The Effectiveness of Mobile Phone-Based Text Messaging to Intervene with Problem Drinking in Youth and Younger Adult Population: A Meta-Analysis

Background: Mobile phone-based text messages have been used to address alcohol use disorder in younger populations by promoting abstinence, decreased alcohol intake, and moderation. Methods: A meta-analysis was conducted to summarize the effectiveness of mobile phone text messaging to address problem drinking by youth and younger adults. Results: Authors systematically searched PubMed, Embase, CINAHL, Web of Science, APA PsycNET, and the Cochrane Central Registry of Controlled Trials for literature published in the past 8 years (2010-2018). Randomized control trials and pre-post studies of younger people that used the problem drinking criteria of the National Institute on Alcohol Abuse and Alcoholism (NIAAA) were included in the meta-analysis. Conclusions: The meta-analysis suggests that text message-based interventions might not be effective in decreasing alcohol intake in the younger populations.

Selenium, copper, zinc and hypertension: an analysis of the National Health and Nutrition Examination Survey (2011-2016)

BACKGROUND

Hypertension is a major cardiovascular illness worldwide with many underlying causes. The role of trace elements selenium, copper, and zinc in hypertension is uncertain. The objective of this study was to evaluate the role of these trace elements in hypertension.

METHOD

Data from 6683 National Health and Nutrition Examination Survey (NHANES) participants from 2011 to 2016 were analyzed using Statistical Analytical System (SAS, version 9.4) software for the role of trace elements in hypertension in age range 8 to 80 years, irrespective of the antihypertensive medication taken. Recent American Heart Association guidelines and pediatric practice guidelines for hypertension were used.

RESULTS

Findings showed a significant positive association between serum selenium levels and hypertension but not serum zinc and copper. At optimal levels for transport and distribution, serum selenium levels of 120 μg/L or higher (reference level 70-150 μg/L) were significantly associated with hypertension (OR = 1.46, 95% CI = 1.29-1.66) after adjusting for confounding factors. At serum selenium level greater than 150 μg/L, the association with hypertension strengthened (OR = 1.69, 95% CI = 1.32-2.17).

CONCLUSION

A positive association was found between serum selenium and hypertension, irrespective of age or anti-hypertensive medications intake. These findings also suggest that the reference levels of serum levels in healthy individuals may need to be re-determined, if supported by additional studies. If validated, patients with hypertension may also need to be cautioned about selenium intake.

Effects of summer internship and follow-up distance mentoring programs on middle and high school student perceptions and interest in health careers

BACKGROUND

Minorities are underrepresented in health professions and efforts to recruit minority students into health careers are considered a way to reduce health disparities. There is little research about the effectiveness of these programs, other than satisfaction. This study aimed to measure program effects on student understanding of and interest in health careers.

METHODS

Students took a career interest inventory, completed a scale measuring their self-reported understanding and interest in health careers, and wrote essays about health careers before and after completing a 1 week on campus internship on health careers and after a 9 month follow up distance mentoring program where they continued to interact with university faculty by videoconference about career options. Changes in inventory, scale, and essay scores were analyzed for changes over time using Wilcoxon and Mann-Whitney tests.

RESULTS

Inventory scores were unchanged over time, but scale and essay scores trended upward significantly post internship and mentoring.

CONCLUSION

Health career education and mentoring programs can positively affect student knowledge of health careers and their attitudes about them. The study's methods extend measures of program impact beyond satisfaction.

Patient and Provider Satisfaction with Teledermatology

BACKGROUND

There is little research comparing dermatologist and patient satisfaction with in-person, store-and-forward, and live interactive examinations.

OBJECTIVE

To compare satisfaction with in-person examinations to store-and-forward and live interactive consultations having two types of video.

METHODS

A controlled study was conducted where patients referred for dermatology consultations were examined in-person, by video, and by store-and-forward methods. Video changed between compressed and uncompressed on alternate clinics. Patients and dermatologists rated encounters after each examination. Dermatologists doing store-and-forward evaluations rated the quality of information provided. After experiencing all methods patients ranked their preferences. Dermatologists ranked their preferences at the end of the study.

RESULTS

In-person examinations were preferred by both patients and dermatologists. Overall, satisfaction with teledermatology was still high. Patients were evenly divided in preferring store-and-forward workups or live interactive video. Dermatologists were also divided on store-and-forward and uncompressed video, but tended toward the latter. Compressed video was the least preferred method among dermatologists.

