bluuebunny/crossref_metadata_2025 huggingface dataset:
Plasma catecholamines, pharmacotherapy and mood of subjects with cardiovascular disorder
Authors: Stanford S. Clare , Salmon Peter , Mikhail Ghada , Gettins Doreen , Zielinski Simon , Pepper John R.
Published: April 2009

This study investigated whether drug therapy explains why the concentration of arterial plasma catecholamines in patients who have received an orthotopic heart transplant (OHT) or coronary bypass and graft (CABG) is greater than in those with heart failure (HF).The results suggest that the differences in plasma catecholamine concentrations in these groups of patients could not be attributed to administration of any of the drugs studied here. An additional finding is that the use of aspirin is associated with a higher concentration of plasma noradrenaline, but not adrenaline. Patients who were taking aspirin also had a more positive mood, as rated by the Profile of Mood States; this was mainly because they had a lower fatigue score than did patients who were not taking this drug. In contrast, several agents (warfarin, Ca2+-channel blockers and `mixed cardiac' drugs), which had no effects on catecholamine overspill, were linked with negative mood; this was expressed consistently as a higher tension score. These findings suggest that drugs which are administered for their effects in the periphery could also influence patients' psychological status. With the possible exception of aspirin, this does not involve changes in spillover of catecholamines in the periphery.
Comparative effects of serotonergic agonists withvarying efficacy at the 5-HT1Areceptor on core body temperature: modification by the selective 5-HT1Areceptor antagonist WAY 100635
Authors: Cryan John F. , Kelliher Padraig , Kelly John P. , Leonard B. E.
Published: April 2009

A reduction in core body temperature is one of the characteristic consequences of 5-HT1Areceptor activation in rodents. In this study, we characterized the hypothermic effects of four 5-HT1Areceptor ligands with varying affinity and selectivity at the 5-HT1Areceptor. 8-OH-DPAT and flesinoxan (full agonists); ipsapirone (selective partial agonist) and eltoprazine (non selective partial agonist), all induced a dose-dependent reduction in core body temperature, which was maximal 30 min subsequent to administration. This response differed quantitatively between the agonists, in both the extent and the duration of its effects. The selective 5-HT1Areceptor antagonist WAY 100635 (0.15 mg/kg), attenuated the hypothermia induced by the partial agonists, ipsapirone (10 mg/kg) and eltoprazine (10 mg/kg). In contrast, the higher dose of WAY 100635 (1mg/kg) antagonized the effects of all agonists. This study therefore further confirms the utility of hypothermia as a simple, robust in-vivo probe of 5-HT1Areceptor function.This paradigm, which was enhanced by use of specific antagonists such as WAY 100635, may prove useful for the detection and characterization of novel 5-HT1Areceptor ligands.
Do antidepressants have any potential to cause addiction?
Authors: Haddad Peter
Published: April 2009

Addiction/dependence is a syndrome in which the hallmark is a compulsive pattern of drug use. Most authorities do not regard antidepressants as causing addiction but this has been challenged. This debate is explored drawing on case reports and related clinical and pharmacological data. An extensive literature review identified 21 English language case reports of antidepressant addiction (DSM-IV `substance dependence' criteria) published since 1963. Sixteen involved tranylcypromine or amineptine and may reflect their dopaminergic and stimulant properties. Subject characteristics included male sex (14/21), personality problems (10/21) and prior substance misuse (14/21). Withdrawal or discontinuation symptoms have long been recognized with antidepressants but other features of addiction such as tolerance and compulsive use are exceptionally rare. Common clinical problems are patients taking subtherapeutic dosages and prematurely stopping antidepressants. The pharmacodynamic profiles of most antidepressants and the absence of acute `desirable' effects make addiction theoretically unlikely. It is concluded that, with the exception of tranylcypromine and amineptine, antidepressants do not have a clinically significant liability to cause addiction. Tranylcypromine and amineptine should be avoided in those with a history of substance misuse. Patients prescribed other antidepressants should be told that they are not addictive.
Present and future capabilities of molecular imaging techniques to understand brain function
Authors: Jones Terry
Published: April 2009

This article focuses on the use of positron emitting tracers and positron emission tomography (PET) as the most specific and sensitive means for imaging molecular interactions and pathways within the human brain. The concept of the imaging science of PET is developed whereby the key components that contribute to the overall accuracy of the image of molecular activity need to be separately optimized. These include radiolabelling of tracer molecules and ligands with radioisotopes of short radioactive half-life, the search for specific radioligands and tracers, and hence the need to mine molecular databases for molecules suitable for in-vivo imaging. The sensitivity and accuracy of PET scanners need to be advanced along with improvements in the signal-to-noise ratio of the tomographic reconstruction algorithms. Finally, the models used for the analysis of serial time frames of kinetic data need to be developed, the operation of which have to be effected with the minimum of noise propagation. The future use of PET for drug discovery and development is discussed whereby it offers proof principle for assays of in-vivo expression of therapeutic molecular targets as accessed from the blood stream; tissue pharmacokinetics of novel compounds; degree of occupancy of molecular targets; and pharmacodynamic measures of drug action. The future application of PET rests heavily on drug discoverers contributing to discovering specific PET radioligands and tracers in order to provide these assays through in-vivo molecular imaging.
effects of d-amphetamine and haloperidol on latent inhibition in healthy male volunteers
Authors: Kumari Veena , Cotter Paul A. , Mulligan Owen F. , Checkley Stuart A. , Gray Nicola S. , Hemsley David R. , Thornton Jasper C. , Corr Philip J. , Toone Brian K. , Gray Jeffrey A.
Published: April 2009

