bluuebunny/crossref_metadata_2025 huggingface dataset:
Cognitive-Behaviour Therapy and Medication in the Treatment of Obsessive-Compulsive Disorder: A Controlled Study
Authors: O'Connor K , Todorov C , Robillard S , Borgeat F , Brault M
Published: January 2017

Objective:

To evaluate the effect of combining cognitive-behaviour therapy (CBT) and medication in the treatment of obsessive-compulsive disorder (OCD).

Method:

Twenty-nine subjects diagnosed with OCD according to Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R) criteria were recruited through the Anxiety Clinic of Louis-H Lafontaine Hospital. They were evaluated at baseline and after treatment on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) by a psychiatrist who was blind to treatment modality. Subjects rated their degree of resistance to their rituals and the strength of their obsessional beliefs. Subjects then received 1 of 4 treatments: medication and CBT simultaneously (n = 9), CBT only (n = 6), medication while on a wait-list for CBT (n = 6), or no treatment while on a wait-list for CBT (n = 5).

Results:

Multivariate analysis revealed that Y-BOCS scores and clinical ratings significantly improved posttreatment in all groups except the nontreatment wait-list control group. Subjects in the 2 active treatment groups receiving CBT showed reduced strength in their obsessional beliefs. The subsequent administration of CBT to those groups on the wait-list also decreased the strength of their primary obsessional beliefs and beliefs about the consequences of not performing the rituals.

Conclusions:

Our results suggest that either CBT or medication alone is more effective than no treatment. The combination of CBT and medication seems to potentiate treatment efficacy, and we found it more clinically beneficial to introduce CBT after a period of medication rather than to start both therapies simultaneously.
Economic Impacts of Assertive Community Treatment: A Review of the Literature
Authors: Latimer Eric A
Published: January 2017

Background:

Assertive community treatment (ACT) is an extensively studied and widely imitated community support treatment model for severely mentally ill individuals. Several previous reviews have documented its favourable effects on clients and their families. This is the first review to focus on economic outcomes.

Methods:

Nineteen randomized studies and 15 nonrandomized studies describing ACT programs were identified based on 2 criteria: 1) provision of services primarily in the community and 2) shared caseloads. Percentage reduction in hospital days was calculated for the 34 study sites where reported data allowed it. Multiple-regression methods were used to relate reduction in hospital days to program fidelity and other contextual factors. The impacts of ACT on emergency-room use, use of outpatient services, housing, costs, and other economic outcomes were also examined.

Results:

Higher-fidelity programs appear to reduce hospital days by about 23 percentage points more than lower-fidelity programs (95% CI = −41.2, −5.2). The estimated regression coefficients imply that a high-fidelity program reduces hospitalizations by about 58% over 1 year if the alternative involves some type of case management and by 78% if it does not. A CT appears to increase the proportion of clients who live in independent housing situations, but the effect on use of supervised housing, and therefore on housing costs, is ambiguous. The effects on use of most other resources are inconsistent across studies. Overall, ACT appears to result in somewhat lower costs, whatever the perspective of analysis adopted.

Conclusions:

The most reliable cost offset to A CT treatment costs appears to be reduced hospital use. Using Quebec costs, an A CT program must enroll people with prior hospital use of about 50 days yearly, on average, to break even. As care systems evolve to reduce their reliance on hospitalization as a care modality with or without ACT, this threshold will become increasingly difficult to achieve. The primary justification for implementing ACT services will then become their clinical benefits.
The Valuation of Productivity Costs Due to Premature Mortality: A Comparison of the Human-Capital and Friction-Cost Methods for Schizophrenia
Authors: Goeree Ron , O'Brien Bernie J , Blackhouse Gordon , Agro Karen , Goering Paula
Published: January 2017

Objective:

To compare productivity-cost estimates/or schizophrenia-related premature mortality in Canada in 1996 using the human-capital (HC) approach and friction-cost (FC) method.

Methods:

The number of deaths directly attributed to schizophrenia was combined with the estimated number of deaths attributable to schizophrenia from suicide. These premature deaths were valued using 2 methods: J) the traditional HC approach, based on “potential” lost output to normal age of retirement, and 2) the FC method, based on finding a replacement worker.

Results:

In 1996, there were 342 male and female preretirement deaths attributed to schizophrenia, directly or indirectly by suicide, in Canada. Most deaths were in males (78%) and by suicide (97%). The productivity cost of these deaths was estimated to be $105 million using the HC approach but only $1.53 million using the FC method.

Conclusions:

Productivity-cost estimates from the HC approach are substantially higher than those obtained from the FC method (69 times higher). In circumstances of unemployment, the HC approach is an overestimate of future productivity losses for premature mortality.
Recruitment into Psychiatry: Increasing the Pool of Applicants
Authors: Weintraub Walter , Plaut S Michael , Weintraub Eric
Published: January 2017

Objective:

To demonstrate that it is possible to identify the cohort of students in their first year of medical school from which future psychiatrists will be recruited.

