Awareness of headache and of National Headache Society activities among primary care physicians - a qualitative study

BACKGROUND Headache is one of the most common symptoms in primary care. To improve the quality of headache diagnosis and management with the largest possible benefit for the general population, headache and pain societies around the world have recently been devoting more attention to headache in primary care.The aim of the study was to investigate the potential contribution that national societies can make toward raising the awareness of primary headaches in general practice. FINDINGS In a qualitative telephone survey, targeting primary care practices (PCP), we asked about the frequency of headache patients in their practices and inquired about their treatment and referral strategies.A total of 1000 telephone interviews with PCP have been conducted. Three-hundred and fifty physicians have been directly interviewed, 95% of them see headache patients every week, 23% daily. Direct MRI referral is done by 84%. Sixty-two per cent of the physicians knew the Swiss headache society, 73% were interested in further education about headaches. CONCLUSION The survey yielded information about the physicians' awareness of the Swiss Headache Society and its activities, and about their desire for continuing education in the area of headache. National headache societies should work to improve the cooperation between headache specialists and PCP, aiming for a better care for our patients with headache.

Poor Reliability between Cochrane Reviewers and Blinded External Reviewers When Applying the Cochrane Risk of Bias Tool in Physical Therapy Trials

OBJECTIVES To test the inter-rater reliability of the RoB tool applied to Physical Therapy (PT) trials by comparing ratings from Cochrane review authors with those of blinded external reviewers. METHODS Randomized controlled trials (RCTs) in PT were identified by searching the Cochrane Database of Systematic Reviews for meta-analysis of PT interventions. RoB assessments were conducted independently by 2 reviewers blinded to the RoB ratings reported in the Cochrane reviews. Data on RoB assessments from Cochrane reviews and other characteristics of reviews and trials were extracted. Consensus assessments between the two reviewers were then compared with the RoB ratings from the Cochrane reviews. Agreement between Cochrane and blinded external reviewers was assessed using weighted kappa (κ). RESULTS In total, 109 trials included in 17 Cochrane reviews were assessed. Inter-rater reliability on the overall RoB assessment between Cochrane review authors and blinded external reviewers was poor (κ  =  0.02, 95%CI: -0.06, 0.06]). Inter-rater reliability on individual domains of the RoB tool was poor (median κ  = 0.19), ranging from κ  =  -0.04 ("Other bias") to κ  =  0.62 ("Sequence generation"). There was also no agreement (κ  =  -0.29, 95%CI: -0.81, 0.35]) in the overall RoB assessment at the meta-analysis level. CONCLUSIONS Risk of bias assessments of RCTs using the RoB tool are not consistent across different research groups. Poor agreement was not only demonstrated at the trial level but also at the meta-analysis level. Results have implications for decision making since different recommendations can be reached depending on the group analyzing the evidence. Improved guidelines to consistently apply the RoB tool and revisions to the tool for different health areas are needed.

Gynaecologists' awareness of bone healthcare in Switzerland

PRINCIPLES To assess gynaecologists' awareness of bone healthcare in women and the prevalence of application of national recommendations on bone healthcare in Switzerland. METHODS During the annual meeting of the Swiss Society of Gynaecology and Obstetrics 2012, the Swiss Association against Osteoporosis (SVGO) performed standardised interviews with conference participants (n = 210). Questions addressed responsibility for bone healthcare, and whether diagnostic procedures, initiation of bone-specific treatment and follow-up were performed in accordance with SVGO recommendations. RESULTS The majority of respondents were aged 30-50 years (60%), female (70%) and working as board-certified gynaecologists (69%). Ninety-three percent of respondents considered care for bone health as part of the gynaecologist's expertise. As diagnostic procedures, 44% recommended performing bone densitometry (DXA) only, 34% ordered additional laboratory testing. Seventy-two percent of respondents initiated a bone-specific treatment. Predictors for not performing diagnostic procedures and not initiating a bone-specific treatment were physician's age below 30, being a trainee gynaecologist, and working at a university clinic. Particularly, young trainee gynaecologists working at a university clinic were especially unlikely to initiate a bone-specific treatment (regression coefficient = -2.68; odds ratio [OR] 0.069, 95% confidence interval [CI] 0.01-0.61; p = 0.16). Follow-ups were performed by 77% of respondents, but were less likely to be by female physicians (OR 0.27, 95% CI 0.09-0.84; p = 0.024). CONCLUSIONS Although the majority of board-certified gynaecologists follow national recommendations on bone healthcare, current medical training in obstetrics and gynaecology does not sufficiently cover the subject of women's health. However, since this is a small study our findings may not reflect the findings in the total population.

