bluuebunny/crossref_metadata_2025 huggingface dataset:
Cigarette Smoking, Stages of Change, and Major Depression in the Canadian Population
Authors: Khaled Salma M , Bulloch Andrew , Exner Derek V , Patten Scott B
Published: January 2017

Objective:

To describe the 12-month prevalence of major depression in relation to smoking status, nicotine dependence levels, commitment to quit, attempts to quit, and maintenance of smoking cessation in the Canadian general population.

Method:

Data from Public Use Microdata File of the Canadian Community Health Survey: Health and Well-Being were used. The Composite International Diagnostic Interview—Short Form (CIDI-SF) for major depression was used to assess depressive disorder status. The survey also included a smoking module. There were 49 249 respondents assessed by the CIDI-SF, of whom 10 236 were administered the smoking module. Analyses used appropriate measures to deal with survey design effects.

Result:

The prevalence of major depression was highest in current smokers, followed by ever smokers, former smokers, and was lowest in the never smokers. This pattern persisted after stratification for age and sex. For quitting, the prevalence of major depression was highest among people who tried to quit, followed by those who considered quitting, those who quit in the past year, and lowest among those who maintained their smoking cessation status for longer than 1 year. The prevalence of depression among those with a high nicotine dependence level, as assessed by the Fagerstrom Tolerance Questionnaire, was about twice that of people with a low nicotine dependence level.

Conclusion:

The strikingly high prevalence of major depression among current smokers who are young, trying to quit, and with high nicotine dependence levels in the general population indicates that further longitudinal exploration of this topic is urgently needed.
How Does Electroconvulsive Therapy Work? Theories on its Mechanism
Authors: Bolwig Tom G
Published: January 2017

This article reviews 3 current theories of electroconvulsive therapy (ECT). One theory points to generalized seizures as essential for the therapeutic efficacy of ECT. Another theory highlights the normalization of neuroendocrine dysfunction in melancholic depression as a result of ECT. A third theory is based on recent findings of increased hippocampal neurogenesis and synaptogenesis in experimental animals given electroconvulsive seizures. Presently, the endocrine theory has the strongest foundation to explain the working mechanism of ECT.
Prevalence and Correlates of 12-Month Prescription Drug Misuse in Alberta
Authors: Currie Cheryl L , Schopflocher Donald P , Wild T Cameron
Published: January 2017

Objective:

We examined the prevalence and correlates of prescription drug misuse (PDM) in a population-based sample of adults from Alberta.

Methods:

Data were collected from 3511 adults in Alberta aged 18 years and older in 2002 using a computer-aided telephone survey; the survey response rate was 57.4%.

Results:

The prevalence of 12-month PDM in Alberta was 8.2% in 2002. Opiates were the most frequently misused drug class, followed by sedatives, stimulants, and tranquilizers. Current disability was particularly associated with PDM. Odds of PDM were also elevated among adult students and adults with a high school diploma relative to adults with a post-secondary degree. Past-year problem gambling, illicit drug use, and alcohol use and dependence were each associated with PDM, while past-year binge drinking and daily smoking were not.

Conclusions:

Findings suggest PDM was an important public health concern in Alberta in 2002. Estimates suggest prescription use and misuse have increased substantially in Canada since that time. There is an urgent need for an ongoing assessment of this evolving problem so that effective prevention and therapeutic strategies can be developed.
La thérapie cognitivo-comportementale des psychoses en début d'évolution: étude ouverte en milieu clinique
Authors: Marois Marie-Josée , Gingras Nathalie , Provencher Martin D , Mérette Chantal , Émond Claudia , Bourbeau Julie , Jomphe Valérie , Roy Marc-André
Published: January 2017

Objectif:

Les résultats des méta-analyses concluent à l'efficacité de la thérapie cognitivo-comportementale des psychoses (TCCp) sur les symptômes persistants. Cependant, la validité externe reste à explorer. L'application de la TCCp aux psychoses débutantes (c'est-à-dire, les 5 premières années suivant le diagnostic) paraît particulièrement pertinente, compte tenu de l'effet possible sur l'évolution au long cours. Cependant, les quelques études ayant expérimenté la TCCp auprès de cette population ont eu des résultats décevants. Toutes ont introduit la thérapie en phase psychotique aiguë et la plupart ont effectué un nombre limité de séances. Ainsi, la présente étude ouverte d'implantation vise à évaluer l'efficience d'un programme de TCCp australien de 25 séances, introduit en phase stable, auprès de patients de Québec souffrant de psychoses débutantes.

Méthode:

Le programme Active Cognitive Psychotherapy for Early Psychosis a été offert à 20 patients âgés de 14 ans et plus, à raison d'une séance hebdomadaire pendant 6 mois.

Résultats:

Le taux d'acceptation était de 75 %, le taux moyen d'observance des séances de 84 %, et les participants étaient satisfaits du programme. Les analyses d'avant et d'après la TCCp rapportent des améliorations statistiquement significatives de la symptomatologie psychotique, lesquelles sont maintenues au suivi de 6 mois. L'autocritique est également améliorée de façon statistiquement significative après la TCCp.

