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[On Balint groups, the Balint movement, and care of the doctor-patient relationship]

Aten Primaria. 2005 Nov;36(8):453-555

Authors: Tizón JL

PMID: 16287559 [PubMed - indexed for MEDLINE]

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Low-income groups and behaviour change interventions: a review of intervention content, effectiveness and theoretical frameworks.

J Epidemiol Community Health. 2009 Aug;63(8):610-22

Authors: Michie S, Jochelson K, Markham WA, Bridle C

BACKGROUND: Interventions to change health-related behaviours have potential to increase health inequalities. METHODS: This review investigated the effectiveness of interventions targeting low-income groups to reduce smoking or increase physical activity and/or healthy eating. Of 9766 papers identified by the search strategy, 13 met the inclusion criteria. Intervention content was coded into component technique and theoretical basis, and examined as a potential source of effect heterogeneity. RESULTS: Interventions were heterogeneous, comprising 4-19 techniques. Nine interventions had positive effects, seven resulted in no change and one had an adverse effect. Effective interventions had a tendency to have fewer techniques than ineffective interventions, with no evidence for any technique being generally effective or ineffective. Only six studies cited theory relative to intervention development, with little information about how theory was used and no obvious association with intervention content or effect. CONCLUSION: This review shows that behaviour change interventions, particularly those with fewer techniques, can be effective in low-income groups, but highlights the lack of evidence to draw on in informing the design of interventions for disadvantaged groups.

PMID: 19386612 [PubMed - indexed for MEDLINE]

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[Effectiveness of advanced group and individual interventions in tackling tobacco dependency in primary care]

Aten Primaria. 2005 Nov;36(8):462-5

Authors: Montserrat MR

OBJECTIVES: To compare the effectiveness of group advanced intervention and individual advanced intervention for smoking management in primary health care; b) to know if in group intervention exists an added positive effect due of the group and, if this is true, to characterize it; and c) to know the advantages and inconvenients that the participants attribute to each intervention. DESIGN: Control clinic trial randomized in individual scale. SETTING: Mallorca primary health centers, Spain. PARTICIPANTS: Smokers >5 packet-year or monoxid carbon levels >15 ppm prepared for give up smoking. People younger than 18 years, people with terminal illness, and mental problems will be excluded. INTERVENTIONS: Candidates will be assigned to: a) group intervention; b) individual intervention; or c) short intervention or control group. Interventions will be done by a nurse and a general practitioner. Depth interview will be done for qualitative study. PRINCIPAL MEASUREMENT: Maintained cessation during 12 months confirmed by expired-air carbon monoxide measurement. SECONDARY MEASUREMENTS: Self-declared cessation and confirmed by expired-air carbon monoxide measurement months 1, 2, 3, 6, and 9, and tobacco reduction if there isn’t abandonment. ANALYSIS: Intention treatment. Multilevel analysis will be done to determinate the positive effect added of the group if it’s proved that exists. Content analysis for qualitative study. DISCUSSION: Randomization will prevent participants will be treated by their general practitioner o their nurse, this can mean worse results than results obtained in practice.

PMID: 16287561 [PubMed - indexed for MEDLINE]

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Complementary and alternative medicine use in patients presenting to a head and neck oncology clinic.

Head Neck. 2010 Jun;32(6):793-9

Authors: Vyas T, Hart RD, Trites JR, Philips TJ, Archibald KE, Phillips JE, Taylor SM

BACKGROUND: The aim of this study was to determine the prevalence of complementary and alternative medicine (CAM) use among patients presenting to a head and neck oncology clinic prior to a diagnosis. METHODS: The study was conducted by administering questionnaires to 102 patients after being seen in the Head and Neck Oncology clinic for their initial consultation. The questionnaire assessed the extent of CAM use, types of CAMs used, and their reasons for use. RESULTS: A total of 132 CAMs were currently being used among 56 patients. The most common CAMs in use were multivitamins (26/132) and vitamin D (21/132). Meditation and yoga were associated with the greatest perceived benefit. The majority of patients obtained their information from family and friends. Most patients were using CAMs for physical health and well-being. CONCLUSION: As CAM use among the population is widespread, it is important for clinicians to specifically address their use on initial presentation.

PMID: 19890909 [PubMed - indexed for MEDLINE]

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Multimodal therapy for painful bladder syndrome / interstitial cystitis: pilot study combining behavioral, pharmacologic, and endoscopic therapies.

