Effects of affective and anxiety disorders on outcome in problem gamblers attending routine cognitive-behavioural treatment in South Australia

This study evaluated the influence of 12-month affective and anxiety disorders on treatment outcomes for adult problem gamblers in routine cognitive–behavioural therapy. A cohort study at a state-wide gambling therapy service in South Australia. Primary outcome measure was rated by participants using victorian gambling screen (VGS) ‘harm to self’ sub-scale with validated cut score 21? (score range 0–60) indicative of problem gambling behaviour. Secondary outcome measure was Work and Social Adjustment Scale (WSAS). Independent variable was severity of affective and anxiety disorders based on Kessler 10 scale. We used propensity score adjusted random-effects models to estimate treatment outcomes for sub-populations of individuals from baseline to 12 month follow-up. Between July, 2010 and December, 2012, 380 participants were eligible for inclusion in the final analysis. Mean age was 44.1 (SD = 13.6) years and 211 (56 %) were males. At baseline, 353 (92.9 %) were diagnosed with a gambling disorder using VGS. For exposure, 175 (46 %) had a very high probability of a 12-month affective or anxiety disorder, 103 (27 %) in the high range and 102 (27 %) in the low to moderate range. For the main analysis, individuals experienced similar clinically significant reductions (improvement) in gambling related outcomes across time (p\0.001). Individuals with co-varying patterns of problem gambling and 12 month affective and anxiety disorders who present to a gambling help service for treatment in metropolitan South Australia

Experiences and perceptions of problem gamblers on cognitive and exposure therapies when taking part in a randomised controlled trial: a qualitative study

In South Australia (SA) problem gambling is mainly a result of the widespread availability of electronic gaming machines. A key treatment provider in SA offers free cognitive and behavioural therapy (CBT) to help-seeking problem gamblers. The CBT program focuses on the treatment of clients' urge to gamble using exposure therapy (ET) and cognitive therapy (CT) to restructure erroneous gambling beliefs. The aim of this study was to explore treatment specific and non-specific effects for CT alone and ET alone using qualitative interviews. Interviewees were a sub-sample of participants from a randomised trial that investigated the relative efficacy of CT versus ET. Findings revealed that all interviewees gained benefit from their respective therapies and their comments did not appear to favour one therapy over another. Both treatment specific and treatment non-specific effects were well supported as playing a therapeutic role to recovery. Participants' comments in both therapy groups suggested that symptom reduction was experienced on a gambling related urge-cognition continuum. In addition to symptom improvement from therapy-specific mechanisms, ET participants described a general acquisition of "rational thought" from their program of therapy and CT participants had "taken-over" their gambling urges. The findings also highlighted areas for further improvement including therapy drop-out.

Assessing randomised clinical trials of cognitive and exposure therapies for gambling disorders : a systematic review

Aims: Problem or pathological gambling is associated with significant disruption to the individual, family and community with a range of adverse outcomes, including legal, financial and mental health impairment. It occurs more frequently in younger populations, and comorbid conditions are common. Cognitive–behaviour therapy (CBT) is the most empirically established class of treatments for problematic gambling. This article reports on a systematic review and evaluation of randomised clinical trials (RCTs) concerning two core techniques of CBT: cognitive and behavioural (exposure-based) therapies. Methods: PsycINFO, MEDLINE and the Cochrane library were searched from database inception to December 2012. The CONsolidated Standards Of Reporting Trials (CONSORT) for non-pharmacological treatments was used to evaluate each study. Results: The initial search identified 104 references. After two screening phases, seven RCTs evaluating either cognitive (n = 3), exposure (n = 3) or both (n = 1) interventions remained. The studies were published between 1983 and 2003 and conducted across Australia, Canada, and Spain. On average, approximately 31% of CONSORT items were rated as ‘absent’ for each study and more than 52% rated as ‘present with some limitations’. For all studies, 70.83% of items rated as ‘absent’ were in the methods section. Conclusions: The findings from this review of randomised clinical trials involving cognitive and exposure-based treatments for gambling disorders show that the current evidence base is limited. Trials with low risk of bias are needed to be reported before recommendations are given on their effectiveness and clinicians can appraise their potential utility with confidence.