Conclusion:

La TCCp semble applicable à nos milieux cliniques, notamment chez les adolescents. De plus, la posologie employée semble favoriser l'observance des rencontres.
Beyond Pharmacotherapy: Understanding the Links between Obesity and Chronic Mental Illness
Authors: Taylor Valerie H , McIntyre Roger S , Remington Gary , Levitan Robert D , Stonehocker Brian , Sharma Arya M
Published: January 2017

While differences in weight-gain potential exist, both between and within classes of psychiatry medications, most commonly used atypical antipsychotics, mood stabilizers, and antidepressants result in some degree of weight gain. This is not new information and it requires an understanding of the tolerability profiles of different treatments and their goodness of fit with specific patient phenotypes. However, this iatrogenic association represents only a piece of this obesity–mental illness dyad. The complex interplay between psychiatric illness and weight involves neurobiology, psychology, and sociological factors. Parsing the salient variables in people with mental illness is an urgent need insofar as mortality from physical health causes is the most common cause of premature mortality in people with chronic mental illness. Our review examines issues associated with common chronic mental illnesses that may underlie this association and warrant further study if we hope to clinically intervene to control this life-threatening comorbidity.
Ten Years of Antipsychotic Prescribing to Children: A Canadian Population-Based Study
Authors: Alessi-Severini Silvia , Biscontri Robert G , Collins David M , Sareen Jitender , Enns Murray W
Published: January 2017

Objective:

To report the prescribing of antipsychotics to the youth population of the Canadian province of Manitoba during the course of a decade.

Methods:

Use of antipsychotics in children and adolescents (aged 18 years or younger) was described using data collected from the administrative health databases of Manitoba Health and the Statistics Canada census between the fiscal years of 1999 and 2008.

Results:

The prevalence of antipsychotic use in this segment of the population increased with the introduction of the second-generation antipsychotics (SGAs) from 1.9 per 1000 in 1999 to 7.4 per 1000 in 2008. The male-to-female antipsychotic usage ratio increased from 1.9 to 2.7 as the male youth population represented the fastest-growing subgroup of antipsychotic users in the entire population of Manitoba. The total number of prescriptions also increased significantly despite the lack of approved indications in this population. Proportion of use remained equally split between high- and low-income users. More than 70% of antipsychotic prescriptions to children and adolescents were written by general practitioners. The most common diagnoses linked to antipsychotic use were attention-deficit hyperactivity disorder and conduct disorders. Use of antipsychotics in combination with methylphenidate increased from 13% to 43%.

Conclusion:

Extensive off-label use of SGAs has been observed in the youth population of Manitoba for treatment of aggressive behaviours across a range of diagnoses. It is important to monitor antipsychotic prescribing to children as more reports of significant adverse events associated with antipsychotics become available.
Educating Family Physicians to Recognize and Manage Depression: Where are We Now?
Authors: Gask Linda
Published: January 2017

Objectives:

To consider what the barriers are to effective depression education; to understand what attitudes, knowledge, and skills doctors need to acquire, and finally to examine what we currently know about effective ways of training family physicians (FPs) about depression.

Methods:

A narrative review of the published literature compiled from searching reviews and original articles was conducted using the following key words: education, training, attitudes, depression, and primary care. Further relevant articles were identified from reference lists.

Results:

The identified barriers are FPs' attitudes and confidence toward recognizing and managing depression, the way in which they conceptualize depression, and the difficulties they face in implementing change in the systems in which they work. We, as educators, can identify what FPs need to know, and this should include novel ways of organizing care. However, of key importance is the need to address how more effective interventions may be provided, recognizing that FPs may be starting from many different points on 3 differing continua of attitude, skills, and knowledge in relation to depression.

Conclusions:

We have to not only ensure that the content of what we teach is perceived as relevant to primary care but also review exactly how we go about providing it, using methods that will engage and stimulate doctors at differing stages of readiness to acquire new attitudes, skills, and knowledge about depression. However, we still need to find better ways of helping FPs to recognize and acknowledge their educational needs. Further research is also required to thoroughly evaluate these novel approaches to tailoring educational interventions.
Psychosocial Interventions for Bipolar Disorder and Coping Style Modification: Similar Clinical Outcomes, Similar Mechanisms?
Authors: Parikh Sagar V , Hawke Lisa D , Zaretsky Ari , Beaulieu Serge , Patelis-Siotis Irene , MacQueen Glenda , Young L Trevor , Yatham Lakshmi , Velyvis Vytas , Bélanger Claude , Poirier Nancy , Enright Jean , Cervantes Pablo
Published: January 2017

Objective:

To investigate changes in the use of coping styles in response to early symptoms of mania in cognitive-behavioural therapy (CBT), compared with psychoeducation, for bipolar disorder.

Method:

Data were drawn from a randomized controlled trial comparing CBT and psychoeducation. A subsample of 119 participants completed the Coping Inventory for the Prodromes of Mania and symptom assessments before treatment and 72 weeks later.

Results:

Both CBT and psychoeducation were associated with similar improvements in symptom burden. Both treatments also produced equivalent improvements in stimulation reduction and problem-directed coping styles, but no statistically significant change on the endorsement of help-seeking behaviours. A treatment interaction showed that a reduction in denial and blame was present only in the CBT treatment condition.

