining follow-up care was present. The participants who completed the study protocol and described their blood pressure as OK or a little high were statistically more likely to get follow-up care than those who described it as high or very high. All those on oral medications for hypertension (12/12) and diabetes (4/4) who were told to obtain follow-up care did so; however, the small sample size allows this correlation to be of statistical significance only for those treating hypertension. ^ The variables significantly associated with obtaining follow-up care were having a regular source of care, self-described health status of poor, fair, or not sure, self-described blood pressure of OK or a little high, and taking medication for blood pressure. ^ At the follow-up telephone calls, 34 participants identified barriers to care; cost was a significant barrier reported by 16 participants, and 10 reported that they didn’t have time because they were working long hours after Hurricane Ike. ^ The study included the offer of access assistance: information about nearby safety-net providers, a visit to or information from the Health Information Center at their Neighborhood Center location, or information from Project Safety Net (a searchable web site for safety net providers). Access assistance was offered at the health fairs and then again at follow-up telephone calls to those who had not yet obtained follow-up care. Of the 48 participants who reported obtaining follow-up care, 26 said they had made use of the access assistance to do so. The use of access assistance was associated with being Hispanic, not having health insurance or a regular source of care, and speaking Spanish. It was also associated with being worried about blood glucose. ^ Conclusion. Access assistance, as a community enabling characteristic, may be useful in aiding low-income people in obtaining medical care. ^

Perceived risk and outcome expectancy on the practice of home infusion technique in a hemophilia population

This study described home infusion techniques and practices, measured the perceived risk of HIV and hepatitis transmission to self and others, and measured the outcome expectancy of following risk reduction guidelines for 90 hemophilia patients and/or their infusion assistants. It also assessed general knowledge of HIV and hepatitis information for the same population.^ The study subjects were hemophilia patients or their infusion assistants from the Gulf States Hemophilia Center in Houston, the El Paso Satellite Hemophilia Clinic in El Paso, or Texas members of the Women Outreach Network of the National Hemophilia Foundation (WONN) group. Each subject was interviewed either by telephone or in person. The questionnaire used was developed for the study and consisted of 60 items. These items assessed general demographics for the patients and assistants, including questions about their training to do infusions as well as the actual practices, measured perceived personal risk for the transmission of HIV or hepatitis to the assistants, perceived risk of transmission of HIV or hepatitis to others for assistants and self-infusers, and the outcome expectancy for following recommended risk reduction guidelines also for both groups.^ The theoretical framework used assumed that perceived risk and outcome expectancy would be predictive of behavior. The findings did not support this theory. Instead, the findings suggest that infusion behavior is habitual in nature; most respondents perform exactly the same behavior for every infusion. Since none of the variables selected were predictive of the compliance behavior for home infusion the teaching method should be directed towards mastery learning, or learning that will incorporate the correct behavior into a habitual pattern of home infusion. ^

An Institutional Analysis of Environmental Pollution Disputes in Taiwan: Cases of 'Self-Relief'

During the late 1980s and early 1990s in Taiwan, people's protests against environmental pollution often took the form of "self-relief," meaning that they attempted to fight polluters using their own resources, without relying on legal or administrative procedures. Why did such an extreme form of disputes become so widespread? What institutional changes did these movements bring about? These questions are analyzed using the analytical framework of "law and economics." Our research shows that "self-relief" functioned to a certain extent as a means of realizing quick compensation for victims, and for reflecting the opinions of local people concerning development projects; in addition, it served to promote the formulation of law and administrative systems. However, as it was based on direct negotiations between the parties concerned, the outcome of each dispute only reflected the transient balance of forces, and the experience gained in negotiations was not accumulated as a social norm.

The paradox of alloreactivity and self MHC restriction: Quantitative analysis and statistics

Although 1–24% of T cells are alloreactive, i.e., respond to MHC molecules encoded by a foreign haplotype, it is generally believed that T cells cannot recognize foreign peptides binding foreign MHC molecules. We show using a quantitative model that, if T cell selection and activation are affinity-driven, then an alloreactivity of 1–24% is incompatible with the textbook notion that self MHC restriction is absolute. If an average of 1% of clones are alloreactive, then according to our model, at most 20-fold more clones should, on average, be activated by antigens presented on self MHC than by antigens presented on foreign MHC. This ratio is at best 5 if alloreactivity is 5%. These results describe average properties of the murine immune system, but not the outcome of individual experiments. Using supercomputer technology, we simulated 100,000 MHC restriction experiments. Although the average restriction ratio was 7.1, restriction was absolute in 10% of the simulated experiments, greater than 100, although not absolute, in 29%, and below 6 in 24%. This extreme variability agrees with experimental estimates. Our analysis suggests that alloreactivity and average self MHC restriction both cannot be high, but that a low average restriction level is compatible with high levels in a significant number of experiments.

