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Exploration of potential preliminary screeners, and examination of social intervention outcomes for effects on comorbid symptoms is imperative. The Child Behavior Checklist (CBCL; Achenbach & Rescorla, Achenbach and Rescorla, Manual for the ASEBA school-age forms & profiles, University of Vermont, Research Center for Children, Youth & Families, 2001) provides a potential ASD screener and intervention outcome evaluation. This study had two aims: (1) to examine CBCL scales scores as a potential ASD screener; (2) to investigate PEERS® outcomes via the CBCL for Autistic adolescents. Results indicated elevated scores on four CBCL scales in the ASD groups, contrasted to a typically-developing group. Furthermore, decreases in the two CBCL scales for adolescents that received the intervention were found. Findings support prior research indicating a unique CBCL elevation pattern as a potential screener for ASD, and provide additional support for the efficaciousness of PEERS®.

This paper presents a review of research on intervention of behaviour problem in young children with Autistic Spectrum Disorder (ASD) between 2002 and 2019. 15 literatures include in this review based on inclusion and exclusion criteria that involves 490 participants. The analysis is categorized into Three Theme: 1) the behaviour problem that exist most in young children with ASD, 2) The intervention overview, and 3) the intervention outcome. The analysis results a recommendation that various approach and method in this review is effective to reduce behaviour problem as well as improve appropriate behaviour.

This pilot study aimed to test whether increase in daily steps and day-to-day consistency in daily steps during the first several weeks of a physical activity intervention predicted outcomes. This was a secondary analysis from two concurrent studies testing a positive psychology-motivational interviewing intervention to increase physical activity and positive affect in individuals with type 2 diabetes. Steps were measured with accelerometers at study assessments (baseline, end-of-treatment, and 8-week follow-up) and were measured daily throughout the intervention by participants using provided pedometers. We calculated change in steps from intervention week 1 to week 3, along with variability in daily steps over the first 3 weeks, using the best fitting regression line modeling their change. Multiple regression analyses tested whether these predictors were associated with change in physical activity at the end of treatment and at 8-week follow-up. Additionally, we explored the utility of specific cutoffs (e.g., 500 steps) for early step change using a minimum p-value approach. In 52 participants, larger step increases by week 3 predicted activity increase at end-of-treatment and follow-up. Variability in early steps was not associated with outcomes. Early increase cutoffs of 500 and 2000 steps may have practical relevance. Early response to a physical activity intervention appears to be a useful predictor of outcome and could be used to identify those unlikely to succeed in a given intervention early in treatment. ClinicalTrials.gov identifiers NCT03150199 and NCT03001999

Funding Acknowledgements Type of funding sources: None. onbehalf The BSCMR Valve Consortium Background Patients with low-flow aortic stenosis (LF-AS) have higher mortality than those with high-flow severe AS. The conventional echocardiographic definition of LF-AS is an indexed stroke volume (SVi) Purpose To determine the association between CMR SVi, myocardial remodelling and survival in severe symptomatic AS. Methods In a multi-centre longitudinal outcome study of patients with severe AS listed for either surgical (SAVR) or transcatheter aortic valve intervention (TAVI) at six cardiothoracic centres, survival was assessed and stratified by SVi. Patients underwent preprocedural echocardiography and CMR between January 2003 and May 2015. Standardised core-lab analyses on pre-procedural CMR for biventricular volumes, function and scar quantification were performed. All-cause and cardiovascular mortality were tracked for a minimum of two years after AVR. Results A total of 674 patients with severe AS (age 75 ± 14years; 63% male, aortic valve area 0.4 ± 0.1 cm2/m2) were included. Patients with low SVi by CMR Conclusion SVi by CMR is an independent predictor of cardiovascular mortality. Mortality hazard increases progressively below a SVi of 50mL/m2. Abstract Figure 1

Tuberculosis (TB) remains a leading cause of death globally among infectious diseases that has killed more numbers of people than any other infectious diseases. Animal models have become the lynchpin for mimicking human infectious diseases. Research on TB could be facilitated by animal challenge models such as the guinea pig, mice, rabbit and non-human primates. No single model presents all aspects of disease pathogenesis due to considerable differences in disease resistance/susceptibility between these models. Availability of a wide range of animal strains, Mycobacterium tuberculosis strains, route of infection and doses affect the disease progression and intervention outcome. Different animal models have contributed significantly to the drug and vaccine development, identification of biomarkers, understanding of TB immunopathogenesis and host genetic influence on infection. In this review, the commonly used animal models in TB research are discussed along with their advantages and limitations.

