bluuebunny/crossref_metadata_2025 huggingface dataset:
Managing Depression during Hepatitis C Treatment
Authors: Sockalingam Sanjeev , Abbey Susan E
Published: January 2017

Objective:

The prevalence of hepatitis C virus (HCV) infection in Canada is estimated to be 1% and expected to increase during the next decade. Mental illness, particularly depression, is common among HCV-infected patients and remains an obstacle to interferon-alpha (IFN-α) treatment. We summarize the risk factors for interferon-α–induced major depressive disorder (IFN-α–MDD) in HCV patients and the evidence for antidepressant prophylaxis and symptomatic antidepressant treatment of depression.

Methods:

We searched MEDLINE, EMBASE, and CINAHL for randomized controlled or quasi-experimental trials evaluating antidepressant prophylactic and symptomatic treatment approaches for depression emerging during IFN-α treatment. Manual searches of references listed in review articles, case series, and anecdotal reports supplemented our literature search.

Results:

A total of 9 trials involving prophylactic and symptomatic treatment approaches for IFN-α–MDD are summarized in our review. Antidepressant pretreatment is beneficial for patients with elevated baseline depressive symptoms and a preexisting history of IFN-α–MDD. Although limited evidence exists for several antidepressant agents, much of the evidence suggests that selective serotonin reuptake inhibitors (SSRIs) are safe and efficacious in treating depressive symptoms secondary to IFN-α therapy.

Conclusion:

Both antidepressant pretreatment and symptomatic treatment are viable strategies for treating IFN-α–MDD. Improved treatment outcomes and early identification of depression during HCV treatment can be achieved using an integrated medical and mental health treatment approach.
Social Support Moderates Outcome in a Randomized Controlled Trial of Exposure Therapy and (or) Cognitive Restructuring for Chronic Posttraumatic Stress Disorder
Authors: Thrasher Sian , Power Michael , Morant Nicola , Marks Isaac , Dalgleish Tim
Published: January 2017

Objective:

To understand what predicts good outcome in psychiatric treatments, thus creating a pathway to improving efficacy.

Method:

Our study investigated relations between predictor variables and outcome (on the Clinician Administered Posttraumatic Stress Disorder [PTSD] Scale [CAPS]) at posttreatment for 77 treatment completers in a randomized controlled trial of exposure therapy and (or) cognitive restructuring, compared with relaxation, for chronic PTSD in adults.

Results:

More social support on the Significant Others Scale significantly predicted better outcome on the CAPS, even after controlling for the effects of treatment group and of pretreatment severity. Importantly, social support was only a significant predictor of outcome for participants receiving cognitive restructuring and (or) exposure therapy and not for participants in the relaxation condition.

Conclusions:

Better social support is associated with significantly greater gain following cognitive restructuring and (or) exposure therapy for PTSD. Future interventions should consider augmenting social support as an adjunct to treatment.
Does Early Emotional Distress Predict Later Child Involvement in Gambling?
Authors: Pagani Linda S , Derevensky Jeffrey L , Japel Christa
Published: January 2017

Objective:

Younger people are engaging in gambling, with some showing excessive involvement. Although a consequence of gambling could be anxiety and depression, emotional distress could be a precursor to gambling involvement. This could reflect developmental proneness toward problem behaviour. We assessed whether early emotional distress directly influences later gambling or if it operates through an indirect pathway.

Methods:

Using a prospective longitudinal design, an intentional subsample of children from the 1999 kindergarten cohort of the Montreal Longitudinal Preschool Study (Quebec) from intact families were retraced in 2005 for follow-up in Grade 6. Consenting parents and children were separately interviewed. Key child variables and sources included kindergarten teacher ratings of emotional distress and impulsivity and self-reported parent and child gambling.

Results:

Higher levels of teacher-rated emotional distress in kindergarten significantly predicted a higher propensity toward later gambling behaviour. Impulsivity, a factor often comorbidly present with emotional distress, completely explained this predictive relation above and beyond potential child- and family-related confounds, including parental gambling.

Conclusions:

Children with higher levels of emotional distress at kindergarten were more inclined toward child gambling behaviour in Grade 6. The influence of early emotional distress completely vanished when behaviours reflecting impulsivity were considered when predicting later child gambling behaviour. The relation between emotional distress and child gambling involvement in children was thus explained by its comorbidity with early impulsivity. This study does not rule out the possibility that emotional distress could become a correlate or consequence of excessive involvement in gambling activities at a later developmental period.
The Utilization of Antidepressants and Benzodiazepines among People with Major Depression in Canada
Authors: Sanyal Chiranjeev , Asbridge Mark , Kisely Steve , Sketris Ingrid , Andreou Pantelis
Published: January 2017

Objective:

Although clinical guidelines recommend monotherapy with antidepressants (ADs) for major depression, polypharmacy with benzodiazepines (BDZs) remains an issue. Risks associated with such treatments include tolerance and dependence, among others. We assessed the prevalence and determinants of AD and BDZ utilization among Canadians who experienced a major depressive episode (MDE) in the previous 12 months, and determined the association of seeing a psychiatrist on the utilization of ADs and BDZs.

