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Anne Lambert-Kerzner,1,2 Edward P Havranek,2,3 Mary E Plomondon,1,2 Katherine M Fagan,1 Marina S McCreight,1 Kelty B Fehling,1 David J Williams,2 Alison B Hamilton,4 Karen Albright,2 Patrick J Blatchford,2 Renee Mihalko-Corbitt,5 Chris L Bryson,6 Hayden B Bosworth,7 Miriam A Kirshner,7 Eric J Del Giacco,5 P Michael Ho1,2 1Department of Cardiology, Veterans Health Administration (VA) Eastern Colorado Health Care System, Denver, CO, 2School of Public Health or School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO, 3Cardiology, Denver Health Medical Center, Denver, CO, 4Health Services Research, Veterans Health Administration (VA) Greater Los Angeles Healthcare System, Los Angeles, CA, 5Internal Medicine, John L. McClellan Memorial Veterans Hospital, Little Rock, AR, 6Health Services Research, Veterans Health Administration (VA) Puget Sound Health Care System, Seattle, WA, 7Health Services Research, Durham Veterans Affairs Medical Center, Durham, NC, USA Purpose: Poor adherence to cardioprotective medications after acute coronary syndrome (ACS) hospitalization is associated with increased risk of rehospitalization and mortality. Clinical trials of multifaceted interventions have improved medication adherence with varying results. Patients’ perspectives on interventions could help researchers interpret inconsistent outcomes. Identifying factors that patients believe would improve adherence might inform the design of future interventions and make them more parsimonious and sustainable. The objective of this study was to obtain patients’ perspectives on adherence to medical regimens after experiencing an ACS event and their participation in a medication adherence randomized control trial following their hospitalization. Patients and methods: Sixty-four in-depth interviews were conducted with ACS patients who participated in an efficacious, multifaceted, medication adherence randomized control trial. Interview transcripts were analyzed using the constant comparative approach. Results: Participants described their post-ACS event experiences and how they affected their adherence behaviors. Patients reported that adherence decisions were facilitated by mutually respectful and collaborative provider–patient treatment planning. Frequent interactions with providers and medication refill reminder calls supported improved adherence. Additional facilitators included having social support, adherence routines, and positive attitudes toward an ACS event. The majority of patients expressed that being active participants in health care decision-making contributed to their health. Conclusion: Our findings demonstrate that respectful collaborative communication can contribute to medication adherence after ACS hospitalization. These results suggest a potential role for training health-care providers, including pharmacists, social workers, registered nurses, etc, to elicit and acknowledge the patients’ views regarding medication treatment in order to improve adherence. Future research is needed with providers to understand how they elicit and acknowledge patients’ views, particularly in the face of nonadherence, and with patients to understand how to empower them to share their opinions with their providers. Keywords: cardiovascular disease, compliance, qualitative analysis, medications

A major function of the helping professions is to promote quality of life (QOL) for all people. Since this concept is commonly embodied in ethics codes within the various human services, it can be easy for professionals to assume that clients share the same perceptions of our function, However, when working with offenders, this assumption, along with the QOL concept, may have unique ramifications to the therapeutic process. The purpose of this study was to explore QOL perceptions of offenders and subsequent therapeutic implications. Participants were 23 sex offenders who were released from jail or prison to attend treatment at a community correctional center. Qualitative and quantitative methods were used to assess offenders' QOL perceptions, and findings are discussed in relation to efforts to improve offender rehabilitation. KEYWORDS Offender rehabilitation, quality of life, psychotherapy, halfway house, therapeutic alliance, sex offenders

Objective: Women with pre-eclampsia have elevated circulating levels of soluble fms-like tyrosine kinase-1 (sFlt-1). Statins can reduce sFlt-1 from cultured cells and improve pregnancy outcome in animals with a pre-eclampsia-like syndrome. We investigated the effect of pravastatin on plasma sFlt-1 levels during pre-eclampsia.Design: Blinded (clinician and participant), proof of principle, placebo-controlled trial.Setting: Fifteen UK maternity units.Population: We used a minimisation algorithm to assign 62 women with early-onset pre-eclampsia (24+0 -31+6  weeks of gestation) to receive pravastatin 40 mg daily (n = 30) or matched placebo (n = 32), from randomisation to childbirth.Primary Outcome: Difference in mean plasma sFlt-1 levels over the first 3 days following randomisation.Results: The difference in the mean maternal plasma sFlt-1 levels over the first 3 days after randomisation between the pravastatin (n = 27) and placebo (n = 29) groups was 292 pg/ml (95% CI -1175 to 592; P = 0.5), and over days 1-14 was 48 pg/ml (95% CI -1009 to 913; P = 0.9). Women who received pravastatin had a similar length of pregnancy following randomisation compared with those who received placebo (hazard ratio 0.84; 95% CI 0.50-1.40; P = 0.6). The median time from randomisation to childbirth was 9 days (interquartile range [IQR] 5-14 days) for the pravastatin group and 7 days (IQR 4-11 days) for the placebo group. There were three perinatal deaths in the placebo-treated group and no deaths or serious adverse events attributable to pravastatin.Conclusions: We found no evidence that pravastatin lowered maternal plasma sFlt-1 levels once early-onset pre-eclampsia had developed. Pravastatin appears to have no adverse perinatal effects.Tweetable Abstract: Pravastatin does not improve maternal plasma sFlt-1 or placental growth factor levels following a diagnosis of early preterm pre-eclampsia #clinicaltrial finds. [ABSTRACT FROM AUTHOR]