Method:

During a 3-year period, all first-year medical students at the University of Maryland completed a form indicating their specialty preference. Of those students, 403 pursued the regular psychiatry curriculum, and 34 participated in an enriched behavioural science and psychiatry program. Specialty was chosen after graduation.

Results:

The higher the first-year student ranked psychiatry as a preferred specialty, the more likely the student was to choose psychiatry as a career after graduation. This was true both for students in the regular psychiatry program and for those in the enriched program. Students in the enriched program were significantly more likely to choose psychiatry as a career than were “regular” psychiatry students who gave psychiatry the same ranking in their first year. Freshman students who ranked psychiatry 4th or lower were not likely to choose psychiatry, no matter how much encouragement they received from their psychiatry departments.

Conclusions:

1)Specialty preferences in the freshman year are predictive of future career choices. 2) An enriched medical school program in psychiatry can increase the number of graduates choosing careers in psychiatry. To help resource-poor medical schools increase the number of American medical graduates choosing psychiatry, the authors propose 2 inexpensive enriched programs.
Suprachiasmatic Nucleus Neurons Are Glucose Sensitive
Authors: Hall Adam C. , Hoffmaster Roselle M. , Stern Edra L. , Harrington Mary E. , Bickar David
Published: January 2017

The suprachiasmatic nucleus (SCN) in the hypothalamus serves as the pacemaker for mammalian circadian rhythms. In a hamster brain slice preparation, the authors were able to record spontaneous activity from SCN cells for up to 4 days in vitro and verify a self-sustained rhythm in firing. The phase of this rhythm was altered by the concentration of glucose in the bathing medium, with time of peak firing advanced for a 20 mM glucose condition and slightly delayed for a 5 mM glucose condition, relative to 10 mM. The advancing effect of 20 mM glucose and the delaying effect of 5 mM glucose were not maintained during a 2nd day in vitro after changing the bathing medium back to 10 mM glucose, thus indicating the effect was not a permanent phase shift of the underlying oscillation. In experiments recording from cell-attached membrane patches on acutely dissociated hamster SCN neurons, exchanging the bathing medium from high (20 mM) to zero glucose increased potassium (K+)-selective channel activity With inside-out membrane patches, the authors revealed the presence of a glybenclamide-sensitive K+ channel (190 pS) and a larger conductance (260 pS) Ca2+- dependent K+ channel that were both reversibly inhibited by ATP at the cytoplasmic surface. Furthermore, 1 mM tetraethylammonium chloride was demonstrated to advance peak firing time in the brain slice in a similar manner to a high concentration of glucose (20 mM). The authors interpret the results to imply that SCNs are sensitive to glucose, most probably via ATP modulation of K+ channel activity in these neurons. Tonic modulation of K+ channel activity appears to alter output of the pacemaker but does not reset the phase.
End of Term
Authors: Bant Clyde
Published: January 2017

It's the end of term - time for relaxation and for review of how far we've progressed along the roads to reform planned by our governments. Celebrate collaboration by trying this exercise with a friend. Celebrate competition by photocopying the page and working independently of your partner. This idea came from an Australian contributor but you'll find that we seem to have the same situations here.
Health, Energy and Power as Experienced by Nurses in their Everyday Work Lives
Authors: Brown Carolyn T.
Published: January 2017

Abstract: Energy health and well-being areshaped by how we choose to be with one another in creating our work lives as nurses. Choices of how to be with one another are based in power relationships and how we create and enact our organizations. When predominantly overpowered, persons feel less enwgeticnnd unwell. The constricted energy in predominantly overpowering relationships is not available for creating the practice of nursing. What energy persons are able to free up is used fo survive in the work place, rather than to create healthy vibrant ways of being and places to work. All persons, whether patients, nurses, administrators or physicians, suffer When empowered, persons feel energized, experience well-being and all persons benefit. Enwgy and creativity increase as persons are empowered.
Patient Attitude towards Waiting in an Outpatient Clinic and its Applications
Authors: Huang Xiao-Ming
Published: January 2017

Patient waiting time in outpatient clinics is often the major reason for patients' complaints about their experiences of visiting outpatient clinics. Therefore, patient satisfaction with waiting time plays a crucial role in the process of health quality assurance or quality management.

This paper reports the results of a survey on patient attitude towards waiting in an outpatient surgery clinic Generally patients appear reasonably satisfied if they wait no more than 37 minutes when arriving on time, and no more than 63 minutes when late for appointments. Patients coming up to 15 minutes early are prepared to take full responsibility for the extra waiting caused, but the patients coming even earlier intend to be seen earlier and are only prepared to wait 15 minutes longer than otherwise.