Self-Injurious Behavior And Its Relationship To Eating Disorder Symptom Severity

Widely held clinical assumptions about self-harming eating disorder patients were tested in this project. Specifically, the present study had two aims: (1) to confirm research that suggests patients with self-injurious behavior exhibit greater severity in eating disorder symptomology; and (2) to document the treatment course for these patients (e.g. reported change in eating disorder attitudes, beliefs, and behaviors) from admission to discharge. Data from 43 participants who received treatment at a Partial Hospitalization Program (PHP) for Eating Disorders were used in the current study. The length of treatment required for study inclusion reflected mean lengths of stay (Williamson, Thaw, & Varnardo-Sullivan, 2001) and meaningful treatment lengths in prior research (McFarlane et al., 2013; McFarlane, Olmsted, & Trottier, 2008): five to eight weeks. Scores on the Eating Disorder Inventory-III (Garner, 2004) at the time of admission and discharge were compared. These results suggest that there are no significant differences between eating disordered patients who engage in self-injury and those who do not in terms of symptom severity or pathology at admission. The results further suggest that patients in both groups see equivalent reductions in symptoms from admission to discharge across domains and also share non-significant changes in emotional dysregulation over the course of treatment. Importantly, these results also suggest that general psychological maladjustment is higher at discharge for eating disordered patients who engage in self-injury.

The Eating Disorder Inventory-III Maturity Fears Scale and Treatment Outcome in an Intensive Outpatient Eating Disorder Program

Eating disorders present a significant physical and psychological problem with a prevalence rate of approximately six percent in the United States. Despite the extensive literature, identifying the consistent risk factors for predicting the course of treatment in eating disorders remains difficult. The present study explores the use of a standardized assessment, using the consistently validated Eating Disorder Inventory-III (EDI-3), in predicting treatment outcome. Specifically, the study investigates the particular scale of Maturity Fears (MF) on the EDI-3, hypothesizing that higher scores on the MF scale would predict lower rates of recovery and treatment completion. The participants were 52 eating disorder patients (19 AN, 18 BN, and 15 EDNOS), consecutively admitted to a five-month long intensive outpatient program (IOP). The participants completed an EDI-3 self-report at pre and post treatment, and their score on the MF scale did not show a significant predictive relationship to treatment completion or change in symptoms, as measured by the Eating Disorder Risk Composite (EDRC) scale on the EDI-3. This finding primarily suggests that maturity fears are not a significant predictive factor in an outpatient setting with adults, as compared to previous studies that found a relationship between maturity fears and treatment outcome, primarily with adolescent and inpatient populations.

Assessment of fight outcome is needed to activate socially driven transcriptional changes in the zebrafish brain

Group living animals must be able to express different behavior profiles depending on their social status. Therefore, the same genotype may translate into different behavioral phenotypes through socially driven differential gene expression. However, how social information is translated into a neurogenomic response and what are the specific cues in a social interaction that signal a change in social status are questions that have remained unanswered. Here, we show for the first time, to our knowledge, that the switch between status-specific neurogenomic states relies on the assessment of fight outcome rather than just on self- or opponent-only assessment of fighting ability. For this purpose, we manipulated the perception of fight outcome in male zebrafish and measured its impact on the brain transcriptome using a zebrafish whole genome gene chip. Males fought either a real opponent, and a winner and a loser were identified, or their own image on a mirror, in which case, despite expressing aggressive behavior, males did not experience either a victory or a defeat. Massive changes in the brain transcriptome were observed in real opponent fighters, with losers displaying both a higher number of differentially expressed genes and of coexpressed gene modules than winners. In contrast, mirror fighters expressed a neurogenomic state similar to that of noninteracting fish. The genes that responded to fight outcome included immediate early genes and genes involved in neuroplasticity and epigenetic modifications. These results indicate that, even in cognitively simple organisms such as zebrafish, neurogenomic responses underlying changes in social status rely on mutual assessment of fighting ability.

A combined analysis of two randomized controlled trials evaluating the effect of Mindfulness-Based Stress Reduction on self-reported emotional experience and physiological symptoms among Veterans with Posttraumatic Stress Disorder

Thesis (Master's)--University of Washington, 2016-06

Social Support Networks and Self-Efficacy of Peruvian Women Diagnosed with Cancer: A Biocultural Analysis of Health Behavior Constructs

Thesis (Ph.D.)--University of Washington, 2016-06

Self-Reported Fall and Associate Risk Factors Among Korean American Adults In Washington State

Thesis (Master's)--University of Washington, 2016-06

Improving family functioning and child outcome in methadone maintained families: the Parents Under Pressure programme

