Systematic counselling by general practitioners for promoting physical activity in elderly patients: a feasibility study.

RESEARCH QUESTIONS: To investigate how the daily physical activities of elderly patients can be enhanced by systematic counselling conducted by general practitioners (GPs). METHODS: In this feasibility study with pre-post design, 29 people (14 females, mean age 72.2 years, SD = 6.1) were enrolled during routine visits by two general practitioners. A baseline assessment of current physical activity based on the stages according to the Transtheoretical Model was followed by a counselling session. The target behaviour was defined by performance of 30 minutes of daily moderate-intensity activities that increase the breathing rate, on five days per week. At the 2-month follow-up, subjects were assessed for improvement in stage of physical activity since baseline. After the end of the intervention, participating GPs and patients were asked questions focusing on the feasibility, acceptance and usefulness of counselling. RESULTS: Interview results showed that the two GPs considered the counselling protocol easy to handle and useful for promoting physical activity. Counselling sessions were especially encouraging for the not sufficiently active people. Most of them would like to have additional counselling session. At baseline, 9 of 29 people were sufficiently active. After 2 months, this proportion was 21 of 29. The mean of the number of minutes of physical activity during the previous 4 weeks increased from 247 to 436 minutes (weekly). CONCLUSIONS: The programme was judged positively by the general practitioners and the participating elderly patients. Systematic counselling by general practitioners led to an increase in the physical activity behaviour. Therefore, a more rigorous randomised controlled trial with adequate followup is recommended.

Effects of habitat destruction and resource supplementation in a predator-prey metapopulation model.

We developed a mean field, metapopulation model to study the consequences of habitat destruction on a predator-prey interaction. The model complements and extends earlier work published by Bascompte and Solé (1998, J. theor. Biol.195, 383-393) in that it also permits use of alternative prey (i.e., resource supplementation) by predators. The current model is stable whenever coexistence occurs, whereas the earlier model is not stable over the entire domain of coexistence. More importantly, the current model permits an assessment of the effect of a generalist predator on the trophic interaction. Habitat destruction negatively affects the equilibrium fraction of patches occupied by predators, but the effect is most pronounced for specialists. The effect of habitat destruction on prey coexisting with predators is dependent on the ratio of extinction risk due to predation and prey colonization rate. When this ratio is less than unity, equilibrial prey occupancy of patches declines as habitat destruction increases. When the ratio exceeds one, equilibrial prey occupancy increases even as habitat destruction increases; i.e., prey "escape" from predation is facilitated by habitat loss. Resource supplementation reduces the threshold colonization rate of predators necessary for their regional persistence, and the benefit derived from resource supplementation increases in a nonlinear fashion as habitat destruction increases. We also compared the analytical results to those from a stochastic, spatially explicit simulation model. The simulation model was a discrete time analog of our analytical model, with one exception. Colonization was restricted locally in the simulation, whereas colonization was a global process in the analytical model. After correcting for differences between nominal and effective colonization rates, most of the main conclusions of the two types of models were similar. Some important differences did emerge, however, and we discuss these in relation to the need to develop fully spatially explicit analytical models. Finally, we comment on the implications of our results for community structure and for the conservation of prey species interacting with generalist predators.

Stages of change for perceived stress in a Swiss population sample: an explorative study.

OBJECTIVES: Data from a cross-sectional survey of the Swiss general population were used in an explorative attempt to apply the transtheoretical model of behavioural change to perceived stress. METHODS: The sample comprised 575 respondents who reported having experienced stressful situations in the previous month. Other variables assessed included gender, age, education, reported symptoms, and three constructs representing stages and processes of change as well as self-efficacy. RESULTS: Findings indicated that (1) about one third of respondents appeared to cope successfully with the stressful situations they experienced, one third intended to do so, while one quarter appeared to have no intention of managing their stress more effectively. (2) There was no difference in stage of change distribution by gender or age, while those with higher education were more frequently represented in the latter stages than those with lower education. (3) Those in the maintenance stage reported significantly less symptoms than others. CONCLUSIONS: We conclude that the assessment of readiness to change could be of valuable support in designing stage-specific interventions in the area of stress management.

