bluuebunny/crossref_metadata_2025_split huggingface dataset:
Residents' Perceived Physician-Manager Educational Needs: A National Survey of Psychiatry Residents
Authors: Sockalingam Sanjeev , Stergiopoulos Vicky , Maggi Julie 
Published: January 2017

Objective: To determine Canadian psychiatry residents' perceived gaps in physician-manager competencies during their residency training. Methods: Residents at 16 Canadian psychiatry residency programs were mailed an 11-item questionnaire (a copy is available from the authors) assessing their perceived deficiencies in selected managerial knowledge (GSk) and skill (GSs) areas as determined by gap scores (GS). GSs are defined as the difference between residents' perceived current and desired level of knowledge or skill in selected physician-manager domains. Residents' educational preferences were also elicited in the questionnaire. Results: Among the 494 psychiatry residents who were sent the survey, 237 residents (48%) responded. Residents reported the greatest GSk in Program Planning and the greatest GSs in Personal and Professional Self-Care. Predictors of greater total GSks included a lack of previous administrative education during medical school, higher training level, and female sex. Only sex was a significant predictor of total GSss. More than 50% of residents preferred workshops, small groups, mentoring, and didactic learning methods for furthering their knowledge and skills. Conclusion: Residents report significant gaps in specific physician-manager training areas, specifically Program Planning, and Personal and Professional Self-Care. The results of this national survey can inform the development of formal physician-manager curricula. To appeal to residents, such curricula should incorporate more interactive pedagogical methods combined with mentoring opportunities.
The Beck Cognitive Insight Scale in Outpatients with Psychotic Disorders: Further Evidence from a French-Speaking Sample
Authors: Favrod Jérôme , Zimmermann Grégoire , Raffard Stéphane , Pomini Valentino , Khazaal Yasser 
Published: January 2017

Objective: The Beck Cognitive Insight Scale (BCIS) evaluates patients' self-report of their ability to detect and correct misinterpretation. Our study aims to confirm the factor structure and the convergent validity of the original scale in a French-speaking environment. Method: Outpatients ( n = 158) suffering from schizophrenia or schizoaffective disorders fulfilled the BCIS. The 51 patients in Montpellier were equally assessed with the Positive and Negative Syndrome Scale (PANSS) by a psychiatrist who was blind of the BCIS scores. Results: The fit indices of the confirmatory factor analysis validated the 2-factor solution reported by the developers of the scale with inpatients, and in another study with middle-aged and older outpatients. The BCIS composite index was significantly negatively correlated with the clinical insight item of the PANSS. Conclusions: The French translation of the BCIS appears to have acceptable psychometric proprieties and gives additional support to the scale, as well as cross-cultural validity for its use with outpatients suffering from schizophrenia or schizoaffective disorders. The correlation between clinical and composite index of cognitive insight underlines the multidimensional nature of clinical insight. Cognitive insight does not recover clinical insight but is a potential target for developing psychological treatments that will improve clinical insight.
Basal Thyrotropin and Major Depression: Relation to Clinical Variables and Treatment Outcome
Authors: Joffe Russell T , Levitt Anthony J 
Published: January 2017

Objective: There is a current argument in thyroidology about whether the normal range for basal thyrotropin (TSH) is too broad. Some groups suggest that a TSH of less than 2.5 mIU/L is a better cut-off for euthyroidism. Because major depression is associated with changes in thyroid hormone status and thyroid hormones may be an effective treatment for major depression, we examined whether TSH levels above or below 2.5 mIU/L were related to clinical variables or treatment outcome in euthyroid patients with major depression. Methods: Outpatients with major depression ( n =166) were assigned to high–normal and low–normal TSH groups based on their basal TSH levels. The 2 groups were compared along clinical variables and treatment outcome. Results: The low–normal TSH group was significantly more depressed, as measured by Hamilton Depression Rating Scale scores, and had more anxiety symptoms and suicidal tendencies than the high–normal group. There was no difference in treatment response between the groups. Conclusions: A comparison of low–normal and high–normal basal TSH groups with major depression revealed significant differences in severity and symptoms of depression but no difference in treatment outcome. These data are preliminary and require replication in a larger sample.
Managing Depression during Hepatitis C Treatment
Authors: Sockalingam Sanjeev , Abbey Susan E 
Published: January 2017

