Bodyweight Perceptions among Texas Women: The Effects of Religion, Race/Ethnicity, and Citizenship Status

Despite previous work exploring linkages between religious participation and health, little research has looked at the role of religion in affecting bodyweight perceptions. Using the theoretical model developed by Levin et al. (Sociol Q 36(1):157–173, 1995) on the multidimensionality of religious participation, we develop several hypotheses and test them by using data from the 2004 Survey of Texas Adults. We estimate multinomial logistic regression models to determine the relative risk of women perceiving themselves as overweight. Results indicate that religious attendance lowers risk of women perceiving themselves as very overweight. Citizenship status was an important factor for Latinas, with noncitizens being less likely to see themselves as overweight. We also test interaction effects between religion and race. Religious attendance and prayer have a moderating effect among Latina non-citizens so that among these women, attendance and prayer intensify perceptions of feeling less overweight when compared to their white counterparts. Among African American women, the effect of increased church attendance leads to perceptions of being overweight. Prayer is also a correlate of overweight perceptions but only among African American women. We close with a discussion that highlights key implications from our findings, note study limitations, and several promising avenues for future research

Cognitive abnormalities and cannabis use

OBJECTIVE: Evidence that cannabis use impairs cognitive function in humans has been accumulating in recent decades. The purpose of this overview is to update knowledge in this area with new findings from the most recent literature. METHOD: Literature searches were conducted using the Web of Science database up to February 2010. The terms searched were: cannabi* or marijuana , and cogniti* or memory or attention or executive function , and human studies were reviewed preferentially over the animal literature. DISCUSSION: Cannabis use impairs memory, attention, inhibitory control, executive functions and decision making, both during the period of acute intoxication and beyond, persisting for hours, days, weeks or more after the last use of cannabis. Pharmacological challenge studies in humans are elucidating the nature and neural substrates of cognitive changes associated with various cannabinoids. Long-term or heavy cannabis use appears to result in longer-lasting cognitive abnormalities and possibly structural brain alterations. Greater adverse cognitive effects are associated with cannabis use commencing in early adolescence. CONCLUSION: The endogenous cannabinoid system is involved in regulatory neural mechanisms that modulate processes underlying a range of cognitive functions that are impaired by cannabis. Deficits in human users most likely therefore reflect neuroadaptations and altered functioning of the endogenous cannabinoid system

Cannabis and cognition: short- and long-term effects

Twenty years ago cannabis was generally perceived to be a benign drug with few significant adverse effects. As outlined elsewhere in this book, evidence has since mounted in the scientific literature for a range of harms associated with the use of cannabis, including the development of dependence and health-related harms (see also Hall and Solowij, 1998; Hall and Degenhardt, 2009). As the overall theme of this book indicates, an association between cannabis use and the development of psychotic symptoms or overt psychosis has grown to be recognized as a significant potential harm, and investigating the mechanisms by which cannabis may trigger psychosis is a priority. This includes understanding the effects of cannabis on brain structure, biology and function. We recently highlighted a similarity between the cognitive impairment that has been reported in cannabis users and the deficits observed in schizophrenia (Solowij and Michie, 2007), suggesting common underlying neuropathology. Few would argue that cognition is not impaired to some degree during acute intoxication with cannabis. That impaired cognition persists beyond the period of acute intoxication is more contentious. Despite objective appraisals of the literature in interpreting the evidence, it is inevitable that researchers will be influenced by the weight of their own data in formulating scientific opinion. Accordingly, and on the basis of the accumulating evidence, this review will come to some rather different conclusions from those made in the first edition of this book (Pope and Yurgelun-Todd, 2004). The goal of this chapter is to update our knowledge of the short- and long-term effects of cannabis on cognition based on integrating evidence from the most recent literature on this topic. We acknowledge the weight of evidence from our own studies that must inevitably guide us to the conclusions that we draw, while also aiming objectively to assess the evidence from multiple sources. We consider evidence from preclinical research, studies of acute administration of cannabinoids to humans, studies of long-term or heavy cannabis users tested in the unintoxicated state, including adults and adolescents and patients with schizophrenia, and we evaluate the evidence for recovery of function after prolonged abstinence