Method:

Data were drawn from the 2002 Canadian Community Health Survey: Health and Well-Being, a nationally representative sample of Canadians aged 15 years and older. Descriptive statistics quantified utilization, while logistic regression identified factors associated with utilization, such as sociodemographic characteristics or type of physician seen. Sampling weights and bootstrap variance estimations were used for all analysis.

Results:

The overall prevalence of AD and BDZ utilization was 49.3% of respondents who experienced an MDE in the past 12 months and reported AD use. Key determinants of utilization were younger age and unemployment in the past week (OR 2.6; P < 0.001). Being seen by a psychiatrist increased utilization (OR 2.5; P < 0.001), possibly because psychiatrists were seeing patients with severe depression.

Conclusion:

A large proportion of people with past-year MDEs utilized ADs and BDZs. It is unclear how much of this is appropriate given that evidence-based clinical guidelines recommend monotherapy with ADs in the treatment of major depression.
Mental Illness and Mental Health: Is the Glass Half Empty or Half Full?
Authors: Pierre Joseph M
Published: January 2017

During the past century, the scope of mental health intervention in North America has gradually expanded from an initial focus on hospitalized patients with psychoses to outpatients with neurotic disorders, including the so-called worried well. The Diagnostic and Statistical Manual of Mental Disorders (DSM), Fifth Edition, is further embracing the concept of a mental illness spectrum, such that increasing attention to the softer end of the continuum can be expected in the future. This anticipated shift rekindles important questions about how mental illness is defined, how to distinguish between mental disorders and normal reactions, whether psychiatry is guilty of prevalence inflation, and when somatic therapies should be used to treat problems of living. Such debates are aptly illustrated by the example of complicated bereavement, which is best characterized as a form of adjustment disorder. Achieving an overarching definition of mental illness is challenging, owing to the many different contexts in which DSM diagnoses are used. Careful analyses of such contextual utility must inform future decisions about what ends up in DSM, as well as how mental illness is defined by public health policy and society at large. A viable vision for the future of psychiatry should include a spectrum model of mental health (as opposed to exclusively mental illness) that incorporates graded, evidence-based interventions delivered by a range of providers at each point along its continuum.
Predicting Treatment Response in Major Depressive Disorder: The Impact of Early Symptomatic Improvement
Authors: Kudlow Paul A , Cha Danielle S , McLntyre Roger S
Published: January 2017

Objective:

Antidepressants (ADs) are the mainstay of treatment for major depressive disorder (MDD). Despite their widespread usage, a consensus does not exist as to the timing of clinically significant symptomatic improvement during an AD trial. The objective of this review is to provide practitioners with empirically based recommendations pertaining to the optimal duration of index (initial) AD therapy before a clinical intervention is warranted.

Methods:

We conducted a nonsystematic review, using a combination of a MeSH key word search, Google Scholar, and the Scopus database. Our search strategy focused on research papers reporting on the early symptomatic response to AD therapy.

Results:

Available evidence suggests that there are several subpopulations that exist within whole-group data assigned to an AD treatment. Among the responder subgroups, an early responder group (that is, less than 3 weeks) and later responder group (that is, 3 weeks or more) are identified. People who exhibit early partial symptomatic improvement are more likely to respond to therapy thereafter. However, the interpretability of extant evidence is complicated by the use of disparate statistical approaches with differing computational complexity and sample heterogeneity.

Conclusions:

Response outcomes in MDD are heterogeneous. Available data suggest that people may respond early, late, and (or) continuously over time, and may represent distinct subpopulations that provide a proximate indication for treatment response outcomes. Notwithstanding, a pragmatic recommendation would be to consider a treatment intervention (for example, dosage optimization and [or] augmentation) if, after 3 to 4 weeks, symptomatic improvement is insufficient.
Psychiatry and Fads: Why is This Field Different from All other Fields?
Authors: Shorter Edward
Published: January 2017

Fads in psychiatry are little more than bad ideas with short half-lives. They have arisen because of the great discontinuities that have swept psychiatry unlike other specialties in the 20th century: the transition in the 1920s from asylum-based biological psychiatry to psychoanalysis, and the transition in the 1960s from psychoanalysis to a biological model based on psychopharmacology. In no other medical specialty has the knowledge base been scrapped and rebuilt, and then again scrapped and rebuilt. In these great transitions, when psychiatry each time has had to reconstruct from scratch, bad ideas have crept in with good. Psychiatry, in its heavy use of consensus conferences, is often unable to employ science as a means of discarding fads, which, once installed, are often difficult to remove. Each of the great paradigms of psychiatry in the last hundred years has given rise to fads, and psychopharmacology is no exception, with faddish uses of neurotransmitter doctrine claiming centre stage. Only when psychiatry becomes firmly linked to the neurosciences will its subjugation to the turbulence of faddism be moderated.
Memory Impairment in Schizophrenia: Perspectives from Psychopathology and Pharmacotherapy
Authors: Stip Emmanuel
Published: January 2017

Objective:

To describe the concept of memory impairment in schizophrenia and the clinical implications of this concept in terms of patient assessment and neuroleptic drug use.

Method:

Narrative literature review.

