Internet-based self-help treatment for panic disorder: a randomized controlled trial comparing mandatory versus optional complementary psychological support.

Panic disorder (PD) is one of the most common psychiatric disorders. Web-based self-help treatments for PD have had promising results. These online treatments seem to have larger effect sizes (ESs) when professional support is added. However, the amount of support or how it should be administered is not yet clear. The aim of this trial was to study two ways of administering psychological support provided by phone as a part of Internet-based self-help treatment for PD based on cognitive behavioral therapy. Seventy-seven participants diagnosed with PD were randomly assigned to one of three experimental conditions: a waiting list control group; a treatment group with non-scheduled psychological support; or a treatment group with scheduled psychological support. PD symptoms of participants who received treatment improved significantly compared to the control group (mean ES d = 1.18, p < .05). In addition, there were statistically and clinically significant differences between treatment groups (Mean difference = -3.20, p = .005, 95% CI [-5.62, -.79]). The scheduled group showed a larger ES, a lower dropout rate, and better adherence to treatment than the non-scheduled group. Scheduled support seems to be indicated for patients who seek Web-based treatment for PD, and their symptoms of panic, anxiety, and depression improve at post-treatment and six-month follow-up. In contrast, when support depends on patient demand, they receive less support and so, the therapeutic effect is poorer.

A comparison of medical students', residents' and tutors' attitudes towards communication skills learning.

BACKGROUND: The consensus about the importance of communication skills in patient-care does not guarantee that students and faculty perceive the usefulness of these skills. This study evaluated and compared medical students', residents' and tutors' attitudes towards learning communication skills, and examined the association with gender and year of residency. METHODS: We conducted a cross-sectional survey with 492 participants (282 second-year students, 131 residents and 79 tutors). They completed the Communication Skills Attitude Scale (CSAS) and demographic/educational information. RESULTS: In general, participants showed positive attitudes towards learning communication skills. Medical students, residents and tutors did not differ on the Positive Attitudes Scale (CSAS-PAS). Residents scored higher than medical students on the Negative Attitudes Scale (CSAS-NAS) (P < 0.01). Females showed higher scores on the CSAS-PAS (P < 0.05) and lower scores on the CSAS-NAS (P < 0.01) than males in all subsamples. The effect sizes were medium. There were no significant differences according to year of residency. DISCUSSION: Medical students, residents and tutors consider training in communication skills an essential component for clinical practice and they agree about the need to learn these communication skills. Attention should be paid to measuring attitudes at all three levels of medical education in the design of communication skills courses.

Under the tip of the iceberg: psychological factors in incontinence.

AIMS: To highlight two main psychological factors (cognitive barriers and safety-behaviors) involved in the development and maintenance of emotional distress in patients with urinary incontinence (UI) and thus facilitate a better understanding of this condition and contribute to a more comprehensive treatment. MATERIALS AND METHODS: Articles and books were reviewed up to December 2010 using a non-systematic research in MEDLINE and PsycINFO, focusing on the situations more frequently seen in our clinical experience. RESULTS: Several emotional symptoms that hinder a person's ability to benefit from urological treatment were found. An "accident" places a person at risk of developing a constant state of heightened worry and increased vigilance that predisposes the individual to develop significant anxiety and depression. Cognitive barriers such as dysfunctional beliefs, automatic negative thoughts, and cognitive biases are frequent. They affect patients' behavior and influence the development of coping strategies (safety-seeking behaviors) to manage symptoms and prevent feared consequences. Cognitions may act as barriers that lead to a misperception of one's health and maintain emotional distress. Safety behaviors are negatively reinforced and prevent disconfirmation of dysfunctional cognitions, thus maintaining the trouble and distress. Clinical examples are outlined. CONCLUSIONS: Cognitive barriers and safety behaviors explain some of the atypical psychological patterns seen in patients with UI. Future research should be oriented to design multimodal interventions and assess their impact on health outcomes. Whenever possible, the assessment of emotional, cognitive, and behavioral responses in individuals with UI could improve the management of this condition. Cognitive-behavioral therapy should be recommended to certain patients.

How we train undergraduate medical students in decoding patients' nonverbal clues.

