bluuebunny/crossref_metadata_2025 huggingface dataset:
Determining the optimal dose of haloperidol in first-episode psychosis
Authors: Oosthuizen Piet , Emsley Robin A. , Turner Jadri , Keyter Natasha
Published: April 2009

Uncertainty exists as to the most appropriate dose of haloperidol in first-episode psychosis. This study set out to determine whether ultra-low doses of haloperidol could successfully treat patients with first-episode psychosis. Thirty-five patients with a first episode of psychosis were treated with haloperidol in an open label, fixed protocol over a 12-week period with doses restricted to 1 mg per day for the first 4 weeks. Twenty-nine (83%) remained on haloperidol after 12 weeks at a mean dose of 1.78 mg per day, 16 (55%) had stabilized on 1 mg/day or less. The mean percentage reduction in Positive and Negative Symptom Scale score between baseline and 6 and 12 weeks was 30.3% (SD 20.9%) and 41.4% (SD 16.6%), respectively. There were no significant differences in mean extrapyramidal symptom ratings between baseline and 12 weeks. Ultra-low doses of haloperidol are effective and well tolerated in first-episode psychosis. Initial doses should be maintained for a sufficient period of time to allow for the medication to take full effect.
Ecstasy use: cognitive deficits related to dosage rather than self-reported problematic use of the drug
Authors: Fox H. C. , Parrott A. C. , Turner J. J. D.
Published: April 2009

Previous research has shown drug-free Ecstasy users to demonstrate selective cognitive impairment However, there seems to be a degree of individual variation in the occurrence of such deficits. The present study aimed to assess whether these cognitive deficits are related to an awareness of problematic Ecstasy use, or to past drug dosage. Twenty regular Ecstasy users who reported experiencing Ecstasy-related problems were compared with 20 Ecstasy users who had not reported any previous problems. The two groups displayed similar past histories in relation to a range of illicit drugs, and were divided into low, medium and high users. The controls comprised 20 illicit recreational drug users who had never taken Ecstasy. Executive task measures comprised the Tower of London (TOL), the Wisconsin Card Sorting Task (WCST) and spatial working memory. Immediate and delayed word recall, matched verbal recognition and recall and simple reaction time were also included. Both Ecstasy groups performed significantly worse than controls on two executive measures: TOL planning time and spatial working memory score. There were no differences in cognitive impairment between the Ecstasy users who complained of problems and those who did not. In both groups, decrement on executive tasks was demonstrated as a function of previous drug dose. The study confirms that heavy Ecstasy polydrug use may culminate in selective executive deficits. It also demonstrates that two differently self-perceived Ecstasy groups showed similar cognitive impairment, despite only one group complaining of problems. Because all Ecstasy participants also consumed a range of other illicit drugs, the results are reflective of Ecstasy polydrug use in individuals who use Ecstasy as a drug of preference.
Augmenting antipsychotic treatment with lamotrigine or topiramate in patients with treatment-resistant schizophrenia: a naturalistic caseseries outcome study
Authors: Dursun S. M. , Deakin J. F. W.
Published: April 2009

The glutamate hyperfunction hypothesis of schizophrenia has been proposed largely on the basis of studies in post-mortem brain and the lack of efficacy of glutamate agonists as antipsychotic drugs. Recent reports have also suggested that the addition of lamotrigine, a glutamate excess release inhibitor, can cause a dramatic improvement in clozapine treatment-resistant patients, as well as attenuate the neuropsychiatric effects of ketamine in healthy volunteers. To explore the glutamate hyperfunction hypothesis, patients with schizophrenia who were treatment-resistant to current antipsychotic medications were augmented with either lamotrigine (n = 17) or topiramate (a glutamate kainate/α-amino-3-hydroxy-5-methyl-4-isoxazolaproprionate antagonist that potentiates GABA function) (n = 9) for 24 weeks. Patients receiving lamotrigine augmentation of clozapine had a significant decrease in Brief Psychiatric Rating Scale score after 2 weeks of treatment. There was no significant improvement when lamotrigine was added to risperidone, haloperidol, olanzapine or fluphenthixol. There was also no significant improvement observed with topiramate augmentation of clozapine, olanzapine, haloperidol and fluphenthixol. These preliminary data support previous evidence that lamotrigine is an effective augmentation agent for clozapine. Although limited by sample size, the findings also suggest glutamate hyperfunction in schizophrenia may have a presynaptic basis and that atypicals with low dopamine receptor occupancy may have antagonistic actions on glutamate function which confer additional antipsychotic activity.
Effect of intracerebroventricular injection of GABA receptor agents on morphine-induced antinociception in the formalin test
Authors: Mahmoudi Mitra , Zarrindast Mohammad-Reza
Published: April 2009

