Nature and extent of Posttraumatic Stress Disorder (PTSD) symptoms presenting in an adult psychological therapies service

Posttraumatic stress disorder (PTSD) is complex and no one theory can fully explain the development and maintenance of PTSD symptoms. In Scotland, where trauma focused care initiatives are being considered, little is known about the extent of trauma history and associated symptoms presenting in primary care services. Furthermore, subthreshold posttraumatic stress disorder (sPTSD) has recently been associated with clinically significant impairment. With PTSD symptoms often comorbid with other psychopathology such as depression, individuals potentially seek treatment for these symptoms rather than underlying trauma which therefore may go unrecognised. Studies on the effectiveness of psychological treatment for PTSD demonstrate reasonable efficacy for well developed interventions. However, up to half of individuals may not make significant clinical improvements and withdrawal rates are high. This suggests that current treatments are not acceptable to some individuals and may be ineffective for others. In light of such clinical challenges the aim of the thesis was to investigate the incidence and nature of trauma symptoms in an Adult Psychological Therapies Service. Firstly, a systematic review was conducted to appraise the current level of evidence for prevalence and impairment associated with sPTSD. Secondly, an empirical study was undertaken to review the prevalence of trauma history and symptoms in the service. This was followed by an investigation of the relationships between processes posited to underpin many forms psychological distress by a promising new treatment approach called Acceptance and Commitment Therapy (ACT). These include; cognitive fusion, experiential avoidance and valued action. A quantitative cross sectional design collecting self report questionnaire data was used and mixed statistical methodology employed. Results from the systematic review suggest that PTSD was associated with the most impairment, followed by sPTSD, then no PTSD. Subthreshold PTSD was reported to be as, or more prevalent than, PTSD. The results from the empirical study found 89 per cent reported exposure to one or more traumatic events, 51 per cent met PTSD screening criteria, whilst a further 7 per cent reached a sPTSD diagnostic cut-off. Trauma history was positively correlated with increased psychological distress at initial assessment. Cognitive fusion, experiential avoidance and valued action were all correlated with trauma symptom severity. Both cognitive fusion and experiential avoidance mediated the relationship between number of traumatic events and trauma symptom severity in a simple mediation model. However, multiple mediation analysis demonstrated that experiential avoidance, over and above cognitive fusion, explained 33 per cent of the variance. In addition, cognitive fusion and experiential avoidance jointly had a significant indirect effect on the relationship between trauma history and valued action. The implications of the findings and further directions are discussed

Drawing a line in the sand’: Physician diagnostic uncertainty in pediatric chronic pain

Background: Diagnostic uncertainty is the subjective perception of an inability to provide an accurate explanation of the patient’s health problem or that a label is missing or incorrect. While recently explored in youth with chronic pain and families, this is the first study to investigate diagnostic uncertainty from the perspectives of physicians. Methods: Individual, semi-structured interviews were conducted with sixteen pediatricians who assess and/or treat youth who experience complex chronic pain. Interviews explored pediatricians’ perceptions, beliefs, and confidence regarding the assessment and management of chronic pain in youth and how they manage uncertainty regarding the diagnosis. Interviews were analysed using inductive reflexive thematic analysis. Results: Analyses generated one prominent theme: ‘drawing a line in the sand’. Within this theme, physicians discussed uncertainty as inherent to their role treating youth with chronic pain. The metaphor of ‘drawing a line in the sand’ was used to describe a process of identifying a point at which physicians no longer sought a new diagnosis for the child’s pain or continued diagnostic investigations. This line was influenced by numerous factors, which are highlighted through four subthemes: physician training, experience, and mentorship; individual patient and family factors; perceived reassurance of diagnostic investigations; and the broader social context and implications. Conclusions: How physicians manage diagnostic uncertainty must be understood, as it is likely to critically impact how a diagnosis of chronic pain is communicated, the diagnostic investigations undertaken, the wait time to receiving a diagnosis, and ultimately youths’ pain experiences. <br/

HIV among pregnant women in Moshi Tanzania: the role of sexual behavior, male partner characteristics and sexually transmitted infections