Objective: The prevalence of hepatitis C virus (HCV) infection in Canada is estimated to be 1% and expected to increase during the next decade. Mental illness, particularly depression, is common among HCV-infected patients and remains an obstacle to interferon-alpha (IFN-α) treatment. We summarize the risk factors for interferon-α–induced major depressive disorder (IFN-α–MDD) in HCV patients and the evidence for antidepressant prophylaxis and symptomatic antidepressant treatment of depression. Methods: We searched MEDLINE, EMBASE, and CINAHL for randomized controlled or quasi-experimental trials evaluating antidepressant prophylactic and symptomatic treatment approaches for depression emerging during IFN-α treatment. Manual searches of references listed in review articles, case series, and anecdotal reports supplemented our literature search. Results: A total of 9 trials involving prophylactic and symptomatic treatment approaches for IFN-α–MDD are summarized in our review. Antidepressant pretreatment is beneficial for patients with elevated baseline depressive symptoms and a preexisting history of IFN-α–MDD. Although limited evidence exists for several antidepressant agents, much of the evidence suggests that selective serotonin reuptake inhibitors (SSRIs) are safe and efficacious in treating depressive symptoms secondary to IFN-α therapy. Conclusion: Both antidepressant pretreatment and symptomatic treatment are viable strategies for treating IFN-α–MDD. Improved treatment outcomes and early identification of depression during HCV treatment can be achieved using an integrated medical and mental health treatment approach.
Social Support Moderates Outcome in a Randomized Controlled Trial of Exposure Therapy and (or) Cognitive Restructuring for Chronic Posttraumatic Stress Disorder
Authors: Thrasher Sian , Power Michael , Morant Nicola , Marks Isaac , Dalgleish Tim 
Published: January 2017

Objective: To understand what predicts good outcome in psychiatric treatments, thus creating a pathway to improving efficacy. Method: Our study investigated relations between predictor variables and outcome (on the Clinician Administered Posttraumatic Stress Disorder [PTSD] Scale [CAPS]) at posttreatment for 77 treatment completers in a randomized controlled trial of exposure therapy and (or) cognitive restructuring, compared with relaxation, for chronic PTSD in adults. Results: More social support on the Significant Others Scale significantly predicted better outcome on the CAPS, even after controlling for the effects of treatment group and of pretreatment severity. Importantly, social support was only a significant predictor of outcome for participants receiving cognitive restructuring and (or) exposure therapy and not for participants in the relaxation condition. Conclusions: Better social support is associated with significantly greater gain following cognitive restructuring and (or) exposure therapy for PTSD. Future interventions should consider augmenting social support as an adjunct to treatment.
Does Early Emotional Distress Predict Later Child Involvement in Gambling?
Authors: Pagani Linda S , Derevensky Jeffrey L , Japel Christa 
Published: January 2017

Objective: Younger people are engaging in gambling, with some showing excessive involvement. Although a consequence of gambling could be anxiety and depression, emotional distress could be a precursor to gambling involvement. This could reflect developmental proneness toward problem behaviour. We assessed whether early emotional distress directly influences later gambling or if it operates through an indirect pathway. Methods: Using a prospective longitudinal design, an intentional subsample of children from the 1999 kindergarten cohort of the Montreal Longitudinal Preschool Study (Quebec) from intact families were retraced in 2005 for follow-up in Grade 6. Consenting parents and children were separately interviewed. Key child variables and sources included kindergarten teacher ratings of emotional distress and impulsivity and self-reported parent and child gambling. Results: Higher levels of teacher-rated emotional distress in kindergarten significantly predicted a higher propensity toward later gambling behaviour. Impulsivity, a factor often comorbidly present with emotional distress, completely explained this predictive relation above and beyond potential child- and family-related confounds, including parental gambling. Conclusions: Children with higher levels of emotional distress at kindergarten were more inclined toward child gambling behaviour in Grade 6. The influence of early emotional distress completely vanished when behaviours reflecting impulsivity were considered when predicting later child gambling behaviour. The relation between emotional distress and child gambling involvement in children was thus explained by its comorbidity with early impulsivity. This study does not rule out the possibility that emotional distress could become a correlate or consequence of excessive involvement in gambling activities at a later developmental period.
The Utilization of Antidepressants and Benzodiazepines among People with Major Depression in Canada
Authors: Sanyal Chiranjeev , Asbridge Mark , Kisely Steve , Sketris Ingrid , Andreou Pantelis 
Published: January 2017