Intergroup bias in third-party punishment stems from both ingroup favoritism and outgroup discrimination

Social norms pervade almost every aspect of social interaction. If they are violated, not only legal institutions, but other members of society as well, punish, i.e., inflict costs on the wrongdoer. Sanctioning occurs even when the punishers themselves were not harmed directly and even when it is costly for them. There is evidence for intergroup bias in this third-party punishment: third-parties, who share group membership with victims, punish outgroup perpetrators more harshly than ingroup perpetrators. However, it is unknown whether a discriminatory treatment of outgroup perpetrators (outgroup discrimination) or a preferential treatment of ingroup perpetrators (ingroup favoritism) drives this bias. To answer this question, the punishment of outgroup and ingroup perpetrators must be compared to a baseline, i.e., unaffiliated perpetrators. By applying a costly punishment game, we found stronger punishment of outgroup versus unaffiliated perpetrators and weaker punishment of ingroup versus unaffiliated perpetrators. This demonstrates that both ingroup favoritism and outgroup discrimination drive intergroup bias in third-party punishment of perpetrators that belong to distinct social groups.

Negative bias of processing ambiguously cued emotional stimuli.

Daily we cope with upcoming potentially disadvantageous events. Therefore, it makes sense to be prepared for the worst case. Such a 'pessimistic' bias is reflected in brain activation during emotion processing. Healthy individuals underwent functional neuroimaging while viewing emotional stimuli that were earlier cued ambiguously or unambiguously concerning their emotional valence. Presentation of ambiguously announced pleasant pictures compared with unambiguously announced pleasant pictures resulted in increased activity in the ventrolateral prefrontal, premotor and temporal cortex, and in the caudate nucleus. This was not the case for the respective negative conditions. This indicates that pleasant stimuli after ambiguous cueing provided 'unexpected' emotional input, resulting in the adaptation of brain activity. It strengthens the hypothesis of a 'pessimistic' bias of brain activation toward ambiguous emotional events.

Wahrnehmung und Interpretation von Unterrichtsstörungen aus Schülerperspektive sowie aus Sicht der Lehrpersonen.

The contribution is based on an understanding of teaching as an interaction system that encompasses all parties in the classroom. Social order in classrooms is established through mutual awareness, which includes the perception of classroom disruptions. Using qualitative data, this paper examines the extent to which students’ and teachers’ perspectives coincide with respect to both the perception of classroom disruptions and the teachers’ reaction to discipline disruptions. For this purpose, classrooms were categorized into either infrequent-disruption or frequent-disruption classrooms. The results show, firstly, a high correspondence between teachers’ and students’ perception of classroom disruptions; secondly, a self-serving bias in the teachers’ perception of their own reactions on discipline disruptions; and thirdly, a different interpretation of the term discipline disruption in infrequent- and frequent-disruption classrooms. The possibility that teachers themselves might cause classroom disruptions is discussed. In addition, the concept of classroom management is put into perspective.

Effect of standardized training on the reliability of the Cochrane risk of bias assessment tool: a study protocol