Conclusions:

CBT and psychoeducation have similar impacts on coping styles for the prodromes of mania. The exception to this is denial and blame, which is positively impacted only by CBT but which does not translate into improved outcome. Given the similar change in coping styles and mood burden, teaching patients about how to cope in adaptive ways with the symptoms of mania may be a shared mechanism of change for CBT and psychoeducation.
Childhood Maltreatment and Aggressive Behaviour in Violent Offenders with Psychopathy
Authors: Kolla Nathan J , Malcolm Charlotte , Attard Stephen , Arenovich Tamara , Blackwood Nigel , Hodgins Sheilagh
Published: January 2017

Objective:

To document experiences of childhood maltreatment among violent offenders with antisocial personality disorder (ASPD) distinguishing between those with and without the syndrome of psychopathy (+P and –P), and to determine whether maltreatment is associated with proactive and reactive aggression.

Method:

The sample included 10 violent offenders with ASPD+P, 15 violent offenders with ASPD-P, and 15 nonoffenders. All participants completed interviews with the same forensic psychiatrist focusing on physical, sexual, and emotional abuse prior to age 18 using the Early Trauma Inventory. Aggression was assessed using the Reactive-Proactive Questionnaire.

Results:

Violent offenders with ASPD+P reported significantly more severe childhood physical abuse, but not more sexual or emotional abuse, than violent offenders with ASPD-P and nonoffenders. Psychopathy Checklist—Revised (PCL-R) scores, but not childhood physical abuse, were associated with proactive aggression. Childhood physical abuse was associated with reactive aggression, as was an interaction term indicating that when both PCL-R scores and childhood physical abuse were high, so was reactive aggression.

Conclusions:

Among violent offenders, PCL-R scores were positively associated with proactive aggression, while experiences of childhood maltreatment were not. This finding concurs with previous studies of children and adults and suggests that proactive aggression may be a behavioural marker of psychopathic traits. By contrast, childhood physical abuse was associated with reactive aggression, even among violent offenders with high PCL-R scores. This latter finding suggests a strong influence of childhood physical abuse on the development of reactive aggression that persists over the lifespan.
The Burden of Mental Illness and Addiction in Ontario
Authors: Ratnasingham Sujitha , Cairney John , Manson Heather , Rehm Jürgen , Lin Elizabeth , Kurdyak Paul
Published: January 2017

Objective:

Public Health Ontario and the Institute for Clinical Evaluative Sciences have collaborated to estimate the burden of illness attributable to mental disorder and addictions in Ontario.

Methods:

Health-adjusted life years were used to estimate burden. It is conceptually similar to disability-adjusted life years that were used in the global burden of disease studies. Data sources for the mental illnesses and addictions used in our study included health administrative data for the province of Ontario, survey data from Statistics Canada and the Centre for Addiction and Mental Health, vital statistics data from the Ontario Office of the Registrar General, and US epidemiologic survey data.

Results:

The 5 conditions with the highest burden are: major depression, bipolar affective disorder, alcohol use disorders (AUDs), social phobia, and schizophrenia. The burden of depression is double the next highest mental health condition (that is, bipolar affective disorder) and is more than the combined burden of the 4 most common cancers in Ontario. AUDs were the only disease group that had a substantial proportion of burden attributable to early death. The burden estimates for the other conditions were primarily due to disability.

Conclusions:

The burden of these conditions in Ontario is as large or larger than other conditions, such as cancer and infectious diseases, owing in large part to the high prevalence, chronicity, and age of onset for most mental disorders and addiction problems. The findings serve as an important baseline for future evaluation of interventions intended to address the burden of mental health and addictions.
The Maternal Adversity, Vulnerability and Neurodevelopment Project: Theory and Methodology
Authors: O'Donnell Katherine A , Gaudreau Hélène , Colalillo Sara , Steiner Meir , Atkinson Leslie , Moss Ellen , Goldberg Susan , Karama Sherif , Matthews Stephen G , Lydon John E , Silveira Patricia P , Wazana Ashley D , Levitan Robert D , Sokolowski Marla B , Kennedy James L , Fleming Alison , Meaney Michael J
Published: January 2017

Objective:

To describe the theory and methodology of the multi-wave, prospective Maternal Adversity, Vulnerability and Neurodevelopment (MAVAN) study. The goal of MAVAN is to examine the pre- and postnatal influences, and their interaction, in determining individual differences in mental health.

Method:

MAVAN is a community-based, birth cohort study of pregnant Canadian mothers and their offspring. Dyads are assessed longitudinally, with multiple assessments of both mother and child in home and laboratory across the child's development. Study measures, including assessments of cognitive and emotional function, are described. The study uses a candidate gene approach to examine gene–environment interdependence in specific developmental outcomes. Finally, the study includes measures of both brain-based phenotypes and metabolism to explore comorbidities associated with child obesity. One of the unique features of the MAVAN protocol is the extensive measures of the mother–child interaction. The relation between these measures will be discussed.

Results:

Evidence from the MAVAN project shows interesting results about maternal care, families, and child outcomes. In our review, preliminary analyses showing the correlations between measures of maternal care are reported. As predicted, early evidence suggests that maternal care measures are positively correlated, over time.