Objective: Although clinical guidelines recommend monotherapy with antidepressants (ADs) for major depression, polypharmacy with benzodiazepines (BDZs) remains an issue. Risks associated with such treatments include tolerance and dependence, among others. We assessed the prevalence and determinants of AD and BDZ utilization among Canadians who experienced a major depressive episode (MDE) in the previous 12 months, and determined the association of seeing a psychiatrist on the utilization of ADs and BDZs. Method: Data were drawn from the 2002 Canadian Community Health Survey: Health and Well-Being, a nationally representative sample of Canadians aged 15 years and older. Descriptive statistics quantified utilization, while logistic regression identified factors associated with utilization, such as sociodemographic characteristics or type of physician seen. Sampling weights and bootstrap variance estimations were used for all analysis. Results: The overall prevalence of AD and BDZ utilization was 49.3% of respondents who experienced an MDE in the past 12 months and reported AD use. Key determinants of utilization were younger age and unemployment in the past week (OR 2.6; P < 0.001). Being seen by a psychiatrist increased utilization (OR 2.5; P < 0.001), possibly because psychiatrists were seeing patients with severe depression. Conclusion: A large proportion of people with past-year MDEs utilized ADs and BDZs. It is unclear how much of this is appropriate given that evidence-based clinical guidelines recommend monotherapy with ADs in the treatment of major depression.
Predicting Treatment Response in Major Depressive Disorder: The Impact of Early Symptomatic Improvement
Authors: Kudlow Paul A , Cha Danielle S , McLntyre Roger S 
Published: January 2017

Objective: Antidepressants (ADs) are the mainstay of treatment for major depressive disorder (MDD). Despite their widespread usage, a consensus does not exist as to the timing of clinically significant symptomatic improvement during an AD trial. The objective of this review is to provide practitioners with empirically based recommendations pertaining to the optimal duration of index (initial) AD therapy before a clinical intervention is warranted. Methods: We conducted a nonsystematic review, using a combination of a MeSH key word search, Google Scholar, and the Scopus database. Our search strategy focused on research papers reporting on the early symptomatic response to AD therapy. Results: Available evidence suggests that there are several subpopulations that exist within whole-group data assigned to an AD treatment. Among the responder subgroups, an early responder group (that is, less than 3 weeks) and later responder group (that is, 3 weeks or more) are identified. People who exhibit early partial symptomatic improvement are more likely to respond to therapy thereafter. However, the interpretability of extant evidence is complicated by the use of disparate statistical approaches with differing computational complexity and sample heterogeneity. Conclusions: Response outcomes in MDD are heterogeneous. Available data suggest that people may respond early, late, and (or) continuously over time, and may represent distinct subpopulations that provide a proximate indication for treatment response outcomes. Notwithstanding, a pragmatic recommendation would be to consider a treatment intervention (for example, dosage optimization and [or] augmentation) if, after 3 to 4 weeks, symptomatic improvement is insufficient.
Memory Impairment in Schizophrenia: Perspectives from Psychopathology and Pharmacotherapy
Authors: Stip Emmanuel 
Published: January 2017

