Evaluating an intervention to increase cancer knowledge in racially diverse communities in South Carolina

Objective

To conduct a cancer education intervention with racially diverse communities in South Carolina.

Methods

The study was conducted at eight different sites in six counties in SC. The intervention included a 3-h general cancer knowledge and 30-min prostate cancer knowledge component. Pre- and post-intervention surveys were administered. Maximum scores were 31, 10 and 5 for the general cancer knowledge, prostate cancer knowledge and perceived self-efficacy in patient-physician interaction instruments, respectively. Analyses were completed using SPSS 16.0, SAS 9.1.3, and R v2.6.1.

Results

The study sample consisted of 164 predominantly African American participants. Most of the participants who reported age were 50+ years (62.5%). Among those who reported income, 46.1% had an annual household income <$40,000. The mean general cancer knowledge pre-test score was 26.2 (standard deviation (SD) 3.7) with a mean post-intervention increase of 2.15 points (p < 0.01). The mean pre-test prostate cancer knowledge score was 7.3 (SD 2.0) with a post-intervention increase of 0.48 points (p < 0.01). Perceived self-efficacy in patient-physician interaction scores had a ceiling effect.

Conclusion

General cancer knowledge and prostate cancer knowledge scores increased following the intervention.

Practice Implications

The intervention was successful in the short-term. It could be continued by community members.     

Emotional and physiological responses to normative and idiographic positive stimuli in bipolar disorder

Background

Few studies have examined differences in emotional responding among distinct types of positive stimuli. This is important to understand both for individuals characterized by extreme positive mood (i.e., bipolar disorder) and healthy adults.

Methods

Using a multi-method within-subjects design, the current study examined physiological, behavioral, and self-reported responses to normative (film) and idiographic (memory) happy stimuli in bipolar (BD; n = 25) and healthy control groups (CTL; n = 23).

Results

For both groups, the happy films were associated with greater self-reported and behavioral displays of positive emotion compared to the happy memory. Furthermore, the BD group displayed greater cardiac vagal tone - a putative marker of positive emotion - across both the film and memory.

Conclusion

Normative stimuli were more potent elicitors of positive emotion compared to idiographic stimuli. The study provided further evidence for cardiac vagal tone as a potential biomarker of extreme positive emotion in BD.     

What goes up can come down? A preliminary investigation of emotion reactivity and emotion recovery in bipolar disorder

Background

How is emotion disrupted in bipolar disorder? Two studies are presented that adopt a multi-method approach to investigate emotion reactivity and emotion recovery in bipolar I disorder.

Methods

Across both studies, individuals with inter-episode bipolar disorder and healthy controls were shown three emotion-eliciting films (neutral, happy, and sad) and experiential and physiological responses were measured. In Study 1, bipolar (BD; n = 23) and non-clinical control (NC; n = 24) participants' emotional reactivity during film clips was assessed. In Study 2, a separate sample of BD (n = 23) and NC (n = 25) participants' emotion recovery was assessed after the film clips were assessed.

Results

Results indicated that the BD group exhibited increased self-reported positive emotion and respiratory sinus arrhythmia across all films compared to the NC group. There were no group differences in emotion recovery.

Discussion

Taken together, these results suggest that bipolar disorder is associated with increased positive emotion reactivity, but not emotion recovery, across contexts.     

Survey of family physicians' perspectives on management of immigrant patients: attitudes, barriers, strategies, and training needs

Objective

Immigrants in Canada form a significant portion of the population and have unique and complex health needs. This study was undertaken to evaluate family physicians’ perspectives on the care of this population.

Methods

Questionnaires were distributed to family physicians in Montreal (n = 598). The main outcomes of interest were attitudes of family physicians to care of immigrants including barriers perceived, resources and strategies used to accommodate immigrant patients, as well as physicians’ training in immigrant care.

Results

Family physicians find communication difficulties to be the key barrier and would like to see the access to interpreters improved. Very few physicians make use of professional interpreters. Only a minority of physicians have received specific cross-cultural competence training but those who have seem to provide better quality of care.

Conclusions

Knowledge of physician perspectives is an essential element on which to base interventions to improve the quality of care to this population.

Practice implications

Physicians should be reminded of the importance of using professional interpretation services in multi-lingual encounters. Cross-cultural training should be further advanced in Canadian medical curricula.     