LIMITATIONS

Dermatology residents took store-and-forward photos and their quality was likely superior to those normally taken in practice.

CONCLUSIONS

Patients and dermatologists prefer in-person examinations and diverge on preferring store-and-forward and live interactive when video is not compressed. The amount of video compression that can be applied without noticeable image degradation is a question for future research.

Comparing High Definition Live Interactive and Store-and-Forward Consultations to In-Person Examinations

BACKGROUND

There is little teledermatology research directly comparing remote methods, even less research with two in-person dermatologist agreement providing a baseline for comparing remote methods, and no research using high definition video as a live interactive method.

OBJECTIVE

To compare in-person consultations with store-and-forward and live interactive methods, the latter having two levels of image quality.

METHODS

A controlled study was conducted where patients were examined in-person, by high definition video, and by store-and-forward methods. The order patients experienced methods and residents assigned methods rotated, although an attending always saw patients in-person. The type of high definition video employed, lower resolution compressed or higher resolution uncompressed, was alternated between clinics. Primary and differential diagnoses, biopsy recommendations, and diagnostic and biopsy confidence ratings were recorded.

RESULTS

Concordance and confidence were significantly better for in-person versus remote methods and biopsy recommendations were lower. Store-and-forward and higher resolution uncompressed video results were similar and better than those for lower resolution compressed video.

LIMITATIONS

Dermatology residents took store-and-forward photos and their quality was likely superior to those normally taken in practice. There were variations in expertise between the attending and second and third year residents.

CONCLUSION

The superiority of in-person consultations suggests the tendencies to order more biopsies or still see patients in-person are often justified in teledermatology and that high resolution uncompressed video can close the resolution gap between store-and-forward and live interactive methods.

Telephone follow-up in primary care: can interactive voice response calls work?

Follow-up calls after ambulatory visits are not routinely done, yet they can potentially detect and mitigate unresolved problems. Automated calls via an Interactive Voice Response System (IVRS) are an innovative way to conduct follow-up, but patients' attitudes toward follow-up calls are unknown. This study assessed 1) patient perceptions about follow-up calls after visits; 2) differences in perceptions between human and IVRS calls; and 3) association between follow-up calls and patient satisfaction with care. Post-visit follow-up calls in two ambulatory care setting were done in two phases. Phase 1 used a human caller and phase 2 used IVRS. Patient satisfaction questionnaires were completed after each phase. Results showed that 88% of patients favor the idea of the calls and those receiving them found them helpful. There were no differences in attitudes between patients receiving calls from clinic staff or from an IVRS. Patients receiving calls had higher patient satisfaction scores than those not called.

CONCLUSION

Patients value follow-up calls and they are associated with patient satisfaction with care. IVRS is an innovative way to conduct post-visit follow-up.

Communication and proximity effects on outcomes attributable to sense of presence in distance bioinformatics education

BACKGROUND

Online learning is increasingly popular in medical education and sense of presence has been posited as a factor contributing to its success. Communication media influences on sense of presence and learning outcomes were explored in this study. Test performance and ratings of instruction and technology, factors influenced by sense of presence, are compared under four conditions involving different media and degrees of student physical presence: 1) videoconference co-located, 2) webcast co-located, 3) videoconference dispersed, and 4) webcast dispersed.

METHODS

Eighty one first to forth year medical students heard a lecture on telemedicine and were asked to collaboratively search a telemedicine website under conditions where the lecture was delivered by videoconference or one way streaming (webcast) and where students were either co-located or dispersed. In the videoconference conditions, co-located students could use the technology to interact with the instructor and could interact with each other face to face, while the dispersed students could use the technology to interact with both the instructor and each other. In the webcast conditions, all students could use chat to communicate with the instructor or each other, although the co-located students also could interact orally. After hearing the lecture, students collaboratively searched a telemedicine website, took a test on lecture-website content and rated the instruction and the technology they used. Test scores on lecture and website content and ratings of instruction and technology for the four conditions were compared with analysis of variance and chi-square tests.

RESULTS

There were no significant differences in overall measures, although there were on selected ratings of instruction. Students in both webcast conditions indicated they were encouraged more to follow up on their own and felt instruction was more interactive than co-located videoconferencing students. Dispersed videoconferencing students indicated the highest levels of interaction and there was evidence they interacted more.

