Parents' preferences for return of results in pediatric genomic research.

BACKGROUND: The aim of this study was to ascertain parental preferences for the return of genetic research results on themselves and their children and their choices for genetic research results to receive. METHODS: A mail survey was sent to 6,874 families seen at Boston Children's Hospital. The survey included questions assessing the respondents' preferences regarding the types of result they wanted to receive on themselves and their children. RESULTS: Most of the 1,060 respondents 'probably' or 'definitely' wanted to receive genetic research results about themselves (84.6%) and their children (88.0%). Among those who wanted to receive results, 83.4% wanted to receive all research results for themselves and 87.8% for their children. When questions about specific types of research results were combined into a composite measure, fewer respondents chose to receive all results for themselves (53.5%) and for their children (56.9%). CONCLUSION: Although most parents report a desire to receive all research results on a general question, almost half chose to receive only a subset of research results when presented with specific types of research results. Our findings suggest that participants might not understand the implications of their choice of individual research results to receive unless faced with specific types of results.

Everyday interpersonal conflicts of middle-aged women: an examination of strategies and their contextual correlates.

Everyday problem solving within the interpersonal domain has been identified as propelling cognitive development in adulthood, and may be particularly relevant to women's development. Yet few studies of everyday problem solving in adulthood focus on interpersonal problems, on women, or on the middle adult years. We examined strategies middle-aged women used for real-life interpersonal problems, and contextual variables associated with strategy use. In contrast to research with younger and older women, in which lower-level strategies were favored, strategy use here was fairly evenly split between higher and lower levels. Also in contrast to other research with younger and older women, participants here favored lower-level strategies that were directive, rather than submissive. Thematic analyses showed a high degree of felt emotional distress to be associated with lower-level strategy use, and attempts at controlling emotions and overcoming fundamental attribution errors in judgment to be related to higher-level strategy use.

Risk and reluctance: understanding impediments to colorectal cancer screening.

PURPOSE: Screening to detect and prevent colorectal cancer (CRC) is well below optimal, contributing to needless CRC-related morbidity and mortality. Little detailed information exists explaining why screening technologies are underutilized and why screening adherence rates are low. Prior to the design of an intervention study, we assessed knowledge about CRC among adult women and men with access to health care. We also investigated patterns of perceived risk for CRC, barriers and facilitators to screening, and experience and intentions with regard to both fecal occult blood testing and flexible sigmoidoscopy. METHODS: We analyzed data from semistructured focus group interviews with a small, nonrepresentative sample (n = 39) of community-dwelling adult men and women ages 50 to 64 and 65 plus. RESULTS: CRC-related knowledge is low, and misperceptions are common. Provider practices reinforce low levels of perceived risk. Multiple barriers to screening exist, of which many are remediable. CONCLUSIONS: We are at an early stage in the diffusion of information about CRC. Screening utilization may be improved through development of appropriate public health awareness campaigns and by addressing service factors. Recommendations are provided.

Giving means receiving: the protective effect of social capital on binge drinking on college campuses.

OBJECTIVES: We tested whether higher levels of social capital on college campuses protected against individual risks of binge drinking. METHODS: We used a nationally representative survey of 17,592 young people enrolled at 140 4-year colleges. Social capital was operationalized as individuals' average time committed to volunteering in the past month aggregated to the campus level. RESULTS: In multivariate analyses controlling for individual volunteering, sociodemographics, and several college characteristics, individuals from campuses with higher-than-average levels of social capital had a 26% lower individual risk for binge drinking (P < .001) than their peers at other schools. CONCLUSIONS: Social capital may play an important role in preventing binge drinking in the college setting.

Directiveness in teachers' language input to toddlers and preschoolers in day care.

Five subtypes of directiveness were examined in the interactions of day care teachers with toddler and preschooler groups. The instructional context (book reading, play dough) yielded significant differences across all five subtypes of directiveness, indicating that these two activities elicited different types of teacher-child discourse. Book reading was characterized by significantly more behavior and response control and less conversation control in comparison with the play-dough activity. Correlations between teachers' directiveness and child language productivity indicated that behavior control and turn-taking control were associated with low levels of productivity, whereas conversation control was associated with the highest levels of productivity. The results of this study confirm that instructional context is an important mediator of teachers' directiveness and suggest that subtypes of directiveness have differential effects on child language output.

Patient delay in seeking care for heart attack symptoms: findings from focus groups conducted in five U.S. regions.