© The Author(s) 2018. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. Objective Parental factors are central in the development and maintenance of chronic pain in youths. Only a handful of studies have investigated the impact of psychological treatments for pediatric chronic pain on parental factors, and the relationships between changes in parental and adolescent factors. In the current study, we evaluated the effects of an intensive interdisciplinary pain treatment (IIPT) program based on Acceptance and Commitment Therapy (ACT) for adolescents with chronic pain, on adolescent and parental variables, and the relationship between parental psychological flexibility and adolescent pain acceptance. Methods Adolescents (N ¼ 164) with chronic pain were included, with a mean age of 15.5 years, and completed the 3-week treatment with an accompanying parent (N ¼ 164). Linear mixed-effects models were used to analyze change over time (from pretreatment to 3-month follow-up) on parent (depression, health-related quality of life and parent psychological flexibility) and adolescent (physical, social and emotional functioning, and adolescent pain acceptance) variables. Additionally, linear mixed-effects models were used to analyze the relationship between parent psychological flexibility and adolescent pain acceptance. Results Results illustrated significant improvements over time in depressive symptoms and levels of psychological flexibility in parents. Excluding social development, adolescents improved significantly in all assessed aspects of functioning and pain acceptance. Additionally, changes in parent psychological flexibility were significantly associated with changes in adolescent pain acceptance. Conclusions Results indicated that treatment had positive effects for parents and adolescents, and a significant positive relationship between changes in parent psychological flexibility and adolescent pain acceptance was found.

We use divestitures to examine all possible outcomes of activist intervention. Using hand-collected data on activist-initiated divestitures, we show that hedge funds do not use divestitures to attract bidders, nor do they liquidate their holdings faster than other activists. Rather, divestitures initiated by hedge funds improve long-term target firm profitability, even relative to other activists. We show that hedge fund activists use derivatives to accumulate voting rights without having to disclose—a strategy that is not available (or is much more costly) to other activists—when they identify value-creating opportunities through divestitures.

application/pdf, Article, Clinical Neurophysiology. 2019, 130 (6), p.1027-1028

This review examined the effectiveness of peer-mediated pivotal response treatment (PM-PRT) to increase social-communication skills for children with autism spectrum disorders (ASD). A systematic review was conducted of all published studies examining PM-PRT in school-aged children with ASD, based on an established rubric. Five PM-PRT studies utilizing single-subject research designs were reviewed, involving 29 participants (8 with ASD and 21 peer coaches). Most studies of PM-PRT observed positive outcomes. However, the existing research base did not meet criteria for classification as promising or established evidence-based practice (EBP) for improving social skill deficits in children with ASD. More research is required for PM-PRT to be considered formally as EBP. This review may be used to guide clinical decisions for school psychologists and future research. Our aim was to highlight the rationale for, and core aspects of, this intervention and discuss school-based applications.

The purposes of this article are to (a) summarize the status of career intervention research since Spokane and Oliver’s seminal meta-analysis of vocational intervention outcome and (b) discuss in more detail a recently proposed method for determining whether career interventions make a difference in the lives of clients (clinical significance). Although several excellent meta-analyses of the career intervention outcome literature have appeared since 1983, we briefly summarize the meta-analytic results, discuss future research directions that were suggested by the meta-analyses, and evaluate our progress in addressing suggestions. The bulk of the article focuses on summarizing how clinical significance of career outcomes can be addressed, presenting normative data that can be used to address clinical significance questions with several widely used outcome measures, and illustrating clinical significance calculations using published career intervention studies.

School counselors increasingly are being asked to develop and implement data-based interventions for academic and social/emotional problems. The purpose of this article is to provide a demonstration of goal attainment scaling (GAS) as an intervention outcome assessment tool for school counselor’s work with students. The strengths and limitations of the GAS method are described and an application is provided on the use of the method with school counseling consultation cases. We conclude that GAS is a useful tool for school counselors to evaluate individual or group intervention outcomes.