CONCLUSION

Results do not strongly support proximity as a sense of presence factor affecting performance and attitudes, but do suggest communication medium may affect interactivity.

Comparing in-person, video, and telephonic medical interpretation

BACKGROUND

Using trained interpreters to provide medical interpretation services is superior to services provided on an ad hoc basis, but little is known about the effectiveness of providing their services remotely, especially using video.

OBJECTIVE

To compare remote medical interpretation services by trained interpreters via telephone and videoconference to those provided in-person.

DESIGN

Quasi-randomized control study.

PARTICIPANTS

Two hundred and forty-one Spanish speaking patient volunteers, twenty-four health providers, and seven interpreters.

APPROACH

Patients, providers and interpreters each independently completed scales evaluating the quality of clinical encounters and, optionally, made free text comments. Interviews were conducted with 23 of the providers, the seven interpreters, and a subset of 30 patients. Time data were collected.

RESULTS

Encounters with in-person interpretation were rated significantly higher by providers and interpreters, while patients rated all methods the same. There were no significant differences in provider and interpreter ratings of remote methods. Provider and interpreter comments on scales and interview data support the higher in-person ratings, but they also showed a distinct preference for video over the phone. Phone interviews were significantly shorter than in-person.

DISCUSSION

Patients rated interpretation services highly no matter how they were provided but experienced only the method employed at the time of the encounter. Providers and interpreters were exposed to all three methods, were more critical of remote methods, and preferred videoconferencing to the telephone as a remote method. The significantly shorter phone interviews raise questions about the prospects of miscommunication in telephonic interpretation, given the absence of a visual channel, but other factors might have affected time results. Since the patient population studied was Hispanic and predominantly female care must be taken in generalizing these results to other populations.

An exploratory study of co-location as a factor in synchronous, collaborative medical informatics distance education

BACKGROUND

This study determined differences in learning, judgments of teaching and technology, and interaction when videoconferencing was used to deliver instruction on telemedicine to medical students in conditions where they were co-located and dispersed. A lecture on telemedicine was given by videoconference to medical students at a distant site. After a question and answer period, students were then given search problems on the topic and encouraged to collaborate. Half the students were randomly assigned to a co-located condition where they received the presentation and collaborated in a computer lab, and half were assigned to a dispersed condition where they were located in different rooms to receive the presentation and collaborate online using the videoconferencing technology. Students were observed in both conditions and they individually completed a test on presentation content and a rating scale about the quality of the teaching and the technology.

FINDINGS

There were no differences between the two groups in the learning outcomes or judgments about the teaching and technology, with the exception that more students in the dispersed condition felt more interaction was fostered. The level and patterns of interaction were very different in the two conditions and higher for dispersed students.

CONCLUSIONS

Synchronous communication at a distance via videoconference may give sufficient sense of presence that the learning experience may be similar to that in actual classrooms, even when students are far apart. The technology may channel interaction in desirable ways.

Dietitian Services Are Associated with Improved Patient Outcomes and the MEDFICTS Dietary Assessment Questionnaire Is a Suitable Outcome Measure in Cardiac Rehabilitation

OBJECTIVE

The purposes of this study were to (a) examine the effectiveness of registered dietitian (RD) education and counseling on diet-related patient outcomes compared with general education provided by the cardiac rehabilitation (CR) staff, and (b) evaluate the effectiveness of the Meats, Eggs, Dairy, Fried foods, In baked goods, Convenience foods, Table fats, Snacks (MEDFICTS) score as an outcome measure in CR.

METHODS

Observational study data examined from 426 CR patients discharged between January 1996 and February 2004. Groups were formed based on education source: (a) RD and (b) general education from CR staff. Baseline characteristics were compared between groups; pre/post diet-related outcomes (lipids, waist circumference, body mass index, MEDFICTS score) were compared within groups. Controlling for baseline measures and lipid-lowering medication, associations were examined between (a) RD education and diet-related outcomes and (b) ending MEDFICTS score and diet-related outcomes.

RESULTS

Mean age was 62+/-11 years, 30% of patients were female, and 28% were nonwhite. At baseline, the RD group (n=359) had more dyslipidemia (88% vs 76%), more obesity (47% vs 27%), a larger waist (40+/-6 vs 37+/-5 inches), a higher body mass index (calculated as kg/m(2); 30+/-6 vs 27+/-5), a higher diet score (32+/-28 vs 19+/-19), and lower self-reported physical activity (7+/-12 vs 13+/-18 metabolic equivalent hours) (all P<.05) than the general education group (n=67). RD education was associated with improved low-density lipoprotein (r=0.13; P=.04), triglycerides (r=0.48; P=.01), and MEDFICTS score (r=0.18; P=.01). Improvements in MEDFICTS scores were correlated with improved total cholesterol, triglycerides, and waist measurements (all r=0.19; P=.04).