Increased erythrocyte eicosapentaenoic acid and docosahexaenoic acid are associated with improved attention and behavior in children with ADHD in a randomized controlled three-way crossover trial

OBJECTIVE: To investigate effects of omega-3 polyunsaturated fatty acids (n-3 PUFA) docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) on attention, literacy, and behavior in children with ADHD.

METHOD: Ninety children were randomized to consume supplements high in EPA, DHA, or linoleic acid (control) for 4 months each in a crossover design. Erythrocyte fatty acids, attention, cognition, literacy, and Conners' Parent Rating Scales (CPRS) were measured at 0, 4, 8, 12 months.

RESULTS: Fifty-three children completed the treatment. Outcome measures showed no significant differences between the three treatments. However, in children with blood samples (n = 76-46), increased erythrocyte EPA + DHA was associated with improved spelling (r = .365, p < .001) and attention (r = -.540, p < .001) and reduced oppositional behavior (r = -.301, p < .003), hyperactivity (r = -.310, p < .001), cognitive problems (r = -.326, p < .001), Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) hyperactivity (r = -.270, p = .002) and DSM-IV inattention (r = -.343, p < .001).

CONCLUSION: Increasing erythrocyte DHA and EPA via dietary supplementation may improve behavior, attention, and literacy in children with ADHD.

A NATURALISTIC COMPUTATIONAL MODEL OF HUMAN BEHAVIOR IN NAVIGATION AND SEARCH TASKS

Planning, navigation, and search are fundamental human cognitive abilities central to spatial problem solving in search and rescue, law enforcement, and military operations. Despite a wealth of literature concerning naturalistic spatial problem solving in animals, literature on naturalistic spatial problem solving in humans is comparatively lacking and generally conducted by separate camps among which there is little crosstalk. Addressing this deficiency will allow us to predict spatial decision making in operational environments, and understand the factors leading to those decisions. The present dissertation is comprised of two related efforts, (1) a set of empirical research studies intended to identify characteristics of planning, execution, and memory in naturalistic spatial problem solving tasks, and (2) a computational modeling effort to develop a model of naturalistic spatial problem solving. The results of the behavioral studies indicate that problem space hierarchical representations are linear in shape, and that human solutions are produced according to multiple optimization criteria. The Mixed Criteria Model presented in this dissertation accounts for global and local human performance in a traditional and naturalistic Traveling Salesman Problem. The results of the empirical and modeling efforts hold implications for basic and applied science in domains such as problem solving, operations research, human-computer interaction, and artificial intelligence.

Social-cognitive Antecedents of Ambidextrous Orientation in Family-owned Startups: The Role of Family Ties, Achievement Motivation, and Internal Locus of Control

Regulatory Focus Theory predicts that the motivation to self-regulate goal-directed thought and behavior depends on two distinct regulation strategies: a promotion focus based on attaining gains and a prevention focus based on avoiding losses. This study took a social-cognitive approach predicting that regulatory focus has an impact on how family startups (several family related founders) explore “new ideas”, exploit “old certainties” and achieve the balance of both (ambidexterity), compared to lone founder startups (only one founder present). It was proposed that the social context of family ties among founders leads them to a prevention focus concerned with avoiding the loss of the socio-emotional benefits of those ties. In order to avoid such a loss, family founders were expected to increase their risk perceptions and thus, explore less than lone founders, who lack such socio-emotional ties. It was also proposed that two commonly used psychological traits in entrepreneurship research --achievement motivation and internal locus of control, predispose entrepreneurs to a promotion focus. Founders with a promotion focus, in turn, were hypothesized to lead startups to more risk-seeking behaviors and to more explorative orientation. The previous argument was used as a springboard to derive hypotheses about ambidexterity (the ability to exploit and explore simultaneously) and survival hazards. Using Regulatory Focus Theory, exploitative orientation, conceptualized as the motivational strength to continue on previous paths of action, was hypothesized to be not significantly different from that of lone founder startups. Taking previous arguments together, lone founder startups were hypothesized to be more ambidextrous than family startups. Finally, ambidexterity and internal locus of control were hypothesized to reduce survival hazards in family startups. The findings suggested that family startups explore less than lone founder startups even after controlling for group effects. Interesting but contradictory findings revealed that internal locus of control have both a positive direct effect and a positive interaction that increases the explorative and ambidextrous orientation gap of family startups over lone founder startups. As expected, ambidexterity and internal locus of control reduced survival hazards on family startups. Implications for practitioners were derived based on a sample of 470 nascent entrepreneurs.