Latent inhibition (LI) refers to a retardation of learning about the consequences of a stimulus when that stimulus has been passively presented a number of times without reinforcement. Acute positive-symptom schizophrenics, normal volunteers who score high on questionnaire measures of schizotypy and non-patients or animals treated with dopamine agonists show reduced LI. Neuroleptic drugs, such as haloperidol, administered at low doses, potentiate LI and effectively reverse disruption of LI induced by dopamine agonists in animals. However, a high dose of haloperidol, administered on its own, has been found to reduce LI. We examined the effects on LI of acute oral administration of an indirect dopamine-agonist, d-amphetamine (5 mg), and a nonselective dopamine receptor antagonist, haloperidol (5 mg), in normal male volunteers, using an associative learning task. Replicating previous reports, we found that d-amphetamine reduced LI; haloperidol also reduced LI, but only in subjects who scored low on the Psychoticism scale of the Eysenck Personality Questionnaire. In a subsequent study, no effect was found of 2 mg oral haloperidol administration on LI. The effect of 5 mg haloperidol on LI is interpreted as similar to that observed with a high dose of haloperidol in rats.
Evidence-based psychopharmacology 2. Appraising a systematic review: is risperidone better than conventional antipsychotics in the treatment of schizophrenia?
Authors: Warner James P.
Published: April 2009

Systematic reviews are increasingly used to combine the results of several studies in order to define the treatment effect with a high degree of precision. However, reviews of this nature may lead to spurious results and should not be accepted uncritically. This article, the second in a series on evidence-based psychopharmacology, is intended to illustrate the process of critical appraisal of a systematic review. In this example, a systematic review of studies comparing risperidone with conventional antipsychotics is appraised. Interpretation of the results of the systematic review may be hampered by the way in which studies were selected.
Survival Impact of Tamoxifen Use for Breast Cancer Risk Reduction: Projections from a Patient-Specific Markov Model
Authors: Col Nananda F. , Goldberg Robert J. , Orr Richard K. , Erban John K. , Fortin Jennifer M. , Chlebowski Rowan T.
Published: April 2009

The authors estimate tamoxifen’s impact on life expectancy among healthy women. A Markov model compared the effects of 5 years of tamoxifen on survival among 50-year-old postmenopausal women. Scenarios were explored using alternative assumptions with regard to tamoxifen’s long-term effects on breast and endometrial cancer. Postmenopausal women without a uterus had substantial life expectancy gains from tamoxifen (1 to 4 months), whereas women with a uterus had such gains only if they were at a very high breast cancer risk. If tamoxifen’s impact on endometrial cancer persists after treatment is discontinued, women at high risk for endometrial cancer have life expectancy losses from tamoxifen unless they are at a very high risk for breast cancer. The authors conclude that tamoxifen use among postmenopausal women is associated with substantial life expectancy gains. However, this benefit is modulated in women at increased endometrial cancer risk and depends on assumptions concerning tamoxifen’s lingering effects on breast and endometrial cancer.
The Role of Risk and Benefit Perception in Informed Consent for Surgery
Authors: Lloyd Andrew , Hayes Paul , Bell Peter R. F. , Naylor A. Ross
Published: April 2009

Background. Informed consent relies on patients’ ability to understand risk information. Evidence suggests that people may extract the gist of any risk information to make medical decisions. Existing evidence also suggests that there is an inverse relationship between the perception of risk and the perception of benefit. Method. Seventy-one patients on the waiting list for carotid endarterectomy (CEA) were surveyed regarding their understanding and recall of the risk and benefit to health of undergoing CEA. Patients were surveyed 1 month after their initial consultation, and a subgroup was surveyed again on the day before their operation. Results. Patients’ estimates of their baseline risk of stroke without surgery were significantly different from what they had been told by the surgeon. Patients’ estimates of stroke risk due to surgery ranged from 0% to 65% (actual local risk 2%). Patients also had unreasonable expectations about the benefit of the operation for their health. Estimates of stroke risk correlated positively with the degree of expected benefit from the operation (r = 0.29, P = 0.05). When resurveyed the day before the operation, patients’ perceptions of both risk and benefit had increased significantly. The risk perception data from some patients appeared to contradict some of the predictions of the fuzzy-trace theory. Conclusions. Most patients failed to understand the risks and benefits associated with CEA. Some patients’ estimates of stroke risk were actually greater than the perceived potential benefit of surgery in terms of risk reduction. The data also suggested a positive correlation between the degree of perceived benefit and the degree of perceived risk.
Effect of Written and Computerized Decision Support Aids for the U.S. Agency for Health Care Policy and Research Depression Guidelines on the Evaluation of Hypothetical Clinical Scenarios
Authors: Medow Mitchell A. , Wilt Timothy J. , Dysken Signe , Hillson Steve D. , Woods Sharon , Borowsky Steven J.
Published: April 2009