Results:

Individuals suffering from schizophrenia normally exhibit some degree of memory impairment. Recent work in psychopathology indicates that the impairment is comprehensive, involving the sensory, short-term, and long-term memory stores. Memory impairment appears to be a primary symptom of the disease, and its underlying causes are likely organic. A number of medications, however (for example, traditional neuroleptics and drugs that have pronounced anticholinergic activity), may cause or exacerbate impairment. In particular, anticholinergic agents used to treat extrapyramidal symptoms, a common complication of neuroleptic drugs, appear to have a deleterious effect on memory.

Conclusions:

Memory impairment is an important consideration in the clinical assessment and management of patients with schizophrenia. The use of atypical antipsychotics like risperidone appears to have no impact on memory function: because risperidone is associated with a low incidence of extrapyramidal side effects, it can obviate the need for anticholinergic medications— thus offering greater hope of nondebilitative intervention. The advent of medications that are safer (on cognition) could also lead to generally better outcomes by facilitating compliance with drug regimens and rehabilitation programs.
Maintaining Standards: Differences between the Standard Deviation and Standard Error, and When to Use Each
Authors: Streiner David L
Published: January 2017

Many people confuse the standard deviation (SD) and the standard error of the mean (SE) and are unsure which, if either, to use in presenting data in graphical or tabular form. The SD is an index of the variability of the original data points and should be reported in all studies. The SE reflects the variability of the mean values, as if the study were repeated a large number of times. By itself, the SE is not particularly useful; however, it is used in constructing 95% and 99% confidence intervals (CIs), which indicate a range of values within which the “true” value lies. The CI shows the reader how accurate the estimates of the population values actually are. If graphs are used, error bars equal to plus and minus 2 SEs (which show the 95% CI) should be drawn around mean values. Both statistical significance testing and CIs are useful because they assist the reader in determining the meaning of the findings.
Hyponatremia and Hyperglycemia during Cardiopulmonary Bypass Related to Cardioplegia Solution
Authors: Tobias Joseph D.
Published: January 2017

Alterations of sodium and glucose concentration may result from disorders of the normal regulatory mechanisms or from excessive intake of glucose, sodium, or free water. In children, hyponatremia most commonly results from excessive free water intake, frequently combined with inadequate sodium intake. The author reports a child who developed hyponatremia and hyperglycemia during cardiopulmonary bypass that was eventually attributed to the large volume of cardioplegia solution that was used. When excess free water administration is suspected as the etiology of hyponatremia, all possible sources should be considered.
In Search of Service Quality Measures: Some Questions regarding Psychometric Properties
Authors: Shewchuk Richard M. , O'Connor Stephen J. , White John B.
Published: January 2017

Confirmatory factor analysis was used to evaluate the construct validity of SERVQUAL, an instrument intended to measure consumer-reported service quality. Results indicate the hypothesized conceptualization of service quality was not valid in a health care setting. It is suggested that additional measurement attention to consumer perceptions may provide further insight into subjective health care service quality evaluation. Implications of failing to consider the measurement properties of this and other constructs are discussed.
TQM as a Managerial Innovation: Research Issues and Implications
Authors: Kaluzny Arnold D. , McLaughlin Curtis P. , Jaeger B. Jon
Published: January 2017

TQM is a managerial innovation that is likely to have profound consequences on the delivery of health services. As an innovation, it is important that attention be given to the fundamental research issues associated with implementation and impact. Using a variance and process perspective, selected research issues are identified within organizations and among work units within these organizations. The variance perspective at both the organizational and work unit level considers the explanation of impact and adoption at a particular point in time. The process perspective considers the particular steps or events in the overall adoption process. The managerial implications for each perspective are discussed.
Drug Use and Sexual Risk Behaviours among Female Russian IDUs Who Exchange Sex for Money or Drugs
Authors: Benotsch E G , Somlai A M , Pinkerton S D , Kelly J A , Ostrovski D , Gore-Felton C , Kozlov A P
Published: January 2017

Countries of the former Soviet Union are experiencing the steepest increases in annual HIV incidence in the world. Over 80% of registered HIV cases in Russia have occurred among intravenous drug users (IDUs), but current conditions set the stage for a heterosexually-transmitted epidemic. IDUs who also trade sex for money or drugs may serve as a conduit, or ‘bridge’ group, through which HIV could make inroads into the general Russian population. The present study examined the prevalence of sex trading among female Russian IDUs, and further examined drug use, sexual behaviour, and perceived vulnerability in this group. Female IDUs ( n=100) in St Petersburg, Russia participated; 37% reported a history of sex trading. This group reported a mean of 49.5 male sexual partners in the previous month and an average of 15.4 unprotected vaginal intercourse acts in the previous 30 days. A significant minority (44%) also reported sharing injection equipment with others. Mathematical models to calculate risk estimates for HIV seroconversion indicated that participants were at significant risk of contracting HIV and infecting sexual partners. Despite significant rates of risk behaviours, most participants perceived themselves to be at little risk of contracting HIV. Effective HIV prevention programmes targeted at this group are urgently needed and are likely to be a cost-effective step in curtailing the spread of HIV In the region.
Dried Blood Spots are an Acceptable and Useful HIV Surveillance Tool in a Remote Developing World Setting
Authors: Solomon S S , Pulimi S , Rodriguez I I , Chaguturu S K , Kumar S K Satish , Mayer K H , Solomon S
Published: January 2017

