Gloria D. Eldridge

Health care-seeking behavior related to the transmission of sexually transmitted diseases in Kenya

OBJECTIVES The purpose of this study was to identify health-care seeking and related behaviors relevant to controlling sexually transmitted diseases in Kenya. METHODS A total of 380 patients with sexually transmitted diseases (n = 189 men and 191 women) at eight public clinics were questioned about their health-care seeking and sexual behaviors. RESULTS Women waited longer than men to attend study clinics and were more likely to continue to have sex while symptomatic. A large proportion of patients had sought treatment previously in both the public and private sectors without relief of symptoms, resulting in delays in presenting to study clinics. For women, being married and giving a recent history of selling sex were both independently associated with continuing to have sex while symptomatic. CONCLUSIONS Reducing the transmission of sexually transmitted diseases in Kenya will require improved access, particularly for women, to effective health services, preferably at the point of first contact with the health system. It is also critical to encourage people to reduce sexual activity while symptomatic, seek treatment promptly, and increase condom use.

Effects of prior response-contingent reinforcement on superstitious behavior

Three pigeons were exposed to fixed-time (FT) 15 sec, fixed-interval (FI) 15 sec for performing an arbitrary response, a reversal back to FT 15 sec, and then extinction (no reinforcement). During each phase, a computer-controlled tracking system continuously recorded the position of the bird’s head as it moved freely in the experimental chamber. During the first exposure to FT 15 sec, all 3 birds developed a pattern of feeder-wall-directed behavior with occasional circular excursions from the feeder immediately following reinforcement. During FI 15 sec, all birds performed the arbitrary operant, which consisted of contacting a virtual target sphere near the rear of the chamber, and did not engage in feeder-wall-directed behavior. During the reversal back to FT 15 sec, the birds developed a behavior sequence consisting of moving in the direction of the target sphere after reinforcement, followed by feeder-wall-directed behavior prior to the next reinforcement. During extinction, either moves toward the target sphere or wall-directed behavior occurred separately, interspersed with reappearance of the two as a sequence, followed by cessation of both members of the behavior sequence. These findings indicate that prior reinforcement of an arbitrary response can affect the location and form of superstitious behavior that develops near the beginning of the interreinforcement interval, but that other factors (e.g., immediacy of reinforcement) affect the location and form of the behavior near the end of the interval. The findings can be interpreted in the context of superstitious chaining.

Anxiety sensitivity and treatment outcome in panic disorder

The purpose of this study was to examine the relationship between change in anxiety sensitivity, as measured by the Anxiety Sensitivity Index (ASI), and treatment outcome in a sample of 106 subjects with a DSM-III-R diagnosis of panic disorder (with or without agoraphobia) who were participants in an evaluation study of cognitive-behavioral treatment. Results revealed that subjects who received active treatment had significantly lower anxiety sensitivity scores at post-treatment than the wait-list control group. We also examined change in anxiety sensitivity from pre- to post-treatment in reference to Clinical Global Improvement (CGI) ratings and with the effect size statistic. Subjects who showed improvement based on CGI ratings also demonstrated a reduction in anxiety sensitivity. Furthermore, the effect sizes obtained with the ASI were greater in magnitude than those obtained with other widely used anxiety self-report measures. Taken together, the finds supported the use of the Anxiety Sensitivity Index as a treatment outcome measure in panic disorder research.

Contextual issues in the assessment of post‐traumatic stress disorder

In recent years, there has been an explosion of information on the etiology, assessment, and treatment of post-traumatic stress disorder (PTSD) in individuals exposed to a wide variety of traumatic stressors. Comprehensive assessment techniques are being developed for diagnosis and treatment evaluation in PTSD; however, there remain numerous pragmatic issues related to the context of assessment for PTSD. Issues addressed in this paper include (1) implications of the purpose of the assessment (e.g., crisis intervention, treatment planning, evaluation for compensation); (2) sequelae of the assessment, including positive and negative outcomes of exposure to traumatic memories during assessment, (3) characteristics and training of the assessor and the impact of exposure to reports of traumatic events on the assessor; and (4) features of PTSD which affect the ease of case-finding and suggest the necessity for training a variety of health care providers to recognize symptoms of PTSD.

Sexual behaviour in Kenya: Implications for sexually transmitted disease transmission and control

Sexual behaviour in Kenya in relation to STD transmission was investigated with a view to forming a basis for the more rational design of STD/HIV control interventions. Questionnaires were administered to a sample of 762 men and women attending eight health facilities in two urban centres. Equal numbers of STD patients (cases) and non-STD related clinic attenders (clinic controls) were selected, matched by gender and clinic. Another sample of 427 men and women was obtained from a random sampling of households in a slum area in Nairobi (community controls). Male STD patients who were unmarried, or married but living apart from their wives, reported a higher mean number of sex partners in the previous three months than did male clinic or community controls. Unmarried female STD patients reported a higher mean number of sex partners in the previous three months than did unmarried female clinic or community controls. Both male and female STD patients were more likely to report having been involved in commercial sex transactions in the previous three months than clinic or community controls. Considerable heterogeneity in sexual behaviour was apparent. In multivariate analysis, the most important predictor of STD acquisition for both men and women was the number of reported sex partners in the previous three months. In addition, for men only, marital status (unmarried, or married but living apart from their wives) and purchasing sex were significant predictors of being an STD patient. These data confirm the importance of commercial sex in STD transmission, and suggest that men play a bridging role between female sex workers and the general population of women.(ABSTRACT TRUNCATED AT 250 WORDS)

Cognitive-behavioral treatment for panic disorder with gastrointestinal symptoms: a case study.

A 25-year-old woman with a 12-year history of panic disorder with agoraphobia and gastrointestinal symptoms was treated using a cognitive-behavioral program which included: (a) correcting misconceptions about normal bowel functioning, (b) graduated in vivo exposure to internal stimuli which she misinterpreted as precursors of loss of bowel control, (c) graduated in vivo exposure to external stimuli associated with fears of loss of bowel control, (d) establishment of regular eating patterns, and (e) bowel control training. Self-ratings of avoidance and distress, frequency of panic attacks, diazepam use, and negative cognitions decreased with treatment. Treatment gains were maintained at 18-month follow-up. Tailoring of cognitive-behavioral treatment to panic with fears of loss of bowel control was emphasized.