Cancer pain management in developing countries: a mosaic of complex issues resulting in inadequate analgesia

OBJECTIVE: To determine the prevalence of suicidal ideation and the symptomatic profile as well as to identify the sociodemographic characteristics highlighting female adolescents with the highest scores on suicidal ideation in adolescents living in Mexico City: students and suicidal patients. MATERIAL AND METHODS: A cross-sectional and ex-post-facto study was carried out in order to analyze information from two samples: 1,712 junior and junior high school women students (representative student sample in Mexico City), and 30 adolescents inpatient hospitalized for her suicide attempts (clinical sample). RESULTS: Prevalence of presence as well as persistence of suicidal ideation were higher in the clinical sample, nevertheless 11.8% of the school sample had everyone of the symptoms in a range of 1 to 7 days. The most persistent of the ideation symptoms was: "My family would be better if I were dead"; and in the clinical sample it was "I thought about killing myself". Finally, the sociodemographic characteristics that best matched the student girls having the highest scores in suicidal ideation were: to be on junior high school, to get low grades, to acknowledge school performance as bad and to have interrupted her studies. The characteristics that highlight the girls with a first attempt were analyzed in the clinic sample in comparison with those ones with two or more attempts. It was significant that girls in the second group were living only with one parent and they thought in the last attempt that their dead would be possible or certain. CONCLUSIONS: The prevalence of suicidal ideation was important in the school sample. If it is considered that this psychological construct has a strong association with suicidal attempt, and multiple suicide conduct, then is a priority to detect adolescents in risk and to make preventive efforts, considering the sociodemographic characteristics that configurate in risk for suicidal ideation.     

Cost effectiveness and medical cost-offset considerations in psychological service provision.

Suggests that empirical evidence has demonstrated that psychological interventions can effectively treat a wide range of child and adult health problems. The focus of this review is on costing issues associated with psychological interventions, including cost-effectiveness and cost offset (i.e., a reduction in health care costs attributable to effective intervention). Recent evidence has demonstrated that psychological interventions can be more cost-effective than optimal drug treatment. For example, although having comparable effectiveness, cognitive-behavioral treatments for panic disorder and for depression have been estimated to cost approximately one-third less than pharmacological treatment. Further, a recent meta-analysis of 91 research studies published between 1967 and 1997 found that average health care cost savings due to psychological intervention were in the range of 20-30% across studies, and 90% of the studies reported evidence of a medical cost offset. In conclusion, the evidence indicates that psychological treatments (1) can be cost-effective forms of treatment and (2) have the potential to reduce health care costs, as successfully treated patients typically reduce their utilization of other health care services. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The power of Filial Relationship Enhancement therapy as an intervention in child abuse and neglect.

Identified variables that influence intervention in child abuse and neglect and proposes a constructive approach that can help these children and their families change. This is a difficult and complex societal problem, and it is difficult to tease out the specific elements that are responsible for the frequency of its occurrence. The family context is often recognized as having a significant influence. Filial Relationship Enhancement, using an improved family context to support gains, has a long history of research and practice to support its efficacy to intervene in difficulties that impede optimum functioning in children. Filial Relationship Enhancement helps parents learn to conduct weekly child-centered play therapy sessions with their own children at home. This article presents the basic assumptions and the rationale for considering the potential power of this approach. It also describes a program of intervention incorporated by a child protective unit of a county agency. Using informal measures, outcomes are described as well. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Overview: Can psychologists help the obese child?

To submit personal problems to psychological analysis is no longer to imply that one is emotionally immature. Psychological intervention can be justified rather differently. Since achieving such a negative energy balance necessitates a change in one's behaviour, the behaviour modifier (of whatever psychological persuasion) does have a role to play. The negative energy balance proposition that I have suggested as the basic assumption for psychological intervention may be a sufficient argument for having psychologists involved in weight management; but with benefit of archival records of more than 15 years of an applied psychology of obesity, our contributors are able to delineate many complexities that are now seen to characterize the experience of fatness in children. Donna White discusses the implications for children of our using Stunkard's categorization of levels of obesity. Michael LeBow examines the evidence on the basic question of whether it is dangerous to be an obese child and then proceeds to consider whether it is dangerous to be treated for obesity. Erik Woody reviews the evidence on these and related issues and shows that much of our clinical lore about the obese child is in need of serious revision. And Coates and Thoreson (1981) will encourage us to return more often to a careful individual functional analysis as the basis for design of a client's weight management programme. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Ethnic identity development of internationally adopted children and adolescents: implications for family therapists