Validity of a low literacy version of the Decisional Conflict Scale

Objective

To evaluate the psychometric properties of the 4-factor low literacy Decisional Conflict Scale (DCS-LL) with men eligible for prostate cancer screening (PCS).

Methods

We used baseline (T0; n = 149) and post-intervention (T2; n = 89) data from a randomized, controlled trial of a PCS decision aid to assess internal consistency reliability and construct, discriminant, and factor validity.

Results

There was evidence of excellent internal consistency reliability (α’s ≥ .80) and fair construct validity (most r's ≥ .40) for the DCS-LL except for the Supported subscale. The DCS-LL was able to discriminate between men who had decided and those who had not. There was evidence for the original 4-factor model at T0 but exploratory analysis suggested a 3-factor solution at T0 and T2 with Informed and Value Clarity as one factor.

Conclusion

For men eligible for PCS, feeling informed and feeling clear about values may not reflect distinct cognitive processes. Feeling supported may not be a factor contributing to uncertainty.

Practice Implications

Research should address whether current DCS subscales best represent the factors that contribute to uncertainty for PCS and for other screening decisions. Research should also explore the influence of health literacy on the factor structure of the DCS-LL.     

A meta-analysis of experimental studies of diversion programs for juvenile offenders

Objective

Research to establish an evidence-base for the treatment of conduct problems and delinquency in adolescence is well established; however, an evidence-base for interventions with offenders who are diverted from the juvenile justice system has yet to be synthesized. The purpose of this study was to conduct a meta-analysis of experimental studies testing juvenile diversion programs and to examine the moderating effect of program type and implementation quality.

Method

A literature search using PsycINFO, Web of Science, and the National Criminal Justice Reference Service data-bases and research institute websites yielded 28 eligible studies involving 57 experimental comparisons and 19,301 youths.

Results

Recidivism was the most common outcome reported across all studies. Overall, the effect of diversion programs on recidivism was non-significant (k = 45, OR = 0.83, 95%CI = 0.43-1.58). Of the five program types identified, including case management (k = 18, OR = 0.78), individual treatment (k = 11, OR = 0.83), family treatment (k = 4, OR = 0.57), youth court (k = 6, OR = 0.93), and restorative justice (k = 6, OR = 0.87), only family treatment led to a statistically significant reduction in recidivism. Restorative justice studies that were implemented with active involvement of researchers led to statistically significant reductions in recidivism (k = 3, OR = 0.69). Other outcomes, including frequency of offending, truancy, and psycho-social problems were reported infrequently and were not subjected to meta-analysis.

Conclusions

High levels of heterogeneity characterize diversion research. Results of this study recommend against implementation of programs limited to case management and highlight the promise of family interventions and restorative justice.     

Computer-generated tailored feedback letters for smoking cessation: theoretical and empirical variability of tailoring

Purpose

This study examines tailored feedback letters of a smoking cessation intervention that is conceptually based on the transtheoretical model, from a content-based perspective.

Methods

Data of 2 population-based intervention studies, both randomized controlled trials, with total N = 1044 were used. The procedure of the intervention, the tailoring principle for the feedback letters, and the content of the intervention materials are described in detail. Theoretical and empirical frequencies of unique feedback letters are presented.

Results

The intervention system was able to generate a total of 1040 unique letters with normative feedback only, and almost half a million unique letters with normative and ipsative feedback. Almost every single smoker in contemplation, preparation, action, and maintenance had an empirically unique combination of tailoring variables and received a unique letter. In contrast, many smokers in precontemplation shared a combination of tailoring variables and received identical letters.

Conclusion

The transtheoretical model provides an enormous theoretical and empirical variability of tailoring. However, tailoring for a major subgroup of smokers, i.e. those who do not intend to quit, needs improvement. Conceptual ideas for additional tailoring variables are discussed.     

Advancing nursing documentation—An intervention study using patients with leg ulcer as an example

Aim

The aim was to implement and evaluate a standardised nursing record, using patients with leg ulcer as an example, regarding the content of the nursing record and district nurses’ experiences of documentation.

Method

This was a prospective, stratified and randomised intervention study, with one intervention group and one control group. A standardised nursing wound care record was designed and implemented in the electronic patient record in the intervention group for a period of 3 months. Pre- and post-intervention audits of nursing records [n = 102 and n = 92, respectively] were carried out and 126 district nurses answered questionnaires pre-intervention and 83 post-intervention.