In the present study, the effects of γ-aminobutyric acid (GABA) receptor agonists and antagonists on antinociception induced by morphine in the formalin test were investigated in rats. Intraperitoneal (i.p.) injection of different doses of morphine (1, 3, 6 and 9 mg/kg) and intracerebroventricular (i.c.v.) injection of different doses of muscimol (0.5, 1 and 2 μg per rat) or baclofen (0.25, 0.5 and 1 μg per rat) induced a dose-related antinociception in the both first and second phases of the formalin test. The responses induced by muscimol or baclofen in both phases were reduced by bicuculline or CGP35348 [p-(3-aminopropyl)-p-diethoxymethyl-phosphinic acid], respectively. Bicuculline alone has produced antinociception in the second phase and CGP35348 alone has had antinociception in both phases of the formalin test. Morphine in combination with different doses of muscimol or baclofen did not elicit potentiation. The opioid receptor antagonist naloxone reduced the response induced by muscimol in the second phase and baclofen in both phases of the formalin test. It may be concluded that central GABAA and GABAB receptor stimulation induces antinociception in the formalin test. However, the antinociception induced by GABA receptor agonists may be mediated partly through supraspinal opioid receptor mechanisms and, for the GABAB receptor agonist, through spinal and supraspinal opioid receptor mechanisms.
Anxiogenic and depressive-like effects, but no cognitive deficits, after repeated moderate tryptophan depletion in the rat
Authors: Blokland Arjan , Lieben Cindy , Deutz Nicolaas E. P.
Published: April 2009

The tryptophan (TRP) depletion method has been used as a tool to investigate the effects of acute lowered serotonin levels in the brain. In the present study, the effects of this treatment were investigated in rat models of anxiety (open field test, home cage emergence test), depression (forced swimming test, sucrose preference test) and cognition (spatial discrimination learning, sustained attention). It was found that the repeated TRP depletion increased anxiety-related behaviour in the open field test and increased immobility in the forced swimming test. The other behavioural tests did not reveal effects of treatment. TRP levels were decreased in plasma (34%) and hippocampus (33%) but not in the cortex. Stress-induced corticosterone levels were not affected after TRP depletion. The present findings indicate that repeated moderate TRP depletion leads to anxiogenic and depressive-like behaviour in the rat and corroborates the notion of the involvement of serotonin in these behaviours.
The cost-effectiveness of clozapine: a controlled, population-based, mirror-image study
Authors: Hayhurst K. P. , Brown P. , Lewis S. W.
Published: April 2009

A retrospective cohort study, with a mirror-image design, was used to measure inpatient service utilization in 63 consecutive patients started on clozapine from a geographical catchment area compared to a control group matched for previous inpatient service use. An intent-to-treat analysis, including those patients (n = 28) who discontinued clozapine during the study period, showed a significant reduction in number of admissions and total time spent in hospital in the 2 years following clozapine initiation compared to the previous 2 years and to the follow-up period in the control group. This translated into a reduction of £7300 in hospitalization costs per patient started on clozapine, over the 2-year period. In those patients who continued clozapine treatment for the whole of the 2-year period, there was a two-thirds reduction in number of admissions and total time spent in hospital compared to no change in the clozapine discontinuers. These findings suggest that clozapine is a clinically and cost-effective intervention for severe schizophrenia in routine clinical settings.
Evaluation of EMD 128 130 occupancy of the 5-HT1A and the D2 receptor: a human PET study with [11]WAY-100635 and [11C]raclopride
Authors: Rabiner Eugenii A. , Gunn Roger N. , Wilkins Martin R. , Sedman Ewen , Grasby Paul M.
Published: April 2009

The use of so-called, atypical antipsychotic medication is becoming more widespread in the treatment of psychotic disorders. EMD 128 130 is a novel compound acting as an agonist at the 5-HT1A receptor, and as an antagonist at the dopamine-2 (D2) receptor. This dual action may confer additional benefits over selective D2 antagonists in the treatment of psychotic disorders. In this study, we investigated the occupancy of EMD 128 130 in vivo at the human D2 and 5-HT1A receptors with positron emission tomography using the radiotracers [11C]raclopride and [11C]WAY-100635. Seven healthy volunteers were examined before and after 5 days of treatment with EMD 128 130, administered in an incremental dose building up to 50 mg, b.d. A significant occupancy was demonstrated at the human D2 receptor (40% following a dose of 50 mg, b.d.) while there was no consistent effect observed at the 5-HT1A receptor, despite a similar affinity of EMD 128 130 for cloned human D2 and 5-HT1A receptors, and the presence of typical, central 5-HT1A agonist side-effects. The differential effects of EMD 128 130 at the D2 and the 5-HT1A receptor (antagonist at D2 receptor, agonist at the 5-HT1A receptor) may explain the differences in occupancy observed.
Memory performance in panic disorder patients after chronic use of clomipramine
Authors: de Carvalho Stefania Caldeira , Marcourakis Tania , Artes Rinaldo , Gorenstein Clarice
Published: April 2009