Twelve families responded to posters displayed in a methadone clinic for inclusion in a pilot study assessing the viability and potential utility of an intensive, multi-component family-focused intervention, the Parents Under Pressure programme. The programme was designed to improve child behaviour, decrease parental stress and improve family functioning in methadone-maintained families by targeting affect regulation, mood, views of self as a parent, drug use and parenting skills. Nine of the families completed the programme delivered in their homes; eight were recontacted at 3 months. Each family reported significant improvements in three domains: parental functioning, parent - child relationship and parental substance use and risk behaviour. In addition to the changes in family functioning, the majority of families reported a decrease in concurrent alcohol use, HIV risk-taking behaviour and maintenance dose of methadone. The families reported high levels of satisfaction with the programme. It is recommended that future studies include independent measures (e.g. behavioural observations) of child outcome and parental functioning. The results were optimistic and provided the impetus to evaluate the treatment programme using a randomized controlled trial.

Social approval and trait self-esteem

Interpersonal theories of self-esteem that tie self-esteem to perceptions of ones acceptability to other people suggest that self-evaluations should predict global self-esteem to the degree to which an individual believes that a particular attribute is important for social approval. In the present study, participants completed a measure of global self-esteem, rated themselves in five domains, and indicated how important those domains were for approval or disapproval. The results showed that, in four of five domains, the interaction between self-evaluations and the perceived approval-value of that domain aided in the prediction of global self-esteem. Generally, for participants who rated themselves positively in a domain, those who believed that the domain was important in affecting social approval or disapproval had higher self-esteem than those who did not believe it would influence acceptability.

Investigation of psychological and neuropsychological factors associated with clinical outcome following a group rehabilitation programme

The present study investigated neuropsychological and psychological factors associated with successful treatment outcome following a group intervention for individuals with acquired brain injury (ABI). Participants were classified into two groups (Clinically Improved and Not Improved) based upon the findings of a previous study (Ownsworth, McFarland, & Young, 2000a). A discriminant analysis was used to predict group membership on three outcome measures (Awareness and Strategy Behaviour indices of the Self-Regulation Skills Interview and the Psychosocial Dimension of the Sickness Impact Profile) between pre-assessment and post-assessment, and between pre-assessment and 6 months follow-up. Neuropsychological factors involved measures of executive functioning and psychological factors were assessed using measures of personality-related denial and coping-related denial. Overall, the results indicated that individuals with impaired executive functioning were most likely to be classified as Clinically Improved on measures of awareness, strategy behaviour and psychosocial functioning. Individuals who deny or minimise their ABI symptoms were less likely to improve their psychosocial functioning following the group intervention. Future research needs to evaluate interventions for enhancing self-regulation skills and improving psychosocial functioning for individuals who employ denial as a main strategy for coping following ABI.

Loyalty without Conformity: Tailoring Self-perception as a Means of Balancing Belonging and Differentiation

We argue that members of individualist cultures balance their desire to belong with their desire to be different by maintaining a self-image as being loyal but relatively immune to group influence. Consistent with this, in Study 1 there was a strong tendency for people to rate themselves as being more independent (i.e., less conformist) than other people in their college. College students also rated themselves as being highly loyal to the group, however no self - other discrepancies were found on this dimension. This is despite the fact that traits of loyalty were rated more positively than were traits of independence. Study 2 provided evidence that culture influences the pattern of self - other discrepancies. Whereas people from individualist countries self-enhance on independence dimensions, people from collectivist countries self-enhance on loyalty dimensions. Again, these effects could not be explained as being a function of how positive these traits were seen to be, suggesting a cultural explanation rather than a straight forward superiority bias explanation for the observed discrepancies in self - other ratings. Results are discussed in relation to the SCENT model.

Drinking refusal self-efficacy questionnaire-revised (DRSEQ-R): a new factor structure with confirmatory factor analysis

The drinking refusal self-efficacy questionnaire (DRSEQ: Young, R.M., Oei, T.P.S., 1996. Drinking expectancy profile: test manual. Behaviour Research and Therapy Centre, University of Queensland, Australia Young, R.M., Oei, T.P.S., Crook, G.M., 1991. Development of a drinking refusal self-efficacy questionnaire. J. Psychopathol. Behav. Assess., 13, 1-15) assesses a person's belief in their ability to resist alcohol. The DRSEQ is a sound psychometric instrument based on exploratory factor analyses, but has not been subjected to confirmatory factor analysis. In total 2773 participants were used to confirm the factor structure of the DRSEQ. Initial analyses revealed that the original structure was not confirmed in the current study. Subsequent analyses resulted in a revised factor structure (DRSEQ-R) being confirmed in community, student and clinical samples. The DRSEQ-R was also found to have good construct and concurrent validity. The factor structure of the DRSEQ-R is more stable than the original structure of the DRSEQ and the revised scale has considerable potential in future alcohol-related research. (c) 2004 Elsevier Ireland Ltd. All rights reserved.