Enzyme-linked immunosorbent assay and Western blot analysis of dried blood spots (DBS) on filter paper have been shown to be as sensitive and specific as analysis of serum, and therefore may be a cost-effective and culturally appropriate HIV seroprevalence tool in remote areas. This study examines the acceptability of DBS in a tropical, rural population from an outpatient clinic in Andhra Pradesh, India, where participation was offered to every fifth patient seeking general medical care between March and April 2001. All 1413 patients approached for the study agreed to participate and provide a DBS for examination. The overall HIV seroprevalence in this sample was 2.8%. Of the participants, 51.7% were male, 93.2% were between the ages of 18 and 40, 85.3% were married, 29.7% were employed, 47.6% had no education and 73.1% resided in a rural setting. In the univariate analysis, history of genital warts ( P=0.01), sexually transmitted disease ( P=0.001), premarital sexual intercourse ( P=0.002), sexual contact with a commercial sex worker ( P=0.003), being employed ( P=0.011) and having more than 10 injections for medical purposes ( P=0.006) all correlated with being HIV-infected.

Given the uniform willingness of these clinic attendees to be tested, we conclude that DBS is a useful, cost-effective tool in HIV serosurveillance in a rural, tropical setting.
Comparison of Pharmacia Chlamydia EIA, IDEIA and Cell Culture in the Detection of Urogenital Chlamydial Infection
Authors: Bygdeman S M , Lidbrink P , Nahkiaisoja M , Parkhede U
Published: January 2017

Two commercial test kits, Pharmacia Chlamydia EIA (PhEIA) and IDEIA Chlamydia Test, for the identification of Chlamydia trachomatis and McCoy cell culture were compared in urogenital specimens. The sediments of the transportation buffers of specimens with discordant results were investigated for elementary bodies (EB) with fluorescein-labelled antichlamydial antibodies. The prevalence of chlamydial infection among the men was 16% (48 of 293), 47 culture positive and one EB positive, and among the women 10% (10 of 97), 10 culture positive. In men, the sensitivity of PhEIA, IDEIA and culture was 71%, 40% and 98%, respectively. In women, irrespective of site, corresponding figures were 100%, 80% and 100%. The specificity and positive predictive values were 100% for both enzyme immunoassays in men and women. The low sensitivity of IDEIA could not be explained by the degree of infection as measured by the number of inclusion bodies in cell culture, the presence of antigen as measured by the number of EBs or the sampling order.
HIV/AIDS, Advocacy and Anti-Discrimination Legislation—The Australian Response
Authors: Neilsen G A , Young F J
Published: January 2017

This paper will address the role of mass communication strategies in the reduction of HIV/AIDS discrimination in Australia. It will focus on the interdependence of mass communication and legislation in health promotion campaigns with particular reference to the Disability Discrimination Act 1992. This will be discussed in the context of other HIV/AIDS strategies in Australia.

The public health impact of discrimination is explored in relation to HIV/AIDS and the role of anti-discrimination legislation is discussed. Public health legislation can serve as a symbolic reflection of public opinion or actively change it. Laws can transform the practices of both public and private institutions and thus decrease discrimination. They can also provide specific remedies for people adversely affected by discriminatory attitudes and practices. Mass communication can maximize the impact of legislation by promoting awareness of new laws and, more importantly, lead changes in the attitudes of the polity and the wider public.
Demonstration of Epstein-Barr Virus DNA in Acetowhite Lesions of the Vulva
Authors: Voog E , Ricksten A , Löwhagen G B , Ternesten A
Published: January 2017

Acetowhite lesions in the vulva disclosing koilocytosis have been related to infection by human papilloma virus (HPV). Because of the clinical resemblance of these lesions to oral hairy leukoplakia (OHL), and EBV-manifestation, 23 women with acetowhite koilocytotic lesions in the vulva were examined. The PCR-technique was used to detect EBV DNA as well as HPV DNA in 17% of 23 patients examined. In a control group of 19 patients EBV DNA was detected in 11% and HPV DNA in 42% of cell samples from normal vulvar mucosa. EBV DNA has not previously been demonstrated in the vulvar mucosa, and this virus might be related to subclinical acetowhite lesions.
Why Do Antenatal Attenders Decide to Have the HIV Antibody Test?
Authors: Meadows Jean , Catalan Jose
Published: January 2017

The aim of the study was to investigate factors influencing the parturient woman's decision to accept or decline the HIV antibody test in the antenatal clinic. Eighty-eight women attending an antenatal clinic, in a central London hospital, for an appointment at 28–32 weeks of pregnancy were given a structured face to face interview. Results indicated that 36% (n=32) had elected to be tested. Reasons for declining included assumption of no risk, being in a stable relationship, not wanting to think about HIV when pregnant and not wanting to know if HIV positive. Reasons for accepting included fears for health of the baby and fears for own health. 52% ( n=46) had discussed the test with their partner, most of whom had agreed with the woman's decision or left the decision to her. Only 31% of the women were aware they had been automatically tested for syphilis. Knowledge about vertical transmission was poor. Anxiety levels of those tested and those not tested were not significantly different nor did either group differ over time. The groups did not differ on demographic variables, transmission knowledge or perceived likelihood of infection. Most women elected not to be tested and reasons around the decision are very individualistic and varied. HIV testing does not appear to cause anxiety when it is offered on a voluntary basis. Knowledge of routine testing and of vertical transmission is poor and should be the focus of health education intervention.
The sooterkin Doctor: The London Career of John Maubray, MD (1700–1732), “Andro-Boethogynist”
Authors: Bates A W
Published: January 2017