Result

The standardised nursing wound care record led to more informative, comprehensive and knowledge-intensive documentation according to the audit and district nurses’ opinions. Furthermore, the district nurses’ self-reported knowledge of nursing documentation increased in the intervention group. When the standardised nursing wound care record was not used, the documentation was mostly incomplete with a lack of nursing relevance. There were no differences in the district nurses’ experiences of documentation in general between the two groups.

Conclusion

Using the standardised nursing wound care record improved nursing documentation meeting legal demands, which should increase the safety of patient. There was however a discrepancy between the nurses stated knowledge and how they carried out the documentation. Regular in-service training together with use of evidence based standardised nursing records, as a link to clinical reasoning about nursing care, could be ways effecting change.     

Hypersomnia in inter-episode bipolar disorder: does it have prognostic significance?

Background

Hypersomnia in inter-episode bipolar disorder has been minimally researched. The current study sought to document the prevalence of hypersomnia in a sample of inter-episode patients with bipolar disorder and to examine the relationship between hypersomnia and future bipolar depressive symptoms.

Methods

A total of 56 individuals with bipolar disorder (51 type I + 5 type II) who were currently inter-episode, along with 55 non-psychiatric controls, completed a baseline assessment, including semi-structured interviews for psychiatric diagnoses, sleep disorders, and a battery of indices that included assessment of hypersomnia. Approximately 6 months later, participants were recontacted by telephone and mood was re-evaluated.

Results

Three of six indices suggested that approximately 25% of participants with bipolar disorder endorsed symptoms of hypersomnia in the inter-episode period. Within the bipolar group, hypersomnia in the inter-episode period was associated with future depressive symptoms. This finding was independent of baseline depressive symptoms and medication use.

Limitations

Small sample size and concurrent psychopharmacology in the bipolar sample.

Discussion

Though no gold standard measure for hypersomnia currently exists, this research takes a step towards identifying a clinically and empirically useful hypersomnia assessment. This study demonstrates that hypersomnia in the inter-episode period of bipolar disorder relates to future depressive symptoms, and adds to the growing body of evidence on the importance of inter-episode symptoms predicting bipolar relapse.     

Increased DNA methylation status of the serotonin receptor 5HTR1A gene promoter in schizophrenia and bipolar disorder

Background

Epigenetic changes may play a role in the etiology of psychotic diseases. It has been demonstrated that the serotonin receptor, 5HTR1A, is implicated in schizophrenia (SCZ) and bipolar disorder (BPD). The aim of this study was to investigate the methylation status of a promoter region of the 5HTR1A gene in BPD and SCZ patients.

Methods

Our study included 58 BPD and 40 SCZ (DSM-IV criteria) as well as 67 control subjects. DNA was extracted from blood leukocytes and high-resolution melt (HRM) method was used for analysis.

Results

Non-parametric analysis of variance (Kruskal-Wallis) within groups was significant: H = 67.6; p < 0.0001. The Mann-Whitney U-test showed increased methylation level in both BPD (Z = − 7.4; p < 0.0001) and SCZ (Z = 4.2; p < 0.0001) compared to controls. No effect either of age or gender by own, was observed. ANCOVA revealed a modest effect of age/gender covariance (F = 3.99; p < 0.048).

Limitation

We used a peripheral tissue. The relationship between methylation of blood and brain DNA is not well known. Data need to be replicated in a brain tissue.

Conclusion

We observed increased DNA methylation in the promoter region of the 5HTR1A gene of SCZ and BPD. This could explain the reported decrease of the receptor expression. The current study supports the growing interest of DNA methylation in psychopathology.     

Early Maladaptive Schemas in the risk for bipolar spectrum disorders

Background

The hypomanic personality style is a risk factor for bipolar spectrum disorders and shares many cognitive and affective features with the bipolar spectrum. Schema theory may serve as a unifying theory that would explain many of these features. This study is an exploratory investigation of Early Maladaptive Schemas (EMSs) in association with the hypomanic personality and bipolar spectrum risk.

Methods

A sample of 966 participants completed the Young Schema Questionnaire, the Hypomanic Personality Scale and the Patient Health Questionnaire. Associations were investigated using univariate and multivariate analyses. Participants deemed at risk of developing a bipolar disorder (N = 107) were compared to low-risk controls (N = 681).

