9,130 research outputs found

    Health state values for the HUI 2 descriptive system: results from a UK survey

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    This paper reports the results of a study to estimate a statistical health state valuation model for a revised version of the Health Utilities Index Mark 2, using Standard Gamble health state preference data. A sample of 51 health states were valued by a sample of the 198 members of the UK general population. Models are estimated for predicting health state valuations for all 8,000 states defined by the revised HUI2. The recommended model produces logical and significant coefficients for all levels of all dimensions in the HUI2. These coefficients appear to be robust across model specifications. This model performs well in predicting the observed health state values within the valuation sample and for a separate validation sample of health states. However, there are concerns over large prediction errors for two health states in the valuation sample. These problems must be balanced against concerns over the validity of using the VAS based health state valuation data of the original HUI2 valuation model.HUI2

    Factors affecting patients' trust and confidence in GPs: evidence from the English national GP patient survey.

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    OBJECTIVES: Patients' trust in general practitioners (GPs) is fundamental to effective clinical encounters. Associations between patients' trust and their perceptions of communication within the consultation have been identified, but the influence of patients' demographic characteristics on these associations is unknown. We aimed to investigate the relative contribution of the patient's age, gender and ethnicity in any association between patients' ratings of interpersonal aspects of the consultation and their confidence and trust in the doctor. DESIGN: Secondary analysis of English national GP patient survey data (2009). SETTING: Primary Care, England, UK. PARTICIPANTS: Data from year 3 of the GP patient survey: 5 660 217 questionnaires sent to patients aged 18 and over, registered with a GP in England for at least 6 months; overall response rate was 42% after adjustment for sampling design. OUTCOME MEASURES: We used binary logistic regression analysis to investigate patients' reported confidence and trust in the GP, analysing ratings of 7 interpersonal aspects of the consultation, controlling for patients' sociodemographic characteristics. Further modelling examined moderating effects of age, gender and ethnicity on the relative importance of these 7 predictors. RESULTS: Among 1.5 million respondents (adjusted response rate 42%), the sense of 'being taken seriously' had the strongest association with confidence and trust. The relative importance of the 7 interpersonal aspects of care was similar for men and women. Non-white patients accorded higher priority to being given enough time than did white patients. Involvement in decisions regarding their care was more strongly associated with reports of confidence and trust for older patients than for younger patients. CONCLUSIONS: Associations between patients' ratings of interpersonal aspects of care and their confidence and trust in their GP are influenced by patients' demographic characteristics. Taking account of these findings could inform patient-centred service design and delivery and potentially enhance patients' confidence and trust in their doctor

    Glue ear, hearing loss and IQ:an association moderated by the child's home environment

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    BACKGROUND: Glue ear or otitis media with effusion (OME) is common in children and may be associated with hearing loss (HL). For most children it has no long lasting effects on cognitive development but it is unclear whether there are subgroups at higher risk of sequelae. OBJECTIVES: To examine the association between a score comprising the number of times a child had OME and HL (OME/HL score) in the first four/five years of life and IQ at age 4 and 8. To examine whether any association between OME/HL and IQ is moderated by socioeconomic, child or family factors. METHODS: Prospective, longitudinal cohort study: the Avon Longitudinal Study of Parents and Children (ALSPAC). 1155 children tested using tympanometry on up to nine occasions and hearing for speech (word recognition) on up to three occasions between age 8 months and 5 years. An OME/HL score was created and associations with IQ at ages 4 and 8 were examined. Potential moderators included a measure of the child's cognitive stimulation at home (HOME score). RESULTS: For the whole sample at age 4 the group with the highest 10% OME/HL scores had performance IQ 5 points lower [95% CI -9, -1] and verbal IQ 6 points lower [95% CI -10, -3] than the unaffected group. By age 8 the evidence for group differences was weak. There were significant interactions between OME/HL and the HOME score: those with high OME/HL scores and low 18 month HOME scores had lower IQ at age 4 and 8 than those with high OME/HL scores and high HOME scores. Adjusted mean differences ranged from 5 to 8 IQ points at age 4 and 8. CONCLUSIONS: The cognitive development of children from homes with lower levels of cognitive stimulation is susceptible to the effects of glue ear and hearing loss

    Differences in prefrontal blood oxygenation during an acute multitasking stressor in ecstasy polydrug users

