The roles of intolerance of uncertainty, anxiety sensitivity and distress tolerance in hoarding disorder compared with OCD and healthy controls.

BACKGROUND: It is suggested that the different psychological vulnerability factors of intolerance of uncertainty (IU), anxiety sensitivity (AS) and distress tolerance (DT) may be in important in hoarding disorder (HD). However, the extent to which these factors are specific to HD compared with other disorders remains unclear. AIMS: The current study aimed to investigate differences in IU, AS and DT in three groups: HD (n=66), obsessive compulsive disorder (OCD; n=59) and healthy controls (HCs; n=63). METHOD: Participants completed an online battery of standardised self-report measures to establish the independent variable of group membership (HD, OCD and HC) and the dependent variables (IU, AS and DT). RESULTS: A MANOVA analysis indicated statistically significant differences in IU, AS and DT between the clinical groups and HCs. Follow-up analyses showed no statistically significant differences between the HD and OCD group for any of the three constructs. The results remained the same when examining the effects of co-morbid HD and OCD. An unexpected finding was the trend for IU, AS and DT to be more severe when HD and OCD were co-morbid. CONCLUSIONS: The evidence suggests the absence of a specific relationship between IU, AS or DT in HD and instead is consistent with existing research which suggests that these psychological vulnerability factors are transdiagnostic constructs across anxiety disorders. The implications of the findings are discussed.

Determinants of butyrylcholinesterase inhibition among agricultural pesticide handlers in Washington State: an update.

OBJECTIVES: Organophosphate (OP) and N-methyl-carbamate (CB) insecticides are used widely in agriculture to manage insect pests of economic importance. Agricultural workers are more likely to suffer exposure because of the widespread use of OP/CBs in agriculture, and pesticide-related illnesses among handlers may be more severe when compared to other farm workers. The goal of this study was to identify occupational and personal characteristics associated with butyrylcholinesterase (BuChE) inhibition in participants recruited from the Washington State Cholinesterase Monitoring Program from 2006 to 2011. METHODS: We conducted a longitudinal study among agricultural pesticide handlers in Washington State during the OP/CB spray season (March-July) over a 6-year period (2006-2011). Linear mixed effects regression models were used to evaluate BuChE inhibition in relation to self-reported occupational and personal characteristics. RESULTS: Relative to pre-season baseline levels, the mean decrease in BuChE activity during the OP/CB spray season over all years of the study period was 3.77% (P < 0.001). Greater BuChE inhibition was observed among handlers who reported using multiple OP/CBs (ß = -2.70, P = 0.045), mixed or loaded OP/CBs (ß = -3.97, P = 0.002), did not store personal protective equipment (PPE) in a locker at work (ß = -3.4, P = 0.014), or did not wear chemical-resistant boots (ß = -16.6, P < 0.001). DISCUSSION AND CONCLUSIONS: The Washington State Cholinesterase Monitoring Program has provided a valuable opportunity to evaluate potential sources of OP/CB exposure among agricultural pesticide handlers. Several previously reported associations were confirmed in the current analysis, which included a larger number of pesticide handlers enrolled over a longer time period. The use of multiple OP/CBs and mixing/loading activities were significant risk factors, and the use of chemical-resistant boots and lockers for PPE storage were protective factors. Our findings point toward logical interventions to reduce exposure such as the implementation of engineering controls for mixing/loading activities, requirements for appropriate footwear, and the regular use of lockers for PPE storage.

Effect of Coping Strategies on Patient and Physician Perceptions of Disease Severity and Disability in Systemic Sclerosis.

OBJECTIVE: Systemic sclerosis (SSc) results in impaired function, disability, and reduced health-related quality of life. We investigated the effect of coping strategies on the patient global assessment of health (PtGA) and Health Assessment Questionnaire-Disability Index (HAQ-DI), after controlling for clinical characteristics and disease activity. We also explored the relationship between coping strategies and the correlation between the PtGA and physician global assessment (PGA) in SSc. METHODS: We undertook posthoc analyses using baseline data obtained from the Raynaud Symptom Study (RSS). The PtGA, Coping Strategies Questionnaire, Pain Catastrophizing Scale, and Scleroderma Health Assessment Questionnaire were collected alongside the PGA, clinical characteristics, and patient demographics. Multivariable linear regression models and correlations were used to evaluate the relationship between coping strategies with the PtGA, HAQ-DI, and PGA. RESULTS: Of the 107 patients with SSc enrolled in the RSS, there were sufficient data available for the analysis of 91 participants. The mean PtGA was 40/100 (SD 27) and the mean HAQ-DI was 0.87/3.0 (SD 0.73). After controlling for clinical and patient demographics, pain catastrophizing and maladaptive coping skills were significantly associated with the PtGA and HAQ-DI scores (P < 0.05 for both), but not the PGA. CONCLUSION: The effect of coping strategies on PtGA and HAQ-DI (but not PGA in SSc) could influence the result of composite measures incorporating these outcome measures. Interventions to improve patient coping skills may support increased resilience and improve patient-perceived functional status and PtGA in SSc.

Restricted Covariance Priors with Applications in Spatial Statistics.

We present a Bayesian model for area-level count data that uses Gaussian random effects with a novel type of G-Wishart prior on the inverse variance- covariance matrix. Specifically, we introduce a new distribution called the truncated G-Wishart distribution that has support over precision matrices that lead to positive associations between the random effects of neighboring regions while preserving conditional independence of non-neighboring regions. We describe Markov chain Monte Carlo sampling algorithms for the truncated G-Wishart prior in a disease mapping context and compare our results to Bayesian hierarchical models based on intrinsic autoregression priors. A simulation study illustrates that using the truncated G-Wishart prior improves over the intrinsic autoregressive priors when there are discontinuities in the disease risk surface. The new model is applied to an analysis of cancer incidence data in Washington State.