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PubMed1983

Progress in the treatment of female sexual dysfunction.

Over a decade of research since the publication of Human Sexual Inadequacy by Masters and Johnson has confirmed the effectiveness of psychological treatment for sexual problems, but has not advanced our understanding of aetiology very much. It is generally assumed that anxiety blocks normal function in sexual disorders such as impotence or frigidity, although hormonal changes have also been suggested. Evidence for either proposition is lacking. Our own attempts to understand mechanisms have included the use of a dismantling strategy to investigate the effective components of psychological treatment, and latterly the role of exogenous androgens. In our first study, brief treatment modelled on that of Masters and Johnson proved superior to another version of graded practice in sexual contact which lacked the counselling component. Similarly, the fuller version had more effect than did imaginal desensitization, suggesting that sexual dysfunctions cannot be treated like phobic anxiety. A second study focused on women complaining of little sexual interest or enjoyment. The use of a minor tranquillizer was compared with that of androgen (testoral) in the hope that different treatments would be shown to be best for different types of disorder. Unexpectedly, the androgen proved best overall while another variable, monthly vs weekly sessions, did not produce any differences in effect. In the most recent study, a further 48 women were given androgens or placebo, and were seen weekly or monthly for four months by either one or two therapists. There were few significant differences, the most consistent being greater subjective improvement by the women being seen at weekly intervals. The failure to find a positive hormone effect in comparison with placebo raises the possibility that the anxiolytic used earlier may have been counter-productive. If so, it seems unlikely that either excessive anxiety or simple androgen deficiency is an adequate aetiological explanation for female sexual dysfunction.

Anxiety↗

PubMed1995

Alliance formation and treatment outcome among maltreated adolescents.

This study examined relationships among maltreatment experience, therapeutic alliance formation, and treatment outcome in a sample of 38 psychiatrically hospitalized adolescents. It was hypothesized that the experience of maltreatment would interfere with alliance formation, thereby compromising the effectiveness of therapy. Results indicated that maltreatment, multiplicity of maltreatment, and type of perpetrator of maltreatment were all associated with initial alliance difficulties. None of these variables predicted change in the alliance over time; instead, severity of interpersonal problems was the best predictor of alliance development. Maltreatment status was not directly related to treatment outcome; however, maltreated adolescents who failed to develop positive alliances with their therapists tended to show the poorest outcomes. Given the strong relationship between alliance formation and outcome, clinical recommendations for therapists who treat maltreated adolescents are presented.

Adolescent↗

PubMed2006

Risk-factor analysis of high school basketball-player ankle injuries: a prospective controlled cohort study evaluating postural sway, ankle strength, and flexibility.

OBJECTIVE: To analyze risk factors, including postural sway, ankle strength, and flexibility, for the prediction of ankle injuries in men's high school basketball players. DESIGN: A cohort study with follow-up duration of 1 basketball season. SETTING: Biomechanics laboratory. PARTICIPANTS: Forty-two (age, 16.5+/-1.1y) players competing in first league of the High School Basketball Association without history of injury in the lower extremities within 6 months before recruitment and without significant malalignment in the lower extremities were included. None of these players met exclusion criteria such as using ankle braces or taping or failed in wearing low-top sports shoes during the follow-up season. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Biomechanic measurements including isokinetic ankle strength, 1-leg standing postural sway, and ankle joint dorsiflexion flexibility were performed before the basketball season by 1 physical therapist. The subsequent monthly follow-up questionnaires were sent and returned by mail to prospectively record the incidence of ankle injury occurring in the season. Results of these preseason measurements were analyzed to correlate if any of these measured variables could predict future ankle injuries. RESULTS: Eighteen ankle sport injuries were recorded for 42 players during the follow-up season. High variation of postural sway in both anteroposterior and mediolateral directions corresponded to occurrences of ankle injuries (P=.01, odds ratio [OR]=1.220; P< .001, OR=1.216, respectively). All other variables were not associated with injury. CONCLUSIONS: High variations of postural sway in 1-leg standing test could explain partly the increased prevalence of ankle injury in basketball players. It may be used as a screening tool to recommend balance training before basketball season.

