Peter Dore

The association of physical and sexual abuse with HIV risk behaviors in adolescence and young adulthood: implications for public health

This paper explores the relationship between changes in HIV risk behaviors and physical and sexual abuse. A stratified random sampling procedure selected 602 youths from a sample of 2,787 patients seen consecutively at public health clinics in 10 cities. Face-to-face structured interviews conducted since 1984-85 provide a history of change in risk behavior from adolescence to young adulthood. Univariate and bivariate analyses assessed differences in demographic and number and type of risk behaviors between those experiencing single or multiple types of abuse and those with no abuse history at all. The results show that a history of physical abuse, sexual abuse, or rape is related to engaging in a variety of HIV risk behaviors and to a continuation or increase in the total number of these behaviors between adolescence and young adulthood. This information might help practitioners to both prevent initial involvement in HIV risk behaviors and to prevent continuation of behaviors as youths move into young adulthood.

The influence of mental health problems on AIDS-related risk behaviors in young adults.

This paper explores how symptoms of mental health problems influence acquired immune deficiency syndrome-related risk behaviors, and how changes in those symptoms relate to risk behaviors engaged in by young adults. Repeated interviews with 602 youths since 1984 provide a history of change in behaviors. Mental health symptoms during adolescence (alcohol/drug [r =.28]; conduct disorder [r =.27]; depression [r =.16]; suicide [r =.14]; anxiety [r =16]; and posttraumatic stress [r =.09]) are associated with higher numbers of risk behaviors (specifically, prostitution, use of intravenous drugs, and choice of a highrisk sex partner) during young adulthood. Changes in mental health symptoms between adolescence and young adulthood are related to the number of risk behaviors engaged in by young adulthood (total number of symptoms [B =.10], alcohol/drug abuse or dependence [B =.34], depression [B =.20], suicidality [B =.35], anxiety [B =.13], and posttraumatic stress [B =.14]). Changes in symptoms of mental health problems are associated specifically with those risk behaviors that are initiated primarily in young adulthood: intravenous drug use, prostitution, and choice of risky partners. The findings show that prevention and treatment of mental health problems are important components of preventive interventions for human immunodeficiency virus infection in high-risk teens and young adults.

Person and Environment in HIV Risk Behavior Change Between Adolescence and Young Adulthood

This article explores how personal and environmental variables influence change in human immunodefi ciency virus (HIV)-related risk behaviors between adolescence and young adulthood. Repeated interviews with 602 youths from 10 cities across the United States provide the data These interviews first occurred in 1984-1985 and 1985-1986 when the youths were adolescents and were repeated again in 1989-1990 and 1991-1992 when they were all young adults. A longitudinal multivariate analysis shows that 31% of the variance in HIV risk behaviors by inner-city young adults is predicted by a combination of adolescent risk behaviors, personal variables (suicidality, substance misuse, antisocial behavior), environmental variables (history of child abuse, poor relations with parents, stressful events, peer misbehavior, number of AIDS prevention messages), and interactions between variables (number of neighborhood murders with child abuse, number of neighborhood murders with substance misuse, and unemployment rates with antisocial behavior).

Mindfulness-based stress reduction for older adults with worry symptoms and co-occurring cognitive dysfunction.

Mindfulness‐based stress reduction (MBSR) has the potential to reduce worry and improve cognitive functioning.

Measuring treatment fidelity in a rehabilitation intervention study.

ABSTRACTAttaining and demonstrating treatment fidelity is critical in the development and testing of evidence-based interventions. Treatment fidelity refers to the extent to which an intervention was implemented in clinical testing as it was conceptualized and is clearly differentiable from control or standard-of-care interventions. In clinical research, treatment fidelity is typically attained through intensive training and supervision techniques and demonstrated by measuring therapist adherence and competence to the protocol using external raters. However, in occupational and physical therapy outcomes research, treatment fidelity methods have not been used, which, in our view, is a serious gap that impedes novel treatment development and testing in these rehabilitation fields. In this article, we describe the development of methods to train and supervise therapists to attain adequate treatment fidelity in a treatment development project involving a novel occupational and physical therapy–based intervention. We also present a data-driven model for demonstrating therapist adherence and competence in the new treatment and its differentiation from standard of care. In doing so, we provide an approach that rehabilitation researchers can use to address treatment fidelity in occupational and physical therapy–based interventions. We recommend that all treatment researchers in rehabilitation disciplines use these or similar methods as a vital step in the development and testing of evidence-based rehabilitation interventions.

