Integrating fragmented evidence by network meta-analysis: relative effectiveness of psychological interventions for adults with post-traumatic stress disorder

BACKGROUND To summarize the available evidence on the effectiveness of psychological interventions for patients with post-traumatic stress disorder (PTSD). METHOD We searched bibliographic databases and reference lists of relevant systematic reviews and meta-analyses for randomized controlled trials that compared specific psychological interventions for adults with PTSD symptoms either head-to-head or against control interventions using non-specific intervention components, or against wait-list control. Two investigators independently extracted the data and assessed trial characteristics. RESULTS The analyses included 4190 patients in 66 trials. An initial network meta-analysis showed large effect sizes (ESs) for all specific psychological interventions (ESs between -1.10 and -1.37) and moderate effects of psychological interventions that were used to control for non-specific intervention effects (ESs -0.58 and -0.62). ES differences between various types of specific psychological interventions were absent to small (ES differences between 0.00 and 0.27). Considerable between-trial heterogeneity occurred (τ 2 = 0.30). Stratified analyses revealed that trials that adhered to DSM-III/IV criteria for PTSD were associated with larger ESs. However, considerable heterogeneity remained. Heterogeneity was reduced in trials with adequate concealment of allocation and in large-sized trials. We found evidence for small-study bias. CONCLUSIONS Our findings show that patients with a formal diagnosis of PTSD and those with subclinical PTSD symptoms benefit from different psychological interventions. We did not identify any intervention that was consistently superior to other specific psychological interventions. However, the robustness of evidence varies considerably between different psychological interventions for PTSD, with most robust evidence for cognitive behavioral and exposure therapies.

Post-concussive symptoms and neuropsychological performance in the post-acute period following pediatric mild traumatic brain injury

Objective: There is evidence that children after mild traumatic brain injuries (mTBI) suffer ongoing post-concussive symptoms (PCS). However, results concerning neuropsychological outcome after mTBI are controversial. Thus, our aim was to examine group differences regarding neuropsychological outcome and PCS. Additionally, we explored the influence of current and pre-injury everyday attention problems on neuropsychological outcome in children after mTBI. Method: In a prospective short-term longitudinal study, 40 children (aged 6-16 years) after mTBI and 38 children after orthopedic injury (OI) underwent neuropsychological, socio-behavioral and PCS assessments in the acute stage and at 1 week, at 4 weeks, and 4 months after the injury. Results: Parents of children after mTBI observed significantly more PCS compared to parents of children after OI, especially in the acute stage. Our results revealed no neuropsychological or socio-behavioral differences over time between both groups. However, in children after mTBI, we found negative correlations between elevated levels of everyday attention problems and reduced neuropsychological performance. Furthermore, there was a negative influence of pre-injury everyday attention problems on neuropsychological performance in children after mTBI. Conclusion: In accordance with earlier studies, parents of children after mTBI initially observed significantly more PCS compared to parents of children after OI. There were no neuropsychological or socio-behavioral group differences between children after mTBI and OI in the post-acute period. However, our exploratory findings concerning the influence of everyday attention problems on neuropsychological outcome indicate that current and pre-injury everyday attention problems were negatively associated with neuropsychological performance in children after mTBI.

What is the best time point to identify patients at risk of developing persistent low back pain?

BACKGROUND Early identification of patients at risk of developing persistent low back pain (LBP) is crucial. OBJECTIVE Aim of this study was to identify in patients with a new episode of LBP the time point at which those at risk of developing persistent LBP can be best identified.METHODS: Prospective cohort study of 315 patients presenting to a health practitioner with a first episode of acute LBP. Primary outcome measure was functional limitation. Patients were assessed at baseline, three, six, twelve weeks and six months looking at factors of maladaptive cognition as potential predictors. Multivariate logistic regression analysis was performed for all time points. RESULTS The best time point to predict the development of persistent LBP at six months was the twelve-week follow-up (sensitivity 78%; overall predictive value 90%). Cognitions assessed at first visit to a health practitioner were not predictive. CONCLUSIONS Maladaptive cognitions at twelve weeks appear to be suitable predictors for a transition from acute to persistent LBP. Already three weeks after patients present to a health practitioner with acute LBP cognitions might influence the development of persistent LBP. Therefore, cognitive-behavioral interventions should be considered as early adjuvant LBP treatment in patients at risk of developing persistent LBP.

