Interactive voice response system (IVRS): Data quality considerations and lessons learned during a microbicide placebo adherence trial with young men who have sex with men.

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/106616/1/Interactive voice response system IVRS Data quality considerations and lessons learned during a microbicide placebo adherence trial with young men who have sex with men.pd

Detecting, Preventing, and Responding to “Fraudsters” in Internet Research: Ethics and Tradeoffs

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/111094/1/jlme12200.pd

Individual and Contextual Factors of Sexual Risk Behavior in Youth Perinatally Infected with HIV

Abstract This study prospectively examines the effects of maternal and child HIV infection on youth penetrative and unprotected penetrative sex, as well as the role of internal contextual, external contextual, social and self-regulatory factors in influencing the sexual behaviors of HIV?infected (PHIV+), HIV?affected (uninfected with an HIV+ caregiver), and HIV unaffected (uninfected with an HIV? caregiver) youth over time. Data (N=420) were drawn from two longitudinal studies focused on the effects of pediatric or maternal HIV on youth (51% female; 39% PHIV+) and their caregivers (92% female; 46% HIV+). PHIV+ youth were significantly less likely to engage in penetrative sex than HIV? youth at follow-up, after adjusting for contextual, social, and self-regulatory factors. Other individual- and contextual-level factors such as youth alcohol and marijuana use, residing with a biological parent, caregiver employment, caregiver marijuana use, and youth self-concept were also associated with penetrative sex. Youth who used alcohol were significantly more likely to engage in unprotected penetrative sex. Data suggest that, despite contextual, social, and self-regulatory risk factors, PHIV+ youth are less likely to engage in sexual behavior compared to HIV? youth from similar environments. Further research is required to understand delays in sexual activity in PHIV+ youth and also to understand potential factors that promote resiliency, particularly as they age into older adolescence and young adulthood.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/98470/1/apc%2E2012%2E0005.pd

Algoritmo de Tratamiento Multimodal para Preescolares Latinoamericanos con Trastorno por Déficit de Atención con Hiperactividad (TDAH)