Conclusions:

This review provides evidence for the feasibility and value of laboratory-based measures embedded within a longitudinal birth cohort study. Though retention of the samples has been a challenge of MAVAN, they are within a comparable range to other studies of this nature. Indeed, the trade-off of somewhat greater participant burden has allowed for a rich database. The results yielded from the MAVAN project will not only describe typical development but also possible targets for intervention. Understanding certain endophenotypes will shed light on the pathogenesis of various mental and physical disorders, as well as their interrelation.
The Prevalence of Major Depression is Not Changing
Authors: Patten Scott B , Williams Jeanne V A , Lavorato Dina H , Fiest Kirsten M , Bulloch Andrew G M , Wang JianLi
Published: January 2017

Objective:

To evaluate trends in the prevalence of major depressive episodes (MDEs) in Canada during the past 2 decades using data collected in a series of national surveys.

Method:

MDE prevalence has been assessed in national surveys that either used a short form version of the Composite International Diagnostic Interview Short Form for Major Depression (CIDI-SFMD) or an adaptation of the World Health Organization's (full-length) version, World Mental Health (WMH) CIDI. We applied meta-regression methods to adjust for instrument type while also addressing design effects in the individual data sets. Interprovincial differences that might have confounded estimation of national trends were also explored.

Results:

Interprovincial differences were not found to be significant, nor were time by province interactions. Estimates based on the WMH-CIDI were about 1% lower than those using the CIDI-SFMD. There was no evidence of changing prevalence over time, with slope for time, adjusted for assessment instrument, being nearly zero (β = 0.0007, P = 0.24).

Conclusion:

An extensive collection of surveys conducted in Canada between 1994 and 2012 provide an opportunity to examine long-term trends in the prevalence of major depression. MDE prevalence has not changed during this period of time.
Differential Effects of D2- and D4-Blocking Neuroleptics on the Procedural Learning of Schizophrenic Patients
Authors: Bédard Marc-André , Scherer Hélène , Delorimier Julie , Stip Emmanuel , Lalonde Pierre
Published: January 2017

Objective:

To illustrate the differential effects of D2- and D4-blocking neuroleptics on the procedural learning of patients with schizophrenia.

Method:

Twenty-nine schizophrenic patients were divided into 3 groups according to their pharmacological treatment: 1) drug naive, 2) haloperidol, and 3) clozapine. They were all assessed on clinical and procedural measures, the latter being the mirror drawing task.

Results:

All groups showed progressive learning over the successive trials, and drug-naive patients performed better than the other groups. Patients in the haloperidol group showed many fluctuations over trials, suggesting difficulty in the progressive automation of the task. Such fluctuations did not occur in the clozapine group, but performances per se were worse than in the other groups during the learning trials. A utomation of the task occurred at the same point (second block of trials) for all groups.

Conclusion:

These results suggest that D2- and D4-blocking neuroleptics do not similarly affect striatal dependent procedural learning in schizophrenia.
Posttraumatic Stress Disorder and Motor Vehicle Accidents: A Multidisciplinary Overview
Authors: Kuch Klaus , Cox Brian J , Evans Ramon J
Published: January 2017

Objective:

Motor vehicle accidents (MVA) may result in intractable disability. This paper investigates posttraumatic stress disorder (PTSD) as a potential cause.

Method:

The literature was reviewed for recent studies on prevalence, symptom profile, and outcome of PTSD.

Results:

PTSD is prevalent in roughly 10% of survivors of MVAs during the first year. Comorbid depression and pain are common. Medical complications, psychophysiological reactivity, and possibly litigation may slow remission. Phobic symptoms can persist for years. Mood disturbance may augment the impact of pain on daily living and on self-perceived disability.

Conclusion:

Recently developed screening instruments, structured interviews, and behavioural approach tests yield quantitative and reliable assessments of symptom severity. Cognitive–behavioural intervention and antidepressants may improve coping, ease fear, and reduce the impact of pain.
Serum Cholesterol Levels in Patients with Generalized Anxiety Disorder (GAD) and with GAD and Comorbid Major Depression
Authors: Kuczmierczyk Andrzej R , Barbee James G , Bologna Nancy A , Townsend Mark H
Published: January 2017

Objective:

To investigate risk for cardiovascular disease inpatients with GAD, as well as the effects of comorbid major depression (MD).

Method:

Predrug-trial serum cholesterol and triglyceride levels were assessed in 38 patients with pure GAD and compared with those of 21 patients with mixed GAD and comorbid (MD).

Results:

Significantly higher cholesterol and triglyceride levels were found in the GAD group.