Social Capital, HIV Risk Behavior and Substance Use among Recent Latino Immigrants in South Florida

Social capital, or social cohesion or group connectedness, can influence both HIV risk behavior and substance use. Because recent immigrants undergo a change in environment, one of the consequences can be a change in social capital. There may be an association among changes in social capital, and HIV risk behavior and substance use post immigration. The dissertation focused on the interface of these three variables among recent Latino immigrants (RLIs) in South Florida. The first manuscript is a systematic review of social capital and HIV risk behavior, and served as a partial background for the second and third manuscripts. Twelve papers with a measure of social capital as an independent variable and HIV risk as the dependent variable were included in the analysis. Eleven studies measured social capital at the individual level, and one study measured social capital at the group level. HIV risk was influenced by social capital, but the type of influence was dependent on the type of social capital and on the study population. Cognitive social capital, or levels of collective action, was protective against HIV in both men and women. The role of structural social capital, or levels of civic engagement/group participation, on HIV risk was dependent on the type of structural social capital and varied by gender. Microfinance programs and functional group participation were protective for women, while dysfunctional group participation and peer-level support may have increased HIV risk among men. The second manuscript was an original study assessing changes in social capital and HIV risk behavior pre to post immigration among RLIs in South Florida (n=527). HIV risk behavior was assessed through the frequency of vaginal-penile condom use, and the number of sexual partners. It was a longitudinal study using secondary data analysis to assess changes in social capital and HIV risk behavior pre immigration to two years post immigration, and to determine if there was a relationship between the two variables. There was an 8% decrease in total social capital (p ˂ .05). Reporting of ‘Never use’ of condoms in the past 90 days increased in all subcategories (p ˂ .05). Single men had a decrease in number of sexual partners (p ˂ .05). Lower social capital measured on the dimension of ‘friend and other’ was marginally associated with fewer sexual partners. The third manuscript was another original study looking at the association between social capital and substance use among RLIs in South Florida (n=527). Substance use with measured by frequency of hazardous alcoholic drinking, and illicit drug use. It was a longitudinal study of social capital and substance-use from pre to two years post immigration. Post-immigration, social capital, hazardous drinking and illicit drug use decreased (p˂.001). After adjusting for time, compared to males, females were less likely to engage in hazardous drinking (OR=.31, p˂.001), and less likely to engage in illicit drug use (OR=.67, p=.01). Documentation status was a moderator between social capital and illicit drug use. ‘Business’ and ‘Agency’ social capital were associated with changes in illicit drug use for documented immigrants. After adjusting for gender and marital status, on average, documented immigrants with a one-unit increase in ‘business’ social capital were 1.2 times more likely to engage in illicit drug use (p˂.01), and documented immigrants with one-unit increase in ‘agency’ social capital were 38% less likely to engage in illicit drug use (p˂.01). ‘Friend and other’ social capital was associated with a decrease in illicit drug use among undocumented immigrants. After adjusting for gender and marital status, on average, undocumented immigrants with a one-unit increase in ‘friend and other’ social capital were 45% less likely to engage in hazardous drinking and 44% less likely to use illicit drugs (p˂.01, p˂.05). Studying these three domains is relevant because HIV continues to be a public health issue, particularly in Miami-Dade County, which is ranked among other U.S. regions with high rates of HIV/AIDS prevalence. Substance use is associated with HIV risk behavior; in most studies, increased substance use is associated with increased chances of HIV risk behavior. Immigration, which is the hypothesized catalyst for the change in social capital, has an impact on the dynamic of a society. Greater immigration can be burdensome on the host country’s societal resources; however immigrants are also potentially a source of additional skilled labor for the workforce. Therefore, successful adaption of immigrants can have a positive influence on receiving communities. With Florida being a major receiver of immigrants to the U.S, this dissertation attempts to address an important public health issue for South Florida and the U.S. at large.