This study investigated the chronic use (6.3 ± 0.5 years; mean ± SEM) of therapeutic doses of clomipramine (57.0 ± 8.0 mg/day) by outpatients with panic disorder/agoraphobia who were currently in remission to assess impairment of memory and psychomotor functions. In addition, the association between test performance and serum levels of clomipramine (CMI) and its active metabolite desmethylclomipramine (DCMI) was also assessed. Patients and healthy volunteers matched for sex, age and educational level were submitted to rating scales and to memory and psychomotor tests. There was no significant difference between groups regarding any variable, except for metamemory. Significant associations were found between (i) longer-term clomipramine treatment and poorer performance in the implicit test and (ii) higher serum levels of clomipramine or desmethylclomipramine, or both (CMI + DCMI) and lower performance in central executive tests and metamemory. The results showed that low doses of CMI chronically administered to panic patients are associated with diminished metamemory and impaired priming and working memory. Further investigations are needed to confirm these results and to determine whether the chronic use of higher therapeutic doses of tricyclic antidepressants is associated with more intense deleterious effects on memory and psychomotor functions.
Effects of 5 weeks of administration of fluoxetine and dothiepin in normal volunteers on sleep, daytime sedation, psychomotor performance and mood
Authors: Wilson S. J. , Bailey J. E. , Alford C. , Weinstein A. , Nutt D. J.
Published: April 2009

This was a placebo-controlled, double-blind randomized crossover study of long-term (5 weeks) administration of fluoxetine (20 mg/day) and dothiepin (75 mg/day for 1 week followed by 150 mg/day for 4 weeks) in 12 healthy male volunteers. Subjects were studied on day 10 and day 36 of treatment, with tests of nocturnal sleep, driving performance, continuous electroencephalogram (EEG), sleep during scheduled naps, computerized visual attention tasks, saccadic eye movement measurement and visual analogue ratings of mood. Both drugs had a marked suppressive effect on nocturnal rapid eye movement (REM) sleep; these effects were less at 36 days than at 10 days, and fluoxetine decreased and dothiepin increased REM in daytime naps. Sleep fragmentation after fluoxetine is similar to that reported in the literature. We found no sleep-promoting effects of dothiepin, in contrast to our previous single-dose study, and no subjective sleep effects of either drug. Subjects were less sleepy after both antidepressants than placebo at 5 weeks measured by sleep latencies and EEG. Saccadic eye movement measures were significantly faster after 5 weeks of fluoxetine than after 5 weeks of placebo. Reaction times to a peripheral stimulus during computerized tracking task were shorter after 10 days of dothiepin compared with placebo. Driving performance, visual attention and mood ratings showed no treatment effects. Subjective health reports during each 5 weeks of treatment were similar in number for the two drugs but showed a different profile of side-effects.
The effects of reboxetine, a noradrenaline reuptake inhibitor, on the plasma noradrenaline response to a cold pressor test in healthy volunteers
Authors: Kelly C. B. , McAree S. , Cooper S. J. , Stevenson M.
Published: April 2009

Previous studies have shown peripheral abnormalities in noradrenergic activity in depressed melancholic patients. These abnormalities have a relationship with short-term and long-term outcome. Little is known about the effects of antidepressant treatment on these peripheral measures such as plasma noradrenaline (NA) and the plasma NA response to a laboratory stressor, the cold pressor test (CPT). The present study examines the effects of the antidepressant reboxetine, a noradrenaline reuptake inhibitor, on baseline plasma NA and the plasma NA response to a CPT, in nine healthy volunteers compared to placebo. A double-blind crossover design was used, with each agent given for 4 weeks with a 4-week washout period. There was no effect of reboxetine on baseline plasma NA. The plasma NA response to reboxetine, with a CPT, was blunted 3 days after commencing treatment. Reboxetine alters the plasma NA response to a CPT independent of baseline plasma NA.
Efficacy of olanzapine in social anxiety disorder: a pilot study
Authors: Barnett Stewart D. , Kramer Michelle L. , Casat Charles D. , Connor Kathryn M. , Davidson Jonathan R. T.
Published: April 2009

Based on evidence suggesting anxiolytic properties of the atypical antipsychotic olanzapine, this study was conducted to evaluate whether olanzapine may be efficacious in treating social anxiety disorder (SAD). This study was an 8-week, double-blind, placebo-controlled evaluation of olanzapine as monotherapy in which 12 patients with the DSM-IV diagnosis of SAD were randomized to either olanzapine (n= 7) or placebo (n= 5). An initial dose of 5 mg/day was titrated to a maximum of 20 mg/day. Baseline to endpoint scores from the Brief Social Phobia Scale (BSPS), Social Phobia Inventory (SPIN), Liebowitz Social Anxiety Scale and Sheehan Disability Scale, as well as Clinical Global Impression-Improvement ratings, were compared for olanzapine versus placebo. Seven subjects completed all 8 weeks of the study, four in the olanzapine group and three in the placebo group. In the intent-to-treat analysis, olanzapine yielded greater improvement than placebo on the primary measures: BSPS (p= 0.02) and SPIN (p= 0.01). Both treatments were well tolerated, although the olanzapine group had more drowsiness and dry mouth. Olanzapine and placebo were both associated with negligible weight gain. Olanzapine was superior to placebo on the primary outcome measures in this preliminary study of SAD. Additional studies of olanzapine as a treatment for SAD are warranted.
Selective processing of smoking-related cues in smokers: manipulation of deprivation level and comparison of three measures of processing bias
Authors: Mogg Karin , Bradley Brendan P.
Published: April 2009