BACKGROUND: Patient delay in seeking health care for heart attack symptoms is a continuuing problem in the United States. METHODS: Investigators conducted focus groups (N = 34; 207 participants) in major U.S. regions (NE, NW, SE, SW, MW) as formative evaluation to develop a multi-center randomized community trial (the REACT Project). Target groups included adults with previous heart attacks, those at higher risk for heart attack, and bystanders to heart attacks. There were also subgroups reflecting gender and ethnicity (African-American, Hispanic-American, White). FINDINGS: Patients, bystanders, and those at higher risk expected heart attack symptoms to present as often portrayed in the movies, that is, as sharp, crushing chest pain rather than the more common onset of initially ambiguous but gradually increasing discomfort. Patients and those at higher risk also unrealistically judge their personal risk as low, understand little about the benefits of rapid action, are generally unaware of the benefits of using EMS/9-1-1 over alternative transport, and appear to need the "permission" of health care providers or family to act. Moreover, participants reported rarely discussing heart attack symptoms and appropriate responses in advance with health care providers, spouses, or family members. Women often described heart attack as a "male problem," an important aspect of their underestimation of personal risk. African-American participants were more likely to describe negative feelings about EMS/9-1-1, particularly whether they would be transported to their hospital of choice. CONCLUSIONS: Interventions to reduce patient delay need to address expectations about heart attack symptoms, educate about benefits and appropriate actions, and provide legitimacy for taking specific health care-seeking actions. In addition, strategy development must emphasize the role of health care providers in legitimizing the need and importance of taking rapid action in the first place.

Alcohol use, abuse, and related problems among children of problem drinkers: findings from a national survey of college alcohol use.

The purpose of this study was to estimate the prevalence of parental problem drinking reported by a national sample of college students and to examine the relations between such reports and respondents' patterns of drinking, alcohol abuse, abstinence, and utilization of treatment/counseling. Responses to mailed questionnaires completed by a random sample of 17,592 students at a representative national sample of 140 four-year colleges were analyzed using logistic regression. About 10% of college students reported problem-drinking parents. These children of problem drinkers (COPDs) exhibited a bimodal pattern of drinking behavior, showing higher than normal odds of past year abstinence or heavy episodic drinking. Males were more likely than females to report heavy episodic drinking, and children of affected mothers were at greatest risk. Approximately 23% of COPDs met proxy DSM-IV alcohol abuse criteria COPDs in college are a heterogeneous group showing both vulnerability and resistance. Those reporting treatment are more likely to be abstainers.

What colleges are doing about student binge drinking. A survey of college administrators.

In 1999, the Harvard School of Public Health College Alcohol Study surveyed 734 US college administrators to learn what colleges were doing to prevent binge drinking. Respondents rated the severity of student alcohol-abuse problems and described prevention efforts and institutional investments in prevention infrastructure. Prevention practices were widespread in the areas of general education about alcohol, use of policy controls to limit access to alcohol, restricting advertising at home-game sporting events, and allocation of living space to alcohol-free dormitories. Programming was less prevalent for more targeted alcohol education, outreach, and restrictions on alcohol advertising in campus media. Nationally, most of the surveyed colleges reported having a campus alcohol specialist, many had task forces, and about half were performing in-house data collection. Less common were program evaluations, community agreements, or neighborhood exchanges. Prevention practices varied with institutional characteristics and the surveyed administrators' perceptions of the severity of alcohol problems.

Analyzing qualitative data with computer software.

OBJECTIVE: To provide health services researchers with an overview of the qualitative data analysis process and the role of software within it; to provide a principled approach to choosing among software packages to support qualitative data analysis; to alert researchers to the potential benefits and limitations of such software; and to provide an overview of the developments to be expected in the field in the near future. DATA SOURCES, STUDY DESIGN, METHODS: This article does not include reports of empirical research. CONCLUSIONS: Software for qualitative data analysis can benefit the researcher in terms of speed, consistency, rigor, and access to analytic methods not available by hand. Software, however, is not a replacement for methodological training.

Effects of lexical intervention on the phonology of late talkers.

The purpose of this investigation is to determine whether a focused stimulation intervention focusing on lexical training has indirect, secondary effects on children's phonological abilities. Twenty-five toddlers with expressive vocabulary delays and their mothers were randomly assigned to intervention and control groups. The children were between 23 and 33 months of age at entry into the study and were at the single-word stage of language development. Parents of late talkers in the experimental group were trained to employ frequent, highly concentrated presentations of target words without requiring responses. Two measures of phonological diversity (i.e., syllable structure level and consonant inventory) and one measure of accuracy of production (i.e., percent consonants correct) were measured prior to and following intervention within the context of mother-child interactions. The toddlers who received intervention made treatment gains in two areas of phonological ability. They used a greater variety of complex syllable shapes and expanded their speech sound inventories to include more consonant sounds in both initial and final position. In contrast, there were no effects of language treatment on the accuracy of correct production when compared to the adult phonological system.

Interactive focused stimulation for toddlers with expressive vocabulary delays.

This study explores the effects of training parents to administer focused stimulation intervention to teach specific target words to their toddlers with expressive vocabulary delays. Twenty-five mothers and their late-talking toddlers were randomly assigned to treatment and delayed-treatment (control) groups. Vocabulary targets were individually selected for each toddler based on the child's phonetic repertoire and parent report of vocabulary development. Following treatment, mothers' language input was slower, less complex, and more focused than mothers in the control group. Concomitantly, their children used more target words in naturalistic probes, used more words in free-play interaction, and were reported to have larger vocabularies overall as measured by parent report. In addition, the treatment had an effect on language development-children in the experimental group used more multiword combinations and early morphemes than children in the control group. The implications of these results are discussed with regard to the role of focused stimulation intervention for children with expressive vocabulary delays.

