This study examines the confidentiality practices of highly experienced, well-trained group psychotherapists. A provocative finding was that practitioners rarely inform prospective clients of ...confidentiality limitations. Their reluctance to do so appears to be based upon the belief that it might discourage persons from entering treatment, as well as having negative ramifications for the therapeutic process (e.g., members may be less likely to talk about unprotected topics). The prevalence and content of breaches in confidentiality are explored. Ethical, legal, clinical, and educational implications of these and other findings are addressed. Research recommendations are offered.
Describes findings from the National Survey of Sexual Attitudes and Lifestyles (Natsal 2000) carried out in 1999-2001 to provide population estimates of sexual behaviour patterns and how these ...compared with estimates from 1990-1991 (Natsal 1990). The increased reporting of risky sexual behaviours is consistent with changing cohabitation patterns and rising incidence of sexually transmitted infections. Observed differences between Natsal 1990 and Natsal 2000 are likely to result from a combination of true change and greater willingness to report sensitive behaviours in Natsal 2000 due to improved survey methodology and more tolerant social attitudes. (Original abstract - amended)
In the absence of biological markers, dementia classification remains complex both in terms of characterization as well as early detection of the presence or absence of dementing symptoms, ...particularly in diseases with possible secondary dementia. An empirical, statistical approach using neuropsychological measures was therefore developed to distinguish demented from non-demented patients and to identify differential patterns of cognitive dysfunction in neurodegenerative disease. Age-scaled neurobehavioral test results (Wechsler Adult Intelligence Scale-Revised and Wechsler Memory Scale) from Alzheimer's (AD) and Huntington's (HD) patients, matched for intellectual disability, as well as normal controls were used to derive a classification formula. Stepwise discriminant analysis accurately (99% correct) distinguished controls from demented patients, and separated the two patient groups (79% correct). Variables discriminating between HD and AD patient groups consisted of complex psychomotor tasks, visuospatial function, attention and memory. The reliability of the classification formula was demonstrated with a new, independent sample of AD and HD patients which yielded virtually identical results (classification accuracy for dementia: 96%; AD versus HD: 78%). To validate the formula, the discriminant function was applied to Parkinson's (PD) patients, 38% of whom were classified as demented. The validity of the classification was demonstrated by significant PD subgroup differences on measures of dementia not included in the discriminant function. Moreover, a majority of demented PD patients (65%) were classified as having an HD-like pattern of cognitive deficits, in line with previous reports of the subcortical nature of PD dementia. This approach may thus be useful in classifying presence or absence of dementia and in discriminating between dementia subtypes in cases of secondary or coincidental dementia.
Abstract Health care professionals have become increasingly interested in motivating individuals to comply with health recommendations. One approach to this issue has been to evaluate the impact of ...message framing on behavior change processes. Three types of framing are described: gain, loss and fear. Theoretical considerations from such theories as the Health Belief Model, Prospect Theory, and Protection Motivation reveal the significance of two dimensions, the perceived value and perceived threat of an outcome. The perceived value dimension focuses on the importance of defining messages on the basis of whether or not a valued outcome is acquired, and the perceived threat dimension stresses the importance of negative outcomes. Perceived value is critical to a manipulation of gain and loss framing, while perceived threat is critical to a manipulation of fear framing. The assumptions underlying the theories relevant to these distinctions are considered, followed by a review of the literature, and speculations about the possible mechanisms which may mediate framing effects.
To compare the antiviral activity of abacavir (ABC) with stable background therapy (SBG) and SBG alone in antiretroviral therapy-experienced subjects as demonstrated by the proportion of subjects ...with plasma HIV-1 RNA < or = 400 copies/ml, plasma HIV-1 RNA and CD4 cell count profiles, and safety and tolerance of the two regimens over 16 weeks.
One-hundred and eighty-five HIV-1 infected adults, with CD4 cell counts > or = 100 x 10(6)/l and plasma HIV-1 RNA of 400-50,000 copies/ml and who had received SBG therapy for at least 12 weeks, were randomized to receive ABC (300 mg twice daily) or placebo in a double blind, multi-centre study.
Antiretroviral activity was assessed by measuring changes in plasma HIV-1 RNA levels and CD4 cell counts. Genotypic and phenotypic resistance was determined at baseline and week 16. Evaluation of safety and tolerance was based on clinical adverse events and laboratory analyses.
At week 16 significantly more subjects receiving ABC + SBG had plasma HIV-1 RNA < or = 400 copies/ml (36/92, 39%) than subjects receiving SBG alone (7/93, 8%; P < 0.001). A similar response was observed in both the lamivudine naive and lamivudine-experienced subjects. The presence of the M184V mutation did not preclude an antiviral response to ABC; 73% of subjects with the M184V mutation alone experienced a > or = 1.0 log10 copies/ml reduction in plasma HIV-1 RNA or had a value of < or = 400 copies/ml by week 16.
ABC was generally well tolerated and exerted significant antiviral effect when added to combination antiretroviral therapy over 16 weeks.
This study examines the influence of group therapists' professional characteristics on their attitudes and practices regarding confidentiality. Eighty-three highly experienced and well-trained group ...therapy providers representing the fields of psychiatry, psychology, and social work completed a survey questionnaire inquiring into their confidentiality practices. Although there is considerable consensus between medical and nonmedical practitioners on the issues addressed, there are also interesting differences and trends. Implications of the findings for clinical practice, ethics training, and confidentiality legislation are addressed.
Researchers are directing their attention toward message framing as a technique for motivating individuals to comply with health recommendations. However, research, to date, has been limited in its ...ability to make firm conclusions about (i) the types of frames most effective for altering different types of behaviors, and (ii) the mechanisms that underlie these differential effects. However, the research on message framing has been promising enough to encourage further exploration of these two issues. (PFB)