Background The interrelationship between the well-being of injecting drug users (IDUs) and their family environment has been widely documented. However, few intervention programs have addressed the needs of both IDUs and their family members. Methods This study describes a randomized intervention pilot targeting 83 IDUs and 83 of their family members from four communes in Phu Thọ province, Vietnam. The IDUs and family members in the intervention condition received multiple group sessions, with the intent to improve psychological well-being and family relationships. The intervention outcomes (depressive symptoms and family relations) were evaluated at baseline, 3-month and 6-month follow-up assessments. Results Depressive symptoms and family relations reported by IDUs were found to be correlated to those reported by their family members. Overall, significant intervention effects on depressive symptoms and family relations were observed for both IDUs and family members. A similar improvement pattern in family relations emerged for both the IDU and family member samples, although the intervention effect of reducing depressive symptoms was more sustainable for family members at the 6-month assessment when compared to the IDU sample. Conclusion The intervention pilot addressed challenges faced by IDUs and their family members and revealed correlated outcomes for the two groups. Findings suggest a vital need to include family members in future drug prevention and harm reduction intervention efforts.

SYNOPSIS This tutorial provides an overview of major considerations in the design and implementation of research on outcomes of parenting interventions. It is offered in the context of escalating interest in the use of rigorous research designs for determining effective strategies for improving parents’ contributions to the well-being of their children. The tutorial provides guidance on preliminary work for conducting an outcome study, sampling, research designs that permit causal inference, options for comparison conditions, the measurement of implementation fidelity and parent/child outcomes, and basic considerations in outcome analyses.

The goal of this study was to investigate moderators of mindfulness training. The present study employed a brief form of mindfulness training with moderately distressed participants. Psychological distress was measured before and after a five-session mindfulness intervention. Two hypothesized moderators of treatment outcome, discomfort with emotion and mindfulness were measured before the intervention. Consistent with previous research, the brief mindfulness intervention was associated with reductions in psychological distress with a large pre-post effect size. Importantly, reductions in distress were significantly moderated by discomfort with emotion. Individuals reporting the most discomfort with emotion showed less reduction in distress after the mindfulness intervention. Results highlight the importance of investigating moderators of mindfulness intervention outcome.

Meniscal replacement to treat early osteoarthritis of the knee after meniscectomy may be accompanied by other surgical procedures to treat factors predisposing to a negative intervention outcome. Overload of the medial compartment in slight varus can be reduced by applying the new KineSpring system, which can promote the best possible outcome of a biodegradable meniscal scaffold implantation, without producing biomechanical and anatomical alterations of the joint. This is the first case report on the combination of these hi-tech and bio-tech techniques.

This meta-analysis focuses on the efficacy of interventions for adults facing separation or divorce designed to help them through the process of divorce. In this meta-analysis we investigate the nature of these programmes and their influence on reduction of divorce-related symptoms. Using a heterogeneous data-set (amount of variance explained by sampling error 58.68%) of N = 2022 adults, 24 independent effect sizes were calculated. The overall mean effect size was= 0.47. Due to the heterogeneity of the results, partial analyses were also conducted. Our results on study characteristics and effect sizes as well as standards for presenting results in primary studies are discussed. Altogether, this meta-analysis provides a detailed and methodologically valid contribution to quantitative research in the field of divorce adjustment.

Data from 326 children taught consecutively in a physical education clinic were reviewed. Only 63 children (39 males, 24 females) (19%) met the diagnostic criteria for developmental coordination disorder (DCD) specified by the American Psychiatric Association (2000). The other children were diagnosed with neuromuscular disorders and medical conditions. After an average intervention period of 12 weeks, the mean performance percentile of children with DCD significantly improved beyond the cutoff of the diagnostic criteria. Student teachers’ knowledge of the constraint-based approach, in addition to knowledge of the more traditional information-processing approach, made no difference to the intervention outcome. Results showed that children with DCD benefited from either the constraint-based approach or the information-processing approach to individual physical education programs. This review also highlighted the need for direct services in the treatment of developmental and physical disabilities. In addition to treatment programs affiliated with universities, family focused or community based intervention may be realistic and potential solutions under the financial constraints on the educational and medical systems.

Response to intervention (RTI) is a rationally appealing approach to meeting the needs of all students; it is predicated on providing students support at the time and in the environment in which they need support with intensity match to that need. However, the rationality of the system is grounded on providing interventions at a meaningful level of implementation. Extensive research now exists demonstrating that in the absence of systematic follow-up, implementation of interventions is commonly poor and deteriorates over time. This chapter reviews the existing literature as it relates to the definition of intervention implementation, its measurement, improving implementation, and the relationship between implementation and intervention outcome. Central conclusions are that measures based on procedural step completion have been practically and scientifically successful measures and that a number of variations of performance feedback successfully have been used as follow-up. The implications of the existing literature for current RTI practice and additional research needs are discussed.