BACKGROUND The Cochrane risk of bias (RoB) tool has been widely embraced by the systematic review community, but several studies have reported that its reliability is low. We aim to investigate whether training of raters, including objective and standardized instructions on how to assess risk of bias, can improve the reliability of this tool. We describe the methods that will be used in this investigation and present an intensive standardized training package for risk of bias assessment that could be used by contributors to the Cochrane Collaboration and other reviewers. METHODS/DESIGN This is a pilot study. We will first perform a systematic literature review to identify randomized clinical trials (RCTs) that will be used for risk of bias assessment. Using the identified RCTs, we will then do a randomized experiment, where raters will be allocated to two different training schemes: minimal training and intensive standardized training. We will calculate the chance-corrected weighted Kappa with 95% confidence intervals to quantify within- and between-group Kappa agreement for each of the domains of the risk of bias tool. To calculate between-group Kappa agreement, we will use risk of bias assessments from pairs of raters after resolution of disagreements. Between-group Kappa agreement will quantify the agreement between the risk of bias assessment of raters in the training groups and the risk of bias assessment of experienced raters. To compare agreement of raters under different training conditions, we will calculate differences between Kappa values with 95% confidence intervals. DISCUSSION This study will investigate whether the reliability of the risk of bias tool can be improved by training raters using standardized instructions for risk of bias assessment. One group of inexperienced raters will receive intensive training on risk of bias assessment and the other will receive minimal training. By including a control group with minimal training, we will attempt to mimic what many review authors commonly have to do, that is-conduct risk of bias assessment in RCTs without much formal training or standardized instructions. If our results indicate that an intense standardized training does improve the reliability of the RoB tool, our study is likely to help improve the quality of risk of bias assessments, which is a central component of evidence synthesis.

Can eye movements bias memory recall?

A large body of research suggests that when we retrieve visual information from memory, we look back to the location where we encoded these objects. It has been proposed that the oculomotor trace we act out during encoding is stored in long-term memory, along other contents of the episodic representation. If memory recall triggers the eyes to revisit the location where the stimulus was encoded, is there also an effect in the reverse direction? Can eye movements trigger memory recall? In Experiment 1 participants encoded two faces at two different locations on the computer screen. Then, the average face (morph) of these two faces appeared in either of the two encoding locations and participants had to indicate whether it resembles more the first or second face. In Experiment 2 the morph appeared in a new location, but participants had to repeat one of the oculomotor traces that was used during encoding. Participants’ morph perception was influenced both by the location and the eye-movement it was presented with. Our results suggest that eye-movements can bias memory recall, but only in a short-lasting and rather fragile way.

Reactivity to Accelerometer Measurement of Children and Adolescents

PURPOSE: Awareness of being monitored can influence participants' habitual physical activity (PA) behavior. This reactivity effect may threaten the validity of PA assessment. Reports on reactivity when measuring the PA of children and adolescents have been inconsistent. The aim of this study was to investigate whether PA outcomes measured by accelerometer devices differ from measurement day to measurement day and whether the day of the week and the day on which measurement started influence these differences. METHODS: Accelerometer data (counts per minute [cpm]) of children and adolescents (n = 2081) pooled from eight studies in Switzerland with at least 10 h of daily valid recording were investigated for effects of measurement day, day of the week, and start day using mixed linear regression. RESULTS: The first measurement day was the most active day. Counts per minute were significantly higher than on the second to the sixth day, but not on the seventh day. Differences in the age-adjusted means between the first and consecutive days ranged from 23 to 45 cpm (3.6%-7.1%). In preschoolchildren, the differences almost reached 10%. The start day significantly influenced PA outcome measures. CONCLUSIONS: Reactivity to accelerometer measurement of PA is likely to be present to an extent of approximately 5% on the first day and may introduce a relevant bias to accelerometer-based studies. In preschoolchildren, the effects are larger than those in elementary and secondary schoolchildren. As the day of the week and the start day significantly influence PA estimates, researchers should plan for at least one familiarization day in school-age children and randomly assign start days.

School-age children show a bias toward fantasy classifications after playing a platform game

We investigated the influence of playing a video game on children’s ability to distinguish between fantasy and reality. School-age children played a platform game for 15 min and then performed a fantasy/reality distinction task in which they were to judge whether images (from the platform game and from other games) were fantasy images or reality images. Unlike those in the control group (who played a memory game), the children in the experimental group showed a response bias toward mistakenly classifying reality images from the video game as fantasy images (as determined by means of an analysis based on signal detection theory). We conclude that playing the video game exerted a short-term influence on children’s ability to distinguish between fantasy and reality.

