Distribution by Scientific Domains
Distribution within Medical Sciences

Terms modified by Urge

  • urge incontinence
  • urge urinary incontinence

  • Selected Abstracts

    State Boards of Education Urged to Internationalize Education

    Article first published online: 31 DEC 200
    No abstract is available for this article. [source]

    HUMAN STUDY: Preconscious attentional bias in cigarette smokers: a probe into awareness modulation on attentional bias

    ADDICTION BIOLOGY, Issue 4 2009
    Xiaodan Yan
    ABSTRACT It has been frequently reported that smokers showed attentional bias toward smoking-related stimuli. The current study aimed to examine whether such bias was also present when subjects were unaware of the presented stimuli and the possible role of awareness modulation on attentional bias. With a psychophysical approach (interocular suppression), we suppressed subjects' awareness to the cigarette pictures presented to one of their eyes. The visual dot probe task was modified to increase the perceptual load and to control the physical features between two rivaling images. Twenty-eight male smokers and 25 male non-smokers participated in the experiment. We found a significant interaction between experiment conditions and subject groups, with only the smoker group showed attentional bias toward cigarette pictures in unaware condition. Moreover, smokers' attentional bias in unaware condition was negatively correlated with their scores on Cigarette Dependence Scale while their attentional bias in aware condition was positively correlated with scores on Questionnaires of Smoking Urges. Such dissociation indicates the possibility of awareness modulation on attentional bias: it is possible that in aware condition, the attentional bias was modulated by smoking urge in awareness, thus concealed the effect of dependence degree. Further studies indicated that awareness modulated attentional bias through many factors, such as craving, quit attempt, attitude and disgust. Interestingly, non-smokers also showed attentional bias in aware condition, which further suggested that due to awareness modulation, attentional bias could even be addiction-unrelated. [source]

    Building Bridges: The Transdisciplinary Study of Craving From the Animal Laboratory to the Lamppost

    ALCOHOLISM, Issue 2 2004
    Peter M. Monti
    Abstract: This article represents the proceedings of a symposium at the 2003 Research Society on Alcoholism meeting in Ft. Lauderdale, Florida, organized and chaired by Peter M. Monti. The presentations and presenters were (1) Alcohol Seeking and Self-Administration in Rats: The Role of Serotonin Activity, by Cristine L. Czachowski; (2) Assessing Binge Drinking in Monkeys, by Kathleen A. Grant; (3) Craving and the Perception of Time, by Michael Sayette; (4) Ecological and Laboratory Assessment of Alcohol Urges and Drinking: Effects of Naltrexone, by Peter M. Monti; and (5) Discussion, by Damaris J. Rohsenow. [source]


    ABSTRACT In practices of philanthropy and charity, the impulse to give to immediate others in distress is often tempered by its regulation. Although much of what is written on charity and philanthropy focuses on the effects of the gift, I suggest more attention be paid to the impulse of philanthropy. To coerce the impulse to give into rational accountability is to obliterate its freedom; to render giving into pure impulse is to reinforce social inequality. The only solution is to allow both to exist, and to create structures to encourage them. This essay examines the power of the spontaneous and fleeting impulse to give and its regulation through an analysis of contemporary practices of philanthropy and their relation to sacred conceptions of d,n (donation) in New Delhi. When scriptural ideas of disinterested giving intersect with contemporary notions of social responsibility, new philanthropic practices are formed. On the basis of ethnographic research with philanthropists who built temples, started NGOs, and managed social welfare programs, as well as families who gave d,n daily out of their homes, this essay documents how both NGO and government efforts to regulate one of the most meritorious forms of d,n, gupt d,n (or, anonymous d,n) expresses critical issues in philanthropy between the urge to give in response to immediate suffering and the social obligation to find a worthy recipient for the gift. [source]

