Morning and evening behavior in children and adolescents treated with atomoxetine once daily for Attention-Deficit/Hyperactivity Disorder (ADHD): Findings from two 24-week, open-label studies

<p>Abstract</p> <p>Background</p> <p>The impact of once daily atomoxetine treatment on symptoms in children and adolescents with ADHD may vary over the day. In order to capture such variations, two studies were undertaken in children and adolescents with ADHD using two instruments that capture morning and evening behavior and ADHD-related difficulties over the day. This secondary measure analysis builds on two primary analyses that were conducted separately for children and adolescents and also published separately.</p> <p>Methods</p> <p>In two open-label studies, ADHD patients aged 6–17 years (n = 421), received atomoxetine in the morning (target-dose 0.5–1.2 mg/kg/day) for up to 24 weeks. Morning and evening behavior was assessed using the investigator-rated Weekly Rating of Evening and Morning Behavior (WREMB-R) scale. ADHD-related difficulties at various times of the day (morning, during school, during homework, evening) were assessed using the Global Impression of Perceived Difficulties (GIPD) scale, rated by patients, parents and physicians. Data from both studies were combined for this secondary measure analysis.</p> <p>Results</p> <p>Both WREMB-R subscores decreased significantly over time, the evening subscore from 13.7 (95% CI 13.2;14.2) at baseline to 8.0 (7.4;8.5) at week 2, the morning subscore from 4.3 (4.0;4.5) to 2.4 (2.2;2.6). Scores then remained stable until week 24. All GIPD items improved correspondingly. At all times of the day, patients rated ADHD-related difficulties as less severe than parents and physicians.</p> <p>Conclusion</p> <p>These findings from two open-label studies suggest that morning and evening behavior and ADHD-related difficulties in the mornings and evenings improve over time with once daily atomoxetine treatment.</p

Do tobacco regulatory and economic factors influence smoking cessation outcomes? A post-hoc analysis of the multinational EAGLES randomised controlled trial.

INTRODUCTION: We previously reported global regional differences in smoking cessation outcomes, with smokers of US origin having lower quit rates than smokers from some other countries. This post-hoc analysis examined global regional differences in individual-level and country-level epidemiological, economic and tobacco regulatory factors that may affect cessation outcomes. METHODS: EAGLES (Evaluating Adverse Events in a Global Smoking Cessation Study) was a randomised controlled trial that evaluated first-line cessation medications and placebo in 8144 smokers with and without psychiatric disorders from 16 countries across seven regions. Generalised linear and stepwise logistic regression models that considered pharmacotherapy treatment, psychiatric diagnoses, traditional individual-level predictors (eg, demographic and smoking characteristics) and country-specific smoking prevalence rates, gross domestic product (GDP) per capita, relative cigarette cost and WHO-derived MPOWER scores were used to predict 7-day point prevalence abstinence at the end of treatment. RESULTS: In addition to several traditional predictors, three of four country-level variables predicted short-term abstinence: GDP (0.54 (95% CI 0.47, 0.63)), cigarette relative income price (0.62 (95% CI 0.53, 0.72)) and MPOWER score (1.03 (95% CI 1.01, 1.06)). Quit rates varied across regions (22.0% in Australasia to 55.9% in Mexico). With northern North America (USA and Canada) as the referent, the likelihood of achieving short-term abstinence was significantly higher in Western Europe (OR 1.4 (95% CI 1.14, 1.61)), but significantly lower in Eastern Europe (0.39 (95% CI 0.22, 0.69)) and South America (0.17 (95% CI 0.08, 0.35)). CONCLUSIONS: Increased tobacco regulation was associated with enhanced quitting among participants in the EAGLES trial. Paradoxically, lower GDP, and more affordable cigarette pricing relative to a countrys GDP, were also associated with higher odds of quitting. Geographical region was also a significant independent predictor. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov, NCT01456936

Explanation and elaboration of the Standards for UNiversal reporting of patient Decision Aid Evaluations (SUNDAE) guidelines: examples of reporting SUNDAE items from patient decision aid evaluation literature

This Explanation and Elaboration (E&E) article expands on the 26 items in the Standards for UNiversal reporting of Decision Aid Evaluations (SUNDAE) guidelines. The E&E provides a rationale for each item and includes examples for how each item has been reported in published papers evaluating patient decision aids. The Explanation and Elaboration focuses on items key to reporting studies evaluating patient decision aids and is intended to be illustrative rather than restrictive. Authors and reviewers may wish to use the Explanation and Elaboration broadly to inform structuring of patient decision aid evaluation reports, or use it as a reference to obtain details about how to report individual Checklist items

A Cross-Sectional Survey of Online Health Information Seeking Behavior Pattern of Undergraduate Students in a Nigerian Private University