Years ago, a small handful of leisure scholars suggested that serial murder may be a form of leisure. However, to date this possibility remains virtually unexplored. This article draws from recent research to share reflections and rich, new insights on how leisure science may provide important contributions to serial homicide researchers and law enforcement personnel. At the same time, exploring such intersections offers leisure scholars new ways of understanding familiar concepts and theories. Possibilities for future research are discussed. [ABSTRACT FROM AUTHOR]

In recent years, there has been considerable attention within the social work profession surrounding diverse personal, family, and community issues pertaining to sexuality, yet social workers typically receive very little training on sexuality. This article discusses several such issues before introducing a recently proposed positive sexuality framework, which was designed to help facilitate sexual diversity and resolve a wide range of sociosexual problems. The positive sexuality framework is comprised of eight interrelated dimensions and, while designed to address sexual issues specifically, overlaps with and complements social work generalist practice. Thus, social workers and helping professionals may find increased success in better understanding and addressing a wide variety of sociosexual problems and issues by utilizing a positive sexuality framework in conjunction with generalist practice. [ABSTRACT FROM AUTHOR]

Introduction Recent studies have suggested that, in contrast to traditional psychopathologic explanations, bondage and discipline, dominance and submission, and sadomasochism (BDSM) could be understood as recreational leisure. However, the theoretical framing of BDSM as potential leisure has not been empirically explored. Aim To conduct an initial empirical exploration to determine whether BDSM experience fits established characteristics of recreational leisure. Methods A convenience sample of BDSM participants (N = 935) completed an online survey (9 demographic questions and 17 leisure questions) that assessed BDSM experience according to important attributes of leisure. Responses also were assessed and statistically compared as being primarily casual or serious leisure according to general BDSM identities (ie, dominants vs submissives vs switches). Main Outcome Measures BDSM experiences were assessed as a form of potential leisure. Results Most BDSM experiences met leisure criteria. Participants reported that “most of the time or nearly always” BDSM was associated with a sense of personal freedom (89.7% of participants), pleasure or enjoyment (98.5%), sense of adventure (90.7%), use of personal skills (90.8%), relaxation or decreased stress (91.4%), self-expression or exploration (90.6%), and positive emotions (96.6%). BDSM seemed to function as primarily serious, rather than casual, leisure, but important statistical differences were observed based on specific BDSM identities. Conclusion A leisure science perspective could be valuable to researchers and clinicians in reinterpreting the wide range of diverse BDSM motivations and practices. [ABSTRACT FROM AUTHOR]

This article calls for a more thorough exploration of the concept of deviant leisure. Although deviant leisure often relies on psychiatric discourse as a primary explanation for participation, many forms of deviant leisure cannot be explained convincingly through accounts that focus on psychopathological motivations. Examples discussed herein include consensual sexual sadomasochism, self-identified human vampires, and radical body modification. Such forms of deviant leisure may be better understood by focusing on diverse social discourses and the properties of legitimate leisure experience. [ABSTRACT FROM AUTHOR]

Background. The new General Medical Services (nGMS) contract was introduced in April 2004 to improve care of chronic diseases such as coronary heart disease (CHD) and reduce differences in treatment between patient subgroups. Objective. To determine whether the recording of CHD-related health indicators and prescribing of medicines have increased following the introduction of the nGMS contract and whether differences in the treatment of patients of differing age, gender and deprivation have been affected. Methods. A serial cross-sectional study carried out with 310 general practices in Scotland. The subjects were patients with CHD as identified by their GP. Main outcome measures were the recording of CHD-related health indicators and prescribing of medicines at pre- and post-contract time points (covariates: gender, age, co-morbidity, deprivation and practice size). Results. The recording of CHD-related quality indicators and prescribing increased dramatically (mean absolute increase of 17.1%) after the introduction of the nGMS contract. Post-contract, disparities between patient subgroups, continued for certain components of care. Women were less likely to be recorded than men in 9 of 11 components of care, with older patients (7 of 11 components of care) and the most deprived (4 of 11 components of care) also less likely to have a record than the youngest and least deprived, respectively. Conclusion. The introduction of the new contract was associated with a dramatic rise in the recording of CHD-related quality indicators. However, not all the population benefited equally for certain aspects of care. [ABSTRACT FROM AUTHOR]