    Pathological gambling: an increasing public health problem

    Article first published online: 7 JUL 200
    Gambling has always existed, but only recently has it taken on the endlessly variable and accessible forms we know today. Gambling takes place when something valuable , usually money , is staked on the outcome of an event that is entirely unpredictable. It was only two decades ago that pathological gambling was formally recognized as a mental disorder, when it was included in the DSM-III in 1980. For most people, gambling is a relaxing activity with no negative consequences. For others, however, gambling becomes excessive. Pathological gambling is a disorder that manifests itself through the irrepressible urge to wager money. This disorder ultimately dominates the gambler's life, and has a multitude of negative consequences for both the gambler and the people they interact with, i.e. friends, family members, employers. In many ways, gambling might seem a harmless activity. In fact, it is not the act of gambling itself that is harmful, but the vicious cycle that can begin when a gambler wagers money they cannot afford to lose, and then continues to gamble in order to recuperate their losses. The gambler's ,tragic flaw' of logic lies in their failure to understand that gambling is governed solely by random, chance events. Gamblers fail to recognize this and continue to gamble, attempting to control outcomes by concocting strategies to ,beat the game'. Most, if not all, gamblers try in some way to predict the outcome of a game when they are gambling. A detailed analysis of gamblers' selfverbalizations reveals that most of them behave as though the outcome of the game relied on their personal ,skills'. From the gambler's perspective, skill can influence chance , but in reality, the random nature of chance events is the only determinant of the outcome of the game. The gambler, however, either ignores or simply denies this fundamental rule (1). Experts agree that the social costs of pathological gambling are enormous. Changes in gaming legislation have led to a substantial expansion of gambling opportunities in most industrialized countries around the world, mainly in Europe, America and Australia. Figures for the United States' leisure economy in 1996 show gross gambling revenues of $47.6 billion, which was greater than the combined revenue of $40.8 billion from film box offices, recorded music, cruise ships, spectator sports and live entertainment (2). Several factors appear to be motivating this growth: the desire of governments to identify new sources of revenue without invoking new or higher taxes; tourism entrepreneurs developing new destinations for entertainment and leisure; and the rise of new technologies and forms of gambling (3). As a consequence, prevalence studies have shown increased gambling rates among adults. It is currently estimated that 1,2% of the adult population gambles excessively (4, 5). Given that the prevalence of gambling is related to the accessibility of gambling activities, and that new forms of gambling are constantly being legalized throughout most western countries, this figure is expected to rise. Consequently, physicians and mental health professionals will need to know more about the diagnosis and treatment of pathological gamblers. This disorder may be under-diagnosed because, clinically, pathological gamblers usually seek help for the problems associated with gambling such as depression, anxiety or substance abuse, rather than for the excessive gambling itself. This issue of Acta Psychiatrica Scandinavica includes the first national survey of problem gambling completed in Sweden, conducted by Volberg et al. (6). This paper is based on a large sample (N=9917) with an impressively high response rate (89%). Two instruments were used to assess gambling activities: the South Oaks Gambling Screen-Revised (SOGS-R) and an instrument derived from the DSM-IV criteria for pathological gambling. Current (1 year) and lifetime prevalence rates were collected. Results show that 0.6% of the respondents were classified as probable pathological gamblers, and 1.4% as problem gamblers. These data reveal that the prevalence of pathological gamblers in Sweden is significantly less than what has been observed in many western countries. The authors have pooled the rates of problem (1.4%) and probable pathological gamblers (0.6%), to provide a total of 2.0% for the current prevalence. This 2% should be interpreted with caution, however, as we do not have information on the long-term evolution of these subgroups of gamblers; for example, we do not know how many of each subgroup will become pathological gamblers, and how many will decrease their gambling or stop gambling altogether. Until this information is known, it would be preferable to keep in mind that only 0.6% of the Swedish population has been identified as pathological gamblers. In addition, recent studies show that the SOGS-R may be producing inflated estimates of pathological gambling (7). Thus, future research in this area might benefit from the use of an instrument based on DSM criteria for pathological gambling, rather than the SOGS-R only. Finally, the authors suggest in their discussion that the lower rate of pathological gamblers obtained in Sweden compared to many other jurisdictions may be explained by the greater availability of games based on chance rather than games based on skill or a mix of skill and luck. Before accepting this interpretation, researchers will need to demonstrate that the outcomes of all games are determined by other factor than chance and randomness. Many studies have shown that the notion of randomness is the only determinant of gambling (1). Inferring that skill is an important issue in gambling may be misleading. While these are important issues to consider, the Volberg et al. survey nevertheless provides crucial information about gambling in a Scandinavian country. Gambling will be an important issue over the next few years in Sweden, and the publication of the Volberg et al. study is a landmark for the Swedish community (scientists, industry, policy makers, etc.). This paper should stimulate interesting discussions and inspire new, much-needed scientific investigations of pathological gambling. Acta Psychiatrica Scandinavica Guido Bondolfi and Robert Ladouceur Invited Guest Editors References 1.,LadouceurR & WalkerM. The cognitive approach to understanding and treating pathological gambling. In: BellackAS, HersenM, eds. Comprehensive clinical psychology. New York: Pergamon, 1998:588 , 601. 2.,ChristiansenEM. Gambling and the American economy. In: FreyJH, ed. Gambling: socioeconomic impacts and public policy. Thousand Oaks, CA: Sage, 1998:556:36 , 52. 3.,KornDA & ShafferHJ. Gambling and the health of the public: adopting a public health perspective. J Gambling Stud2000;15:289 , 365. 4.,VolbergRA. Problem gambling in the United States. J Gambling Stud1996;12:111 , 128. 5.,BondolfiG, OsiekC, FerreroF. Prevalence estimates of pathological gambling in Switzerland. Acta Psychiatr Scand2000;101:473 , 475. 6.,VolbergRA, AbbottMW, RönnbergS, MunckIM. Prev-alence and risks of pathological gambling in Sweden. Acta Psychiatr Scand2001;104:250 , 256. 7.,LadouceurR, BouchardC, RhéaumeNet al. Is the SOGS an accurate measure of pathological gambling among children, adolescents and adults?J Gambling Stud2000;16:1 , 24. [source]

