Summary of Therapeutic Uses Discussion

Summarizes the group discussion held following the keynote on therapeutic outdoor recreation

The Impact of Community Based Adventure Therapy on Stress and Coping Skills in Adults.

Stress and coping skills are among the most essential components of the mental health counseling field. The use of coping skills (e.g., meditation, physical activities, appropriate uses of leisure) has been identified as an effective strategy for stress management. Adventure therapy has emerged as a modality that can positively augment other therapeutic approaches by improving coping skills and assisting clients in managing stress. As with all therapies, a positive working alliance has been found to be important toward achieving clinical outcomes. This study explored how adventure therapy enhanced learned coping strategies for stress and improved therapeutic alliance. Outcomes from this exploratory research highlighted the potential of adventure therapy to decrease stress, increase coping skills, and build therapeutic rapport with the therapist

An Evaluation of the Impact of a One-Week Summer Camp Experience on Participants\u27 Social Skill Development

Social skill development is emerging as an important issue for educators and practitioners in their work with adolescent youth. Within the summer camp industry, youth development researchers are beginning to focus more intentionally on the ability of summer camp programming to develop social skill capacity among its participants (Thurber, Scanlin, Scheuler, & Henderson, 2007). While research in camp settings has been occurring for several decades, much of the inquiry has been descriptive in nature (Henderson, Thurber, Scanlin, & Bialeschki, 2007) or focused on individual psychological traits such as self-esteem and self-concept.(Gillis & Speelman, 2007). More recently, however, social skill development has received more focused attention in both in and out-of-school settings, namely from researchers investigating the emerging theory of social and emotional learning (SEL), with the Collaborative for Academic, Social, and Emotional Learning (CASEL) foremost in this process (Durlak & Weissberg, 2007; Rimm-Kauffman & Chiu, 2007; Rimm-Kauffman, Fan, Chiu, & You, 2007; Zins, Bloodworth, Weissberg, & Walberg, . 2004 ). Encouraged by this trend, researchers within the camping industry have called for a more intentional focus on promoting social skill development in their respective programming (Jordan, 1994; Nicholson, Collins, & Holmer, 2004). In the youth development literature social skills are critical to the educational process of adolescent students and have been shown to be a fundamental asset for healthy psychosocial development and (Moote Jr & Wodarski, 1997; Scales, Benson, Leffert, & Blyth, 2000). Additionally, social skills serve as a preventative tool for future issues such as misbehavior in school, criminal conduct, dropping out of school, unhealthy stress, and violent behavior (Mahoney, Stattin, & Magnusson, 2001; Marsh & Kleitman, 2002). While acting as a deterrent to these problems, social skill development has also been shown to be a significant factor in current and future academic functioning and achievement (Eccles, Barber, Stone, & Hunt, 2003; Malecki & Elliot, 2002). Within the camping and outdoor education literature, research findings are mixed regarding the impact of adventure-based programming on social skill development. A small number of studies have found no significant change in the social skill development of participants in adventure­-based programs (Dickey, 1996; Michalski, Mishna, Worthington, & Cummings, 2003). However, other studies have shown positive gains in social development through such programming (Boyle, 2002; Guettal & Potter, 2000; Reefe, 2005), with more recent studies utilizing considerably larger sample sizes to enhance the significance of their findings (Henderson, et al., 2007; Thurber, et al., 2007). Given the increased focus on the relationship between camp programming and social skill development, this study aims to provide additional insight into this topic

Diffusion-weighted imaging for the differential diagnosis of disorders affecting the hippocampus

Background: The human hippocampus can be affected in a large variety of very different neurological diseases, of which acute ischemic stroke, transient global amnesia, epilepsy, and limbic encephalitis are the most common. Less frequent etiologies include various infections and encephalopathy of different origins. Clinical presentation notably comprises confusional state, altered vigilance, memory deficits of various extent and seizures. While in hypoxic or hypoglycemic encephalopathy, clinical presentation and surrounding circumstances provide some clues to reach the correct diagnosis, in the above-listed more common disorders, signs and symptoms might overlap, making the differential diagnosis difficult. This review presents recent studies using the diffusion-weighted imaging (DWI) technique in diseases involving the hippocampus. Methods: References for the review were identified through searches of PubMed from 1965 to January 2011. Only papers published in English were reviewed. Full articles were obtained and references were checked for additional material where appropriate. Results: All pathologies affecting the hippocampus are associated with distinct lesion patterns on magnetic resonance imaging, and especially DWI has the ability to demonstrate even minute and transient hippocampal lesions. In acute ischemic stroke in the posterior cerebral artery territory, involvement of the hippocampal formation occurs in four distinct patterns on DWI that can be easily differentiated and correspond to the known vascular anatomy of the hippocampus. In the subacute phase after transient global amnesia (TGA), dot-like hyperintense lesions are regularly found in the lateral aspect of the hippocampus on DWI. The DWI lesions described after prolonged seizures or status epilepticus include unilateral or bilateral hippocampal, thalamic, and cortical lesions of various extent, not restricted to vascular territories. In limbic encephalitis, DWI lesions are only infrequently found and usually affect the hippocampus, uncus and amygdala. Furthermore, in some rare cases DWI lesions of different etiology may coexist. Conclusion: In patients with diseases affecting the hippocampus, DWI appears to be useful in differentiating between underlying pathologies and may facilitate a definite diagnosis conducive to an optimal treatment. With a careful clinical examination, experience with the interpretation of DWI findings and knowledge of associated phenomena, it is indeed possible to differentiate between ischemic, ictal, metabolic, and TGA-associated findings. Copyright (C) 2011 S. Karger AG, Base

