Benzodiazepines and group transdiagnostic cognitive-behaviour therapy for anxiety disorders : a mixed methods study

Abstract : Background: Cognitive behavioural therapy (CBT) is an evidence-based treatment for anxiety disorders. Patients engaging in CBT often have an ongoing pharmacological treatment, generally antidepressants. Benzodiazepines are also commonly used, although they are recommended as short-term adjunctive treatment due to side effects. Aims: Exploring the influence of benzodiazepine use prior to group transdiagnostic CBT (tCBT) and the participants’ experience of their use before, during and after therapy. Method: Mixed methods study embedded in a randomized controlled trial of group tCBT. The experimental arm received tCBT and treatment-as-usual (TAU) (n = 117) for 12 weeks while the control arm received TAU (n = 114). Anxiety symptoms were assessed with the Beck Anxiety Inventory (BAI). Multiple linear regression analysis examined BAI pre-post differences with benzodiazepine use in the past 12 months, tCBT and their interaction. Semi-structured interviews were conducted with 13 participants reporting the use of benzodiazepines at baseline and analyzed using an interpretive descriptive method. Results: tCBT had a significant effect on anxiety symptoms change, but this effect was non- differential according to benzodiazepine use in the past 12 months. Qualitative results provided nuances about the perceived helpfulness of benzodiazepines. Participants reported that benzodiazepines facilitated the experience of sharing in group therapy and conducting exposure exercises. Despite some benefits, participants perceived that benzodiazepines may have interfered with the effectiveness of exposure exercises and the acquisition of concepts due to a sedative effect. Conclusions: Results highlight the importance of sensitizing therapists and patients to the potential effects of benzodiazepines on the experience of tCBT

Estimating the economic impact of a possible equine and human epidemic of West Nile virus infection in Belgium

This study aimed at estimating, in a prospective scenario, the potential economic impact of a possible epidemic of WNV infection in Belgium, based on 2012 values for the equine and human health sectors, in order to increase preparedness and help decision-makers. Modelling of risk areas, based on the habitat suitable for Culex pipiens, the main vector of the virus, allowed us to determine equine and human populations at risk. Characteristics of the different clinical forms of the disease based on past epidemics in Europe allowed morbidity among horses and humans to be estimated. The main costs for the equine sector were vaccination and replacement value of dead or euthanised horses. The choice of the vaccination strategy would have important consequences in terms of cost. Vaccination of the country's whole population of horses, based on a worst-case scenario, would cost more than EUR 30 million; for areas at risk, the cost would be around EUR 16–17 million. Regarding the impact on human health, short-term costs and socio-economic losses were estimated for patients who developed the neuroinvasive form of the disease, as no vaccine is available yet for humans. Hospital charges of around EUR 3,600 for a case of West Nile neuroinvasive disease and EUR 4,500 for a case of acute flaccid paralysis would be the major financial consequence of an epidemic of West Nile virus infection in humans in Belgium. (Résumé d'auteur

Assessing medical student knowledge and attitudes about shared decision making across the curriculum: protocol for an international online survey and stakeholder analysis

Introduction: Shared decision making (SDM) is a goal of modern medicine; however, it is not currently embedded in routine care. Barriers include clinicians’ attitudes, lack of knowledge and training and time constraints. Our goal is to support the development and delivery of a robust SDM curriculum in medical education. Our objective is to assess undergraduate medical students’ knowledge of and attitudes towards SDM in four countries. Methods and analysis: The first phase of the study involves a web-based cross-sectional survey of undergraduate medical students from all years in selected schools across the United States (US), Canada and undergraduate and graduate students in the Netherlands. In the United Kingdom (UK), the survey will be circulated to all medical schools through the UK Medical School Council. We will sample students equally in all years of training and assess attitudes towards SDM, knowledge of SDM and participation in related training. Medical students of ages 18 years and older in the four countries will be eligible. The second phase of the study will involve semistructured interviews with a subset of students from phase 1 and a convenience sample of medical school curriculum experts or stakeholders. Data will be analysed using multivariable analysis in phase 1 and thematic content analysis in phase 2. Method, data source and investigator triangulation will be performed. Online survey data will be reported according to the Checklist for Reporting the Results of Internet E-Surveys. We will use the COnsolidated criteria for REporting Qualitative research for all qualitative data. Ethics and dissemination: The study has been approved for dissemination in the US, the Netherlands, Canada and the UK. The study is voluntary with an informed consent process. The results will be published in a peer-reviewed journal and will help inform the inclusion of SDM-specific curriculum in medical education worldwide