Objective. The objective of this study was to compare the effects of written and computerized decision support aids (DSAs) based on U.S. Agency for Health Care Policy and Research depression guidelines. Methods. Fifty-six internal medicine residents were randomized to evaluate clinical scenarios using either a written or a computerized DSA after first assessing scenarios without a DSA. The paired difference between aided and unaided scores was determined for diagnostic accuracy, treatment selection, severity and subtype classification, antipsychotic use, and mental health consultations. Results. Diagnostic accuracy with the written DSA increased from 64% to 73%, and with the computerized DSA decreased from 67% to 64% (P = 0.0065). Residents using the computerized DSA (vs. no DSA) requested fewer consultations (65% vs. 52%, P = 0.028). In post hoc analysis, the written DSA increased sensitivity (66% to 89%, P < 0.001) and the computerized DSA improved specificity (66% to 86%, P = 0.0020) but reduced sensitivity (67% to 49%, P = 0.011). Conclusions. A written DSA improved diagnostic accuracy, whereas a computerized DSA did not. However, the computerized DSA improved specificity and reduced mental health consultations.
The Beguiling Pursuit of More Information
Authors: Redelmeier Donald A. , Shafir Eldar , Aujla Prince S.
Published: April 2009

Background. The authors tested whether clinicians make different decisions if they pursue information than if they receive the same information from the start. Methods. Three groups of clinicians participated (N = 1206): dialysis nurses (n = 171), practicing urologists (n = 461), and academic physicians (n = 574). Surveys were sent to each group containing medical scenarios formulated in 1 of 2 versions. The simple version of each scenario presented a choice between 2 options. The search version presented the same choice but only after some information had been missing and subsequently obtained. The 2 versions otherwise contained identical data and were randomly assigned. Results. In one scenario involving a personal choice about kidney donation, more dialysis nurses were willing to donate when they first decided to be tested for compatibility and were found suitable than when they knew they were suitable from the start (65% vs. 44%, P =0.007). Similar discrepancies were found in decisions made by practicing urologists concerning surgery for a patient with prostate cancer and in decisions of academic physicians considering emergency management for a patient with acute chest pain. Conclusions. The pursuit of information can increase its salience and cause clinicians to assign more importance to the information than if the same information was immediately available. An awareness of this cognitive bias may lead to improved decision making in difficult medical situations.
Assessing Values for Health: Numeracy Matters
Authors: Woloshin Steven , Schwartz Lisa M. , Moncur Megan , Gabriel Sherine , Tosteson Anna N. A.
Published: April 2009

Background. Patients’ values are fundamental to decision models, cost-effectiveness analyses, and pharmacoeconomic analyses. The standard methods used to assess how patients value different health states are inherently quantitative. People without strong quantitative skills (i.e., low numeracy) may not be able to complete these tasks in a meaningful way. Methods. To determine whether the validity of utility assessments depends on the respondent’s level of numeracy, the authors conducted in-person interviews and written surveys and assessed utility for the current health for 96 women volunteers. Numeracy was measured using a previously validated 3-item scale. The authors examined the correlation between self-reported health and utility for current health (assessed using the standard gamble, time trade-off, and visual analog techniques) across levels of numeracy. For half of the women, the authors also assessed standard gamble utility for 3 imagined health states (breast cancer, heart disease, and osteoporosis) and asked how much the women feared each disease. Results. Respondent ages ranged from 50 to 79 years (mean = 63), all were high school graduates, and 52% had a college or postgraduate degree. Twenty-six percent answered 0 or only 1 of the numeracy questions correctly, 37% answered 2 correctly, and 37% answered all 3 correctly. Among women with the lowest level of numeracy, the correlation between utility for current health and self-reported health was in the wrong direction (i.e., worse health valued higher than better health): for standard gamble, Spearman r = -0.16, P =0.44; for time trade-off, Spearman r = -0.13, P = 0.54. Among the most numerate women, the authors observed a fair to moderate positive correlation with both standard gamble (Spearman r = 0.22, P = 0.19) and time trade-off (Spearman r = 0.50, P = 0.002). In contrast, using the visual analog scale, the authors observed a substantial correlation in the expected direction at all levels of numeracy (Spearman r =0.82, 0.50, and 0.60 for women answering 0-1, 2, and 3 numeracy questions, respectively; all P s ≤ 0.003). With regard to the imagined health states, the most feared disease had the lowest utility for 35% of the women with the lowest numeracy compared to 76% of the women with the highest numeracy (P = 0.03). Conclusions. The validity of standard utility assessments is related to the subject’s facility with numbers. Limited numeracy may be an important barrier to meaningfully assessing patients’ values using the standard gamble and time trade-off techniques.
A Cost-Effectiveness Analysis of Alternative At-Home or In-Laboratory Technologies for the Diagnosis of Obstructive Sleep Apnea Syndrome
Authors: Reuveni Haim , Schweitzer Eithan , Tarasiuk Ariel
Published: April 2009

