Integrated motivational interviewing and cognitive behavioural therapy for people with psychosis and comorbid substance misuse: randomised controlled trial

Objectives To evaluate the effectiveness of integrated motivational interviewing and cognitive behaviour therapy in addition to standard care for patients with psychosis and a co-morbid substance use problem. Design Two-centre, open, rater-blind randomised controlled trial Setting UK Secondary Care Participants 327 patients with clinical diagnoses of schizophrenia, schizophreniform or schizoaffective disorder and DSM-IV diagnoses of drug and/or alcohol dependence or abuse Interventions Participants were randomly allocated to integrated motivational interviewing and cognitive behaviour therapy or standard care. Therapy has two phases. Phase one – “motivation building” – concerns engaging the patient, then exploring and resolving ambivalence for change in substance use. Phase two –“Action” – supports and facilitates change using cognitive behavioural approaches. Up to 26 therapy sessions were delivered over one year. Main outcomes The primary outcome was death from any cause or admission to hospital in the 12 months after therapy. Secondary outcomes were frequency and amount of substance use (Timeline Followback), readiness to change, perceived negative consequences of use, psychotic symptom ratings, number and duration of relapses, global assessment of functioning and deliberate self harm, at 12 and 24 months, with additional Timeline Followback assessments at 6 and 18 months. Analysis was by intention-to-treat with robust treatment effect estimates. Results 327 participants were randomised. 326 (99.7%) were assessed on the primary outcome, 246 (75.2%) on main secondary outcomes at 24 months. Regarding the primary outcome, there was no beneficial treatment effect on hospital admissions/ death during follow-up, with 20.2% (33/163) of controls and 23.3% (38/163) of the therapy group deceased or admitted (adjusted odds-ratio 1.16; P= 0.579; 95% confidence interval 0.68 to 1.99). For secondary outcomes there was no treatment effect on frequency of substance use or perceived negative consequences, but a statistically significant effect of therapy on amount used per substance-using day (adjusted odds-ratios: (a) for main substance 1.50; P=0.016; 1.08 to 2.09, (b) all substances 1.48; P=0.017; 1.07 to 2.05). There was a statistically significant treatment effect on readiness to change use at 12 months (adjusted odds-ratio 2.05; P=0.004; 1.26 to 3.31), not maintained at 24 months. There were no treatment effects on assessed clinical outcomes. Conclusions Integrated motivational interviewing and cognitive behaviour therapy for people with psychosis and substance misuse does not improve outcome in terms of hospitalisation, symptom outcomes or functioning. It does result in a reduction in amount of substance use which is maintained over the year’s follow up. Trial registration Current Controlled Trials: ISRCTN14404480

Meta-analysis to integrate effect sizes within a paper: Possible misuse and Type-1 error inflation

In recent years an increasing number of papers have employed meta-analysis to integrate effect sizes of researchers’ own series of studies within a single paper (“internal meta-analysis”). Although this approach has the obvious advantage of obtaining narrower confidence intervals, we show that it could inadvertently inflate false-positive rates if researchers are motivated to use internal meta-analysis in order to obtain a significant overall effect. Specifically, if one decides whether to stop or continue a further replication experiment depending on the significance of the results in an internal meta-analysis, false-positive rates would increase beyond the nominal level. We conducted a set of Monte-Carlo simulations to demonstrate our argument, and provided a literature review to gauge awareness and prevalence of this issue. Furthermore, we made several recommendations when using internal meta-analysis to make a judgment on statistical significance.

The imminent availability of a potent weight-loss medicine in pharmacies: public perception of effectiveness

Orlistat is an effective weight-loss medicine, which will soon be available for purchase in pharmacies. We used a factorial experiment and found that informing people about the availability for purchase of this medicinal product previously only available on prescription resulted in higher ratings of perceived value and effectiveness compared to a natural health supplement even though we used the same statement about effectiveness. This positive perception of orlistat was not impaired by the provision of side-effect information. Orlistat will soon be available in pharmacies. Health professionals must act to prevent its misuse by those not overweight.

The language of science

Some aspects of the use and misuse of scientific language are discussed, particularly in relation to quantity calculus, the names and symbols for quantities and units, and the choice of units – including the possible use of non-SI units. The discussion is intended to be constructive, and to suggest ways in which common usage can be improved.

Significance tests in climate science

A large fraction of papers in the climate literature includes erroneous uses of significance tests. A Bayesian analysis is presented to highlight the meaning of significance tests and why typical misuse occurs. The significance statistic is not a quantitative measure of how confident we can be of the ‘reality’ of a given result. It is concluded that a significance test very rarely provides useful quantitative information.

Why don’t pesticide applicators protect themselves? Exploring the use of personal protective equipment among Colombian smallholders

The misuse of personal protective equipment (PPE) during pesticide application was investigated among smallholders in Colombia. The integrative agent-centered (IAC) framework and a logistic regression approach were adopted. The results suggest that the descriptive social norm was significantly influencing PPE use. The following were also important: (1) having experienced pesticide-related health problems; (2) age; (3) the share of pesticide application carried out; and (4) the perception of PPE hindering work. Interestingly, the influence of these factors differed for different pieces of PPE. Since conformity to the social norm is a source of rigidity in the system, behavioral change may take the form of a discontinuous transition. In conclusion, five suggestions for triggering a transition towards more sustainable PPE use are formulated: (1) diversifying targets/tools; (2) addressing structural aspects; (3) sustaining interventions in the long-term; (4) targeting farmers’ learning-by-experience; and (5) targeting PPE use on a collective level.