Qualification sanitaire des troupeaux, représentations du risque selon les acteurs et les disciplines

La qualification sanitaire vise à établir de manière objective et fiable le statut sanitaire d'un animal ou d'un ensemble d'animaux au regard d'une maladie infectieuse. Concevoir une qualification sanitaire repose sur des connaissances biologiques concernant l'agent pathogène, ses voies de transmission et les moyens de détection de la maladie. Les modèles mathématiques et les outils statistiques et probabilistes permettent d'intégrer ces connaissances tout en prenant en compte l'incertitude et la variabilité des données biologiques. Les sciences humaines apportent un éclairage sur les enjeux, les perceptions et les logiques des individus et des collectifs, afin d'étudier la demande et l'acceptabilité de la qualification sanitaire. Chaque discipline apporte ainsi son point de vue sur la notion de risque sous-jacente à la démarche de qualification. Cette approche interdisciplinaire nécessite une coconstruction de la recherche, qui doit dépasser les différences culturelles et épistémologiques entre disciplines. Elle n'obéit pas à un seul type de rationalité, scientifique ou juridico-administrative ; elle mobilise nécessairement des connaissances savantes et des savoirs empiriques et dépend de nombreuses décisions pouvant engendrer convergences ou contradictions. (Résumé d'auteur

Medical students’ knowledge and attitudes towards shared decision-making: results from a multinational cross-sectional survey

Introduction: We aimed to conduct a multinational cross-sectional online survey of medical students' attitudes towards, knowledge of, and experience with shared decision-making (SDM). Methods: We conducted the survey from September 2016 until May 2017 using: 1) a convenience sample of students from four medical schools each in Canada, the US, and the Netherlands (n=12), and 2) all medical schools in the UK through the British Medical School Council (n=32). We also distributed the survey through social media. Results: 765 students read the information sheet and 619 completed the survey. Average age was 24, 69% were female. Mean SDM knowledge score was 83.6% (range:18.8%-100%; 95% CI 82.8%-84.5%). US students had the highest knowledge scores (86.2%, 95% CI 84.8%-87.6%). The mean risk communication score was 57.4% (range: 0%-100%; 95% CI 57.4%-60.1%). Knowledge did not vary with age, race, gender, school, or school year. Attitudes were positive, except 46% believed SDM could only be done with higher educated patients and 80.9% disagreed that physician payment should be linked to SDM performance (increased with years in training, p<.05). Attitudes did not vary due to any tested variable. Students indicated they were more likely than experienced clinicians to practice SDM (72.1% vs. 48.8%). 74.7% reported prior SDM training and 82.8% were interested in learning more about SDM. Discussion: SDM knowledge is high among medical students in all four countries. Risk communication is less well-understood. Attitudes indicate that further research is needed to understand how medical schools deliver and integrate SDM training into existing curricula

Spin Observables in Antilambda-Lambda Production from Antiproton-Proton Annihilation with a Transverse Inital State Polarization

The formalism describing the scattering of two spin-1/2 objects is reviewed for the case of antilambda-lambda production from antiproton-proton annihilation. It is shown that an experiment utilizing a transverse target polarization can, in principle, completely determine the spin structure of the reaction. Additional measurements, even those using both beam and target polarizations, would not be sensitive to any additional spin dynamics. Thus, the transverse target polarization allows access to the complete set of spin observables, not just the subset upon which the literature has previously focused. This discussion is especially relevant in light of the data collected by PS185/3 at LEAR.Comment: 7 pages, no figure

Sensibilité à la récompense et à la punition chez les individus à risque de dépendance aux drogues et à l’alcool