Recent theories of addiction suggest that an attentional bias for drug-related cues plays an important role in maintaining drug-taking behaviours. A key feature of the present study is that it used three different meas ures of processing bias for linguistic and pictorial smoking-related cues: masked and unmasked conditions of the modified Stroop task, and a pictorial version of the visual probe task. Participants were smokers (n= 27), who were tested twice, with deprivation level manipulated as a within-subjects variable. They were asked to abstain from smoking for 12 h before one session, and to smoke normally before the other. Results were consistent with an attentional bias for smoking-related pictures on the visual probe task, and for smoking-related words in the unmasked condition of the modified Stroop task. The latter bias was most strongly predicted by self-reported urge to smoke, rather than by the deprivation manipulation. There was no evidence of a preconscious bias for smoking cues. The three measures of cognitive bias (from masked and unmasked Stroop and visual probe tasks) were not significantly correlated with each other, which suggests they may tap different underlying mechanisms. We discuss the results with respect to conceptualizations ofselective attention, addiction and motivational states in general.
Serum levels of clomipramine and desmethylclomipramine and clinical improvement in panic disorder
Authors: Marcourakis T. , Gorenstein C. , Ramos R. T. , da Motta Singer J.
Published: April 2009

Several placebo-controlled trials have shown the effcacy of clomipramine (CMI) in panic disorder. However, none has investigated the relationship between CMI, and desmethylclomipramine (DCMI) plasma levels, and outcome. In this trial, 41 patients meeting the DSM-III-R criteria for panic disorder with/without agoraphobia received 50-200 mg of CMI daily in a single-blind, flexible dose regimen for 14 weeks. At the end of treatment, 97% of the patients were free of panic attacks. Patients were classified into two groups of improvement according to the panic symptom items of the `Patient-Rated Anxiety Scale'. A repeated-measures analysis of variance suggested a significant association between outcome and serum DCMI level/daily dose ratio as well as total serum level/daily dose. Patients with intense improvement showed DCMI and total serum levels lower than those with moderate improvement. The results indicate the importance of monitoring clomipramine and desmethylclomipramine serum levels in this disorder.
Effect of a long-term low tryptophan diet on the prolactin responses to the 5-HT1A and 5-HT2C agonists, 8-OH-DPAT and mCPP in the male rat
Authors: Franklin M. , Craven R. D. , Dowling B. , Campling G. , Elliott J. M. , Cowen P. J.
Published: April 2009

The study was undertaken to assess the long term effects of tryptophan (TRP) depletion through diet on the prolactin (PRL) responses to the serotonin (5-hydroxytryptophan, 5-HT) agonists m-chlorophenyl-piperazine (mCPP) and 8-hydroxy-2-(di-n-propylamino) tetralin (8-OH-DPAT) in the male rat. The low TRP diet caused significant reductions in both plasma total TRP and brain cortical 5-HT content together with a significant increase in the PRL responses to mCPP. In contrast the PRL responses to 8-OH-DPAT in animals on the low TRP diet for 1week and 6 weeks were similar to control rats. However, a small but significant increase in PRL was observed at 2 min after dosing in the 1-week group. At the same time the 3H-8-OH-DPAT binding parameters, Kdand Bmax, were similar in both control and TRP depleted animals. The results conform that long-term TRP depletion causes a deficiency of brain TRP and a subsequent reduction of brain 5-HT.This is associated with an enhanced PRL response to mCPP probably resulting from a functional up-regulation of post-synaptic 5-HT2Creceptors. The small or transient changes brought about by long-term TRP depletion on post-synaptic 5-HT1Areceptors, suggests that these receptors may be less susceptible to 5-HT depleting effects than the 5-HT2Csubtype.
The serotonin syndrome and its treatment
Authors: Gillman P. K.
Published: April 2009

Serotonin syndrome is caused by drug induced excess of intrasynaptic 5-hydroxytryptamine. The clinical manifestations are mediated by the action of 5-hydroxytryptamine on various subtypes of serotonin receptors. There is no effective drug treatment established. The history of the treatment of serotonin syndrome with 5-hydroxytryptamine blocking drugs is reviewed. A literature search was undertaken using both Medline and a manual search of the older literature. Reports of cases treated with the 5-HT2blockers cyproheptadine and chlorpromazine were identified and analysed. There is some evidence suggesting the efficacy of chlorpromazine and cyproheptadine in the treatment of serotonin syndrome. The evidence for cyproheptadine is less substantial, perhaps because the dose of cyproheptadine necessary to ensure blockade of brain 5-HT2receptors is 20–30 mg, which is higher than that used in the cases reported to date (4–16 mg).
The effects of acutely administered low dose sarin on cognitive behaviour and the electroencephalogram in the common marmoset
Authors: Pearce P. C. , Crofts H. S. , Muggleton N. G. , Ridout D. , Scott E. A. M.
Published: April 2009