Background. Obstructive sleep apnea syndrome (OSAS) is a common disorder that affects 2% to 9% of the population. Health care policy makers have noted increased referrals for sleep studies. Objective. In this article, the authors conduct a cost-effectiveness analysis to determine the optimal technology for the diagnosis of OSAS using polysomnography (PSG) or partial sleep monitoring (PSM). Design. The target population was a hypothetical cohort of patients suspected of having OSAS. A 2-level decision tree was formulated that reflects all possible steps of OSAS diagnosis and therapy. The method represents a comprehensive strategy to determine which of the 2 systems—PSG or PSM—has cost advantages. The financial and operational aspects of OSAS diagnosis and therapy were analyzed. A sensitivity analysis was performed over all uncertain parameters (i.e., diagnostic agreement, data loss, and referral to therapy). Results. Unattended at-home sleep monitoring was the most expensive method. The combination of 1:2 PSG and attended PSM strategy was the optimal strategy with respect to financing and operations. Compared to the PSG-only strategy, this combination may lead to a 10% reduction of the annual expenditure. Conclusion. This study provides proof of concept (under a wide range of sensitivity assumptions) that the cost of sleep study techniques can be modeled. It rejects the assumption that at-home portable sleep monitoring is cost advantageous. The combination of PSG and attended PSM OSAS is the most cost-effective approach to sleep evaluation.
Using Life Expectancy to Communicate Benefits of Health Care Programs in Contingent Valuation Studies
Authors: Morris Jill , Hammitt James K.
Published: April 2009

Background. There is growing interest in the use of contingent valuation (CV) to estimate the monetary value of health program benefits. Ideally, CV could be used to value a specific shift in survival curve. However, a shift in survival curve may prove too complex for widespread use in CV instruments. To facilitate the use of CV in valuing longevity benefits, researchers need alternative summary measures that describe the longevity benefit in a single number that is more readily communicated in a CV context. Methods. The authors compare 2 methods for communicating longevity benefits in a CV survey. Random subsamples of respondents valued a longevity benefit expressed either as a continuing reduction in annual mortality risk or as a gain in life expectancy. To compare the validity of the alternative descriptions, the authors evaluate willingness to pay (WTP) estimates for consistency with theoretical predictions. Results. It is found that WTP for a longevity benefit is sensitive to the framing of the benefit, with respondents expressing higher WTP for the benefit expressed as a life expectancy gain. The life expectancy format performs better than the risk reduction format in one important regard—sensitivity to scope of the benefit—and no worse than the risk reduction format in other regards. Conclusion. Expressing longevity benefits in terms of life expectancy appears to hold promise as a method for enhancing the validity of economic evaluation of health care programs.
Comparison of Appropriateness Ratings for Cataract Surgery between Convened and Mail-only Multidisciplinary Panels
Authors: Tobacman Joanne K. , Scott Ingrid U. , Cyphert Stacey T. , Zimmerman M. Bridget
Published: April 2009

Background. In this article, the authors determine the reproducibility of appropriateness ratings for cataract surgery between a multidisciplinary physician panel that convened and a multidisciplinary physician panel that completed ratings by mail. Methods. Eighteen panelists, who constituted 2 distinct multidisciplinary panels, rated 2894 clinical scenarios as an appropriate, inappropriate, or uncertain indication to perform cataract surgery. Each panel’s summary score for each scenario was calculated. Weighted kappa values were determined to assess the level of agreement between the ratings of the 2 panels. Results. The panels had a substantial level of agreement overall, with a weighted kappa statistic of 0.64. There was agreement on about 68% of the scenarios, and serious disagreement, in which one panel rated an indication appropriate and the other rated it inappropriate, occurred in only 1% of the ratings. Conclusion. There was substantial agreement about the ratings by the 2 panels. The panel that convened rated fewer scenarios uncertain and more appropriate, suggesting the impact of group dynamics and face-to-face discussion on resolution of uncertainty.
A Real-Time Classification System of Thalassemic Pathologies Based on Artificial Neural Networks
Authors: Amendolia S. R. , Brunetti A. , Carta P. , Cossu G. , Ganadu M. L. , Golosio B. , Mura G. M. , Pirastru M. G.
Published: April 2009

Thalassemias are pathologies that derive from genetic defects of the globin genes. The most common defects among the population affect the genes that are involved in the synthesis of α and β chains. The main aspects of these pathologies are well explained from a biochemical and genetic point of view. The diagnosis is fundamentally based on hematologic and genetic tests. A genetic analysis is particularly important to determine the carriers of α -thalassemia, whose identification by means of the hematologic parameters is more difficult in comparison with heterozygotes for β -thalassemia. This work investigates the use of artificial neural networks (ANNs) for the classification of thalassemic pathologies using the hematologic parameters resulting from hemochromocytometric analysis only. Different combinations of ANNs are reported, which allow thalassemia carriers to be discriminated from normals with 94% classification accuracy, 92% sensitivity, and 95% specificity. On the basis of these results, an automated system that allows real-time support for diagnoses is proposed. The automated system interfaces a hemochromo analyzer to a simple PC.
Effects of Baseline Risk Information on Social and Individual Choices
Authors: Gyrd-Hansen Dorte , Kristiansen Ivar Sønbø , Nexøe Jørgen , Nielsen Jesper Bo
Published: April 2009