How do medical doctors use a web-based oncology protocol system? A comparison of Australian doctors at different levels of medical training using logfile analysis and an online survey

BACKGROUND: Electronic decision support is commonplace in medical practice. However, its adoption at the point-of-care is dependent on a range of organisational, patient and clinician-related factors. In particular, level of clinical experience is an important driver of electronic decision support uptake. Our objective was to examine the way in which Australian doctors at different stages of medical training use a web-based oncology system (http://www.eviq.org.au). METHODS: We used logfiles to examine the characteristics of eviQ registrants (2009–2012) and patterns of eviQ use in 2012, according to level of medical training. We also used a web-based survey to evaluate the way doctors at different levels of medical training use the online system and to elicit perceptions of the system’s utility in oncology care. RESULTS: Our study cohort comprised 2,549 eviQ registrants who were hospital-based medical doctors across all levels of training. 65% of the cohort used eviQ in 2012, with 25% of interns/residents, 61% of advanced oncology trainees and 47% of speciality-qualified oncologists accessing eviQ in the last 3 months of 2012. The cohort accounted for 445,492 webhits in 2012. On average, advanced trainees used eviQ up to five-times more than other doctors (42.6 webhits/month compared to 22.8 for specialty-qualified doctors and 7.4 webhits/month for interns/residents). Of the 52 survey respondents, 89% accessed eviQ’s chemotherapy protocols on a daily or weekly basis in the month prior to the survey. 79% of respondents used eviQ at least weekly to initiate therapy and to support monitoring (29%), altering (35%) or ceasing therapy (19%). Consistent with the logfile analysis, advanced oncology trainees report more frequent eviQ use than doctors at other stages of medical training. CONCLUSIONS: The majority of the Australian oncology workforce are registered on eviQ. The frequency of use directly mirrors the clinical role of doctors and attitudes about the utility of eviQ in decision-making. Evaluations of this kind generate important data for system developers and medical educators to drive improvements in electronic decision support to better meet the needs of clinicians. This end-user focus will optimise the uptake of systems which will translate into improvements in processes of care and patient outcomes

Uptake of a web-based oncology protocol system: how do cancer clinicians use eviQ cancer treatments online?

Background: The use of computerized systems to support evidence-based practice is commonplace in contemporary medicine. Despite the prolific use of electronic support systems there has been relatively little research on the uptake of web-based systems in the oncology setting. Our objective was to examine the uptake of a web-based oncology protocol system (http://www.eviq.org.au) by Australian cancer clinicians.Methods: We used web-logfiles and Google Analytics to examine the characteristics of eviQ registrants from October 2009-December 2011 and patterns of use by cancer clinicians during a typical month.Results: As of December 2011, there were 16,037 registrants; 85% of whom were Australian health care professionals. During a typical month 87% of webhits occurred in standard clinical hours (08:00 to 18:00 weekdays). Raw webhits were proportional to the size of clinician groups: nurses (47% of Australian registrants), followed by doctors (20%), and pharmacists (14%). However, pharmacists had up to three times the webhit rate of other clinical groups. Clinicians spent five times longer viewing chemotherapy protocol pages than other content and the protocols viewed reflect the most common cancers: lung, breast and colorectal.Conclusions: Our results demonstrate eviQ is used by a range of health professionals involved in cancer treatment at the point-of-care. Continued monitoring of electronic decision support systems is vital to understanding how they are used in clinical practice and their impact on processes of care and patient outcomes