Given the wide-ranging influence of the internet on people in this digital age and the extensive reliance of young people on internet-enabled mobile devices, our study aimed to assess the pattern of online health information seeking behavior among undergraduate students in a Nigerian private university. Employing the cross-sectional survey design and purposive sampling technique, three hundred and four (304) undergraduates took part in the study. A semi-structured questionnaire was used to collect information on the socio-demographic characteristics, participant’s use of the internet, online health information seeking behaviour and use of online health information. The results showed that the mean age of 20.012.34 years whereby the age range of the respondents was from 15 to 29 years. Also, most of the students were active users of the internet as 94.1% used the internet daily while 83.2% used the internet for health purpose. Topmost among the reasons given for usage and non-usage of the internet for health information included convenience (74.3%) and unreliability (10.5%) respectively. Majorly (67.1%) of the respondents sought online health information using the Google search engine. Skin conditions (62.5%) and sexual/reproductive health (59.9%) were the most searched topics. Also, most (51%) used online health information as a basis for lifestyle change while only 38% consulted health professionals after obtaining online information. In conclusion, the internet has assumed a very important role in the lives of undergraduate students in Nigeria, more so in the area of seeking for health information. There is therefore an urgent need to promote information literacy tailored towards online health information among undergraduate students in particular and young people in general. There is a need for practitioners in the Nigerian health sector to take an active position in regulating and ensuring the availability of health-related information, especially that which is related to locally common health conditions

Strategies for Improving Construction Safety Performance in Developing Context

Inexperience and lack of awareness of workplace appropriate actions are the common reasons behind accidents and injuries. Researchers and industry practitioners in developed countries identified more than 12 strategies that might lead to preventing worksite injuries. However, these strategies are specific to the developed context. Developing countries still fail to identify safety strategies that might align with their safety policies and procedures. This paper aims to take the first step towards identifying the best safety strategies in the developing context. Thus, the main research question is how can companies start to implement safety strategies with consideration of their context? This study applied a mixed method to meet the objectives of the study. The Delphi method was used to obtain the needed data. The descriptive analysis shows that four important strategies are identified out of the 12 strategies: Upper Management Support, Safety and Health Committees, Record Keeping and Accident Analysis, and Job Hazard Analyses. The findings of this paper can be used by managers to make defendable decisions to start implementing safety strategies in their organizations. Also, they will illuminate the developing countries' safety culture perspective and the implementation processes

A Blended Learning Approach to Adult Advanced Cardiac Life Support Training for Healthcare Professionals

Background: In-hospital cardiac arrest is a global public health problem, accounting for up to ten events per 1,000 hospital admissions every year. Advanced life support training is used worldwide to educate healthcare professionals in how to prevent and treat cardiac arrest. Stakeholders have challenged the amount of time and associated costs needed for this vital educational intervention. Aim: To develop a new blended learning approach to advanced life support education for healthcare professionals to meet stakeholders’ needs and evaluate whether this new approach is equivalent in terms of educational outcomes compared to the conventional instructor led approach. Methods: Multi-methods were used to pilot, evaluate, improve and re-evaluate the Resuscitation Council (UK) e-ALS course. Results: This research programme consisted of five publications. Findings from a systematic review and meta-analysis (Paper 1) showed a positive association between participation of healthcare professionals in an accredited advanced life support course and improved patient outcomes. An openlabel non-inferiority randomised trial (Paper 2) was inconclusive in determining whether the e-ALS course produced educational outcomes equivalent to those of conventional instructor-led training. In parallel with this, a multi-methods study (Paper 3) concluded that participant satisfaction was mixed. These findings were used to inform the improvement of the e-ALS course. A descriptive analysis of 27,170 course participants (paper 4) showed that the revised version now demonstrated equivalent educational outcomes in comparison with the conventional course. Finally, an additional descriptive analysis (Paper 5) showed that younger participants, those with prior experience of a life support course, or those from a relevant clinical background were more likely to have a successful course outcome for e-ALS. Conclusion: Advanced life support training results in improved patient survival and a blended learning approach (e-ALS course) delivers equivalent educational outcomes to the conventional ALS course, but with half of the required face-to-face time and cost

Pharmacokinetic Profile and Palatability of Atomoxetine Oral Solution in Healthy Japanese Male Adults