    Effect of an antismoking advertisement on cinema patrons' perception of smoking and intention to smoke: a quasi-experimental study

    ADDICTION, Issue 7 2010
    Reiner Hanewinkel
    ABSTRACT Aims To assess the effect of an antismoking advertisement under real-world conditions. Design Quasi-experimental study. Setting/participants Multiplex cinema in Kiel, Germany; 4073 patrons were surveyed after having viewed a movie. Some 4005 patrons were ,10 years old (28.7% between 10 and 17 years). A total of 654 subjects (16.3%) were smokers. Intervention In the intervention condition (weeks 1 and 3), a 30-second antismoking advertisement,accentuating long-term health consequences of smoking and promoting cessation,was shown prior to all movies; in the control condition (weeks 2 and 4) no such spot was shown. Main outcome measures (i) Awareness of smoking in the movie, (ii) approval of smoking in the movie, (iii) attitude towards smoking, (iv) intention to smoke in the future and (v) desire to smoke among smokers. Findings Patrons who were exposed to the antismoking advertisement were more likely to be female, but did not differ with respect to smoking status. After controlling for gender differences, patrons exposed to the antismoking advertisement had (i) higher awareness of smoking in the movies, (ii) lower levels of approval of smoking in the movies, and (iii) a more negative attitude towards smoking in general compared with those not exposed. Among smokers, smoking in the movies increased urge to smoke, but there was no interaction between smoking in the movies and experimental condition. Conclusions Study results suggest that placing an antismoking advertisement before movies can affect attitudes towards smoking, bolstering evidence in support of such policies. [source]

    Do the Transtheoretical Model processes of change, decisional balance and temptation predict stage movement?