Affiche présentée dans le cadre du colloque de l'ARC «Favoriser l’accès et le partage par la création d’un observatoire» lors du 86e Congrès de l'Acfas à l' Université du Québec à Chicoutimi (UQAC), les 7 et 8 mai 2018.Une minorité de consommateurs de drogues et d’alcool développe un trouble d’utilisation de substances (TUS). Les jeunes dont le niveau de comportements externalisés (EXT) est supérieur sont à risque plus élevé de TUS. Cette étude examine si les individus aux traits EXT élevés (eEXT), comparés à des EXT faibles (fEXT), ont une sensibilité altérée aux récompenses et punitions – par exemple, des évaluations sociales positives. Un total de 72 jeunes adultes (18-20 ans) suivis depuis la naissance ont été catégorisés comme fEXT (n=37) ou eEXT (n=35) selon leurs données (11-16 ans). Ils ont rempli l’Alcohol Use Disorders Identification Test (AUDIT), le Baratt Impulsiveness Scale, Sensitivity to Punishment & Reward Questionnaire, et la Substance Use Risk Profile Scale (SURPS). Des tests t pour échantillons indépendants et des corrélations de Pearson ont été utilisés pour examiner les différences entre les groupes et le lien entre les mesures comportementales. On constate chez les eEXT une sensibilité accrue aux récompenses et punitions, une impulsivité plus élevée et une consommation significativement supérieure de cannabis. Au total, la sensibilité aux récompenses corrèle avec l’AUDIT et la consommation de cannabis. Les individus avec eEXT sont plus sensibles aux récompenses, ce qui peut contribuer à leur développement de TUS. Ces résultats fournissent des informations importantes pour le développement de stratégies d’intervention précoces, la prévention et le traitement des TUS

Variation in the psychosocial determinants of the intention to prescribe hormone therapy prior to the release of the Women's Health Initiative trial: a survey of general practitioners and gynaecologists in France and Quebec

BACKGROUND: Theory-based approaches are advocated to improve our understanding of prescription behaviour. This study is an application of the theory of planned behaviour (TPB) with additional variables. It was designed to assess which variables were associated with the intention to prescribe hormone therapy (HT). In addition, variations in the measures across medical specialities (GPs and gynaecologists) and across countries (France and Quebec) were investigated. METHODS: A survey among 2,000 doctors from France and 1,044 doctors from Quebec was conducted. Data were collected by means of a self-administered questionnaire. A clinical vignette was used to elicit doctors' opinions. The following TPB variables were assessed: attitude, subjective norm, perceived behavioural control, attitudinal beliefs, normative beliefs and power of control beliefs. Additional variables (role belief, moral norm and practice pattern-related factors) were also assessed. A stepwise logistic regression was used to assess which variables were associated with the intention to prescribe HT. GPs and gynaecologists were compared to each other within countries and the two countries were compared within the specialties. RESULTS: Overall, 1,085 doctors from France returned their questionnaire and 516 doctors from Quebec (response rate = 54% and 49%, respectively). In the overall regression model, power of control beliefs, moral norm and role belief were significantly associated with intention (all at p < 0.0001). The models by specialty and country were: for GPs in Quebec, power of control beliefs (p < 0.0001), moral norm (p < 0.01) and cytology and hormonal dosage (both at p < 0.05); for GPs in France, power of control beliefs and role belief (both at p < 0.0001) and perception of behavioural control (p < 0.05) and cessation of menses (p < 0.01); for gynaecologists in Quebec, moral norm and power of control beliefs (both at p = 0.01); and for gynaecologists in France, power of control beliefs (p < 0.0001), and moral norm, role belief and lipid profile (all at p < 0.05). CONCLUSION: In both countries, compared with GPs, intention to prescribe HT was higher for gynaecologists. Psychosocial determinants of doctors' intention to prescribe HT varied according to the specialty and the country thus, suggesting an influence of contextual factors on these determinants

Brain Serotonin Synthesis in Adult Males Characterized by Physical Aggression during Childhood: A 21-Year Longitudinal Study

Adults exhibiting severe impulsive and aggressive behaviors have multiple indices of low serotonin (5-HT) neurotransmission. It remains unclear though whether low 5-HT mediates the behavior or instead reflects a pre-existing vulnerability trait.C-AMT bilaterally in the orbitofrontal cortex and self-reported more impulsiveness. Despite this, in adulthood there were no group differences in plasma tryptophan levels, genotyping, aggression, emotional intelligence, working memory, computerized measures of impulsivity, psychosocial functioning/adjustment, and personal and family history of mood and substance abuse disorders.These results force a re-examination of the low 5-HT hypothesis as central in the biology of violence. They suggest that low 5-HT does not mediate current behavior and should be considered a vulnerability factor for impulsive-aggressive behavior that may or may not be expressed depending on other biological factors, experience, and environmental support during development