The potential applications of patient attitude towards waiting in the quality assurance process, ie setting up waiting time limits and designing patient dispatching rules, are also discussed.
Modeling Two Dimensions of Patient Satisfaction: A Panel Study
Authors: Ho Pei-Shu , Stegall Meri Beth Herzberg , Wan Thomas T. H.
Published: January 2017

Measurement of patient satisfaction is an essential part of health outcome assessment. The purpose of this study is (a) to compare the stability of an aggregate summary measure and two separate summary measures of patient satisfaction; and, (b) to examine causal effects between two separate summary measures at two points in time. Data were collected from 1,451 Medicare HMO beneficiaries. In conclusion, (a) separate summary measures are recommended for constructing the measure of patient satisfaction and (b) moderate causal relationships and cross-lagged effects between the patient satisfaction measures of qualify of care and access to care were found.
Efficiency Analysis of Federally Funded Hospitals: Comparison of DoD and VA Hospitals Using Data Envelopment Analysis
Authors: Bannick Richard R. , Ozcan Yasar A.
Published: January 2017

This article applies the technique known as Data Envelopment Analysis (DEA) to assess differences in performance efficiency among two branches of the federal hospital system, The Department of Defense (DoD) and The Department of Veterans' Affairs (VA). The analysis is based on two measures of performance output (inpatient days and outpatient visit, and six measures of resource input (capital investment in operational beds, service mix intensity, and supplies and three components of labor— providers, nurses and support). This study finds that based on these input and output measures, DoD hospitals are, on average, significantly more efficient than their VA counterparts. Within DoD, however, there are no significant differences in efficiency among the service components (US Air Force, Army or Navy), although Army hospitals appear more efficient in using service mix and provider labor.
The Role and Impact of Formal Strategic Planning in Public Hospitals
Authors: Denis Jean-Louis , Langley Ann , Lozeau Daniel
Published: January 2017

In recent years, formal strategic planning methods originally developed for private business have been increasingly adopted by health care institutions, including publicly funded hospitals. Yet, as a technocratic management process, formal planning may seem at first sight to run counter to the natural mode of strategy formation in these organizations where negotiation and mutual adjustment between powerful groups of professionals, managers and government agencies traditionally control decision-making. This article describes an exploratory study aimed at understanding how formal strategic planning has become integrated and adapted into the management practices of a group of 23 Canadian hospitals. The context, processes and impact of planning are first examined over the entire sample of hospitals (descriptive analysis), and an attempt is then made to explain different planning outcomes in terms of a variety of contextual and process design characteristics (comparative analysis). The descriptive analysis shows that in practice formal strategic planning is easily absorbed into the political process: political and symbolic motives often drive the initiation of planning, the processes themselves are highly participative and the resulting plans often reflect the difficulties of obtaining consensus on goals in these complex organizations. The comparative analysis suggests that in general, contextual factors (eg, stimuli behind planning) appear to be more significant than process design factors (eg, extent of participation) in determining outcomes. In conclusion, it is noted that the confrontation between technocratic rationality and professional bureaucracy gives rise to a number of paradoxes that make both the use and the subsequent evaluation of formal strategic planning a difficult task in these organizations.
An Analysis of the Adoption of Managerial Innovation: Cost Accounting Systems in Hospitals
Authors: Glandon Gerald L. , Counte Michael A.
Published: January 2017

The adoption of new medical technologies has received significant attention in the hospital industry, in part, because of its observed relation to hospital cost increases. However, few comprehensive studies exist regarding the adoption of non-medical technologies in the hospital setting. This paper develops and tests a model of the adoption of a managerial innovation, new to the hospital industry, that of cost accounting systems based upon standard costs. The conceptual model hypothesizes that four organizational context factors (size, complexity, ownership and slack resources) and two environmental factors (payor mix and interorganizational dependency) influence hospital adoption of cost accounting systems. Based on responses to a mail survey of hospitals in the Chicago area and AHA annual survey information for 1986, a sample of 92 hospitals was analyzed. Greater hospital size, complexity, slack resources, and interorganizational dependency all were associated with adoption. Payor mix had no significant influence and the hospital ownership variables had a mixed influence. The logistic regression model was significant overall and explained over 15% of the variance in the adoption decision.
Evidence-Based Care in Nursing: Reforms versus Research, Rhetoric versus Reality
Authors: Hicks C.
Published: January 2017

The new evidence-based health care culture, together with nurses' demands for enhanced professional status, has embedded within its strategy the imperative to develop a corpus of nursing-specific research. These apparently compatible aims were intended to meet the need for enhanced professional status while at the same time enabling clinical nursing practice to be justified on scientific grounds. While the dual reform agendas brought with them the resistance that always accompanies radical amendments to the status quo, they also seem to have created an unanticipated reciprocal antagonism which has impeded the development of nursing research. The policy changes that were necessary to meet the prerequisites for professional status have had a detrimental effect on the potential for generating an adequate body of nursing research. This second paper discusses some of the key reforms to nursing that have been implemented over the last decade and their impact on nursing's progress towards creating its own esoteric research knowledge base that could inform clinical care. It is suggested that policy and research may be diametrically opposed, and that nursing, if it is committed to professionalization, may have to reconsider its allegiance to the scientific research culture in favour of achieving some of the other objectives on its agenda.
Implementing Information Technology in the NHS: The Role of Narrative
Authors: Brown A. D.
Published: January 2017