BACKGROUND: Communication skills (CS) and the psychosocial dimensions of patient care are currently considered core competencies in medical schools. CS programs have focused on verbal communication rather than the nonverbal communication. AIM: To present a training program aimed to decode patients' nonverbal clues for second year medical students implemented at the School of Medicine of the Autonomous University of Barcelona. METHOD: A description of a theoretical framework, principles, general and specific goals, learning settings, strategies, skills, and assessment tools. RESULTS: A model of training for preclinical medical students in decoding patients' nonverbal clues is shown. The students have shown satisfaction with the program. CONCLUSIONS: The detection of patients' nonverbal clues can be regarded as a humanistic skill that can be defined, trained, and evaluated. The program can be transferable to other institutions on health sciences and adapted to other academic levels or, even, clinical specialties.

Validation of the Catalan version of the communication skills attitude scale (CSAS) in a cohort of south European medical and nursing students.

CONTEXT: The relevance of healthcare student training in communication skills has led to the development of instruments for measuring attitudes towards learning communication skills. One such instrument is the Communication Skills Attitude Scale (CSAS), developed in English speaking students and adapted to different languages and cultures. No data is available on the performance of CSAS with South European students. The aims of the present study were to translate the CSAS into the Catalan language and study its psychometric properties in South European healthcare students. METHODS: A total of 569 students from the School of Medicine of the Universitat Autònoma de Barcelona (UAB) participated. Students completed a Catalan version of the CSAS and provided demographic and education information. FINDINGS: Principal component analysis with oblimin rotation supported a two-factor original structure with some modifications. In general, internal consistency and test-retest reliability of the scales were satisfactory, especially for the factor measuring positive attitudes. Relationships of student responses on the two factors with demographic and education variables were consistent with previous work. Students with higher positive attitudes tended to be female, to be foreign students and to think that their communication skills needed improving. Students with higher negative attitudes tended to be male and to have parents that were doctors or nurses. CONCLUSIONS: These data support the internal validity of a Catalan version of the CSAS and support its use in future research and educational studies related to attitudes towards learning communication skills for South European students who speak Catalan.

Psychometric analysis of the Catalan version of the Alabama Parenting Questionnaire (APQ) in a community sample.

The aim of this study was to adapt to Catalan the parents' and children's global report forms of the Alabama Parenting Questionnaire (APQ), using a community sample of 364 children between 10 and 15 years old and their families. Sociodemographic information (from parents) and the presence of externalizing problems (from parents and teachers) were collected. The results suggest a 3-factor structure corresponding to the scales of Positive Parenting Practices (PPP), Inconsistent and Negative Discipline (IND) and Poor Monitoring/Supervision (PMS). The internal consistency is acceptable in all the scales, except for the IND in the children's format. The scales also present good convergent and discriminant validity, and the relations with the external variable studied pointed in the expected direction: inefficient parenting practices are related to the presence of more behavior problems in children. To sum up, the Catalan version of the parents' and children's global report forms of the APQ are considered suitable for use in the area of children's and adolescents' behavior problems.

Alcohol use as a behavioural sign of disinhibition: evidence from J.A. Gray's model of personality.

Based on Gray's Reinforcement Sensitivity Theory, the influence of behavioural disinhibition upon alcohol consumption was studied. A sample of undergraduates answered different questionnaires related to the Behavioural Inhibition System and Behavioural Activation System. In relation to alcohol use, three aspects of alcohol consumption were assessed: frequency, quantity of alcohol intake and the age at first drink. From a series of correlation and regression analyses, we found that both high scores on BAS-related scales and low scores on those scales related to the BIS were jointly associated with current alcohol-taking habits. Additionally, the Sensitivity to Reward (SR) scale (BAS) was negatively correlated with, and a predictor of, the onset age of alcohol use. We conclude by proposing that research on alcohol use can benefit from this well-grounded theory of the neuropsychology of the individual differences.

Web-based screening for Panic Disorder: Validity of a single-item instrument.

BACKGROUND: Panic Disorder (PD) is a common mental disorder with an important social and economic cost. Web-based screening tools for early detection of PD are useful for clinical and research purposes. However, there is a paucity of instruments that specifically measure PD online. The aim of this study is to analyze the validity of one item from the Web Screening Questionnaire designed to detect PD symptoms (WSQ-Panic). METHODS: A total of 171 participants completed the WSQ-Panic online and were assessed by telephone using the Structured Clinical Interview for DSM Disorders (SCID-I). The sensitivity, the specificity, predictive values (PPV, NPV), and area under the ROC curve (AUC) were calculated, and the optimal cut-off point was determined. RESULTS: The WSQ-Panic showed a sensitivity of 0.83 and a specificity of 0.74. The PPV was 0.46 and NPV was 0.94. The AUC was 0.82 (95% CI: 0.74-0.90), which indicates a moderate accuracy. The optimal cut-off point is ≥2. LIMITATIONS: The representativeness of the sample is limited. All the interviews were conducted by phone. Six-month prevalence according to SCID-I criteria was considered, whereas the WSQ-Panic assesses current symptoms. CONCLUSION: The WSQ-Panic accuracy is acceptable as an Internet screening tool, comparable to longer instruments for PD detection. This instrument is valid to quickly identify patients who suffer from panic symptoms, which can cause important distress and possibly lead to PD. It can also be very useful for screening participants in online self-help treatments and for research purposes.