The value of outdoor behavioral healthcare for adolescent substance users with comorbid conditions

The damage inflicted on our society by mental health and substance use issues is reaching epidemic proportions with few signs of abating. One new and innovative strategy for addressing these comorbid issues has been the development of outdoor behavioral healthcare (OBH). This study compared the effectiveness of three post-acute adolescent substance use situations: OBH, treatment as usual (TAU), and no structured treatment (NST). The simulated target population was 13-17 years old with comorbid substance use and mental health issues. When costs were adjusted for actual completion rates of 94% in OBH, 37% in TAU, and $0 for NST, the actual treatment costs per person were$27 426 for OBH and $31 113 for TAU. OBH also had a cost–benefit ratio of 60.4$36 100, and 424% better treatment outcomes as measured by the Youth Outcome Questionnaire (YOQ) research instrument

Brain imaging in patients with transient ischemic attack: a comparison of computed tomography and magnetic resonance imaging

Background: Brain imaging in stroke aims at the detection of the relevant ischemic tissue pathology. Cranial computed tomography (CT) is frequently used in patients with transient ischemic attack (TIA) but no data is available on how it directly compares to magnetic resonance imaging (MRI). Methods: We compared detection of acute ischemic lesions on CT and MRI in 215 consecutive TIA patients who underwent brain imaging with either CT (n = 161) or MRI (n = 54). An MRI was performed within 24 h in all patients who had CT initially. Results: An initial assessment with CT revealed no acute pathology in 154 (95.7%) and possible acute infarction in 7 (4.3%) patients. The acute infarct on CT was confirmed by diffusion-weighted imaging (DWI) in only 2 cases (28.6%). DWI detected an acute infarct in 50 of the 154 patients with normal baseline CT (32.5%). Among 54 patients without baseline CT, DWI showed acute ischemic lesions in 19 (35.2%). The ischemic lesions had a median volume of 0.87 cm 3 (range: 0.08–15.61), and the lesion pattern provided clues to the underlying etiology in 13.7%. Conclusion: Acute MRI is advantageous over CT to confirm the probable ischemic nature and to identify the etiology in TIA patients

Potential strategies for strengthening surveillance of lymphatic filariasis in American Samoa after mass drug administration: reducing ‘number needed to test’ by targeting older age groups, hotspots, and household members of infected persons

Under the Global Programme to Eliminate Lymphatic Filariasis (LF), American Samoa conducted mass drug administration (MDA) from 2000–2006. Despite passing Transmission Assessment Surveys (TAS) in 2011/2012 and 2015, American Samoa failed TAS-3 in 2016, with antigen (Ag) prevalence of 0.7% (95%CI 0.3–1.8%) in 6–7 year-olds. A 2016 community survey (Ag prevalence 6.2% (95%CI 4.4–8.5%) in age ≥8 years) confirmed resurgence. Using data from the 2016 survey, this study aims to i) investigate antibody prevalence in TAS-3 and the community survey, ii) identify risk factors associated with being seropositive for Ag and anti-filarial antibodies, and iii) compare the efficiency of different sampling strategies for identifying seropositive persons in the post-MDA setting. Antibody prevalence in TAS-3 (n = 1143) were 1.6% for Bm14 (95%CI 0.9–2.9%), 7.9% for Wb123 (95%CI 6.4–9.6%), and 20.2% for Bm33 (95%CI 16.7–24.3%); and in the community survey (n = 2507), 13.9% for Bm14 (95%CI 11.2–17.2%), 27.9% for Wb123 (95%CI 24.6–31.4%), and 47.3% for Bm33 (95%CI 42.1–52.6%). Multivariable logistic regression was used to identify risk factors for being seropositive for Ag and antibodies. Higher Ag prevalence was found in males (adjusted odds ratio [aOR] 3.01), age ≥18 years (aOR 2.18), residents of Fagali’i (aOR 15.81), and outdoor workers (aOR 2.61). Ag prevalence was 20.7% (95%CI 9.7–53.5%) in households of Ag-positive children identified in TAS-3. We used NNTestav (average number needed to test to identify one positive) to compare the efficiency of the following strategies for identifying persons who were seropositive for Ag and each antibody: i) TAS of 6–7 year-old children, ii) population representative surveys of older age groups, and iii) targeted surveillance of subpopulations at higher risk of being seropositive (older ages, householders of Ag-positive TAS children, and known hotspots). For Ag, NNTestav ranged from 142.5 for TAS, to <5 for households of index children. NNTestav was lower in older ages, and highest for Ag, followed by Bm14, Wb123 and Bm33 antibodies. We propose a multi-stage surveillance strategy, starting with population-representative sampling (e.g. TAS or population representative survey of older ages), followed by strategies that target subpopulations and/or locations with low NNTestav. This approach could potentially improve the efficiency of identifying remaining infected persons and residual hotspots. Surveillance programs should also explore the utility of antibodies as indicators of transmission