Dr John Maubray (1700–1732) was one of the most prominent man-midwives of Georgian London. His emphasis on the importance of physical examination and a combination of theoretical and practical teaching seems to have foreshadowed later methods of training in midwifery. His espousal of the non-instrumental Deventerian system of obstetrics and his activities in the parish of St George's, Hanover Square in London, identified him with the dominant Whig party. Although he failed to acquire a major patron, his network of social connections enabled him to obtain charitable and public service appointments, culminating in his chairmanship of the Charitable Corporation.
Dr W G Grace: Cricketer and General Practitioner
Authors: Toghill P J
Published: January 2017

During the winters of the last quarter of the nineteenth century, Dr W G Grace - undeniably the most famous cricketer in the world (Figure 1) - went about his business in Bristol as a family doctor in one of the city's poorer areas. Though instantly recognizable by the Victorian public, his professional activities were unhindered by the press, by his cricketing admirers or by his sporting colleagues. Such a situation is now scarcely credible when lesser sporting heroes are pursued and harassed by the ubiquitous press and media, eager for trivia, tittle-tattle, and salacious gossip. Nevertheless, William Gilbert Grace (WG) was able to pursue two separate and entirely different careers. The first, his cricketing life, was crowned with spectacular sporting success and erratic financial rewards; the second, his doctor's life, gave him domestic security and stability, and the means to enjoy his sport. For him life was topsy-turvy, with cricket as his profession and medicine as his hobby.
Diagnostic Effectiveness of Simultaneous Thyroxine and Thyroid-Stimulating Hormone Screening Measurements. Thirteen Years' Experience in the Northeast Italian Screening Programme
Authors: Zamboni G , Zaffanello M , Rigon F , Radetti G , Gaudino R , Tatò L
Published: January 2017

Objectives:

To evaluate the effectiveness of thyroid-stimulating hormone (TSH) and thyroxine [T4) measurements at neonatal screening for congenital hypothyroidism, we compared our false-negative results with those we would have obtained if we had used TSH screening alone.

Subjects and methods:

Between January 1989 and December 2001 745,258 newborns were screened (98.3% of total born) for congenital hypothyroidism in northeast Italy. T4 and TSH were measured simultaneously on blood spots collected after birth. Between 1989 and 1998, semiquantitative total T4 (tT4) and TSH concentrations were measured by radiolabelled immunological assay and, from 1999 to 2001, using time-resolved fluorometer Delfia instruments (EG&G Wallac Oy, Finland) and fluoroimmunometric assay (Delfia neonatal hTSH and T4 kits).

Results:

Ten neonates were missed by our screening programme (normal tT4 and TSH) and classified as false negatives; these infants were diagnosed later in life with central hypothyroidism. If we had measured TSH alone in our screening programme, we would have missed an additional 21 patients with low tT4 and normal TSH; of these, four were affected by central hypothyroidism and 17 were diagnosed within the second month of life as affected by primary hypothyroidism with delayed TSH rise.

Conclusions:

Simultaneous T4 and TSH measurements at neonatal screening can miss patients affected by central hypothyroidism. However, this screening procedure allows identification of cases of central hypothyroidism with low T4 values and those neonates affected by primary hypothyroidism with delayed TSH rise who we would have missed by using the TSH measure alone.
Cost-Effectiveness of Screening for Colorectal Cancer: Evidence from the Nottingham Faecal Occult Blood Trial
Authors: Whynes David K
Published: January 2017

Objectives:

To estimate the cost-effectiveness of faecal occult blood (FOB) screening for colorectal cancer within the Nottingham trial.

Setting:

A randomised controlled trial (1981–present) of 153,000 subjects, of whom approximately half were offered biennial FOB testing over up to five screening rounds.

Methods:

The additional costs of participation in screening relative to symptomatic presentation were calculated by combining the results of (i) a comprehensive audit of resource use on the part of subjects within the trial, (ii) previously-established unit costs for each of the procedures involved. Life expectancy gains were estimated from a survival analysis of those trial subjects who had been diagnosed with cancer (screening participants vs controls).

Results:

The cost of screening under the Nottingham trial protocol was 5290 per cancer detected (at 2002 prices). Under conservative assumptions, the incremental cost per life year gained as a result of screening was 1584 (Confidence Interval [CI]:717 to 8612).
Written Information Needs of Women Who are Recalled for Further Investigation of Breast Screening: Results of a Multicentre Study
Authors: Austoker Joan , Ong Giok
Published: January 2017

To assess the written information needs of women who are recalled for further investigation of breast screening.

Women from eight breast screening centres in England, Scotland, and Wales who had been recalled for further investigation were invited to complete a structured questionnaire about aspects of recall. Four hundred and eighty four consecutive women were invited to be interviewed immediately before assessment. Two weeks after attendance for assessment 2132 consecutive women (including all women who had been interviewed) were sent a postal questionnaire. No reminder was sent. Subjects from four of the centres received an information leaflet with their recall letter, the remainder did not. Letters/leaflets used by the centres differed markedly.

