Implementation of Patient-Reported Outcomes in a Medical Oncology Setting (the iPROMOS Study): Type II Hybrid Implementation Study.

BACKGROUND: Clinical trials have demonstrated that patient-reported outcome measures (PROMs) can improve mortality and morbidity outcomes when used in clinical practice. OBJECTIVE: This study aimed to prospectively investigate the implementation of PROMs in routine oncology. Outcomes measured included improved symptom detection, clinical response to symptom information, and health service outcomes. METHODS: Two of 12 eligible clinics were randomized to implement symptom PROMs in a medical oncology outpatient department in Australia. Randomization was carried out at the clinic level. Patients in control clinics continued with usual care; those in intervention clinics completed a symptom PROM at presentation. This was a pilot study investigating symptom detection, using binary logistic models, and clinical response to PROMs investigated using multiple regression models. RESULTS: A total of 461 patient encounters were included, consisting of 242 encounters in the control and 222 in the intervention condition. Patients in these clinics most commonly had head and neck, lung, prostate, breast, or colorectal cancer and were seen in the clinic for surveillance and oral or systemic treatments for curative, metastatic, or palliative cancer care pathways. Compared with control encounters, the proportion of symptoms detected increased in intervention encounters (odds ratio 1.05, 95% CI 0.99-1.11; P=.08). The odds of receiving supportive care, demonstrated by nonroutine allied health review, increased in the intervention compared with control encounters (odds ratio 3.54, 95% CI 1.26-9.90; P=.02). CONCLUSIONS: Implementation of PROMs in routine care did not significantly improve symptom detection but increased the likelihood of nonroutine allied health reviews for supportive care. Larger studies are needed to investigate health service outcomes. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12618000398202; https://tinyurl.com/3cxbemy4.

Prevalence, Mortality, and Access to Care for Chronic Kidney Disease in Medicaid-Enrolled Adults With Sickle Cell Disease in California: Retrospective Cohort Study.

BACKGROUND: Chronic kidney disease (CKD) is a significant complication in patients with sickle cell disease (SCD), leading to increased mortality. OBJECTIVE: This study aims to investigate the burden of CKD in Medicaid-enrolled adults with SCD in California, examine differences in disease burden between male and female individuals, and assess mortality rates and access to specialized care. METHODS: This retrospective cohort study used the California Sickle Cell Data Collection program to identify and monitor individuals with SCD. Medicaid claims, vital records, emergency department, and hospitalization data from 2011 to 2020 were analyzed. CKD prevalence was assessed based on ICD (International Classification of Diseases) codes, and mortality rates were calculated. Access to specialized care was examined through outpatient encounter rates with hematologists and nephrologists. RESULTS: Among the 2345 adults with SCD, 24.4% (n=572) met the case definition for CKD. The SCD-CKD group was older at the beginning of this study (average age 44, SD 14 vs 34, SD 12.6 years) than the group without CKD. CKD prevalence increased with age, revealing significant disparities by sex. While the youngest (18-29 years) and oldest (>65 years) groups showed similar CKD prevalences between sexes (female: 12/111, 10.8% and male: 12/101, 11.9%; female: 74/147, 50.3% and male: 34/66, 51.5%, respectively), male individuals in the aged 30-59 years bracket exhibited significantly higher rates than female individuals (30-39 years: 49/294, 16.7%, P=.01; 40-49 years: 52/182, 28.6%, P=.02; and 50-59 years: 76/157,48.4%, P<.001). During this study, of the 2345 adults, 435 (18.5%) deaths occurred, predominantly within the SCD-CKD cohort (226/435, 39.5%). The median age at death was 53 (IQR 61-44) years for the SCD-CKD group compared to 43 (IQR 33-56) years for the SCD group, with male individuals in the SCD-CKD group showing significantly higher mortality rates (111/242, 45.9%; P=.009) than female individuals (115/330, 34.9%). Access to specialist care was notably limited: approximately half (281/572, 49.1%) of the SCD-CKD cohort had no hematologist visits, and 61.9% (354/572) did not see a nephrologist during this study's period. CONCLUSIONS: This study provides robust estimates of CKD prevalence and mortality among Medicaid-enrolled adults with SCD in California. The findings highlight the need for improved access to specialized care for this population and increased awareness of the high mortality risk and progression associated with CKD.

Exploring the Prevalence of Tinnitus and Ear-Related Symptoms in China After the COVID-19 Pandemic: Online Cross-Sectional Survey.