Previous studies have suggested that administration of a clinically sign-free dose of sarin to non-human primates gives rise to subtle changes in brain electrical activity as measured by electroencephalography (EEG) several months following exposure. The functional significances of such changes are unclear. The present study monitored EEG by using implantable radiotelemetry, and also assessed the performance of complex behavioural tasks, in non-human primates for up to 15 months following exposure to a low dose of sarin. Baselines of EEG and behaviour were shown to be stable over several months in control animals. The doses of sarin administered caused erythrocyte cholinesterase inhibitions of 36.4% to 67.1%. Overall, no significant changes in EEG patterns were observed although there were increases in beta 2 amplitude which approached significance (p=0.07). No deleterious effects on performance were seen on the touchscreen mediated discrimination tasks presented from the Cambridge Neuropsychological Test Automated Battery (CANTAB). This study illustrates the validity of the approach employed and makes an important contribution to the investigation of the long-term effects of organophosphorous compounds.
The 5-HTlA receptor agonist flesinoxan increases aversion in a model of panic-like anxiety in rats
Authors: Jenck Franqois , Martin James R. , Moreau Jean-Luc
Published: April 2009

Acute systemic administration of the selective serotonin (5-HT)lA receptor full agonist fiesinoxan enhanced the sensitivity of rats to the panic-like aversion elicited by local stimulation of the dorsolateral periaqueductal grey (dPAG). This experimental paradigm in rats has previously been validated as a simulation of acute anxiety with particular relevance to panic disorder. The dose-dependent decrease in threshold for acute fear responses recorded in rats following intraperitoneal administration of flesinoxan (1-10mg/kg) was similar to that induced by the panic precipitating agent yohimbine and opposite to the threshold increase induced by the antipanic drug alprazolam. The proaversive effect of flesinoxan observed in rats is consistent with the reported aggravation of the condition of panic patients following oral flesinoxan treatment. Thus, the model adequately detects drug-induced panicogenic-like properties. Data suggest that selective activation of 5-HTIA receptors (preand/or post-synaptic in brain and/or periphery) following systemic administration of 5-HTIA receptor full agonists exacerbates aversion in animals or patients with panic anxiety; activation of these receptor subtypes may probably mediate the panicogenic action reported under certain circumstances with non-selective 5-HT mimetics.
Plasma tryptophan and trait aggression
Authors: Wingrove Janet , Bond Alyson J. , Cleare Anthony J. , Sherwood Roy
Published: April 2009

Many studies have reported correlations between measures of aggression and indices of serotonergic function, but most have studied patient or o¡ender populations and relatively few have investigated plasma concentrations of the serotonin precursor tryptophan.This study investigates the relationship between plasma concentrations of tryptophan and trait hostility, depression and anxiety in male healthy volunteers. Sixty-seven healthy male volunteers gave blood samples and completed trait questionnaires. Plasma tryptophan was positively correlated with the BussDurkee Hostility Inventory Total score and Motor Aggression subscale, but not with the Attitudinal Hostility subscale or with trait anxiety or depression. In conclusion, there is evidence for an association between high concentrations of plasma tryptophan and aggressive behaviour in men, presumably mediated by some aspect of central serotonergic function, which seems unlikely to be explained by high trait anxiety or depression.
Comparison of the effects of a-methyl-p-tyrosine and a tyrosine-free amino acid load on extracellular noradrenaline in the rat hippocampus in vivo
Authors: McTavish S. F. B. , Callado L. , Cowen P. J. , Sharp T.
Published: April 2009

Peripheral administration of an amino acid load lacking tyrosine and its precursor, phenylalanine, causes a lowering of central tyrosine levels. The aim of the present study was to examine the effects of tyrosine depletion on extracellular noradrenaline using microdialysis. Extracellular noradrenaline was measured in hippocampus of the anaesthetized rat under both baseline conditions (with reuptake inhibitor, desipramine, in the perfusion medium) and following administration of the a2-adrenoreceptor antagonist, idazoxan. The tyrosine free amino acid load did not alter either baseline noradrenaline or the twofold rise in noradrenaline evoked by idazoxan compared with saline controls. In contrast, the catecholamine synthesis inhibitor, a-methyl-p-tyrosine, caused a marked reduction in baseline extracellular noradrenaline and abolished the rise induced by idazoxan. In conclusion, the present data indicate that under the conditions used, a tyrosine-free amino acid mixture may not be an effective means to interfere with central noradrenaline function. This contrasts with recent findings demonstrating that the tyrosine-depletion approach can be used to decrease presynaptic dopamine function.
What do brain imaging studies tell us about anxiety disorders?
Authors: Malizia Andrea L.
Published: April 2009

In-vivo neuroimaging allows the investigation of brain circuits involved in the experience of anxiety and of receptor changes associated with anxiety disorders. This review focuses on studies by research groups who have compared brain activation maps in different forms of anxiety and on binding studies of the benzodiazepine-GABAAreceptor. Activation studies have revealed the involvement of many brain areas depending on the condition and the paradigm. However, the orbitofrontal cortex/anterior insula and the anterior cingulate are implicated in all the studies and may represent the nodal point between somatic and cognitive symptoms of any form of anxiety. Most studies of binding at the benzodiazepine-GABAAreceptor are not interpretable because of substantial methodological problems, however, regional and/or global reductions are the most consistent finding in panic disorder.
Does Choosing a Treatment Depend on Making a Diagnosis? US and French Physicians’ Decision Making about Acute Otitis Media
Authors: Sorum Paul Clay , Stewart Thomas R. , Mullet Etienne , González-Vallejo Claudia , Shim Junseop , Chasseigne Gérard , Sastre María Teresa Muñoz , Grenier Bernard
Published: April 2009