Growing up in a bubble: using germ-free animals to assess the influence of the gut microbiota on brain and behavior

There is a growing recognition of the importance of the commensal intestinal microbiota in the development and later function of the central nervous system. Research using germ-free mice (mice raised without any exposure to microorganisms) has provided some of the most persuasive evidence for a role of these bacteria in gut-brain signalling. Key findings show that the microbiota is necessary for normal stress responsivity, anxiety-like behaviors, sociability, and cognition. Furthermore, the microbiota maintains central nervous system homeostasis by regulating immune function and blood brain barrier integrity. Studies have also found that the gut microbiota influences neurotransmitter, synaptic, and neurotrophic signalling systems and neurogenesis. The principle advantage of the germ-free mouse model is in proof-of-principle studies and that a complete microbiota or defined consortiums of bacteria can be introduced at various developmental time points. However, a germ-free upbringing can induce permanent neurodevelopmental deficits that may deem the model unsuitable for specific scientific queries that do not involve early-life microbial deficiency. As such, alternatives and complementary strategies to the germ-free model are warranted and include antibiotic treatment to create microbiota-deficient animals at distinct time points across the lifespan. Increasing our understanding of the impact of the gut microbiota on brain and behavior has the potential to inform novel management strategies for stress-related gastrointestinal and neuropsychiatric disorders.

Lost in translation? The potential psychobiotic Lactobacillus rhamnosus (JB-1) fails to modulate stress or cognitive performance in healthy male subjects

Background: Preclinical studies have identified certain probiotics as psychobiotics a live microorganisms with a potential mental health benefit. Lactobacillus rhamnosus (JB-1) has been shown to reduce stress-related behaviour, corticosterone release and alter central expression of GABA receptors in an anxious mouse strain. However, it is unclear if this single putative psychobiotic strain has psychotropic activity in humans. Consequently, we aimed to examine if these promising preclinical findings could be translated to healthy human volunteers. Objectives: To determine the impact of L. rhamnosus on stress-related behaviours, physiology, inflammatory response, cognitive performance and brain activity patterns in healthy male participants. An 8 week, randomized, placebo-controlled, cross-over design was employed. Twenty-nine healthy male volunteers participated. Participants completed self-report stress measures, cognitive assessments and resting electroencephalography (EEG). Plasma IL10, IL1β, IL6, IL8 and TNFα levels and whole blood Toll-like 4 (TLR-4) agonist-induced cytokine release were determined by multiplex ELISA. Salivary cortisol was determined by ELISA and subjective stress measures were assessed before, during and after a socially evaluated cold pressor test (SECPT). Results: There was no overall effect of probiotic treatment on measures of mood, anxiety, stress or sleep quality and no significant effect of probiotic over placebo on subjective stress measures, or the HPA response to the SECPT. Visuospatial memory performance, attention switching, rapid visual information processing, emotion recognition and associated EEG measures did not show improvement over placebo. No significant anti-inflammatory effects were seen as assessed by basal and stimulated cytokine levels. Conclusions: L. rhamnosus was not superior to placebo in modifying stress-related measures, HPA response, inflammation or cognitive performance in healthy male participants. These findings highlight the challenges associated with moving promising preclinical studies, conducted in an anxious mouse strain, to healthy human participants. Future interventional studies investigating the effect of this psychobiotic in populations with stress-related disorders are required.

