Female Sexual Abuse Survivors and the Therapeutic Relationship

Childhood abuse can impact the survivors\u27 life in many ways. Children learn various skills from their caregivers, such as the tools needed to develop and maintain healthy relationships. When a child is abused by their caregiver, there can be a drastic impact on how the child perceives the world, and the therapeutic relationship is important in the healing process. This interpretative phenomenological analysis (IPA) study explored the lived experiences of therapists who work with adult women who are survivors of childhood sexual abuse to better understand the effects that childhood sexual abuse has on the therapeutic relationship. The theoretical base for the study was attachment theory that was conceptualized within a traumatic framework. Participants were recruited through online media forums and with the use of flyers posted at local counseling offices in the metro area of Albuquerque, New Mexico. Eight therapists who self-identified as meeting the criteria for this study were recruited and interviewed in-person; the data was analyzed by hand. Five themes emerged during the analysis: the enhancing effects of disclosure, seeking to empower clients, the client\u27s emotional distress, negative feelings and loss of self, and ability to maintain boundaries. This study contributes to provide avenues for social change by developing awareness and education resources for therapists to increase their effectiveness of treatment and develop ways in which support can be employed to serve the affected population through education and rapport building. This in turn has the potential of increasing successful treatment outcomes, which allows clients to build better external positive, healthy relationships

Reducing smoking in adolescents: cost-effectiveness results from the cluster randomized ASSIST (A Stop Smoking In Schools Trial)

Introduction: School-based smoking prevention programmes can be effective, but evidence on cost-effectiveness is lacking. We conducted a cost-effectiveness analysis of a school-based “peer-led” intervention.<p></p> Methods: We evaluated the ASSIST (A Stop Smoking In Schools Trial) programme in a cluster randomized controlled trial. The ASSIST programme trained students to act as peer supporters during informal interactions to encourage their peers not to smoke. Fifty-nine secondary schools in England and Wales were randomized to receive the ASSIST programme or usual smoking education. Ten thousand seven hundred and thirty students aged 12–13 years attended participating schools. Previous work has demonstrated that the ASSIST programme achieved a 2.1% (95% CI = 0%–4.2%) reduction in smoking prevalence. We evaluated the public sector cost, prevalence of weekly smoking, and cost per additional student not smoking at 24 months.<p></p> Results: The ASSIST programme cost of £32 (95% CI = £29.70–£33.80) per student. The incremental cost per student not smoking at 2 years was £1,500 (95% CI = £669–£9,947). Students in intervention schools were less likely to believe that they would be a smoker at age 16 years (odds ratio [OR] = 0.80; 95% CI = 0.66–0.96).<p></p> Conclusions: A peer-led intervention reduced smoking among adolescents at a modest cost. The intervention is cost-effective under realistic assumptions regarding the extent to which reductions in adolescent smoking lead to lower smoking prevalence and/or earlier smoking cessation in adulthood. The annual cost of extending the intervention to Year 8 students in all U.K. schools would be in the region of £38 million and could result in 20,400 fewer adolescent smokers.<p></p&gt

Anxious to see you: Neuroendocrine mechanisms of social vigilance and anxiety during adolescence.

Social vigilance is a behavioral strategy commonly used in adverse or changing social environments. In animals, a combination of avoidance and vigilance allows an individual to evade potentially dangerous confrontations while monitoring the social environment to identify favorable changes. However, prolonged use of this behavioral strategy in humans is associated with increased risk of anxiety disorders, a major burden for human health. Elucidating the mechanisms of social vigilance in animals could provide important clues for new treatment strategies for social anxiety. Importantly, during adolescence the prevalence of social anxiety increases significantly. We hypothesize that many of the actions typically characterized as anxiety behaviors begin to emerge during this time as strategies for navigating more complex social structures. Here, we consider how the social environment and the pubertal transition shape neural circuits that modulate social vigilance, focusing on the bed nucleus of the stria terminalis and prefrontal cortex. The emergence of gonadal hormone secretion during adolescence has important effects on the function and structure of these circuits, and may play a role in the emergence of a notable sex difference in anxiety rates across adolescence. However, the significance of these changes in the context of anxiety is still uncertain, as not enough studies are sufficiently powered to evaluate sex as a biological variable. We conclude that greater integration between human and animal models will aid the development of more effective strategies for treating social anxiety

