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Adolescents in Panama face multiple barriers that affect their health, such as high rates of teenage pregnancy, increased human immunodeficiency virus (HIV) infections and sexual violence. Equal relationships between women and men are likely to reduce such risks. Here, we suggest that the school-based enhancement of Social and Emotional Learning core competencies-awareness of self and others, positive attitudes and values, responsible decision-making, and social interaction skills-could foster positive changes in behaviors between boys and girls, specifically through a focus on equal roles, equal rights in relationships and nonviolent problem solving. This paper, using the Intervention Mapping Protocol, describes the process of development of, and planning surrounding the implementation and evaluation of the program 'Me and My new World', a Social Emotional Learning intervention for middle school students (12-15 years old) in Panama. Program development was based on a needs assessment (Araúz Ledezma et al. (2020) Behavioural and environmental influences on adolescent decision making in personal relationships: a qualitative multi-stakeholder exploration in Panama. Health Education Research, 35, 1-14.) and a literature review of theory- and evidence-based Social and Emotional Learning (SEL)-programs. Intervention outcomes, performance objectives and change objectives of the intervention were identified. The practical applications of different theory-based methods allowed for contextual considerations that could potentially influence the expected behavioral outcomes of the intervention. Teachers were the implementers of the program, and during development, implementation, and evaluation, the roles, opinions, and teaching methods of all stakeholders were recognized. We conclude that Intervention Mapping allows for the analysis of multiple factors influencing the development and implementation of Social Emotional Learning programs promoting equal relationships among adolescents in a developing country, with a special consideration of culture, educational systems, and policies, from a capability development perspective., (© The Author(s) 2020. Published by Oxford University Press.)

Introduction: This study is one of the first to examine the association between relationship and sexual variables as approached from a dyadic perspective in Saudi Arabian couples. Theoretical models assign an important role to relationship factors in women's sexuality., Aim: We examined the role of sexual and relationship satisfaction relative to sexual desire in explaining sexual function in a sample of clinical versus nonclinical couples., Methods: This is a cross-sectional, observational study in a sample of 50 heterosexual couples with sexual problems and 50 control couples without problems (N = 100 couples; 200 men and women)., Main Outcome Measure: All participants completed an Arabic version of measures of relationship satisfaction, sexual satisfaction, sexual desire, sexual distress, and sexual function., Results: Results showed that in the clinical group, sexual function of women was predicted by their own and their partner's level of sexual satisfaction, and their own level of solitary and dyadic sexual desire. Men's sexual function was predicted by their own sexual satisfaction and their partner's relationship satisfaction. In the control group, the sexual function of women was predicted only by their level of sexual satisfaction. In men, sexual function was predicted by their own sexual satisfaction and their level of dyadic sexual desire., Conclusion: These results suggest that sexual desire rather than relationship satisfaction plays an important role in women's sexual dysfunction. Being the most consistent determinant of male and female sexual functioning, sexual satisfaction is an important target of intervention in Arabian couples. A Attaky, J Schepers, G Kok, et al. The Role of Sexual Desire, Sexual Satisfaction, and Relationship Satisfaction in the Sexual Function of Arab Couples Living in Saudi Arabia. Sex Med 2021;9:100303., (Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Attachment and intimacy play an important role in shaping sexual and relational experiences. Yet, their interrelation has rarely been investigated in the context of sexual problems and never been tested in Saudi Arabian women., Aim: The present study examined the interrelations of attachment orientation and sexual function, distress, satisfaction, and relational satisfaction in a sample of Saudi Arabian women and explored whether this link can be explained by 2 important aspects of (sexual) intimacy, namely perceived partner responsiveness (PPR) and sexual assertiveness., Method: This is a cross-sectional, observational study in a sample of 50 heterosexual women with sexual problems and 50 control women without problems, who completed an Arabic version of questionnaires on attachment orientation, sexual assertiveness, PPR, relationship satisfaction, sexual satisfaction, sexual distress, and sexual function., Results: We found that both attachment anxiety and sexual refusal showed a significant association with the level of sexual function, sexual distress, and sexual satisfaction (P < .01) in the clinical group. No mediating effects of sexual refusal were found. In the control group, sexual function, sexual distress, and sexual satisfaction were predicted by attachment avoidance (P < .01). Level of sexual function was also predicted by sexual initiation (P < .05). PPR fully mediated the association between attachment anxiety and relational satisfaction in the clinical group (P < .01), while in the control group the link between attachment avoidance and relational satisfaction was only partially mediated by PPR (P < .01)., Strengths & Limitations: This study offers unique information on relational and sexual functioning in a culture in which sexual expression and intimate behavior are restricted, particularly in women., Clinical Implications: Perceiving the partner as being more responsive is an important target of intervention to increase satisfaction with the relationship., Conclusions: Our results suggest that attachment anxiety and low sexual assertiveness, as indicated by lower tendencies to refuse sex when not desired, play a significant role in predicting negative sexual experiences in women who cope with sexual difficulties. Attaky A, Kok G, Dewitte M. Attachment Insecurity and Sexual and Relational Experiences in Saudi Arabian Women: The Role of Perceived Partner Responsiveness and Sexual Assertiveness. J Sex Med 2020;17:1383-1394., (Copyright © 2020 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.)