Adolescent↗

PubMedDate not supplied

Interactions between psychotherapy procedures and patient attributes that predict alcohol treatment effectiveness: a preliminary report.

This study examined interactions between patient attributes and therapist interventions on alcoholism treatment outcome. Process analyses of an early psychotherapy session from either cognitive-behavioral (CBT) or family systems (FST) therapy and baseline patient information (N=47) were used to measure theory-based therapy and patient variables. Hierarchical linear regression was used to test the effect of each patient-therapy interaction on changes in drinking behavior. Two disordinal interactions were predictors of alcohol use during the maintenance phase of treatment. Patients high in emotional distress did best when their therapy addressed emotional experiences, and the converse was observed for patients low in distress. Patients high in reactance had better drinking outcomes when their therapy was nondirective, and patients low in reactance improved more with directive therapy. In contrast to the interactions between patient attributes and the therapy process, the interactions between patient attributes and treatment model (CBT versus FST) were not reliable predictors of alcohol use.

Adaptation, Psychological↗

PubMed1996

Influence of exposure to fluoridated water on socioeconomic inequalities in children's caries experience.

This study aimed to evaluate inequalities in children's dental caries experience among socioeconomic status (SES) groups and to investigate effects of exposure to fluoride in water on those inequalities. Cross-sectional data were obtained from 6704 Queensland children aged 5-12 years and 6814 South Australian children aged 5-15 years. School dental therapists and dentists recorded dmfs and DMFS data. A questionnaire to parents sought information about household SES and each child's lifetime exposure to fluoridated drinking water. SES fluoride exposure and multiplicative interactions between the two were used as explanatory variables in least squares models in which dmfs and DMFs were dependent variables. Additive interactions were evaluated by calculating the excess rate of disease. In both states, children from low SES groups (categorized by household income or parental education) had higher mean dmfs and DMFS values than children from high SES groups (P < 0.01). Independent effects of income and education remained significant (P < 0.01) after controlling for exposure to fluoride in drinking water. In Queensland, there was a significant multiplicative interaction whereby SES inequalities were lower among children exposed to fluoride: dmfs ratios between low- and high-income groups ranged among ages from 1.54 to 3.56 for children with no exposure to fluoride and from 0.84 to 2.07 for children with lifetime exposure to fluoride. Multiplicative interactions were not statistically significant in South Australia or when DMFS was the dependent variable. However, additive interactions were consistent and most pronounced for deciduous teeth in both States. Absolute differences in caries experience between low and high SES children were greater among non-exposed groups due to the higher underlying levels of caries experience of children with no exposure to fluoride in water.

Adolescent↗

PubMed1982

What research says about the effectiveness of psychotherapy.

Meta-analysis is a new statistical technique used to integrate the results of many separate studies of a topic. The author, along with two colleagues, applied meta-analysis to 475 studies of the effectiveness of psychotherapy and 112 studies of the comparative effects of psychotherapy and psychoactive drugs. The investigators examined the studies' effect sizes--the standard mean difference on the outcome variable between the treated group and the comparison group. Since many studies had more than one outcome variable, the 475 studies actually produced 1,766 effect sizes. Meta-analysis of these data shows that psychotherapy is effective in enhancing psychological well-being, however it is measured by researchers. The patient's age and diagnosis, the therapist's training and experience, and the duration and mode of therapy bear little relation to the psychotherapy's outcome. Behavioral therapies are somewhat more effective than verbal ones, and drug therapy, while combining well with psychotherapy, is not more effective than psychotherapy alone.

Behavior Therapy↗

PubMed1993

Occupational therapy guidelines for client-centred practice: impact study findings.

The Guidelines Impact Study investigated use and usefulness of the guidelines for client-centred practice produced in the 1980's by the Department of National Health and Welfare and the Canadian Association of Occupational Therapists. This paper outlines the study, summarizes findings, and discusses implications for revising and updating the Guidelines. Qualitative interview data from key informants across Canada were incorporated into a quantitative survey of a 5% sample of CAOT members. Data reveal variable use of the Guidelines, with greatest use in acute care and rehabilitation services; and mixed interpretations of the Model of Occupational Performance, particularly 'environment' and 'spiritual component'. Recommendations include: clarification of the purpose and audience of revised Guidelines; national consultation during updating to include diverse forms of practice; and rethinking the Model of Occupational Performance as a dynamic model. Updated Guidelines should include both generic concepts and specific applications for different types of occupational therapy practice.