Evidence-supported psychosocial treatment for dual disorder patients

Results on the effectiveness of psychosocial treatments for patients with comorbid psychiatric and substance use disorders (dual disorders) will be discussed based on relevant meta-analyses and comprehensive reviews. Findings pertaining to severe (e.g., schizophrenia) and mild to moderate (e.g., anxiety disorders) dual disorders will be presented. The heterogeneity in patient characteristics, treatments, settings, and measured outcomes within the studies hinders the extraction of simple conclusions regarding how to effectively integrate psychiatric and addiction-oriented services into one psychosocial treatment. However, promising treatment strategies and interventions include integrative programs that comprise motivational interviewing; disorder-specific cognitive-behavioral interventions; substance use reduction interventions such as relapse prevention or contingency management; and/or family interventions. Such programs are generally superior to control groups (e.g., waiting list, treatment as usual) and are sometimes superior to other active treatments (e.g., skills training) in outcomes of substance use, psychiatric disorders, and social functioning.

Effects of a Transdiagnostic Internet Intervention («velibra») for Anxiety Disorders in Primary Care: Results of a Randomized Controlled Trial

Internet-based cognitive behavioral self-help treatment (ICBT) for anxiety disorders has shown promising results in several trials, but there is yet a lack of studies of ICBT in „real world” primary care settings. In this randomized controlled trial we recruited participants through general practitioners. The aim of the study was to examine whether treatment-as-usual (TAU) in primary care settings plus ICBT is superior to TAU alone in reducing anxiety symptoms and other outcome measures among individuals meeting diagnostic criteria of a least one of three anxiety disorders (social anxiety disorder, panic disorder with or without agoraphobia, generalized anxiety disorder). 150 adults fulfilling diagnostic criteria for a least one of the anxiety disorders according to a diagnostic interview are randomly assigned to one of the two conditions: TAU plus ICBT versus TAU. Randomization is stratified by primary disorder, medication (yes/no) and concurrent psychotherapy. ICBT consists of a transdiagnostic and tailored Internet-based self-help program for several anxiety disorders which also includes cognitive bias modification for interpretation (CBM-I). Primary outcomes are symptoms of disorder-specific anxiety measures and diagnostic status after the intervention (9 weeks). Secondary outcomes include primary outcomes at 3-month follow-up and secondary measures such as general symptomatology, depression, quality of life, adherence to ICBT and satisfaction with ICBT. The study is currently being completed. Primary results along with results for specific subgroups (e.g. primary diagnosis, concurrent medication and/or psychotherapy) will be presented and discussed.

[Risk factors for the oral use of antibiotics and animal treatment incidence of weaners in Switzerland].

In the present study, risk factors for the use of oral antibiotics in weaned piglets were collected on 112 pig farms by a personal questionaire. The most common indication for an antibiotic group therapy was diarrhoea, and the most frequently used antibiotic was Colistin. On average, 27.33 daily doses in the control farms and 387.21 daily doses in the problem farms per 1000 weaners were administered on a given day. The significant risk factors in the multivariate model were poor hygiene in the water supply of suckling piglets, less than two doses ofprestarter feed daily, lack of an all-in-and-all-out production system in weaners, no herd book performance data analysis, and less than two of the legally prescribed veterinary visits per year. Furthermore, the treatment incidence of weaners for oral antibiotics was calculated on the basis of the drug inventory. This study provides evidence that the use of oral antibiotics in weaners can be reduced by interventions in hygiene and management.

