Placebo-controlled manipulations of testosterone levels and dominance

Mazur & Booth present an intriguing model of the relationship between circulating testosterone levels and dominance behaviour in man, but their review of studies on testosterone–behaviour relationships in man is selective. Much of the evidence they cite is correlational in nature. Placebo-controlled manipulations of testosterone levels are required to test their hypothesis that dominance levels are testosterone-dependent in man. The changes in testosterone level that follow behavioural experience may be a consequence of stress. Testosterone levels in man are determined by a wide variety of factors, and a multivariate approach is required

Neuropsychological Aspects of Liver Disease and its Treatment

Liver disease can lead to serious impairment in cognitive functioning, through the development of a condition known as hepatic encephalopathy (HE). While gross impairment is clinically obvious, milder variants of the condition may escape detection at bedside examination and yet may have a significant impact on day-to-day activities. In this brief review article, the neuropsychology of liver disease is examined, focusing on nature, aetiology and significance. The possible contributory role of endogenous benzodiazepines in HE is described, as is the evidence regarding the effect of benzodiazepine antagonism on cognitive functioning in HE. The functional localisation of HE is briefly reviewed, as is the use of neuropsychological measures to evaluate treatment efficacy, e.g. following shunt procedures or liver transplantation. Finally, living donor liver transplantation is described, and the case is made for rigorous longitudinal neuropsychological evaluation of potential donors and recipients

Behavioural effects of androgens in men

A series of studies are presented which attempt to answer specific questions concerning the androgen-behaviour relationship in the adult human male. A critical review of the literature revealed that the androgen-behaviour relationship in the human male has been poorly researched. In particular, unsatisfactory experimental methodology and inexact operational definitions of behaviour have been employed. In the studies presented in this thesis an attempt was made to specifically define dysfunctional states and to carefully monitor the resultant behavioural effects of androgen administration. In the hypogonadal man, a dose-dependent relationship was demonstrated for specific aspects of sexual functioning, in particular self-rated interest in sex and frequency of morning erections appeared to vary with androgen replacement dose. In the eugonadal man, intramuscular depot injections of testosterone were shown to be the best method of overcoming the homeostatic mechanisms and increasing circulating androgen levels in the blood. High dosage testosterone administration acted to increase the level of sexual interest of a group of men whose presenting complaint was loss of libido. This treatment, however, did not result in an increased frequency of sexual activity. High dosage testosterone administration had no behavioural effect, compared with placebo, in a group of eugonadal men presenting with erectile dysfunction. Androgen administration appeared to have a stimulatory effect on the nocturnal erections of a group of hypogonadal men, although androgen withdrawal resulted in differing rates of diminution of nocturnal erectile response. In contrast, androgen administration had no effect on the nocturnal erections of a group of eugonadal men presenting with erectile dysfunction. Androgen administration to hypogonadal and eugonadal men had a general lack of effect on a series of psychometric test scores, which measure various aspects of cognitive functioning and personality. (Previous investigators had proposed that these test scores were correlated with circulating androgen levels). A case study is presented, reporting the lack of behavioural effect of oral testosterone undecanoate administration in an institutionalised hypogonadal man who had previously responded very aggressively to testosterone injections. The implications of these experimental findings are discussed in relation to the results of previous studies

Medication adherence across the lifespan: Theory, methods, interventions and six grand challenges

First paragraph: Taking medication as agreed with a health care provider ‘i.e. adherence’, is a critically important health behaviour throughout life for both the prevention and treatment of illness and the maintenance of health (Osterberg & Blaschke, 2005). From childhood use of antibiotics (Baguley, Lim, Bevan, Pallet, & Faust, 2012), to early adulthood use 15 of oral contraceptives (Molloy, Graham, & McGuinness, 2012) to older adulthood use of cardiovascular risk reduction medications (O’Carroll, Chambers, Dennis, Sudlow, & Johnston, 2014), evidence-based treatments such as these can have profound impact on health across the lifespan. Variability in the initiation, execution and persistence of med- ication taking behaviour plays a significant role in explaining the difference between 20 the trial-based efficacy and ‘real-world’ effectiveness for many medications (Blaschke, Osterberg, Vrijens, & Urquhart, 2012). Medication adherence has therefore been the focus of systematic investigation for several decades by both behavioural and clinical scientists (DiMatteo, 2004).Output Type: Editoria