Attitude of Health Personnel↗

PubMed1994

Depression, mastery and number of group sessions attended predict outcome of patients with panic and agoraphobia in a behavioural/medication program.

From a list of 214 patients suffering from panic and agoraphobia and who had been treated with cognitive behaviour therapy, 30 patients who had very good outcomes and 32 who had poor outcomes were selected. The groups were selected by the nurse therapist and psychiatrist on the basis of personal knowledge of the patients. The distinction into good and poor outcome groups was confirmed by the results of a follow-up questionnaire completed by the patient. Of several clinical and demographic variables which had been hypothesized to be predictors of outcome, only depression, as measured by the Beck Depression Inventory, mastery, as measured by the Pearlin Mastery Scale and the number of group therapy sessions attended predicted outcome. Levels of depression and mastery might be clinically modifiable variables which affect the outcome of treatment for patients with panic and agoraphobia.

Adult↗

PubMed2004

Considerations for the future development of virtual technology as a rehabilitation tool.

BACKGROUND: Virtual environments (VE) are a powerful tool for various forms of rehabilitation. Coupling VE with high-speed networking [Tele-Immersion] that approaches speeds of 100 Gb/sec can greatly expand its influence in rehabilitation. Accordingly, these new networks will permit various peripherals attached to computers on this network to be connected and to act as fast as if connected to a local PC. This innovation may soon allow the development of previously unheard of networked rehabilitation systems. Rapid advances in this technology need to be coupled with an understanding of how human behavior is affected when immersed in the VE. METHODS: This paper will discuss various forms of VE that are currently available for rehabilitation. The characteristic of these new networks and examine how such networks might be used for extending the rehabilitation clinic to remote areas will be explained. In addition, we will present data from an immersive dynamic virtual environment united with motion of a posture platform to record biomechanical and physiological responses to combined visual, vestibular, and proprioceptive inputs. A 6 degree-of-freedom force plate provides measurements of moments exerted on the base of support. Kinematic data from the head, trunk, and lower limb was collected using 3-D video motion analysis. RESULTS: Our data suggest that when there is a confluence of meaningful inputs, neither vision, vestibular, or proprioceptive inputs are suppressed in healthy adults; the postural response is modulated by all existing sensory signals in a non-additive fashion. Individual perception of the sensory structure appears to be a significant component of the response to these protocols and underlies much of the observed response variability. CONCLUSION: The ability to provide new technology for rehabilitation services is emerging as an important option for clinicians and patients. The use of data mining software would help analyze the incoming data to provide both the patient and the therapist with evaluation of the current treatment and modifications needed for future therapies. Quantification of individual perceptual styles in the VE will support development of individualized treatment programs. The virtual environment can be a valuable tool for therapeutic interventions that require adaptation to complex, multimodal environments.

Journal Article↗

PubMed2001

The impact of Thought Field Therapy on heart rate variability.

Thought Field Therapy (TFT) is a rapid treatment for psychological problems typically taking only minutes. HRV has been shown to be a strong predictor of mortality and is adversely affected by such problems as anxiety, depression, and trauma. Interventions presented in the current literature show modest improvements in HRV. Twenty cases, treated by the author and other therapists with TFT, are presented. The cases include some with diagnosed heart problems and very low HRV, which is ordinarily more resistant to change. The degree of improvements that are registered on HRV as a result of TFT treatment exceeds reports found in the current literature. There is a close correspondence between improved HRV and client report of reduced degree of upset. HRV may prove to be an appropriate objective measure of psychotherapy efficacy given the correspondence between client report and HRV outcome. Further research in TFT and HRV is encouraged by these results.

Adolescent↗

PubMed1989

"Come on, Jack, tell us about yourself": the growth spurt of group psychotherapy.