Alpha-thujone, widely used in beverages (1-5 mg/kg), is known to have cytotoxic effects, but the mode of action and the role of potential apoptotic proteins in yeast cell death should be unraveled. In this study, we used Schizosaccharomyces pombe, which is a promising unicellular model organism in mechanistic toxicology and cell biology, to investigate the involvement of pro-apoptotic factors in alpha-thujone-induced cell death. We showed alpha-thujone-induced ROS accumulation-dependent cytotoxicity and apoptosis. In addition, we used superoxide dismutase-deficient cells (sod1 and sod2 mutants) to understand the effect of oxidative stress. Alpha-thujone caused significant cytotoxicity and apoptotic cell death, particularly in sod mutants. Moreover, two potential apoptotic factors, pca1 and pnu1 (pombe caspase-1 and pombe nuc1) were investigated to understand which factor mediates alpha-thujone-induced cell death. Pca1-deficient cells showed increased survival rates and reduced apoptosis in comparison to parental cells after chemical treatment while pnu1 mutation did not cause any significant change and the response was found identical as of parental cells. Yeast responded to alpha-thujone in caspase-dependent manner which was very similar to that for acetic acid. In conclusion, alfa-thujone-induced apoptosis and accounting mechanisms, which were mediated by ROS and driven by Pca1, were clarified in the unicellular model, S. pombe., (© FEMS 2020.)

Adolescents in Panama face multiple challenges to their sexual health, rights and well-being such as high rates of teenage pregnancy (∼30% of all pregnancies), increased HIV infections and sexual violence. In the absence of sufficient evidence-based data and an ongoing debate in Panamanian society about how to approach adolescents' health problems, the aim of this qualitative study was to explore the perceptions and attitudes of different societal actors, namely governmental employees, NGO employees, academics, members from religious groups, teachers and parents. We conducted in-depth interviews (N = 34) which focused on the behavioural and environmental factors considered to influence adolescents' decision making with regard to love, friendships and family relations. Furthermore, we explored how these stakeholders viewed the role of the education system, and the potential of including social-emotional learning (SEL) in the curriculum to provide skills and capacities, which could encourage adolescents to make better decisions and improve their well-being, in general but also in the context of sexual behaviours. Analysis revealed five central themes, i.e. perceptions towards gender roles and equality, adolescents' love (sexual) relationships, capacity needs regarding prevention of risk behaviours and the role of education, comprehensive sexuality education in schools and the potentiality of SEL in the education system. The findings of the study can enhance understanding on the views of stakeholders regarding the factors influencing adolescents' decision making, as well as regarding the possibilities of introducing SEL in the Panamanian educational curriculum., (� The Author(s) 2019. Published by Oxford University Press.)

Schools are a common setting for adolescents to receive health education, but implementation of these programs with high levels of completeness and fidelity is not self-evident. Programs that are only partially implemented (completeness) or not implemented as instructed (fidelity) are unlikely to be effective. Therefore, it is important to identify which determinants affect completeness and fidelity of program implementation. As part of the launch of Long Live Love+ (LLL+), an online school-based sexuality education program for adolescents aged 15-17, we performed a process evaluation among teachers and students to measure the levels of completeness and fidelity, identify factors influencing teachers' implementation, and to evaluate the students' response. Sixteen Biology teachers from nine secondary schools throughout the Netherlands who implemented LLL+ were interviewed and 60 students participated in 13 focus group discussions. Results showed that teachers' completeness ranged between 22-100% (M = 75%). Fidelity was high, but many teachers added elements. Teachers and students enjoyed LLL+, particularly the diversity in the exercises and its interactive character. The most important factors that influenced implementation were time and organizational constraints, lack of awareness on the impact of completeness and fidelity, and student response. These factors should be taken into account when developing school-based prevention programs., (© The Author 2017. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

