An Israeli RCT of PEERS®: Intervention Effectiveness and the Predictive Value of Parental Sensitivity.

Objectives: A Randomized Controlled Trial was conducted to evaluate the effectiveness of the Hebrew adaptation of the Program for the Education and Enrichment of Relational Skills (PEERS®), a parent-assisted intervention. Parental sensitivity (PS), measured in conflict and support contexts, was assessed as a predictor of adolescents' intervention-related outcomes.Design: Eighty-two Hebrew-speaking adolescents (9 females), aged 12-17 years, and their parents (62 mothers), were randomly allocated into immediate intervention (II; n = 40) or delayed intervention control (DI; n = 42) groups. Participants were tested at three time-points (Pre-Post-Follow Up for II, Pre-Pre-Post for DI). Outcome measures included behavioral assessments of adolescents' social communication (SC), a social-skills knowledge test, and self, parent, and teacher reported questionnaires. PS was assessed using support and conflict parent-adolescent interactions. Repeated measures ANOVAs were used to assess intervention effectiveness. SEM was used to examine PS pre- and post-intervention as predictors of adolescents' immediate and follow-up outcomes.Results: The II group improved on adolescents' measured SC and social knowledge, on parent-(but not teacher-) reported social skills, and on self-reported empathy. Gains maintained at follow-up. The DI group showed similar gains following their intervention. Adolescents' intervention-related SC gains were negatively predicted by pre-intervention PS, and positively predicted by intervention-related PS changes in the support context. Pre-intervention PS in the conflict context positively predicted adolescent SC at follow-up.Conclusions: The Hebrew-adapted PEERS® is an effective intervention for adolescents with ASD. PS plays an important role in the promotion of SC in adolescents with ASD and should receive clinical attention.

The influence of nurses' knowledge, attitudes, and health beliefs on their safe behavior with cytotoxic drugs in Israel.

The purpose of this study was to examine the influence of the nurses' knowledge, attitudes, and health beliefs on their behavior and their actual usage of safety measures while handling cytotoxic drugs in their daily work surroundings. The Health Belief Model (HBM) and its extensive form, the Protection Motivation Theory (PMT), were used as the theoretical frameworks. Sixty-one nurses participated in the study, 31 hospital-based nurses daily exposed to cytotoxic drugs for the last 5 years, and 30 non-exposed community nurses. An occupational questionnaire was used to test the nurses' actual safe behavior and compliance with the recommended guidelines. A randomly selected group of exposed nurses were observed to validate their compliant behavior. A gap was found between the nurses' knowledge and their actual behavior concerning the potential risks of cytotoxic drugs and their use of protective measures (p < .005). Significant correlations were found among the components of the extensive HBM (perceived susceptibility, barriers, benefits and self-efficacy). The observational findings supported the above results. The study's findings support the need to promote primary prevention by providing a safe environment for the employee by means of education, training with regard to safety measures, clear policy, written guidelines and their enforcement.

A pictorial review of coronary artery anatomy on spiral CT.

Coronary artery calcification quantification (scoring) has been done with electron beam CT (EBCT), but is now being done with spiral or helical CT. Many radiologists and cardiologists who do not have EBCT but do have access to spiral CT will now be able to do coronary artery calcification scoring, and will now need to know the spiral CT appearance of the coronary artery anatomy. This pictorial review will demonstrate the anatomy needed for coronary artery calcium scoring.

A multifaceted mental health training program in reducing burnout among occupational social workers.

This article looks at ways of reducing stress through a multifaceted training program involving the acquisition of mental health knowledge and skills and experiential training in a group of occupational social workers. The training group of 13 occupational workers was compared to a group of occupational social workers not attending the program. Post-training revealed statistically significant increases in professional self-efficacy associated with awareness of psychological and psychopathological issues and professional social support. Reduction in cognitive weariness and listlessness associated with burnout was also found. Gaining competence in mental health issues relating to the occupational setting coupled with emotional sharing helped to reduce professional burnout.

Knowledge and attitudes of primary care physicians regarding battered women. Comparison between specialists in family medicine and GPs.

BACKGROUND: Domestic violence is a widespread public health problem and an important part of primary care practice. OBJECTIVE: To evaluate the approach of primary care physicians (family physicians and GPs) to the care of battered women. METHODS: A self-report questionnaire containing items about experience, knowledge and attitudes regarding the care of battered women was mailed to a random sample of 300 primary care physicians employed by the two major health management organizations in Israel. The population included family physicians, who have 4 years of residency training in primary care, and GPs, who do not undergo specialization after completing their medical studies. RESULTS: A total of 236 physicians (130 family physicians and 106 GPs) responded. In general, the physicians had had very little exposure to the problem and estimated its prevalence in the community as less than half that indicated in the medical literature. Compared with the GPs, however, the family physicians reported more exposure to the subject (P < 0.001) and had better knowledge of its prevalence and risk factors (P < 0.001). They also showed a greater tendency to view the problem as universal (P < 0.05) and as part of their professional responsibilities. However, both groups tended not to include the care of battered women with no physical injury within their professional duties. CONCLUSIONS: Physicians should be made more aware of the problem of battered women within the context of their routine professional practice and of the importance of keeping abreast of the subject. Educators should place more emphasis on imparting knowledge and skills in the management of battered women, especially for GPs.