Background: Individual coaching has become a popular intervention tool to increase manager’s (named coaches) affective commitment, competences and effectiveness in conducting healthy organizational changes. The aim of this chapter is to explore the influence of the role behavior of the coach and the participants on intervention outcome. Intervention: An eight month individual coaching intervention focusing on the safety-related competencies of the top manager and the safety manager was carried out in a medium-sized Danish company. Results: The coaching interventions towards the top manager generally succeeded and supported substantial changes in the Company’s approach to safety. The safety manager solved 69% of the coaching tasks. However, the safety manager did not change her role behavior substantially and this intervention was categorized as partly failed. In this case, the role behaviors of the coach and the safety manager and the power relation between these lead to implementation failure. Lessons learned and possible solutions: Role behaviors of the coach and the participants are important for the implementation of individual coaching interventions. The theory of individual coaching needs to address these issues. Additional, a clarification of power interest between the coach and the company is a precondition for successful coaching interventions.

Dislike of one's clients is a problem many clinicians encounter and it can have a drastic negative impact on client-clinician rapport, as well as the intervention outcome. Reasons for dislike can be varied and are not clearly known, as little research has been done on the topic. The purpose of this pilot study was to begin to understand how clinicians experience and navigate dislike for clients in practice. The study yielded critical information regarding the factors that influence dislike and the coping skills utilized by practitioners to counter or ameliorate such feelings. Recommendations for practitioners are provided, including a better understanding of feelings of dislike for one's client outside of the countertransference framework of understanding.

Background Mechanical obstruction of odorant flow to the olfactory neuroepithelium may be a primary cause of olfactory loss in nasal-sinus disease patients. Surgical removal of nasal obstruction may facilitate the recovery of olfactory ability. Unfortunately, quantifying the functional impact of nasal obstruction and subsequent surgical outcomes using acoustic rhinometry, rhinomanometry, or CT scans is inadequate. Methods Using computational fluid dynamics (CFD) techniques, we can convert patient CT scans into anatomically accurate 3D numerical nasal models that can be used to predict nasal airflow and odorant delivery rates. These models also can be rapidly modified to reflect anatomic changes, e.g., surgical removal of polyps. Results CFD modeling of one patient's nose pre- and postsurgery showed significant improvement in postsurgical ortho- and retronasal airflow and odorant delivery rate to olfactory neuroepithelium (Conclusion This study has introduced a novel technique (CFD) to calculate nasal airflow dynamics and its effects on olfaction, nasal obstruction, and sinus disease. In the future, such techniques may provide a quantitative evaluation of surgical outcome and an important preoperative guide to optimize nasal airflow and odorant delivery.

The clomiphene citrate challenge test is a tool to predict ovarian reserve and fertility. It has mainly been used as a predictor of success of IVF/intracytoplasmic sperm injection (ICSI) cycles. Infertile young women with diminished ovarian reserve have a worse prognosis than women with adequate ovarian reserve attempting IVF/ICSI cycles. Nothing is known regarding the outcome of young women with diminished ovarian reserve undergoing low-complexity assisted reproductive treatment such as ovulation induction plus intrauterine insemination (IUI). This study included all women under 37 years who consulted in the authors’ centre between May 2004 and August 2005 who underwent ovulation induction and IUI. Ninety-six women younger than 37 years with adequate ovarian reserve, and 50 women with diminished ovarian reserve were found. The pregnancy rate and pregnancy rate per cycle in the adequate ovarian reserve group were significantly higher than those of the diminished ovarian reserve group (46.7% versus 25%, P < 0.02; 15.9% versus 7.6%, P < 0.02 respectively). It is concluded that the clomiphene citrate challenge test is a good predictor of low-complexity infertility intervention outcome, and represents an effective tool to establish a prognosis. Therefore, it is very useful in planning therapy, and advising the infertile couple.

College alcohol use and abuse is a serious problem, in part because many college students do not view their drinking as problematic. Consequently, a harm reduction approach is especially appealing for the prevention of alcohol use and associated negative consequences among this population. By taking steps to reduce the harmful effects of drinking, without requiring abstinence, harm reduction holds the potential to reach many young adults who would not otherwise utilize traditional intervention efforts. The Lifestyle Management Class (LMC) was developed as a holistic approach that embraces the tenants of harm reduction. The LMC is delivered in two, 2-h group sessions that include didactic presentations, personal exercises, individualized feedback, and facilitated discussion. The basic philosophy, content, and processes of the LMC are presented in this article. A recent intervention outcome study is also summarized in which the LMC was found to be effective as both a targeted and universal intervention appr...