Introduction During the first Latin American ADHD consensus held in Mexico in 2007 a treatment algorithm for attention-deficit/hyperactivity disorder (ADHD) in preschoolers was proposed. Since then, some studies have emerged regarding not only pharmacological treatment but also psychosocial managing strategies for this population that require a review. The main objective was to review the recent literature on preschool ADHD clinical management in order to update the treatment algorithm and to include together both psychopharmacological treatment and psychosocial management strategies into the decision tree. Method A task force with six experts from five Latinamerican countries was constituted. The task force included different health specialties: child and adolescent psychiatry, neuropaediatrics, psychology and neuropsychology. Literature in the field of preschool ADHD, published between 2006 and 2008, was reviewed, and the evidence level of studies was assessed, to develop the Multimodal Treatment Algorithm for Preschool ADHD in accordance with the Latin American population needs. From the gathered information, the experts elaborated the main recommendations for the assessment and management of ADHD Latin American preschoolers, and constructed the decision tree according to the evidence level of each treatment intervention. Results ADHD is among the most common neuropsychiatric consultations in preschool-aged children. There are five studies in Latin America showing a preschool ADHD prevalence between 3.24% and 11.2%. The main clinical manifestations are mostly related with poor impulse control, difficulty to follow simple instructions, overactivity and, in some cases, aggression and rejection by peers. Many studies show high comorbidity with oppositional defiant disorder and other neuropsychiatric disorders, such as language, learning and motor disorder and anxiety and depression as well. The ADHD clinical presentation in preschoolers has the same severity level and comorbidity as in school-age children, and it requires comprehensive treatment. There are some helpful scales to assess ADHD preschool children, such as the Parent and Teacher versions of the Conners Rating Scale, the IDC-PRE Scale, and the Early Childhood Inventory4. A diagnosis of preschool ADHD requires patient fulfilling DSM-IVTR criteria. Special recommendations made by the Latin American Multimodal Treatment Algorithm for Preschool ADHD group were: 1. to guarantee a minimum duration of ADHD symptoms of nine months; 2. to verify the report of symptoms directly with teachers; 3. to obtain clear-cut impact and repercussion criteria for «clear evidence of clinically significant impairment in social, academic, or family functioning»; severity is more important than the number of symptoms, and finally; 4. to rule out a list of different disorders mimicking ADHD, and also to detect factors and psychosocial situations influencing the ADHD presentation. There are several alternatives for the preschool ADHD treatment, population, which were inserted in the decision tree according to their evidence level. The Latin American Multimodal Treatment Algorithm for Preschool ADHD group recommends the integrated and rational use of both pharmacological and psychosocial treatments. Psychosocial treatments for the ADHD preschooler with good clinical evidence are: psychoeducation, parental management training (PMT), parentchild interaction therapy (PCIT) and behavioral school-based intervention. After parental assessment on ADHD knowledge, parent’s psychoeductation promotes good information about ADHD, and also gives parents guidance and support. There are some published studies about the efficacy of PMT and PCIT in Latin American preschool population. These therapeutic interventions help families to learn how to manage their children difficulties and improve family functioning. PCIT was designed for 2-7 year old children; it has a clinical orientation and involves the child, parents, and other family members in the treatment. Recent studies show a robust response to the PCIT reducing the ADHD symptomatology. Finally, behavioral school-based intervention has some evidence, and its implementation includes teacher training in contingency management plans in order to promote children self-regulation. Methylphenidate (MPD) is the most studied psychopharmacological agent in this young population. Due to its robust clinical evidence, it is the first-line agent for the treatment of preschool children with ADHD. The group for the development of the Multimodal Treatment Algorithm for Latin American Preschool ADHD recommends to start with low doses of MPD, 1.25–2.5 mg/day, and gradually increase them every 2-3 weeks, until the maximum dose of 2.5-7.5 mg/day is reached. There are only two open-studies showing atomoxetine efficacy in this population. Atomoxetine has a medium evidence level and further studies are needed for more conclusions. The group recommends the use of atomoxetine with a maximum dose of 1.25 mg/kg/day. Other agents have a low level of evidence. Ampehtamines (available only in Chile and Puerto Rico), with only one study, and the alpha-agonists (clonidine and guanfacine) have been used based on clinical experience only. Further research is needed, especially head to head studies, comparing these agents with the MPD gold standard in both short and long-term follow-up studies. Any treatment decision should be closely monitored in order to make efficacy accurate in clinical response and to provide security for the young patient. While a child is using psychopharmacological treatment, it is important to monitor weight and size monthly. The main modifications to the former version of the Multimodal Treatment Algorithm for Latin American Preschool ADHD are: 1. the specific recommendation of psychosocial treatment such as psychoeducation, PMT, PCIT, and behavioral school-based intervention; 2. the recommendation of methylphenidate (available in all Latin American countries) as first pharmacological agent, followed by atomoxetine or amphetamines, and, in last instance, to consider the use of clonidine, and; 3. psychosocial treatment continuation is recommended for the maintenance jointly with the medication showing the best response. Conclusions There are two main pillars for the adequate treatment of preschool ADHD. On the one hand, there are psychosocial interventions such as psychoeducation, PMT, PCIT and behavioral school-based interventions; on the other hand, pharmacological treatment, especially with methylphenidate. Other pharmacological agents have a lack of scientific evidence. As the Multimodal Treatment Algorithm for Latin American Preschoolers with ADHD group, we recommend to start with the psychosocial treatment intervention, and then to follow the pharmacological options. New proposals should be developed according to the special needs and contexts of Latin America. - Introducción: En el Primer Consenso Latinoamericano de TDAH, celebrado en México en 2007 se propuso un algoritmo de tratamiento farmacológico para preescolares con Trastorno por Déficit de Atención con Hiperactividad (TDAH). Desde entonces han surgido algunos estudios no solo sobre tratamiento farmacológico, sino también sobre estrategias de manejo psicosociales en esta población que ameritan una revisión. El objetivo fue integrar la literatura reciente sobre el manejo clínico del TDAH en preescolares con el fin de actualizar el algoritmo latinoamericano de tratamiento e incorporar al árbol de decisiones las medidas psicosociales. Metodología: Se integró un panel de expertos con seis especialistas de diferentes áreas: psiquiatría infantil y de la adolescencia, neuropediatría, psicología y neuropsicología de cinco países latinoamericanos. Se revisó la literatura de entre 2006 y 2008; se evaluó el nivel de evidencia científica de los estudios, y se desarrolló el algoritmo de tratamiento de preescolares con TDAH, de acuerdo con las necesidades de la población latinoamericana. A partir de la información obtenida los especialistas propusieron las principales recomendaciones para evaluar y manejar a los preescolares latinoamericanos con TDAH y construyeron un árbol de decisiones según el nivel de evidencia científica de cada propuesta de tratamiento. Resultados: El algoritmo multimodal para el tratamiento de preescolares latinoamericanos con TDAH plantea como primer recurso el manejo psicosocial y luego el tratamiento farmacológico. Los principales cambios en el algoritmo son: la recomendación específica de los tratamientos psicosociales como la psicoeducación, el Entrenamiento en Manejo Parental (EMP) y la Terapia Interaccional Padre-Hijo (TIPH). La recomendación del metilfenidato como primera etapa farmacológica (disponible en todos los países de Latinoamérica), seguido de la atomoxetina o las anfetaminas; en el último término se puede considerar el uso de clonidina. Finalmente, se recomienda continuar con los tratamientos psicosociales para el mantenimiento en conjunto con la medicación con la que se mostró la mejor respuesta. Conclusiones: Existen diversas alternativas de tratamiento para esta población; éstas se distribuyeron en el árbol de decisiones de acuerdo con el nivel de evidencia. El algoritmo para preescolares latinoamericanos con TDAH recomienda el uso conjunto y racional de tratamientos farmacológicos y psicosociales