The response rate was 95% for the interview questionnaires and 70% for the postal questionnaires. Women who were prepared in advance for a possible recall were less likely to feel distressed/very distressed when receiving a recall letter. The more aspects of the recall process included in the recall literature, the more women were likely to think that assessment had been explained (89% of women (544/609) receiving six or more items of information compared with 73% of women (269/370) receiving four or fewer items (P<0·0001). Women who received a leaflet with their recall letter were significantly more likely to find some aspect of the information about recall reassuring than women who did not (61% (313/510) ν 50% (278/557); P<0·0001). Distressed/very distressed women were significantly more likely than somewhat/not distressed women to want further information about the reasons for recall (48% (403/834) ν 26% (157/598); P<0·0001 and how to get more information (29% (237/811) ν 19% (116/616); P<0·0001).

Information can increase satisfaction and reduce distress. The amount of information women needed about recall was consistently underestimated. Inclusion of a leaflet improved satisfaction. Sensitive topics, words, and phrases should be carefully expressed.
Participation in Faecal Occult Blood Screening for Colorectal Cancer in a Well Defined French Population: Results of Five Screening Rounds from 1988 to 1996
Authors: Tazi M A , Faivre J , Dassonville F , Lamour J , Milan C , Durand G
Published: January 2017

Objective—

To evaluate the influence on compliance of demographic variables and of the way of proposing a faecal occult blood test in a colorectal cancer mass screening programme.

Setting—

Well defined population in Burgundy (France).

Methods—

From 1988 to 1996 five screening rounds were conducted in people aged 4S to 74 on entering the study. The screening test was provided free of charge by primary care physicians over a four month period, then mailed to non-consultants, followed by a potential reminder letter. The whole population was invited to participate in each screening campaign.

Results—

During the five successive rounds, compliance was 52.8%, 54.0%, 57.3%, 58.3%, and 56.2%. It was higher in women than in men, in those initially aged 50 to 69 than in the extreme age groups, and in urban than in rural areas. Overall, 68.7% of the invited population completed at least one screening test and 37.2% completed the five rounds. Among those who participated once in a screening campaign, between 79.6% and 87.6% participated in the succeeding ones. Compliance was higher when the test was proposed by GPs (varying between 85.2% and 94.0% according to the screening campaign) than when it was sent by post (varying between 26.0% and 33.7%).

Conclusion—

In France, a participation rate of over 50% can be achieved in colorectal cancer screening by means of a faecal occult blood test. To achieve this, primary care physicians have to play an active part in the programme and the test must be mailed to non-consultants.
Exit/Voice Behaviors in the Czech Republic: A Longitudinal Study of Consumer Response to Market Dissatisfaction
Authors: Gurdon Michael A. , Savitt Ronald
Published: January 2017

The focus of this article is the consumer in post-communist society, specifically the evolution of a repertoire of adaptive behaviors under the new market conditions. The conceptual framework underpinning the research is Hirschman's typology of exit and voice. Over one thousand Czech respondents were surveyed in 1995 and again in 1999 to ascertain their readiness to exercise their right to engage in exit or voice when confronted with an unsatisfactory retail experience. The data show a growing willingness to use voice, a trend which was evident sooner among the more highly educated but which spread over time to consumers generally. This research is among the first published evidence of the impact at the level of individual choice of the transition of a former communist state to a western-style market society.
Cross-Border Mergers and Acquisitions and the Competitive Positioning of European National Industries
Authors: Colombo Massimo G. , Mariotti Sergio
Published: January 2017

This paper relies on the eclectic paradigm of foreign direct investments and Porter's theory on the competitive advantages of nations to study the localisation of target firms of international M&As by European enterprises. Firms' propensities towards extra- and infra-European acquisitions are correlated with the competitive position of European national industries in the international arena. Strategic groups of national industries are created through a cluster analysis based on the Fortune lists of the 500 world largest enterprises. Logit econometric estimates and statistical tests of hypotheses suggest that the share of extra-European acquisitions is greater in a) sectors where European large firms have achieved leadership of the world oligopoly, and b) sectors where the competitive position of Europe is rather weak though stable. Instead, firms belonging to national industries which have been rapidly increasing their share of the international oligopoly during the ′80s concentrate their M&As within Europe. The same holds true for declining weak competitors.
Possible Short-Term Memory Loss Associated with Nafarelin Acetate
Authors: Kortepeter Cindy , MacMillan Mary , Ferrell Richard
Published: January 2017

OBJECTIVE AND DESIGN:

A survey was conducted to determine the occurrence of short-term memory loss in patients using nafarelin acetate nasal spray.

SETTING AND PATIENTS:

A list of all patients receiving nafarelin acetate from our pharmacy over a four-month period was generated. We contacted and surveyed 16 women.

INTERVENTIONS:

Each patient was asked to repeat three words at the beginning of the survey and after a series of questions, each patient was asked to recall the three words. Patients were also asked if they believed that their memory was affected by nafarelin acetate nasal spray.

