Motivational intervention to reduce cannabis use in young people with psychosis: a randomized controlled trial.

Background: Cannabis use has a negative impact on psychosis. Studies are needed to explore the efficacy of psychological interventions to reduce cannabis use in psychosis. Our aim is to study the efficacy of a specific motivational intervention on young cannabis users suffering from psychosis. Methods: Participants (aged less than 35 years) were randomly assigned to treatment as usual (TAU) alone, or treatment as usual plus motivational intervention (MI + TAU). TAU was comprehensive and included case management, early intervention and mobile team when needed. Assessments were completed at baseline and at 3, 6 and12 months follow-up. Results: Sixty-two participants (32 TAU and 30 MI + TAU) were included in the study. Cannabis use decreased in both groups at follow-up. Participants who received MI in addition to TAU displayed both a greater reduction in number of joints smoked per week and greater confidence to change cannabis use at 3 and 6 months follow-up, but differences between groups were nonsignificant at 12 months. Conclusions: MI is well accepted by patients suffering from psychosis and has a short-term impact on cannabis use when added to standard care. However, the differential effect was not maintained at 1-year follow-up. MI appears to be a useful active component to reduce cannabis use which should be integrated in routine clinical practice.

¿Y después del trabajo, qué? Más allá de la integración laboral de las personas con discapacidad = What happens after work? Going further than labour integration for disabled people

La actividad profesional es fundamental en la vida de cualquier persona y en el caso de las que padecen una discapacidad tiene una gran importancia para contribuir a configurar su identidad adulta. En este sentido, la finalidad del artículo es valorar la importancia del trabajo en los procesos de participación social y de calidad de vida de las personas con discapacidad. Por ello, en el artículo se pone de manifiesto la relación que se establece entre la dimensión laboral y la integración social de los individuos con discapacidad mediante el análisis de investigaciones desarrolladas en nuestro contexto, entre las que figuran diversos estudios realizados por nuestro grupo de investigación durante los últimos años. Con la voluntad de conocer con más detalle esta cuestión, se presenta una investigación reciente realizada por nuestro equipo. En ella desarrollamos un estudio de casos centrado en personas con discapacidad psíquica que han participado en experiencias de integración laboral en el mercado ordinario, con el objetivo de obtener información sobre la incidencia de la inserción laboral en diferentes dimensiones de la vida de los trabajadores con discapacidad. Los resultados nos permiten valorar que la experiencia genera cambios positivos, sobre todo a nivel personal (expectativas personales, potenciación del proyecto de vida, mejora de competencias…). Sin embargo, a pesar de que se aprecian mejoras en la dimensión social, el estudio plantea la necesidad de emprender acciones alternativas para potenciar la participación comunitaria de las personas implicadas en la investigación. El artículo concluye con algunas propuestas orientadas a mejorar los procesos de inserción social del colectivo

Long term retention of retigabine in a cohort of people with drug resistant epilepsy.

PURPOSE: To assess the utility of retigabine (RTG) for epilepsy in clinical practice at a single UK tertiary centre. METHODS: We identified all individuals who were offered RTG from April 2011 to May 2013. We collected demographics, seizure types, previous and current antiepileptic drugs (AEDs), starting and maximum attained daily dose of RTG, clinical benefits, side effects, and reason to discontinue RTG from in- and outpatient encounters until February 28, 2014. RESULTS: 145 people who had failed a median of 11 AEDs took at least one dose of RTG. One year retention was 32% and decreased following the safety alert by the US Federal Drug Administration (FDA) in April 2013. None became seizure free. 34 people (24%) reported a benefit that was ongoing at last assessment in five (3%). The most relevant benefit was the significant reduction or cessation of drop attacks or seizure-related falls in four women, this persisted at last assessment in two. The presence of simple partial seizures was associated with longer retention, as was a higher attained dose of RTG. Adverse effects were seen in 74% and largely CNS-related or nonspecific and affected the genitourinary system in 13%. CONCLUSION: Retention of RTG was less favourable compared to data from open label extension studies of the regulatory trials. In comparison with historical data on similar retention audits retention of RTG at one year appears to be less than lamotrigine, topiramate, levetiracetam, pregabalin, zonisamide, and lacosamide, and slightly higher than gabapentin.

Iowans with Disabilities, 2006

Demographic snapshot of Census statistics about the Iowa population with disabilities.

Iowans with Disabilities, 2008

Demographic snapshot of Census statistics about the Iowa population with disabilities.