Primary care physicians' attitudes to battered women and feelings of self-competence regarding their care.

BACKGROUND: Previous descriptive studies have demonstrated the problematic nature of physicians' attitudes toward battered women. However, little empirical research has been done in the field, especially among the various medical specialties. OBJECTIVES: To compare the approach and feelings of competence regarding the care of battered women between primary care and non-primary care physicians. The non-primary care physicians who are likely to encounter battered women in the ambulatory setting are gynecologists and orthopedists. METHODS: A self-report questionnaire formulated for this study was mailed to a random sample of 400 physicians working in ambulatory clinics of the two main health maintenance organizations in Israel (300 primary care physicians, 50 gynecologists and 50 orthopedists). RESULTS: In both physician groups, treating battered women tended to evoke more negative emotional states than treating patients with infectious disease. The most prevalent mood state related to the management of battered women was anger at her situation. Primary care physicians experienced more states of tension and confusion than non-primary care physicians and had lower perceived self-efficacy and self-competence in dealing with battered women. CONCLUSIONS: Though both physician groups exhibited negative feelings when confronting battered women, the stronger emotion of the primary care physicians may indicate greater sensitivity and personal awareness. We believe that more in-service training should be introduced to help physicians at the undergraduate and postgraduate levels to cope both emotionally and professionally with these patients.

Job satisfaction among certified and non-certified general practitioners.

BACKGROUND: The aim of family medicine is to provide patients with comprehensive care within the biopsychosocial model. High job satisfaction is necessary to attract physicians to this specialty. OBJECTIVE: To compare job satisfaction levels between primary physicians with training in family medicine and physicians without specialty training. METHODS: A self-report questionnaire, the "Task Profiles of General Practitioners in Europe," was mailed to a stratified random sample of 664 primary care physicians in Israel. The response rate was 77.6%. Bivariate and logistic regression procedures were used to analyze the data. RESULTS: Physicians with training in family medicine were less satisfied with the rewards for their work than general practitioners with no formal specialization in family medicine. Satisfaction with the intrinsic aspects of the work was found to be equal. Women and rural physicians were more satisfied than men and urban physicians. CONCLUSION: Measures should be taken by health maintenance organizations to increase the level of job satisfaction of specialist-certified family physicians to avoid a crisis in the profession.

Stress and intervention strategies in mental health professionals.

There is growing evidence to show that mental health professionals by the nature of their work are particularly vulnerable to stress with all its detrimental effects on service delivery and quality of care. This comes at a time when mental health services in many countries are under considerable strain. The present paper examines the multifaceted stressors encountered by the mental health team and recommends possible ways of reducing burnout through innovative intervention strategies. The detection of emotional distress and psychological dysfunctioning in mental health providers is outlined and their management carefully considered.

Comparison of 4 computed tomographic imaging protocols for lateral tibial plateau fractures.

OBJECTIVE: Many computed tomographic (CT) imaging protocols are used for pretreatment assessment of tibial plateau fractures. This study compares the diagnostic capabilities of 4 CT protocols. METHODS: Lateral tibial plateau fractures were induced in 19 knee specimens and CT scans were obtained with the following protocols: 1) 3-mm collimation, axial acquisition, 2) 3-mm collimation, helical acquisition, 3) mixed-increment collimation, axial acquisition, and 4) 3-mm collimation, helical acquisition with 50% overlap reconstruction of raw data. Two-dimensional coronal and sagittal reformations and 3-dimensional surface reconstruction images were analyzed for maximum fragment depression, peripheral fragment displacement, fracture pattern classification and quality of image. Specimen dissection established maximal articular surface depression, fragment displacement and actual fracture pattern. RESULTS: None of the 2-dimensional reformations from the 4 protocols proved statistically superior for determining maximal fracture depression, fragment displacement, or fracture classification. There was a trend toward more accurate fracture classification with the mixed-increment axial protocol and the overlap protocol than either of the 3-mm protocols, but this was not statistically significant. All protocols were statistically equivalent in predicting fracture pattern classification using 3-dimensional images. However, the 3-dimensional images were of significantly higher quality when obtained with either the mixed-increment axial protocol or the overlap protocol. CONCLUSIONS: There were no statistically significant differences in the objective assessment of tibial plateau fractures among the 4 different protocols. The 3-dimensional images derived from the mixed-increment axial protocol and the 3-mm helical protocol with 50% overlap reconstruction were of superior quality.