Group psychotherapy evidenced a growth spurt in the decade of the 1930s and prior to World War II. Following upon the pioneering efforts of the psychoeducators (Pratt, Marsh, Lazell) and the writings of the early analysts (Freud, Adler, Dreikurs, Burrow), the next wave of practitioners and theorizers popularized and expounded the use of the group treatment modality in hospitals, clinics, and private practice. A review of the seminal ideas and efforts of Jacob Moreno, Louis Wender, Paul Schilder, Lauretta Bender, Alexander Wolf, and Samuel Slavson continues the historical overview begun earlier in this journal (Ettin, 1988). In a continuing effort to call up the wisdom of the past in the service of the work of the present, the emphasis in this paper will be on practical application. Representative quotes will be embedded in the text to capture the tenor of the times, and special attention will be given to (1) theoretical underpinnings such as the proposed advantages, curative variables, and therapy goals of a group treatment; (2) the basic logistics of practice, including optimum group size, composition, membership and exclusion criteria, and length, frequency, and structure of the meetings; and (3) technical considerations, such as the role of the therapist and the techniques, procedures, and processes of the ongoing group endeavor, as well as the interface between individual and group sessions. In conclusion, it will be argued that group psychotherapy matured just in time to respond to the pressing need for efficient mental treatment mandated by the coming of the Second World War.

History, 20th Century↗

PubMedDate not supplied

Pitch change in male-to-female transsexuals: has phonosurgery a role to play?

Male-to-female transsexuals, who have undergone gender reassignment surgery, may continue to have low pitched voices. Voice therapy may assist them to use their voice in a manner more likely to be perceived as female but, if this approach is unsuccessful, a laryngeal framework operation may be necessary to raise vocal pitch. This study assessed the effects of crico-thyroid approximation surgery in 14 transsexuals. Modal pitch was significantly increased by surgery but with substantial variation across speakers. Modal pitch was significantly correlated with judgements of gender by speech and language therapists who listened to tapes of the subjects. The results suggest that crico-thyroid approximation may be used to raise the pitch of voices of male-to-female transsexuals. Further research is needed to clarify the reasons for the variability in outcome, to monitor the longer-term changes in voice and the impact for clients of their modified voice in real life situations.

Adult↗

PubMed1998

Classification and low back pain: a review of the literature and critical analysis of selected systems.

Classification systems for patients with low back pain have become more abundant in the literature since the mid-1980s. Some classification systems are designed to determine the most appropriate treatment, some are designed to aid in prognosis, and others are designed to identify pathology. Still other classification systems categorize patients into homogeneous groups based on selected variables. The purpose of this review is to describe and critically evaluate low back pain classification systems. Several classification systems were summarized and examined. Four classification systems that were judged to be the most commonly cited and most relevant to physical therapists were critiqued using a more thorough systematic approach. The analysis suggests that future research should address the usefulness of existing classification systems as well as the development of new classification systems designed using commonly accepted measurement principles.

Humans↗

PubMed1999

Organizational and environmental factors associated with nursing home participation in managed care.

OBJECTIVE: To develop and test a model, based on resource dependence theory, that identifies the organizational and environmental characteristics associated with nursing home participation in managed care. DATA SOURCES AND STUDY SETTING: Data for statistical analysis derived from a survey of Directors of Nursing in a sample of nursing homes in eight states (n = 308). These data were merged with data from the On-line Survey Certification and Reporting System, the Medicare Managed Care State/County Data File, and the 1995 Area Resource File. STUDY DESIGN: Since the dependent variable is dichotomous, the logistic procedure was used to fit the regression. The analysis was weighted using SUDAAN. FINDINGS: Participation in a provider network, higher proportions of resident care covered by Medicare, providing IV therapy, greater availability of RNs and physical therapists, and Medicare HMO market penetration are associated with a greater likelihood of having a managed care contract. CONCLUSION: As more Medicare recipients enroll in HMOs, nursing home involvement in managed care is likely to increase. Interorganizational linkages enhance the likelihood of managed care participation. Nursing homes interested in managed care should consider upgrading staffing and providing at least some subacute services.

Contract Services↗

PubMed2003

Invasive and noninvasive pediatric mechanical ventilation.