BACKGROUND AND OBJECTIVES: There is a clinical need for a liquid formulation of atomoxetine. We assessed the safety and bioequivalence of an atomoxetine oral solution. METHODS: This was an open-label, randomized, crossover study. Healthy adult male Japanese subjects (n = 42) with a cytochrome P450 2D6 extensive (including intermediate and ultrarapid) metabolizer genotype were administered atomoxetine 50 mg as oral solution and capsules once each, with a washout period >5 days between doses. Blood samples were used to analyze pharmacokinetic parameters, particularly maximum observed drug concentration (C (max)) and area under the concentration vs. time curve from time zero to the last time point with a measurable concentration (AUC(0-last)). Bioequivalence was concluded if the 90 % confidence interval of the ratio of geometric means between formulations for both C (max) and AUC(0-last) were within the interval of 0.8–1.25. Safety assessments included determination of adverse events. Taste was evaluated via a five-item questionnaire immediately and 10 min after taking atomoxetine oral solution. RESULTS: Forty subjects completed the study. Plasma concentration–time profiles of atomoxetine oral solution and capsules were similar, and the statistical analysis of systemic exposure showed that the two formulations were bioequivalent. Adverse events were mild and similar in type and frequency between the formulations. For taste acceptability, only 7.1 % of subjects responded that the oral solution would be difficult to take every day. CONCLUSION: Atomoxetine oral solution is bioequivalent to atomoxetine capsules and potentially fulfills the need for an oral solution atomoxetine formulation that will facilitate treatment of children with attention-deficit hyperactivity disorder

Linking functional skills to educational goals for students with significant disabilities: a professional development series

“Linking Functional Skills to Educational Goals for Students with Significant Disabilities: A Professional Development Series” is an occupational therapist-developed multi-disciplinary professional development and mentorship series that helps special educators link educational standards to functional life skills to support improved post-school outcomes. The evidence-based and theoretically-grounded professional development series addresses the need for ongoing professional development for educators working with students with significant disabilities and in so doing also attempts to improve the long-standing poor post-school outcomes of this student population. A review of the literature indicated that overall, post-school outcomes continue to be poor for students with significant disabilities as they remain dependent upon their caregivers for daily living activities and are consistently under-employed, if employed at all. Content of the program will help educational staff integrate functional life skills into academic curriculum thereby supporting functional as well as academic outcomes using Alwell and Cobb’s (2009) five domains of life skills. Structure of the program will entail collaborative sessions using matrices that guide goal and curriculum development based on assessment protocols. Monthly job-embedded coaching and mentorship opportunities will align with recommendations in the literature. Local and national grant opportunities will fund the project and dissemination of program results will occur via local, state, and national conference opportunities. Such an occupation- and performance-based curriculum serves to develop young adults whose education truly results in participating and active members of their community, with decreased caregiver burden, as well as increased student self-concept and established and continuously emerging identities and roles

Forming Impressions on Computer-Mediated Healthcare Peer-Support Systems for Informal Caregivers

The rapid evolution of Information technology (IT) has seen its adoption during many aspects of our lives, including healthcare. Healthcare IT provides the public with access to governmental records, electronic health records, healthcare websites, internet-based medical consultation, and more recently, online peer-support portals. These peer-support portals, which are directed not only towards patients but also caregivers, have been found to be a source of informational and emotional support. In addition, for caregivers who cannot leave their loved ones to access in-person support groups, these online support portals are an important substitute. In these online peer-support portals, informal caregivers interact with one another, providing emotional and personal support, leading to a sense of camaraderie and thereby a social relationship. The contributions on these portals are voluntary, with some members contributing more often than others. The first study in this dissertation focuses on understanding the patterns of interaction between these top contributors, referred to here as peer patrons, and other informal caregivers in terms of the information they provide, and the unique characteristics of the top contributors based on these interactions. Several unique interaction patterns related to peer patrons were found along with information about how peer patrons contribute towards the coping mechanism of informal caregivers. Interface design implications based on these outcomes were discussed. With informal caregivers exchanging not only information and emotional content on online peer-support portals but also forming social relations, it is important to understand how these users form impressions of others based on the information they access. The possible consequences of following healthcare and medical advice posted on these portals further emphasize the need to understand how users form impressions of one another on these portals. The second study in this dissertation focuses on impression formation using profiles based on those of the peer patrons who were the focus of the previous study. This exploratory study brought to light the prominence of the comment content and the profile picture in forming impressions on these portals, thereby supporting literature regarding context effects on impression formation. The final chapter is an intervention-based study investigating factors leading to positive impression formation on online healthcare peer-support portals. It supported the findings from the previous study regarding the importance of comment and profile picture and suggested the use of other peer ratings to solidify impressions formed using the former two cues. Additionally, the contribution of this dissertation to the literature and the improvement of online healthcare peer-support portals is discussed

Cross-cultural evidence for the influence of positive self-evaluation on cross-cultural differences in well-being

Poster Session F - Well-Being: abstract F197We propose that cultural norms about realism and hedonism contribute to the cross-cultural differences in well-being over and above differences in objective living conditions. To test this hypothesis, we used samples from China and the United States. Results supported the mediating role of positive evaluative bias in cross-cultural differences in well-being.postprin