Research on aggression and violence has consistently recognized two subtypes of aggressive behavior: a reactive or impulsive type and a predatory or premeditated type. Several studies have also demonstrated the importance of classifying aggressive behavior in relation to treatment/intervention outcome, suggesting that the extent to which neurobiological variables influence impulsive and premeditated aggressive behavior differs. Despite these results, few neurobiological studies of aggression have attempted to classify violent behavior according to these subtypes. This article selectively reviews literature on the neurobiological correlates of aggression focusing on studies that have specifically examined or compared aggressive subtypes (impulsive or premeditated). In addition, a clinically effective classification scheme for aggressive behavior is presented along with supporting personality and psychophysiological data. Issues relevant to the study, identification, and treatment of aggressive beh...

Executive dysfunction is present in children, adolescents, and adults with a wide range of clinical conditions. A growing body of literature has demonstrated the usefulness of rating scales designed to gauge executive functioning in everyday life. In this article, we discuss evidence supporting the use of such rating scales to assess intervention outcome, how they may inform development of interventions, and how comparing rater perspectives can assess awareness of cognitive dysfunction. We provide an example of how an executive function rating scale helped define intervention targets and measured outcomes in a recently published real-world intervention for children with autism spectrum disorder. Rating scales of executive function provide valuable information with respect to treatment planning and assessment of intervention outcome.

Background: The standardized patient approach has proved to be an effective training tool for medical educators. This article explains the process of employing standardized patients in an HIV stigma reduction intervention in healthcare settings in China.Methods: The study was conducted in 40 hospitals in two provinces of China. One year after the stigma reduction intervention, standardized patients made unannounced visits to participating hospitals, randomly approached service providers on duty and presented symptoms related to HIV and disclosed HIV-positive test results. After each visit, the standardized patients evaluated their providers' attitudes and behaviours using a structured checklist. Standardized patients also took open-ended observation notes about their experience and the evaluation process.Results: Seven standardized patients conducted a total of 217 assessments (108 from 20 hospitals in the intervention condition; 109 from 20 hospitals in the control condition). Based on a comparative analysis, the intervention hospitals received a better rating than the control hospitals in terms of general impression and universal precaution compliance as well as a lower score on stigmatizing attitudes and behaviours toward the standardized patients.Conclusion: Standardized patients are a useful supplement to traditional self-report assessments, particularly for measuring intervention outcomes that are sensitive or prone to social desirability.© The Author 2013; all rights reserved.

Children with communication needs are often allocated intervention services as a result of the relationship between their cognitive ability and language performance. Children with higher cognitive skills relative to language skills are considered promising candidates for language services. In contrast, children who are delayed in both cognitive and language abilities are considered poor candidates for intervention and are often excluded from services, or given a lower priority for services. This study examines the effects of intervention on one aspect of pragmatic development (discourse skills) following intervention for two groups of young children with delayed language development: one group with measured cognitive performance above language performance, and the other group with similar delays in both language and cognitive performance. Repeated measures analyses of variance indicated significant differences between groups for two of 15 measures derived from language samples. Both favored the children with equivalent delays in language and cognition. These findings do not support the notion that children with equivalent delays in cognition and language development are poor candidates for language intervention. Service delivery and policy implications are discussed.

Studies published between 1983 and 1995 that examined the effectiveness of career interventions were subjected to a meta-analytic review to replicate L. W. Oliver and A. R. Spokane's (1988) study. Using a sophisticated coding system and extensive data analyses, this study examined 268 treatment-control contrasts from 47 studies that involved 4,660 participants. The average overall effect sizes were smaller but similar to those found previously. Individual career counseling was found to be the most effective and efficient treatment, whereas computer interventions were the most cost-effective. The results of this study do not support the previous finding that treatment intensity predicted effect-size magnitude.

This article describes the implementation of mental health intervention programs for children, adolescents, and their families exposed to natural disaster and violence. Recommendations are made regarding needed levels of organization, methods of screening and triage, training and supervision of mental health staff, design and implementation of treatment approaches, and longitudinal monitoring of course of recovery and intervention outcome.