Evaluation of family structures with figure placement techniques.

The relevance of figure placement techniques for analyzing family cohesion and hierarchy structures in various settings is described and the completion of further studies including these instruments is suggested.

The Family System Test (FAST). A pilot study in families with a young adult member with cancer.

The impact of a cancer diagnosis upon a family has become a focus of clinical interest, but few scientific studies have been completed in this area. The objectives of this pilot study were twofold: first, to test the applicability of the Family System Test (FAST) in families (n = 5) with a young adult member with cancer and secondly to evaluate patterns of interactions within these families. Results show that the FAST is applicable and useful to evaluate the different perceptions of hierarchy and cohesion--two essential variables--within these families. The great majority of family members represented their relationships as balanced (i.e., cohesive and moderately hierarchical). However, contrary to nonclinical families, fathers had a less positive view than mothers and patients: fathers more often perceived family and parenteral relations as unbalanced, and also more often perceived a reversal of hierarchy and a cross-generational coalition within the family. Implications for future research and clinical care are discussed.

Are preventive HIV interventions at airports effective?

BACKGROUND: Few empirical data exist on the impact of preventive human immunodeficiency virus (HIV) interventions on intended and actual sexual behavior of international tourists. The present cross-sectional study is based on a 2 3 2 design. METHODS: The sample consisted of departing and arriving passengers (n = 3100) at Zurich Airport with destinations in countries where heterosexual HIV transmission is dominant. While 41% of the tourists obtained information about safer sex, the remaining 59% without such intervention served as control group. Departing passengers completed a short questionnaire focusing on their planned sexual behavior. Arriving passengers were asked about their actual behavior during the journey. Subjects of the intervention group also evaluated the impact of the consultation. RESULTS: Most travelers appreciated the intervention and reported that they received important information. Members of the intervention group were better informed than those of the control group about the risk of heterosexually transmitted HIV infection (p <.01). They also indicated more often that they could imagine having casual sex abroad (23% vs 16%, p <.01). However, the two groups did not differ with regard to planned condom use or actual sexual behavior. Whereas most of departing passengers indicated that they would use condoms consistently, only half of the passengers who reported casual sex actually did so. Subjects who refused to participate in the intervention tended to consider it as irrelevant and reported less consistent condom use. CONCLUSIONS: Although travel health interventions focusing on casual sex are appreciated and increase the knowledge, they failed to result in significant behavior modification. Future projects should attempt to approach possible risk groups more specifically and to have more impact.

[Computer-assisted smoking cessation]. / Computergestützte Raucherentwöhnung.

Though the prevalence of cigarette smoking has declined it still remains the leading cause of premature death from chronic disease. In the prevention of tobacco associated disease the promotion of smoking cessation is a key strategy. This article presents a smoking cessation program based on the transtheoretical model, an empirical model distinguishing five stages of behavioral change. Specific interventions are matched to the current stage of change. Smokers in the intervention program repeatedly fill in questionnaires about their smoking habits, attitudes and strategies in the smoking cessation process. The individual questionnaires are analyzed by a computerized expert system which creates letters with comments on the smoking cessation process and suggestions for further steps from a pool of feedback paragraphs. A further component of the program are five stage-matched brochures. The efficacy of the expert system and its potential impact on Public Health are discussed.

Family System Test (FAST): the relevance of parental family constructs for clinical intervention.

On the basis of the Family System Test (FAST), family representations of parents with healthy and biopsychosocially distressed children were compared, and family structure changes in the context of interventions on the parent-level were described. Results indicated that parental family constructs are related to offspring's health and clinical intervention. Parents of psychiatric patients showed their families to have low cohesion, and hierarchically unclear generational boundaries (i.e. unbalanced structure). As had been their wish at therapy onset, the family patterns they indicated after completion of treatment were balanced.