BACKGROUND: Tinnitus is a complex and heterogeneous disease that has been identified as a common manifestation of COVID-19. To gain a comprehensive understanding of tinnitus symptoms in individuals following COVID-19 infection, we conducted an online survey called the China Ear Nose and Throat Symptom Survey in the COVID-19 Pandemic (CENTSS) among the Chinese population. OBJECTIVE: Our objective was to investigate tinnitus and ear-related symptoms after COVID-19 infection in the Chinese population, with the aim of providing a solid empirical foundation for improved health care. The findings from CENTSS can contribute to the development of enhanced management strategies for tinnitus in the context of long COVID. By gaining a better understanding of the factors contributing to tinnitus in individuals with COVID-19, health care providers can tailor interventions to address the specific needs of affected patients. Furthermore, this study serves as a basis for research on the long-term consequences of COVID-19 infection and its associated tinnitus symptoms. METHODS: A quantitative, online, cross-sectional survey study design was used to explore the impact of the COVID-19 pandemic on experiences with tinnitus in China. Data were collected through an online questionnaire designed to identify the presence of tinnitus and its impacts. Descriptive statistics were used to analyze individuals' demographic characteristics, COVID-19 infection-related ear symptoms, and the cognitive and emotional implications of tinnitus. Univariable and multivariable logistic regression analyses were used to model the cross-sectional baseline associations between demographic characteristics, noise exposure, educational level, health and lifestyle factors, and the occurrence of tinnitus. RESULTS: Between December 19, 2022, and February 1, 2023, we obtained responses from 1262 Chinese participants representing 24 regions, with an average age of 37 years. Among them, 540 patients (42.8%) reported experiencing ear-related symptoms after COVID-19 infection. Only 114 (9%) of these patients sought medical attention specifically for their ear symptoms, while 426 (33.8%) did not seek hospital care. Tinnitus emerged as the most prevalent and impactful symptom among all ear-related symptoms experienced after COVID-19 infection. Of the respondents, female participants (688/888, 77.78%), younger individuals (<30 years), individuals with lower education levels, participants residing in western China, and those with a history of otolaryngology diseases were more likely to develop tinnitus following COVID-19 infection. CONCLUSIONS: In summary, tinnitus was identified as the most common ear-related symptom during COVID-19 infection. Individuals experiencing tinnitus after COVID-19 infection were found to have poorer cognitive and emotional well-being. Different ear-related symptoms in patients post-COVID-19 infection may suggest viral invasion of various parts of the ear. It is therefore crucial to monitor and manage hearing-related changes resulting from COVID-19 as clinical services resume.

A Unique Delusion with Depression in Early Stage of Neurocognitive Disorder Due to Vascular Disease: Considerations for Clinicians.

As global aging becomes more prominent, neurocognitive disorders (NCD) incidence has increased. Patients with NCD usually have an impairment in one or more cognitive domains, such as attention, planning, inhibition, learning, memory, language, visual perception, and spatial or social skills. Studies indicate that 50-80% of these adults will develop neuropsychiatric symptoms (NPS), such as apathy, depression, anxiety, disinhibition, delusions, hallucinations, and aberrant motor behavior. The progression of NCD and subsequent NPS requires tremendous care from trained medical professionals and family members. The behavioral symptoms are often more distressing than cognitive changes, causing caregiver distress/depression, more emergency room visits and hospitalizations, and even earlier institutionalization. This signifies the need for early identification of individuals at higher risk of NPS, understanding the trajectory of their NCD, and exploring treatment modalities. In this case report and review, we present an 82-year-old male admitted to our facility for new-onset symptoms of depression, anxiety, and persecutory delusions. He has no significant past psychiatric history, and his medical history is significant for extensive ischemic vascular disease requiring multiple surgeries and two episodes of cerebrovascular accident (CVA). On further evaluation, the patient was diagnosed with major NCD, vascular subtype. We discuss differential diagnoses and development of NPS from NCD in order to explain the significance of more thorough evaluation by clinicians for early detection and understanding of NCD prognosis.

Monitoring changes in the volatile fraction of roasted nuts and seeds by using comprehensive two-dimensional gas chromatography and matrix templates.

Static headspace coupled with comprehensive two-dimensional gas chromatography and a flame ionization detector (HS-GC × GC-FID), has been applied to monitor changes in the volatile fraction of commercial edible nuts and seeds (peanuts, almonds, hazelnuts, and sunflower seeds). Effects of the roasting conditions (time, 5-40 min; temperature, 150-170 °C), which were employed under different combinations by using a ventilated oven, on target volatile fraction were examined to identify potential differences in relation to the roasting treatment of raw samples. In addition, reference templates were created, from the HS-GC × GC-FID method, for each of the four food matrices analyzed, and they were applied to characterize the samples according to the presence or absence of volatile compounds. Finally, these templates were successfully employed to make a quick distinction between different roasting conditions.•HS-GC × GC-FID was applied to study the volatile profile of edible nuts and seeds.•Reference templates (GC × GC-FID) were created for each of the four food matrices.•Rapid discrimination between raw and roasted samples was achieved.

Cross-sectional survey on cigarette smoking in Chinese high-income areas.

