The Mothering of Conduct Problem and Normal Children in Spain and the USA: Authoritarian and Permissive Asynchrony

Ninety-two clinic-referred and nonclinical mother-child dyads in Spain and the USA were observed in their home settings under naturalistic conditions for a total of 477 hours. Children in the clinic-referred dyads were considered troubled because of conduct problems. The observations were aimed at assessing two forms of mother-child asynchrony, either of which was expected to differentiate clinic referred from nonclinical dyads. Authoritarian asynchrony was defined as a mother’s indiscriminate use of aversive reactions to her child, whereas the permissive form entailed indiscriminate positive reactions. Results showed the American mothers to generate more permissive asynchrony, whereas the Spanish mothers were inclined in the authoritarian direction. Only authoritarian asynchrony differentiated the clinical versus nonclinical dyads in each country. Discussion was centered on the greater salience of aversive as opposed to positive maternal attention, and cultural differences between countries that might have accounted for the different parenting [email protected]

Morphine and Hydromorphone-Induced Hyperalgesia in a Hospice Patient

Opioids including morphine and hydromorphone are widely used for control of moderate to severe pain and dyspnea in hospice and palliative care patients. Accumulation of the active morphine-3-glucuronide (M3G) and hydromorphone-3-glucuronide (H3G) metabolites is one proposed mechanism for the development of neuroexcitatory effects including allodynia and opioid-induced hyperalgesia (OIH). We report the case of a 43-year-old female hospice patient with metastatic non-small cell lung cancer who initially developed allodynia following morphine administration and again following administration of hydromorphone. The allodynia resolved both times following the discontinuation of the opioid and rotation to a different opioid regimen. Potential opioid-induced neuroexcitatory treatment options include opioid rotation to an agent with inactive metabolites, use of adjuvant pain medications for opioid-sparing effects, management of undesired symptoms (e.g., myoclonus), or increasing opioid clearance with intravenous (IV) fluids. Although the incidence is not well defined in the literature, hospice and palliative care clinicians should suspect OIH in patients with allodynia and/or hyperalgesia, especially when repeated dose escalations do not improve analgesia or pain escalates following opioid dose titration

Reperfusion therapy for ST elevation acute myocardial infarction 2010/2011: current status in 37 ESC countries

Aims Primary percutaneous coronary intervention (PPCI) is the preferred reperfusion therapy in ST-elevation myocardial infarction (STEMI). We conducted this study to evaluate the contemporary status on the use and type of reperfusion therapy in patients admitted with STEMI in the European Society of Cardiology (ESC) member countries. Methods and results A cross-sectional descriptive study based on aggregated country-level data on the use of reperfusion therapy in patients admitted with STEMI during 2010 or 2011. Thirty-seven ESC countries were able to provide data from existing national or regional registries. In countries where no such registries exist, data were based on best expert estimates. Data were collected on the use of STEMI reperfusion treatment and mortality, the numbers of cardiologists, and the availability of PPCI facilities in each country. Our survey provides a brief data summary of the degree of variation in reperfusion therapy across Europe. The number of PPCI procedures varied between countries, ranging from 23 to 884 per million inhabitants. Primary percutaneous coronary intervention and thrombolysis were the dominant reperfusion strategy in 33 and 4 countries, respectively. The mean population served by a single PPCI centre with a 24-h service 7 days a week ranged from 31 300 inhabitants per centre to 6 533 000 inhabitants per centre. Twenty-seven of the total 37 countries participated in a former survey from 2007, and major increases in PPCI utilization were observed in 13 of these countries. Conclusion Large variations in reperfusion treatment are still present across Europe. Countries in Eastern and Southern Europe reported that a substantial number of STEMI patients are not receiving any reperfusion therapy. Implementation of the best reperfusion therapy as recommended in the guidelines should be encourage

Oppositional children: a quest for parental reinforcement control

The present study attempted to examine changes in parental reinforcement value as a function of parental use of timeout and differential attention. Subjects were two children classified by their parents as highly oppositional to parental requests or commands. Results showed that the children's oppositional behavior varied predictably with the presence and absence of parental use of timeout and differential attention. As expected, parental reinforcement value for the children was higher during treatment periods than during baseline periods

Setting generality: some specific and general effects of child behavior therapy

The present study attempted to assess experimentally, functional relationships between home and school settings. Two children, both considered deviant in their homes and in their schools, were observed in both settings. The observations revealed that the children's deviant behaviors at home were quite similar to their deviant behaviors at school. Contingency operations were then performed in the children's homes. Results showed that the children's behavior changed predictably in the homes and remained at baseline level in school

Peer reinforcement control of classroom problem behavior1

Peer and teacher interactions with five “disruptive” children were studied in an elementary school classroom. The intent of the study was to analyze experimentally peer reinforcement control of the disruptive children's problem behaviors. Social attention provided by all peers was found to be directed exclusively to the problem behaviors during baseline. Following baseline, several manipulations of selected peer social attention demonstrated the reinforcement function of this stimulus class

Setting events in applied behavior analysis: Toward a conceptual and methodological expansion

The contributions of applied behavior analysis as a natural science approach to the study of human behavior are acknowledged. However, it is also argued that applied behavior analysis has provided limited access to the full range of environmental events that influence socially significant behavior. Recent changes in applied behavior analysis to include analysis of side effects and social validation represent ways in which the traditional applied behavior analysis conceptual and methodological model has been profitably expanded. A third area of expansion, the analysis of setting events, is proposed by the authors. The historical development of setting events as a behavior influence concept is traced. Modifications of the basic applied behavior analysis methodology and conceptual systems that seem necessary to setting event analysis are discussed and examples of descriptive and experimental setting event analyses are presented

Naturalistic treatment of an autistic child

The present research experimentally evaluated a “naturalistic” treatment program for an autistic child administered by the parents over a 2-yr period. Operant reinforcement techniques previously developed and tested in laboratory settings were initially assessed in a clinic and eventually in the family's home. Experimental manipulations were performed in both settings on rituals, crying and whining, compliance, non-verbal imitation, and verbal imitation. The results clearly indicated that parents can effectively treat autistic behaviors provided that they receive adequate training and supervision in operant reinforcement therapy, and provided that sufficiently potent reinforcers are available to maintain behavior