HIV is a growing public health problem in Europe, with men-having-sex-with-men and migrants from endemic regions as the most affected key populations. More evidence on effective behavioral interventions to reduce sexual risk is needed. This article describes the systematic development of a theory-guided computer-assisted safer sex intervention, aiming at supporting people living with HIV in sexual risk reduction. We applied the Intervention Mapping (IM) protocol to develop this counseling intervention in the framework of a European multicenter study. We conducted a needs assessment guided by the information-motivation-behavioral (IMB) skills model, formulated change objectives and selected theory-based methods and practical strategies, i.e. interactive computer-assisted modules as supporting tools for provider-delivered counseling. Theoretical foundations were the IMB skills model, social cognitive theory and the transtheoretical model, complemented by dual process models of affective decision making to account for the specifics of sexual behavior. The counseling approach for delivering three individual sessions was tailored to participants' needs and contexts, adopting elements of motivational interviewing and cognitive-behavioral therapy. We implemented and evaluated the intervention using a randomized controlled trial combined with a process evaluation. IM provided a useful framework for developing a coherent intervention for heterogeneous target groups, which was feasible and effective across the culturally diverse settings. This article responds to the need for transparent descriptions of the development and content of evidence-based behavior change interventions as potential pillars of effective combination prevention strategies., (© The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Complex behavior change interventions need evidence regarding the effectiveness of individual components to understand how these interventions work. The objective of this study was to identify the least and most promising behavior change techniques (BCTs) within the Dutch intervention 'A Matter of Balance' (AMB-NL) aimed at concerns about falls in old age as an example. After the identification of 27 BCTs within AMB-NL, an online two-round Delphi survey among 16 international experts was conducted to reach consensus on the least and most promising BCTs. The level of consensus and the level of importance of BCTs were determined. In total, 23 of the 27 (>85%) BCTs identified reached consensus. Most promising BCTs were goal setting (behavior), graded tasks and behavioral practice/rehearsal. Information about health consequences, salience of consequences and information about emotional consequences were considered least promising. These outcomes provide a first but important step in the evidence building process regarding the effectiveness of BCTs in a complex intervention., (© The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Implementation of health education programs is often inadequately considered or not considered at all in planning, developing and evaluating interventions. With the focus being predominantly on the adoption stage, little is known about the factors influencing the implementation and continuation stages of the diffusion process. This study contributes to the understanding of factors that promote or impede each stage of the diffusion process in the school setting using the sex education program Long Live Love (LLL) as an example. A survey integrating different diffusion-related concepts was completed by 130 teachers. Results showed that teacher curriculum-related beliefs were associated with all stages in the diffusion process. Although adoption of LLL was predominantly related to teacher curriculum-related beliefs, implementation completeness and fidelity and continued use of LLL were also enhanced by contextual factors, namely teacher training and interactive context variables (school policy, governing body support and student response), respectively. The results of this study can be used to optimize the adoption, implementation and continuation of school-based (sexual) health promotion programs., (© The Author 2014. Published by Oxford University Press.)

Out-of-wedlock pregnancy among adolescents in sub-Saharan Africa is a major concern, because of its association with health, social, psychological, economic and demographic factors. This article describes the development of the Teenage Mothers Project, a community-based intervention to improve psychological and social well-being of unmarried teenage mothers in rural Uganda. We used Intervention Mapping (IM) for systematically developing a theory and evidence-based comprehensive health promotion programme. A planning group consisting of community leaders, teenage mothers, staff of a community-based organization and a health promotion professional was involved in the six steps of IM: needs assessment, programme objectives, methods and applications, intervention design, planning for adoption and implementation and planning for evaluation. The programme includes five intervention components: community awareness raising, teenage mother support groups, formal education and income generation, counselling, and advocacy. The intervention components are based on a variety of theoretical methods, including entertainment education, persuasive communication, mobilization of social networks and social action. In conclusion, IM facilitated the planning group to structure the iterative, bottom-up, participatory design of the project in a real-life setting and to use evidence and theory. The article provides suggestions for the planning of support interventions for unmarried teenage mothers., (© The Author 2014. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