OBJECTIVE: To evaluate smoking status and its influencing factors in high-income areas of China. DESIGN: Cross-sectional. SETTING: High-income areas in China. PARTICIPANTS: 4064 persons aged 15 years or older from the survey results in Global Adult Tobacco Survey-China 2018. METHODS: Gross national income data were used to determine China's high-income economic regions, and the results of the survey in Global Adult Tobacco Survey-China 2018 were used for statistical analysis. RESULTS: A total of 4064 people were included in our study, including 881 current smokers, 2884 who had never smoked and 299 who had quit smoking. Using the standardised rate method, the standardised smoking rates in high-income and non-high-income areas in China were calculated to be 23.56% and 27.77%, respectively. Men, high school education or below, knowledge of e-cigarette information, permission to smoke at home and people with poor smoking health literacy are the main influencing factors of smokers in high-income areas of China. CONCLUSION: The smoking rate of people in China's high-income areas is lower than the overall smoking rate in China, and we should increase the public awareness that smoking is harmful to health, encourage the prohibition of smoking at home, increase investment in higher education and improve residents' smoking health literacy level. The purpose of this study was to encourage reduction in the rate of smoking and better control the prevalence of smoking.

Serum apelin-13 levels and total oxidant/antioxidant status of patients with Alzheimer's disease.

OBJECTIVE: We aimed to evaluate apelin-13 levels, total oxidant/antioxidant status in Alzheimer's disease (AD) and to investigate the relationship between these parameters. METHODS: Patients newly diagnosed with AD were enrolled in the study. The control group consisted of age- and gender-matched healthy individuals. Serum levels of apelin-13, total antioxidant status (TAS), and total oxidant status (TOS) were measured. Oxidative stress index was calculated (TOS/TAS) for each participant. RESULTS: We reported that serum apelin-13 and TAS values were significantly lower in the AD group compared with controls, and they found a fair but insignificant relationship between Apelin-13 and TAS values. CONCLUSION: According to our results, we suggested that insufficient apelin-13 and TAS levels may contribute to the pathogenesis of AD.

Residential Institutions Redress Board of the Irish Government 2002-2018.

In 1999, the Irish Government commissioned a report into the abuse of children who were in the care of facilities managed and run under the auspices of the Roman Catholic Church in the Irish Republic in the 1940s and 1950s. It reported in 2009. A Redress Board was set up to investigate and compensate claimants who were abused physically and mentally as children when living in these facilities. The Board sat for 16 years. In total, 16,650 applications were processed with awards worth €970 million. Of these, 1069 applications were withdrawn, refused or had a nil award. This report on work of the Commission and the Board derives from the histories given and the expert assessment of 19 claimants for compensation. Their ages ranged between 47 and 72 years at the time of the expert's assessment.

Stressors, coping and symptoms of adjustment disorder in the course of the COVID-19 pandemic - study protocol of the European Society for Traumatic Stress Studies (ESTSS) pan-European study.

BACKGROUND: During the current COVID-19 pandemic, the people in Europe are exposed to self-isolation, quarantine, job loss, risk of contracting COVID-19, or grief of loved ones. Such a complex array of stressors may lead to symptoms of adjustment disorder or posttraumatic stress disorder. This research protocol describes a study launched by the European Society of Traumatic Stress Studies (ESTSS) to investigate the impact of the COVID-19 pandemic on symptoms of adjustment disorder across European countries. OBJECTIVE: The longitudinal online cohort study aims (1) to explore psychosocial reactions to the COVID-19 pandemic across ten European countries; (2) to examine the relationships between risk and resilience factors, stressors and symptoms of adjustment disorder during the pandemic; and (3) to investigate whether these relationships are moderated by coping behaviours. METHOD: In ten countries (Austria, Croatia, Georgia, Germany, Italy, Lithuania, Netherlands, Poland, Portugal, and Sweden), between 1,000 and 2,000 participants will be recruited, depending on the size of the country. Participants will be assessed at two timepoints with a six-month interval. Following a conceptual framework based on the WHO's social framework of health, an assessment of risk and resilience factors, COVID-19 related stressors and pandemic-specific coping behaviours will be measured to estimate their contribution to symptoms of adjustment disorder. The Adjustment Disorder New Module 8 (ADNM-8) will be used to assess symptoms of adjustment disorder. As a secondary measure, symptoms of posttraumatic stress disorder will be measure using the Primary Care PTSD Screen for DSM-5 (PC-PTSD-5). DATA ANALYSIS: The relative contribution of risk factors, resilience factors, and stressors on symptoms of adjustment disorder or symptoms of posttraumatic stress disorder will be estimated using multilevel analysis. To determine the moderating effects of different types of coping behaviours on these relationships, a multilevel mediation analysis will be carried out.