This article analyzes preferences for risk reductions in the context of individual and societal decision making. The effect of information on baseline risk is analyzed in both contexts. The results indicate that if individuals are to imagine that they suffer from 1 low-risk and 1 high-risk ailment, and are offered a specified identical absolute risk reduction, a majority will ceteris paribus opt for treatment of the low-risk ailment. A different preference structure is elicited when priority questions are framed as social choices. Here, a majority will prefer to treat the high-risk group of patients. The preference reversal demonstrates the extent to which baseline risk information can influence preferences in different choice settings. It is argued that presentation of baseline risk information may induce framing effects that lead to nonoptimal resource allocations. A solution to this problem may be to not present group-specific baseline risk information when eliciting preferences.
Judgment Analysis of Prioritization Decisions within a Dialysis Program in One United Kingdom Region
Authors: Kee Frank , Patterson Chris C. , Wilson Ann E. , McConnell Janice M. , Wheeler Seana M. , Watson John D.
Published: April 2009

Background. Some previous research on rationed clinical services has confused the conceptual differences underpinning prioritization decisions on the one hand and assessments of individual need on the other. The balance of the clinical and nonclinical drivers of these decisions can be different. Our objective was to study the basis and extent of variation among nephrologists in one NHS region in their views concerning prioritization for dialysis. Design and methods. In a clinical judgment analysis, multiple regression analysis was used to express the impact of clinical and nonclinical cues on nephrologists’ decisions to offer dialysis and attribute priority to 50 “paper patients.” Cues were selected for the decision-making models using stepwise (backward) elimination of variables. Further “policy” models for priority were derived by forcing in the doctors’ views about the capacity of dialysis to extend life expectancy or improve its quality. Results. Comparison of “propensity to offer” and “prioritization” decision models showed a modest degree of correspondence. Among the nonrenal cues, the patient’s mental state made the single greatest contribution to the priority decision models (mean contribution to R2 = 12.1, with temporary or permanent confusional states in patients changing the priority [1-50] by an average of 15 rank places). Although patient age significantly influenced the decision models of half of the doctors, the beta-coefficients were very modest, suggesting a change in rank order of no more than one place. There was a significant improvement in the overall explained variance (R2 )of the models when varying perceptions of the capacity of dialysis to improve the quality or extend the duration of the patient’s life were forced into the model. Although, in general, temporary or permanent confusion in the patient downgraded the priority for dialysis by between 10 and 20 places, this tendency was largely unchanged when the doctors’ perceptions of benefit were forced into the priority model. Among renal cues, the presence of uremic symptoms had the greatest impact on priority (mean contribution to R2 = 49.1, mean beta-coefficient -17.1), whereas the presence of other comorbid disease had relatively little effect. Conclusions. When forced to rank patients, the nonrenal factor that had the most significant bearing on perceived priority for dialysis was the patient’s mental state. However, the impact of the patient’s mental state on priority did not appear to be driven by its influence on the doctors’ perceptions of how dialysis might improve quality of life.
The Role of Physicians’ Recommendations in Medical Treatment Decisions
Authors: Gurmankin Andrea D. , Baron Jonathan , Hershey John C. , Ubel Peter A.
Published: April 2009

Background. A shift away from the medical paternalism of the past has occurred, and today, the law and ethics advocate that physicians share decision-making responsibility with their patients. It is unclear, however, what the appropriate role of physicians’ recommendations ought to be in this new shared decision-making paradigm. One way to approach this question is to assess the influence of physicians’ recommendations. Objective. In this study, the authors examine the influence of physicians’ recommendations on hypothetical treatment decisions. Do physicians’ recommendations influence treatment decisions in scenarios where the decision that maximizes health is obvious and apparent to subjects? Do recommendations pull subjects away from the treatment choice that they otherwise prefer (based on their decision when unaware of the physicians’ recommendation)? Design. An experimental web questionnaire presented hypothetical medical treatment scenarios in which the treatment choice that maximized health was obvious. Across scenarios, the authors varied physicians’ recommendations in 3 ways:(1) physicians’ recommendations supporting what maximized health, (2) physicians’ recommendations that went against what maximized health, and (3) no physicians’ recommendation. The participants were 102 volunteers. Results. Hypothetical treatment decisions were significantly influenced by physicians’ recommendations (P < 0.0001), and physicians’ recommendations against the decision that maximized health pulled subjects away from the treatment decision that they made when no recommendation was given (P <0.0001). Conclusion. Physicians’ recommendations can lead people to make decisions that go against what is best and against what they would otherwise prefer. Physicians must take care in making recommendations and should incorporate patient preferences into their recommendations.
Primary Prevention Drug Therapy: Can It Meet Patients’ Requirements for Reduced Risk?
Authors: Llewellyn-Thomas Hilary A. , Paterson J. Michael , Carter Judy A. , Basinski Antoni , Myers Martin G. , Hardacre Gordon D. , Dunn Earl V. , D’Agostino Ralph B. , Wolf Philip A. , Naylor C. David
Published: April 2009