Evaluating alternative therapies. Support/imagery and immune function in breast cancer: A pilot study

Cancer patients increasingly request alternative therapies such as imagery techniques and support groups. Although research suggests evidence of enhanced psychosocial functioning with supportive group therapy and enhanced immune function with imagery techniques, studies are anecdotal or limited to case studies or descriptive reports. The efficacy of these alternative therapies should be validated by randomized, controlled trials and the mechanisms of action mediating immune function and outcome examined.^ In a 12-month pilot study, we evaluate the feasibility of conducting a controlled study with clinical trial methodology to test the effects of imagery/relaxation and support on quality of life, emotional well-being, and immune function for women after breast cancer. Using a randomized pre-post test design with three intervention waves, we assigned women (n = 47) to either standard care (n = 15), standard care plus 6-weekly support sessions (n = 16) or imagery/relaxation sessions (n = 16).^ The primary aim of this pilot study is to determine the feasibility of conducting a clinical trial of alternative therapies in a clinical care setting. Secondary aims are to determine parameter estimates for the effects of the two treatment groups on quality of life, coping, social support, and immune function and describe methodology issues related to trials of alternative therapies.^ The research provides direction for future studies of alternative therapies by describing the recruitment, clinical trial experience, and related methodology issues. The study extends previous work by differentiating the effects of support group from mental imagery among outpatient groups who are homogeneous regarding cancer type and treatment stage. The study provides data for future longitudinal studies of disease progression by differentiating the effectiveness of interventions designed to enhance quality of life, coping, social support, and immune function and subsequently, alter the clinical course of disease. ^

Estudio del impacto del usuario final en los procesos de desarrollo de sistemas de información