Antecedentes: Durante la actual pandemia de COVID-19, las personas en Europa están expuestas a autoaislamiento, cuarentena, pérdida de empleo, riesgo de contraer COVID-19 o duelo de sus seres queridos. Un conjunto tan complejo de factores estresantes puede provocar síntomas de trastorno de adaptación o trastorno de estrés postraumático. Este protocolo de investigación describe un estudio lanzado por la Sociedad Europea de Estudios de Estrés Traumático (ESTSS) para investigar el impacto de la pandemia COVID-19 en los síntomas del trastorno de adaptación en países europeos.Objetivo: El estudio longitudinal de cohorte en línea tiene como objetivo (1) explorar las reacciones psicosociales a la pandemia de COVID-19 en diez países europeos; (2) examinar las relaciones entre los factores de riesgo y resiliencia, estresores y síntomas de trastorno de adaptación durante la pandemia; e (3) investigar si estas relaciones son moderadas por comportamientos de afrontamiento.Método: En diez países (Austria, Croacia, Georgia, Alemania, Italia, Lituania, Países Bajos, Polonia, Portugal y Suecia) serán reclutados entre 1,000 y 2,000 participantes, dependiendo del tamaño del país. Los participantes serán evaluados en dos momentos con un intervalo de seis meses. Siguiendo un marco conceptual basado en el marco social de salud de la OMS, una evaluación de los factores de riesgo y resiliencia, factores estresantes relacionados con COVID-19 y el comportamiento de afrontamiento específico de la pandemia serán medidos para estimar su contribución a los síntomas de trastorno de adaptación. El nuevo módulo de trastorno de adaptación 8 (ADNM-8) se utilizará para medir los síntomas del trastorno de adaptación. Como medida secundaria, se evaluarán síntomas de trastorno de estrés postraumático usando el cribaje de TEPT en atención primaria para DSM-5 (PC-PTSD-5).Análisis de datos: La contribución relativa de los factores de riesgo, factores de resiliencia y los estresores sobre los síntomas de trastorno de adaptación o síntomas de trastorno de estrés postraumático se estimará mediante análisis multinivel. Para determinar los efectos moderadores de diferentes tipos de conductas de afrontamiento en estas relaciones, se llevará a cabo un análisis de mediación multinivel.

Purification of Yeast Spores to Investigate Their Dynamics of Activation.

Germination is an important developmental process that supports resumption of growth in dormant spores. The study of the mechanisms underlying germination requires a pure spore population devoid of other cell types. This article describes the sporulation of wild Saccharomyces cerevisiae and Saccharomyces paradoxus strains, and the isolation and purification of ascospores. We also describe a method to synchronously induce germination in a spore population as well as to measure spore activation. This procedure can be applied, for example, to the study of environmental conditions that trigger germination. © 2020 Wiley Periodicals LLC. Basic Protocol 1: Sporulation Basic Protocol 2: Spore purification Basic Protocol 3: Germination induction Support Protocol 1: Flow cytometry analysis Support Protocol 2: Heat-shock resistance measurement.

The leaching of phthalates from PVC can be determined with an infinite sink approach.

Polyvinyl chloride (PVC) is the third most used polymer for plastic products in the European Union (+NO/ CH) and contains the highest amounts of additives, especially phthalic acid esters (phthalates). Leaching kinetics of additives from (micro-) plastics into aqueous environments are highly relevant for environmental risk assessment and modelling of the fluxes of plastics and its associated additives. Investigating the leaching of phthalates into aqueous environments in batch experiments is challenging due to their low solubility and high hydrophobicity and there are no standard methods to study release processes. Here we describe an infinite sink method to investigate the leaching of phthalates from PVC into the aqueous phase. Spiking and leaching experiments using bis(2-ethylhexyl) phthalate as a model phthalate enabled the validation and evaluation of the designed infinite sink method. The developed method offers: •a low-cost and simple approach to investigate leaching of phthalates from PVC into aqueous environments•the use of a high-surface activated carbon powder as an infinite sink•a tool to elucidate the transport fluxes of plastics and additives.

The relationship between sense of coherence and post-traumatic stress: a meta-analysis.

Background: Antonovsky's concept of sense of coherence (SOC) - as a global orientation reflecting an individual's feeling of confidence in both the predictability of their internal and external environment and their ability to cope with stressful and challenging situations in life - shows a negative association with symptoms of post-traumatic stress. However, single studies varying in study characteristics provide heterogeneous effect size estimations. Objective: The purpose of the current study is to investigate the relationship between SOC and post-traumatic stress disorder (PTSD) symptom severity for the first time on a meta-analytical level. Method: The random-effects meta-analysis is based on zero-order correlations (r) and consists of 47 independent samples out of 45 studies (N = 10,883). Results: After correcting for sampling error, the mean correlation between SOC and PTSD symptoms was M(r) = -.41 (excluding four outliers: -.39). However, this effect could not be generalized to all types of PTSD samples owing to substantial remaining heterogeneity. Subsequent moderator analyses investigating the influence of different SOC and PTSD measures, trauma type and duration, mean age and gender imbalances per sample did not reveal significant moderating effects. Conclusions: The meta-analysis reveals a substantial correlation between SOC and PTSD symptom severity: higher SOC levels are associated with lower symptom severity. Thus, future research should progress to the question of whether the relationship between SOC and post-traumatic stress is causal, and by which factors it is moderated. Abbreviations: CD, Cook's distance; DSM, Diagnostic and Statistical Manual of Mental Disorders; (G)RR, general (and specific) resistance resources; IES(-R), Impact of Event Scale (Revised); PDS, Posttraumatic Stress Diagnostic Scale; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses; PTSD, post-traumatic stress disorder; SDR, standard deleted residual; SOC, sense of coherence; SOC-R, Sense of Coherence Scale - Revised.