An Investigation of Item Type in a Standards-Based Assessment

Large-scale state assessment programs use both multiple-choice and open-ended items on tests for accountability purposes. Certainly, there is an intuitive belief among some educators and policy makers that open-ended items measure something different than multiple-choice items. This study examined two item formats in custom-built, standards-based tests of achievement in Reading and Mathematics at grades 3-8. In this paper, we raise questions about the value of including open-ended items, given scoring costs, time constraints, and the higher probability of missing data from test-takers. Accessed 19,320 times on https://pareonline.net from December 10, 2007 to December 31, 2019. For downloads from January 1, 2020 forward, please click on the PlumX Metrics link to the right

The Reporting of Treatment Nonadherence and Its Associated Impact on Economic Evaluations Conducted Alongside Randomized Trials:A Systematic Review

AbstractObjectivesTo review trial-based economic evaluations, identifying 1) the proportion reporting adherence, 2) methods for assigning intervention costs according to adherence, 3) which participants were included in the economic analysis, and 4) statistical methods to estimate cost-effectiveness in those who adhered. We provide recommendations on handling nonadherence in economic evaluations.MethodsThe National Health Service Economic Evaluation Database was searched for recently published trials. We extracted information on the methods used to assign shared costs in the presence of nonadherence and methods to account for nonadherence in the economic analysis.ResultsNinety-six eligible trials were identified. For one-off interventions, 86% reported the number of participants initiating treatment. For recurring interventions, 56% and 73%, respectively, reported the number initiating and completing treatment, whereas 66% reported treatment intensity. Most studies (23 of 31 [74%] trials and 42 of 53 [79%] trials of one-off and recurring interventions, respectively) reported strict intention-to-treat or complete case analyses. A minority (3 of 31 [10%] and 7 of 53 [13%], respectively), however, performed a per-protocol analysis. No studies used statistical methods to adjust for nonadherence directly in the economic evaluation. Only 13 studies described patient-level allocation of intervention costs; there was variation in how fixed costs were assigned according to adherence.ConclusionsMost of the trials reported a measure of adherence, but reporting was not comprehensive. A nontrivial proportion of studies report a primary per-protocol analysis that potentially produces biased results. Alongside primary intention-to-treat analysis, statistical methods for obtaining an unbiased estimate of cost-effectiveness in adherers should be considered

Reconciling AG-star Formation, the Soltan Argument, and Meier\u27s Paradox

We provide a theoretical context for understanding the recent work of Kalfountzou et al. showing that star formation is enhanced at lower optical luminosity in radio-loud quasars. Our proposal for coupling the assumption of collimated FRII quasar-jet-induced star formation with lower accretion optical luminosity also explains the observed jet power peak in active galaxies at higher redshift compared to the peak in accretion power, doing so in a way that predicts the existence of a family of radio-quiet active galactic nuclei associated with rapidly spinning supermassive black holes at low redshift, as mounting observations suggest. The relevance of this work lies in its promise to explain the observed cosmological evolution of accretion power, jet power, and star formation in a way that is both compatible with the Soltan argument and resolves the so-called Meier Paradox

Genes of the serotonergic and dopaminergic pathways and their interaction affect the expression of Behavioural and Psychological Symptoms in Dementia (BPSD).

Although there is evidence for the involvement of genes of serotonergic and dopaminergic systems in the manifestation of the Behavioural and Psychological Symptoms in Dementia (BPSD), genetic association studies are contradictory. We used 1008 probable AD patients from the UK and applied a Multiple Indicators Multiple Causes (MIMIC) approach to investigate the effect of 11 polymorphisms in the serotonergic and dopaminergic systems, on four behavioural sub-phenotypes, namely "psychosis"," moods", "agitation" and "behavioural dyscontrol", as well as on 12 NPI items. Significant findings included the association of DRD1 A48G with "psychosis" (p=0.037), the association of DAT1 VNTR with "agitation" (p=0.006) and the association of DRD4 with "moods" sub-phenotype (p=0.008). In addition, associations were identified between DRD1 A48G and DAT1 VNTR with aberrant motor behaviour (AMB) symptoms (p=0.001 and p=0.015 respectively), between DRD4 and sleep disturbances (p=0.018) and between 5HTTLPR and apathy (p=0.033). Finally, significant interactions were observed between COMT Val158Met and 5HTTLPR with "psychosis" (p=0.026), between HTTLPR and STin2 with "psychosis" (p=0.005), between DAT1 3'UTR VNTR and COMT Val158Met with "agitation" (p=0.0001) and between DAT1 3'UTR VNTR and 5HTTLPR with the "moods" factor (p=0.0027). The complexity of the interrelations between genetic variation, behavioural symptoms and clinical variables was efficiently captured by this MIMIC model