Background. The classic sequential processing model of clinical decision making—in which the treatment choice follows and depends on the diagnostic judgment—may in some cases be replaced by a processing model in which the treatment choice depends on an independent assessment of the diagnostic and other cues. The aim of this study was to determine which processing model would better describe physicians’ treatment choices in a simulated clinical task. Methods. Seventy-five US and French primary care physicians were presented twice, in a different order, with the same set of 46 scenarios of 15-month-old children suspected of having acute otitis media (AOM). They rated in one set the probability of AOM and in the other set whether they would treat the child with antibiotics (and how confident they felt in their decision). Linear regression analyses revealed the individuals’ 2 judgment policies. Hierarchical discriminant analysis was used to analyze the variance explained in the treatment choice by, 1st, the diagnostic judgment, 2nd, the cues specific to treatment, and 3rd, the cues specific to diagnosis. Results. Even when choosing treatment, the participants placed greatest weight on diagnostic cues, especially the ear findings. Only 28% used the cues that reflected parental issues. For 36%, the diagnostic cues had an effect on the treatment choice independent of the effect (if any) of the diagnostic judgment. Conclusion. In deciding how to treat AOM, the majority of the participating US and French primary care physicians followed the classic sequential processing model, but a substantial minority used instead an independent processing model.
The Inclusion of Patient Testimonials in Decision Aids
Authors: Ubel Peter A. , Jepson Christopher , Baron Jonathan
Published: April 2009

Background. Decision aids often provide statistical information and patient testimonials to guide treatment choices. This raises the possibility that the testimonials will overwhelm the statistical information. Methods. Prospective jurors in Philadelphia County were presented with hypothetical statistical information about the percentage of angina patients who benefit from angioplasty and bypass surgery (50% and 75%, respectively). They were also given written testimonials from hypothetical patients who had benefited or not benefited from each of the two treatments. The numbers of patients benefiting and not benefiting were varied to be either proportionate to the statistical information or disproportionate. In study 1, all participants received 1 testimonial from a patient who had benefited from angioplasty and 1 from a patient who had not. Participants receiving the proportionate questionnaire version were also given 3 testimonials from patients who benefited from bypass surgery and 1 from a patient who did not, coinciding with the hypothetical statistical information. In contrast, participants receiving the disproportionate questionnaire version received only 1 testimonial from a patient who benefited from surgery and 1 from a patient who did not. In study 2, all participants received 2 examples of patients who benefited from angioplasty and 2 who did not. Participants with the proportionate questionnaire version received the same testimonials regarding surgery as in study 1. Those receiving the disproportionate questionnaire version received 2 testimonials from patients who benefited from bypass and 2 from patients who did not. Finally, a separate set of participants in study 2 received a questionnaire with no testimonials. Results. In study 1, 30% of participants receiving the disproportionate questionnaire version chose bypass surgery versus 44% of those receiving the proportionate questionnaire (P = 0.002 by X2). In study 2, 34% of participants receiving the disproportionate questionnaire version chose bypass surgery versus 37% of those receiving the proportionate questionnaire (P= 0.59 by X2). Of those receiving no patient testimonials, 58% chose bypass surgery. Conclusions. The inclusion of written patient testimonials significantly influenced hypothetical treatment choices. Efforts to make the mix of positive versus negative testimonials proportionate to statistical information may, under some circumstances, affect choices in ways that cannot automatically be assumed to be optimal.
Revising a Priority List Based on Cost-Effectiveness
Authors: Baron Jonathan , Ubel Peter A.
Published: April 2009

Background. People sometimes object to the results of cost-effectiveness analysis when the analysis produces a ranking of options based on both cost and benefit. We suggest 2 new reasons for these objections: the prominence effect, in which people attend mostly to a more prominent attribute (benefit as opposed to cost), and distortion of utility judgments. Method. We simulated the production of a cost-effectiveness ranking list in 3 experiments using questionnaires on the World Wide Web. Subjects rated the utility of 16 health benefits using either rating scale or person trade-off elicitation methods. In some experiments, subjects were asked to rate the utility of the health benefits with attention also to the cost of achieving the benefits. In all experiments, at the end, subjects were shown a priority list based on their own utility judgments and were asked whether they wanted to move any of the health benefits up or down the list. Results. In all experiments, subjects wanted to give higher priority to treatments with higher benefit, even when they also had higher cost. They thus wanted to give less weight to high cost (which would, by itself, lead to lower ranking) and more weight to benefit than the weight implied by their own prior judgments. The desire for revision was reduced when subjects made their utility judgments after indicating whether the utility was above or below the midpoint of the scale (a manipulation previously found to reduce distortion). Conclusion. The desire to change cost-effectiveness rankings is in part a preference reversal phenomenon that occurs because people attend mainly to the benefit of health interventions as opposed to cost, when they examine the ranking. People should be wary of tinkering with priority lists by examining the lists themselves.
Quantitative Risk Stratification in Markov Chains with Limiting Conditional Distributions
Authors: Chan David C. , Pollett Philip K. , Weinstein Milton C.
Published: April 2009