    ADDICTION, Issue 5 2009
    Evidence from smoking cessation in adolescents
    ABSTRACT Aims To examine the effects of processes of change (POC) on forward stage movement directly, indirectly through decisional balance and temptation, and total effects as a test of the key hypothesis of the Transtheoretical Model (TTM). Design Prospective cohort study. Setting United Kingdom. Participants A total of 1160 adolescents aged 13,14 years who were current or former smokers at baseline. Measurements Stage was assessed with the standard algorithm three times, once every 3 months. On each occasion the POC, decisional balance and temptation were measured with the standard questionnaires. Path analysis was used to examine the direct, indirectly mediated and total contribution of POC and the other constructs to stage movement 3 months later. Findings Four of the 24 analyses showed evidence that the theoretically appropriate POC predicted stage transition, with statistically significant total effects. Effect sizes were small. When the POC were summarized to experiential and behavioural process means, one transition from pre-contemplation was predicted by experiential processes and, contrary to the TTM, one transition predicted by behavioural processes. There was slightly more evidence that decisional balance (attitudes towards smoking) and temptation (ability to resist the urge to smoke) was associated with stage transition. Conclusions POC use was not associated generally with stage transition and evidence that effects, if missed, must be modest, giving no support to the central tenet of the TTM. [source]

    Genital Automatisms: A Video-EEG Study in Patients with Medically Refractory Seizures

    EPILEPSIA, Issue 7 2004
    Judith Dobesberger
    Summary:,Purpose: Genital automatisms (GAs) are rare clinical phenomena during or after epileptic seizures. They are defined as repeated fondling, grabbing, or scratching of the genitals. The anatomic correlates of GAs have been discussed controversially. The aim of this investigation was to assess the localizing and lateralizing value of GAs. Methods: The authors studied 207 consecutive patients with intractable seizures referred to a University Hospital for presurgical evaluation between 1998 and 2002: 135 had temporal lobe epilepsy (TLE); 23, frontal lobe epilepsy (FLE); 29, generalized epilepsies (GEs); and 20 had extratemporal or multifocal epilepsy. Results: Twenty-three (11%) of 207 patients showed GAs in 42 (3%) of 1,299 seizures. GAs occurred significantly more often in men (17 of 93, 18%) than in women (six of 114, 5%; p = 0.0037). Twenty-one (16%) of 135 patients with TLE performed GAs, one (4%) of 23 with FLE and one (3%) of 29 with GE. GAs were associated with unilateral hand automatisms in 16 (70%) of 23 and with periictal urinary urge in five (22%) of 23. All patients had amnesia for the performance of GAs. Conclusions: GAs appear in the ictal or postictal period with impaired consciousness. Men exhibit GAs significantly more often than do women. GAs do not localize or lateralize per se, but may localize seizure onset in the presence of periictal urinary urge or unilateral hand automatisms. They show a tendency to occur more often in TLE. [source]

    Motivational enhancement and coping skills training for cocaine abusers: effects on substance use outcomes

    ADDICTION, Issue 7 2004
    Damaris J. Rohsenow
    Abstract Aims This clinical trial investigated effects of motivational enhancement treatment (MET) and group coping-skills training (CST) tailored for cocaine dependence. Effects of MET were hypothesized to be greater with CST and for less motivated patients. Design and interventions A 2 × 2 design investigated two individual sessions of MET compared to meditation,relaxation (MRT), followed by four group sessions of CST versus drug education (ED), as daily adjuncts to intensive treatment. Setting The substance abuse program provided full-day treatment with a learning-theory and 12-Step orientation. Participants Cocaine-dependent patients were recruited. Measurements Assessment included treatment retention; change in cocaine-related urge, self-efficacy, pros and cons, and motivation; substance use and problems during 12-month follow-up. Findings Of 165 patients, follow-up status is known for 90% (n = 149). Patients in MET with low initial motivation to change reported less cocaine and alcohol relapse and use days and fewer alcohol problems than MET patients with higher initial motivation. MET produced more employment improvement than MRT, with no other significant benefit for MET. Patients with higher motivation had more cocaine use and alcohol problems after MET than MRT. Group CST reduced cocaine and alcohol use during follow-up for women only and reduced alcohol relapse for men and women. Conclusions MET is more beneficial for patients with lower initial motivation than for patients with high initial motivation. CST reduced cocaine and alcohol use for women only and reduced alcohol relapses, in contrast to results with lengthier individual CST. [source]