Antecedentes: El concepto de sentido de coherencia (SOC) de Antonovsky- como una orientación global reflejando el sentimiento de seguridad de un individuo, tanto en la previsibilidad de su ambiente interno y externo y su habilidad para enfrentar situaciones estresantes y desafiantes en su vida- muestra una asociación negativa con el estrés postraumático. Sin embargo, estudios individuales que varían en las características proporcionan estimaciones del tamaño del efecto heterogéneo.Objetivo: El propósito de este estudio es investigar la relación entre SOC y severidad de los síntomas de TEPT por primera vez a un nivel metaanalítico.Método: El metanálisis de efectos aleatorios se basa en correlaciones de orden cero (r) y consta de 47 muestras independientes de 45 estudios (N= 10.883).Resultados: Después de corregir por error de muestreo, la correlación media entre SOC y síntomas de TEPT fue M(r) =−.41 (excluyendo cuatro valores atípicos: −.39). Sin embargo, este efecto podría no ser generalizado a todos los tipos de muestras de TEPT debido a la importante heterogeneidad restante. Los siguientes análisis del moderador investigan la influencia de diferentes mediciones de SOC y TEPT, tipo de trauma y duración, edad media y desbalance de género por muestra no revela efectos moderados significativos.Conclusiones: El metanálisis revela una importante correlación entre SOC y severidad de los síntomas de TEPT: Niveles más altos de SOC están asociados con menor severidad de los síntomas. De este modo, las investigaciones futuras deberían progresar a la pregunta de si la relación entre SOC y estrés postraumático es causal, y por cuáles factores es moderada.

Perceived danger during deployment: a Rasch validation of an instrument assessing perceived combat exposure and the witnessing of combat consequences in a war zone.

The potential stressors associated with military deployment are related to an increased risk of adverse mental health outcomes. Perceived exposure to combat has been found to be proportional to the severity of post-deployment posttraumatic stress disorder (PTSD). However, other perceived adversities during deployment, such as witnessing danger, distress, and hardship in the war zone, have been less systematically studied, but might play an equally substantial role for post-deployment mental health. The development and validation of scales that assess these related constructs are needed to distinguish their contribution to post-deployment risk of PTSD. We evaluated the validity of 10 items measuring perceived danger distributed to all deployed personnel with the Danish Defense since 1998. We hypothesize two scales: Exposure to Danger and Combat (EDC) and Witnessing Consequences of War (WCW). Two military cohorts deployed to Afghanistan in 2009 (Cohort 1, N = 276) and 2013 (Cohort 2, N = 273) were included. Questionnaire data was collected six months after homecoming, including deployment experiences and post-deployment reactions. We tested the construct validity of the 10 items of perceived danger with Rasch models (RM), focusing specifically on presence of subscales, and differential item functioning (DIF) across cohorts. We confirmed the existence of two separate subscales, EDCS and WCWS, both with adequate reliability. None of the subscales fitted a pure RM, but adequate fit was found for graphical log-linear RMs with evidence of DIF for the ECDS. However, adjusting the score to account for DIF had practically no effect, suggesting that the total non-adjusted mean score can be used in future cohort comparisons. Perceived exposure to combat and danger and witnessing consequences of war are related, but essentially distinct, concepts, each providing unique information about deployment adversities. Future studies should evaluate their shared and unique contribution to the risk of post-deployment PTSD.

La percepción de exposición al combate ha resultado ser proporcional a la severidad del trastorno por estrés post-traumático (TEPT) posterior al despliegue militar. Sin embargo, otras adversidades percibidas durante el despliegue, tales como experimentar peligro, angustia, y dificultades en la zona de guerra, han sido menos sistemáticamente estudiadas, pero podrían jugar un rol sustancialmente equivalente para el impacto en la salud mental posterior al despliegue militar. Se requiere desarrollar y validar escalas que evalúen estos constructos relacionados para distinguir su contribución al riesgo de desarrollar TEPT posterior al despliegue. El objetivo es evaluar la validez de 10 ítems que miden el peligro percibido distribuido a todo el personal desplegado con la Defensa Danesa desde 1998. Se hipotetizan dos escalas; Exposición a Peligro y Combate (EDC) y Exposición a Consecuencias de Guerra (WCW). Se incluyó a dos cohortes militares, que se desplegaron en Afganistán el año 2009 (Cohorte 1, N=276), y el 2013 (Cohorte 2, N=273). Se recopiló datos a partir de cuestionarios seis meses después de regreso al país de origen, incluyendo experiencias dentro del despliegue y reacciones posteriores a éste. Se probó en las cohortes la validez de constructo de los 10 ítems de peligro percibido con modelos Rasch (RM), poniendo especial énfasis en la presencia de subescalas, e Ítem de funcionamiento diferencial (DIF). Se confirmó la existencia de dos subescalas separadas, EDC y WCW, ambas con fiabilidad adecuada. Ninguna de las subescales correspondía a un modelo Rasch puro, pero sí se encontró una relación adecuada para un modelo Rasch logarítmico-lineal con evidencia de DIF para EDC. No obstante, el ajustar el puntaje para explicar el IFD prácticamente no tuvo efectos, sugiriendo que la puntuación media total no ajustada puede ser utilizada en futuras comparaciones de cohortes. La exposición percibida al combate y el peligro y exposición a consecuencias de guerra son dos conceptos relacionados, pero esencialmente distintos, cada uno proveyendo información única sobre los efectos adversos del despliegue militar. Futuros estudios deberían evaluar su contribución compartida y única al riesgo de desarrollar TEPT posterior al despliegue militar.