Family System Test (FAST): are parents' and children's family constructs either different or similar, or both?

Perceptions of family cohesion and hierarchy structures were assessed by the Family System Test (FAST), a clinically-derived figure placement technique. Parents (N = 140) and their preadolescent offspring (N = 70) completed typical and conflict representations in individual as well as group settings. Typical representations were characterized by balanced family structures (i.e. cohesive and moderately hierarchical) and those displaying conflict situations showed predominantly unbalanced patterns. FAST portrayals were related to respondent (mother vs. father vs. child). Fathers represented typical family relations as balanced more often than mothers. Regarding conflict representations, children were more likely than fathers to portray the family as unbalanced. However, analyses of representations of the same family (i.e. intra-family comparisons) indicated that all respondents differed in their perceptions and, that fathers' typical portrayals showed most often the same structure as those done by the family members as a group.

The Family System Test: differences in perception of family structures between nonclinical and clinical children.

Nonclinical respondents and psychiatric outpatients (N = 400) between the first and twelfth grades portrayed their families as they perceived them in typical and in conflict situations using the Family System Test (FAST), a figure placement technique that focuses on cohesion and hierarchy in the family. Results showed that typical representations were influenced by whether a respondent was a patient or not, but not by the type of mental disorder. Clinical respondents were less likely to represent their families as being either cohesive, moderately hierarchical or as having clear generational boundaries. In conflict representations, both clinical and nonclinical respondents indicated low cohesion in family patterns. Results were interpreted from a family systems approach as well as from a clinical perspective.

Is there a relationship between children's mental disorders and their ideal family constructs?

Psychiatric outpatients (N = 72) and nonclinical children (N = 72) from 1st to 12th grades portrayed their families as they wished they were (ideal representation), using the Family System Test (FAST), a figure placement technique that focuses on cohesion and hierarchy. Results showed that constructs of ideal family relations were related to age group (1st to 3rd graders versus 4th to 12th graders) and to clinical status (clinical versus nonclinical) but not to the type of mental disorder. First, younger children portrayed less cohesion than did older ones. Second, clinical respondents were less likely to represent cohesive family patterns and were more likely to report ideal family situations as special events. Results are discussed from a developmental as well as from a family systems perspective.

[The Family System Test: a 3-dimensional method for analyzing social relation structures]. / Der Familiensystem-Test (FAST): Eine drei-dimensionale Methode zur Analyse sozialer Beziehungsstrukturen.

The Family System Test (FAST) is a clinically-derived figure placement technique designed for a three-dimensional representation of cohesion and power in the family. The FAST measures individual and group perceptions in typical, ideal and conflict situations. The flexibility of family structures is assessed by comparing representations of these situations. Scoring procedures as well as validity and reliability of the FAST are described. The relevance of the FAST is discussed from a systemic, developmental and clinical perspective.

Changing perceptions of family cohesion and power across adolescence.

Adolescents' perceptions of family relationships were studied using the FAST, a spatial technique in which wooden figures were placed on a board to represent cohesion and power. 150 subjects, drawn equally from sixth, ninth, and twelfth grades, portrayed the family in 2 representations: as perceived typically and ideally. Father-mother, father-child, and mother-child dyads were analyzed. Perceptions were strongly influenced by age, type of representation, and dyad. In accord with a developmental perspective, older adolescents portrayed less cohesion in parent-child dyads and smaller power differences in all dyads than did younger adolescents. In accord with family systems theory, the father-mother dyad was depicted as the most cohesive and as near egalitarian in power. At all ages and in both representations, parents were perceived as more powerful than their children. The family was generally portrayed as cohesive, significantly more so in the ideal than typical representation. Furthermore, in the ideal representation there were no significant power differences between the parents but moderate power differences in the parent-child dyads. Results were interpreted from both developmental and family systems perspectives.