Simpler is better—the case of colorectal cancer screening

No abstract available

An international comparison of deceased and living organ donation/transplant rates in opt-in and opt-out systems: a panel study

Background: Policy decisions about opt-in and opt-out consent for organ donation are based on limited evidence. To fill this gap we investigated the difference between deceased and living organ donation rates in opt-in and opt-out consent systems across a 13 year period. We controlled for extensive covariates and estimated the causal effect of consent with instrumental variables analysis. Method: This panel study used secondary data analysis to compare organ donor and transplant rates in 48 countries that had either opt-in or opt-out consent. Organ donation data were obtained over a 13-year period between 2000 and 2012. The main outcome measures were the number of donors, number of transplants per organ and total number (deceased plus living) of kidneys and livers transplanted. The role of consent on donor and transplant rates was assessed using multilevel modeling and the causal effect estimated with instrumental variables analysis. Results: Deceased donor rates (per-million population) were higher in opt-out (M = 14.24) than opt-in consent countries (M = 9.98; Β = -4.27, 95% confidence interval (CI) = -8.08, -0.45, P = .029). However, the number of living donors was higher in opt-in (M = 9.36) than opt-out countries (M = 5.49; B = 3.86, 95% CI = 1.16, 6.56, P = .006). Importantly, the total number of kidneys transplanted (deceased plus living) was higher in opt-out (M = 28.32) than opt-in countries (M = 22.43; B = -5.89, 95% CI = -11.60, -0.17, P = .044). Similarly, the total number of livers transplanted was higher in opt-out (M = 11.26) than opt-in countries (M = 7.53; B = -3.73, 95% CI = -7.47, 0.01, P = .051). Instrumental variables analysis suggested that the effect of opt-in versus opt-out consent on the difference between deceased and living donor rates is causal. Conclusions: While the number of deceased donors is higher than the number of living donors, opt-out consent leads to a relative increase in the total number of livers and kidneys transplanted

'What if I'm not dead?' - Myth-busting and organ donation

Objectives. In the UK, three people die every day awaiting an organ transplant. To address this, Scotland and England plan to follow Wales and introduce opt-out donor consent. However, emotional barriers, myths and misconceptions may deter potential registrants. Our objectives were to estimate the number of people who plan to opt-out of the donor register and to test if emotional barriers (e.g., medical mistrust) differentiated participants within this group. Finally, in an experimental manipulation, we tested whether intention to donate decreased by making emotional barriers more salient and increased following a widely used myth-busting intervention. Design. Mixed between-within design. Methods. UK residents (n = 1202) were asked whether they would choose; opt-in, deemed consent, or opt-out/not sure if legislation changes to opt-out. Participants also completed measures of donor intentions at baseline, following a 12-item emotional barriers questionnaire and again, following a 9-item myth-busting intervention. Results. Findings indicate that 66.1% of participants selected to opt-in to the donor register, 24.3% selected deemed consent and 9.4% selected opt-out/not sure. Emotional barriers, notably, fears surrounding bodily integrity were significantly elevated in participants who selected opt-out/not sure. Increasing the salience of emotional barriers reduced donor intentions in the opt-out/not sure group. However, dispelling organ donation myths did not increase intention within this group. Conclusions. If opt-out legislation is introduced in Scotland and England, approximately 10% of participants plan to opt-out or are not sure. Dispelling organ donation myths with facts may not be the best method of overcoming emotional barriers and increasing donor intentions for those planning to opt-out

'If I donate my organs it's a gift, if you take them it's theft': a qualitative study of planned donor decisions under opt-out legislation