Exploring behavioural change through an agent-oriented system dynamics model: the use of personal protective equipment among pesticide applicators in Colombia

The misuse of Personal Protective Equipment results in health risk among smallholders in developing countries, and education is often proposed to promote safer practices. However, evidence point to limited effects of education. This paper presents a System Dynamics model which allows the identification of risk-minimizing policies for behavioural change. The model is based on the IAC framework and survey data. It represents farmers' decision-making from an agent-oriented standpoint. The most successful intervention strategy was the one which intervened in the long term, targeted key stocks in the systems and was diversified. However, the results suggest that, under these conditions, no policy is able to trigger a self sustaining behavioural change. Two implementation approaches were suggested by experts. One, based on constant social control, corresponds to a change of the current model's parameters. The other, based on participation, would lead farmers to new thinking, i.e. changes in their decision-making structure.

The domestic garden: its contribution to urban green infrastructure

Domestic gardens provide a significant component of urban green infrastructure but their relative contribution to eco-system service provision remains largely un-quantified. ‘Green infrastructure’ itself is often ill-defined, posing problems for planners to ascertain what types of green infrastructure provide greatest benefit and under what circumstances. Within this context the relative merits of gardens are unclear; however, at a time of greater urbanization where private gardens are increasingly seen as a ‘luxury’, it is important to define their role precisely. Hence, the nature of this review is to interpret existing information pertaining to gardens /gardening per se, identify where they may have a unique role to play and to highlight where further research is warranted. The review suggests that there are significant differences in both form and management of domestic gardens which radically influence the benefits. Nevertheless, gardens can play a strong role in improving the environmental impact of the domestic curtilage, e.g. by insulating houses against temperature extremes they can reduce domestic energy use. Gardens also improve localized air cooling, help mitigate flooding and provide a haven for wildlife. Less favourable aspects include contributions of gardens and gardening to greenhouse gas emissions, misuse of fertilizers and pesticides, and introduction of alien plant species. Due to the close proximity to the home and hence accessibility for many, possibly the greatest benefit of the domestic garden is on human health and well-being, but further work is required to define this clearly within the wider context of green infrastructure.

An investigation of thermal comfort adaptation behaviour in office buildings in the UK

Around 40% of total energy consumption in the UK is consumed by creating comfortable indoor environment for occupants. Occupants’ behaviour in terms of achieving thermal comfort could have a significant impact on a building’s energy consumption. Therefore, understanding the interactions of occupants with their buildings would be essential to provide a thermal comfort environment that is less reliance on energy-intensive heating, ventilation and air-conditioning systems, to meet energysaving and carbon emission targets. This paper presents the findings of a year-long field study conducted in non-air-conditioned office buildings in the UK. Occupants’ adaptive responses in terms of technological and personal dimensions are dynamic processes which could vary with both indoor and outdoor thermal conditions. The adaptive behaviours of occupants in the surveyed building show substantial seasonal and daily variations. Our study shows that non-physical factors such as habit could influence the adaptive responses of occupants. However, occupants sometimes displayed inappropriate adaptive behaviour, which could lead to a misuse of energy. This paper attempts to illustrate how occupants would adapt and interact with their built environment and consequently contribute to development of a guide for future design/refurbishment of buildings and to develop energy management systems for a comfortable built environment.

Acceptable use policy and employee computer usage: case of Sri Lankan software development industry

Organizations introduce acceptable use policies to deter employee computer misuse. Despite the controlling, monitoring and other forms of interventions employed, some employees misuse the organizational computers to carry out their personal work such as sending emails, surfing internet, chatting, playing games etc. These activities not only waste productive time of employees but also bring a risk to the organization. A questionnaire was administrated to a random sample of employees selected from large and medium scale software development organizations, which measured the work computer misuse levels and the factors that influence such behavior. The presence of guidelines provided no evidence of significant effect on the level of employee computer misuse. Not having access to Internet /email away from work and organizational settings were identified to be the most significant influences of work computer misuse.

Effect of acceptable use policy on employee computer use : case of Sri Lankan software development organizations

It is a known fact that some employees misuse the organizational computers to do their personal work such as sending emails, surfing the Internet, chatting, playing games. These activities not only waste productive time of employees but also bring a risk factor to the organization. This affects organizations in the software industry very much as almost all of their employees are connected to the Internet throughout them day./ By introducing an Acceptable Use Policy (AUP) for an organization, it is believed that the computer misuse by its employees could be reduced. In many countries Acceptable Use Policies are used and they have been studied with various perspectives. In Sri Lankan context research on these areas are scarce. This research explored the situation in Sri Lanka with respect to AUPs and their effectiveness./ A descriptive study was carried out to identify the large and medium scale software development organizations that had implemented computer usage guidelines for employees. A questionnaire was used to gather information regarding employee’s usual computer usage behavior. Stratified random sampling was employed to draw a representative sample from the population./ Majority of the organizations have not employed a written guideline on acceptable use of work computers. The study results did not provide evidence to conclude that the presence or non presence of an AUP has a significant difference in computer use behaviors of employees. A significant negative correlation was observed between level of awareness about AUP and misuse. Access to the Internet and organizational settings were identified as significant factors that influence employee computer misuse behavior.