Background . Many clinical decisions require patient risk stratification. The authors introduce the concept of limiting conditional distributions, which describe the equilibrium proportion of surviving patients occupying each disease state in a Markov chain with death. Such distributions can quantitatively describe risk stratification. Methods . The authors first establish conditions for the existence of a positive limiting conditional distribution in a general Markov chain and describe a framework for risk stratification using the limiting conditional distribution. They then apply their framework to a clinical example of a treatment indicated for high-risk patients, first to infer the risk of patients selected for treatment in clinical trials and then to predict the outcomes of expanding treatment to other populations of risk. Results . For the general chain, a positive limiting conditional distribution exists only if patients in the earliest state have the lowest combined risk of progression or death. The authors show that in their general framework, outcomes and population risk are interchangeable. For the clinical example, they estimate that previous clinical trials have selected the upper quintile of patient risk for this treatment, but they also show that expanded treatment would weakly dominate this degree of targeted treatment, and universal treatment may be cost-effective. Conclusions . Limiting conditional distributions exist in most Markov models of progressive diseases and are well suited to represent risk stratification quantitatively. This framework can characterize patient risk in clinical trials and predict outcomes for other populations of risk.
The Clash of Family Values: The PLA's Grassroots Officer Couples
Authors: Bi Jianxiang
Published: April 2009

This article explores the opposing perceptions of Chinese family values, confronted by the grassroots officer couples of the People's Liberation Army (PLA). Individual freedom-centered family values, associated with reforms, emphasize the importance of private family life. Yet, the PLA continues to impose institutional control-centered family values, sustained by Confucian culture, on the grassroots officer couples to compel them to self-sacrifice for public life. The clash of family values has dysfunctionalized their families, eroded their morale, and undermined their career commitment. Without the properly refined family values, however, the grassroots officer couples will not meet PLA needs and expectations in the twenty-first century.
Abandoned Children and Their Transitions to Adulthood in Nineteenth-Century Italy
Authors: Sigle Wendy , Kertzer David I. , White Michael J.
Published: April 2009

Recent work on the large-scale abandonment of European infants has focused on abandonment itself, how the infants were treated, and how many survived infancy. Little is known about what happened to those who survived. The authors focus on what happened to the foundlings of Bologna, Italy, over the course of the nineteenth century, at the point in their lives when foster families were no longer paid to care for them. The evidence from Bologna does not support previous assumptions that their ties to their foster families were weak and that their fate was thus a bleak one.
Canadian Fertility Transitions: Quebec and Ontario at the Turn of the Twentieth Century
Authors: Gauvreau Danielle , Gossage Peter
Published: April 2009

This article uses nominal data from the Canadian Families Project national sample to analyze and compare fertility in Canada’s two largest provinces at the turn of the twentieth century. The authors argue that material and cultural factors must be considered if similarities and differences in reproductive behavior between Quebec and Ontario are to be understood. They use regression models to identify the independent influence of factors such as religion, language, occupation, class, urban versus rural residence, and literacy on marital child-woman ratios in the two provinces. Fertility levels in Quebec were about 50 percent higher than those in Ontario, where a very conspicuous downward trend had begun by the 1870s. But Quebec fertility in this period was not as monolithically high as some authors—and much of the province’s popular culture—would suggest. Nor did Quebec fail entirely to “turn the contraceptive corner” in the decades after 1871.
Representations of Adolescence in the Modern City: Voluntary Provision and Work in Nottingham and Saint-Etienne, 1890-1914
Authors: Pomfret David M.
Published: April 2009

Historians agree that around 1900 the concept of adolescence was reworked, valorized, and given scientific legitimacy. In Western political, pedagogical, philanthropic, and literary circles, an understanding of adolescence as a distinct and universal stage of life achieved currency. However, broad studies have glossed over local differences in provision for and representations of adolescence. By comparing representations of adolescence drawn from voluntary provision and the workplace in two cities, Nottingham (England) and Saint-Etienne (France), this article highlights the cultural relativity of this construct, the different rhythms of its institutionalization, and the motives that led local interest groups to emphasize or underplay its significance.
Government Policy, Prejudice, and the Experience of Black Civil War Soldiers and Their Families
Authors: Reid Richard M.
Published: April 2009

During the American Civil War, the federal and state governments greatly expanded the financial assistance available to soldiers and their families. While a pension system was instituted after the war to provide a safety net for the aging veterans and their families, African Americans did not receive equal benefits, nor did local communities equally support the black families. The wartime experience of African Americans varied enormously depending on the region in which they lived. Even after the federal government had been persuaded to pass color-blind legislation, the black veterans and their families consistently faced difficulties in getting equal payment. The factors behind the inequitable treatment were a complex mix of widespread prejudice, structural problems, and the difficulties of poor and illiterate groups' receiving government consideration.
Infanticide and Infant Abandonment in the New South: Richmond, Virginia, 1865-1915
Authors: Green Elna C.
Published: April 2009