    RESEARCH FOCUS ON COMPULSIVE BEHAVIOUR IN ANIMALS: Compulsive alcohol drinking in rodents

    ADDICTION BIOLOGY, Issue 4 2009
    Valentina Vengeliene
    ABSTRACT Upon prolonged alcohol exposure, the behaviour of an individual can gradually switch from controlled to compulsive. Our review is focused on the neurobiological mechanisms that might underlie this transition as well as the factors that are influencing it. Animal studies suggest that temporally increased alcohol consumption during post-abstinence drinking is accompanied by a loss of flexibility of the behaviour and therefore, could serve as a model for compulsive alcohol drinking. However, studies using different alcohol-preferring rat lines in the post-abstinence drinking model suggest that high alcohol consumption does not necessarily lead to the development of compulsive drinking. This indicates the significance of genetic predisposition to compulsive behaviour. Neuroimaging data show that chronic alcohol consumption affects the activity of several brain regions such as the extrapyramidal motor system and several areas of the prefrontal cortex including the orbitofrontal and anterior cingulate cortex. Similar changes in brain activity is seen in patients suffering from obsessive,compulsive disorder at baseline conditions and during provocation of obsessive thoughts and urge to perform compulsive-like rituals. This indicates that dysfunction of these regions may be responsible for the expression of compulsive components of alcohol drinking behaviour. Several brain neurotransmitter systems seem to be responsible for the switch from controlled to compulsive behaviour. In particular, hypofunctioning of monoaminergic systems and hyperfunctioning of glutamatergic systems may play a role in compulsive alcohol drinking. [source]

    HUMAN STUDY: Preconscious attentional bias in cigarette smokers: a probe into awareness modulation on attentional bias

    ADDICTION BIOLOGY, Issue 4 2009
    Xiaodan Yan
    ABSTRACT It has been frequently reported that smokers showed attentional bias toward smoking-related stimuli. The current study aimed to examine whether such bias was also present when subjects were unaware of the presented stimuli and the possible role of awareness modulation on attentional bias. With a psychophysical approach (interocular suppression), we suppressed subjects' awareness to the cigarette pictures presented to one of their eyes. The visual dot probe task was modified to increase the perceptual load and to control the physical features between two rivaling images. Twenty-eight male smokers and 25 male non-smokers participated in the experiment. We found a significant interaction between experiment conditions and subject groups, with only the smoker group showed attentional bias toward cigarette pictures in unaware condition. Moreover, smokers' attentional bias in unaware condition was negatively correlated with their scores on Cigarette Dependence Scale while their attentional bias in aware condition was positively correlated with scores on Questionnaires of Smoking Urges. Such dissociation indicates the possibility of awareness modulation on attentional bias: it is possible that in aware condition, the attentional bias was modulated by smoking urge in awareness, thus concealed the effect of dependence degree. Further studies indicated that awareness modulated attentional bias through many factors, such as craving, quit attempt, attitude and disgust. Interestingly, non-smokers also showed attentional bias in aware condition, which further suggested that due to awareness modulation, attentional bias could even be addiction-unrelated. [source]