Objective: To describe the concept of memory impairment in schizophrenia and the clinical implications of this concept in terms of patient assessment and neuroleptic drug use. Method: Narrative literature review. Results: Individuals suffering from schizophrenia normally exhibit some degree of memory impairment. Recent work in psychopathology indicates that the impairment is comprehensive, involving the sensory, short-term, and long-term memory stores. Memory impairment appears to be a primary symptom of the disease, and its underlying causes are likely organic. A number of medications, however (for example, traditional neuroleptics and drugs that have pronounced anticholinergic activity), may cause or exacerbate impairment. In particular, anticholinergic agents used to treat extrapyramidal symptoms, a common complication of neuroleptic drugs, appear to have a deleterious effect on memory. Conclusions: Memory impairment is an important consideration in the clinical assessment and management of patients with schizophrenia. The use of atypical antipsychotics like risperidone appears to have no impact on memory function: because risperidone is associated with a low incidence of extrapyramidal side effects, it can obviate the need for anticholinergic medications— thus offering greater hope of nondebilitative intervention. The advent of medications that are safer (on cognition) could also lead to generally better outcomes by facilitating compliance with drug regimens and rehabilitation programs.
Dried Blood Spots are an Acceptable and Useful HIV Surveillance Tool in a Remote Developing World Setting
Authors: Solomon S S , Pulimi S , Rodriguez I I , Chaguturu S K , Kumar S K Satish , Mayer K H , Solomon S 
Published: January 2017

Enzyme-linked immunosorbent assay and Western blot analysis of dried blood spots (DBS) on filter paper have been shown to be as sensitive and specific as analysis of serum, and therefore may be a cost-effective and culturally appropriate HIV seroprevalence tool in remote areas. This study examines the acceptability of DBS in a tropical, rural population from an outpatient clinic in Andhra Pradesh, India, where participation was offered to every fifth patient seeking general medical care between March and April 2001. All 1413 patients approached for the study agreed to participate and provide a DBS for examination. The overall HIV seroprevalence in this sample was 2.8%. Of the participants, 51.7% were male, 93.2% were between the ages of 18 and 40, 85.3% were married, 29.7% were employed, 47.6% had no education and 73.1% resided in a rural setting. In the univariate analysis, history of genital warts ( P=0.01), sexually transmitted disease ( P=0.001), premarital sexual intercourse ( P=0.002), sexual contact with a commercial sex worker ( P=0.003), being employed ( P=0.011) and having more than 10 injections for medical purposes ( P=0.006) all correlated with being HIV-infected. Given the uniform willingness of these clinic attendees to be tested, we conclude that DBS is a useful, cost-effective tool in HIV serosurveillance in a rural, tropical setting.
HIV/AIDS, Advocacy and Anti-Discrimination Legislation—The Australian Response
Authors: Neilsen G A , Young F J 
Published: January 2017

This paper will address the role of mass communication strategies in the reduction of HIV/AIDS discrimination in Australia. It will focus on the interdependence of mass communication and legislation in health promotion campaigns with particular reference to the Disability Discrimination Act 1992. This will be discussed in the context of other HIV/AIDS strategies in Australia. The public health impact of discrimination is explored in relation to HIV/AIDS and the role of anti-discrimination legislation is discussed. Public health legislation can serve as a symbolic reflection of public opinion or actively change it. Laws can transform the practices of both public and private institutions and thus decrease discrimination. They can also provide specific remedies for people adversely affected by discriminatory attitudes and practices. Mass communication can maximize the impact of legislation by promoting awareness of new laws and, more importantly, lead changes in the attitudes of the polity and the wider public.
Diagnostic Effectiveness of Simultaneous Thyroxine and Thyroid-Stimulating Hormone Screening Measurements. Thirteen Years' Experience in the Northeast Italian Screening Programme
Authors: Zamboni G , Zaffanello M , Rigon F , Radetti G , Gaudino R , Tatò L 
Published: January 2017