Conclusion:

Increased noradrenergic activity may be responsible for elevations in lipid levels in patients with pure GAD.
Addition of a small amount of multiwalled carbon nanotubes and flaked graphene to epoxy resin
Authors: Koziol Mateusz , Jesionek Marcin , Szperlich Piotr
Published: January 2017

The paper presents an attempt to evaluate the technically important properties of epoxy resin modified alternatively with multi-walled carbon nanotubes and flaked graphene. It is a presentation of experimental results supported by extensive referring to the professional literature. The nano-components were added in the amount which was economically justified and provides hope for a significant improvement of some of the properties of pure resin. Flowability, glass wettability, curing process and gelation time and curing shrinkage of the resin were evaluated. After the resin was cured, inner and outer hardness, thermal conductivity, flexural strength and impact resistance were measured. Glass fibre-reinforced laminates were also prepared with use of the nano-modified resin. The mechanical properties, interlaminar shear strength and flexural strength of the laminates, were evaluated for them. The obtained results showed either no effect or only technically slight effect of the nano-modification on the evaluated properties. Noticeable improvement in interlaminar shear strength and impact resistance for laminates containing resin filled with graphene can predestine this kind of modification as a method of increasing the delamination resistance of laminates.
Plasma lipid peroxidation and erythrocyte antioxidant enzymes status in workers exposed to cadmium
Authors: Babu Kalahasthi Ravi , Rajmohan Hirehal Raghavendra Rao , Rajan Bagalur Krishna Murthy , M Karuna Kumar
Published: January 2017

Background: Cadmium (Cd) is a corrosion-resistant metal, used extensively for electroplating in the automobile, electronic and aerospace industry. Only a few studies are available regarding Cd-induced oxidative stress in animals, but no reports are available regarding the effects of Cd on oxidative stress during occupational exposure.

Objective: The present study was carried out to determine the plasma lipid peroxidation and erythrocyte antioxidant enzymes status in workers exposed to Cd during electroplating.

Methods: 50 subjects exposed to Cd during electroplating formed the study group. An equal number of age-sex matched subjects, working in the administrative section, formed the control group. Urinary Cd levels were determined using the flameless atomic absorption spectrophotometer. Plasma lipid peroxidation and erythrocyte antioxidant enzymes were determined using spectrophotometric methods. Results: A significant increase of plasma lipid peroxidation and a significant decrease of superoxide dismutase and glutathione peroxidase levels were noted in the study group compared with the control group. The level of plasma lipid peroxidation was positively and erythrocyte antioxidant enzymes were negatively and significantly associated with Cd levels in urine. Multiple regression analysis assessed the oxidative stress associated with Cd and other lifestyle confounding factors, such as age, body mass index, the consumption of vegetables, coffee, tea, smoking and alcohol. Analysis showed that the lifestyle confounding factors viz; smoking, body mass index and urinary Cd levels >5 μg/g of creatinine, were significantly associated with oxidative stress. Conclusion: The results of the present study suggest that increased plasma lipid peroxidation and decreased superoxide dismutase levels could be used as biomarkers of oxidative stress in cadmium-exposed workers.
The effect of Mentha spicata Labiatae on uterine tissue in rats
Authors: Güney Mehmet , Oral Baha , Karahanli Nermin , Mungan Tamer , Akdogan Mehmet
Published: January 2017

The plant Mentha spicata, or peppermint, is commonly used in the treatment of loss of appetite, common cold, bronchitis, sinusitis, fever, nausea and vomiting, and indigestion as a herbal agent. In this study, we aimed to investigate the biochemical and histological effects of M. spicata Labiatae, growing on the Anamas high plateau of Yenisarbademli town, on rat uterine tissue. Twenty female Wistar albino rats weighing 160±10 g were used for this study. Rats were divided into two groups of ten animals: group I received no herbal tea (control group) and group II received 20 g/L M. spicata tea. Control group rats were given commercial drinking water (Hayat DANONESA water). Herbal tea was prepared daily and provided at all times to the rats over 30 days as drinking water. Plasma malondialdehyde (MDA) levels were determined. In addition, uterine tissues were submitted for histopathologic examination. MDA levels were increased in group II when compared with the control group. The difference between group II and the control group was statistically significant ( P < 0.01). In the M. spicata Labiatae-treated group, histopathological changes like apoptosis and diffuse eosinophil leucocyte infiltration in surface and stromal glandular epithelium were observed in both endometrium and endocervix. It was concluded that lipid peroxidation and uterine damage occurs after M. spicata administration in rat uterus. Despite the beneficial effects of M. spicata Labiatae in indigestion, we should also be aware of the toxic effects when it is not used in the recommended fashion, at the recommended dose.
Characterization of Death in Neonatal Encephalopathy in the Hypothermia Era
Authors: Lemmon Monica E. , Boss Renee D. , Bonifacio Sonia L. , Foster-Barber Audrey , Barkovich A. James , Glass Hannah C.
Published: January 2017

This study aimed to characterize the circumstances of death in encephalopathic neonates treated with therapeutic hypothermia. Patients who died after or during treatment with therapeutic hypothermia between 2007-2014 were identified. Patient circumstance of death was characterized using an established paradigm. Thirty-one of 229 patients died (14%) at a median of 3 days of life. Most who died were severely encephalopathic on examination (90%) and had severely abnormal electroencephalographic (EEG) findings (87%). All those who had magnetic resonance images (n = 13) had evidence of moderate-severe brain injury; 6 had near-total brain injury. Cooling was discontinued prematurely in 61% of patients. Most patients (90%) were physiologically stable at the time of death; 81% died following elective extubation for quality of life considerations. Three patients (10%) died following withholding or removal of artificial hydration and nutrition. Characterization of death in additional cohorts is needed to identify differences in decision making practices over time and between centers.
Does Body Mass Index Predict Premature Cardiomyopathy Onset for Duchenne Muscular Dystrophy?
Authors: McKane Meghann , Soslow Jonathan H. , Xu Meng , Saville Benjamin R. , Slaughter James C. , Burnette W. Bryan , Markham Larry W.
Published: January 2017