    Epicureanism and the poetics of consumption

    Dawn Wood
    Abstract Consumption, ,to use up, to destroy', is a dirty word. It conjures piles of rubbish; it suggests an extravagant attitude. We, each one of us hoping to be a unique, careful individual, can feel offended at being referred to as ,the consumer'. Yet, ,to consume' is not only a human activity, it is one of the fundamental processes of nature, a natural aspect of the creative process. In this paper, I will emphasize connections between the creative research process, poetics and consumerism. I suggest that research can be envisioned as a cycle of consumption and renewal. Our tools in such a natural philosophy are the contemplation of natural events, and the insights that a poetic understanding of language can give us. To this end, I draw on the ancient Epicurean philosophy, as demonstrated in De rerum natura, written by the Roman poet, Lucretius, in the first century BCE. Lucretius gave a scientific explanation of the universe, in poetry, to demonstrate that natural laws can be derived by reason, contemplation and by the use of the senses. Further, Lucretius' use of language, as a creative medium, modelled the actions of the universe. This insight provides a link between poetry, science and research, one which is still relevant to twenty-first-century scientific research generally. In this paper, I will suggest that it is also specifically relevant to the design and practice of consumer research. For instance, both research and creativity are aspects of that urge to move beyond subjectivity, towards knowledge that is whole and shared. In Epicureanism, subjective engagement provides access to that which is universal. We can conceive of consumerism, and of consumer research, in the same terms, as a striving for completion, and as a poetic, natural and reciprocal act, involving the transformation of the consumer, and that which is consumed. [source]

    Understanding the biodiversity consequences of habitat change: the value of secondary and plantation forests for neotropical dung beetles

    Toby A. Gardner
    Summary 1Secondary and plantation forests are becoming increasingly widespread in the tropics. A recent meta-analysis on the impacts of land-use change on tropical forest dung beetles concluded that regenerating forests can be effective in helping to offset species loss following deforestation. However, our understanding of the extent to which these results can be generalized to new locations remains very poor. 2We attempted to overcome many of the design limitations that characterize previous studies by collecting spatially independent dung beetle samples from primary, secondary and Eucalyptus plantation forests in north-east Brazilian Amazonia across a large quasi-experimental landscape that minimized confounding edge and fragmentation effects. 3We recorded 9203 dung beetles, comprising 85 species. Species richness was significantly higher in primary forest and the majority of species were more abundant there than elsewhere, whereas secondary and plantation sites harboured an impoverished subset of primary forest species. 4Our data illustrate the low value of tropical secondary and plantation forests for dung beetles in our study area, and our conclusions are more pessimistic than those of earlier studies. 5Because of differences in the order of species rank-abundance and rank-biomass patterns, re-coding community data from abundance to biomass significantly altered the analytical weight of individual species in determining community patterns. Larger bodied beetles were more prone to local extinctions and abundance declines and this effect was consistent both within and between genera. 6Synthesis and applications. Our study demonstrates that secondary and plantation forests in a large neotropical landscape host exceptionally impoverished dung beetle communities. Furthermore, the depletion of beetle abundance combined with a reduction in average body mass in converted forests is likely to have detrimental consequences for the maintenance of dung beetle-mediated ecosystem services in these habitats. Differences in biogeographical and landscape context, and the influence of common limitations in sampling design, may explain why many other studies have painted a more optimistic picture of the conservation value of anthropogenic habitats. In the absence of further evidence we caution strongly against the claim that forest regeneration schemes on degraded land can effectively offset the loss of species following deforestation, and urge that conservation strategies prioritize the protection of remaining areas of primary forest. [source]

    Are bigger acquisitions always better?

    David A. Burnie
    Making an acquisition is a lot like getting married. About half the time, it doesn't work out. And the only people who "live happily ever after" are the lawyers. Nevertheless, the urge to merge seems to be on the rise again. More mega-deals may be on the horizon. But is bigger always better? To answer this question, the authors analyzed four large acquisitions. They also examined what really enhances value, why some deals fail to add value, and some important accounting issues. © 2005 Wiley Periodicals, Inc. [source]

    Post-colonial Fragments: Representations of Abortion in Irish Law and Politics

    Ruth Fletcher
    The Republic of Ireland has become infamous for its legal stance against abortion, especially since it went as far as stopping, albeit temporarily, a young rape victim from travelling abroad for an abortion in 1992. I argue that one of the rationales behind anti-abortion law is a post-colonial urge to mark Irishness distinctively by constructing it in exclusively ,pro-life' terms. I discuss examples of how Irish colonial experiences have been used to justify the effort to keep Ireland abortion-free, and to resist that effort. Representations of colonial history in the context of Irish abortion law and politics have changed over time and between groups. Such changes indicate a need for post-colonial critique to account for the fragmentation of colonialism as it is displaced, a need which the conceptualization of post-coloniality as a historical object can address. [source]