Durante décadas y aun en la actualidad muchas organizaciones, a nivel mundial, continúan afrontando pérdidas significativas debido a fracasos parciales y totales respecto a sus inversiones en sistemas de información (SI), planteando serios retos a los niveles gerenciales y los profesionales de SI. Estadísticas alarmantes y décadas de experiencia en la praxis en el área de SI en diversas organizaciones llevan al autor a poner el énfasis en los usuarios finales internos (UF) que son designados como representantes (UFR) de sus pares en los proyectos de desarrollo de SI (PDSI) por considerarlos como factores influyentes de manera significativa en el problema. Particularmente, con enfoque en ciertos factores de los UFR críticos para el éxito de los PDSI, con dimensiones analizadas de forma aislada o incompleta en otros estudios empíricos, a la fecha. No se encontraron estudios en Latinoamérica ni en otras latitudes que abordasen el fenómeno del éxito/fracaso de los SI desde el punto de vista adoptado en esta tesis. Por ello, esta investigación empírica ha evaluado en qué grado estos factores pudiesen influenciar los resultados durante el desarrollo e implementación de SI y su posible impacto en la satisfacción de los UF, siendo esta última aceptada por variados autores como la principal medida del éxito de los SI. Este estudio fue realizado en América Latina en las cuatro grandes empresas industriales que integran verticalmente el sector aluminio de Venezuela, sometidas a un macro PDSI para instalar el paquete, de tipo ERP, SAP/R3. Experimentados profesionales fueron encuestados o entrevistados, tales como altos ejecutivos, desarrolladores, líderes de proyecto y líderes de los UF. Un enfoque metodológico de triangulación permitió combinar un análisis cuantitativo con un análisis cualitativo interpretativo del tipo hermenéutico/dialéctico, hallándose resultados convergentes y complementarios. Un análisis estadístico, utilizando Partial Least Squares (PLS), seguido de un análisis hermenéutico/dialéctico. Los resultados confirmaron un hecho importante: en los casos problemáticos, paradójicamente, los orígenes de las razones de rechazo de esos SI argumentadas por los UF, en alto grado, apuntaron a los UFR o a ellos mismos. Los resultados también confirmaron la prevalencia de factores de orden cognitivo, conductual y político en estas organizaciones sobre los tecnológicos, al igual que el alto riesgo de dar por sentado la presencia y calidad de los factores requeridos de los UFR y de los otros factores estudiados. La validación estadística del modelo propuesto reveló al constructo conocimientos de los UFR como la principal variable latente, con los variables indicadoras que componen este constructo ejerciendo la mayor influencia sobre la calidad y el éxito de los SI. Un hallazgo contrario al de otros estudios, mostró que los conocimientos sobre las tecnologías de la información (TI) fueron los menos relevantes. Los SI de nómina y de administración de los RRHH fueron los más problemáticos, como suele ser el caso, por su complejidad en organizaciones grandes. Las conclusiones principales confirman el decisivo rol de los UF para el éxito de los PDSI y su relación con la creciente problemática planteada, la cual amerita más investigación y de las organizaciones una mayor atención y preparación. Descuidar los factores humanos y sociales así como una efectiva planificación y gestión de los mismos en preparación para estos proyectos origina serios riesgos. No obstante las limitaciones de este trabajo, la problemática analizada suele influir en los PDSI en diversas organizaciones, indistintamente de su tamaño o tipo de SI, estimándose, por tanto, que los resultados, conclusiones y recomendaciones de esta investigación tienen un alto grado de generalización. Una relación de indicadores claves es suministrada con fines preventivos. Finalmente, los factores evaluados pueden usarse para ampliar el modelo reconocido de DeLone y McLean (2003), conectándolos como variables latentes de sus variables independientes calidad de la información y calidad del SI. ABSTRACT For decades, many organizations worldwide have been enduring heavy losses due to partial and total failures regarding their investments in information systems (IS), posing serious challenges to all management levels and IS practitioners. Alarming statistics in this regard and decades of practice in the IS area lead the author to place an emphasis on the end users (EU) who are appointed in representation of their peers (EUR) to IS development projects (ISDP), considering them as highly influential factors on the problem. Especially, focusing on certain EUR success factors, and their dimensions, deemed critical to any IS development and implementation, omitted or not thoroughly analyzed neither in the theory nor in the empirical research on the subject, so far. No studies were found in Latin America or elsewhere addressing the phenomenon of IS success/failure from the perspective presented herein. Hence, this empirical research has assessed to what degree such factors can influence the outcomes of an ISDP and their feasible impact on the EU´s satisfaction, being the latter accepted by several authors as the main measure of IS success. This study was performed in Latin America embracing four major industrial enterprises, which vertically integrate the aluminum sector of Venezuela, subjected to a macro ISDP to install the ERP-type package SAP/R3. The field work included surveying and interviewing experienced professionals such as IS executives, IS developers, IS project leaders and end-user project leaders. A triangulation methodological approach allowed combining quantitative and interpretive analyses, obtaining convergent and complementing results. A statistical analysis, using Partial Least Squares (PLS), was carried out followed by a hermeneutical/dialectical analysis. Results confirmed a major finding: in problematic cases, paradoxically, the origins of IS rejection reasons argued by the EU, at a high degree, were usually traceable to the EUR and themselves. The results also confirmed the prevalence of cognitive, behavioral and political factors in these organizations as well as the high risk of taking for granted the presence and quality of those factors demanded from the EUR. The statistical validation of the proposed model revealed the construct EUR knowledge as the main latent variable, with its items exerting a major influence on IS quality and success. Another finding, in contradiction with that of other studies, proved knowledge of information technology (IT) aspects to be irrelevant. The payroll and the human resources administration IS were the most problematic, as is usually the case in large companies. The main conclusions confirm the EU´s decisive role for IS success and their relationship with the problem, which continues, demanding more research and, from organizations, more attention and preparation. Neglecting human and social factors in organizations as well as their effective planning and management in preparation for ISDP poses serious risks. Despite the limitations of this work, the analyzed problem tends to influence ISDP in a wide range of organizations; regardless of their size or type of IS, thus showing a high degree of generalization. Therefore it is believed that the results, conclusions and suggestions of this research have a high degree of generalization. A detailed checklist comprising key measures is provided for preventive actions. Finally, the factors evaluated can be used to expand the well-known model of DeLone & McLean (2003), by connecting them as latent variables of its independent variables information quality and IS quality.

JUVENTUDE E A ERA DA INTERNET: integração e interação

O objetivo deste trabalho é refletir sobre o processo cognitivo comportamental dos jovens, imersos em tecnologias contemporâneas como a Internet. A luz dos debates trazidos pelos pensadores das áreas de Comunicação e Psicologia Social, realizou-se uma avaliação comparativa de diferentes fontes. Através da revisão bibliográfica, passou-se a uma investigação em caráter exploratório sobre as abordagens integradas de alguns trabalhos, acerca da relação dos jovens com a Internet, o processo comunicativo, o desenvolvimento cognitivo humano e mudanças comportamentais nessa relação. Verificou-se que na maioria desses trabalhos, a Internet exerceu um papel de mecanismo facilitador para a interação entre os jovens, na identificação com seus pares, o que propiciou um diferencial no processo cognitivo, e, por fim, em sua singularização. Porém, não podemos deixar de apresentar os resultados dos demais trabalhos, pois, nos levou a ter um olhar mais cuidadoso nos background individual e social da população em questão.(AU)