RESULTS:

Eleven patients (69 percent) recalled three words, 3 (19 percent) recalled two words, and 2 (13 percent) recalled one word at the conclusion of the survey. Nine of 16 patients (56 percent) reported some type of memory difficulty.

CONCLUSIONS:

Nafarelin acetate nasal spray may adversely affect short-term memory. This effect is not documented in current literature and further investigation is warranted in the possible relationship between gonadotropin releasing hormone agonists, estrogen deficiency, menopause, and short-term memory. Our survey also demonstrates the significance of communication between pharmacists and patients on newly marketed medications.
Adverse Drug Events and the Freedom of Information Act: An Apple in Eden
Authors: Stang Paul E. , Fox Janet L. , Hartzema Abraham G. , Porta Miquel S. , Tilson Hugh H.
Published: January 2017

OBJECTIVE:

To review some of the abuses and proper uses of the Food and Drug Administration's (FDA's) spontaneous adverse-reaction reporting system, as a way of educating the reader to its strengths and limitations.

DATA SOURCE:

Published literature and reports based on information obtained from the FDA's database of spontaneous adverse drug-event reports.

DATA SYNTHESIS:

The Freedom of Information Act has increased public access to the FDA's database of spontaneous adverse drug reaction reports. As these reports are voluntarily received and reported to the FDA, their use for comparisons of drug safety is severely limited. Despite these limitations and the FDA's caveats for use of these data, consumer advocacy groups, researchers, and various pharmaceutical marketing groups have used this source to project the incidence of adverse drug reactions.

CONCLUSIONS:

The FDA's spontaneous adverse-event reporting system is designed to generate signals of unexpected adverse drug events. Use of the data gathered by this system to make drug safety comparisons is beyond their credible scope because many factors influence the reporting of adverse events. Researchers and peer reviewers should place these data in the proper perspective and support sound research into questions of drug safety.
Rxpert: A Prototype Expert System for Formulary Decision Making
Authors: Greer Marianne L.
Published: January 2017

OBJECTIVE:

RXPERT, a prototype, computer-based, expert system that models the decision-making processes for an ambulatory (non-hospital) formulary, is described as an example of how expert systems may be used to support pharmacy decision making. Basic information about expert-system technology is provided through this example.

BACKGROUND:

Computer-assisted decision making is becoming an important and accepted aspect of complex, health-related decisions. Because expert-system support may become an integral component of future, complex, pharmacy decision making, it is important for pharmacists to become familiar with this technology and its possibilities for supporting pharmacy decisions.

METHOD:

Expert systems offer the potential advantages of making the human decision-making process explicit, more consistent, easily duplicated in many locations simultaneously, and easy to update and document. Although an expert system is seldom intended to replace human decision makers, it can provide valuable support for complex, multivariable decisions. Typical knowledge-acquisition and knowledge-engineering techniques, as well as the characteristics and structure of expert systems, are described, relative to the development of the RXPERT prototype.

CONCLUSIONS:

Although RXPERT is not yet in use, the process for using an expert system to support an individual committee member's personal assessment of a drug product is described. Decision-support expert systems are potentially useful to pharmacists in complex decision-making tasks.
Prevalence of Invasive Cytomegalovirus Disease with Administration of Muromonab Cd-3 in Patients Undergoing Orthotopic Liver Transplantation
Authors: Hooks Michael A. , Perlino Carl A. , Henderson J. Michael , Millikan William J. , Kutner Michael H.
Published: January 2017

OBJECTIVE:

To assess the association of cytomegalovirus (CMV) disease with the administration of muromonab CD-3 (OKT-3) in patients undergoing liver transplant; specifically, to assess the risk of OKT-3 use as an agent for rejection prophylaxis and as an agent for therapy of rejection.

DESIGN:

Retrospective review of medical records.

STUDY POPULATION:

83 liver transplant recipients (43 men, 40 women) with a mean age of 41.5 years (range 16–62).

DATA EXTRACTION:

The medical record for each liver transplant recipient was reviewed and analyzed for the following variables: (1) preoperative recipient CMV serology, (2) donor CMV serology, (3) incidence of invasive CMV disease, (4) administration of OKT-3, (5) postoperative administration time of OKT-3, and (6) the relationship between the administration of OKT-3 and the prevalence of invasive CMV disease.

RESULTS:

OKT-3 was administered to 34 of 83 (40.9 percent) liver recipients, 7 of whom received OKT-3 as rejection prophylaxis; the remainder received OKT-3 as rejection rescue. All patients received OKT-3 5 mg iv for 14 days. Seventeen of the 34 patients receiving OKT-3 (50 percent) developed invasive CMV disease; 58.8 percent of the patients (20/34) receiving OKT-3 were given the agent within the first 14 postoperative days. Sixteen of these 20 patients (80 percent) developed invasive CMV disease. One of 14 patients (7.1 percent) who received OKT-3 after the first 14 postoperative days developed invasive CMV disease. Of those patients 94 percent (16/17) received OKT-3 in the first 14 postoperative days. This prevalence differed significantly from those receiving OKT-3 after the 14th postoperative day and those who did not receive OKT-3 at any time during their hospital course.