Background. There is potential for unintended effects on intervention outcome when using the Canadian Occupational Performance Measure (COPM) in intervention studies. Purpose. To determine the effect of blinded parent-proxy ratings of the COPM on outcomes at later endpoints. Methods. Data were drawn from a randomized trial of 50 children with hemiplegic cerebral palsy aged 19 months to seven years. Outcomes were measured at baseline, post-intervention, and six months. Parents of 36 children were randomly allocated to complete six-month COPM proxy ratings blinded or unblinded to previous ratings. A group of 32 parents rated the six-month COPM blinded and then re-rated it after access to previous ratings. Findings. There was no statistically significant difference in ratings between those completing the COPM blinded compared to unblinded. Implications. The COPM should continue to be rated blinded at post-intervention endpoints in the absence of further research to the contrary.

The aim of the present thesis was to examine the effectiveness of the Illness Management and Recovery (IMR) program for teaching clients with schizophrenia or schizoaffective disorder to better manage their illness and to promote recovery. This was accomplished through an examination of the program’s effects on psychosocial functioning and psychopathology, the evaluation of general and specific impact of neurocognition on learning the fundamentals of illness self-management, and the impact of symptom severity on outcome of the IMR program. The utility of the illness management and recovery scale to evaluate illness self-management of clients with schizophrenia and schizoaffective disorder was also investigated. The effects of the IMR program were evaluated in a randomized controlled trial that compared participants in the program to participants receiving treatment as usual. 41 participants were recruited at six psychiatric outpatient rehabilitation centers in Uppsala, Sweden, and were randomly assigned to IMR groups for approximately 40 sessions or to a treatment as usual control condition. The IMR program participants demonstrated greater improvement compared to participants in treatment as usual in illness self-management, reduced psychiatric symptoms, improved coping skills, and decreases in suicidal ideation. The findings suggest that the IMR program is effective in improving the ability of individuals with schizophrenia and schizoaffective disorder to better manage their illness. Possible association between neurocognitive functioning and the acquisition of illness self-management skills was investigated in a total of 53 participants who completed the IMR program. Speed of processing was related to client reported illness self-management skills acquisition, before and after controlling for psychiatric symptoms and medication, but neurocognitive functioning did not predict improvement in clinician ratings of client illness self-management skills. The findings suggest that compromised neurocognitive functioning does not reduce response to training in illness self-management. The impact of symptom severity on outcome of the IMR program was explored in 52 participants who completed the program. The results suggest that significantly more participants met the severity criterion of remission at post-treatment, and it appears that participants not reaching the severity criterion at post-treatment, also benefited from the IMR program, as indicated by the similar effect sizes of the two subgroups (meeting versus not meeting the severity criterion at post-treatment). The psychometric properties of the Illness Management and Recovery Scale (IMRS) were evaluated in 107 participants with a diagnosis of schizophrenia or schizoaffective disorder. And an item-by-item investigation was conducted in order to establish their utility in monitoring the clients' progress in the IMR program. Both the client and clinician version of the IMRS demonstrated satisfactory internal consistency, large test-retest reliability, and convergent validity with conceptually related measures of psychiatric symptoms, quality of life, and perception of recovery. The findings support the utility of the IMRS as a measure of illness self-management and recovery in clients with schizophrenia and schizoaffective disorder. The general findings of this thesis support the IMR program to be effective in improving the ability of the participants to manage their disorder. The impact of neurocognitive dysfunction on the participants’ ability to learn the fundamentals of illness self-management seems to be limited, and symptom severity did not limit the benefits of the IMR program. Support for the utility of the IMRS to monitor the participants’ progress in the program was also found, providing a brief and economical method for assessing outcome of the IMR program. Syftet med föreliggande avhandlingsarbete var att undersöka Illness Management and Recovery (IMR) programmets effekter av att lära klienter att bättre hantera negativa konsekvenser av schizofreni eller schizoaffektiv sjukdom och att främja återhämtning. Detta åstadkoms genom en utvärdering av IMR programmets inverkan på psykosocial funktion och psykopatologi, en undersökning av specifik och generell påverkan av neurokognition avseende deltagarnas möjligheter att lära in grundläggande sjukdomshanteringsfärdigheter (illness self-management), samt en undersökning av huruvida schizofrenisymtomens svårighetsgrad inverkar på programutfallet. Vidare undersöktes Illness Management and Recovery Skalans (IMRS) användbarhet för att utvärdera sjukdomshantering och återhämtning (illness self-management and recovery) hos personer med schizofreni eller schizoaffektiv sjukdom. IMR programmets effekter utvärderades genom en randomiserad kontrollerad studie i vilken 41 programdeltagare jämfördes med deltagare i kontrollgrupp vilka fick enbart sedvanlig psykiatrisk behandling. Deltagarna rekryterades vid sex subspecialiserade psykiatriska öppenvårdsmottagningar och slumpades till att antingen delta i IMR programmet eller kontrollgrupp. IMR programmets deltagare uppvisade i jämförelse med kontrollgruppen förbättring i sjukdomshantering, minskade psykiatriska symtom, förbättrade coping-färdigheter samt minskade självmordsbeteenden. Resultaten stöder antagandet att IMR programmet är effektivt vad gäller att förbättra deltagarnas förmåga att hantera negativa effekter av schizofreni och schizoaffektiv sjukdom. Möjliga associationer mellan neurokognitiv funktion och förmågan att tillägna sig färdigheter för sjukdomshantering undersöktes hos 53 deltagare som genomförde IMR programmet. Resultaten pekar på att neurokognitiva svårigheter inte inverkar på deltagarnas möjligheter att lära sig sjukdomshantering enligt IMR modellen. Processhastighet var relaterad till klientrapporterad sjukdomshantering men inte till klinikerrapporterad sjukdomshantering. Processhastighet tycks vara relevant för klientens upplevelse av hur väl han eller hon tillägnat sig programmets strategier och färdigheter, snarare än sjukdomshantering per se. Huruvida schizofrenisymtomens svårighetsgrad inverkar på utfallet av IMR programmet undersöktes hos 52 deltagare som genomförde IMR programmet. Resultaten pekar på att signifikant fler deltagare uppfyllde svårighetsgradskriteriet för remission av schizofrenisymtom efter genomfört IMR program. Även deltagare som inte uppfyllde svårighetsgradskriteriet har nytta av IMR programmet något som indikeras av de båda gruppernas (uppfyllde jämfört med uppfyllde inte svårighetsgradskriteriet) likartade effektstorlekar. Illness Management and Recovery Skalans (IMRS) psykometriska egenskaper undersöktes för 107 deltagare med en schizofreni eller schizoaffektiv diagnos. Skalans enskilda frågor analyserades för att undersöka skalans användbarhet för att utvärdera deltagares progress och utfall i IMR programmet. Både klient och kliniker versionen av skalan uppvisade tillfredsställande intern konsistens, stor test-retest reliabilitet och konvergent validitet med konceptuellt relaterade instrument för psykiatriska symtom, livskvalité och återhämtning. Resultaten stöder antagandet att IMRS är ett användbart instrument för att utvärdera sjukdomskontroll och återhämtning för personer med schizofreni eller schizoaffektiv sjukdom. Avhandlingsarbetets resultat stöder antagandet att IMR programmet är effektivt vad gäller att förbättra deltagarnas förmåga att hantera de negativa konsekvenserna av schizofreni och schizoaffektiv sjukdom. Neurokognitiva svårigheter inverkar i begränsad utsträckning på deltagarnas möjligheter att lära sig sjukdomshantering och schizofrenisymtom tycks ha begränsad inverkan på programutfallet. Resultaten stöder även antagandet att IMRS är ett användbart instrument för att utvärdera sjukdomskontroll och återhämtning för personer med schizofreni eller schizoaffektiv sjukdom, vilket erbjuder en kortfattad och ekonomisk metod att utvärdera effekterna av IMR.