Doctors' narratives in Balint groups.

There is a limited place today for narratives in traditional medicine. However, the Balint group is a legitimate forum providing doctors to unconditionally engage in discussing patients' stories within a secure and safe environment. This paper examines the importance of doctors' narratives in Balint groups and describes how insightful listening may help them move from a mainly biomedical mode to a narrative one, in order to change and repair their patients' and their own personal narratives.

Radiologic case study. Fractures of the foot masquerading as ankle injuries.

An ankle radiographic series frequently is obtained when a patient presents with an acute ankle and foot injury. Although many fractures are confined to the ankle and are readily apparent, fractures of the foot can mimic ankle injuries. It is important to differentiate these fractures of the foot from the more common ankle sprain. Most ankle sprains are treated with ice, compression, and elevation, followed by range-of-motion exercises and progressive weight bearing as tolerated. When foot fractures are not identified, however, lack of appropriate treatment can result in late complications. Concentration on key areas as described here will reduce the incidence of missed fractures of the foot in these patients.

Dexamethasone induces hypertrophy of developing medial septum cholinergic neurons: potential role of nerve growth factor.

Glucocorticoid hormones influence neuronal plasticity during development; however little is known about the mechanisms of this trophic activity. Because glucocorticoids increase nerve growth factor (NGF) synthesis in selected brain areas and NGF plays a role in the development of basal forebrain cholinergic neurons, we tested the hypothesis that glucocorticoids may foster maturation of the cholinergic phenotype during postnatal development via the induction of NGF biosynthesis. The synthetic glucocorticoid dexamethasone (DEX) was injected systemically (0.5 mg/kg, s.c.) once a day for 1 week in 7-d-old (P7) rats. DEX elicited an increase in NGF mRNA and protein levels in the cerebral cortex and hippocampus as well as specific NGF responses, such as TrkA tyrosine phosphorylation in the septum, choline acetyltransferase (ChAT) and p75 neurotrophin receptor (p75NTR) immunoreactivity, and a relative number of cholinergic neurons in the medial septum. To examine whether the effect of DEX is age-related, we treated 1- and 14-d-old rats with DEX for 1 week. DEX increased NGF expression in rats treated from P1 to P8 but not in those treated from P14 to P21. The age-related increased expression of NGF correlated with the induction of ChAT immunoreactivity in the medial septum. Moreover, in the spinal cord, neither NGF nor ChAT levels were increased by DEX, suggesting that the glucocorticoid-mediated changes seen in the basal forebrain are associated with specific NGF responses. Our data suggest that by increasing NGF levels, glucocorticoids may play a role in the maturation of postnatal cholinergic neurons.

Activity-dependent release of brain-derived neurotrophic factor underlies the neuroprotective effect of N-methyl-D-aspartate.

The molecular mechanism(s) of N-methyl-D-aspartate (NMDA) neuroprotective properties were investigated in primary cultures of cerebellar granule cell neurons. Granule cells express the neurotrophin receptor TrkB but not TrkA or TrkC. In these cells, the TrkB ligand brain-derived neurotrophic factor (BDNF) prevents glutamate toxicity. Therefore, we have tested the hypothesis that NMDA activates synthesis and release of BDNF, which may prevent glutamate toxicity by an autocrine loop. Exposure of granule cells for 2 and 5 min to a subtoxic concentration of NMDA (100 microM) evoked an accumulation of BDNF in the medium without concomitant changes in the intracellular levels of BDNF protein or mRNA. The increase in BDNF in the medium is followed by enhanced TrkB tyrosine phosphorylation, suggesting that NMDA increases the release of BDNF and therefore the activity of TrkB receptors. To examine whether BDNF and TrkB signaling play a role in the NMDA-mediated neuroprotective properties, neurons were exposed to soluble trkB receptor-IgG fusion protein, which is known to inhibit the activity of extracellular BDNF, and to K252a, a tyrosine kinase inhibitor. Both compounds blocked the NMDA-mediated TrkB tyrosine phosphorylation and subsequently its neuroprotective properties. We suggest that NMDA activates the TrkB receptor via a BDNF autocrine loop, resulting in neuronal survival.

Malingering assessment in behavioral toxicology: what, why, and how.

Neurobehavioral assessment is frequently made in a forensic context. The cognitive assessment may be biased due to an international manipulation of data by the patient motivated by attainment of compensation, that is, malingering. Although malingering is highly relevant in behavioral toxicology, the issue and its assessment are underrepresented in the literature. A routine assessment of malingering is important to reduce false-positive and false-negative errors in assessment, thereby establishing the credibility and validity of behavioral assessment. In the long run, the routine inclusion of malingering measurements might reduce claims and encourage employers to be more cooperative in behavioral toxicology studies. Guidelines for malingering assessment and research, inferred from the clinical and research literature, are discussed. Sensitivity to the problematic issues involved in assessing malingering behavior is an important step toward malingering detection in the clinical setting and to the establishment of assessment methods that are less confounded by these issues.