A five-day inpatient EMDR treatment programme for PTSD: pilot study.

Background: Trauma-focused psychotherapies for posttraumatic stress disorder (PTSD) have been demonstrated to be efficacious, but also have considerable non-response and dropout rates. Intensive treatment may lead to faster symptom reduction, which may contribute to treatment motivation and thereby to reduction of dropout. Objective: The aim of the current study was to investigate the feasibility and preliminary effectiveness of an intensive five-day inpatient treatment with Eye Movement Desensitization and Reprocessing (EMDR) and trauma-informed yoga for patients with PTSD. Method: A non-controlled pilot study with 12 adult patients with PTSD was conducted. At baseline the PTSD diagnosis was assessed with the Clinician-Administered PTSD Scale (CAPS-5) and comorbid disorders with the Mini International Neuropsychiatric Interview (MINI). Primary outcome was self-reported PTSD symptom severity (PTSD Check List for DSM-5; PCL-5) measured at the beginning of day 1 (T1), at the end of day 5 (T2) and at follow-up on day 21 (T3). Reliable change indexes (RCI) and clinically significant changes were calculated. Results: From T1 to T3, PTSD symptoms significantly improved with a large effect size (Cohen's d = 0.91). Nine of the 11 patients who completed treatment showed reliable changes in terms of self-reported PTSD. At T3, two of the patients no longer met criteria for PTSD as measured with the PCL-5. One patient dropped out after the first day. No serious adverse events occurred. Conclusions: The majority of patients in our pilot study experienced symptom reduction consistent with reliable changes in this five-day inpatient treatment with EMDR and yoga. Randomized controlled trials - with longer follow up periods - are needed to properly determine efficacy and efficiency of intensive clinical treatments for PTSD compared to regular treatment. This is one of the first studies to show that intensive EMDR treatment is feasible and is indicative of reliable improvement in PTSD symptoms in a very short time frame.

Planteamiento: Se ha demostrado que las psicoterapias centradas en el trauma para el TEPT son eficaces, pero también tienen tasas considerables de falta de respuesta y abandono. El tratamiento intensivo puede llevar a una reducción más rápida de los síntomas, lo que puede contribuir a la motivación para el tratamiento y, por lo tanto, a la reducción del abandono. Objetivo: El objetivo del presente estudio fue investigar la viabilidad y eficacia preliminar de un tratamiento intensivo de 5 días para pacientes hospitalizados con Desensibilización y Reprocesamiento por Movimientos Oculares (EMDR) y yoga basado en el trauma para pacientes con TEPT. Método: Se realizó un estudio piloto no controlado con 12 pacientes adultos con TEPT. Al inicio del estudio, se evaluó el diagnóstico de TEPT con el CAPS-5 y los trastornos comórbidos con el MINI. El resultado principal fue la gravedad de los síntomas de PTSD por medio de autoinforme (PCL-5) medida al comienzo del día 1 (T1), al final del día 5 (T2) y en el seguimiento el día 21 (T3). Se calcularon los índices de cambio fiable (RCI, por sus siglas en inglés) y los cambios clínicamente significativos. Resultados: De T1 a T3, los síntomas de TEPT mejoraron significativamente con un tamaño de efecto grande (d de Cohen = 0,91) y 9 de los 11 pacientes que completaron el tratamiento mostraron cambios fiables en términos de auto-informes de TEPT. En T3, dos de los pacientes ya no cumplían los criterios para el trastorno de estrés postraumático medido con el PCL-5. Un paciente se retiró después del primer día. No se produjeron eventos adversos graves. Conclusiones: la mayoría de los pacientes en nuestro estudio piloto experimentaron una reducción de síntomas consistente con cambios fiables en este tratamiento de 5 días con EMDR y yoga. Se necesitan ensayos controlados aleatorios, con períodos de seguimiento más largos, para determinar adecuadamente la eficacia y la eficiencia de los tratamientos clínicos intensivos para el TEPT en comparación con el tratamiento habitual. Este es uno de los primeros estudios que demuestra que el tratamiento intensivo con EMDR es factible y es indicativo de una mejora fiable en los síntomas de TEPT después de un período de tiempo muy corto.

Utilization of Hospice Services in a Population of Patients With Huntington's Disease.