Can the green economy enhance sustainable mountain development? The potential role of awareness building

Mountain socio-ecological systems produce valuable but complex ecosystem services resulting from biomes stratified by altitude and gravity. These systems are often managed and shaped by smallholders whose marginalization is exacerbated by uncertainties and a lack of policy attention. Human–environment interfaces in mountains hence require holistic policies. We analyse the potential of the Global Mountain Green Economy Agenda (GMGEA) in building awareness and thus prompting cross-sectoral policy strategies for sustainable mountain development. Considering the critique of the green economy presented at the Rio + 20 conference, we argue that the GMGEA can nevertheless structure knowledge and inform regional institutions about the complexity of mountain socio-ecological systems, a necessary pre-condition to prompt inter-agency collaboration and cross-sectoral policy formulation. After reviewing the content of the GMGEA, we draw on two empirical cases in the Pakistani and Nepali Himalayas. First, we show that lack of awareness has led to a sequence of fragmented interventions with unanticipated, and unwanted, consequences for communities. Second, using a green economy lens, we show how fragmentation could have been avoided and cross-sectoral policies yielded more beneficial results. Project fragmentation reflects disconnected or layered policies by government agencies, which inherently keep specialized agendas and have no incentive to collaborate. Awareness makes agencies more likely to collaborate and adopt cross-sectoral approaches, allowing them to target more beneficiaries, be more visible, and raise more funds. Nevertheless, we also identify four factors that may currently still limit the effect of the GMGEA: high costs of inter-agency collaboration, lack of legitimacy of the green economy, insufficiently-secured smallholder participation, and limited understanding of the mechanisms through which global agendas influence local policy.

Meta-Awareness During Day and Night: The Relationship Between Mindfulness and Lucid Dreaming

The present study explored the relationship between lucidity in dreams (awareness of dreams while dreaming) and mindfulness during wakefulness, also considering meditation as a possible moderating variable. An online survey was completed by 528 respondents, of whom 386 (73.1%) had lucid dream experiences. The reported frequency of lucid dreams was found to be positively related to higher dispositional mindfulness in wakefulness. This relationship was only present in those participants who reported acquaintance with meditation. Regarding the dimensions of mindfulness, lucid dream frequency was more strongly associated with mindful presence rather than acceptance. The findings support the notion of an existing relationship between lucidity in dreams and mindfulness during wakefulness, yet it remains unclear whether the relationship is influenced by actual meditation practice or whether it reflects some natural predispositions. Future studies should examine the role of different meditation practices, investigate personality variables that might influence the relationship, and explore how different facets of mindfulness and lucidity interrelate.

8p23 beta-defensin copy number determination by single-locus pseudogene-based paralog ratio tests risk bias due to low-frequency sequence variations.

BACKGROUND The copy number variation (CNV) in beta-defensin genes (DEFB) on human chromosome 8p23 has been proposed to contribute to the phenotypic differences in inflammatory diseases. However, determination of exact DEFB CN is a major challenge in association studies. Quantitative real-time PCR (qPCR), paralog ratio tests (PRT) and multiplex ligation-dependent probe amplification (MLPA) have been extensively used to determine DEFB CN in different laboratories, but inter-method inconsistencies were observed frequently. In this study we asked which one is superior among the three methods for DEFB CN determination. RESULTS We developed a clustering approach for MLPA and PRT to statistically correlate data from a single experiment. Then we compared qPCR, a newly designed PRT and MLPA for DEFB CN determination in 285 DNA samples. We found MLPA had the best convergence and clustering results of the raw data and the highest call rate. In addition, the concordance rates between MLPA or PRT and qPCR (32.12% and 37.99%, respectively) were unacceptably low with underestimated CN by qPCR. Concordance rate between MLPA and PRT (90.52%) was high but PRT systematically underestimated CN by one in a subset of samples. In these samples a sequence variant which caused complete PCR dropout of the respective DEFB cluster copies was found in one primer binding site of one of the targeted paralogous pseudogenes. CONCLUSION MLPA is superior to PRT and even more to qPCR for DEFB CN determination. Although the applied PRT provides in most cases reliable results, such a test is particularly sensitive to low-frequency sequence variations preferably accumulating in loci like pseudogenes which are most likely not under selective pressure. In the light of the superior performance of multiplex assays, the drawbacks of such single PRTs could be overcome by combining more test markers.