Perceptions of risk are an inherent part of the decision-making process. What is more, risk perception can be understood as an individual's assessment of risk, and the adequacy of any risk assessment is reliant on the adequacy of the accessible risk information. Consequently, one way to understand the effect of risk perception on decision-making, and the approach taken in this literature review, is to understand how risk information is communicated and received by an individual. A number of factors are identified that have been found to influence perceptions of risk, which are related to the design of risk messages: the message (colour, signal word, surround shape, and the framing effect), the source of the message (credibility and trust), and the target of the message (risk target). It is concluded that, in order to design effective risk communications, and to facilitate decision-making and safe behaviour, these factors need to be considered, in a context-dependent manner. [ABSTRACT FROM AUTHOR]

BACKGROUND: In April 2004, an incentive based contract was introduced to UK primary care. An important element of the new contract is the ability to exclude individuals from quality indicators for a variety of reasons (known as 'exception reporting'). Exception of patients with stroke or TIA from the recording and achievement of quality indicators may have important consequences in terms of stroke recurrence and mortality. METHODS: A cross-sectional retrospective analysis of anonymised patient data was performed using 312 Scottish primary care practices. RESULTS: Patients recorded as unsuitable for inclusion in the contract were more likely to be female (odds ratio (OR) 1.51, 95% confidence interval (CI) 1.36-1.68), older (>75 years:OR 3.15, 95%CI 2.69-3.69), and have dementia (OR 4.40, 95%CI 3.57-5.43) when compared to those patients without such a code. Patients were less likely to be older (>75 years:OR 0.70, 95%CI 0.56-0.87) and were more likely to be from the most deprived areas of Scotland (Quintile 5: OR 2.02, 95%CI 1.50-2.70) if they refused to attend for review or did not reply to letters asking for attendance at primary care clinics. Patients with multiple co-morbidities were more likely to have exclusions for achieving diagnostic clinical targets such as cholesterol control (3 or more co-morbidities: OR 3.37, 95%CI 2.50-4.50). CONCLUSION: Scottish practices have appeared to use exception reporting appropriately by excluding patients who are older or have dementia. However, younger or more socio-economically deprived patients were more likely to be recorded as having refused to attend for review or not replying to letters asking for attendance at primary care clinics. It is important for primary care practices to identify and monitor these individuals so that all patients fully benefit from the implementation of an incentive based contract and receive appropriate clinical care to prevent stroke recurrence, further disability and mortality. [ABSTRACT FROM AUTHOR]

This article, written primarily for clinicians, draws from a variety of sources and provides a basic overview of sexual sadomasochism (SM). SM represents a wide range of behaviors and practices often associated with sexuality, yet it may also refer to a specific lifestyle or subculture composed of participants who regularly engage in such practices. Although large numbers of individuals are likely to participate in SM practices in various possible forms, many professionals may be unfamiliar with the diversity, terminology, possible motivations, and issues surrounding SM. Given that SM is easily misunderstood, it is important for professionals working in the area of human sexuality to become familiar with alternative expressions of eroticism, creative stimulation, and intimacy. It is suggested that SM potentially may be enriching and beneficial to many who safely participate, or it sometimes may be considered pathological and destructive. Insights are provided herein to raise awareness of issues and to help clinicians negotiate these determinations. [ABSTRACT FROM AUTHOR]

Opportunities for gambling in mainstream North American society have increased greatly over the past two decades. Despite the popularity of legalized gambling and attention it is receiving among social science researchers and economists, gambling within jails and prisons has been overlooked. This study utilized a semistructured interviewing procedure (Smith, 1995) to gain information about prison gambling from 11 sexual offenders on parole—all had spent significant time incarcerated. Qualitative analyses of responses suggest that offenders may gamble in various forms and for a variety of reasons, including a means of alleviating boredom, providing excitement and risk, and an opportunity to socialize. Prison gambling appears to be a complex phenomenon. A substantial amount of prison gambling seems to be associated with certain psychosocial benefits, while for a minority of cases there may be severe violence and victimization. [ABSTRACT FROM AUTHOR]