CONCLUSIONS

Dietary education by an RD is associated with improved diet-related outcomes. The MEDFICTS score is a suitable outcome measure in CR.

Heart failure mortality among older Medicare beneficiaries: association with left ventricular function evaluation and angiotensin-converting enzyme inhibitor use

BACKGROUND

Left ventricular function evaluation and angiotensin-converting enzyme (ACE) inhibitor use are the two basic indicators of heart failure quality of care. In this retrospective follow-up study, we analyzed the association between these two quality indicators and mortality in elderly hospitalized heart failure patients.

METHODS

The patients in our study were older Alabama Medicare beneficiaries discharged with a diagnosis of heart failure in 1994. Cox regression analyses, adjusted for various patient and care characteristics, were performed to estimate the overall mortality rate.

RESULTS

The mean age of the 1,090 patients in our study was 79+/-7.5 years. Both left ventricular function evaluation (hazard ratio, 0.83; 95% confidence interval, 0.705-0.976) and ACE inhibitor use (hazard ratio, 0.77; 95% confidence interval, 0.655-0.905) were associated with a lower 3-year mortality rate. Adjustment for various patient and care characteristics did not alter these associations.

CONCLUSION

Left ventricular function evaluation and ACE inhibitor use were each associated with increased survival time in older Medicare beneficiaries with heart failure.

The Ocular Trauma Score (OTS)

Only based on a standardized terminology of ocular trauma terms, and using a very large number of injuries treated by a wide variety of ophthalmologists, could a reliable method be developed so that the functional outcome of a serious eye injury can be predicted with reasonable certainty. The authors used the databases of the United States and Hungarian Eye Injury Registries and, with a grant from the National Center for Injury Prevention at the Centers for Disease Control and Prevention, designed such a system.

Epidemiology and socioeconomics

Ophthalmologists should be responsible for a systemic collection of standardized data on the occurrence of eye injuries. Such a database is the key for designing prophylactic measures to successfully prevent ocular trauma. The USEIR model, whether reporting takes place over the Internet [www.USEIRonline.org www.WEIRonline.org (worldwide)] or on paper, has proved to be an efficient epidemiological tool. Use of this model in different countries has allowed making unbiased comparisons between regions or countries, highlighting injury patterns that may be different in different geographical areas, and pinpointing areas where prophylaxis (through legislation and public campaigns) appears most effective. Participation of all ophthalmologists who evaluate/treat patients with serious eye trauma is strongly encouraged.

Medical status of adolescents at time of admission to a juvenile detention center

PURPOSE

To examine the medical status and history of health care utilization of adolescents at the time of their admission to a juvenile detention facility.

METHODS

Data were collected over an 18-month period on all detainees admitted for the first time to a juvenile detention facility in a major southeastern city in the United States. Information was gathered through a private, confidential interview completed by a medical social worker and a physical examination by a physician. Information was obtained regarding past medical history, complaints at the time of admission, health care utilization, and physical examination.

RESULTS

Approximately 10% of teenagers admitted to a detention facility have a significant medical problem (excluding drug/alcohol abuse, or uncomplicated sexually transmitted diseases) that requires medical follow-up. The majority of these conditions were known to the adolescent at the time of admission. Only a third of adolescents admitted to the detention facility reported a regular source of medical care, and only about 20% reported having a private physician. A majority of all the detainees had already fallen behind in or dropped out of school. More than half of the families of the adolescents with a medical problem appeared to be unable or unwilling to assist in ensuring proper medical follow-up.

CONCLUSIONS

A significant percentage of adolescents entering a detention facility have a medical problem requiring health care services. Detention facilities offer an opportunity to deliver and coordinate medical care to high-risk adolescents. Programs linking public and private health care providers with the correctional care system may provide juveniles with an acceptable option for obtaining needed health care services.

Health outcomes of two telephone interventions for patients with rheumatoid arthritis or osteoarthritis

OBJECTIVE

The effects of treatment counseling or symptom monitoring telephone intervention strategies on the health outcomes of patients with rheumatoid arthritis (RA) or osteoarthritis (OA), compared with usual care, were assessed.

