Identity as a Determinant of the Overreporting of Church Attendance in Canada

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/91358/1/j.1468-5906.2012.01640.x.pd

Psychiatric comorbidity in multiple sclerosis : biological and epidemiological aspects

Multiple sclerosis (MS) is a chronic, neuroinflammatory disease and one of the leading reasons for neurological disability among young people in the Western World. MS patients commonly experience neuropsychiatric symptoms including depression and cognitive dysfunction. The aims of this thesis were to (study I-III) epidemiologically study the occurrence of common psychiatric diagnoses and their consequences, such as disability pension (DP) and suicide, among MS patients, and (study IV) examine the association between inflammatory biomarkers, depression and stressful events in a clinical cohort of MS patients. For studies I-III, Swedish national and clinical registers were used to identify patients with MS from the 1960s to 2012 (n=10,750- 29,617) and non-MS comparison subjects, as well as several covariates including sociodemographic data, disability pension, psychiatric diagnoses, prescriptions of psychiatric drugs, and attempted and completed suicide. Statistical analyses estimated the adjusted risks for a) having psychiatric diagnoses, b) the risk for being granted DP if having a psychiatric diagnosis, c) the prescription patterns of selective serotonin reuptake inhibitors (SSRIs), benzodiazepines and sleeping medications in the years around DP, and d) the risk for attempted and completed suicide. For study IV, 47 patients with MS in a clinical setting were assessed using self-rating scales and clinical interviews regarding symptoms and diagnosis of depression, and exposure to violence in childhood or adult life. Cerebrospinal fluid (CSF) interleukin (IL)-6 and -8 levels were analyzed and compared with results from the psychiatric ratings. In study I-III, MS patients were at higher risk for having most psychiatric diagnoses and medications compared to non-MS subjects. MS patients with psychiatric diagnoses or medications had a higher risk for DP compared to those without. MS patients with DP had a higher risk for prescription of SSRIs and benzodiazepines than non-MS subjects with DP. MS patients had a nearly doubled risk for both attempted and completed suicide. In study IV, higher IL-6 levels were associated with depressive symptoms and exposure to violence in adult life, while IL-8 levels were not associated with any investigated parameters. We conclude that MS patients are at risk for psychiatric comorbidity, with increased rates of serious consequences such as DP and attempted and completed suicide. Furthermore, DP is not associated with a decrease in psychiatric drug prescription, as in non-MS patients. Also, both depressive symptoms and exposure to violence were associated with an inflammatory biomarker in CSF in MS patients, further establishing the association between neuroinflammation, psychiatric symptoms and exposure to stress

A new view of radiation-induced cancer: integrating short- and long-term processes. Part I: Approach

Mathematical models of radiation carcinogenesis are important for understanding mechanisms and for interpreting or extrapolating risk. There are two classes of such models: (1) long-term formalisms that track pre-malignant cell numbers throughout an entire lifetime but treat initial radiation dose–response simplistically and (2) short-term formalisms that provide a detailed initial dose–response even for complicated radiation protocols, but address its modulation during the subsequent cancer latency period only indirectly. We argue that integrating short- and long-term models is needed. As an example of this novel approach, we integrate a stochastic short-term initiation/inactivation/repopulation model with a deterministic two-stage long-term model. Within this new formalism, the following assumptions are implemented: radiation initiates, promotes, or kills pre-malignant cells; a pre-malignant cell generates a clone, which, if it survives, quickly reaches a size limitation; the clone subsequently grows more slowly and can eventually generate a malignant cell; the carcinogenic potential of pre-malignant cells decreases with age

A new view of radiation-induced cancer: integrating short- and long-term processes. Part II: second cancer risk estimation

As the number of cancer survivors grows, prediction of radiotherapy-induced second cancer risks becomes increasingly important. Because the latency period for solid tumors is long, the risks of recently introduced radiotherapy protocols are not yet directly measurable. In the accompanying article, we presented a new biologically based mathematical model, which, in principle, can estimate second cancer risks for any protocol. The novelty of the model is that it integrates, into a single formalism, mechanistic analyses of pre-malignant cell dynamics on two different time scales: short-term during radiotherapy and recovery; long-term during the entire life span. Here, we apply the model to nine solid cancer types (stomach, lung, colon, rectal, pancreatic, bladder, breast, central nervous system, and thyroid) using data on radiotherapy-induced second malignancies, on Japanese atomic bomb survivors, and on background US cancer incidence. Potentially, the model can be incorporated into radiotherapy treatment planning algorithms, adding second cancer risk as an optimization criterion

Testing a Planned Missing Design to Reduce Respondent Burden in Web and SMS Administrations of the CAHPS Clinician and Group Survey (CG-CAHPS)

We test a planned missing design to reduce respondent burden in Web and SMS administrations of the CAHPS Clinician and Group Survey (CG-CAHPS), a survey of patient experiences widely used by health care providers. Members of an online nonprobability panel were randomly assigned to one of three invitation and data collection mode protocols: email invitation to a Web survey, SMS invitation to a Web survey, or SMS invitation to an SMS survey. Within these three mode protocols, respondents were randomly assigned to a planned missing design, which shortened the survey by about 40%, or to a control group that received the survey in its entirety. We compare survey duration, breakoff and completion rates, and five key patient experience measures across conditions to assess the effect of the planned missing design across the three modes. We found that a planned missing design worked well with our Web survey, reducing survey duration and breakoff without changing estimates relative to the full-survey control condition. However, mixed findings in the SMS survey suggest that even shortened, 15-item surveys may be too long to substantially reduce respondent burden. We conclude with recommendations for future research