"Drugs and AIDS--reaching for help": a videotape on AIDS and drug abuse prevention for criminal justice populations.

This article describes the development of a videotape targeted at persons under supervision of the criminal justice system. The videotape seeks to encourage those who use illicit drugs to enter drug treatment and to motivate those at risk for exposure to human immunodeficiency virus (HIV) to alter behaviors that may transmit infection. The criminal justice system presents an important opportunity to deliver such messages, particularly to a large population of persons briefly detained in a jail or lockup and released without subsequent incarceration. Evidence suggests that, even in this audience, knowledge of how to prevent exposure to HIV is widespread, yet those at risk often fail to take appropriate precautions: motivating behavior change demands more than imparting information. In order to shape this videotape, we analyzed the target audience and developed a drama-based approach that applies the framework of social learning theory, the health belief model, and principles of social marketing. This article describes the integration of that theoretical framework into the production process, content, and strategy of the videotape.

Parents of adolescents: help-seeking intentions as a function of help sources and parenting issues.

This study examined the declared intentions of parents of adolescents to seek help from potential sources for a variety of hypothetical problems related to parenting. The relationship between hypothetical help-seeking and certain characteristics of the help-seeker (sex, educational level, parenting, self-confidence, birth order, and sex of the adolescent), and the source of help (natural support system, professional support system, and media); and the problem type were investigated. The research population included 187 parents of adolescents. A questionnaire was formulated for the purpose of the study which examined help-seeking from nine sources of help on eight hypothetical parenting issues. Intention to seek help was found to be a function of both the particular problem type and the potential source of help. In general, parents declared their intention to seek help from and rely on a variety of sources. It was found that parents said that they were most likely to seek help from their spouses regardless of the issue, whereas professional sources were most likely to be consulted in their area of expertise.

Are periodic movements in sleep a basal ganglia dysfunction?

Muscle activity during sleep is a new area of interest in sleep research. No precise brain structures are known to be involved in sleep movement. The etiology of periodic movements during sleep is unknown. The present study was dedicated to evaluate involvement of basal ganglia in periodic movements of the legs during sleep (PMS) in Parkinson's diseased patients. Sleep was monitored in 3 patients suffering from Parkinson's disease and PMS (PMS/PD) and in 3 patients suffering from restless legs syndrome and PMS (PMS/non PD). Following treatment, the six patients were monitored again during sleep. It was found that only the PMS/PD group of patients had improved significantly with appropriate treatment. Improved motor function in PD patients is associated with decreased PMS, regardless of wether the patients are treated with dopaminergic or anticholinergic agents. This is consistent with our previous data. It may be suggested that the striopallidal system is involved in periodic sleep movements of Parkinson's diseased patients.

Human growth hormone release is decreased during sleep in temporal isolation (free-running).

Growth hormone (hGH) secretion was measured during sleep in 10 healthy male subjects isolated from all time cues. HGH concentrations following sleep onset were compared between scheduled sleep episodes (entrainment) and self-selected sleep episodes (free-running). Peak sleep-related hGH values were decreased significantly during free-running. The duration of the first slow wave sleep (SWS) episode and the latency to the first REM sleep episode also decreased significantly during free-running. The latencies from sleep onset to SWS and to peak hGH secretion did not differ between entrainment and free-running. These results suggest that sleep-related hGH secretion begins 'on time' during free-running, but is terminated earlier. Thus, while sleep onset facilitates hGH release, the timing of other stages of sleep such as REM may alter the magnitude of sleep-related hGH secretion.

Signs of REM prior to the first REM period in prepubertal children.

In a previous publication, prepubertal depressives were found not to exhibit a shortened REM period latency during active illness when compared with pathological and normal control groups. It was hypothesized that this might be due to a nonselective inhibition of REM sleep by slow-wave sleep (SWS), which is quite intense among prepubertal children, especially during the first 2 h of the sleep period. A number of polysomnographic signs normally associated with REM sleep were observed to occur periodically, prior to the beginning of the first REM period. It was thought that these signs might be indicative of "minor escapes" of REM sleep activity from the inhibitory influence of SWS. It was further hypothesized that differences among the experimental groups in the occurrence (timing and amount per minute) of these signs support the idea of an inhibitory effect of SWS on REM; and thus offer an explanation for the apparent dissociation between the depressive disorder among prepubertal children and a shortened REM period latency. The hypotheses were not supported by the results presented here indicating that the above dissociation is probably not due to inhibitory mechanisms of SWS on REM sleep.

Circadian rhythms in human performance efficiency under free-running conditions.

A series of four experiments is described in which two men and two women (age range 22-79 years) were allowed to 'free-run' under conditions of isolation from all time cues. The circadian rhythms of performance efficiency were studied for three tasks: serial search, verbal reasoning, and manual dexterity (left and right hand versions). Strong evidence was obtained to suggest that different tasks are under the control of different circadian oscillators. The circadian rhythm in verbal reasoning performance tends to run at a shorter circadian period than that in more simple repetitive tasks, and slight differences in circadian behavior can occur between left- and right-handed dexterity.