TrkA receptors delay C6-2B glioma cell growth in rat striatum.

Nerve growth factor (NGF) acts as an anti-mitogenic factor in C6-2B glioma cells stably expressing TrkA (C6trk+). To study the effect of TrkA on cell growth in vivo, we grafted mock and C6trk+ cells into the striatum of ACI nude rats. Thy 1.1 and p75NTR immunohistochemistry revealed that wild type C6-2B cells formed a tumor mass in the striatum by 14 days. In contrast, C6trk+ transplanted rats did not show the presence of a significant tumor mass until 71 days. Analysis of this tumor showed that expression of TrkA was retained, but the synthesis of NGF was abolished. Our data encourage the speculation that expression of TrkA in glioblastoma in vivo will attenuate tumor progression.

Impact of managers' personal determinants in notifying workplace hazards.

Notification about work hazards is a legal requirement in advanced industrial countries, but workers have claimed, that in many cases, they do not receive enough information regarding risks, exposure, and medical problems. The recent professional literature on the subject has explored the ways in which notification is delivered without sufficiently considering the psychological incentives and barriers that may affect managers in transmitting risk information. The present study aimed at examining managers' personal determinants and notification of work hazards in a sample of 106 managers and 460 workers in 40 departments of three industrial plants in Israel. Results of our study showed that both managers and workers perceived the importance of the delivery of safety information as quite high (means of 3.43 and 3.7, respectively, out of 5), with managers reporting that they rely primarily on personal modes of communication. Immediate supervisors were regarded by both groups as the most important persons in notification. Managers having past experience in treating injured workers notified more, primarily using personal notification. The most important personal determinants that positively predicted managers' notification were their sense of self-efficacy and positive expectation of notification. Outcome denial and coping by distancing were negatively correlated with notifying about these risks.

A descriptive study of stress management in a group of pediatric oncology nurses.

Pediatric oncology nursing is associated with highly stressful and emotional situations. This article describes and discusses major sources of occupational stress among a group of nurses participating in a stress management group. The stress sources for these nurses were preoccupation with death and dying, the professional image of the oncology nurse, the nurse as fighter in the war against disease and death, the nurses' perceived isolation from the medical staff, the nurses' perceived inferior professional status compared with that of physicians, emotional overinvolvement with patients and families, suppression of anger, and difficulties in balancing work and home demands. The following factors are suggested as major contributors to the nurses' stress and burnout: increased tendency for irrational-dysfunctional thinking styles (mainly "demandingness" and "awfulizing"), diffuse boundaries between nurses and patients, low professional self-efficacy, and wide prevalence of military metaphors.

Tibial segmental defect repair: chondrogenesis and biomechanical strength modulated by basic fibroblast growth factor.

BACKGROUND: The effect of recombinant human basic fibroblast growth factor (bFGF) on cartilage development and bone biomechanical strength during healing of a tibial segmental defect was studied in the rat. Two reports on the effect of basic FGF administration during fracture healing and several reports on the effects of acidic FGF have documented different responses of callus cartilage to this important growth factor. This is the first report of the effect of bFGF on cartilage formation in the healing of a grafted segmental defect in the rat. METHODS: The tibiae of 80 male rats underwent segmental resection of the mid-diaphyseal region. One-half of this group consisted of controls that received insertion of an intramedullary wire with a coralline hydroxyapatite graft and Gelfoam without bFGF. The tibiae of the other half were treated identically but had the Gelfoam impregnated with 1 microgram bFGF. Animals were killed at 2, 4, and 8 weeks postoperatively. Histological sections were stained with toluidine blue to differentiate the cartilage. Areas of metachromatically stained extracellular matrix, cell areas, cell size, and cellularity were quantified by using image analysis. Unfixed treated and control tibiae were tested for bone failure strength by using four-point bending on an Instron machine. RESULTS: Control bone failure strength was significantly greater than bFGF-treated bones at 2 weeks and energy-to-failure was significantly decreased in treated bones at 2 weeks. Although strength increased with time in all groups, treated groups at 4 and 8 weeks did not differ from controls. Basic FGF treatment promoted an increase in the development of normal hyaline cartilage and vasculogenesis at 2 weeks as compared with controls. Total cartilage declined over time in all groups. Average cell size and cell number did not change with either treatment or time. Bone formation and healing was equivalent in treated and control groups at 8 weeks. CONCLUSIONS: The results indicate that bFGF released directly and initially but not continuously exerts a transient positive effect on hyaline cartilage formation at the expense of repair site strength and does not accelerate healing.