This paper analyses how groups use narratives in social processes of sensemaking and identity construction and in the pursuit and legitimation of their selfish interests. It does so through an examination of the narrativity of the experiences reported by the developers and users of an information technology (IT) system linking a haematology laboratory and a specialist haematology ward in a large acute hospital. The research contribution the paper makes is twofold. First, it illustrates the importance of group-level narratives in enacting organizational realities and especially in the social construction of IT systems. Second, it suggests that the narrative understanding of groups is a significant domain of organizational inquiry because it is through the spread and acceptance of their narratives that groups exercise their most profound influence.
Psychological Determinants of Increased Condom Use and Safer Sex in Homosexual Men: A Longitudinal Study
Authors: Ross Michael W
Published: January 2017

A 6-month longitudinal study of psychological variables predictive of condom use and safer sex in homosexually active men was carried out in Adelaide, a city of one million, in a low prevalence area for human immunodeficiency virus (HIV) infection. Return rate of follow-up questionnaires was 60%, with no significant differences between the returners and non-returners on age, sexual behaviour, condom use, or any of the subscales of the instruments used: Adjective Check List (ACL), Profile of Mood States (POMS), General Health Questionnaire (GHQ) and Attitudes toward Condoms scale. Variables associated with increased condom use included personality style, particularly a more assertive and forceful style, which may be important in raising the issue of condom use with partners and promoting condom use in sexual encounters. These data confirm the findings of previous cross-sectional research. Those items significantly associated with change in the Attitude toward Condoms scale are from the subscales measuring Protection from Infection, and Availability, suggesting that these attitudes are those most closely associated with increasing condom use. The variables associated with lack of change to safer sex are consistently those of dysphoric mood state and psychological maladjustment, suggesting that such individuals may need psychological support to assist them to make the change to safer sex. These data support the view that personality and psychological adjustment are important predictors of risk reduction for HIV infection in homosexually active men.
Incidence of Chlamydia Antibody in Patient Groups, as Measured by the ELISA Technique
Authors: Ben-Ahmeida T , Smith T , Hicks D A , Kinghorn G R , Potter C W
Published: January 2017

An ELISA technique has been used to study the incidence of antibody against Chlamydiae: the results obtained with a panel of control sera were compared with those for the complement fixation (CF) and whole inclusion immunofluorescence (WIF) tests. The results indicate that the ELISA results correlate well with the WIF test but poorly with the CF test; and the correlation allows ELISA results to be directly related to WIF antibody titres. Using the ELISA test, the incidence of antibody to Chlamydiae by age was determined in sera collected in Great Britain and Iraq; and in sera collections made at three periods during the last 30 years in Great Britain: the results indicate the higher incidence of antibody in this country compared to Iraq, but do not suggest an increased incidence of antibody in Great Britain during the last 30 years. Studies on sera collected from patients with non-gonococcal urethritis and pelvic inflammatory disease indicate significantly higher titres and incidence of antibody compared to controls, which suggest a contiguous spread of infection for the primary genital lesion to involve more distant tissues and organs. A higher incidence of antibody was also seen in patients with cervical intraepithelial neoplasia (CIN) which may be interpreted as either indicating a causal relationship between Chlamydiae and CIN or indicating the importance of a venereal infection in this condition.
Microbiological Flora in Men with Non-Gonococcal Urethritis with Particular Reference to Anaerobic Bacteria
Authors: Woolley P D , Kinghorn G R , Talbot M D , Duerden B I
Published: January 2017

In a microbiological study of the urethral flora in men with non-gonococcal urethritis (NGU), Chlamydia trachomatis (isolated from 30% of men) was the only organism isolated significantly more often from men with NGU than controls ( P<0.01). Bacteroids species, especially of the melaninogenicus-oralis group, were the predominant anaerobic bacterial isolate from both men with NGU (isolated from 24%) and controls (isolated from 30%). There was no evidence that aerobic bacteria, anaerobic bacteria or herpes simplex virus made a significant contribution as primary pathogens in non-chlamydial NGU.

Gram-positive cocci were the only anaerobic organism isolated more often from chlamydia-positive men (29%) than chlamydia-negative men (16%) with NGU ( P<0.01). The significance of this remains unclear.
Low Incidence of Anti-Interferon-Alpha Antibodies in Patients Treated with Interferon-Alpha-2A for AIDS-Associated Kaposi's Sarcoma
Authors: de Wit Ronald , Bakker Piet J M , Danner Sven A , Goudsmit Jaap , Veenhof Kees H N
Published: January 2017

Anti-interferon (IFN)-alpha antibodies were determined in the serum of 28 patients treated with high-dose human recombinant IFN-alpha-2a for AIDS-associated Kaposi's sarcoma. After a median treatment duration of 3 months, 3 patients developed anti-IFN-alpha antibodies, of whom 2 showed a long lasting tumour response despite the development of these antibodies. None of 3 patients with tumour progression after an initial treatment response had developed IFN-alpha neutralizing antibodies.