This article explores autoethnography as a unique methodological approach to offender rehabilitation which has the potential to contribute to improving the quality of the therapeutic alliance, and thus improve forensic psychotherapy outcome. I begin by suggesting that a move toward a pluralistic epistemological stance, subsequently welcoming newer qualitative methods (in this case autoethnography) may be valuable in furthering progress within offender rehabilitation. The purposes and evaluation criteria of autoethnography are discussed: a major benefit of such an approach is that it highlights the need among practitioners for us to correct ourselves, as much or more than the need for us to correct them (offenders). Indeed, autoethnography adds a fresh and unique perspective to issues within offender rehabilitation and shows the common ground that we, as humans, share, despite the many artificial divisions that we intentionally or unintentionally create and maintain. [ABSTRACT FROM AUTHOR]

The article reflects on the author's professional work as a forensic leisure scientist. According to the author, he is interested in leisure patterns which is associated with crime and offender rehabilitation. He added that leisure science has much to offer the world of forensics wherein forensics has also much to offer leisure. He defines forensics as a term that broadly refers to law or the legal system wherein a forensic setting includes court rooms, police station, correctional institutions and crime laboratories.

Physical education, medicine, public health, psychology, and the helping professions have traditionally delivered services from a problem focused paradigm. In other words, assessments are conducted, problems are identified, and approaches are proposed based on the best available evidence of problem etiology. Recently, however, a solution focused paradigm has emerged and is being applied in a variety of clinical contexts (De Shazer et al., 1986). The solution focused approach focuses on times when the problem is not present--or exceptions to problems--rather than problems themselves. The purpose of this article is to provide a description of the solution focused approach and to illustrate how this approach may be useful for physical educators when they encounter students of varying ages who may be reluctant to engage in school physical education activities. It is possible that physical education delivery from a solution focused paradigm may have future public health implications. [ABSTRACT FROM AUTHOR]

Since the 1970s individual states in the United States have enacted mandatory long-term sentencing laws for drug offenses. These laws resulted in a 12-fold increase in prison population. The majority of people sentenced under these laws are nonviolent, first-time felony offenders with no or minimal drug use history. Based on open-ended qualitative interviews with 12 formerly incarcerated men and women sentenced for 15-20 years under these laws, the author describes the psychological, familial and social consequences of these mandatory long-term sentencing laws for drug offenses. [ABSTRACT FROM AUTHOR]

This study examined the responses of nine sex offenders who have participated in multiple sex offender treatment programs, regarding their personal treatment experiences. A questionnaire was administered that included open-ended questions about content and process issues in sex offender therapy. Qualitative analysis revealed that process issues are central to the sex offender treatment experience, and that there are vast perceived differences with respect to three interrelated emergent themes: offenders' trust toward individual professionals, the overall motivational climate between various programs, and openness and acceptance by professionals. Findings seem to illuminate substantial variation in professionals' attitudes and practices that relate to correctional treatment and supervision. Subsequent implications for sex offender therapy are also discussed. [ABSTRACT FROM AUTHOR]

Retrospective testing of 3,232 serum samples from the general population and 518 serum samples from a high-risk group showed no evidence of human exposure to Neospora caninum in England. Results were obtained by using immunofluorescence antibody testing and ELISA to analyze frequency distribution. [ABSTRACT FROM AUTHOR]

A priority translational research objective in cancer medicine is the discovery of novel therapeutic targets for solid tumours. Ideally, co-discovery of predictive biomarkers occurs in parallel to facilitate clinical development of agents and ultimately personalise clinical use. However, the identification of clinically useful predictive biomarkers for solid tumours has proven challenging with many initially promising biomarkers failing to translate into clinically useful applications. In particular, the 'failure' of a predictive biomarker has often only become apparent at a relatively late stage in investigation. Recently, the field has recognised the need to develop a robust clinical biomarker development methodology to facilitate the process. This review discusses the recent progress in this area focusing on the key stages in the biomarker development process: discovery, validation, qualification and implementation. Concentrating on predictive biomarkers for selecting systemic therapies for individual patients in the clinic, the advances and progress in each of these stages in biomarker development are outlined and the key remaining challenges are discussed. Specific examples are discussed to illustrate the challenges identified and how they have been addressed. Overall, we find that significant progress has been made towards a formalised biomarker developmental process. This holds considerable promise for facilitating the translation of predictive biomarkers from discovery to clinical implementation. Further enhancements could eventually be found through alignment with regulatory processes. [ABSTRACT FROM AUTHOR]