The objective of this project was to develop a theory- and evidence-based adolescent smoking cessation intervention using both new and existing materials. We used the Intervention Mapping framework for planning health promotion programmes. Based on a needs assessment, we identified important and changeable determinants of cessation behaviour, specified change objectives for the intervention programme, selected theoretical change methods for accomplishing intervention objectives and finally operationalized change methods into practical intervention strategies. We found that guided practice, modelling, self-monitoring, coping planning, consciousness raising, dramatic relief and decisional balance were suitable methods for adolescent smoking cessation. We selected behavioural journalism, guided practice and Motivational Interviewing as strategies in our intervention. Intervention Mapping helped us to develop as systematic adolescent smoking cessation intervention with a clear link between behavioural goals, theoretical methods, practical strategies and materials and with a strong focus on implementation and recruitment. This paper does not present evaluation data.

Evidence-based health promotion programmes, including HIV/AIDS prevention and sexuality education programmes, are often transferred to other cultures, priority groups and implementation settings. Challenges in this process include the identification of retaining core elements that relate to the programme's effectiveness while making changes that enhances acceptance in the new context and for the new priority group. This paper describes the use of a systematic approach to programme adaptation using a case study as an example. Intervention Mapping, a protocol for the development of evidence-based behaviour change interventions, was used to adapt the comprehensive school-based sexuality education programme 'The World Starts With Me'. The programme was developed for a priority population in Uganda and adapted to a programme for Indonesian secondary school students. The approach helped to systematically address the complexity and challenges of programme adaptation and to find a balance between preservation of essential programme elements (i.e. logic models) that may be crucial to the programme's effectiveness, including key objectives and theoretical behaviour change methods, and the adaptation of the programme to be acceptable to the new priority group and the programme implementers.

Registration or recognition systems for best-practice health promotion interventions may contribute to better quality assurance and control in health promotion practice. In the Netherlands, such a system has been developed and is being implemented aiming to provide policy makers and professionals with more information on the quality and effectiveness of available health promotion interventions and to promote use of good-practice and evidence-based interventions by health promotion organizations. The quality assessments are supervised by the Netherlands Organization for Public Health and the Environment and the Netherlands Youth Institute and conducted by two committees, one for interventions aimed at youth and one for adults. These committees consist of experts in the fields of research, policy and practice. Four levels of recognition are distinguished inspired by the UK Medical Research Council's evaluation framework for complex interventions to improve health: (i) theoretically sound, (ii) probable effectiveness, (iii) established effectiveness, and (iv) established cost effectiveness. Specific criteria have been set for each level of recognition, except for Level 4 which will be included from 2011. This point of view article describes and discusses the rationale, organization and criteria of this Dutch recognition system and the first experiences with the system.

A household matched case-control study design was used to explore associations between household characteristics and malaria risk in seven study towns in the hypoendemic area of Mpumalanga Province, South Africa. Controls were identified from neighboring households of each case. Principle component analysis was used to calculate a wealth index for households to allow comparison across socioeconomic groups. Conditional univariate and multiple logistic regression analyses were used to assess associations between household malaria risk and potential risk factors. Univariate analysis demonstrated an increased household malaria risk for people living in mud-walled houses compared with those in brick dwellings (OR=5.10, 95% CI 2.03-12.80, P=0.001). Multivariate analysis confirmed the association between malaria risk and mud-wall construction (OR=6.12, 95% CI 2.26-16.59, P=0.001) and demonstrated an association with opening windows after retiring to sleep (OR=4.01, 95% CI 1.32-12.18, P=0.014). An inverse association between household wealth, third (OR=0.24, 95% CI 0.09-0.65, P=0.005) and fourth quartiles (OR=0.27, 95% CI 0.10-0.79, P=0.016), and malaria risk was observed. Associations found here include increased household malaria risk and mud-wall construction, the practice of opening of windows at night and relative household poverty. Education campaigns targeting risk behavior may reduce malaria risk, but economic development is a more important intervention., (Copyright 2009 Royal Society of Tropical Medicine and Hygiene. Published by Elsevier Ltd. All rights reserved.)