CONTEXT: Although the early and middle stages of Huntington's disease (HD) and its complications have been well described, less is known about the course of late-stage illness. In particular, little is known about the population of patients who enroll in hospice. OBJECTIVES: Our goal is to describe the characteristics of patients with HD who enrolled in hospice. METHODS: This is a retrospective cohort study of electronic medical record data from 12 not-for-profit hospices in the United States from 2008 to 2012. RESULTS: Of the 164,032 patients admitted to these hospices, 101 (0.06%) had a primary diagnosis of HD. Their median age was 57 (IQR 48-65) and 53 (52.5%) were women. Most patients were cared for by a spouse (n = 36, 36.6%) or adult child (n = 20, 19.8%). At the time of admission, most patients were living either at home (n = 39, 38.6%) or in a nursing home (n = 41, 40.6%). All were either bedbound or could ambulate only with assistance. The most common symptom reported during enrollment in hospice was pain (n = 34, 33.7%) followed by anxiety (n = 30, 29.7%), nausea (n = 18, 17.8%), and dyspnea (n = 10, 9.9%). Patients had a median length of stay in hospice of 42 days, which was significantly longer than that of other hospice patients in the sample (17 days), P < 0.001. Of the 101 patients who were admitted to hospice, 73 died, 11 were still enrolled at the time of data analysis, and 17 left hospice either because they no longer met eligibility criteria (n = 14, 13.7%) or because they decided to seek treatment for other medical conditions (n = 3, 3.0%). Of the 73 patients who died while on hospice, most died either in a nursing home (n = 29; 40%) or a hospital (n = 27; 37%). Seventeen patients (23%) died at home. No patient that started in a facility died at home. CONCLUSION: Patients with HD are admitted to hospice at a younger age compared with other patients (57 vs. 76 years old) but have a significant symptom burden and limited functional status. Although hospice care emphasizes the importance of helping patients to remain in their homes, only a minority of these patients were able to die at home.

Impact of continuing medical education in cancer diagnosis on GP knowledge, attitude and readiness to investigate - a before-after study.

BACKGROUND: Continuing medical education (CME) in earlier cancer diagnosis was launched in Denmark in 2012 as part of the Danish National Cancer Plan. The CME programme was introduced to improve the recognition among general practitioners (GPs) of symptoms suggestive of cancer and improve the selection of patients requiring urgent investigation. This study aims to explore the effect of CME on GP knowledge about cancer diagnosis, attitude towards own role in cancer detection, self-assessed readiness to investigate and cancer risk assessment of urgently referred patients. METHODS: We conducted a before-after study in the Central Denmark Region including 831 GPs assigned to one of eight geographical clusters. All GPs were invited to participate in the CME at three-week intervals between clusters. A questionnaire focusing on knowledge, attitude and clinical vignettes was sent to each GP one month before and seven months after the CME. The GPs were also asked to assess the risk of cancer in patients urgently referred to a fast-track cancer pathway during an eight-month period. CME-participating GPs were compared with reference (non-participating) GPs by analysing before-after differences. RESULTS: One quarter of all GPs participated in the CME. 202 GPs (24.3 %) completed both the baseline and the follow-up questionnaires. 532 GPs (64.0 %) assessed the risk of cancer before the CME and 524 GPs (63.1 %) assessed the risk of cancer after the CME in urgently referred consecutive patients. Compared to the reference group, CME-participating GPs statistically significantly improved their understanding of a rational probability of diagnosing cancer among patients urgently referred for suspected cancer, increased their knowledge of cancer likelihood in a 50-year-old referred patient and lowered the assessed risk of cancer in urgently referred patients. CONCLUSIONS: The standardised CME lowered the GP-assessed cancer risk of urgently referred patients, whereas the effect on knowledge about cancer diagnosis and attitude towards own role in cancer detection was limited. No effect was found on the GPs' readiness to investigate. CME may be effective for optimising the interpretation of cancer symptoms and thereby improve the selection of patients for urgent cancer referral. TRIAL REGISTRATION: NCT02069470 on ClinicalTrials.gov. Retrospectively registered, 1/29/2014.

[Classics textual research and using situation investigation of Tibetan medicine "Zha-xun"].

In this article the classics textual research to the origin of "Zha-xun" was carried out, the ethnobotanical research methods, the origin of visits, key informant interviews, sample collection and textual research were applied in the research. The results showed that the hypothesis of Zha-xun"s origin mainly included "source of mine", "source of feces", "source of monkey menstrual blood" in China. There were "source of fossil", "source of the plant secretion" abroad. The authors had interviewed the villagers at origin, herbalists, Tibetan doctors, herb dealers, foreign scholars for a total of 18 people, and collecting 45 batches medicinal materials. According to ancient Tibetan classics textual and Tibetan medicine doctors' views, medicinal materials were divided into the genuine and the substitutes. The genuine was identified as ancient so-called "iron" type "Zha-xun", and the substitute was fecal pellet bonding briquette. According to the field survey and literature research, "source of fossil" more in line with substance of Zha-xun was derived from the rock. As the results, the author believed that Zha-xun was the mixture of organic fossils from the rock seepage with flying squirrel, pika feces. So it is needed to be set up Zha-xun classification standard to evaluate the quality of medicinal materials. Meanwhile, it was necessary to further clarify fecal pellet substitute rationality. Above all, this article clarified the status of the use of Tibetan medicine-"Zha-xun", and laid the foundation of species systematics and quality standards research of "Zha-xun".