Results

The Entitlement/Grandiosity and Insufficient Self-Control/Self-Discipline positively predicted the risk of developing a bipolar disorder, while Emotional Inhibition negatively predicted risk. High-risk participants demonstrated higher mean scores on all EMSs except Emotional Inhibition. These three EMSs, combined with Vulnerability to Harm or Illness, significantly predicted group membership.

Conclusions

A bipolar spectrum EMS profile was identified, consisting of Entitlement/Grandiosity, Insufficient Self-Control/Self-Discipline and the absence of Emotional Inhibition. These EMSs are highly consistent with characteristics of the bipolar spectrum. This study supports the application of schema theory to the hypomanic personality and bipolar spectrum. Future research should explore the possible interaction between EMSs, life events and affective symptoms and the applicability of schema therapy to the bipolar spectrum.     

Evaluation of the web-based Diabetes Interactive Education Programme (DIEP) for patients with type 2 diabetes

Objective

The objective in this study was to evaluate a web-based type 2 diabetes self-management education programme aimed at improving knowledge, encouraging active patient participation and providing supportive self-management tools.

Methods

(1) An effect evaluation was conducted using a randomized controlled trial with a pre-test and post-test design (n = 99) and a knowledge questionnaire. (2) A user evaluation was conducted using an online questionnaire (n = 564) and one-on-one interviews (n = 11) to examine the perceived quality, use of functionalities and use of the programme as a supportive tool in education.

Results

The effect evaluation showed a significant intervention effect (p < 0.01) on knowledge. The user evaluation showed high satisfaction with the programme's content, credibility and user-friendliness. However, functionalities and self-management tools were used by less than half of the participants.

Conclusion

The programme can improve knowledge, but it is not fully used as intended. A more optimal use of the programme is necessary for higher efficacy.

Practice implications

The use of mostly spoken text instead of written text was highly appreciated and could be used more often for educational websites. Furthermore, health care practitioners need support in implementing new educational programmes during consultations.     

Annual cost of managing bipolar disorder to the UK healthcare system

Introduction:

Bipolar disorder is a common illness characterized by recurrent episodes of pathological disturbances of mood. The aim of this study was to estimate the annual cost associated with bipolar disorder to the UK healthcare system (National Health Service).

Methods:

A retrospective observational study was conducted. Primary care resource use was estimated using the IMS Disease Analyzer, a nationally representative sample of general practitioner (GP) practices. Two sources of data from the NHS Information Centre were used to assess resource use in secondary care and in outpatient and community mental health. The number of bed days and day attendances for patients hospitalized was obtained from the Hospital Episode Statistics (HES). This was supplemented with Mental Health Minimum Dataset (MHMDS) to quantify outpatient and community mental health face-to-face contacts. Resource use was examined between 01 April 2007 and 31 March 2008.

Results:

The annual NHS cost of bipolar disorder was estimated to be £342 million at 2009/2010 prices. Hospitalizations accounted for 60%, outpatient and community mental health 26.7%, and medication in primary care 7.4% of the overall direct costs of care.

Limitations:

This study may be confounded by the absence of a control group. This study was limited to an assessment of direct healthcare costs only, not the wider societal cost of bipolar disorder.

Conclusions:

The direct medical cost of managing bipolar disorder in the UK healthcare system is considerable. Therapeutic strategies that optimize community-based management, prevention of recurrence and hospitalization could reduce the economic burden of this illness.     

General practice counseling for patients with chronic obstructive pulmonary disease to quit smoking: Impact after 1 year of two complex interventions

Objective

To evaluate two counseling programs in general practice to help smokers with chronic obstructive pulmonary disease (COPD) to quit smoking.

Methods

Cluster randomized controlled trial including 68 general practices (667 patients) using a randomly assigned intervention program with counseling and advice about nicotine replacement therapy (and additional bupropion-SR in one of the programs) or usual care. Usual care consisted of periodic regular check-ups and COPD information. The main outcome measure was biochemically verified point prevalence at 12 months.

Results

The two intervention groups were treated as one in the analysis because they were equally effective. The intervention resulted in a significantly self-reported higher success rate (14.5%) compared to usual care (7.4%); odds ratio = 2.1, 95% confidence interval = 1.1-4.1. Biochemically verified quit rates were 7.5% (intervention) and 3.4% (usual care); odds ratio = 2.3, 95% confidence interval = 0.9-6.0.

