Impact of a general practice based group parenting programme on the mental health of children and parents 12 months post intervention : quantitative and qualitative results from a controlled trial

Objective To test the effectiveness at one year of the Webster Stratton Parents and Children Series group parenting programme in a population sample of parents Design multicentre block randomised controlled trial Setting 3 urban General Practices in Oxford. Participants Parents of children aged 2-8 years in 116 families who scored in the upper 50% on a behaviour inventory. Intervention Webster-Stratton’s 10-week parenting programme led by health visitors. Outcome measures. Eyberg Child Behaviour Inventory, Goodman Strengths and Difficulties Questionnaire, General Health Questionnaire, Parenting Stress Index, Rosenberg Self Esteem Scale. Qualitative interviews with volunteer parents from both intervention and control groups immediately post intervention. Results The intervention significantly reduced child behaviour problems and improved mental health at immediate and 6-month follow-ups. One-year differences between control and intervention groups were not significant. Possible methodological reasons for this are: Hawthorne effects and contamination of control group. At interview parents spoke of a need for further sessions and a desire for attendance by both parents. They also described how, as a result of the programme, they had gained in confidence, felt less stressed, shouted less and achieved more cooperation from their children. Conclusions Parenting programmes have the potential to promote mental health and reduce social inequalities, but further work is needed to improve long-term effectiveness

A Quadriparametric Model to Describe the Diversity of Waves Applied to Hormonal Data

International audienceSummary Background: Even in normally cycling women, hormone level shapes may widely vary between cycles and between women. Over decades, finding ways to characterize and compare cycle hormone waves was difficult and most solutions, in particular polynomials or splines, do not correspond to physiologically meaningful parameters. Objective: We present an original concept to characterize most hormone waves with only two parameters. Methods: The modelling attempt considered pregnanediol-3-alpha-glucuronide (PDG) and luteinising hormone (LH) levels in 266 cycles (with ultrasound-identified ovulation day) in 99 normally fertile women aged 18 to 45. The study searched for a convenient wave description process and carried out an extended search for the best fitting density distribution. Results: The highly flexible beta-binomial distribution offered the best fit of most hormone waves and required only two readily available and understandable wave parameters: location and scale. In bell-shaped waves (e.g., PDG curves), early peaks may be fitted with a low location parameter and a low scale parameter; plateau shapes are obtained with higher scale parameters. I-shaped, J-shaped, and U-shaped waves (sometimes the shapes of LH curves) may be fitted with high scale parameter and, respectively, low, high, and medium location parameter. These location and scale parameters will be later correlated with feminine physiological events. Conclusion: Our results demonstrate that, with unimodal waves, complex methods (e.g., functional mixed effects models using smoothing splines, second-order growth mixture models, or functional principal-component- based methods) may be avoided. The use, application, and, especially, result interpretation of four-parameter analyses might be advantageous within the context of feminine physiological events

Preconception stress and the secondary sex ratio: a prospective cohort study

OBJECTIVE: To study the association between salivary stress biomarkers and the secondary sex ratio. DESIGN: Prospective, longitudinal cohort study. SETTING: Community setting in the United Kingdom. PATIENT(S): On discontinuation of contraception for purposes of becoming pregnant, 338 women aged 18–40 years with complete data (90%) were followed until pregnant or up to six menstrual cycles. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Secondary sex ratio. RESULT(S): Human chorionic gonadotropin pregnancies were detected in 207 (61%) women of whom 130 (63%) delivered singleton infants with available gender data. The adjusted odds ratio for a male birth was decreased for women in the highest quartile (AOR = 0.26; 95% confidence interval = 0.09, 0.74) of salivary cortisol relative to women in the lowest quartile during cycle 1. An inverse relation was observed between α-amylase and the 2° sex ratio, though not statistically significant. CONCLUSION(S): Our findings are consistent with a reversal in the 2° sex ratio with increasing preconception salivary cortisol concentrations. This relation suggests that activation of the hypothalamus–pituitary–adrenal axis may have implications in sex allocation and requires further study

Expectations of Patients and Physicians Regarding Patient-Accessible Medical Records

BACKGROUND: Middle class populations have supported shared medical records, including Internet-accessible medical records. The attitudes of lower income populations, and of physicians, are less clear. OBJECTIVES: The objective of this study was to compare the attitudes toward shared outpatient medical records among (1) socioeconomically disadvantaged patients in community health centers, (2) insured patients in primary care offices, and (3) a broad range of physicians in outpatient practice. METHODS: Written questionnaires were provided to patients in the waiting rooms of six primary care practices in the metropolitan Denver, Colorado area. Three practices were community health centers, and three practices were primary care clinics of an academic medical center. Questionnaires were also mailed to primary care physicians in the state of Colorado. RESULTS: There was a 79% response rate for patient surveys (601 surveys returned) and a 53% response rate for physician surveys (564 surveys returned). Academic medical center patients and community health center patients were equally likely to endorse shared medical records (94% vs 96%) and Internet-accessible records (54% vs 57%). Community health center patients were more likely than academic medical center patients to anticipate the benefits of shared medical records (mean number of expected benefits = 7.9 vs 7.1, P < .001), and they were also somewhat more likely to anticipate problems with shared records. Significant predictors of patient endorsement of Internet-accessible records were previous use of the Internet (OR = 2.45, CI 1.59–3.79), the number of expected benefits (OR = 1.12 per unit, CI 1.03–1.21), anticipation of asking more questions between visits (OR = 1.73, CI 1.18–2.54), and anticipation of finding the doctors' notes to be confusing (OR = 1.50, CI 1.01–2.22). Physicians were significantly more likely than patients to anticipate that access to records would cause problems. Physicians were significantly less likely than patients to anticipate benefits (mean number of expected benefits = 4.2 vs 7.5, P < .001). CONCLUSIONS: Interest in shared medical records is not confined to a white, middle class population. Shared medical records are almost universally endorsed across a broad range of ethnic and socioeconomic groups. A majority of patients are also interested in Internet-accessible records, but a substantial minority is not. The primary determinants of support of Internet-accessible records are not age, race, or education level; rather, they are previous experience with the Internet and patients' expectations of the benefits and drawbacks of reading their medical records. Physicians have more concerns about shared medical records and see less potential for benefit. The attitudes of patients and physicians may need to be reconciled for widespread adoption of shared medial records to be achieved