Mona Eklund Department of Health Sciences, Lund University, Lund, Sweden Background: Findings from quality of life studies are often inconclusive for reasons such as: i) estimates may address different aspects of quality of life and thus produce different outcomes; ii) quality of life is largely determined by self-factors; and iii) people with a long-term condition rate their quality of life better than those who have had their condition for a short duration. This makes quality of life a complex phenomenon to measure. Aims: The above explanations served as hypotheses for this methodologically oriented paper, based on a longitudinal study on women with stress-related disorders receiving work rehabilitation. Methods: Eighty-four women participating in a lifestyle intervention or care as usual were compared. Self-ratings of “general quality of life” and a summarized “satisfaction with different life domains” index (according to Manchester Short Assessment of Quality of Life) and two self-factors (self-esteem and self-mastery) were administered at admission and a 6-month follow-up. Participant age and amount of months on sick leave prior to rehabilitation were used as two proxies of duration of the condition. Results: General quality of life distinguished between the groups, whereas satisfaction with life domains did not. Self-esteem and self-mastery were related to both quality of life aspects. Age was related to both estimates of quality of life, whereas duration of sick leave was unrelated to both. Conclusion: General quality of life and satisfaction with life domains produced different results. Outcome studies should apply more than one operationalization of quality of life and self-factors should be considered as important determinants of quality of life. Duration of the condition needs to be acknowledged as well when interpreting levels of quality of life, although the current study could not present any clear-cut findings in this respect. Keywords: stress, mastery, sick leave, self, occupation