In conclusion, a low incidence of anti-IFN-alpha antibodies during treatment with high dose IFN-alpha was found, but the appearance had no detrimental effect on the duration of tumour responses in a small number of patients.
AIDS in the Netherlands: The Effects of Several Years of Campaigning
Authors: de Vroome E M M , Paalman M E M , Sandfort Th G M , Sleutjes M , de Vries K J M , Tielman R A P
Published: January 2017

One of the primary aims of acquired immunodeficiency syndrome (AIDS) prevention campaigns in the Netherlands has been to inform the public of the facts about AIDS, thereby stimulating informed, but voluntary action to prevent transmission of the human immunodeficiency virus (HIV). By conducting successive population surveys from April 1987 until October 1989, the effects of this approach were assessed.

Twice a year, approximately 1000 respondents, a random sample from the general population, were interviewed about AIDS and safe sex. Additionally, condom sales figures and STD incidences were evaluated.

It appears that knowledge about the prevention of HIV transmission with condoms has reached 98% of the sample. During the study, there was an increase in the number of people who expressed an intention to use condoms or who already used them. Behaviour, however, appeared to fall short of intention. The observations were confirmed by condom sales figures and STD incidences. We conclude that the AIDS policy in the Netherlands has had beneficial effects, reflected by several indices.
Ageing Populations: Spreading the Costs
Authors: Gillion Colin
Published: January 2017

Over the next 50 years almost all countries of the OECD area will experience a dramatic ageing of their population structures. This process will affect the burden, in terms of taxes or social security contributions, placed on active members of the population. If no changes occur in the (relative) level of benefits, the age of retirement, female participation rates, the level of unemployment, or the level of immigration: then the total burden of support by the active members of the population for the inactive and dependant will rise very considerably. This paper attempts to place broad magnitudes on the amount of the potential increase. The analysis goes on to ask: What if changes should occur in the underlying parameters such as benefit rates, retirement age, female participation, unemployment rates, immigration? The answer appears to be that each of these developments would ease the burden on the active population and would also redistribute it. Some more so than others. If all these things were to happen in combination, it is even possible that the burden of support might be lower in 2040 than it is now. However this paper, which compares potential developments in France, Germany, Japan, the Netherlands, Sweden and the USA, concludes with two, fairly obvious, caveats, first: those countries which are already most generous towards their older generations are also the most vulnerable when it comes to facing the ageing problem; Second: all those developments which might offset the consequences of ageing populations would also be available to improve incomes and welfare even if the ageing problem did not exist. Somewhere along the line, and relative to what might have been, there is a cost to be absorbed.
The Life of Dr Jan Ingen Housz (1730–99), Private Counsellor and Personal Physician to Emperor Joseph II of Austria
Authors: Housz Jan Maarten Ingen , Beale Norman , Beale Elaine
Published: January 2017

A brief biography is presented of Dr Jan Ingen Housz, as written, originally in Dutch, by M J Godefroi, a mid-nineteenth-century Dutch physician who was a friend of a near descendant of Dr Ingen Housz. From being a general practitioner at Breda, his home town, he moved to England to learn smallpox inoculation, was sent to inoculate members of the Habsburg family at Vienna and dedicated his later life to scientific experimentation, notably revealing the fundamentals of photosynthesis.
The Appearance of the Artist to the People: The Creativity, Personality and Malady of Alexander Ivanov (1806–58)
Authors: Lerner Vladimir , Witztum Eliezer
Published: January 2017

Alexander Ivanov was an outstanding Russian painter who lived in the middle of the nineteenth century, during the romantic period. He did not accept romanticism but instead tried to create his own original style, an ambitious combination of spiritual profundity and a manner of execution unparalleled in Western European art. Ivanov's intention and style are best reflected in his major work The Appearance of Christ to the People, a picture on which he worked for over 20 years. He painted more than 400 sketches of the picture while attempting to bring his masterpiece to perfection. At the end of his life Ivanov became disillusioned, renounced his strong religious conviction and became suspicious. This study examines the influence of his background, life story and personality on the creative process. From a diagnostic perspective, Ivanov's personality featured obsessive, narcissistic and schizoid traits. In his final years he suffered from a delusional disorder.
In Memoriam: Clayton Daniel Mote, MD (1905–95)
Authors: Gelpi Armand P
Published: January 2017

Clayton Mote had a long career as a teacher, scholar and practitioner of medicine. He was noted for his diagnostic skills and rigorous approach to bedside teaching, with emphasis on the physical examination. The author's attitude towards him was a mixture of admiration for his talents and anxiety that one could never quite meet his expectations. People of his kind still have a place in modern academic medicine: they can be leaders and role models, they can integrate the new and the old, and they can inspire those under their tutelage to return to hands-on medicine.
How Much Paediatric HIV Infection Could Be Prevented by Antenatal HIV Testing?
Authors: Dunn David T , Nicoll Angus , Holland Fiona J , Davison Clare F
Published: January 2017

Objective

To estimate the reduction in the number of children infected with HIV that might be achieved by extending the provision of voluntary antenatal HIV testing. This effect would be mediated by increased numbers of women infected with HIV who receive an intervention to reduce the risk of vertical transmission (for example, zidovudine or caesarean section delivery), who use an alternative to breast feeding, or whose pregnancy is terminated.