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    Background: Cognitive deficits are well documented in ecstasy (MDMA) users with such deficits being taken as evidence of dysregulation of the 5HT system. More recently neuroimaging has been used to corroborate these deficits. The present study aimed to assess multitasking performance in ecstasy polydrug users, polydrug users and drug naïve individuals. It was predicted that ecstasy polydrug users would perform worse than nonusers on the behavioural measure and this would be supported by difference in cortical blood oxygenation. Methods: Twenty ecstasy-polydrug users, 17 polydrug users and 19 drug naïve individuals took part. On day 1 drug use history was taken and questionnaire measures were completed. On day 2, participants completed a 20 minute multitasking stressor while brain blood oxygenation was measured using functional near infrared spectroscopy (fNIRS). Results: There were no significant differences between the 3 groups on the subscales of the multitasking stressor. In addition, there were no significant differences on self-report measures of perceived workload (NASA – TLX). In terms of mood, ecstasy users were significantly less calm and less relaxed compared to drug-naïve controls. There were also significant differences at 3 voxels on the fNIRS indicating decreased blood oxygenation in ecstasy users compared to drug naïve controls at V2 (left DLPFC), V14 and V16 (right DLPFC), and compared to polydrug controls at V14. Conclusions: The results of the present study provide support for changes in brain activation during performance of demanding tasks in ecstasy polydrug users, which could be related to cerebral vasoconstriction

    Cadaveric Spinal Surgery Simulation: A Comparison of Cadaver Types

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    Study Design: Single-blinded study. Objective: To assess the suitability of three types of cadaver for simulating pedicle screw insertion and establish if there is an ideal. Methods: Three types of cadaver-Thiel-embalmed, Crosado-embalmed, and formaldehyde-embalmed-were draped and the spines exposed. Experienced surgeons were asked to place pedicle screws in each cadaver and give written questionnaire feedback using a modified Likert scale. Soft tissue and bony properties were assessed, along with the role of simulation in spinal surgery training. Results: The Thiel cadaver rated highest for soft tissue feel and appearance with a median score of 6 for both (range 2 to 7). The Crosado cadaver rated highest for bony feel, with a median score of 6 (range 2 to 7). The formaldehyde cadaver rated lowest for all categories with median scores of 2, 2.5, and 3.5, respectively. All surgeons felt pedicle screw insertion should be learned in a simulated setting using human cadavers. Conclusion: Thiel and Crosado cadavers both offered lifelike simulation of pedicle screw insertion, with each having advantages depending on whether the focus is on soft tissue approach or technical aspects of bony screw insertion. Both cadaver types offer the advantage of long life span, unlike fresh frozen tissue, which means cadavers can be used multiple times, thus reducing the costs

    Electrophysiological Evidence of Atypical Processing Underlying Mental Set Shifting in Ecstasy Polydrug and Polydrug Users

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    Executive functioning deficits are reported in ecstasy users. However research into mental set switching has been equivocal, with behavioural studies suggesting the function is preserved. The current study sought to address the issue of switching deficits in ecstasy users by combining behavioural performance with electrophysiological correlates (EEG). Twenty ecstasy polydrug users, 20 non-ecstasy polydrug users and 20 drug naive controls were recruited. Participants completed questionnaires about their drug use, sleep quality, fluid intelligence and current mood state. Each participant completed a mental set switching task (the number-letter task) whilst EEG measures were recorded. ANOVA revealed no between group differences on performance of the task, however a regression suggested that ecstasy use was a significant predictor for performance, after controlling for cannabis use. Mixed ANOVA revealed a significant effect of group on the P3, with significant differences between both drug groups and naives. There was also an interaction between electrode and group on the P2 component, with ecstasy users differing from both other groups. On the P3 component the results suggest a reduction in positivity at parieto-occipital electrodes for drug users compared to controls. Furthermore a significant increase in negativity in ecstasy users compared to control groups could be observed in several occipito-parietal electrodes at an N2 component as well as observable atypicalities in early processing (P2) displayed by ecstasy users and polydrug controls. The present study provides evidence of atypical processing of attentional shifting in ecstasy and polydrug users. Deficits in this executive function could reflect cognitive inflexibility and paucity of rapid behavioural adjustment, which may be problematic in real world situations. Keywords: Ecstasy; cannabis; executive function; stimulants; cannabis
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