Int Braz J Urol. 2009 Jul-Aug;35(4):467-74

Authors: Hanley RS, Stoffel JT, Zagha RM, Mourtzinos A, Bresette JF

Purpose: We evaluated the effectiveness of combining behavioral therapy, pharmacologic therapy and endoscopic hydrodistension for treating painful bladder syndrome / interstitial cystitis (PBS/IC). Materials and Methods: Twenty-five patients with PBS/IC were prospectively enrolled in a pilot multimodal behavioral, pharmacologic and endoscopic treatment protocol. Behavioral modification included diet recommendations, fluid restriction to 64 oz. /day, progressive timed voiding and Kegel exercises. Oral pharmacologic therapy consisted of daily doses of macrodantin 100 mg, hydroxyzine 10-20 mg and urised 4 tablets. Patients underwent endoscopic bladder hydrodistention under anesthesia at least 2 weeks after protocol enrollment. Behavioral and pharmacological treatments were continued after the hydrodistention. O’Leary-Sant questionnaire scores were recorded before starting the protocol, after pharmacologic/behavioral therapy, 2 months post-hydrodistension, and at scheduled follow-up. Results: Eighteen patients (72%) completed the pilot multimodal treatment protocol and were followed for a mean of 10.2 months. All patients were female with a median age of 36.3 years and had mean bladder capacity under anesthesia of 836 milliliters. Mean O’Leary-Sant symptom index scores for baseline symptoms, after behavioral/pharmacologic treatment, post-hydrodistension and during follow up were 12.5, 8.6, 7.0, and 6.7 (p < 0.05). Mean O’Leary-Sant problem index scores for baseline, after behavioral/pharmacologic treatment, post-hydrodistention and during follow up were 12.7, 8.9, 6.7, and 7.7 (p < 0.05). Conclusion: Our pilot multimodal protocol of behavioral modification, pharmacologic therapy and endoscopic hydrodistention demonstrated a significant progressive improvement in PBS/IC quality of life scores, compared to a pre-treatment baseline. These results should be validated in a larger, placebo controlled trial.

PMID: 19719863 [PubMed - indexed for MEDLINE]

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Effectiveness of therapeutic massage for generalized anxiety disorder: a randomized controlled trial.

Depress Anxiety. 2010 May;27(5):441-50

Authors: Sherman KJ, Ludman EJ, Cook AJ, Hawkes RJ, Roy-Byrne PP, Bentley S, Brooks MZ, Cherkin DC

BACKGROUND: Although massage is one of the most popular complementary and alternative medical (CAM) treatments for anxiety, its effectiveness has never been rigorously evaluated for a diagnosed anxiety disorder. This study evaluates the effectiveness of therapeutic massage for persons with generalized anxiety disorder (GAD). METHODS: Sixty-eight persons with GAD were randomized to therapeutic massage (n=23), thermotherapy (n=22), or relaxing room therapy (n=23) for a total of 10 sessions over 12 weeks. Mean reduction in anxiety was measured by the Hamilton Anxiety Rating Scale (HARS). Secondary outcomes included 50% reduction in HARS and symptom resolution of GAD, changes in depressive symptoms (Patient Health Questionnaire (PHQ-8)), worry and GAD-related disability. We compared changes in these outcomes in the massage and control groups posttreatment and at 6 months using generalized estimating equation (GEE) regression. RESULTS: All groups had improved by the end of treatment (adjusted mean change scores for the HARS ranged from -10.0 to -13.0; P<.001) and maintained their gains at the 26-week followup. No differences were seen between groups (P=.39). Symptom reduction and resolution of GAD, depressive symptoms, worry and disability showed similar patterns. CONCLUSIONS: Massage was not superior to the control treatments, and all showed some clinically important improvements, likely due to some beneficial but generalized relaxation response. Because the relaxing room treatment is substantially less expensive than the other treatments, a similar treatment packaged in a clinically credible manner might be the most cost effective option for persons with GAD who want to try relaxation-oriented CAM therapies.

PMID: 20186971 [PubMed - indexed for MEDLINE]

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Waitlist-controlled trial of cognitive behavior therapy for hoarding disorder.