Prévoir la Réussite des Étudiants en Techniques d’inhalothérapie et d’anesthésie

Abstract: Respiratory therapists must be able to care for their patients safely, efficiently and competently. They manage critically ill patients on life support systems. As a member of the anesthesia team they are responsible for the vulnerable patient undergoing surgery. Within all areas of the hospital they are called upon to make decisions and judgements concerning patient treatment. The environment that is found in the modern clinical setting is often stressful and demanding. The respiratory and anesthesia technology program has the responsibility of preparing competent practioners who graduate not only with a broad knowledge base but with the affective competencies that are required to meet these challenges. Faculty and clinical instructors in the program of Respiratory and Anesthesia Technology have been troubled by rising attrition rates and weak performance of students. It is apparent that this is not a problem unique to Vanier College. The rationale for this study was multi-fold; to establish a definition of student success, to determine whether pre-admission academic abilities can predict success in the program and whether scores on a professional behavioural aptitudes tool can predict success in the clinical year of the program. Predictors were sought that could be used either in the pre-program admission policies or during the course of study in order to ensure success throughout the program and beyond. A qualitative analysis involving clinical instructors and faculty (n=5) was carried out to explore what success signified for a student in the respiratory and anesthesia program. While this process revealed that a student who obtained a grade above 77.5% was considered “successful”, the concept surrounding success was a much more complex issue. Affective as well as cognitive and psychomotor abilities complete the model of the successful student. Appropriate behaviour and certain character traits in a respiratory therapy student are considered to be significant elements leading to success. Assessment of students in their clinical year of the respiratory & anesthesia technology program currently include little measurement of abilities in the affective domain, and the resulting grade becomes primarily a measure of academic and procedural skills. A quantitative study of preadmission records and final program grades was obtained from a single cohort of respiratory and anesthesia technology students who began the program in 2005 and graduated in 2008 (n=16). Data was collected and a descriptive analysis (analysis of variance, Pearson correlation) was used to determine the relationship between preadmission grades and success. The lack of association between the high school grades and grades in the program ran contrary to some of the findings in the literature and it can be cautiously inferred that preadmission grades do not predict success in the program. To ascertain the predictive significance of evaluating professional behavioural skills and success in clinical internship, a behaviour assessment tool was used by clinical instructors and faculty to score each student during a rotation in their third year of the program which was clinical internship. The results of this analysis showed that a moderately strong association could be made between a high score on the behavior assessment tool and final clinical grades. Therefore this tool may be effective in predicting success in the clinical year of the program. Refining the admissions process to meet the challenge and responsibility of turning out graduates who are capable of meeting the needs of the profession is difficult but essential. The capacity to predict which students possess the affective competencies necessary to cope and succeed in their clinical year is conceivably more important than their academic abilities. Although these preliminary findings contribute, to some degree, to the literature that exists concerning methods of predicting success in a respiratory and anesthesia technology program, much data is still unknown. Further quantitative and qualitative research is required using a broader population base to substantiate the findings of this small study.||Résumé: Les inhalothérapeutes doivent être capables de prodiguer des soins à leurs patients d’une manière sécuritaire, efficace et compétente. Ils/elles peuvent être appelé(e)s à gérer les soins aux personnes gravement malades branchées à un respirateur artificiel. En tant que membres de l’équipe d’anesthésie, ils/elles sont responsables des patients qui subissent une chirurgie. Ils/elles sont sollicité(e)s par tous les secteurs de l’hôpital pour décider ou juger des traitements à apporter aux malades. L’environnement dans lequel ils/elles travaillent est souvent stressant et exigeant. Le programme de Techniques d’inhalothérapie et d’anesthésie vise à former des inhalothérapeutes compétent(e)s qui possèdent non seulement les connaissances propres à la discipline mais également les aptitudes affectives nécessaires pour faire face à ces défis. Les enseignant(e)s et instructeur(e)s cliniques en Techniques d’inhalothérapie et d’anesthésie sont préoccupé(e)s par le taux d’abandon croissant et la faible performance des étudiant(e)s dans le programme. Il semble que ce problème ne soit pas unique au Collège Vanier. Le but de cette recherche est multiple : définir ce qu’est «réussir» pour les étudiant(e)s de ce programme; déterminer si les aptitudes scolaires acquises avant l’admission au programme peuvent aider à prévoir le succès des étudiant(e)s dans le programme; et si les résultats obtenus à un test mesurant les aptitudes comportementales professionnelles permettent de prévoir le succès des étudiant(e)s dans le stage clinique du programme. On a essayé d’identifier des facteurs qui pourraient être utilisés dans les politiques d’admission au programme ou celles régissant le cheminement dans le programme qui permettraient d’assurer le succès au cours du programme et par la suite. Une analyse qualitative a été conduite auprès des instructeur(e)s cliniques et des enseignant(e)s (n=5) afin d’étudier la notion de « réussite » des étudiant(e)s dans le programme. Bien qu’un(e) étudiant(e) ayant obtenu une note supérieure à 77.5% soit considéré(e) comme ayant « réussi », la notion de « réussite » est beaucoup plus complexe. Des aptitudes affectives, autant que cognitives et psychomotrices complètent le modèle d’un(e) étudiant(e) ayant réussi. Un comportement approprié et certains traits de caractère sont considérés comme des facteurs importants pour la réussite d’un(e) étudiant(e) en techniques d’inhalothérapie et d’anesthésie. L’évaluation qui se fait actuellement des étudiant(e)s dans le stage clinique du programme ne porte que peu sur les aptitudes affectives, et le résultat obtenu témoigne essentiellement des aptitudes scolaires et procédurales. Une analyse quantitative des dossiers des étudiant(e)s avant leur admission au programme et leurs notes finales a été conduite auprès d’une cohorte d’étudiant(e)s ayant commencé le programme en 2005 et gradué en 2008 (n=16). Des données ont été recueillies et une analyse descriptive (analyse de la variance, corrélation de Pearson) ont été faites afin de déterminer l’existence d’un lien entre les notes obtenues au secondaire et celles obtenues dans le programme. L’absence de corrélation entre les deux catégories de notes va à l’encontre de certaines recherches publiées et on peut déduire avec réserve que les notes obtenues avant l’admission au programme ne permettent pas de prévoir la réussite dans le programme. Afin de vérifier la portée de l’évaluation du comportement professionnel et de la réussite en milieu clinique quant à la prévision de réussite dans le programme, une méthode d’évaluation du comportement a été appliquée par les instructeurs(e) cliniques et les enseignant(e)s pour évaluer chaque étudiant(e) au cours d’une rotation dans leur troisième année de stage clinique. Les résultats de cette analyse ont démontré qu’une corrélation moyennement forte pouvait être faite entre une bonne note à l’évaluation comportementale et les notes finales du stage clinique. Perfectionner le processus d’admission au programme afin d’assumer la responsabilité de former des diplômé(e)s capables de répondre aux besoins de la profession est difficile mais essentiel. Avoir les moyens de prévoir quels/quelles étudiant(e)s ont les compétences affectives nécessaires pour faire face à la réussite de leur année de stage clinique est peut être plus important que d’avoir les aptitudes scolaires. Bien que ces observations préliminaires contribuent, à un certain degré, à la littérature existante sur les méthodes de prévoir la réussite dans le programme d’inhalothérapie et d’anesthésie, plusieurs données restent inconnues. Une recherche quantitative et qualitative plus élaborée, conduite sur un échantillon plus large de la population, est nécessaire afin de corroborer les résultats de cette étude limitée.