Delayed preattentional functioning in early psychosis patients with cannabis use

Rationale Cannabis use is prevalent among the early psychosis (EP) population. The event-related potentials, mismatch negativity (MMN) and P3a are reduced in EP. Cannabinoids have been shown to modulate N-methyl-Daspartate receptors which are involved in MMN generation. Objectives This study is the first to investigate the effects of cannabis use on MMN/P3a in EP. Methods EP was defined as a history of psychosis or psychotic symptoms with no progression to date to chronic schizophrenia. Twenty-two EP patients with cannabis use (EP+CANN), 22 non-cannabis-using EP patients (EPCANN) and 21 healthy controls participated in this study. MMN/P3a was elicited using a two-tone, auditory paradigm with 8% duration deviants. Results As expected, EP-CANN showed marked reductions in MMN/P3a amplitudes compared to controls. However, EP+CANN showed evidence of a different pattern of neurophysiological expression of MMN/P3a compared to nonusing patients, most notably in terms of delayed frontal MMN/P3a latencies. Conclusions This study provides further evidence that MMN/P3a deficits are present during early psychosis and suggests that this biomarker may have utility in differentiating substance- from non-substance-related psychoses

Centropa : a journal of Central European architecture and related arts

Rationale: Reflection impulsivity-a failure to gather and evaluate information before making a decision-is a critical component of risk-taking and substance use behaviours, which are highly prevalent during adolescence. Objectives and methods: The Information Sampling Test was used to assess reflection impulsivity in 175 adolescents (mean age 18.3, range 16.5-20; 55% female)-48 cannabis users (2.3 years use, 10.8 days/month), 65 alcohol users, and 62 non-substance-using controls-recruited from a longitudinal cohort and from the general community and matched for education and IQ. Cannabis and alcohol users were matched on levels of alcohol consumption. Results: Cannabis users sampled to the lowest degree of certainty before making a decision on the task. Group differences remained significant after controlling for relevant substance use and clinical confounds (e.g., anxiety, depressive symptoms, alcohol, and ecstasy use). Poor performance on multiple IST indices was associated with an earlier age of onset of regular cannabis use and greater duration of exposure to cannabis, after controlling for recent use. Alcohol users did not differ from controls on any IST measure. Conclusions: Exposure to cannabis during adolescence is associated with increased risky and impulsive decision making, with users adopting strategies with higher levels of uncertainty and inefficient utilisation of information. The young cannabis users did show sensitivity to losses, suggesting that greater impulsivity early in their drug using career is more evident when there is a lack of negative consequences. This provides a window of opportunity for intervention before the onset of cannabis dependence

Hospital discharge diagnostic and procedure codes for upper gastro-intestinal cancer: how accurate are they?

<p>Abstract</p> <p>Background</p> <p>Population-level health administrative datasets such as hospital discharge data are used increasingly to evaluate health services and outcomes of care. However information about the accuracy of Australian discharge data in identifying cancer, associated procedures and comorbidity is limited. The Admitted Patients Data Collection (APDC) is a census of inpatient hospital discharges in the state of New South Wales (NSW). Our aim was to assess the accuracy of the APDC in identifying upper gastro-intestinal (upper GI) cancer cases, procedures for associated curative resection and comorbidities at the time of admission compared to data abstracted from medical records (the ‘gold standard’).</p> <p>Methods</p> <p>We reviewed the medical records of 240 patients with an incident upper GI cancer diagnosis derived from a clinical database in one NSW area health service from July 2006 to June 2007. Extracted case record data was matched to APDC discharge data to determine sensitivity, positive predictive value (PPV) and agreement between the two data sources (κ-coefficient).</p> <p>Results</p> <p>The accuracy of the APDC diagnostic codes in identifying site-specific incident cancer ranged from 80-95% sensitivity. This was comparable to the accuracy of APDC procedure codes in identifying curative resection for upper GI cancer. PPV ranged from 42-80% for cancer diagnosis and 56-93% for curative surgery. Agreement between the data sources was >0.72 for most cancer diagnoses and curative resections. However, APDC discharge data was less accurate in reporting common comorbidities - for each condition, sensitivity ranged from 9-70%, whilst agreement ranged from κ = 0.64 for diabetes down to κ < 0.01 for gastro-oesophageal reflux disorder.</p> <p>Conclusions</p> <p>Identifying incident cases of upper GI cancer and curative resection from hospital administrative data is satisfactory but under-ascertained. Linkage of multiple population-health datasets is advisable to maximise case ascertainment and minimise false-positives. Consideration must be given when utilising hospital discharge data alone for generating comorbidity indices, as disease burden at the time of admission is under-reported.</p