The aim of this study is to demonstrate the usefulness of developing health education materials with a theoretical and empirical research basis. With a specific focus on increasing knowledge, the authors utilized well-researched principles in cognitive psychology to increase the message comprehension of an existing health education brochure. The brochure used was produced by a Dutch national campaign office for preventing alcohol abuse among undergraduate students. In two experimental studies, the original version of the brochure was compared with the theory-based modified version on measures of knowledge and psychosocial determinants of alcohol use among undergraduate university students. The results show significant differences in knowledge uptake between the two versions. In both experiments, the modified version elicited higher scores on knowledge uptake than the original version. These findings underscore the importance of theory in the design of health education brochures. Despite these positive findings, no differences in more proximal psychosocial determinants of behavior could be found. As a result, the authors conclude that principles in cognitive psychology should be complemented by determinant-specific theory-driven change methods if behavior change is to occur.

Since the Lalonde report, contemporary public-health theory has given steadily more attention to the role of environments in influencing health status. Environments, both social and physical, influence health directly or through complex interactions with behavior, genetics and health-care systems. They are also important for public-health because environments are the complex systems through which people are both empowered and exercise their empowerment. If public-health professionals are to play a significant role in influencing environments for health, they need analytical instruments that enable them to link specific environmental conditions with the actions necessary to improve them. These instruments must also enable public-health professionals to identify points of leverage for stimulating key actors to take the actions necessary to make environments more promoting of health. This article first presents one such analytical instrument. Then, building on examples relating to socio-economic health inequities, the analytical instrument is applied to reveal how it can add value to health professionals' effectiveness in planning interventions for more health-promoting environments.

Background: Smoking during pregnancy can have many serious consequences. As the usual providers of pregnancy care in the Netherlands, midwives could serve as effective counsellors to pregnant women about cigarette smoking. The aim of the present study was to identify relevant factors that hamper or promote the provision of effective smoking cessation advice and counselling., Methods: Questionnaires were mailed to midwives; 237 (64.4%) were returned. Questions were asked about advantages and disadvantages of giving smoking cessation advice, perceived health benefits for mother and child, smoking behaviour and normative beliefs of colleagues, self-efficacy and role definition of midwives with regard to giving smoking cessation advice., Results: Midwives who have a more positive role definition regarding giving smoking cessation advice are more convinced of the advantages of giving advice, the advantages of quitting for their clients and perceive more support from their colleagues with regard to giving advice., Conclusion: In general, midwives were motivated to provide their clients with smoking cessation advice. They were less comfortable with guiding women through the cessation process. Therefore, effective materials and training should be developed to facilitate and stimulate midwives in their role as effective counsellors.

Environmental interventions such as labeling and an increased availability of healthy foods may help consumers to meet guidelines for a healthy diet. This article describes a study into the effectiveness of two environmental programs to be used in worksite cafeterias along with an educational program. The aim of the interventions was to reduce fat intake, and to increase fruit and vegetable intake. In the labeling program, low-fat products were labeled. The food supply program comprised an increased availability of low-fat products and fruits and vegetables in worksite cafeterias. The educational program consisted of information about healthy nutrition through brochures, table tents, a self-help manual and posters. The design consisted of a pre-test-post-test experimental control group design, with four conditions: the educational program; the food supply program plus educational program; the labeling program plus educational program; and a control group. Seventeen worksites were randomly assigned to one of the four research conditions. Total fat, fruit and vegetable intake was measured with a quantitative, self-administered food frequency questionnaire (35 questions). Intake during lunch was measured by asking respondents to write down which food items they had purchased during their last lunch in the cafeteria. Furthermore, sales data for some targeted product categories were collected (milk, butter, cheese, meat products, desserts). For the whole study population, no significant effects on consumption data were found for any of the programs. The data showed a beneficial and significant treatment effect of the labeling program on total fat intake for respondents who believed they ate a high-fat diet. Sales data revealed a significant effect of the labeling program on desserts, but not for the other products.

To date, comprehensive community health projects have not been evaluated in terms of their effect at the individual level, because outcomes are usually not defined at this level. In a community health project in The Netherlands, evaluation outcome mapping, a technique derived from intervention mapping, was used to identify distal as well as proximal programme objectives from which outcome measures could be derived. The intervention took place in a deprived area, where community members themselves defined stress, lack of area safety and parenting problems as the health-related problems they wanted to see addressed in the project. Local organizations wrote and implemented an action plan. The effects among residents were studied in a quasi-experimental design. Although no significant effects on improved perceived health or health-related problems were found at the level of the residents, the problems identified and their assumed causes showed significant coherence. This study is believed to be of relevance to evidence-based health promotion theory and practice as it demonstrates that it is possible to conduct an individual effect evaluation in a comprehensive community approach without jeopardizing the process of the intervention.