Creating comprehensive, youth-centered culturally appropriate sex education: What do young gay, bisexual and questioning men want?

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/106604/1/Creating comprehensive, youth-centered culturally appropriate sex education What do young gay, bisexual and questioning men want.pd

Terapeutas de conducta como implementadores del modelo preventivo y de psicología comunal

Resumen en español.Resumen en inglés

Validity of the Sluggish Cognitive Tempo, Inattention, and Hyperactivity Symptom Dimension: Neuropsychological and Psychosocial Correlates

This study examined the latent structure and validity of inattention, hyperactivity-impulsivity, and sluggish cognitive tempo (SCT) symptomatology. We evaluated mother and teacher ratings of ADHD and SCT symptoms in 140 Puerto Rican children (55.7% males), ages 6 to 11 years, via factor and regression analyses. A three-factor model (inattention, hyperactivity-impulsivity, and SCT) provided the best fit for both sets of ratings. Inattention was the strongest correlate of lower scores on neuropsychological, achievement, and psychosocial measures. Externalizing problems were most strongly associated with hyperactivity-impulsivity, and internalizing problems were most strongly associated with parent-rated SCT and teacher-rated Inattention. SCT was not associated with executive function but was negatively associated with math. Inattention accounted for a disproportionate amount of ADHD-related impairment, which may explain the restricted discriminant validity of DSM-IV types. The distinct factors of hyperactivity-impulsivity and SCT had unique associations with impairing comorbidities and are roughly equivalent in predicting external correlates of ADHD-related impairment.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/91267/1/Bauermeisteretal_ValiditySCT.pd

El TDAH en preescolares: validez, diagnóstico, prevención y tratamiento

La literatura científica apoya la validez conceptual y utilidad clínica del trastorno por déficit de atención e hiperactividad (TDAH) en niños preescolares. Estos niños presentan tasas elevadas de psicopatología comórbida y un nivel significativo de dificultades cognitivas, pre-académicas y sociales. Están en alto riesgo de continuar presentando esta condición y dificultades capaces de afectar su funcionamiento adaptativo. Los programas de entrenamiento a padres han demostrado un nivel alto de efectividad. La farmacoterapia puede ser efectiva, pero los tamaños de los efectos son más pequeños y los efectos secundarios mayores a los encontrados en niños de edad escolar. Es evidente la importancia de eliminar o reducir factores no genéticos de riesgo que pueden contribuir al desarrollo del TDAH. Los programas conductuales y de entrenamiento cognitivo, así como actividades y juegos dirigidos a desarrollar funciones ejecutivas, podrían ser efectivos para prevenir o tratar esta condición y sus dificultades asociadas

A Propective Sudy of the Onset of Sexual Behavior and Sexual Risk in Youth Perinatally Infected with HIV

Perinatally HIV-infected (PHIV+) youth are surviving into adolescence and young adulthood. Understanding the sexual development of PHIV+ youth is vital to providing them with developmentally appropriate HIV-prevention programs. Using pooled data (N = 417) from two longitudinal studies focused on HIV among youth (51% female; 39% HIV+) and their caregivers (92% female; 46% HIV+), the rate of sexual onset during adolescence across four youth-caregiver combinations was compared: PHIV+ youth with HIV+caregivers (12%), PHIV+ youth with HIV- caregivers (27%), HIV- youth with HIV+caregivers (34%), and HIV- youth with HIV- caregivers (27%). Youth with HIV- caregivers were more likely than other youth-caregiver groups to have had their sexual onset. Youth with HIV+ caregivers reported a slower rate of onset of penetrative sex across the adolescent years. Findings are discussed by highlighting the role that both youth and caregiver HIV status play in the onset of sexual behavior across adolescence.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/91272/1/Bauermeisteretal_JSR_CASAH_inpress.pd