The Civil War and Reconstruction and the South's postbellum industrialization produced economic dislocation on a tremendous scale. One product of that economic upheaval was an increasing problem of infanticides and infant abandonments. This case study of Richmond, Virginia, examines patterns of abandonment and neonaticide as documented in records of the city almshouse and the city coroner. It demonstrates that race shaped the options available to women with problem pregnancies in that African American women had access to fewer social welfare institutions such as maternity homes. As a result, unmarried black women kept their out-of-wedlock babies more often than did whites, but they also committed infanticide at higher rates than did whites. Moreover, racial trends in infanticides and infant abandonment suggest that Richmond's white working class experienced economic advancements at the turn of the twentieth century, while the city's black working class continued to live in depression-like conditions throughout the period.
Love Letters and Writing Practices: On Écritures Intimes in the Nineteenth Century
Authors: Lyons Martyn
Published: April 2009

Recent approaches to the history of nineteenth-century writing focus not on the contents of intimate writing but rather on letters as cultural artifacts. What is important is what their existence tells us about the act of writing as a cultural practice and about what writing meant to those who practiced it. Personal writings are highly coded forms, obeying generally accepted conventions and applying and adapting unspoken formulas. Using examples from France and Australasia, this article suggests the need to unravel the social grammar of private writings in the cultural exchanges of the nineteenth-century middle classes.
Fatherhood, Masculinity, and the Good Life During Canada's Baby Boom, 1945-1965
Authors: Rutherdale Robert
Published: April 2009

Based on fieldwork completed in two British Columbia locales—Prince George and Abbotsford—this study places oral histories of fatherhood in the context of idealistic depictions of masculine domesticity that circulated in the mass print media during the baby boom. It addresses tendencies among the men interviewed to frame stories of being husbands, parents, coaches, and family vacationers in material terms. Their self-portraits of domestic masculinity, incorporating the details of trailers, boats, cars, televisions, or vacations, suggest how gendered aspects of consumption by fathers in the 1950s and early 1960s became privileged as identifiable measures of both manful assertiveness and respectable manhood.
The Not-So-Merry Widows of Amsterdam, 1740-1782
Authors: McCants Anne E. C.
Published: April 2009

This research examines the remarriage propensities of a group of poor to middling Amsterdam widows in the second half of the eighteenth century. Using family composition, life cycle, and wealth data drawn from a collection of probate inventories originally recorded by the Amsterdam Municipal Orphanage, this study addresses two questions. First, was the substantial differential in the remarriage rates of men and women the result of choice or rather differential opportunities? And second, what were the economic implications of the observed marital outcomes? It will be shown that despite the legal and social freedom typically associated with widowhood, the economic costs of female headship were high.
The Demographic Transition Then and Now: Processes, Perspectives, and Analyses
Authors: Friedlander Dov , Okun Barbara S. , Segal Sharon
Published: April 2009

Fifty years have passed since the post–World War II development of demography as an academic field. During this time, one of the central focuses of research has been the study of demographic and fertility transitions. The authors reviewa selection of research developments and analytic issues that have appeared in the literature. After presenting, in roughly chronological order, the general development of this research work, they raise questions concerning theory and methodology. In doing so, they argue that some research directions have been overemphasized to the neglect of others.
Public Opinion Toward Gay and Lesbian Teachers
Authors: Lewis Gregory B. , Taylor Howard E.
Published: April 2009

Public opinion plays a key role in determining what formal and informal protections gay and lesbian teachers have on the job. This study examines 25 years of professional polling data to discern public attitudes regarding lesbians and gay men as elementary, high school, and college teachers. Data from 23 surveys conducted since 1987, covering over 35,000 respondents, is then analyzed to determine how public opinion varies by educational level, year of birth, religion, marital status, region, party identification, sex, and race. Though gay teachers remain controversial, and majority support for elementary school teachers only emerged in the late 1990s, public acceptance has grown steadily, with the growth accelerating in the past decade.
The Status of the Uniform Guidelines on Employee Selection Procedures
Authors: Ewoh Andrew I. E. , Guseh James S.
Published: April 2009

This article examines the legal status of the Uniform Guidelines on Employee Selection Procedures from the perspectives of judicial opinions and race-norming provisions of the Civil Rights Act of 1991. Specifically, the analysis provides a discussion of important U.S. Supreme Court’s decisions with special emphasis on their relevance for disparate impact theory. Because the 1991 Civil Rights Act has altered the selection procedures somewhat, the article offers implications of these changes for personnel managers or specialists and recommends modification of the Uniform Guidelines.
Is Patronage Dead?
Authors: Hamilton David K.
Published: April 2009

As a result of court cases, Illinois state government and a number of local governments in Cook County have established nonpatronage staffing systems. An analysis of the impact of these staffing systems reveals that patronage has not been eliminated. It is still alive and well but has changed in significant ways. Although there have been positive impacts on staffing from nonpatronage systems, they tend to be overly centralized and bureaucratic. This causes time delays in filling vacant positions and requires additional time and paperwork on the part of hiring officials. Nonpatronage systems are not designed to attract the best and the brightest but rather to keep patronage-oriented applicants out. The author recommends that staffing systems be designed around a public service orientation to strike a balance between patronage and merit. Staffing such systems will de-emphasize centralized, bureaucratic antipatronage procedures in favor of more flexibility and accountability in the operating departments.