CONCLUSIONS:

The patients who received early administration of OKT-3 in our study had a greater risk of invasive CMV disease than did those who received OKT-3 later in the hospital course.
Loss of Seizure Control Associated with Generic Substitution of Carbamazepine
Authors: Welty Timothy E. , Pickering Patricia R. , Hale Bradford C. , Arazi Richard
Published: January 2017

OBJECTIVE:

We report two cases of lost seizure control associated with the generic substitution of carbamazepine, review pertinent literature, and discuss the impact of this substitution on patient care.

DATA SOURCES:

Case studies, abstracts, and research publications identified in MEDLINE and bibliographic review.

DATA EXTRACTION:

One author reviewed cases supplied by the other authors and abstracted information from published literature sources.

DATA SYNTHESIS:

The first case describes a 15-year-old boy who received valproic acid and carbamazepine for partial seizures. A change in government program policies caused him to receive generic carbamazepine. This resulted in loss of seizure control and a decrease in his serum carbamazepine concentration from 12.4 to 6.7 μg/mL. When his carbamazepine concentration returned to previous levels, seizure control was not reestablished. A second case involves a 21-year-old woman who substituted generic carbamazepine because of financial problems. After being seizure-free for at least five years on phenobarbital and carbamazepine, she experienced seizures related to the product change. Her carbamazepine concentration decreased from 11.8 to 8.5 μg/mL; she also became pregnant at that time. Seizure control was not reestablished. At least three other studies do not support these observations, but the tightly controlled conditions in these studies may not have simulated actual clinical practice.

CONCLUSIONS:

When generic substitution of carbamazepine is required, serum concentrations should be carefully monitored. The extra care required may negate the financial advantages of the substitution.
Antibiotic Use in Urban Whites and Blacks: The Minnesota Heart Survey
Authors: Melnick Sandra L. , Sprafka J. Michael , Laitinen David L. , Bostick Roberd M. , Flack John M. , Burke Gregory L.
Published: January 2017

OBJECTIVE:

To assess racial differences in the use of antibiotics, including penicillins, erythromycins, tetracyclines, sulfas, and cephalosporins.

DESIGN:

Population-based surveys, conducted from 1985 to 1987.

SETTING:

The seven-county metropolitan area of Minneapolis-St. Paul, MN.

PARTICIPANTS:

3127 whites (response rate 68 percent) and 1047 blacks (response rate 65 percent), aged 35–74 years.

RESULTS:

White women (26 percent of 1625) were more likely to report having taken an antibiotic in the past year than were white men (18 percent of 1502), black women (18 percent of 590), or black men (15 percent of 457). Reported antibiotic usage decreased with increasing age. Black men were more likely than white men to report the use of tetracyclines or sulfas; otherwise, white men reported higher usage prevalences. White women reported higher usage prevalences of all drug classes than black women.

CONCLUSIONS:

Significant independent predictors of antibiotic use were younger age, white race, and female gender. Potential explanations for these differences include differences in patient access, physician-prescribing behaviors, or both.
Anaphylactoid Reactions with Intraperitoneal Cisplatin
Authors: Hebert Mary E. , Blivin Janye L. , Kessler John , Soper John T. , Oleson James R.
Published: January 2017

Objective:

To report the occurrence of anaphylactoid reactions to intraperitoneal cisplatin in 3 patients.

Case Summaries:

While conducting a protocol evaluating the efficacy of intraperitoneal cisplatin and hyperthermia in the treatment of recurrent ovarian cancer, 3 patients were noted to exhibit anaphylactoid reactions. A 43-year-old woman received cisplatin 60 mg/m2 in 15 minutes during her sixth cycle of therapy. She developed pruritus, edema, and urticaria over both hands. The reaction subsided after treatment with diphenhydramine and dexamethasone. A 57-year-old woman received 400 mL (62.4 mg) of a cisplatin solution concentrated to deliver cisplatin 100 mg/m2 during her first attempted therapy. At this point, she developed whole body urticaria and pruritus with edema of the extremities. The reaction was aborted with diphenhydramine and dexamethasone. Despite premedication with dexamethasone prior to a second attempt at therapy, she again experienced similar symptoms after receiving 500 mL (78 mg) of cisplatin solution. A 55-year-old woman received 2 cycles of therapy with cisplatin 100 mg/m2 without difficulty. During her third cycle, she again received cisplatin 100 mg/m2 over 30 minutes and developed palmar pruritus, urticaria, and edema. Symptomatology resolved with diphenhydramine. Despite premedication with diphenhydramine and dexamethasone, she experienced generalized pruritus and urticaria, as well as headache and chest pain/tightness, after her next infusion. For both the second and third patients, symptomatology failed to resolve until the intraperitoneal cisplatin solution was withdrawn.

Discussion:

Anaphylactoid reactions have been described previously with cisplatin administration. No dose–rate effect has been reported, however. We observed 5 reactions in 3 patients that appear to be related to a high dose–infusion time ratio, indicating that dose and rate of infusion may be important factors in precipitating anaphylactoid reactions with cisplatin.

Conclusions:

We conclude that a high dose combined with a short infusion time increases the risk of anaphylactoid reactions with the administration of intraperitoneal cisplatin. There was no indication that the increase in anaphylactoid reactions was associated with the use of hyperthermia.