The life story of the internationally adopted child tends to be an emotional one. How the story is told and retold in the family can have lasting consequences for the child's adjustment and well-being. In telling the story, parents are faced with a unique challenge: To what extent is it desirable to encourage their children, who already struggle with identity issues related to adoption, to identify with their cultures of origin? Therapists working on these issues with multiethnic adoptive families can find little guidance in the family systems literature. To fill this gap, the present article reviews the literature on racial/ethnic identity development and the available research on ethnic identification, self-esteem, and the psychological adjustment of cross-ethnically adopted children and adolescents. Implications for practice include developmental considerations, identifying children and families at risk, and recommendations for those in need of intervention.     

Psychological distress and its correlates in secondary school students in Pavia, Italy

Adolescence is a time of social as well as biological transition; nevertheless, there are very few epidemiological studies in this field in Italy. Therefore, we felt it would be useful to conduct a cross-sectional study on a sample of 1346 adolescents aged 14-19 years attending high schools in the Health Authority Area of Pavia (northern Italy) through a multi-dimensional approach, taking into consideration physical and psychological health, life habits, family environment and social life of teen-agers. We used a structured self-administered questionnaire consisting of 264 question items to achieve the study aim, which was to find the variables (among personal data, scholastic, family, relational characteristics and habits) correlated with psychological distress. The results showed that in this sample psychological distress (evaluated by GHQ-30) was significatively (p < 0.005) associated with female sex, problems with school friends and teachers, having at least one immigrant parent (from a region different from that of residence), little love for parents and poor parental psycho-physical health status, staying at home on the weekend, smoking and using psychoactive medicines.     

Treatment of Depression Following Spinal Cord Injury: An Evidence-Based Review.

Study Design: Evaluative research review. Objective: Depression is a significant secondary complication of spinal cord injuries (SCI); this study applies the D. L. Sackett (1989) research criteria to evaluate the quality of intervention studies of the treatment of depression among persons with SCI. Method: An extensive range of peer-reviewed published research was identified through established databases, critical reviews, and published meta-analyses. Results: Nine studies met the inclusion criteria. One antidepressant study was rated above Level III; although the psychological intervention studies had control groups, these were not randomized. Conclusion: This review demonstrates the need for randomized clinical trials of psychological and pharmacological interventions for depression and distress among persons with SCI. so that informed decisions concerning cost-effective treatments can be made. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Familial aggregation of emotional and behavioral problems of childhood in the general population

OBJECTIVE: This study sought to evaluate the existence and implications of familial aggregation of emotional and behavioral problems of childhood in a general population sample. METHOD: The children included in the study were chosen with the use of a sampling technique that identified households in which there were two or more children aged 4-16 years living at home at the time of the survey. Ratings on checklists of emotional and behavioral problems were obtained from parents, teachers of children in elementary school, and the children themselves if they were adolescents aged 12-16. Children were classified as having problems if their scores on scales of conduct, attention deficit, or emotional problems were in the top 10% of the distribution of scores from any informant. RESULTS: There was evidence for familial aggregation of these problems, particularly conduct and emotional problems. However, this was largely derived from the parents' reports of symptoms, not the teachers' or adolescents' reports. The degree of familial aggregation varied according to certain sibship characteristics and patterns of comorbidity. CONCLUSIONS: Familial aggregation of emotional and behavioral problems does exist in a community population and is not simply an artifact of clinic attendance.     