In many Western societies, drug users are accountable for heterosexual transmission of HIV. Although various studies have shown that safe sex is not a common practice among drug users, we still have little understanding of the factors that determine their use of condoms in their sexual relationships with steady or casual partners. The objective of this study is to gain more insight into the determinants of drug users' condom use with steady and casual sex partners. In a study conducted among 103 Dutch drug users, the participants indicated their intentions, vulnerability, attitude, personal norms, subjective norms, descriptive norms, self-efficacy and response efficacy regarding condom use with steady and casual partners. The results showed that some drug users had borrowed used syringes and that most drug users practise unsafe sex, especially with steady partners. Most drug users were hardly motivated to start using condoms. The study further showed that antecedents of condom use differ with regard to steady sex partners and casual sex partners. Self-efficacy and subjective norms were predictors of intentions to use condoms with steady partners; intention to use condoms with casual partners was only predicted by self-efficacy. These differences should be taken into account when designing AIDS prevention interventions to encourage use of condoms.

The effect of fear arousal on attitude toward participating in early detection activities [i.e. breast self-examination (BSE)] was studied from an information-processing perspective. It was hypothesized that fear arousal motivates respondents to more argument-based processing of fear-relevant persuasive information. Respondents first read information about breast cancer in which fear was manipulated. After measuring fear arousal, respondents read a persuasive message about performing BSE. Analyses with reported fear, but not manipulated fear, found support for the hypothesis. Respondents who reported mild fear of breast cancer based their attitude toward BSE more on the arguments provided than respondents who reported low fear of breast cancer. This finding suggests that the use of fear arousal may be an efficient tool in health education practice. However, alternative interpretations are provided, in addition to the suggestion to be careful with using fear arousal in health education messages.

Background and Purpose: The purpose of this case report is to describe the use of end-range mobilization techniques in the management of patients with adhesive capsulitis., Case Description: Four men and 3 women (mean age=50.2 years, SD=6.0, range=41-65) with adhesive capsulitis of the glenohumeral joint (mean disease duration=8.4 months, SD=3.3, range=3-12) were treated with end-range mobilization techniques, twice a week for 3 months. Indexes of pain, joint mobility, and function were measured by the same observer before treatment, after 3 months of treatment, and at the time of a 9-month follow-up. In addition, arthrographic assessment of joint capacity (ie, the amount of fluid the joint can contain) and measurement of range of motion of glenohumeral abduction on a plain radiograph were conducted initially and after 3 months of treatment., Outcomes: After 3 months of treatment, there were increases in active range of motion. Mean abduction increased from 91 degrees (SD=16, range=70-120) to 151 degrees (SD=22, range=110-170), mean flexion in the sagittal plane increased from 113 degrees (SD=17, range=90-145) to 147 degrees (SD=18, range=115-175), and mean lateral rotation increased from 13 degrees (SD=13, range=0-40) to 31 degrees (SD=11, range=15-50). There were also increases in passive range of motion: Mean abduction increased from 96 degrees (SD=18, range=70-125) to 159 degrees (SD=24, range 110-180), mean flexion in the sagittal plane increased from 120 degrees (SD=16, range=95-145) to 154 degrees (SD=19, range=120-180), and mean lateral rotation increased from 21 degrees (SD=11, range=10-45) to 41 degrees (SD=8, range=35-55). The mean capacity of the glenohumeral joint capsule (its ability to contain fluid) increased from 10 cc (SD=3, range=6-15) to 15 cc (SD=3, range=10-20). Four patients rated their improvement in shoulder function as excellent, 2 patients rated it as good, and 1 patient rated it as moderate. All patients maintained their gain in joint mobility at the 9-month follow-up., Discussion: There seems to be a role for intensive mobilization techniques in the treatment of adhesive capsulitis. Controlled studies regarding the effectiveness of end-range mobilization techniques in the treatment of adhesive capsulitis are warranted.

World-wide a number of groups have sought ways to incorporate health messages into television entertainment like popular drama and soap serials. In the Netherlands, the Heart Foundation incorporated its cardiovascular health message in several episodes of a popular Dutch hospital serial called Medisch Centrum West. To obtain greater insight into the impact of this so-called 'entertainment-education (E & E) strategy', an evaluation study was carried out. Medisch Centrum West was both entertaining and informative at the same time. Although viewers were well aware that the programme included a health message, they did not find it intrusive to their enjoyment of the storyline. It was interesting to learn that fans were more tolerant and positive towards the E & E strategy than non-fans. Age, sex and education level explained only 5% of the variance.

