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Validation of the Insomnia Treatment Acceptability Scale (ITAS) in primary care.

J Clin Psychol Med Settings. 2011 Sep;18(3):235-42

Authors: Healey AC, Rutledge CM, Bluestein D

Abstract
Patients with insomnia respond best to cognitive-behavioral treatments (CBT) if they find the approach acceptable. One tool, the Insomnia Treatment Acceptability Scale (ITAS), has been used to identify such patients, however, its reliability and validity has not been well established especially in primary care. The purpose of this study was to assess the reliability and validity of the ITAS in a primary care setting. A cross-sectional survey was conducted with 236 primary care patients, aged 18 and above, with clinically significant insomnia (Insomnia Severity Index ≥8). Descriptive and summary statistics, Cronbach’s alpha, Principal Axis Factor analysis with Promax rotation, and comparison of ITAS subscale scores with self-reported treatment preferences (Chi-Square) are included. Factor analysis identified two factor solutions for the ITAS subscales. The ITAS was shown to be a reliable and valid tool that can be used to facilitate psychological practice and research on interdisciplinary behavioral-medical care.

PMID: 21671011 [PubMed - indexed for MEDLINE]

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Genetic association of HLA-DQB1 and HLA-DRB1 polymorphisms with alopecia areata in the Italian population.

Br J Dermatol. 2011 Oct;165(4):823-7

Authors: Megiorni F, Pizzuti A, Mora B, Rizzuti A, Garelli V, Maxia C, Carlesimo M, Fotruna MC, Delle Chiaie R, Cavaggioni G, Rossi A

Abstract
BACKGROUND: Alopecia areata (AA) is a multifactorial disease characterized by hair loss especially from the scalp. As for other autoimmune conditions, the major histocompatibility complex (HLA) region is associated with AA susceptibility.
OBJECTIVE: To provide evidence for the association of specific HLA-DQB1 and HLA-DRB1 alleles with AA in an Italian population, using a case-control approach.
METHODS: We performed a case-control study to investigate whether HLA-DQB1 and -DRB1 alleles predispose to AA in the Italian population. HLA class II typing was performed in 85 patients with AA and 210 healthy controls from the same ethnic group.
RESULTS: An increased frequency of DQB1*03, coding for DQ7 heterodimers, and a decreased rate of the DQB1*06 allele were observed in patients when compared with controls; the greatest and significant difference was in the group of cases with a more severe phenotype [AA>50% patients (more than 50% hair loss) vs. controls, P=4·5×10(-3) , P(c)=0·031, odds ratio (OR) 2·01, 95% confidence interval (CI) 1·22-3·31 and P=2·5×10(-3) , P(c)=0·017, OR 0·22, 95% CI 0·07-0·72, respectively]. DQB1*03, serologically related to DQ8 or coding for DQ9 molecules, was not associated with AA susceptibility. Out of all patients, 65·9% carried DQ7 heterodimers compared with 49·5% of the controls (P=7·3×10(-3) , OR 1·97, 95% CI 1·17-3·32) and DQ7 prevalence rose to 76·3% in patients with AA>50% (P=1·7×10(-3) , OR 3·28, 95% CI 1·48-7·27). No significant difference was found in the distribution of DRB1 variants or phenotypes among cases and controls.
CONCLUSION: Our data show a correlation between the HLA-DQB1 locus and the occurrence of AA in Italy supporting DQB1*03(DQ7) as a predisposing allele for the disease and the relevance of the HLA genetic test in the clinical management of AA.

PMID: 21692766 [PubMed - indexed for MEDLINE]

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Imagery of errors in typing.

Cognition. 2011 Nov;121(2):163-75

Authors: Rieger M, Martinez F, Wenke D

Abstract
Using a typing task we investigated whether insufficient imagination of errors and error corrections is related to duration differences between execution and imagination. In Experiment 1 spontaneous error imagination was investigated, whereas in Experiment 2 participants were specifically instructed to imagine errors. Further, in Experiment 2 we manipulated correction instructions (whether or not to correct errors) and controlled for visual feedback in executed typing (letters appearing on the screen or not). Participants executed and imagined typing proverbs of different lengths. Errors and error corrections explained a significant amount of variance of execution minus imagination differences in Experiment 1, and in Experiment 2 when participants were instructed to correct errors, but not when participants were instructed not to correct errors. In Experiment 2 participants corrected and reported more errors with than without visual feedback. However, the relation between execution-imagination duration differences and errors and error corrections was unaffected by visual feedback. The types of errors reported less often in imagination than in execution were related to processes in typing execution. We conclude that errors and error corrections are not spontaneously imagined during motor imagery, and that even when attention is drawn to their occurrence only some are imagined. This may be due to forward models not predicting all aspects of an action, imprecise forward models, or a neglect of monitoring error signals during motor imagery.

PMID: 21821234 [PubMed - indexed for MEDLINE]

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Perinatal exposure to alcohol disturbs spatial learning and glutamate transmission-related gene expression in the adult hippocampus.