Vascular applications of magnetic resonance (MR) imaging are reviewed, with emphasis on algorithms that use nonpictorial information contained in the MR data set. Current clinical vascular practice generally limits use of MR angiography and three-dimensional vessel images to qualitative pictorial rendering without routinely using the available quantitative information contained within the MR data. This review is dedicated to recent advances that include characterization of vessel histology, assessment of carotid plaque vulnerability, characterization of blood flow dynamics, quantitative analysis of disease severity, and prediction of vascular intervention outcome. Examples from histologic preparation, in vitro and in vivo experiments, are discussed, with an emphasis on potential clinical applications and advances in acquisition technology.

To the Editor: Ethnic disparities in contemporary ST-segment elevation myocardial infarction (STEMI) management have not been well characterized ([1][1]). The National Cardiovascular Data Registry Acute Coronary Treatment and Intervention Outcome Network–Get With The Guidelines Registry (ACTION

OBJECTIVE: To investigate the factors influencing the performance and cost-efficacy of periodic rounds of active case finding (ACF) for TB. METHODS: A mathematical model of TB dynamics and periodic ACF (PACF) in the HIV era, simplified by assuming constant prevalence of latent TB infection, is analyzed for features that control intervention outcome, measured as cases averted and cases found. Explanatory variables include baseline TB incidence, interval between PACF rounds, and different routine and PACF case-detection rates among HIV-infected and uninfected TB cases. FINDINGS: PACF can be cost-saving over a 10 year time frame if the cost-per-round is lower than a threshold proportional to initial incidence and cost-per-case-treated. More cases are averted at higher baseline incidence rates, when more potent PACF strategies are used, intervals between PACF rounds are shorter, and when the ratio of HIV-negative to positive TB cases detected is higher. More costly approaches, e.g. radiographic screening, can be as cost-effective as less costly alternatives if PACF case-detection is higher and/or implementation less frequent. CONCLUSION: Periodic ACF can both improve control and save medium-term health care costs in high TB burden settings. Greater costs of highly effective PACF at frequent (e.g. yearly) intervals may be offset by higher numbers of cases averted in populations with high baseline TB incidence, higher prevalence of HIV-uninfected cases, higher costs per-case-treated, and more effective routine case-detection. Less intensive approaches may still be cost-neutral or cost-saving in populations lacking one or more of these key determinants.

Examined efficacy of an empirically based intervention using 70 divorced mothers who participated in a 12-session program or a wait-list condition. The program targeted five putative mediators: quality of the mother-child relationship, discipline, negative divorce events, contact with fathers, and support from nonparental adults. Posttest comparisons showed higher quality mother-child relationships and discipline, fewer negative divorce events, and better mental health outcomes for program participants than controls. More positive program effects occurred for mothers’ than children’s reports of variables and for families with poorest initial levels of functioning. Analyses indicated that improvement in the mother-child relationship partially mediated the effects of the program on mental health.

In psychosocial outcome research, as contrasted to pharmacologic research, control groups receiving inert treatment, designed to raise expectations but otherwise provide no service, are almost never indicated; this is true because of methodologic as well as ethical reasons. Four types of comparisons suffice as alternatives: treatment versus no treatment, treatment versus minimal treatment, treatment A versus treatment B, and dismantling. When choices are made among these types of comparisons with power analysis and eight other factors taken into account, the questions of outcome research should be answerable with maximum economic efficiency, with maximum benefit to subjects, and without deception.

Summary This paper describes an intervention programme, evaluation procedures, and results from a study of skills training for reducing stress with parents of handicapped children. Four mothers of developmentally disabled children participated in an 8-week training programme designed to teach parents ways to enhance their coping skills, increase their social support networks, and collectively make changes in their environment. Post-test data indicate that the programme shows promise for teaching coping and social support enhancement skills to parents.