Evaluation of attitude to, knowledge of and barriers toward research among medical science students.

BACKGROUND: Plans to increase the role of students in health research require data on students' knowledge and views of research. The aim of the study was to evaluate these factors toward research among medical science students. METHODS: Undergraduate and postgraduate students of three medicine, dentistry and pharmacy schools in Shiraz were enrolled in a cross-sectional descriptive study using questionnaires to provide details of the parameters of attitude to, knowledge of and barriers toward research for each individual. All data was coded for each of the parameters. Data analyses were performed by one-way ANOVA/Tukey and Student's t, Pearson's correlation and Chi-squared tests. RESULTS: A total of 384 questionnaires were returned complete. Mean student scores for attitude, knowledge and barriers were 68.97 ± 12.56, 70.99 ± 20.97 and 75.27 ± 15.38, respectively. On the knowledge parameter, 77.8% of students' scores fell above the middle of the possible attainable score, but 90% of attitude scores came in at below the middle of the possible attainable score. Undergraduate students (70.27 ± 12.00) showed a more positive attitude to research than postgraduate students (65.57 ± 13.06) (p = 0.001). Female students (72.97 ± 20.54) had greater knowledge than males (67.09 ± 21.56) (p = 0.010). Many barriers were highlighted by students such as lack of funding support and lack of time for research. CONCLUSIONS: Students showed favorable knowledge of research, but their attitude to the field was inadequate. More attention must be placed on these parameters in the curriculum to improve student interest in health research. The impact of barrier factors on research demonstrates that there is a need for greater availability of information in order to solve the problems and change strategies for research.

The end-state comfort effect in 3- to 8-year-old children in two object manipulation tasks.

The aim of the study was to compare 3- to 8-year-old children's propensity to anticipate a comfortable hand posture at the end of a grasping movement (end-state comfort effect) between two different object manipulation tasks, the bar-transport task, and the overturned-glass task. In the bar-transport task, participants were asked to insert a vertically positioned bar into a small opening of a box. In the overturned-glass task, participants were asked to put an overturned-glass right-side-up on a coaster. Half of the participants experienced action effects (lights) as a consequence of their movements (AE groups), while the other half of the participants did not (No-AE groups). While there was no difference between the AE and No-AE groups, end-state comfort performance differed across age as well as between tasks. Results revealed a significant increase in end-state comfort performance in the bar-transport task from 13% in the 3-year-olds to 94% in the 8-year-olds. Interestingly, the number of children grasping the bar according to end-state comfort doubled from 3 to 4 years and from 4 to 5 years of age. In the overturned-glass task an increase in end-state comfort performance from already 63% in the 3-year-olds to 100% in the 8-year-olds was significant as well. When comparing end-state comfort performance across tasks, results showed that 3- and 4-year-old children were better at manipulating the glass as compared to manipulating the bar, most probably, because children are more familiar with manipulating glasses. Together, these results suggest that preschool years are an important period for the development of motor planning in which the familiarity with the object involved in the task plays a significant role in children's ability to plan their movements according to end-state comfort.

La construcción de la práctica docente como efecto de la intervención institucional en la formación del psicólogo / Building of the teaching practice as an effect of the institutional intervention in psychologists' education

El artículo refiere al proyecto de investigación "Dispositivos analizadores de la formación y práctica profesional del psicólogo", acreditado por PROINPSI. Trasmite el proceso de sistematización de la experiencia en el aula y de varios espacios de reflexión surgidos a partir de ella, de los docentes de la Cátedra I de Psicología Institucional. La Psicología Institucional es entendida como una perspectiva de conocimiento que interpela los imaginarios compartidos que sostienen las prácticas. El proceso de intervención sobre los saberes instituidos permite acompañar a otros en su revisión, a la vez que conocer los propios. Para hacerlo, se construyó en el espacio de trabajos prácticos un dispositivo de Análisis de las Prácticas. Además, esta investigación sistematiza la experiencia de docencia e intervención y provee herramientas para el Análisis de las Prácticas de los docentes, alumnos y profesionales.

The article attempts to convey the process experienced as lecturers of the Institutional Psychology I professorship that is embodied in the PROINPSI sanctioned research project, Education analyzing devices and the psychologist's professional practice, which aims to systematize the experience in the classroom and other spaces of reflection emerged from it. Institutional Psychology is a knowledge perspective that questions the shared imaginary that maintains the practices. The process of intervention allows to accompany in knowledge revision, at the same time as to know the own ones. In order to do it, a device of Analysis of the Practices was constructed. This research also systematize the teaching and intervention experience, and provides consumptions for the Practice Analysis of proffessors.