Ideación suicida y desesperanza en pacientes con cáncer

El objetivo de la presente investigación fue identificar la relación entre ideación suicida y desesperanza en 160 pacientes con cáncer. La ideación suicida se midió a través de dos ítems de una entrevista semiestructurada, la escala de ideación suicida (ISS), el ítem 9 del inventario de depresión de Beck (BDI-IA). La desesperanza se midió con la escala de desesperanza de Beck (BHS). Los resultados obtenidos indicaron una relación significativa (p=.000) entre ideación suicida y desesperanza; una prevalencia de ideación suicida en los pacientes con cáncer entre 4.4% y 13.8% y de riesgo de suicidio entre 5.6% y 30.6%; y algún grado de desesperanza en 31.9 % de los participantes. De acuerdo con lo anterior, se confirma que existe relación entre la desesperanza y la ideación suicida en pacientes oncológicos adultos. Adicionalmente, que estas variables están presentes en los pacientes y que ameritan atención en la intervención interdisciplinaria.

Actitudes hacia la Enfermedad del Alzheimer según el género y la edad de adultos colombianos

La enfermedad de Alzheimer (EA) es la demencia más frecuente y su prevalencia continúa en aumento tanto en Colombia como en el mundo. Esta investigación tuvo como objetivo explorar si las actitudes hacia la EA varían según la edad y género de 450 personas adultas colombianas. Se realizó un estudio exploratorio de corte transversal en el que se aplicó un cuestionario autodiligenciado. Se encontró que efectivamente hay algunas diferencias según la edad y el género en el componente cognoscitivo (creencias y conocimiento) y conductual (intención conductual y conducta) de las actitudes; y diferencias según el género en el componente afectivo. Se concluye que los conocimientos sobre la EA son escasos, que la tristeza es la emoción predominante hacia la EA y que es un tema de interés en el que predomina la idea de que afecta especialmente la memoria. Se discutieron los resultados reconociendo que esta es una aproximación inicial a las actitudes hacia la EA.