Autism spectrum conditions among children and adolescents: A new profiling tool

There is considerable debate about the sociocognitive features of autism spectrum conditions (ASC), and a tool for profiling the sociocognitive profiles of children and adolescents with ASC is needed. The aim of this research was to evaluate the psychometric properties of a new questionnaire—The Australian Scale for Autism Spectrum Conditions (ASASC). Three hundred twenty‐two parents of children on the ASC spectrum, including autistic disorder (n = 76), Asperger's disorder (n = 188), and pervasive developmental disorder not otherwise specified (n = 21), and a clinical group of children with subclinical ASC features and no ASC diagnosis (n = 37). Measures include an initial scale measuring eight potential dimensions of ASC, a related screening tool for autism, and two previously validated social skills questionnaires. The questionnaires were administered online. The ASASC was factor‐analysed, internal and test–retest reliabilities (for a randomly selected 84 parents) were calculated, and preliminary tests of convergent and divergent validity were conducted. The resulting measure (44 items) contained five coherent and reliable dimensions: understand and express emotion, fact orientation, sensory sensitivity, social communication, and rigidity. The questionnaire had good test–retest reliability and convergent/divergent validity. The ASASC enables profiles of ASC symptomatology that should be useful in adjusting interventions to individual needs.     

Sourcing stereotypes: constructing and challenging simplified knowledge

The social media uproar in Fall 2017 over a nursing textbook chart that presented generalised characterisations of minority groups generated an assumption that medical training needs more Religious Studies expertise. Analysing the sources that the chart cited, we trace the authors’ assertions to studies of varying quality and identify several specific processes involved in simplifying knowledge for dissemination, as the authors disregarded the limits of each specific study and ignored counter-evidence or otherwise evaded critical scrutiny. Comparing this example to examples from world religions discourse illustrates both differences and similarities in the process of constructing simplified presentations. While both presumably developed out of good intentions, they generate significant problems in their effort to shape material to support larger arguments. Thus, scholars across disciplines should critique and complicate their own processes for generating simplified knowledge.     

Physicians' Silent Decisions: Because Patient Autonomy Does Not Always Come First

Physicians make some medical decisions without disclosure to their patients. Nondisclosure is possible because these are silent decisions to refrain from screening, diagnostic or therapeutic interventions. Nondisclosure is ethically permissible when the usual presumption that the patient should be involved in decisions is defeated by considerations of clinical utility or patient emotional and physical well-being. Some silent decisions—not all—are ethically justified by this standard. Justified silent decisions are typically dependent on the physician's professional judgment, experience and knowledge, and are not likely to be changed by patient preferences. We condemn the inappropriate exclusion of the patient from the decision-making process. However, if a test or treatment is unlikely to yield a net benefit, disclosure and discussion are at times unnecessary. Appropriate silent decisions are ethically justified by such considerations as patient benefit or economy of time.     

Transgender Primary Medical Care

SUMMARY

Transgender medical care involves addressing general medical conditions and those related specifically to transgender issues. This article summarizes existing research in transgender medicine and provides guidance for family physicians and nurses in adapting standard primary care protocols relating to health maintenance, acute illness, and chronic disease management to address trans-specific clinical oncerns. Trans-specific issues in physical examination, health history, interpretation of laboratory tests, vaccination, screening, and treatment are explored, and the role of the primary care provider in caring for patients undergoing hormonal or surgical change is discussed.     

Diagnosing depression in patients with physical diseases using the beck depression inventory (BDI)

Abstract

Four-hundred-and-forty-three patients with a physical illness (355 with coronary heart disease and 88 with chronic pain), 150 unemployed persons and 623 subjects from the normal population in Jämtland, Sweden were tested using the BDI (Beck Depression Inventory). The aim of the study was to investigate whether scores on both the physical and non-physical components of the BDI differed between the patients and the other groups, or whether only the physical component was significantly higher in the patient group, and in such a case whether this could be interpreted as symptomatic of physical disease and not of depression. A cutoff score of ≥ 10 to determine mild depression and two different alternative physical and non-physical components were used. Forty-three percent of the patients with coronary heart disease and 50% of patients with chronic pain were categorized as being at least mildly depressed. Factor analyses indicated that a physical component comprising five items was the most meaningful and could best discriminate the physical symptoms. The patients' scores were significantly higher than those of the other two groups on the physical component but only higher than the normal population sample on the nun-physical component. This supports the idea that the items for physical symptoms in the BDI might be confounding when determining depression in patients with physical diseases. The non-physical component seems to be the best indicator of depression and is recommended as a complement to the total BDI scale when determining the degree of depression in patients suffering from a physical disease.     