Towards DSM‐V: considering other withdrawal‐like symptoms of pathological gambling disorder

Despite clinical reports of other withdrawal‐like symptoms, the DSM‐IV considers only restlessness/irritability as a withdrawal‐like criterion comprising pathological gambling disorder (PGD). We explored whether this criterion should be broadened to include other gambling withdrawal‐like symptoms.

Enhanced Medical Rehabilitation Increases Therapy Intensity and Engagement and Improves Functional Outcomes in Postacute Rehabilitation of Older Adults: A Randomized-Controlled Trial

OBJECTIVES For millions of disabled older adults each year, postacute care in skilled nursing facilities is a brief window of opportunity to regain enough function to return home and live independently. Too often this goal is not achieved, possibly because of therapy that is inadequately intense or engaging. This study tested Enhanced Medical Rehabilitation, an intervention designed to increase patient engagement in, and intensity of, daily physical and occupational therapy sessions in postacute-care rehabilitation. DESIGN Randomized controlled trial of Enhanced Medical Rehabilitation versus standard-of-care rehabilitation. SETTING Postacute care unit of a skilled nursing facility in St Louis, MO. PARTICIPANTS Twenty-six older adults admitted from a hospital for postacute rehabilitation. INTERVENTION Based on models of motivation and behavior change, Enhanced Medical Rehabilitation is a set of behavioral skills for physical and occupational therapists that increase patient engagement and intensity, with the goal of improving functional outcome, through (1) a patient-directed, interactive approach, (2) increased rehabilitation intensity, and (3) frequent feedback to patients on their effort and progress. MEASUREMENTS Therapy intensity: assessment of patient active time in therapy sessions. Therapy engagement: Rehabilitation Participation Scale. Functional and performance outcomes: Barthel Index, gait speed, and 6-minute walk. RESULTS Participants randomized to Enhanced Medical Rehabilitation had higher intensity therapy and were more engaged in their rehabilitation sessions; they had more improvement in gait speed (improving from 0.08 to 0.38 m/s versus 0.08 to 0.22 in standard of care, P = .003) and 6-minute walk (from 73 to 266 feet versus 40 to 94 feet in standard of care, P = .026), with a trend for better improvement of Barthel Index (+43 points versus 26 points in standard of care, P = .087), compared with participants randomized to standard-of-care rehabilitation. CONCLUSION Higher intensity and patient engagement in the postacute rehabilitation setting is achievable, with resultant better functional outcomes for older adults. Findings should be confirmed in a larger randomized controlled trial.

Violent behavior in adolescents and young adults: A person and environment model

We explore a model that examines how personal and environmental variables explain violent behavior by adolescents. Repeated interviews with youths from 1984–1992 from 10 cities across the United States provided the data. These interviews first occurred with 2,787 youths when they were adolescents (1984–85 and 1986–87) and the interviews were repeated on a subsample of 602 youths when they were young adults (1989–90 and 1991–92). Longitudinal multivariate analyses showed that almost a third of the variance in adolescent violent behaviors was predicted by a combination of personal variables (gender, substance misuse) and environmental variables (history of child abuse, stressful events, traumatic events, and city rates of unemployment). Further, almost a third of the variance in change in violent behaviors from year to year was predicted by prior violent behavior and a combination of personal variables (gender, suicidality, and substance misuse) and environmental variables (stressful events).

Treatment-related alteration of cortisol predicts change in neuropsychological function during acute treatment of late-life anxiety disorder

Older adults with anxiety disorders are burdened by impairment in neurocognition, which may be mediated by elevated circulating cortisol levels. In a randomized controlled trial of acute serotonin‐reuptake inhibitor treatment for late‐life anxiety disorder, we examined whether change in salivary cortisol concentrations during treatment predicted improvements in measures of memory and executive function.

The association between types of violence exposure and youths' mental health problems.

Highly structured interviews were conducted with 792 adolescents, ages 14 to 18, from St. Louis, Missouri, who received services from gateway sectors (child welfare, education, juvenile justice, and primary health care). These youths were exposed to high rates of violence in their families, neighborhoods, and schools, all of which were associated with suicidality and symptoms of major mental health disorders (i.e., depression, conduct disorder, substance abuse or dependence, and post-traumatic stress). Multivariate analyses demonstrated that personal victimization was associated with each of the assessed mental health problems. Further, intrafamilial violence was a significant predictor of all problems except for suicidality. Witnessing a violent act was associated with all the externalizing problems, as well as with depression and posttraumatic stress symptoms. Participation in structured activities moderated the relationships between intrafamilial violence and each of the externalizing problems.