Objectives: To evaluate the effectiveness of thyroid-stimulating hormone (TSH) and thyroxine [T4) measurements at neonatal screening for congenital hypothyroidism, we compared our false-negative results with those we would have obtained if we had used TSH screening alone. Subjects and methods: Between January 1989 and December 2001 745,258 newborns were screened (98.3% of total born) for congenital hypothyroidism in northeast Italy. T4 and TSH were measured simultaneously on blood spots collected after birth. Between 1989 and 1998, semiquantitative total T4 (tT4) and TSH concentrations were measured by radiolabelled immunological assay and, from 1999 to 2001, using time-resolved fluorometer Delfia instruments (EG&G Wallac Oy, Finland) and fluoroimmunometric assay (Delfia neonatal hTSH and T4 kits). Results: Ten neonates were missed by our screening programme (normal tT4 and TSH) and classified as false negatives; these infants were diagnosed later in life with central hypothyroidism. If we had measured TSH alone in our screening programme, we would have missed an additional 21 patients with low tT4 and normal TSH; of these, four were affected by central hypothyroidism and 17 were diagnosed within the second month of life as affected by primary hypothyroidism with delayed TSH rise. Conclusions: Simultaneous T4 and TSH measurements at neonatal screening can miss patients affected by central hypothyroidism. However, this screening procedure allows identification of cases of central hypothyroidism with low T4 values and those neonates affected by primary hypothyroidism with delayed TSH rise who we would have missed by using the TSH measure alone.
Cost-Effectiveness of Screening for Colorectal Cancer: Evidence from the Nottingham Faecal Occult Blood Trial
Authors: Whynes David K 
Published: January 2017

Objectives: To estimate the cost-effectiveness of faecal occult blood (FOB) screening for colorectal cancer within the Nottingham trial. Setting: A randomised controlled trial (1981–present) of 153,000 subjects, of whom approximately half were offered biennial FOB testing over up to five screening rounds. Methods: The additional costs of participation in screening relative to symptomatic presentation were calculated by combining the results of (i) a comprehensive audit of resource use on the part of subjects within the trial, (ii) previously-established unit costs for each of the procedures involved. Life expectancy gains were estimated from a survival analysis of those trial subjects who had been diagnosed with cancer (screening participants vs controls). Results: The cost of screening under the Nottingham trial protocol was 5290 per cancer detected (at 2002 prices). Under conservative assumptions, the incremental cost per life year gained as a result of screening was 1584 (Confidence Interval [CI]:717 to 8612).
Written Information Needs of Women Who are Recalled for Further Investigation of Breast Screening: Results of a Multicentre Study
Authors: Austoker Joan , Ong Giok 
Published: January 2017

To assess the written information needs of women who are recalled for further investigation of breast screening. Women from eight breast screening centres in England, Scotland, and Wales who had been recalled for further investigation were invited to complete a structured questionnaire about aspects of recall. Four hundred and eighty four consecutive women were invited to be interviewed immediately before assessment. Two weeks after attendance for assessment 2132 consecutive women (including all women who had been interviewed) were sent a postal questionnaire. No reminder was sent. Subjects from four of the centres received an information leaflet with their recall letter, the remainder did not. Letters/leaflets used by the centres differed markedly. The response rate was 95% for the interview questionnaires and 70% for the postal questionnaires. Women who were prepared in advance for a possible recall were less likely to feel distressed/very distressed when receiving a recall letter. The more aspects of the recall process included in the recall literature, the more women were likely to think that assessment had been explained (89% of women (544/609) receiving six or more items of information compared with 73% of women (269/370) receiving four or fewer items (P<0·0001). Women who received a leaflet with their recall letter were significantly more likely to find some aspect of the information about recall reassuring than women who did not (61% (313/510) ν 50% (278/557); P<0·0001). Distressed/very distressed women were significantly more likely than somewhat/not distressed women to want further information about the reasons for recall (48% (403/834) ν 26% (157/598); P<0·0001 and how to get more information (29% (237/811) ν 19% (116/616); P<0·0001). Information can increase satisfaction and reduce distress. The amount of information women needed about recall was consistently underestimated. Inclusion of a leaflet improved satisfaction. Sensitive topics, words, and phrases should be carefully expressed.