Testing the temporal stability of individual differences in the acquisition and generalization of fear.

We studied the temporal stability of individual differences in the acquisition and generalization of fear. Seventy-one participants were tested in two almost identical fear-acquisition and fear-generalization sessions (separated by 8 months). Acquisition and generalization were measured by the fear-potentiated startle, the skin conductance response, and online expectancies of the unconditioned stimulus. To control for the effects of previous experience, different stimuli were used for half of the participants in Session 2. Acquisition and generalization did not differ across sessions or as a function of the stimuli used in Session 2, and a significant proportion of individual differences in these processes was stable over time (generalizability coefficients ranged from 0.17 to 0.38). When the same stimuli were used, acquisition measures showed compromised stability. The results are discussed in terms of their theoretical and applied implications.

Anammox for ammonia removal from pig manure effluents: effect of organic matter content on process performance.

The anammox process, under different organic loading rates (COD), was evaluated using a semi-continuous UASB reactor at 37 degrees C. Three different substrates were used: initially, synthetic wastewater, and later, two different pig manure effluents (after UASB-post-digestion and after partial oxidation) diluted with synthetic wastewater. High ammonium removal was achieved, up to 92.1+/-4.9% for diluted UASB-post-digested effluent (95 mg COD L(-1)) and up to 98.5+/-0.8% for diluted partially oxidized effluent (121 mg COD L(-1)). Mass balance clearly showed that an increase in organic loading (from 95 mg COD L(-1) to 237 mg COD L(-1) and from 121 mg COD L(-1) to 290 mg COD L(-1) for the UASB-post-digested effluent and the partially oxidized effluent, respectively) negatively affected the anammox process and facilitated heterotrophic denitrification. Partial oxidation as a pre-treatment method improved ammonium removal at high organic matter concentration. Up to threshold organic load concentration of 142 mg COD L(-1) of UASB-post-digested effluent and 242 mg COD L(-1) of partially oxidized effluent, no effect of organic loading on ammonia removal was registered (ammonium removal was above 80%). However, COD concentrations above 237 mg L(-1) (loading rate of 112 mg COD L(-1)day(-1)) for post-digested effluent and above 290 mg L(-1) (loading rate of 136 mg COD L(-1)day(-1)) for partially oxidized effluent resulted in complete cease of ammonium removal. Results obtained showed that, denitrification and anammox process were simultaneously occurring in the reactor. Denitrification became the dominant ammonium removal process when the COD loading was increased.

Impact of lower urinary tract symptoms on quality of life using Functional Assessment Cancer Therapy scale.

OBJECTIVES: To assess the impact of lower urinary tract symptoms (LUTS) on general quality-of-life (QOL) measures in an outpatient setting. METHODS: A total of 1546 male patients aged 51 years or older and scoring more than 11 in the International Prostate Symptom Score completed the general version of the Functional Assessment Cancer Therapy, the Benign Prostatic Hyperplasia Impact Index, and additional questions. Previous prostatic surgery and neurourologic conditions were exclusion criteria, but the use of urologic medication was not. RESULTS: LUTS and QOL were significantly related to age, with older patients presenting with more symptoms and worse QOL. In addition, the results showed negative correlations between LUTS and QOL. The division of the severity groups according to the International Prostate Symptom Score showed that patients from the severe group reported significantly worse QOL compared with the moderate group. The 32% variance in the FACT-G was explained by the International Prostate Symptom Score items, controlling for age. Nocturia combined with incomplete bladder emptying were the strongest predictors of QOL. CONCLUSIONS: LUTS have considerable impact on the general well-being of the patient. Combined with age, they can explain up to 30% of the variance in QOL. Nocturia and incomplete emptying are the most troublesome symptoms.