BACKGROUND: Women continue to be disproportionately affected by HIV in Tanzania, and factors contributing to this situation need to be identified. The objective of this study was to determine social, behavioral and biological risk factors of HIV infection among pregnant women in Moshi urban, Tanzania. In 2002 – 2004, consenting women (N = 2654), attending primary health clinics for routine antenatal care were interviewed, examined and biological samples collected for diagnosis of HIV and other sexually transmitted/reproductive tract infections. RESULTS: The prevalence of HIV was 6.9%. The risk for HIV was greater among women whose male partner; had other sexual partners (adjusted odds ratio [AOR], 15.11; 95% confidence interval [CI], 8.39–27.20), traveled frequently (AOR, 1.79; 95% CI, 1.22–2.65) or consumed alcohol daily (AOR, 1.68; 95% CI, 1.06–2.67). Other independent predictors of HIV were age, number of sex partners, recent migration, and presence of bacterial vaginosis, genital ulcer, active syphilis and herpes simplex virus type 2. CONCLUSION: Development of programs that actively involve men in HIV prevention is important in reducing transmission of HIV in this population. Further, interventions that focus on STI control, the mobile population, sexual risk behavior and responsible alcohol use are required

A Minimum Income Standard for the UK in 2012: keeping up in hard times

This is the 2012 update of the Minimum Income Standard for the United Kingdom, based on new research into what members of the public think people need for an acceptable minimum standard of living. Budgets for families with children, originally researched in 2008, have for the first time been researched again from scratch. Budgets for other household types have been reviewed. Overall, the report shows that in the past four years both minimum living costs and the earnings needed to afford them have risen significantly more than headline inflation for families with children. For households without children, they have remained more stable

The effects of digital predistortion in a CO-OFDM system – a stochastic approach

Digital predistortion is topic of significant interest in telecommunications – both in the wireless radio field and, more recently, in photonics. In the present letter, the authors undertake a sensitivity analysis of various digital predistortion algorithms. Using recent metamodeling techniques designed for efficient stochastic analysis, the authors show that using predistortion not only leads to a reduction of the error vector magnitude in general but can also make the system less sensitive to uncertainties

Prevalence of sexually transmitted infections among pregnant women with known HIV status in northern Tanzania

<p>Abstract</p> <p>Objectives</p> <p>To determine the prevalence of sexually transmitted infections (STIs) and other reproductive tract infections (RTIs) among pregnant women in Moshi, Tanzania and to compare the occurrence of STIs/RTIs among human immunodeficiency virus (HIV)-infected and uninfected women.</p> <p>Methods</p> <p>Pregnant women in their 3^rdtrimester (N = 2654) were recruited from two primary health care clinics between June 2002 and March 2004. They were interviewed, examined and genital and blood samples were collected for diagnosis of STIs/RTIs and HIV.</p> <p>Results</p> <p>The prevalence of HIV, active syphilis and herpes simplex virus – type 2 (HSV-2) were 6.9%, 0.9% and 33.6%, respectively, while 0.5% were positive for <it>N gonorrhoeae</it>, 5.0% for <it>T vaginalis </it>and 20.9% for bacterial vaginosis. Genital tract infections were more prevalent in HIV-seropositive than seronegative women, statistically significant for syphilis (3.3% vs 0.7%), HSV-2 (43.2% vs 32.0%), genital ulcers (4.4% vs 1.4%) and bacterial vaginosis (37.2% vs 19.6%). In comparison with published data, a declining trend for curable STIs/RTIs (syphilis, trichomoniasis and bacterial vaginosis) was noted.</p> <p>Conclusion</p> <p>Rates of STIs and RTIs are still high among pregnant women in Moshi. Where resources allow, routine screening and treatment of STIs/RTIs in the antenatal care setting should be offered. Higher STIs/RTIs in HIV-seropositive women supports the expansion of HIV-counseling and testing services to all centers offering antenatal care. After identification, STIs/RTIs need to be aggressively addressed in HIV-seropositive women, both at antenatal and antiretroviral therapy care clinics.</p