Duchenne muscular dystrophy leads to cardiomyopathy. The objective of this study was to estimate the association of body mass index with cardiomyopathy onset. Cardiomyopathy was defined as left ventricular ejection fraction <55% or left ventricular fractional shortening <28%. Overall, 48% met the criteria for cardiomyopathy. We were unable to demonstrate an association between body mass index Z score and age of cardiomyopathy onset (hazard ratio 0.79, 95% confidence interval 0.57-1.11, P = .17) after adjusting for covariates. Duration of corticosteroid use ( P = .01), but not loss of ambulatory ability ( P = .47), was associated with age of cardiomyopathy onset. We were unable to detect a significant difference in median body mass index Z scores in corticosteroid-treated boys compared with corticosteroid-naïve boys (1.11, 95% confidence interval 0.25-1.95, vs 1.05, 95% confidence interval 0.01-1.86, P = .69). No association was detected between the body mass index Z scores of Duchenne muscular dystrophy subjects and age of cardiomyopathy onset.
A Review of the Effects of Gamma Radiation on Pharmaceutical Materials
Authors: Jacobs Geoffrey P.
Published: January 2017

This review on the radiation effects on pharmaceutical materials, with a view to their sterilization by gamma radiation, attempts to cover all the pertinent literature published over the period 1975 to 1992.
Sources and Number of Coupons for Cigarettes and Snus Received by a Cohort of Young Adults
Authors: Choi Kelvin , Taylor Naomi , Forster Jean
Published: January 2017

Purpose:

To examine the sources of tobacco coupons and their influence on susceptibility to snus use.

Design:

Cohort study.

Setting:

Minnesota Adolescent Community Cohort Study.

Subjects:

A population-based sample of US Midwest young adults in 2011 to 2012 and 2012 to 2013 (aged 22-28; n = 2384).

Measures:

Exposure to coupons for various tobacco products through various sources in the past 6 months, susceptibility to snus use.

Analysis:

Multiple logistic regressions.

Results:

During the 6 months prior to 2012 to 2013 survey, 11% of the sample received coupons for cigarettes, 5% received coupons for snus, 3% received coupons for other smokeless tobacco products, and <1% received coupons for little cigars. Direct mail was the most commonly cited source of cigarette and snus coupons. Tobacco product packaging provided the highest number of tobacco coupons for current and former smokers. Participants without a 4-year college education (compared to those who had a 4-year college education) were more likely to have received coupons for cigarettes and snus and received more coupons for both products ( P < .05). Racial/ethnic minority young adults (vs non-Hispanic white) received more cigarette and snus coupons ( P < .05). Receiving snus coupons was positively associated with susceptibility to snus use ( P < .05).

Conclusion:

Tobacco companies are successful in reaching young adults using coupons for various tobacco products. Snus coupons may influence snus use, similar to how cigarette coupons influence smoking.
Source and Size of Social Support Network on Sedentary Behavior Among Older Adults
Authors: Loprinzi Paul D. , Crush Elizabeth A.
Published: January 2017

Purpose:

To examine the association of source of social support and size of social support network on sedentary behavior among older adults.

Design:

Cross-sectional.

Setting:

National Health and Nutrition Examination Survey 2003 to 2006.

Participants:

2519 older adults (60+ years).

Measures:

Sedentary behavior was assessed via accelerometry over a 7-day period. Social support was assessed via self-report. Sources evaluated include spouse, son, daughter, sibling, neighbor, church member, and friend. Regarding size of social network, participants were asked, “In general, how many close friends do you have?”

Analysis:

Multivariable linear regression.

Results:

After adjustment, there was no evidence of an association between the size of social support network and sedentary behavior. With regard to specific sources of social support, spousal social support was associated with less sedentary behavior (β = −11.6; 95% confidence interval: −20.7 to −2.5), with evidence to suggest that this was only true for men. Further, an inverse association was observed between household size and sedentary behavior, with those having a greater number of individuals in the house having lower levels of sedentary behavior. These associations occurred independent of moderate-to-vigorous physical activity, age, gender, race–ethnicity, measured body mass index, total cholesterol, self-reported smoking status, and physician diagnosis of congestive heart failure, coronary artery disease, stroke, cancer, hypertension, or diabetes.

Conclusion:

Spouse-specific emotion-related social support (particularly for men) and household size were associated with less sedentary behavior.
Effect of the Knowledge and Attitudes of a Support Person on Maternal Feeding Choice
Authors: Thomas Courtney , O’Riordan Mary Ann , Furman Lydia
Published: January 2017

Background:

Breastfeeding rates among urban, low-income populations are lower than the national average, and social support can affect breastfeeding initiation and duration both positively and negatively.

Research aim:

This study aimed to determine the effect of the presence of a support person and breastfeeding knowledge and attitudes of that person on a mother’s feeding choice and perceived level of support for her choice.