The objective was to identify, in primary prevention, patients whose “required risk reduction” (ReqRR) is greater than the “achievable risk reduction” (ARR) that cholesterol-lowering or antihypertensive medication could provide. Individualized estimates of 10-year coronary heart disease or stroke risk were derived for 66 hypercholesterolemic (HC) and 64 hypertensive (HT) patients without symptomatic cardiovascular disease. These estimates were used in trade-off tasks identifying each individual’s ReqRR. Then individual ARRs were estimated (in HC patients by assuming total cholesterol/high density lipoprotein ratio reductions to 5.0; in HT patients by assuming systolic blood pressure reductions to 120 mmHg). 12 (18%) HC and 12 (19%) HT subjects would refuse medication regardless of the risk reduction offered. Of the remaining patients, 15/54 (28%; 95% C.I.: 16-40%) HC and 19/52 (37%; 95% C.I.: 24-51%) HT subjects were “over-requirers,” in that their ReqRR/ARR ratio was 1.5. There may be a notable proportion of patients whose ReqRR is considerably greater than what is achievable, implying that decision aids may help individuals clarify preferences about accepting/refusing medication for the primary prevention of cardiovascular disease.
How Robust Is the Health Utilities Index Mark 2 Utility Function?
Authors: Wang Qinan , Furlong William , Feeny David , Torrance George , Barr Ronald
Published: April 2009

Purpose. The utility function for the Health Utilities Index Mark 2 (HUI2) system is based on preference measurements from a random sample of parents with exclusion of inconsistent respondents. Would results without exclusions or from a different group of parents have differed? Methods. Scores were obtained from parents of patients (n = 59) undergoing treatment for cancer. Mean scores from the 2 sets of parents were compared: parents of patients and parents from the general population. Three multiattribute utility functions were estimated. Mean scores for HUI2 states using the functions were compared. Results. Most differences in mean scores between different groups were not statistically significant (P < 0.05). Differences in parameter estimates among the 3 utility functions were 0.05 or less. The exponent on the power function for the parent-of-patient group was 2.16, within 6% of that for random sample parents. The intraclass correlation between scores for 144 health states derived from the random-sample-parents and parents-of-patients functions was 0.99; the mean difference per state in scores was 0.018. Conclusion. The HUI2 scoring function generalizes well in that different groups of parents give similar results. The HUI2 scoring function is robust in that the functions without and with exclusions generate scores that are very close in value.
“I was Wife and Mother”: French Widows Present Themselves to the Ministry of Justice in the Early Nineteenth Century
Authors: Troyansky David G.
Published: April 2009

Royal ordinances of 1814 and 1815 gave judges and other fonctionnaires of the Ministère de la Justice the right to demand retirement pensions; they also gave widows the right to demand a portion of such pensions. In making those demands, individuals explained their life histories, summed up their careers, made claims about merit and need, and expressed their hopes for retirement. This article explores female self-images through the study of letters found in career dossiers in the Archives Nationales (Paris) series BB25.
“Crying Whenever Monday Comes”: Older Unmarried Women in the Netherlands and the Game of Comparison, 1955-1980
Authors: Bijsterveld Karin , Horstman Klasien , Mesman Jessica
Published: April 2009

The Dutch Women's Action Committee for Early State Pensions advocated the reduction of the retirement age for unmarried women. In doing this, the committee brought forward an image of older unmarried women that was rather different from the self-images the older unmarried women presented in letters and questionnaires sent to the committee. And the image presented by the committee was again different from the image of older unmarried women that emerged in the parliamentary debate. Such a variation in images and self-images is related to the legal nature of the welfare state and the consequent comparison between social categories.
Children in One-Parent Families: Survival as an Indicator of the Role of the Parents
Authors: van Poppel Frans
Published: April 2009

This study tries to shed light on the way in which family characteristics affected the survival of children in nineteenth-century European societies. Insights from recent epidemiological studies were used to construct a framework via which the absence or loss of one of the parents could affect the health and survival of children. The review not only showed how important family structure was for survival of children, it also provided insight in the differences in the roles played by fathers and mothers and indicated that the wider kinship network is a factor that is of great relevance in studying the effects of family structure on living conditions of children. Current research focuses on the relationship between religion, health, and mortality in the nineteenth and early-twentieth centuries; social-class and gender differences in mortality; and the current social and demographic situation of the Jews in the Netherlands.
Reciprocal Bonding: Parents and Their Offspring in Early Modern England
Authors: Ben-Amos Ilana Krausman
Published: April 2009