Iowans with Disabilities, 2008

Demographic snapshot of Census statistics about the Iowa population with disabilities.

Iowans with Disabilities, 2011

Demographic snapshot of Census statistics about the Iowa population with disabilities.

Iowans with Disabilities, 2013

Demographic snapshot of Census statistics about the Iowa population with disabilities.

Iowans with Disabilities, July 2016

Demographic snapshot of Census statistics about the Iowa population with disabilities.

A Comparative Study: Service Animals and Emotional Support Animals under the Fair Housing Act and the Americans with Disabilities Act & An Overview of Assistance Animal Laws of Select States, April 18, 2010

The Americans with Disabilities Act (ADA) and the Fair Housing Act (FHA) prohibit discrimination on the basis of disability and govern the use of service or emotional support animals in places where pets may not be permitted. However, courts have been struggling with how to define and treat animals that qualify for protection under each law. This has created confusion as to what rights and duties are owed disabled persons and the animals that live with or accompany them. This essay attempts to clarify these two federal laws with regard to service or emotional support animals and the differing parties‘ rights and interests. It also includes an overview of select state laws that govern assistance animals of all types and our recommendations for enhancing the Iowa Civil Rights Act.

Prevalence and predictors of suicide attempt in an incidence cohort of 661 young people with first-episode psychosis

OBJECTIVES: Studies investigating suicidal behaviour in psychosis rarely focus on incidence cohorts of first-episode patients. This is important, because patients who refuse study participation have higher rates of comorbid substance use disorders and longer duration of untreated psychosis as well as worse course illness, variables potentially linked to higher prevalence of suicidal behaviour. The aims of the present study were therefore to examine the prevalence and predictors of suicide and suicide attempt before and during the first 18-24 months of treatment. METHOD: A retrospective file audit of 661 patients was carried out. RESULTS: Six patients (0.9%) died by suicide, 93 (14.3%) attempted suicide prior to entry, and 57 (8.7%) did so during treatment. Predictors of suicide attempt were: previous attempt (odds ratio (OR)=45.54, 95% confidence interval (CI)=9.46-219.15), sexual abuse (OR=8.46, 95%CI=1.88-38.03), comorbid polysubstance (OR=13.63, 95%CI=2.58-71.99), greater insight (OR=0.17, 95%CI=0.06-0.49), lower baseline Global Assessment of Functioning Scale and Scale of Occupational and Functional Assessment score (OR=0.96, 95%CI=0.62-0.91; OR=0.98, 95%CI=0.95-0.99), and longer time in treatment (OR=1.05, 95%CI=1.03-1.08). CONCLUSIONS: The prevalence of suicidal behaviour was high, indicating that suicidal behaviour in incidence populations is higher than in non-epidemiological cohorts of first-episode patients. The rate of repetition of suicide attempt among the sample, however, was lower than expected, suggesting that specialist services can play a role in reducing suicide risk.

Customer References as Marketing Practice in Company Web sites - Content and Discourse Analysis

Työn tarkoituksena oli tutkia sisältö- ja diskurssianalyysin avulla kuinka yritykset viestivät asiakasreferenssejä verkkosivuillaan. Työssä keskityttiin tutkimaan yritysten referenssikuvausten teemoja ja diskursseja, sekä sitä kuinka referenssisuhde rakentuu diskursiivisesti referenssikuvauksissa. Tutkimukseen valittiin kolme suomalaista ICT-alan yritystä: Nokia, TietoEnator ja F-Secure. Aineisto koostuu 140:stä yritysten WWW-sivuilta kerätystä referenssikuvauksesta. Sisältöanalyysin tuloksena havaittiin, että referenssikuvaukset keskittyvät kuvaamaan yksittäisiä tuote- tai projektitoimituksia referenssiasiakkaille kyseisten asiakassuhteiden valossa. Analyysin tuloksena tunnistettiin kolme diskurssia: hyötydiskurssi, sitoutumisen diskurssi sekä teknologisen eksperttiyden diskurssi. Diskurssit paljastavat referenssikuvausten retoriset keinot ja konstruoivat referenssisuhteen ja toimittajan subjektiposition eri näkökulmista. Pääpaino referenssikuvauksissa on toimittajan ratkaisun tuomissa hyödyissä. Diskurssit tuottavat referenssisuhteesta kuvan hyötyjä tuovana ja läheisenä asiakassuhteena, joka tarjoaa väylän ulkopuolisiin kyvykkyyksiin ja teknologioihin. Toimittaja esitetään referenssikuvauksissa diskurssista riippuen hyötyjen tuojana, luotettavana partnerina sekä kokeneena eksperttinä. Referenssiasiakas sen sijaan esitetään vain yhdestä näkökulmasta stereotyyppisesti tärkeänä ja tyytyväisenä asiakkaana.

