Hormone replacement therapy and stroke: the current state of knowledge and directions for future research

The Women's Health Initiative, which reported an increased risk of stroke with hormone therapy (HT), has had a major impact on the use of these drugs. The increased risk was unexpected because experimental animal studies showed estrogen reduced stroke volume and estrogen improves endothelial-dependent blood flow and improves lipid profiles in humans. The mechanisms of risk are uncertain because of the complexity of actions of estrogen in different doses, with or without progesterone, and the presence or absence of atherosclerotic risk factors. Therefore, future research should focus on identifying the mechanism(s) of risk, determining the differential impact of estrogen on stroke compared with heart disease, and identifying women with vasomotor symptoms who may be at risk of stroke with short-term HT use.     

Blinders, phenotype, and fashionable genetic analysis: a critical examination of the current state of epilepsy genetic studies

Although it is accepted that idiopathic generalized epilepsy (IGE) is strongly, if not exclusively, influenced by genetic factors, there is little consensus on what those genetic influences may be, except for one point of agreement: epilepsy is a "channelopathy." This point of agreement has continued despite the failure of studies investigating channel genes to demonstrate the primacy of their influence on IGE expression. The belief is sufficiently entrenched that the more important issues involving phenotype definition, data collection, methods of analysis, and the interpretation of results have become subordinate to it. The goal of this article is to spark discussion of where the study of epilepsy genetics has been and where it is going, suggesting we may never get there if we continue on the current road. We use the long history of psychiatric genetic studies as a mirror and starting point to illustrate that only when we expand our outlook on how to study the genetics of the epilepsies, consider other mechanisms that could lead to epilepsy susceptibility, and, especially, focus on the critical problem of phenotype definition, will the major influences on common epilepsy begin to be understood.     

Reconceptualizing emetophobia: a cognitive-behavioral formulation and research agenda

Fear of vomiting (emetophobia) is a poorly understood anxiety disorder, with little research published into its conceptualization or treatment. The current article uses established cognitive and behavioral models of other anxiety disorders as a basis from which to propose a detailed model of emetophobia. The model proposes that emetophobia results from a constellation of factors including a general anxiety-vulnerability factor, a tendency to somatize anxiety as gastrointestinal distress, a tendency to catastrophically misappraise nausea and other gastrointestinal symptoms, hypervigilance to gastrointestinal cues, beliefs about the unacceptability of vomiting, negatively reinforced avoidance behavior, and selective confirmation biases. A formulation-based treatment package for emetophobia is outlined, including arousal management skills, distraction/attention training, exposure and cognitive restructuring.     

Measuring outcomes in aphasia research: A review of current practice and an agenda for standardisation

Background: Aphasia treatment research lacks a uniform approach to outcome measurement. A wide range of outcome instruments are used across trials and there is a lack of research evidence exploring the outcomes most important to stakeholders. This lack of standardisation produces research outcomes that are difficult to compare and combine, limiting the potential to strengthen treatment evidence through meta-analysis and data pooling. The current heterogeneity in aphasia treatment research outcome measurement may be addressed through the development of a core outcome set (COS)—an agreed standardised set of outcomes for use in treatment trials.

Aims: This article aims to provide a rationale and agenda for the development of a COS for aphasia treatment research.

Main Contribution: A review of the literature reveals heterogeneity in the way outcome measurement is performed in aphasia treatment research. COSs have been developed in a wide range of health fields to introduce standardisation to research outcome measurement. Potential benefits of COSs include easier comparison and combination of research outcomes, improved quality of systematic reviews and greater transparency in research reporting. The use of broad stakeholder consultation also supports the development of research outcomes that are meaningful. It is proposed that a COS for aphasia treatment research could be developed in three stages. First, consensus-based techniques would be used to reach international agreement on the outcomes that are most important to stakeholders. Second, a systematic review and meta-analysis of outcome instruments would provide synthesised evidence to support the choice of tools to most effectively capture the effects of aphasia treatments. Third, final agreement on a COS would be sought through an international consensus conference.

Conclusions: There is an identified need for standardisation in the way outcomes are selected and measured in aphasia treatment research. COS development may provide an effective, consensus-based solution to this need.     