The English family in the early modern period is viewed in the perspective of reciprocity: an exchange of goods that involved giving and obtaining something in return. Reciprocal interactions between parents and children extended throughout the life course and were not confined to infancy or early childhood. The exchange could be delayed, and its timing and duration varied between social groups and across time. It was unequal: the parental investment was large, and the returns were uncertain and less extensive. The exchanges involved a wide range of material and emotional goods: support, affection, prestige, reputation. Reciprocity was not simply granted, but rather it was negotiated and induced with gifts and in other less tangible ways.
Feminist Historians and Family History in Canada in the 1990s
Authors: Bradbury Bettina
Published: April 2009

This review article considers the contribution that monographs and collections of articles published by feminist scholars during the 1990s make to family history in Canada. Feminist historians have successfully exposed the workings of class, gender, and ethnicity in a range of Canadian towns and cities. They have begun to chart the relationships between families and other institutions—most notably religion, leisure, and the law. Recent works contribute to a much clearer understanding of the ways experts and the state have worked to shape families and especially motherhood in Canada and to the discursive role of the white wife and mother in the racial politics of the settlement of the West. And recent work has laid the groundwork for a better understanding of the regulatory discourses around gender, sexuality, and heterosexuality especially in Canada’s most studied province, Ontario.
The Family in Utopia: Celibacy, Communal Child Rearing, and Continuity in a Religious Commune
Authors: Coşgel Metin M.
Published: April 2009

The Shakers sought to replace the nuclear family with the Shaker family through their unorthodox family practices of celibacy and communal child rearing. Although these practices may have been beneficial in some respects, they contributed to the numerical decline of the Shakers. A quantitative analysis of the children (joined with parents or adopted by the society) in Shaker communities between 1850 and 1870 shows that children with natural family ties were more likely than other children to persist in Shaker communities, and a significant fall in the proportion of those who were more likely to persist contributed to the decline in total membership.
Gender, Class, and Generation in Interwar French Catholicism: The Case of the Jeunesse Ouvrière Chrétienne Féminine
Authors: Whitney Susan B.
Published: April 2009

This article examines the history of the female branch of the Jeunesse Ouvrière Chrétienne movement during the 1920s and 1930s. Although the largest organization of young working women in France at a time of intense youth mobilization, the Jeunesse Ouvrière Chrétienne Féminine’s (JOCF’s) distinctive nature as a movement of young women has been omitted from historical accounts. This article examines the movement’s approaches to spirituality, activism, work, and femininity and argues that the JOCF had a complicated approach to both young women and femininity. Indeed, it encouraged young working women to adopt Catholic approaches to morality and to prepare for future roles as mothers at the same time as it promoted notions of spiritual equality and encouraged active, independent, public roles in the present.
Birth Order and Educational Career: A Study of School Performance and Achieved Education of Children Born in Early-Twentieth-Century Sweden
Authors: Modin Bitte
Published: April 2009

This study examines birth order differences in third-grade school marks and achieved education based on the 14,192 boys and girls who were born at the Uppsala Academic Hospital, Sweden, during the period 1915-29. The methods used for the corresponding analyses are OLS regression and logistic regression. In the analysis of third-grade school marks, a subsample is used. The results showed that school marks worsened and the chances of having completed upper secondary school declined with incr asing birth order. Neither biological nor social factors at birth explained the quite dramatic differences found between birth order categories.
The Poisoning Women of Tiszazug
Authors: Bodó Béla
Published: April 2009

This article examines the social causes of the infamous Tiszazug murders (i.e., the poisoning of more than forty people, mainly men, by their female relatives) in interwar Hungary. First, it looks at those elements in peasant culture, such as the traditional neglect of the sick elderly and the disabled, which proved conducive to a violent solution of family problems. Then, the essay analyzes the changes in family structures and inheritance patterns and discusses the impact of political events such as the end of overseas migration, the dissolution of the Austro-Hungarian Empire, the autarchic policies of the “successor states” and the failure of land reform on peasants’ lives. Finally, the article looks at the discovery of the murders and the peasants’ interpretations of the poisonings.
The Legacy of Wealth: Primogeniture Among The Rockefellers
Authors: Rose Marsha Shapiro
Published: April 2009

The philanthropic and corporate legacy of the Rockefeller family is visible through the heirs of John D. Rockefeller's youngest child and only son. However, between 1866 and 1872, Rockefeller and his wife also had four daughters, two of whom lived to maturity. Alta and Edith Rockefeller, while older than their brother, nonetheless were accountable to him and to their father. Early on, John D. Rockefeller targeted his son to inherit the wealth and responsibility of the Rockefeller name. Using correspondence from 1904 through 1937 between the sisters and their father, brother, and their advisers, a portrait emerges of a father and son who controlled the economic direction of the family dynasty. However, Alta and Edith did not acquiesce in silence. This article explores the ways in which the two women tried to assert agency and control their resources.
Small Worlds: Childhood and Empire
Authors: Chamberlain Mary
Published: April 2009