How Accurate Are Blood (or Breath) Tests for Identifying Self-Reported Heavy Drinking Among People with Alcohol Dependence?

AIMS: Managing patients with alcohol dependence includes assessment for heavy drinking, typically by asking patients. Some recommend biomarkers to detect heavy drinking but evidence of accuracy is limited. METHODS: Among people with dependence, we assessed the performance of disialo-carbohydrate-deficient transferrin (%dCDT, ≥1.7%), gamma-glutamyltransferase (GGT, ≥66 U/l), either %dCDT or GGT positive, and breath alcohol (> 0) for identifying 3 self-reported heavy drinking levels: any heavy drinking (≥4 drinks/day or >7 drinks/week for women, ≥5 drinks/day or >14 drinks/week for men), recurrent (≥5 drinks/day on ≥5 days) and persistent heavy drinking (≥5 drinks/day on ≥7 consecutive days). Subjects (n = 402) with dependence and current heavy drinking were referred to primary care and assessed 6 months later with biomarkers and validated self-reported calendar method assessment of past 30-day alcohol use. RESULTS: The self-reported prevalence of any, recurrent and persistent heavy drinking was 54, 34 and 17%. Sensitivity of %dCDT for detecting any, recurrent and persistent self-reported heavy drinking was 41, 53 and 66%. Specificity was 96, 90 and 84%, respectively. %dCDT had higher sensitivity than GGT and breath test for each alcohol use level but was not adequately sensitive to detect heavy drinking (missing 34-59% of the cases). Either %dCDT or GGT positive improved sensitivity but not to satisfactory levels, and specificity decreased. Neither a breath test nor GGT was sufficiently sensitive (both tests missed 70-80% of cases). CONCLUSIONS: Although biomarkers may provide some useful information, their sensitivity is low the incremental value over self-report in clinical settings is questionable.

A genetic risk score combining 32 SNPs is associated with body mass index and improves obesity prediction in people with major depressive disorder.

BACKGROUND: Obesity is strongly associated with major depressive disorder (MDD) and various other diseases. Genome-wide association studies have identified multiple risk loci robustly associated with body mass index (BMI). In this study, we aimed to investigate whether a genetic risk score (GRS) combining multiple BMI risk loci might have utility in prediction of obesity in patients with MDD. METHODS: Linear and logistic regression models were conducted to predict BMI and obesity, respectively, in three independent large case-control studies of major depression (Radiant, GSK-Munich, PsyCoLaus). The analyses were first performed in the whole sample and then separately in depressed cases and controls. An unweighted GRS was calculated by summation of the number of risk alleles. A weighted GRS was calculated as the sum of risk alleles at each locus multiplied by their effect sizes. Receiver operating characteristic (ROC) analysis was used to compare the discriminatory ability of predictors of obesity. RESULTS: In the discovery phase, a total of 2,521 participants (1,895 depressed patients and 626 controls) were included from the Radiant study. Both unweighted and weighted GRS were highly associated with BMI (P <0.001) but explained only a modest amount of variance. Adding 'traditional' risk factors to GRS significantly improved the predictive ability with the area under the curve (AUC) in the ROC analysis, increasing from 0.58 to 0.66 (95% CI, 0.62-0.68; χ(2) = 27.68; P <0.0001). Although there was no formal evidence of interaction between depression status and GRS, there was further improvement in AUC in the ROC analysis when depression status was added to the model (AUC = 0.71; 95% CI, 0.68-0.73; χ(2) = 28.64; P <0.0001). We further found that the GRS accounted for more variance of BMI in depressed patients than in healthy controls. Again, GRS discriminated obesity better in depressed patients compared to healthy controls. We later replicated these analyses in two independent samples (GSK-Munich and PsyCoLaus) and found similar results. CONCLUSIONS: A GRS proved to be a highly significant predictor of obesity in people with MDD but accounted for only modest amount of variance. Nevertheless, as more risk loci are identified, combining a GRS approach with information on non-genetic risk factors could become a useful strategy in identifying MDD patients at higher risk of developing obesity.