METHODS

A 3-group, randomized, controlled 9-month trial was conducted incorporating 405 patients with RA or OA and using the Arthritis Impact Measurement Scales (AIMS2) as the outcome measure.

RESULTS

Analyses of covariance showed that the AIMS2 total health status of the treatment counseling group (effect size = 33, P < 0.01), but not the symptom monitoring group (effect size = 0.21, P = 0.10), was significantly improved, compared with usual care, for both RA and OA patients. The specific types of benefits differed significantly between RA and OA patients. The mean number of medical visits by OA patients in the treatment counseling group was also significantly reduced (P < 0.01).

CONCLUSION

Telephone contact using the treatment counseling strategy produced significant, but different, health status benefits for RA and OA patients. The symptom monitoring strategy produced modest benefits.

The effect of person-centered counseling on the psychological status of persons with systemic lupus erythematosus or rheumatoid arthritis: a randomized, controlled trial

OBJECTIVE

We tested the effectiveness of a 6-month person-centered (PC), nondirective, telephone-based counseling intervention for improving the psychological status of persons with systemic lupus erythematosus (SLE) or rheumatoid arthritis (RA).

METHODS

The design was a parallel-group, randomized, controlled study comparing a PC counseling intervention (8 SLE, 28 RA patients) with usual care (7 SLE, 30 RA patients). The Arthritis Impact Measurement Scales was used to measure psychological dysfunction, physical dysfunction, and pain at baseline and at followup.

RESULTS

The main finding was that the PC counseling intervention significantly improved the psychological status of the SLE patients (P < 0.05, effect size = 1.13, responsiveness = 0.77) in comparison to usual care. There was no evidence of a benefit for persons with RA or of improvements in physical function or pain for persons with either disease.

CONCLUSIONS

PC counseling may be an effective intervention for improving the psychological status of persons with SLE, but may not be for those with RA.

Barriers to return to work among persons unemployed due to arthritis and musculoskeletal disorders

OBJECTIVE

To identify barriers to return to work (RTW) among persons likely to be seen in a clinician's practice who are unemployed due to arthritis and musculoskeletal disorders.

METHODS

Two hundred eighteen persons unemployed due to arthritis and musculoskeletal disorders were interviewed at baseline and followed up for 1 year, at which time their work status was ascertained. Backward stepwise logistic regression was used to determine the association of baseline clinical, sociodemographic, and work-related factors to their work status at 1 year of followup.

RESULTS

Fifty-one (24%) of 216 initially unemployed subjects had returned to permanent paid employment of > or = 20 hours/week after 1 year. Having rheumatoid arthritis, Social Security Disability Insurance (SSDI) status, a high pain level, older age, and lower education were barriers to reemployment.

CONCLUSION

This study establishes the importance of chronic pain and having rheumatoid arthritis as factors independently associated with failure to RTW among persons unemployed due to arthritis and musculoskeletal disorders. The importance of SSDI beneficiary status, age, and education level in RTW is further confirmed. Duration of unemployment or previous work factors were not predictors of RTW in this group.

Musculoskeletal disability, employment, and rehabilitation

OBJECTIVE

To determine which, if any, baseline social and disease characteristics can be used to identify persons with musculoskeletal disabilities accepted for state-federal vocational rehabilitation services who are most likely to return to work.

METHODS

A database of case closures from the Alabama Vocational Rehabilitation Service was analyzed using segmentation modelling. This included all persons (n = 4093) with musculoskeletal disability who were accepted by the Alabama Vocational Rehabilitation Agency in 1987-91. Demographics, income, type of disability, severity of disability, medical insurance, similar benefits, benefit status, and referral source were independent variables. Outcome (dependent) variable was work status at end of agency services.

RESULTS

Overall, 71% of persons with arthritis and musculoskeletal disorders who were accepted for vocational rehabilitation services in 1987-91 returned to work at the end of agency services. Segmentation modelling created a tree in which certain baseline characteristics formed subgroups with differing rates of successful rehabilitation. Social Security Disability Insurance (SSDI) status was the single best predictor of rehabilitation. Seventy-three percent of nonbeneficiaries were rehabilitated compared to 55% of beneficiaries (p < 0.00001). For non-SSDI beneficiaries, education level > or = grade 12 was associated with better rehabilitation outcome (p < 0.00001). SSDI beneficiaries with nonback disorders fared better than those with back disorders (p < 0.05). Disease severity, assessed by Federal Special Programs criteria, was not associated with rehabilitation outcome at any level of the tree.