There are no historical studies and—despite the concern of social sciences with Caribbean families—few scholarly works that have focused on childhood and child rearing. Yet attitudes to children, child care, and child rearing reveal many of the values and philosophies that underpin social organization and may be seen as a litmus test of (formal and informal) social provision. This article examines the narratives of Caribbean colonial childhoods, arguing that they reveal social principles that are essentially egalitarian, a social world characterized by order and respect and an organization of family life modeled on inclusive and communitarian principles. These village-based childhoods not only contrasted with the colonial view of West Indian social organization but also proved a bedrock of social pride, an antidote to the lack of social provision, and an idiom through which Caribbean migrants could both converse and survive in the world beyond the Caribbean.
“I Must Have My House in Order”: The Victorian Fatherhood of John Shoebridge Williams
Authors: Carroll Bret E.
Published: April 2009

This article explores the complexities of middle-class fatherhood in Victorian America through an analysis of the unpublished and published writings of Spiritualist medium John Shoebridge Williams. Through mediumistic dialogues with the spirit of his deceased daughter, Williams negotiated the changing and often contradictory ideologies of ideal manhood and fatherhood that accompanied the modernization of family life. The result was a synthetic model of paternal behavior that combined equality with deference, companionship with control, partnership with patriarchy, and traditional understandings of the father's role with the emerging new standards of the nineteenth century.
Fascism, Fatherhood, and the Family in Interwar France: The Case of Antoine Rédier and the Légion
Authors: Koos Cheryl A.
Published: April 2009

As the leader and founder of the first French “fascist” political organization, the Légion, Antoine Rédier allows us to begin to trace how gender and the family played a pivotal role in the fundamental ideologies of the major fascist and extreme-right political movements of interwar France. Though short-lived, the Légion was importantly the first of several groups on the extreme Right to make gender, the family, and fatherhood central to their political philosophies. By doing so, Rédier and other such political leaders helped pave the way for the transition to the Vichy regime in 1940.
“It is Better to Marry Than to Burn”: Anglo-American Attitudes Toward Celibacy, 1600-1800
Authors: Seeman Erik R.
Published: April 2009

Ministers in England and New England diverged in their writings about lay sexual renunciation. In England, clerical writers were ambivalent about celibacy. In contrast, New England ministers uniformly opposed lay vows of celibacy. These differing responses resulted from both demographic and cultural factors. English ministers found it difficult to criticize celibacy when nearly 20 percent of some birth cohorts never married. In New England, on the other hand, only a tiny percentage of colonists never married, allowing ministers to condemn celibacy. Culturally, the patriarchal family figured more prominently in New England ministers'minds as the foundation of a well-ordered society. Celibacy, then, was a direct attack on the institution that secured religion and promoted social stability. This article helps explain both the virulent attacks on Immortalists and Shakers in New England and the relative lack of controversy that greeted England's few religious celibates.
`No Exit' in Antarctica
Authors: Bouvel Bruno
Published: April 2009

This article recounts the experiences of an all-male group of 59 winterers (explorers) who spent almost a year in Antarctica. As well as a group experience, it was also a deep personal experience. For the author; this stay in another world seeming far beyond that of humans was and remains a quasi-spiritual experience, of immersing oneself in the original, untouched splendour of nature, producing a kind of oceanic feeling at the most archaic level of the coself.
Employee Performance Evaluation in Social Welfare Offices
Authors: Riccucci Norma M. , Lurie Irene
Published: April 2009

This study examines the status and operation of performance evaluation systems in three welfare offices across the country. Welfare offices provide an interesting and auspicious arena for such an examination because of the changes to the goals of welfare policy under recent federal mandates for reform. The study finds that although there is clarity around the performance criteria on which public employees in welfare offices are evaluated, the measures are not linked to one of the principal goals of welfare reform—“welfare-to-work”: moving people off welfare and into jobs.
Theory of Moves: Overview and Examples
Authors: Brams Steven J. , Mattli Walter
Published: April 2009

“We discussed what the Soviet reaction would be to any possible move by the United States, what our reaction with them would have to be to that Soviet reaction, and so on, trying to follow each of those roads to their ultimate conclusion.” Theodore C. Sorensen about the deliberations of the Executive Committee during the October 1962 Cuban missile crisis (Holsti, Brody, and North, 1964: 188). “What are you going to do after that? Look ahead, look ahead-two or three or four steps ahead.” Mikhail S. Gorbachev to emissaries of the junta that staged the August 1991 attempted coup in the Soviet Union (Clines, 1991).
Testing Alternative Models of Reciprocity Against Interaction During the Cold War
Authors: Patchen Martin , Bogumil David D.
Published: April 2009

Three models of reciprocity–simple, trend, and comparative–are applied to events data which describe interaction between the United States and the Soviet Union during the Cold War. The comparative reciprocity model–which predicts that change in each actor's behavior will be based on prior differences in the rivals' actions–received the greatest, although limited, support. There was little agreement in the results of the three reciprocity models for specific years. Overall, while there is some evidence of reciprocity when using either the simple reciprocity or the comparative reciprocity model, reciprocity does not appear to have been a robust process in U.S.-Soviet interaction. It tended to occur most often at times of high tension and conflict.