PubMed · 5567180
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D J Dunn. Work and behavior change.. https://pubmed.ncbi.nlm.nih.gov/5567180/
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Behavior therapy has been viewed by some as disempowering persons with severe mental illness (i.e., undermining their ability to make independent decisions). This is ironic because various behavioral strategies actually promote independent decision making. Behavioral interventions (a) provide a safe place for persons to consider their life decisions; (b) simplify the range of choices that comprise many of these decisions; (c) help persons with severe mental illness learn behaviors so that they can better meet the demands of independent decision making: (d) teach family members skills so that they can provide more resources to support independent decision making; and (e) facilitate self-control over behaviors and the settings in which they occur. Behavior therapists need to assert the important role that behavioral principles assume in empowering persons with mental illness so that these principles are not discarded by professionals who misunderstand, or otherwise stereotype, behavioral interventions.
OBJECTIVE: To determine the incidence of toileting refusal for bowel movements and its outcome when toilet training children using a child-oriented approach. DESIGN: Prospective study. SETTING: Private suburban pediatric setting consisting of middle and upper middle class families. METHODS: Healthy children between 18 and 30 months with no signs of developmental delay were enrolled in the study. Parents were given questions regarding their child's toilet training and behavior. Families were followed every 6 months during an office visit or by phone call until the child was successfully day time toilet trained. RESULTS: A total of 482 children (255 males) completed the study. There were 106 children (54 males) (22%) who experienced at least 1 month of stool toileting refusal. There was an association between the presence of younger siblings (P = .023) and parental inability to set limits for the child (P = .017) and stool toileting refusal. Stool toileting refusers trained at a later age than the rest of the group (P < .0001). Fifty percent (22/44) of the children who trained between 42 and 48 months and 73% (8/11) of the children who trained after 48 months experienced stool toileting refusal. Sixty-one of the study children developed stool withholding during toilet training. Forty-nine (80%) of these children were stool toileting refusers (P < .00001). In 77 (73%) of the children no intervention was undertaken. Of these, the behavior lasted more than 6 months in 20. Intervention was undertaken with 29 children, either because of severe stool withholding (23) or the age of the child (6). Interupting toilet training and having the child return to diapers resulted in the child spontaneously using the toilet for bowel movements within 3 months in 24 of 27 children. CONCLUSION: Stool toileting refusal occurred in one in five children in this study population. Two behaviors associated with stool toileting refusal may require the intervention of the pediatrician. The first is stool withholding causing constipation which can result in rectal impaction and primary encopresis. The second is lack of successful toilet training by 42 months of age. A child who is still untrained at this late age can be a source of family conflict and stress requiring the advice and support of the pediatrician.
A model for evaluating the costs and benefits of smoking-cessation interventions is proposed and published data on the subject are analyzed. Decision-tree analysis was used to determine the costs and benefits, from an employer's perspective, of several smoking-cessation options. The probability that a smoker would stop smoking was based on two published meta-analyses of smoking-cessation interventions and a national study of nicotine patch users who received a smoking-cessation consultation from a pharmacist. The costs were determined by telephone interviews and market research information. A sensitivity analysis of treatment costs was conducted to determine the optimal treatment from the standpoint of costs versus benefits. The smoking-cessation intervention from which an employer would receive the greatest net benefit is the nicotine patch with smoking-cessation consultation from a pharmacist and patient participation in a formal smoking-cessation program. Pharmacists included in this analysis could charge a smoking-cessation consultation fee of up to $109 per patient. Pharmacoeconomic analysis suggested that smoking-cessation therapy consisting of treatment with nicotine patches, consultations with pharmacists, and participation in a comprehensive behavioral program would be the most cost-beneficial to employers.