Current state of research funds and research facilities of the members of the Japanese Society of Child Neurology

The state of research funds and research facilities was analyzed by a questionnaire sent to members of the Council of the Japanese Society of Child Neurology. Research funds were most frequently about 5 million yen, and only 10% of the responder received 10 million yen or more. Still, many of them replied that they were satisfied with their research funds. Research funds of the Japanese Society of Child Neurology are considered to be in a critical condition. Most of the responders wanted information about research funds and a campaign to raise them organized by the Society.     

Chronic insomnia: clinical and research challenges--an agenda

Chronic insomnia afflicts up to 10% of the population in Western industrialized countries. It is characterized by delayed sleep onset, problems in maintaining sleep, early morning awakening or the feeling of non-restorative sleep coupled with significant daytime impairments on an emotional, social or professional level. It can occur as a co-morbid condition in any other medical or mental disorder, but also as a primary condition. Within the last decade new diagnostic and differential diagnostic approaches have been suggested that enhance diagnostic precision. Epidemiological data and data relating to the health care and cost situation of chronic insomnia suggest a huge burden for society. Chronic insomnia leads to a clear-cut increased risk for psychopathology (i. e., affective disorders) and probably also for cardiovascular and metabolic dysfunction. The pathophysiology of the condition is still poorly understood and will profit from integrating modern neuroscientific approaches (animal studies, molecular biology, neuroimaging, neurophysiology, etc.). Current treatment strategies are mainly based on cognitive behavioural interventions (CBT-I) and hypnotic treatment with benzodiazepine receptor agonists and sedating antidepressants. Although the effectiveness of these treatments has been clearly demonstrated, a substantial proportion of patients proves to be treatment-resistant or profits only poorly. The question of long-term pharmaceutical treatment of chronic insomnia, at least in Europe, is unresolved and urgently needs answers. Novel rational treatment avenues require clues on causes and mechanisms from integrated neuroscientific approaches. The important issues concerning insomnia treatment in the future especially in Europe will be reviewed and discussed critically.     

Randomized controlled versus naturalistic studies: a new research agenda

The present article addresses the question of what kind of evidence is required to demonstrate that a method of psychotherapy works. Referring to recent conceptualizations of the logical structure of scientific theories, that is, the structuralistic view of theories, the author shows that randomized controlled studies (RCTs) and naturalistic studies (effectiveness studies) refer to different domains of intended applications (laboratory vs. field). This view has several important implications: (1) RCTs and naturalistic studies do not differ concerning their internal and external validity; (2) naturalistic studies do not necessarily provide lower-level evidence than RCTs; (3) evidence from RCTs cannot be transferred to psychotherapeutic practice in the field; (4) naturalistic studies are required to demonstrate that a form of therapy works in the field; (5) The proposed catalogues for levels of evidence focus on RCTs; thus, they cannot be applied to the question if a therapy works in the field; (6) It is necessary to define separate criteria for levels of evidence of naturalistic studies; and (7) a new research agenda for naturalistic studies can be derived, which is analogous to that of efficacy studies. In this article, a proposal is made to define levels of evidence of naturalistic studies. A gold standard for naturalistic studies is proposed.     

Developing a research agenda for child and adolescent psychotherapy

Child and adolescent therapy has progressed considerably, as reflected in the sheer number of controlled studies, their methodological quality, and identification of empirically supported treatments. Even so, research is not likely to make significant advances, in light of the way in which treatment is studied and the emphasis on technique-focused questions. This article raises 3 questions: What are the goals of child and adolescent psychotherapy research? What type of research is needed to obtain these goals? How can we determine whether we are making progress toward the goals? This article provides a plan to advance research that (1) emphasizes understanding the mechanisms or processes through which therapeutic change occurs, (2) draws on developmental psychopathology research to inform treatment, (3) expands the range of questions that guide treatment research, and (4) elaborates multiple treatment outcomes on which to base conclusions. Recommendations are made to both develop the research agenda and to evaluate progress.     

The current state of personal assistance services: implications for policy and future research

Personal assistant services (PAS) are designed to support persons with disabilities in their routine performance of activities of daily living (ADLs) and to provide individuals with disability the opportunity to go to school, volunteer, obtain active employment, and participate in social and recreational activities. PAS are primary and essential to the realization of societal inclusion and personal freedom among persons with severe, disabling conditions. This paper reviews the personal assistance literature for persons with spinal cord injury and other disabilities. Evidence-based recommendations are made for PAS policy initiatives and future directions in PAS research.