Setting

London, United Kingdom.

Methods

Relevant data were derived from neonatal seroprevalence studies, obstetric and paediatric reporting schemes, and review of external information. Sensitivity analyses were performed for certain parameters.

Results

Of 106 000 births annually in London, an estimated 169 are to women infected with HIV whose infection is not currently recognised before pregnancy. An estimated 28–33 children born to these women will be infected. Precise prediction of the number of paediatric HIV infections that could be prevented is difficult because of uncertainty in certain factors, particularly the uptake of antenatal testing and the efficacy and acceptability of interventions to reduce prenatal or perinatal transmission. If a testing programme detected 70% of infected women, none of whom opted for a termination but all of whom exclusively bottle fed and received an intervention which halved the risk of transmission, about 12–16 (42–46%) paediatric HIV infections would be prevented annually.

Conclusions —

The estimated cost of preventing each paediatric infection is high, but this should be seen in the context of the lifetime health and social care costs for a child infected with HIV. The feasibility of selective testing should be considered when formulating policies on antenatal HIV testing. Programmes that are introduced should be audited to obtain better estimates of costs and benefits.
Failure to Thrive and the Risk of Child Abuse: A Prospective Population Survey
Authors: Skuse David H , Gill Dorothy , Reilly Sheena , Wolke Dieter , Lynch Margaret A
Published: January 2017

Objective —

To identify the relative importance of failure to thrive during infancy as a risk factor for later abuse or neglect.

Design —

Whole population birth cohort (1 January to 31 December 1986) studied prospectively over a four year period.

Setting —

An inner city health district in London, England.

Subjects —

2609 births, of whom 47 were identified as having non-organic failure to thrive by first birthday.

Main outcome measures —

Registration on Child Protection Register, or subject to investigation of suspected abuse or neglect without registration.

Results —

2·5% (64) of birth cohort had been placed on the Child Protection Register during the period 1986–1990, and a further 1·2% (32) had been a cause for concern. The relative risk attributable to nonorganic failure to thrive was 4·3 (95% CI 1·65 to 11·94) and exceeded other measured risk factors, including birth weight <2500g, 1·96 (95% CI 1·01 to 3·82); gestation <35 weeks, 3·26 (95% CI 1·32 to 3·75); ordinal position >4, 1·53 (95% CI 0·72 to 3·23). A multiple logistic regression confirmed the independent contribution of non-organic failure to thrive to subsequent poor parenting warranting professional intervention.

Conclusions —

Early postnatal non-organic failure to thrive is a risk factor for later serious parenting deficiencies, but previous research has overstated its importance. Within the community studied the nature of subsequent risk was (non-nutritional) neglect, rather than non-accidental injury. More than eight out of 10 cases do not give further cause for concern.
The Oxford Growth Study: A District Growth Surveillance Programme 1988–1994
Authors: Ahmed Marion L , Allen Alison D , Dunger David B , Macfarlane Aidan
Published: January 2017

Objectives —

To develop a method of community based growth assessment.

Setting —

Oxford District, United Kingdom.

Methods —

A system of growth surveillance involving a community consultant paediatrician, a paediatric endocrinologist, a clinical auxologist, a project coordinator, and the many primary health care teams was started. Letters and meetings were arranged to introduce the programme to general practitioners and health visitors, emphasising the importance of growth assessment in normal child development. They were asked to measure all children as part of their routine developmental checks at 3 and 4·5 years of age. Community growth assessment clinics staffed by an experienced auxologist were established. Children whose heights were more than two standard deviation (SD) scores below the mean or whose height SD score decreased between the two ages were referred to the clinic. Any child whose height was more than 3 SD scores below the mean was referred directly to the paediatric endocrinologist. Those seen in the community clinics were followed up for a year and if their velocity was >25th centile, karyotype normal, and bone age appropriately delayed, they were discharged to the general practitioner for further follow up. Any child with an annual velocity <25th centile was referred to the endocrinologist.

Results —

Of 20 338 children monitored, 260 (1·3%) had heights >−2 SD scores. Seventy six were lost to follow up, 35 were measuring errors, 69 were already seeing a paediatrician, leaving 80 children to be evaluated. Of these, 69 were “short normals” and 11 were newly identified diagnoses.