CONCLUSION

Simple baseline social and disease characteristics can be used to identify groups of persons accepted for vocational rehabilitation services with musculoskeletal disability with differing rates of vocational rehabilitation. Disability benefit status and education level are important predictors of return to work after agency services. These findings can lead to the development of strategies to improve the efficacy of vocational rehabilitation services.

Treatment regimen and side effects of treatment measures

The severity of asthma can be judged by many features, including the need for medication and associated side effects. Since asthma has both acute and chronic characteristics, therapeutic regimens should be valuable as an instrument to define disease severity and the consequence of intervention. However, because of the variability of asthma severity within each patient, medication quantitation as an index of asthma severity is not without difficulty and limitation. Furthermore, the philosophy of asthma therapy has undergone changes over the past decade. Previously, anti-inflammatory therapy was reserved for only the most severely ill patients. Now, inflammation is recognized as a critical component of asthma, and all patients with active asthma (other than mild symptoms) are recommended to use anti-inflammatory therapy. Although there is little published experience with treatment regimens as an index of disease severity, those that have been used have found validity and reproducibility with this approach. In this paper, a scoring approach to medication use is recommended. Medication is classified into bronchodilator (beta-agonists, theophylline, and anticholinergic) or anti-inflammatory (corticosteroid and cromolyn sodium). Medication scores are given on either a per-use or a new-dosage basis. Furthermore, the eight medications are stratified according to potency (i.e., inhaled corticosteroid < oral corticosteroid < parenteral corticosteroid). From this approach, the severity of an individual patient's asthma can be quantitated, and this value can serve as one instrument to assess disease severity.

Factors associated with successful vocational rehabilitation in persons with arthritis

OBJECTIVE

The objective of this study was to analyze factors associated with successful vocational rehabilitation (return to work) among persons receiving state-federal vocational rehabilitation services because of work disability from arthritis.

METHODS

Multivariate analyses were used to determine the association of sociodemographic, disease-related, and agency factors with work outcome among a group of 456 persons with arthritis receiving state-federal vocational rehabilitation services during 1985-1988.

RESULTS

Agency-sponsored physical restoration services (P less than 0.0001) and retraining (P less than 0.0001) were the variables most strongly correlated with return to work. Age, sex, race, disease severity, financial status, and educational level assessed at intake were not significantly associated with work rehabilitation outcome.

CONCLUSION

Factors potentially amenable to agency intervention were more strongly associated with work rehabilitation outcome than were sociodemographic or disease-related variables.

A curriculum in clinical sexuality for arthritis health care professionals

The results of an experimental training program in sexologic interviewing for a multidisciplinary arthritis patient care team are reported. The program included didactic instruction, observation and practice of interviewing skills, a seminar, and a case presentation. Trainees had gained more knowledge than control subjects at one year. Both groups improved their interviewing skills, but trainees showed more improvement than controls on problem-list generation. All participants showed more improvement when interviewing male than female patients. The data show that training programs in sexologic interviewing can improve both knowledge and skills. Programs should include actual practice interviewing patients.

Subsequent behavior of users of an arthritis information telephone service

Followup telephone interviews were conducted with a stratified random sample of 305 users of a prototype telephone information service for arthritis 2-4 months after their initial contact with the service. The percentage of respondents who reported taking at least 1 positive action for their arthritis because of service usage was 79%. The most frequently reported actions of users were asking their doctor more questions and greater compliance with their doctor's orders. About one-half of the respondents felt more in control of their arthritis because of service usage. Both the taking of at least 1 action and the taking of certain specific actions were significantly correlated with feeling more in control of the arthritis (P less than 0.01). Respondents who were less than 60 years old, black, or symptomatic were significantly more likely to take an action and took significantly more actions (P less than 0.01). This minimal intervention may stimulate positive behaviors for individuals with arthritis.

Users of a public arthritis information service and their needs

Brief interviews were conducted with 1670 users of the Arthritis Information Service of Alabama, a statewide toll-free telephone information service. The results showed the service users were significantly (p less than 0.01) different from both the adult population and from the estimated symptomatic population of the service area. Users tended to be female, symptomatic, white, older, and better educated than the adult population. The most frequent category of need was emotional support, followed by referral, symptom/test explanation, treatment explanation, self-help method, medication, and physician-patient communication. Informational needs were significantly related to the gender, age, and the reported diagnoses of the user. Our results suggested that telephone services for health promotion may need to make special efforts to reach nonwhite and less educated persons and to provide emotional support.