Methods:

Questionnaires were administered to 192 mothers receiving care for their infants in the Pediatric Practice at University Hospitals Rainbow Babies and Children’s Hospital in Cleveland, Ohio, along with 74 adults accompanying these mothers. Data on demographics, feeding characteristics, and breastfeeding knowledge and attitudes were collected.

Results:

Analysis of the entire group of mothers found that breastfeeding-supportive knowledge and attitudes were an independent predictor of exclusive breastfeeding (odds ratio [ OR] = 1.89, 95% confidence interval [CI] [1.38, 2.60]) and any breastfeeding ( OR = 2.28, 95% CI [1.62, 3.21]). The presence of an accompanying adult was not related to feeding choice. Analysis of the subgroup of mothers with surveyed accompanying adults found independent predictors of any breastfeeding include maternal intention to breastfeed ( OR = 23.68, 95% CI [1.48, 377.6]) and breastfeeding-supportive knowledge and attitudes of the mother ( OR = 2.71, 95% CI [1.36, 5.40]) and the accompanying adult ( OR = 2.78, 95% CI [1.17, 6.60]). The only independent predictor of exclusive breastfeeding was maternal intention to breastfeed ( OR = 7.64, 95% CI [2.22, 26.3]). The majority of mothers (91%) felt supported, regardless of presence or absence of an accompanying adult.

Conclusion:

These findings emphasize the importance of breastfeeding education for mothers and their support persons.
Likelihood of Breastfeeding Within the USDA’s Food and Nutrition Service Special Supplemental Nutrition Program for Women, Infants, and Children Population
Authors: Houghtaling Bailey , Byker Shanks Carmen , Jenkins Mica
Published: January 2017

Background:

Breastfeeding is an important public health initiative. Low-income women benefiting from the U.S. Department of Agriculture’s Food and Nutrition Service Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) are a prime population for breastfeeding promotion efforts.

Research aim:

This study aims to determine factors associated with increased likelihood of breastfeeding for WIC participants.

Methods:

The Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement guided the systematic review of literature. Database searches occurred in September and October 2014 and included studies limited to the previous 10 years. The following search terms were used: low-income; WIC; women, infants, and children; breastfeeding; breast milk; and maternal and child health. The criterion for inclusion was a study sample of women and children enrolled in the WIC program, thereby excluding non-United States–based research.

Results:

Factors that increased the likelihood of breastfeeding for WIC participants included sociodemographic and health characteristics ( n = 17); environmental and media support ( n = 4); government policy ( n = 2); intention to breastfeed, breastfeeding in hospital, or previous breastfeeding experience ( n = 9); attitudes toward and knowledge of breastfeeding benefits ( n = 6); health care provider or social support; and time exposure to WIC services ( n = 5).

Conclusion:

The complexity of breastfeeding behaviors within this population is clear. Results provide multisectored insight for future research, policies, and practices in support of increasing breastfeeding rates among WIC participants.
Factors Associated With Extended Breastfeeding in India
Authors: Mehta Arpit R. , Panneer Sigamani , Ghosh-Jerath Suparna , Racine Elizabeth F.
Published: January 2017

Background:

Extended breastfeeding duration is common in India. Extended breastfeeding protects the infant from infectious disease and promotes child spacing. In the 1990s, the median breastfeeding duration in India was 24 months.

Research aim:

This study aimed to investigate the median duration of breastfeeding in India and to identify the factors associated with extended breastfeeding to 24 months as recommended by the World Health Organization.

Methods:

This cross-sectional data analysis used nationally representative data from the 2011–2012 Indian Human Development Survey II. The outcome in this study was extended breastfeeding defined as breastfeeding to 24 months or more. Multivariate logistic regression was used to identify the factors associated with extended breastfeeding.

Results:

The median duration of breastfeeding was 12 months; approximately 25% of women breastfed 24 months or more. Women were at greater odds of breastfeeding 24 months or more if the infant was a boy compared with a girl, if the women lived in a rural area compared with an urban area, if the women were married at a young age (< 17 vs. 20 years or older at marriage), and if the delivery was assisted by a friend or relative compared with a doctor.

Conclusion:

The median duration of breastfeeding has decreased by 50% from 1992–1993 to 2011–2012. The women who continue to breastfeed 24 months or more tend to be more traditional (i.e., living in rural areas, marrying young, and having family/friends as birth attendants). Further research to study the health effect of decreased breastfeeding duration is warranted.
Nurses’ Perceptions of Competence in Providing Spiritual Care
Authors: Abell Cathy H. , Garrett-Wright Dawn , Abell Caitlyn E.
Published: January 2017

Purpose: The study examined nurses’ perception of competence in providing spiritual care. Design of Study: A descriptive correlational research design with a convenience sample was used. Method: Participates completed a demographic questionnaire and the Spiritual Care Competence Scale, which has six domains: assessment and implementation of spiritual care, professionalization and improving the quality of spiritual care, personal support and patient counseling, referral to professionals, attitude toward the patient’s spirituality, and communication. Findings: The domain of communication had the most favorable perception among participants and the domain of professionalization and improving the quality of spiritual care had the least favorable perception. Conclusions: It is important for nurses to have the opportunity to gain knowledge regarding this significant component of holistic care.
Utilisation of Acute Care Hospital Beds by Levels of Care
Authors: Bay K. S. , Toll K. A. , Kerr J. R.
Published: January 2017