Shoujo versus Seinen? Address and reception in Puella Magi Madoka Magica (2011)

This article uses the Japanese television anime series Puella Magi Madoka Magica (2011) as a case study through which to problematise the relationship between two prominent traditions within children’s literature criticism: narratology, with its vocabulary of implied readers and textual address; and reception studies, which typically gather data through empirical work with children. The figure of the “child reader” is claimed by both traditions, although in one case that reader is a textual construct and in the other a human being; yet this ambiguity is not typically addressed within studies of individual texts. Puella Magi Madoka Magica, a complex work that disrupts viewer expectations and genre assumptions, both destabilises its implied viewership and challenges conventional beliefs about the tastes and capacities of actual viewers, especially the extent to which those viewers can be categorised by age or gender. I argue that, by taking a sideways step from page to screen, and especially by analysing a non-Western work, it is possible to highlight the contingent and arbitrary nature of some of the assumptions that permeate literary critical discussion, and to help bring narratalogical and reception studies into a more productive relationship

Altering Pace Control and Pace Regulation: Attentional Focus Effects during Running

Purpose: To date there are no published studies directly comparing self-controlled and externally-controlled pace endurance tasks. However, previous research suggests pace control may impact on cognitive strategy use and effort perceptions. The primary aim of this study was to investigate the effects of manipulating perception of pace control on attentional focus, physiological, and psychological outcomes during running. A secondary aim was to determine the reproducibility of self-paced running performance when regulated by effort perceptions. Methods: Twenty experienced endurance runners completed four 3 km time-trials on a treadmill. Subjects completed two self-controlled pace (SC), one perceived exertion clamped (PE), and one externally-controlled pace (EC) time-trial. PE and EC were completed in a counterbalanced order. Pacing strategy for EC and perceived exertion instructions for PE replicated subjects' fastest SC time-trial. Results: Subjects reported a greater focus on cognitive strategies such as relaxing and optimizing running action during EC than SC. Mean heart rate was 2% lower during EC than SC despite an identical pacing strategy. Perceived exertion did not differ between the three conditions. However, increased internal sensory monitoring coincided with elevated effort perceptions in some subjects during EC, and a 10% slower completion time for PE (13.0 ± 1.6 min) than SC (11.8 ± 1.2 min). Conclusion: Altering pace control and pace regulation impacted on attentional focus. External control over pacing may facilitate performance, particularly when runners engage attentional strategies conducive to improved running efficiency. However, regulating pace based on effort perceptions alone may result in excessive monitoring of bodily sensations and a slower running speed. Accordingly, attentional focus interventions may prove beneficial for some athletes to adopt task-appropriate attentional strategies to optimize performance

Genome wide association scan for chronic periodontitis implicates novel locus

Background: There is evidence for a genetic contribution to chronic periodontitis. In this study, we conducted a genome wide association study among 866 participants of the University of Pittsburgh Dental Registry and DNA Repository, whose periodontal diagnosis ranged from healthy (N = 767) to severe chronic periodontitis (N = 99).Methods: Genotypingi of over half-million single nucleotide polymorphisms was determined. Analyses were done twice, first in the complete dataset of all ethnicities, and second including only samples defined as self-reported Whites. From the top 100 results, twenty single nucleotide polymorphisms had consistent results in both analyses (borderline p-values ranging from 1E-05 to 1E-6) and were selected to be tested in two independent datasets derived from 1,460 individuals from Porto Alegre, and 359 from Rio de Janeiro, Brazil. Meta-analyses of the Single nucleotide polymorphisms showing a trend for association in the independent dataset were performed.Results: The rs1477403 marker located on 16q22.3 showed suggestive association in the discovery phase and in the Porto Alegre dataset (p = 0.05). The meta-analysis suggested the less common allele decreases the risk of chronic periodontitis.Conclusions: Our data offer a clear hypothesis to be independently tested regarding the contribution of the 16q22.3 locus to chronic periodontitis. © 2014 Feng et al.; licensee BioMed Central Ltd