Conclusions —

This system of secondary referral keeps normal healthy children out of hospital, avoids unnecessary over-investigation, reduces travel and anxiety for families, avoids filling specialist clinics with normal children, and provides an inexpensive system of growth surveillance.
An Overview of the Swedish Randomised Mammography Trials: Total Mortality Pattern and the Representivity of the Study Cohorts
Authors: Nyström Lennarth , Larsson Lars-Gunnar , Wall Stig , Rutqvist Lars Erik , Andersson Ingvar , Bjurstam Nils , Fagerberg Gunnar , Frisell Jan , Tabár Laszlo
Published: January 2017

Objectives

–To analyse the cause of death pattern in the cohorts of women included in the Swedish randomised mammography screening trials by comparing the groups of invited and control women both with each other and with the general population of Swedish women.

Setting

–Since 1977 four randomised trials of mammography screening have been performed in Sweden: Malmö, Kopparberg and ÖOstergötland (the two county trial), Stockholm, and Gothenburg.

Design

–Overview of four randomised mammography screening trials.

Results

–The total numbers of deaths in the invited and control groups respectively were 15 695 and 11 887 corresponding to a relative risk (RR) of 1.00. There were no significant differences between the invited and control groups for cause-specific mortality, except for breast cancer. When the total mortality in the invited and the control groups was compared with that for Swedish women in general the standardised mortality ratio was close to 100.

Conclusions

–The cause of death pattern in the invited group was, except for breast cancer, very similar to that in the control group, showing that the groups were comparable. Similarly, the total mortality including breast cancer mortality in the control group was almost identical to that in Swedish women in general. The same was true, with the exception of breast cancer, for the invited group. These observations confirm that the trial cohorts are representative of Swedish women and indicate that the quantitative results from these trials may safely be generalised to the Swedish population.
Population Screening for Haemochromatosis: Expectations Based on a Study of Relatives of Symptomatic Probands
Authors: Bradley Linda A , Haddow James E , Palomaki Glenn E
Published: January 2017

Objectives—

The frequency of symptomatic haemochromatosis in the general population and the potential efficacy of population screening is uncertain. Data from family members of clinically diagnosed index cases were used to estimate the frequency of the haemochromatosis genotype, the proportion of homozygous individuals with clinical manifestations, and the efficacy of transferrin saturation and serum ferritin measurements as screening tests.

Setting—

English language studies from Europe, North America, and Australia.

Methods—

Haemochromatosis zygosity was classified only by HLA haplotyping, the most reliable available method. All subsequent analyses were based on family members classified in this way.

Results—

An estimated 53 individuals per 10 000 are homozygous for haemochromatosis. Overall, 67% of male and 41% of female family members display at least one clinical manifestation; for men, the frequency increases with age. Transferrin saturation levels are 70% or above in an estimated 72% of homozygous men, along with three per 1000 heterozygous or unaffected men. Transferrin saturation levels are 60% or above in an estimated 67% of homozygous women, along with six per 1000 heterozygous or unaffected women. Serum ferritin levels, but not transferrin saturation levels, are associated with clinical manifestations.

Conclusions—

This information can be used to compare expected versus actual screening performance for intervention trials aimed at detecting haemochromatosis in the general population.
Utilization of Preventive Dental Services Before and After Health Insurance Covered Dental Scaling in Korea
Authors: Jang Young-Eun , Kim Chun-Bae , Kim Nam-Hee
Published: January 2017

Health insurance reduces the economic burden of diseases and enhances access to medical services. This study compared, among social classes, the utilization of preventive dental service before and after health insurance covered dental scaling. We analyzed time-series secondary data for 3  175  584 participants from 253 survey areas nationwide in the Community Health Survey (2009-2014) in Korea. The weighted proportion of participants who underwent dental scaling was defined as the scaling rate. Data regarding demographic and socioeconomic characteristics were collected. Scaling rates continuously increased over the 6-year period, particularly in 2014. College graduates had significantly higher scaling rates. Monthly income and scaling rate were positively related. Differences by education decreased over time. Differences by income were particularly high between 2012 and 2014. For women, the temporal rate was 2 times higher for professionals than for the unemployed. Despite increased dental scaling rates since the health coverage change in 2013, socioeconomic differences persist.
Career satisfaction and work stressors in psychiatrists and psychiatry trainees in Australia and New Zealand
Authors: Rotstein Sarah , Jenkins Kym
Published: January 2017

Objective:

To assess the level of career satisfaction and factors associated with work stress in members of the Royal Australian and New Zealand College of Psychiatrists (RANZCP).

Methods:

In 2014 an online survey was distributed to members of the RANZCP (including psychiatrists and psychiatry trainees).

Results:

A total of 1051 members responded to the survey. Almost 85% of respondents indicated that they were satisfied with the work they were doing at the current stage of their career. ‘Too much work to do in too little time’ emerged as a key stressor and was ranked as the number one stressor in last 12 months by over one third of respondents. Where applicable, examinations, prospect of revalidation and training hurdles were all noted to be moderately/extremely stressful by over 50% of respondents.

