James P. Berghuis

Sickness impact of chronic nonbacterial prostatitis and its correlates.

PURPOSE There is evidence that many patients experiencing chronic idiopathic prostatitis or prostadynia not only have recurrent physical symptoms but also display a range of psychological symptoms, such as depression or anxiety, suggesting that the symptoms of chronic prostatitis may seriously impact on quality of life functioning. We investigated the degree of sickness impact of chronic prostatitis, and the differential importance of physical and psychological symptoms in predicting sickness impact. MATERIALS AND METHODS The sickness impact profile as well as several symptom measures were administered to 39 patients with chronic prostatitis. Multiple regression analyses were performed to evaluate what proportion of the variance in quality of life or functional status was explained by physical and psychological symptoms. RESULTS The sickness impact profile mean total score of chronic prostatitis patients was within the range of scores reported in the literature for patients suffering myocardial infarction, angina or Crohns disease. Pain was the only physical symptom that significantly contributed towards explaining variance in sickness impact. Psychological symptoms added significantly to the amount of predicted variance. CONCLUSIONS The results indicate a need for careful evaluation and attention to sickness related dysfunctions in patients with chronic prostatitis.

Psychological and physical factors involved in chronic idiopathic prostatitis

Idiopathic prostatitis is a common, often chronic condition in which psychological factors are suspected to play a role. Men with chronic prostatitis (n = 51) and a control group of 34 men without any chronic pain condition, equivalent on demographic characteristics, were compared on psychological and perineal muscle tension measures. Prostate-specific antigen and expressed prostatic secretion cell counts were also measured. Chronic prostatitis patients were consistently more elevated than controls on hypochondriasis, depression, and hysteria (MMPI), and on somaticization and depression (Brief Symptom Inventory), and were less elevated on masculine/instrumentality (Personal Attributes Questionnaire) scales. A cluster analysis of MMPI profiles revealed that 57% of the chronic prostatitis patients produced generally unelevated MMPI profiles, whereas the remaining 43% fell into two groups with distinct patterns of distress. The results indicate depression and psychosocial distress are common among chronic prostatitis patients, calling for careful evaluation and attention to psychological symptoms.

A Telephone Based Brief Intervention Using Motivational Enhancement to Facilitate HIV Risk Reduction Among MSM: A Pilot Study

We conducted a randomized controlled pilot intervention to evaluate the efficacy of a telephone-based brief counseling intervention to reduce sexual risk taking among men who have sex with men (MSM) in Seattle, Washington. The study targeted individuals who were currently engaging in unsafe sex but were not committed to making changes toward safer behaviors. Counselors used motivational interviewing strategies in a single 90-min session to enhance readiness for change, promote greater intentions to use condoms, and to support safer sex practices. Results are based on 89 MSM randomly assigned to Immediate counseling or a Delayed counseling control condition. Among minority participants, Immediates were significantly less likely to have engaged in unprotected anal intercourse at follow-up, compared to Delays. Immediate participants reported significantly less ambivalence about practicing safer sex at follow-up, and tended to report greater increases in intentions to use condoms. These findings support the potential efficacy of a brief intervention based upon motivational enhancement principles for promoting safer sex practices among at-risk MSM.

HIV Prevention and Attrition: Challenges and Opportunities

A sizable number of individuals at risk of becoming HIV infected or infecting others either do not access or drop out of AIDS prevention programs. Attrition is a relevant concern for HIV prevention research and practice alike as nonparticipation (enrolling in but never attending an intervention) and dropout (beginning but not completing an intervention) can affect internal and external validity, detrimentally impact the service providers morale and standing with funders, and potentially lead to poor outcomes for target populations. Understanding how individual factors including demographic and developmental characteristics and programmatic factors such as intervention dosage and venue are related to attrition and how to attract and retain individuals in proven interventions is crucial to prevention efficacy in the third decade of HIV prevention. In this paper, we provide an overview of factors associated with attrition from HIV counseling interventions, offer remedies for practitioners and researchers, and provide a case analysis of a brief motivational enhancement counseling intervention that was designed, in part, to avoid some of the traditional reasons individuals do not enroll in or drop out of HIV prevention programs.

Motivational Enhancement Counseling Strategies in Delivering a Telephone-Based Brief HIV Prevention Intervention

Motivational enhancement therapy (MET) interventions are being increasingly added to the menu of behavioral interventions for HIV prevention. They present few logistical and psychological barriers for at-risk persons who are ambivalent about transmission risk reduction and appear to offer promise of being transferable to community based organizations and public health programs. We describe the principles of motivational interviewing, a counseling style often used in conjunction with MET, and demonstrate and discuss its application with case examples drawn from a recent pilot trial of a telephone-delivered brief motivational enhancement for HIV risk reduction with men who have sex with men (MSM).