Both invasive and noninvasive mechanical ventilation techniques are inherent to the care of most patients admitted to intensive care units. Despite the everyday use of mechanical ventilation for thousands of patients and the availability of thousands of reports in the medical literature, there are no clear and consistent guidelines for the use of mechanical ventilation for pediatric patients. In many areas data are lacking, and in other areas data are extrapolated from studies performed with adult subjects. Despite the variability in views about mechanical ventilation, 2 themes are consistent. First, modern pediatric respiratory care requires a substantial institutional commitment for state-of-the-art management of the mechanically ventilated patient. Second, a team approach involving physicians, nurses, and respiratory therapists is essential. This review highlights some of the major issues affecting the pediatric patient who requires invasive or noninvasive mechanical ventilation. These issues are pertinent to critical care clinicians because one of the most common reasons for admission to an intensive care unit is the need for mechanical ventilation. Furthermore, the duration of mechanical ventilation is one of the major determinants of the duration and cost of an intensive care unit stay.

Child↗

PubMed1987

Factors related to occupational stress or burnout among music therapists.

The purpose of this study was to obtain demographic data from 500 randomly selected music therapists and to correlate these data with degrees of occupational stress or burnout, as measured by the six subscales of the Maslach Burnout Inventory (MBI). Of 250 replies received, 239 (47.8%) were acceptable for data analysis. Multiple correlation and multiple regression strategies were used to analyze degree of burnout according to hours worked per week, number of years as an RMT, type of institution, sex, age, and years at present job. The correlations were low, indicating that, for this sample, no relationship exists between the predictor variables and the six Maslach subscales. Results of this study may have been confounded due to the number of years that respondents had worked. One hundred and eighty-four subjects (76.9%) had worked 5 years or less; many of these respondents may not have worked long enough to experience burnout. The total sample for this study scored in the medium range of burnout on five of the six MBI subscales. Many respondents included critical comments concerning their work as music therapists. The most prevalent criticisms focused on insufficient pay, lack of respect and support from administrators, and having to perform activities outside their field. Sixty-eight subjects had worked 5 or more years, both as RMTs and at their present jobs. Fifty-two of these subjects scored a moderate degree of burnout on at least one of the six subscales, and 29 scored a high degree of burnout on at least one subscale. Preventive measures that have been found helpful in retarding or preventing burnout are presented.

Burnout, Professional↗

PubMed2005

Semantic and phonological skills in predicting reading development: from 3-16 years of age.

The present longitudinal study investigated the relationship between pre-school semantic skills (vocabulary, comprehension and sentence construction), phonological awareness and later word decoding and reading comprehension skills. More than 200 Danish children were followed from a speech therapist screening at the age of three, through a phonological group screening at six, word decoding tests in Grade 2, sentence reading tests in Grades 3, 4, and 6, and to a text reading test in Grade 9 (age 16). The predictor variables consisted of both standardized test results, professional ratings, and a factor of interest in books. The results showed that both the semantic variables and interest in books at the age of three and the phonological variables at the age of six predicted reading development significantly at the age of 16. In addition the results demonstrated changing main effect from semantic and phonological variables on reading development. Phonological awareness at the age of 6 seemed to have the greatest influence on reading at the beginning of Grade 2 compared to the semantic variables at the age of three. On all other measures in time, the semantic variables had the greatest influence.

Adolescent↗

PubMed1996

Psychological climate and countertransference in psychiatric treatment homes.

The associations between milieu therapists' feelings towards patients and the unit's psychological climate were studied at 21 small treatment homes for severely disturbed psychiatric patients. The milieu therapists filled out self-report instruments where they rated their feelings towards patients on a feeling-word checklist and their opinion about the psychological climate on a Bion-based scale. Scores on the climate scale were used as independent variables in a series of regression analyses, with scores on the feelings as the dependent variables. It was found that a substantial component of the average differences between units with regard to feelings towards patients could be attributed to the unit's climate. Correlations showed that units characterized by "Work' and "Pairing' had high scores for helpful and autonomous feelings, while unhelpful feelings were evoked in units characterized by "Dependency' and "Fight'. Close feelings were evoked in units characterized by "Dependency'.

Analysis of Variance↗