Eur J Neurosci. 2011 Aug;34(3):457-68

Authors: Zink M, Ferbert T, Frank ST, Seufert P, Gebicke-Haerter PJ, Spanagel R

Abstract
Perinatal exposure to alcohol (PEA) induces general developmental and specific neuropsychiatric disturbances accompanied by disturbed synaptic plasticity. Here we studied the long-term behavioral consequences of PEA and investigated glutamate transmission-related genes in a longitudinal fashion. After delivery, female Wistar rats and their pups were exposed to ethanol until postnatal day (PD)8 in vapor chambers. At the age of 5 months, the animals were behaviorally characterized. At both PD8 and after the behavioral testing we examined the expression of the vesicular glutamate transporter 1 and excitatory amino acid transporter (EAAT)1-4, as well as the N-methyl-D-aspartate receptor subunits (NR)1 and 2A-D, and in parallel receptor binding using (3) H-dizocilpine maleate receptor autoradiography. We found highly significant reductions of body weight and length following PEA in pups at PD8. These alterations disappeared in adulthood, when no changes of motor activity and only subtle differences of anxiety-related behavior were observed. It also did not affect T-maze learning, but had a pronounced effect on hippocampus-dependent spatial learning (Morris water maze testing). This specific learning deficit was accompanied by a dysregulation in hippocampal gene expression (significant induction of vesicular glutamate transporter 1, EAAT1, EAAT3, NR2A, 2B, 2C and 2D). Most of the examined genes turned out to be dysregulated to a higher degree at the age of 5 months. We therefore conclude that perinatal ethanol toxicity alters the plasticity of neurodevelopment and the regulation of glutamatergic gene expression, which may result in specific hippocampus-dependent learning deficits in adulthood.

PMID: 21722212 [PubMed - indexed for MEDLINE]

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Acupuncture in children and adolescents with bronchial asthma: a randomised controlled study.

Complement Ther Med. 2011 Oct;19(5):239-46

Authors: Scheewe S, Vogt L, Minakawa S, Eichmann D, Welle S, Stachow R, Banzer W

Abstract
OBJECTIVE: This randomised controlled trial evaluates the immediate effects of acupuncture as an add-on therapy in in-patient rehabilitation of children and adolescents with bronchial asthma.
PATIENTS AND METHODS: In a pre-post design, the severity of symptoms, lung function, illness-specific quality of life (Paediatric Asthma Quality of Life Questionnaire - PAQLQ) and general and asthma-specific level of anxiety (State-Trait Anxiety Inventory for Children - STAIC) were investigated in 46 acupuncture and 47 control patients. In addition to asthma sports, climate therapy and behavioural training, the intervention group received acupuncture treatment with a standardised needle pattern (12 × 30 min.).
RESULTS: With acupuncture, the peak expiratory flow variability differs significantly (p<0.01) from that of the control patients’ group. Moreover, the acupuncture group differs significantly in their rehabilitation response at the time of discharge concerning perceived anxiety (STAIC-S). The lung function tests do not present differences between groups.
CONCLUSION: After additional acupuncture, amelioration of peak expiratory flow variability and anxiety can be shown, without any difference in objective lung function tests and quality of life between study groups. Further studies might evaluate the effects of acupuncture on childhood asthma in an outpatient setting.

PMID: 21944653 [PubMed - indexed for MEDLINE]

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Is yoga effective for pain? A systematic review of randomized clinical trials.

Complement Ther Med. 2011 Oct;19(5):281-7

Authors: Posadzki P, Ernst E, Terry R, Lee MS

Abstract
OBJECTIVE: The objective of this systematic review was to assess the effectiveness of yoga as a treatment option for any type of pain.
METHOD: Seven databases were searched from their inception to February 2011. Randomized clinical trials were considered if they investigated yoga in patients with any type of pain and if they assessed pain as a primary outcome measure. The 5-point Jadad scale was used to assess methodological quality of studies. The selection of studies, data extraction and quality assessment were performed independently by two reviewers.
RESULTS: Ten randomized clinical trials (RCTs) met the inclusion criteria. Their methodological quality ranged between 1 and 4 on the Jadad scale. Nine RCTs suggested that yoga leads to a significantly greater reduction in pain than various control interventions such as standard care, self care, therapeutic exercises, relaxing yoga, touch and manipulation, or no intervention. One RCT failed to provide between group differences in pain scores.
CONCLUSIONS: It is concluded that yoga has the potential for alleviating pain. However, definitive judgments are not possible.

PMID: 21944658 [PubMed - indexed for MEDLINE]

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Gender-dependence of substituted judgment on quality of life in patients with dementia.