Conclusion

The program doubled the cessation rates (statistically nonsignificant). Too few participants used the additional bupropion-SR to prove its effectiveness.

Practice implications

The protocols can be used for COPD patients in general practice, but expectations should be modest. If quitting is unsuccessful, a stepped care approach should be considered.     

Exercise and severe depression: preliminary results of an add-on study

Background

Physical exercise has been extensively researched as a therapeutic option for treatment of major depression.

Methods

In a randomized controlled trial, we analyze the effects of aerobic physical exercise as an add-on strategy for treatment of severe depressed inpatients. The exercise has a “Dose” of 16.5 kcal/kg/week, three times a week during all the hospitalization.

Results

Our preliminary results show that there is no significant difference in scores of Hamilton in the second week between groups (Mean[SD] = 8.2[5.96] × 11.18[5.03], p = 0.192). However, there is a significant reduction in Hamilton scores of patients in exercise group at discharge (Mean[SD] = 5.93[4.46] × 9.45[3.56], p = 0.041). Regarding Quality of Life (QoL), no significant difference were found between groups in the second week in physical domain (Mean[SD] = 56.98[8.96] × 54.54[9.18], p = 0.511) and psychological domain (Mean[SD] = 50.88[13.88] × 42.04[12.42], p = 0.106). However, there is a significant difference in psychological domain (Mean[SD] = 55.88[9.92] v 41.66[13.04], p = 0.004) and a trend but no statistical significance in the physical (Mean[SD] = 58.80[9.14] × 52.12[8.70], p = 0.07) at discharge.

Limitations

Many patients receive different treatment strategies, like ECT (1 patient at exercise group × 3 at control group). Other limitation is the small number of participants included until this moment.

Conclusion

Our preliminary results suggest that physical exercise could be a feasible and effective add-on strategy for treatment of severe depressed inpatients, improving their depressive symptoms and QoL.     

Tryptophan hydroxylase 2 gene is associated with major depressive disorder in a female Chinese population

Background

Previous candidate gene studies of major depressive disorder (MDD) have provided inconclusive evidence of association for genes with strong biological rationale for MDD. In this study, we aimed to investigate the association of tryptophan hydroxylase 2 gene with MDD and its treatment response in the Chinese Han population.

Methods

Three hundred and sixty eight depressed patients who met DSM-IV criteria for major depressive disorder were recruited for the study. 371 normal controls were recruited from local community. Patients and normal controls were genotyped for TPH2 (rs4290270 and rs7305115) variants by polymerase chain reaction. Male and female subjects were analyzed separately.

Results

No differences were found in the frequencies of the single alleles and genotypes of the tested polymorphisms between MDD patients and normal group. The frequency of the A-A haplotype was significantly higher in female MDD compared to healthy female controls (P < 0.05). No significant association with treatment response was discovered in haplotype and single-marker analysis.

Limitations

This study lacks a placebo control and we cannot definitively exclude the possibility that some patients in the responder group responded to the placebo effect alone.

Conclusion

The result suggests that TPH2 gene may have a gender dependent effect on susceptibility to MDD but not with its treatment response in Chinese Han population. Further studies are needed to replicate the association that we observed.     

Preliminary evidence that acute long-chain omega-3 supplementation reduces cardiovascular reactivity to mental stress: a randomized and placebo controlled trial

Objective

Exaggerated cardiovascular reactivity predicts cardiovascular morbidity and mortality. Some evidence suggests that omega-3 fatty acids improve cardiovascular function. The objective of this study was to examine the influence of an acute low dose of long-chain omega-3 fatty acids on young, healthy individuals.

Methods

Participants (n = 34) were randomly assigned to either 21-days of omega-3 fatty acids (1.4 g EPA and DHA) or matched placebo. Cardiovascular measurements were obtained in the laboratory during baseline and during a standard mental arithmetic task, where participants were instructed to engage in serial subtractions by 17s from a four-digit number and cardiovascular reactivity to the task was calculated.

Results

Mean arterial pressure reactivity was significantly reduced by supplementation (F(1,32) = 5. 12, p = .03, η² = .144) but not by placebo.

Conclusion

Supplementation of omega-3 fatty acids may reduce cardiovascular reactivity to stress.