Depress Anxiety. 2010 May;27(5):476-84

Authors: Steketee G, Frost RO, Tolin DF, Rasmussen J, Brown TA

OBJECTIVE: This study investigated a multicomponent cognitive behavioral treatment (CBT) for hoarding based on a model proposed by Frost and colleagues and manualized in Steketee and Frost (2007). METHOD: Participants with clinically significant hoarding were recruited from the community and a university-based anxiety clinic. Of the 46 patients randomly assigned to CBT or waitlist (WL), 40 completed the 12-week assessment and 36 completed 26 sessions. Treatment included education and case formulation, motivational interviewing, skills training for organizing and problem solving, direct exposure to nonacquiring and discarding, and cognitive therapy. Measures included the Saving Inventory-Revised (self-report), Hoarding Rating Scale-Interview, and measures of clinical global improvement. Between group repeated measures analyses using general linear modeling examined the effect of CBT versus WL on hoarding symptoms and moodstate after 12 weeks. Within group analyses examined pre-post effects for all CBT participants combined after 26 sessions. RESULTS: After 12 weeks, CBT participants benefited significantly more than WL patients on hoarding severity and mood with moderate effect sizes. After 26 sessions of CBT, participants showed significant reductions in hoarding symptoms with large effect sizes for most measures. At session 26, 71% of patients were considered improved on therapist clinical global improvement ratings and 81% of patients rated themselves improved; 41% of completers were clinically significantly improved. CONCLUSIONS: Multicomponent CBT was effective in treating hoarding. However, treatment refusal and compliance remain a concern, and further research with independent assessors is needed to establish treatment benefits and durability of gains.

PMID: 20336804 [PubMed - indexed for MEDLINE]

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Can enzyme kinetics of prooxidants teach us a lesson about the treatment of Alzheimer’s disease: a pilot post-mortem study.

World J Biol Psychiatry. 2010 Jun;11(4):677-81

Authors: Michel TM, Gsell W, Geuder J, Frangou S, Durany N, Kircher T, Sheldrick AJ, Tatschner T, Schneider F, Riederer P, Grünblatt E

OBJECTIVES: Oxidative stress (OS), is defined as an imbalance of pro- and antioxidants, leading to increased production of free radicals, which can lead to cell damage and death, has been postulated as important factors in the pathogenesis of neurodegenerative disorders such as Alzheimer’s disease (AD). Most research has concentrated on the antioxidant system, for the first time, this proof of concept study examines the prooxidant system by investigating kinetic parameters of the free radical producing enzyme xanthine oxidase directly in post mortem brain tissue. METHODS: We determined the Michaelis-Menten constant (K(M)) and the maximal velocity (V(Max)) of xanthine oxidase (XO) in the cortico-limbic system of patients with AD using activity assays. RESULTS: We found the Michaelis-Menton constant of XO significantly decreased in hippocampus of patients with AD compared to controls. None of the other brain regions showed any significant alterations of these parameters. CONCLUSIONS: These results add further evidence to the amount of research indicating that OS plays an important role in AD. Moreover, these results should encourage more research in this field and it maybe speculated that this might open new avenues for treatment and prevention in AD.

PMID: 20380619 [PubMed - indexed for MEDLINE]

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Caterpillar crawling over irregular terrain: anticipation and local sensing.

J Comp Physiol A Neuroethol Sens Neural Behav Physiol. 2010 Jun;196(6):397-406

Authors: van Griethuijsen LI, Trimmer BA

Animal locomotion is produced by co-coordinated patterns of motor activity that are generally organized by central pattern generators and modified by sensory feedback. Animals with remote sensing can anticipate obstacles and make adjustments in their gait to accommodate them. It is largely unknown how animals that rely on touch might use such information to adjust their gait. One possibility is immediate (reflexive) change in motor activity. Elongated animals, however, might modulate movements by passing information from anterior to posterior segments. Using the caterpillar Manduca sexta we examined the movements of the most anterior abdominal prolegs as they approached an obstacle. The first pair of prolegs anticipated the obstacle by lifting more quickly in the earliest part of the swing phase: the caterpillar had information about the obstacle at proleg lift-off. Sometimes the prolegs corrected their trajectory mid-step. Removal of sensory hairs on the stepping leg did not affect the early anticipatory movements, but did change the distance at which the mid-step corrections occurred. We conclude that anterior sensory information can be passed backwards and used to modulate an ongoing crawl. The local sensory hairs on each body segment can then fine-tune movements of the prolegs as they approach an obstacle.

PMID: 20414659 [PubMed - indexed for MEDLINE]

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Quality of psychosocial care of suicide attempters at general hospitals in Norway–a longitudinal nationwide study.

Arch Suicide Res. 2010 Apr;14(2):146-57

Authors: Mehlum L, Mork E, Reinholdt NP, Fadum EA, Rossow I

The objective of this study was to identify predictors of a high level of quality of care for suicide attempters at general hospital emergency departments in Norway. Structured interviews with key informants covering the quality of care of patients admitted following attempted suicide were conducted in 1999 and 2006 at 87% of all general hospitals. Hospitals having implemented a chain of care program for suicide attempters in 1999 maintained significantly higher levels on quality of care indicators 7 years later. Predictors of a high quality of care level were training of staff in management and care of suicide attempters and to have written guidelines for the care.

PMID: 20455150 [PubMed - indexed for MEDLINE]

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