BMC Neurol. 2011;11:118

Authors: Schiffczyk C, Jonas C, Lahmeyer C, Müller F, Riepe MW

Abstract
BACKGROUND: Substituted judgment asks the proxy to decide what the patient would have decided, had he or she been competent. It is unclear whether substituted judgment of the patient’s quality of life can serve as a surrogate measure in patients with dementia.
METHODS: 212 patients with dementia and their proxies were interviewed in their homes. Dementia syndrome was characterized with cognitive, non-cognitive and functional scales. Quality of life (QoL) was assessed with the QoL-AD.
RESULTS: Substituted judgment of the patient’s QoL was unrelated to dementia severity but also correlated with the proxie’s own QoL (r = 0.356; p < 0.001). Gender-specific analysis reveals that for male proxies the most important variable is severity of patient’s depression (r = -0.895; p = 0.001) while for female proxies it is the proxie’s own QoL (r = 0.371; p < 0.001). Subjective burden correlates with the proxie’s QoL in females (r = -0.282; p = 0.001) but not in males (r = -0.163, p = 0.161).
CONCLUSION: Substituted judgment of the patient’s QoL does not correlate with dementia severity. Substituted judgment is subject to proxy-related variables in a gender-dependent fashion and therefore not suited to serve as an appropriate surrogate of the patients’ quality of life.

PMID: 21961477 [PubMed - indexed for MEDLINE]

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Can interfaith research partnerships develop new paradigms for condom use and HIV prevention? The implementation of conceptual events in Malawi results in a ’spiritualised condom’.

Sex Transm Infect. 2011 Dec;87(7):611-5

Authors: Willms DG, Arratia MI, Makondesa P

Abstract
OBJECTIVES: The aim of this intervention research study was to engage senior leaders of faith-based organisations (FBOs) in Malawi in a participatory process to construct an interfaith theology of HIV/AIDS. This process was designed to enhance the capacity of faith leaders to respond more effectively to the HIV/AIDS pandemic.
METHODS: An evidence-driven combination of ethnographic and participatory action research methodologies was utilised. Conceptual events-innovative participatory action research processes-were held over the 4-year project and brought together health service providers, policy makers and a non-governmental organisation in partnership with FBOs and grassroots faith-based communities.
RESULTS: Through facilitated dialogue, an interfaith theology of HIV/AIDS emerged, resulting in the proposition that a ’spiritualised condom’ endorses a ‘theology of protecting life’. This proposition was based on the following convictions: (1) life is sacred and to be protected, (2) to kill or murder is a ‘greater sin’ than the ‘lesser sin of infidelity’, (3) protection of the innocent is a moral and religious requirement, (4) condoms have the potential to prevent the death of an innocent person and (5) condoms need to be encouraged, even in the context of marriage.
CONCLUSIONS: Clinicians, non-governmental organisations, health service providers and policy makers, assisted by health social scientists, can successfully partner with FBOs and their leaders to (1) modify and transform faith-based understandings of HIV risk and (2) bring about attitudinal and behaviour changes that help to address the challenges associated with HIV/AIDS.

PMID: 21983882 [PubMed - indexed for MEDLINE]

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Does emotional support during the luteal phase decrease the stress of in vitro fertilization?

Fertil Steril. 2011 Dec;96(6):1467-72

Authors: Skiadas CC, Terry K, De Pari M, Geoghegan A, Lubetsky L, Levy S, Haimovici F, Ashby R

Abstract
OBJECTIVE: To determine if phone calls between ET and pregnancy test, decrease stress levels as determined by the Perceived Stress Scale (PSS).
DESIGN: Randomized controlled trial.
SETTING: Academic medical center.
PATIENT(S): Women undergoing a first fresh cycle of assisted reproductive technology using autologous oocytes with a day 2 or 3 ET.
INTERVENTION(S): Phone calls from specialized social workers or standard of care.
MAIN OUTCOME MEASURE(S): Primary outcome was the change in PSS score from day of ET compared with 10 days after ET; secondary outcome was perceived patient benefit.
RESULT(S): A total of 131 patients were randomized to the intervention (n = 66) or control (n = 65) group. No differences were seen in the final PSS score or the change in PSS score between groups. At the completion of the study, the intervention group was more likely to report that participating in this study was helpful (65.9% vs. 21.4%), as well as to recommend emotional support during an IVF cycle (95.4% vs. 78.6%).
CONCLUSION(S): Although we observed no significant change in PSS score, first-cycle IVF patients felt that increased emotional support was needed during the waiting period between ET and pregnancy test. Additional research should be conducted to determine the best interventions for this time period.

PMID: 22000914 [PubMed - indexed for MEDLINE]

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Coaching for behavior change in physiatry.

Am J Phys Med Rehabil. 2011 Dec;90(12):1074-82

Authors: Frates EP, Moore MA, Lopez CN, McMahon GT

Abstract
Behavior modification is vital to the prevention or amelioration of lifestyle-related disease. Health and wellness coaching is emerging as a powerful intervention to help patients initiate and maintain sustainable change that can be critical to physiatry practice. The coach approach delivers a patient-centered collaborative partnership to create an engaging and realistic individualized plan. The coaching process builds the psychologic skills needed to support lasting change, including mindfulness, self-awareness, self-motivation, resilience, optimism, and self-efficacy. Preliminary studies indicate that health and wellness coaching is a useful and potentially important adjunct to usual care for managing hyperlipidemia, diabetes, cancer pain, cancer survival, asthma, weight loss, and increasing physical activity. Physiatrists can benefit from the insights of coaching to promote effective collaboration, negotiation, and motivation to encourage patients to take responsibility for their recovery and their future wellness by adopting healthy lifestyles.

PMID: 22019966 [PubMed - indexed for MEDLINE]

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