Conclusions:

The majority of psychiatrists and trainees appear to be satisfied with their current work. However, there are many factors creating increased work stress and affecting welfare. The role of the college in protecting the welfare of its members should be further considered.
Access to healthcare by psychiatrists, psychiatric trainees and overseas trained psychiatrists: findings from the RANZCP welfare study
Authors: Jenkins Kym
Published: January 2017

Objective:

To understand the challenges faced by psychiatrists and psychiatry trainees in accessing healthcare.

Methods:

An online survey was distributed to all members (fellows, associates and affiliates) of the Royal Australian and New Zealand College of Psychiatrists (RANZCP) and a number of focus groups were held across Australia and New Zealand.

Results:

A total of 1051 members responded to the survey and nine focus groups were held. Almost all respondents indicated they had a personal general practitioner. However, there were varying factors affecting access to healthcare and the ability to take leave when unwell.

Conclusion:

There are numerous barriers facing RANZCP members in looking after their own health. Addressing these barriers will require action at multiple points in the system.
The Interferons and Their Use in Condyloma Acuminata
Authors: Browder John F. , Araujo Oscar E. , Myer Nancy A. , Flowers Franklin P.
Published: January 2017

There are three naturally occurring interferons: Alfa, beta, and gamma. Alfa, derived from lymphoblastic tissue, is approved by the Food and Drug Administration for the treatment of condyloma acuminata (genital or venereal warts). Genital warts are caused by human papillomaviruses, of which more than 50 subtypes have been described. Traditional therapies have centered on destruction of the lesions by either cytotoxic or physical modalities. Intralesional interferon exerts its antiviral effects on infected cells without causing damage to the surrounding tissue. In general, success rates with intralesional interferon alfa are comparable to traditional modalities. There is also evidence that interferon alfa might be particularly useful in the treatment of lesions that have failed to respond to other modalities.
Crossover Design in Pharmacy Research
Authors: Cody Rebecca L. , Slack Marion K.
Published: January 2017

OBJECTIVE:

Reports of pharmacy research using crossover designs were reviewed to determine if the studies adequately consider interaction effects and use appropriate statistical analyses.

DATA SOURCES:

All crossover studies published in DICP, The Annals of Pharmacotherapy during 1988 and 1989 were analyzed.

STUDY SELECTION:

Reports of crossover studies were included only if at least two treatments were applied in a different order to two or more groups of subjects.

DATA EXTRACTION:

The principal characteristics of crossover studies and the critical design variables were listed and each study analyzed according to these variables. The critical design variables included consideration of period, sequence, and carryover effects as well as the presentation of data by groups and the use of multivariate statistical analysis. The analysis was conducted independently by each author and conflicts were discussed until consensus was obtained.

RESULTS:

A total of 11 crossover studies were identified: 6 were bioavailability trials, 3 were treatment comparisons, and 2 had multiple objectives. The possibility of period, sequence, or carryover effects was less with bioavailability studies than with treatment comparisons. Only 1 study presented data by group and only 4 studies used multivariate analysis.

CONCLUSIONS:

The crossover design appears more appropriate for bioavailability trials than for treatment trials in pharmacy research. Analysis of data from crossover designs could be improved by presenting the data for each treatment group and using multivariate statistical analysis.
The Effects of Impaired Liver Function on the Elimination of Antineoplastic Agents
Authors: Koren Gideon , Beatty Kim , Seto Arnold , Einarson Thomas R. , Lishner Michael
Published: January 2017

OBJECTIVE:

To critically review available data on the disposition of cancer chemotherapy in patients with hepatic dysfunction, and to derive at dose recommendation.

DATA SOURCES:

All published studies in English.

STUDY SELECTION:

Both human and animal studies.

DATA SYNTHESIS:

The available studies were sequentially qualitatively described and critically discussed.

CONCLUSIONS:

The liver is responsible for the metabolism and elimination of many anticancer agents. Their accumulation during hepatic insufficiency may expose the patient to increased risk of drug toxicity. A variety of clinical methods have been described to estimate the need to decrease doxorubicin dose according to degree of hepatic failure to avoid serious toxicity. In some studies prospective ascertainment of clinical indices such as hepatic enzymes and bilirubin was successful in preventing doxorubicininduced hepatotoxicity. Liver dysfunction has a major impact on cyclophosphamide pharmacokinetics. However, because such impairment leads to less production of the active aldophosphamide, fewer adverse effects were observed in hepatically impaired patients. Vinca alkaloids are extensively metabolized by the liver and excreted in the bile. Systemic exposure to these drugs is inversely correlated to the degree of hepatic failure measured by serum alkaline phosphatase. Although hepatic metabolism is a major route of elimination of fluorouracil, the kidney also plays an important role in its elimination. It has been suggested to reduce its dose in cirrhotic patients. Available pharmacokinetic data and their clinical implications are also discussed for azathioprine, mercaptopurine, etoposide, epirubicin, amsacrine, cytarabine, and other less-studied drugs. Recommendations for dose adjustments are presented and discussed.