Objective: To assess satisfaction of patients who participate in clinical trials requiring informed consent and to analyse factors determining patient satisfaction., Setting: The survey took place in 26 clinical trials at the University Hospital Maastricht (azM), The Netherlands., Design and Study Participants: A personal interview and telephone questionnaire were used consecutively (n= 135; 135 out of 172=78.5% response rate) to measure patient's expectancies before starting the trial during the informed consent procedure and to evaluate aspects of trial participation. An additional control group of 34 patients was interviewed only by telephone (100% response)., Measures: Satisfaction was assessed in two distinct ways: first, by measuring the patient's subjective evaluation of several aspects of trial participation; secondly, by comparing prior expectations and subsequent evaluations. Patient satisfaction was subdivided with respect to medical-technical, interpersonal and organizational aspects of trial participation. Changes in patient's health and illness perceptions were regarded as confounding factors in the relationship between satisfaction and its possible causes., Results: Although patient satisfaction was quite high, dissatisfaction with aspects of trial participation became apparent when both prior expectations and subsequent evaluations were compared with each other., Conclusion: Prior expectations and general attitudes towards medical care and research before entering the trial have an impact on satisfaction with aspects of trial participation (10-20% explained variance). No linear relationship was found between perceived improvements in health and illness conditions and patient satisfaction with trial participation.

This paper reports research into the determinants of four cancer-related risk behaviours: smoking, excessive alcohol consumption, high fat consumption and exposure to artificial sunlight. The results indicate that the four types of risk behaviour are determined by several factors: the perceived behaviour of the social environment, individual's attitudes towards the risk behaviour and self-efficacy perceptions on changing the risk behaviour. High fat consumption differs from the other risk behaviours in that people tend not to be aware of their high fat consumption. No significant relationships were found among the risk behaviours apart from small correlations between smoking and heavy alcohol consumption, and between high fat consumption and heavy alcohol consumption. The implications of these results for the development of behaviour change programs are discussed.

Background and Purpose: This correlational study describes factors that are related to patient compliance with exercise regimens during physical therapy. We investigated whether patient compliance was related to characteristics of the patient or the patient's illness, to the patient's attitude, or to the physical therapist's behavior., Subjects and Methods: Of a random sample of 300 physical therapists in private practice in the Netherlands, 222 therapists responded to a questionnaire survey. Eighty-four respondents also made audio recordings. Materials of the study were 1,931 registration forms, 1,837 audio-recorded sessions of physical therapy sessions, and 1,681 patient questionnaires., Results: The results show that the three main factors related to noncompliance were (1) the barriers patients perceive and encounter, (2) the lack of positive feedback, and (3) the degree of helplessness. The first factor, the barriers patients perceive and encounter, shows the strongest relation with noncompliance. The results also show that noncompliance is more strongly related to the characteristics of the illness than to the illness, a bad prognosis is negatively related to compliance, and much hindrance of the complaint is positively related to compliance. There was no difference between men and women with regard to patient compliance, but less educated patients were slightly more compliant than more highly educated patients., Conclusion and Discussion: These correlational findings can be used to formulate hypotheses of cause and effect in future clinical research. Future research should take into account the type and efficacy of therapeutic exercise for different diseases. For physical therapy practice, it seems important that physical therapists carefully explore which problems patients encounter in their efforts to comply and that they seek solutions to those problems in mutual cooperation with their patients.

In this study, exploring the worry experienced by patients in the GP waiting room and the reasons for being worried, 791 patients completed a structured questionnaire just before they consulted their GP, and afterwards. The perceptions of the patients concerning the complaint and the need for more information about the complaint played an important role in the degree of worry. Patients who wanted more information about the complaint were more worried than the patients who did not feel they needed more information. Not surprisingly, the more serious the patients perceived the complaint to be and the greater the perceived chance of serious disease, the more worried they were. General health status and frequency of consultations per year were related to the degree of general worry. According to the patient self-reports, worry was almost never due to information from the mass media or from other persons, or to a concern for the consultation itself. Patients generally evaluated the consultation as positive with respect to the way their worry was discussed. The decrease in worry after consulting the GP, in patients who were positive about the consultation was significantly higher than that in patients who were less positive. The theoretical and practical implications of this study are discussed.