An outbreak of needlestick injuries in hospital employees due to needles piercing infectious waste containers

OBJECTIVES: To investigate the cause of an outbreak of needlestick injuries (NSIs) in hospital employees. SETTING: A 700-bed university hospital. DESIGN: Outbreak investigation, laboratory evaluation of a medical waste disposal device, cost analysis. METHODS: Employee health department records were reviewed of workers suffering sticks from needles piercing fiberboard-contaminated material containers (CMCs). A laboratory evaluation of needle-puncture resistance properties of the CMCs was performed using a testing apparatus. The cost of a hospital waste disposal program using fiberboard CMCs was compared with the cost of a program using rigid plastic (polypropylene) boxes. RESULTS: During 40 months of surveillance in 1986 and from 1989 to 1991, only one NSI had occurred from a needle piercing a CMC. During 9 months in 1993, 13 NSIs occurred due to needles piercing CMCs (P < .001). No clinical illness resulted from the NSIs. The outbreak was halted by a temporary change to plastic (polypropylene) boxes for sharps disposal ($4.92 to $23.33/cu ft) until receipt of a box with a newly designed solid fiberboard liner ($1.25/cu ft). CMC liners used during the epidemic had a mean needle puncture resistance of 527 g, as compared with 660 g for liners used before the outbreak (P < .001). The new solid fiberboard liner has a mean puncture resistance of 1,765 g. A program of waste disposal using fiberboard CMCs was found to cost approximately one-seventh the cost of a program using plastic boxes for disposal of infectious waste. CONCLUSION: A program for infectious waste disposal using fiberboard CMCs can be safe and cost-effective if appropriate standards for puncture resistance are met.     

Reducing conduct problems among children of battered women.

This study was an experimental evaluation of an intervention designed to reduce conduct problems among children of battered women. Participants were 36 families (mothers and children) in which the mother had sought shelter because of relationship violence and had at least 1 child (4-9 years old) with clinical levels of conduct problems. The intervention consisted of 2 primary components: (a) providing instrumental and emotional support and (b) teaching child management skills to mothers. Families were randomly assigned to either the intervention condition or the existing services comparison condition and were assessed on 5 occasions over 16 months after shelter departure. Compared with families receiving existing services, children in the intervention condition improved at a faster rate, the proportion of children displaying clinical levels of conduct problems was greatly diminished, and mothers displayed greater improvements in child management skills. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Is Educational Intervention Research on the Decline?

The authors examined intervention studies that appeared in 4 educational psychology journals (Cognition & Instruction, Contemporary Educational Psychology, Journal of Educational Psychology, Journal of Experimental Education) and the American Educational Research Journal (AERJ) in 1983 and from 1995 to 2004. The majority of studies included adults (age 18 and older) as participants, administered brief (less than 1 day) interventions, assessed intervention effects immediately following the intervention, and did not report treatment integrity. Most studies included multiple outcome measures and exhibited an increase in effect-size reporting from 4% in 1995 to 61% in 2004. The percentage of total articles based on randomized experiments decreased over the 21-year period in both the educational psychology journals (from 40% in 1983 to 34% in 1995 to 26% in 2004) and AERJ (from 33% to 17% to 4%). Limitations of the study and future research issues are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Enhancing the scientific credibility of single-case intervention research: Randomization to the rescue.

In recent years, single-case designs have increasingly been used to establish an empirical basis for evidence-based interventions and techniques in a variety of disciplines, including psychology and education. Although traditional single-case designs have typically not met the criteria for a randomized controlled trial relative to conventional multiple-participant experimental designs, there are procedures that can be adopted to create a randomized experiment in this class of experimental design. Our two major purposes in writing this article were (a) to review the various types of single-case design that have been and can be used in psychological and educational intervention research and (b) to incorporate randomized experimental schemes into these designs, thereby improving them so that investigators can draw more valid conclusions from their research. For each traditional single-case design type reviewed, we provide illustrations of how various forms of randomization can be introduced into the basic design structure. We conclude by recommending that traditional single-case intervention designs be transformed into more scientifically credible randomized single-case intervention designs whenever the research conditions under consideration permit. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Handbook of bereavement research and practice: Advances in theory and intervention.