Background: There is a worldwide shortage of donor organs for transplantation. To overcome this, several countries have introduced an opt-out donor consent system. This system, soon planned for Scotland and England means individuals are automatically deemed to consent for organ donation unless they register an opt-out decision. This study was designed to explore the reasons underpinning donor choices for people who plan to actively opt-in to the register, take no action and be on the register via deemed consent, opt-out, and those who are unsure of their decision. Methods: This study reports the analysis of free-text responses obtained from a large survey of intentions towards opt-out legislation in Scotland, England and Northern Ireland (n = 1202). Of the n = 1202 participants who completed the questionnaire, n = 923 provided a free text response explaining their views. Thematic analysis was used to explore the reasons why participants plan to: opt-in (n = 646), follow deemed consent (n = 205), opt-out (n = 32) and those who were not sure (n = 40) Results: A key theme for people planning to opt-in is that it ensures one’s donor choice is explicitly clear and unequivocal. Some regarded deemed consent as unclear and open to ambiguity, thus actively opting-in was viewed as a way of protecting against family uncertainty and interference. For the deemed consent group, a key theme is that it represents a simple effortless choice. This is important from both a pragmatic time-saving point of view and because it protects ambivalent participants from making a challenging emotive choice about organ donation. Key themes for those planning to opt-out relate to fears around medical mistrust and bodily integrity. Notably, both participants who plan to opt-out and opt-in perceived presumed consent as “authoritarian” and a method of increasing Government control of organs. In response, registering an active decision protected their freedom of choice. Conclusions: The findings highlight the importance of registering deliberate active consent for people who choose opt-in, due to concerns over possible family refusal under deemed consent. These findings could inform the development of communication campaigns that encourage family communication before the implementation of opt-out legislation

The relative importance of avoidance and restoration-oriented stressors for grief and depression in bereaved parents

Previous research has identified a number of individual risk factors for parental bereavement including the sex of the parent, the sex of the child, avoidance-focussed coping style and time since death. These factors emerged from research where variables were tested univariately and their relative importance is currently unknown. The current research, therefore, aims to investigate which risk factors are important, multivariately, for the outcomes of grief and depression in parents following the death of their child. Psychosocial measures were completed by 106 bereaved parents four years post-loss, recruited from death records in Scotland. The cause of the child's death included long-term illness and stillbirths as well as sudden and violent deaths. In multivariate regression analyses, depression was predicted by higher avoidance- focussed coping and higher number of restoration-oriented stressors such as relationship difficulties, problems at work and financial issues. Grief was predicted by higher avoidance, restoration stressors and level of continuing bonds. The present study adds to the knowledge about the phenomenon of parental bereavement with participants recruited directly from death records rather than through support, clinical or obituary sources. Factors previously found to be associated with outcomes when tested univariately such as sudden, violent death or sex of the parent were not significant when tested multivariately. This study highlights that different vulnerability factors exist for grief and depression in bereaved parents

Zuwanderung, Demografie und Arbeitsmarkt: Fakten statt Vorbehalte

Die öffentliche Debatte um Zuwanderung und Integration wird auch heute, ein halbes Jahrhundert nach dem Beginn der neueren Immigrationsgeschichte der Bundesrepublik, noch oft unsachlich geführt. Über die durchweg positiven Erfahrungen mit den ökonomischen Zusammenhängen von Migration, Arbeitsmarkt und Sozialstaat ist zu wenig allgemein bekannt, ebenso über die Vorteilhaftigkeit einer bedarfsorientierten Steuerung der Zuwanderung. Stattdessen finden populistische Thesen rund um eine vermeintlich zum Scheitern verurteilte Zuwandererintegration Widerhall, während zugleich eine ökonomische Kurskorrektur der Zuwanderungspolitik vielfach Skepsis hervorruft. Dieser Beitrag greift verbreitete Vorbehalte gegen Zuwanderung auf und widerlegt sie im Licht internationaler wissenschaftlicher Erkenntnisse. Eine gezielte Öffentlichkeitsarbeit „pro“ Zuwanderung kann und muss Vorbehalten durch klare Fakten begegnen. Dabei sollte dreierlei verdeutlicht werden: (1) Zuwanderung qualifizierter Arbeitskräfte bringt generell klare ökonomische Vorteile. (2) Obwohl in Deutschland bislang eher passiv hingenommen denn aktiv gestaltet, fällt auch die Bilanz für die jüngere deutsche Zuwanderungsgeschichte per Saldo günstig aus. (3) Mit den Mitteln einer aktiven und dabei steuernden Zuwanderungspolitik kann dafür gesorgt werden, dass künftig die Arbeitsmarktbelange bei der Entscheidung über Einwanderungsgenehmigungen stärker Beachtung finden. Dies wird die Wohlfahrtsvorteile durch Zuwanderung weiter vergrößern und ist ein wichtiges Fundament für eine noch größere Akzeptanz der Migranten in unserer Gesellschaft.Demografischer Wandel, Punktesystem, Auswahlverfahren für Zuwanderer, Ungleichheit, Integration, Arbeitsmigration, Zuwanderungspolitik