Web-based CBT for the prevention of anxiety symptoms among medical and health science graduate students

ABSTRACT

Medical and health science graduate students report greater anxiety problems than the general population, but they are less likely to seek treatment due to cultural and logistical barriers. One preventative approach that overcomes these barriers is web-based cognitive behavioral therapy (webCBT). It is unknown whether webCBT is effective for preventing anxiety escalation within this population. A randomized controlled trial was conducted, comparing the effects of webCBT versus a control group (CG). Medical university students (n=594; Mage=27; 67% female; 80% Caucasian) completed online baseline measures and four assigned online activities. Measures were re-administered after approximately three months. There was a small interaction effect between time of assessment and treatment condition. Anxiety severity was lower in the webCBT (M[SD]=2.88[3.36]) versus CG condition (M[SD]=3.69 [3.35]) at follow-up. This effect was moderate for students with mild, versus minimal, anxiety at baseline. The proportion of students with possible anxiety disorder was lower in the webCBT (4.5%) versus CG (8.5%) condition, and the proportion of mildly anxious students with a clinically significant increase in symptoms was lower in the webCBT (10%) versus CG (20%) condition. WebCBT may aid in preventing anxiety escalation in this population, particularly for at-risk students who report mild anxiety symptoms.     

Internet-Delivered Acceptance and Values-Based Exposure Treatment for Fibromyalgia: A Pilot Study

Background: Acceptance and commitment therapy (ACT) is a promising treatment option for fibromyalgia (FM). Studies have shown that many cognitive behavioral protocols can be transferred to the Internet with sustained efficacy. However, no study has investigated the effect on an Internet-delivered ACT-based protocol for FM. This study evaluated the efficacy, acceptability, and the health economic effects of an Internet-delivered acceptance and values-based exposure treatment for FM. Methods: This open pilot trial included 41 self-referred women with a FM diagnosis. The 10-week Internet-delivered treatment included acceptance, mindfulness, work with life-values, and systematic exposure to FM symptoms and FM-related situations. Participants also had regular contact with an assigned online therapist. Assessments were made at pretreatment, post-treatment, and 6-month follow-up. Results: The treatment was completed by 70% of the participants. Attrition rates were low, with 98% completing the post-treatment assessment and 90% completing the 6-month follow-up assessment. Multiple imputations were used to replace missing values. Pre- to post-treatment within-group effect sizes were in the moderate to large range (Cohen's d = 0.62–1.56) on measures of FM symptoms and impact, disability, quality of life, depression, anxiety, fatigue, and psychological flexibility. All improvements were maintained at follow-up. Economical analyses revealed significant societal cost reductions that offset the treatment costs within 2 months of treatment completion. Conclusions: An Internet-delivered psychological treatment based on acceptance and exposure principles seems to be an efficacious, acceptable, and cost-effective treatment for FM. Randomized controlled trials are needed to confirm these results.     

Functional Somatic Syndromes and Childhood Physical Abuse in Women: Data From a Representative Community-Based Sample

This study investigated whether childhood physical abuse was associated with functional somatic syndromes (FSS) in women while controlling for age, race, and four clusters of potentially confounding factors: (a) Other childhood adversities, (b) adult health behaviors, (c) socioeconomic status and stressors, and (d) mental health. A regional subsample of the 2005 Canadian Community Health Survey of 7,342 women was used. Women reported whether they had been diagnosed with chronic fatigue syndrome (CFS), fibromyalgia (Fm), irritable bowel syndrome (IBS), or multiple chemical sensitivities (MCS). Fully 749 reported having been physically abused by someone close to them during their youth. When controlling for potentially confounding factors, childhood physical abuse was significantly associated with CFS (OR = 2.11; 95% CI = 1.22, 3.65), Fm (OR = 1.65; 95% CI = 1.08, 2.52), and MCS (OR = 2.82; 95% = CI 1.90, 4.17). Clinicians using reattribution and stepped care approaches in the management of FSS should assess for a history of abuse.     

The prevalence,risk factors and outcomes of workplace bullying among junior doctors: a systematic review

ABSTRACT

Junior doctors’ exposure to bullying may impact their training and compromise quality healthcare, yet little is known in relation to its predictors and effects. The aim of this paper is to assess the prevalence, factors and outcomes of workplace bullying among junior doctors. Literature search was performed to identify all primary studies examining workplace bullying among junior doctors using the following electronic databases: Medline, Scopus, Web of Science, PsycINFO and Cochrane Library. A total of 18 articles were included, reporting on a total of 9,597 junior doctors. The quality of evidence can be rated as moderate according to the Newcastle Ottawa Scale. From the review, a wide range (30–95%) of bullying prevalence, significant differences in bullying rates according to gender, age, height, ethnicity and subspecialty, and significant associations between bullying and mental strain, job dissatisfaction, burnout, and increased accidents at work were observed. Concurrently, heterogeneity in the terms and methodologies used to examine workplace bullying as well as definitional issues in relation to the persistency of negative interactions were noted. Evidence suggests that workplace bullying is a serious occupational hazard for junior doctors, and more research is warranted to better understand this phenomenon and address its definitional and methodological issues.