JUVENTUDE E A ERA DA INTERNET: integração e interação

O objetivo deste trabalho é refletir sobre o processo cognitivo comportamental dos jovens, imersos em tecnologias contemporâneas como a Internet. A luz dos debates trazidos pelos pensadores das áreas de Comunicação e Psicologia Social, realizou-se uma avaliação comparativa de diferentes fontes. Através da revisão bibliográfica, passou-se a uma investigação em caráter exploratório sobre as abordagens integradas de alguns trabalhos, acerca da relação dos jovens com a Internet, o processo comunicativo, o desenvolvimento cognitivo humano e mudanças comportamentais nessa relação. Verificou-se que na maioria desses trabalhos, a Internet exerceu um papel de mecanismo facilitador para a interação entre os jovens, na identificação com seus pares, o que propiciou um diferencial no processo cognitivo, e, por fim, em sua singularização. Porém, não podemos deixar de apresentar os resultados dos demais trabalhos, pois, nos levou a ter um olhar mais cuidadoso nos background individual e social da população em questão.(AU)

Weight-Based Emotional Abuse: Self Psychological Implications for Treatment

The aim of this paper is to provide evidence that overweight individuals are at increased risk for emotional abuse compared to their normal weight counterparts. Studies examining weight-based discrimination and bullying demonstrate examples of emotional abuse aimed at overweight individuals. The psychological difficulties associated with emotional abuse, such as symptoms of anxiety, depression and social difficulties, are reviewed. It is hypothesized that similar psychological difficulties are experienced when obese persons experience weight based emotional abuse. A self psychological conceptualization is applied to understand the effect emotional abuse has on one's sense of self. A treatment proposal, which aims to utilize self-object transferences to strengthen the self, is offered. Future research for the application of self psychology in a group therapy format is discussed.

DUI program as OEF/OIF Veterans Outreach: Descriptive Data from Two Community-Based Outpatient Clinics

Although initially conceived as providing simply the preventive portion of an extended continuum of care for veterans, the Driving Under the Influence (DUI) program has turned out to be an important outreach service for active duty or recently discharged OEF/OIF (Operation Enduring Freedom/Operation Iraqi Freedom) veterans. Veterans receive empirically-based, state-mandated education and therapy under the only Department of Veterans Affairs (VA) - sponsored DUI program in the State of Colorado, with the advantage of having providers who are sensitive to symptoms of Post-Traumatic Stress Disorder (PTSD) and other relevant diagnoses specific to this population, including Traumatic Brain Injury (TBI). In this paper, the rapid growth of this program is described, as well as summary data regarding the completion, discontinuation, and augmentation of services from the original referral concern. Key results indicated that for nearly one third (31.9%) of the OEF/OIF veterans who were enrolled in the DUI program, this was their initial contact with the VA health care system. Furthermore, following their enrollment in the DUI program, more than one fourth (27.6%) were later referred to and attended other VA programs including PTSD rehabilitation and group therapy, anger management, and intensive inpatient or outpatient dual diagnosis programs. These and other findings from this study suggest that the DUI program may be an effective additional pathway for providing treatment that is particularly salient to the distinctive OEF/OIF population; one that may also result in earlier intervention for problem drinking and other problems related to combat. Relevant conclusions discussed herein primarily aim to improve providers' understanding of effective outreach, and to enhance the appropriate linkages between OEF/OIF veterans and existing VA services.

Mindfulness practice moderates the relationship between craving and substance use in a clinical sample

Thesis (Master's)--University of Washington, 2016-05

Long-term outcome of a school-based, universal approach to prevention of depression in adolescents

In this study. the authors examined the 2-, 3-, and 4-year outcomes of a school-based, universal approach to the prevention of adolescent depression. Despite initial short-term positive effects, these benefits were not maintained over time. Adolescents who completed the teacher-administered cognitive-behavioral intervention did not differ significantly from adolescents in the monitoring-control condition in terms of changes in depressive symptoms, problem solving, attributional style, or other indicators of psychopathology from preintervention to 4-year follow-up. Results were equivalent irrespective of initial level of depressive symptoms.