Reviews the book, Handbook of bereavement research and practice: Advances in theory and intervention, edited by Margaret S. Stroebe, Robert O. Hansson, Henk Schut, and Wolfgang Stroebe (see record 2008-09330-000). The goal of this book is to provide a state-of-the-art overview of the field of bereavement research and practise. To achieve this goal, the editors have enlisted the collaboration of several well-known grief and bereavement researchers. This latest effort tries to relate bereavement research more explicitly to contemporary society and practise issues than was done in the two earlier volumes. The handbook is to be commended for fairly presenting multiple, and at times contradictory, points of view on some of the more controversial issues in the field. This results in a fascinating, well-written book, with many thought-provoking chapters that will challenge some of the persistent misconceptions that psychologists may have about bereavement and the nature of grief work. This book will help guide students who want to pursue clinical work or research in this field. Seasoned researchers will likely also find this book very helpful in terms of its conceptual clarification of terms that are often poorly defined. Readers who are looking for practical advice on how best to help their clients grieve may, however, be disappointed. As the editors indicate, this is not a sourcebook for clinicians looking for practical tips. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Enhancing Treatment Fidelity in Health Behavior Change Studies: Best Practices and Recommendations From the NIH Behavior Change Consortium.

Treatment fidelity refers to the methodological strategies used to monitor and enhance the reliability and validity of behavioral interventions. This article describes a multisite effort by the Treatment Fidelity Workgroup of the National Institutes of Health Behavior Change Consortium (BCC) to identify treatment fidelity concepts and strategies in health behavior intervention research. The work group reviewed treatment fidelity practices in the research literature, identified techniques used within the BCC, and developed recommendations for incorporating these practices more consistently. The recommendations cover study design, provider training, treatment delivery, treatment receipt, and enactment of treatment skills. Funding agencies, reviewers, and journal editors are encouraged to make treatment fidelity a standard part of the conduct and evaluation of health behavior intervention research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treatment of eating disorders in children and adolescents

Anorexia nervosa and bulimia nervosa are expressed differently in children and adolescents than in adults. Consequently, diagnostic procedures and multidisciplinary treatments need to be tailored to the unique developmental, medical, nutritional, and psychological needs of children and adolescents with eating disorders. This paper reviews current research outlining the differences between child, adolescent, and adult eating disorders. Research is then reviewed concerning the effectiveness of hospitalization, partial hospitalization, individual dynamic therapy, cognitive-behavioral therapy, interpersonal therapy, family therapy, and medication for treating anorexia nervosa, bulimia nervosa, and related eating disorders in children and adolescents. Specific recommendations are made for practitioners to tailor these treatments to their eating-disordered child and adolescent patients, following a stepped-care, decision-tree model of intervention that takes into account the effectiveness, cost, and intrusiveness of the interventions.     

Caractéristiques associées à la coocurrence du trouble des conduites et de problèmes de consommation de psychotropes chez les gar?ons et les filles.

Although intervention for adolescents with concomitant conduct disorders and substance abuse must be adapted to the individual, familial and social characteristics of the adolescent, few studies have examined the characteristics specific to the concomitance of these problems. The objective of this study was to examine the differences between adolescents who present with one or both of these problems. The study sampled 486 teenagers (146 girls and 340 boys) divided into one of 4 groups on the basis of the presence or absence of conduct disorder and substance abuse. Results showed that girls with conduct disorder alone present problems as severe as those with concomitant conduct disorder and substance abuse but less severe than those with only substance abuse. For boys, those with the concomitant disorders appeared to have problems more servere than those with conduct disorders alone and less severe than those with substance abuse alone. These findings are discussed in terms of the need to tailor intervention to gender and presenting problem(s). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Surgical techniques of orthotopic rat liver transplantation

OBJECTIVES: To analyze the frequency of behavioral/emotional problems and somatic complaints of children aged four to ten as rated by their parents. METHOD: The analysis is based on the PAK-KID study on behavioural and emotional problems and psychosocial competencies of children and adolescents in Germany. In a nationally representative sample of N = 1030 children aged four to ten years the parents rated their child using the Child Behavior Checklist. RESULTS: The prevalence rates of the symptoms are presented. Additionally global prevalence rates based on three different models were calculated and compared. They range from 13.1% to 28.3%. The issues of defining cutoffs necessary for the calculation of prevalence rates are discussed.