User evaluation of an arthritis information telephone service

Arthritis patients are prone to misperceptions, forgetfulness, and the use of unproven remedies. They also may become noncompliant and be unaware of community resources. Informational or educational programs such as the Arthritis Information Service of Alabama may be useful for reducing these problems. There have been several reports concerning the use of telephone services (e.g.), for providing information about specific diseases but few concerning arthritis. An important step in the evaluation of a telephone information service is the surveying of user opinions concerning the service's procedures and its benefits. The purposes of the present study were to estimate the percentage of users who believed they had benefited from service usage, to identify the potential benefits of service usage, and to identify the groups most likely to report benefits.

Sexual dysfunction among patients with arthritis

The relationship of arthritis and sexual dysfunction was investigated among 169 patients with rheumatoid arthritis, osteoarthritis and spondyloarthropathy, 130 of whom were pair-matched to controls. Assessments of marital happiness and depressed mood were also made using the CES-D and the Azrin Marital Happiness Scale (AMHS). Sexual dysfunctions were found to be common among patients and controls, the majority in both groups reporting one or more dysfunctions. Impotence was more common among male patients than controls and was found to be associated with co-morbidity and the taking of methotrexate. Depressed mood was more common among patients and was associated with certain sexual difficulties, but not with impotence. Marital unhappiness, as indicated by AMHS scores, was not associated with arthritis but was associated with sexual dysfunction, sexual dissatisfaction and being female.

Sexual quality-of-life of patients with arthritis compared to arthritis-free controls

The influence of arthritis upon sexual satisfaction and activity and patient receptivity to sexual rehabilitation was investigated by interviewing 169 patients with arthritis and 130 controls. Patients differed from controls in their greater loss of sexual satisfaction over time, but they were comparably satisfied with their current sexual adjustment. They reported similar reductions in frequency of intercourse over time. Joint symptoms and fatigue disturbed the sexual adjustment of patients more than controls, but damaged body image, worry about partner interest, loss of libido and loss of lubrication did not. There was receptivity to a program of sexual rehabilitation among patients and controls that was not dependent upon sexual dissatisfaction.

The Face Scale: a brief, nonverbal method for assessing patient mood

Validity and reliability studies were conducted on the Face Scale, a very brief, pictorial scale of mood which uses a sequence of 20 faces and does not require reading literacy. Correlational and experimental evidence of the Face Scale's construct validity is presented, as well as its test-retest reliability. Recommendations are made for its use as a screening tool and for additional validity studies.

Unconditional stimulus characteristics in rabbit eyelid conditioning

Three experiments employed aversive or positive subcortical electrical stimulation in an unconditional stimulus (US) role in rabbit eyelid conditioning. Conditional response (CR) development to a tonal conditional stimulus (CS) was examined when the intracranial stimulation was combined with a conventional cheek-shock US (Experiment 1) or with a lightflash US (Experiment 2). Our findings were consistent with previus observations that the affective impact of the US is important in the development of an overt motor CR. The complex pattern of our results, however, implies that intracranial stimulation has multiple effects on conditioning and argues against any unidimensional interpretation of these outcomes. Our analysis of CR-contingent intracranial stimulation presentation in Experiment 3 indicated that such stimulation does not act as a Thorndikian reward or punishment in rabbit eyelid conditioning.

Unconditioned stimulus characteristics in rabbit eyelid conditioning

Three experiments employed aversive or positive subcortical electrical stimulation in an unconditional stimulus (US) role in rabbit eyelid conditioning. Conditional response (CR) development to a tonal conditional stimulus (CS) was examined when the intracranial stimulation was combined with a conventional cheek-shock US (Experiment 1) or with a lightflash US (Experiment 2). Our findings were consistent with previus observations that the affective impact of the US is important in the development of an overt motor CR. The complex pattern of our results, however, implies that intracranial stimulation has multiple effects on conditioning and argues against any unidimensional interpretation of these outcomes. Our analysis of CR-contingent intracranial stimulation presentation in Experiment 3 indicated that such stimulation does not act as a Thorndikian reward or punishment in rabbit eyelid conditioning.