An exploratory analysis of utilisation patterns of acute care hospitals in the Province of Alberta, Canada was carried out to develop a methodology for assessing bed utilisation profiles of acute care hospitals by levels of care. The utilisation of Alberta acute care hospital beds was measured in terms of primary, secondary and tertiary levels of hospital services. Patient origin—destination methodology was applied and a regionalisation perspective employed. The data used for this study were hospital separation abstracts compiled by all Alberta acute care hospitals during year 1986, this coincided with the most recent available Canadian census data. It was estimated that approximately 10–11% of Alberta beds were used for tertiary care as derived from population based utilisation rates and patient flow patterns. With respect to per capita measurement, the number of beds used per 1,000 residents was: 3.5 to 3.9 for primary, 1.2 to 1.6 for secondary, and about 0.6 for tertiary levels of care. Regression analysis revealed that the marginal cost per bed at each level was approximately 75–79, 87–88, and 201–209 thousand Canadian dollars per year in 1986 for primary, secondary and tertiary care respectively. The profiles thus estimated explained about 65% of per bed hospital cost variation.
Managing Physician Efficiency and Effectiveness in Providing Hospital Services
Authors: Chilingerian Jon A. , Sherman H. David
Published: January 2017

Physicians control more than 80 percent of the decisions affecting health costs. Consequently, managing physician practice patterns is an important avenue to reducing health care costs. One approach to identifying inefficient practice patterns is demonstrated in this pilot study of physicians treating heart shock patients. Physicians are evaluated using data envelopment analysis (DEA), a relatively new linear-program-based efficiency evaluation tool. This approach (1) locates physicians using excess resources in treating patients, (2) estimates the amount of excess resources used, and (3) explicitly considers the quality of patient care in the overall assessment of the physician's practice patterns. Findings of physician inefficiency that are stable over time could be used to alter practice patterns and subsequently to assist in cost containment.
Preliminary Report on Nurse Job Satisfaction on Wards for the Elderly, Mentally Ill
Authors: Mountain G. A. , Bowie P. C. W. , Dabbs A. R.
Published: January 2017

The effect of Community Care Policies upon staffing levels within institutions is potentially problematic; wider job opportunities becoming available to nurses as community provision increases. The job satisfaction of nurses still working within institutions must, therefore, be an issue of importance in the maintenance of suitably qualified and experienced staff.

This study examines the differing amounts of job satisfaction reported by a sample of 59 nurses all working on long-stay wards for the elderly, mentally ill; located within three different institutions. The results show that the measures selected for use have high content and face validity for this population. The effects of institutional and staff management are highlighted as being major influences upon the degree of job satisfaction.
The Compatibility of General Managers' Activities and Intentions in Managing Change in the NHS
Authors: Spurgeon Peter , Barwell Frederick
Published: January 2017

As Hales (1986) has observed, the problem of much of the managerial research to date has been the reluctance to ask why managers behave in the way they do. The behaviour of general managers in tackling organisational change in the NHS needs to be viewed not only with respect to what is done but also with respect to how personal and organisational objectives are construed. In other words, the implementation of organisational change ultimately rests on how general managers perceive the nature of this change and their role in structuring their own personal and organisational objectives into appropriate activities.

Examining the compatibility of managerial activities and the underlying values and intentions which support them is of critical importance in any cognitively-based approach. These intentions provide an important link between perceptions (i.e. how the organisation is construed) and behaviour (i.e. what activities managers choose to perform). Understanding the conceptual frameworks which underpin managerial activities could have profound implications for assessing the performance of general managers.
Supply-Induced Demand for Hospital Care
Authors: Rohrer James E.
Published: January 2017

Preliminary analysis of hospital utilization data indicates that Roemer's Law may still be operative in rural Iowa: counties with more hospital beds per capita have more hospital utilization per capita. However, when patient origin data are analyzed findings are entirely different. Bed supply is not related to utilization rates in Iowa counties. Instead, the number of unique hospital services is associated with higher utilization rates. The impact of this characteristic of hospital supply, however, is much weaker than the original Roemer effect. The contradiction of these findings with Roemer's Law is apparently a result of a methods effect: use of hospital utilization data which are not derived from actual population experience reveals a relationship which is a statistical artifact. The data also reveal that suburban counties have higher utilization rates than either rural or urban (MSA core) counties.
The Development of a Points System to Compare the Potential Running Costs of Different Development Options for New Hospitals
Authors: Stollard Paul , Croucher Karen , Clark Tim
Published: January 2017

The points system provides a simple method of assessing the design aspects of health care facilities which have a significant influence on their eventual operating costs. It is intended to assist planning teams working in the early stages of designing a health care facility. The system offers a systematic form of analysis which should be used in the preparation of development proposals as an aide-memoir, and as a method of comparing and evaluating alternative design solutions. It comprises seventeen worksheets which should be used by planning teams as a checklist of Design for Reduced Operating Costs factors. The system was developed by using the ‘delphi’ methodology and has been tested in a series of repeatability tests and field trials; and it is now being used for developments within the NHS.