    Effects of Alcohol Cue Exposure on Response Inhibition in Detoxified Alcohol-Dependent Patients

    ALCOHOLISM, Issue 9 2010
    Siegfried Gauggel
    Background:, There is evidence that exerting self-control during alcohol craving can diminish performance on subsequent tasks that require self-control. Based on the resource depletion model (Muraven and Baumeister, 2000), we examined the influence of alcohol cue exposure on detoxified alcohol-dependent patients' ability to inhibit ongoing responses. Methods:, Twenty alcohol-dependent patients were randomly assigned to an alcohol-cue exposure and a control-cue exposure condition and thereafter had to perform an inhibition task (i.e., stop-signal task). Results:, Participants who sniffed alcohol before performing the inhibition task reported a stronger urge to drink alcohol than the control group that sniffed water. Participants who sniffed alcohol were also impaired in their inhibitory performance but not in their noninhibitory performance on the stop-signal task. Conclusions:, The urge to drink presumably reduced participants' self-control, and this interfered with their ability to inhibit responding. [source]

    Altered Impulse Control in Alcohol Dependence: Neural Measures of Stop Signal Performance

    ALCOHOLISM, Issue 4 2009
    Chiang-shan Ray Li
    Background:, Altered impulse control has been implicated in the shaping of habitual alcohol use and eventual alcohol dependence. We sought to identify the neural correlates of altered impulse control in 24 abstinent patients with alcohol dependence (PAD), as compared to 24 demographics matched healthy control subjects (HC). In particular, we examined the processes of risk taking and cognitive control as the neural endophenotypes of alcohol dependence. Methods:, To this end, functional magnetic resonance imaging (fMRI) was conducted during a stop signal task (SST), in which a procedure was used to elicit errors in the participants. The paradigm allowed trial-by-trial evaluation of response inhibition, error processing, and post-error behavioral adjustment. Furthermore, by imposing on the subjects to be both fast and accurate, the SST also introduced a distinct element of risk, which participants may or may not avert during the task. Brain imaging data were analyzed with Statistical Parametric Mapping in covariance analyses accounting for group disparity in general performance. Results:, The results showed that, compared to HC, PAD demonstrated longer go trial reaction time (RT) and higher stop success rate (SS%). HC and PAD were indistinguishable in stop signal reaction time (SSRT) and post-error slowing (PES). In a covariance analysis accounting for go trial RT and SS%, HC showed greater activity in the left dorsolateral prefrontal cortex than PAD, when subjects with short and long SSRT were contrasted. By comparing PAD and HC directly during stop errors (SE), as contrasted with SS, we observed greater activity in PAD in bilateral visual and frontal cortices. Compared to HC, PAD showed less activation of the right dorsolateral prefrontal cortex during PES, an index of post-error behavioral adjustment. Furthermore, PAD who showed higher alcohol urge at the time of the fMRI were particularly impaired in dorsolateral prefrontal activation, as compared to those with lower alcohol urge. Finally, compared to HC subjects, PAD showed less activity in cortical and subcortical structures including putamen, insula, and amygdala during risk-taking decisions in the SST. Conclusion:, These preliminary results provided evidence for altered neural processing during impulse control in PAD. These findings may provide a useful neural signature in the evaluation of treatment outcomes and development of novel pharmacotherapy for alcohol dependence. [source]

    A Functional Polymorphism of the , -Opioid Receptor Gene (OPRM1) Influences Cue-Induced Craving for Alcohol in Male Heavy Drinkers

    ALCOHOLISM, Issue 1 2007
    Esther Van Den Wildenberg
    Background: The , -opioid receptor gene (OPRM1) codes for the , -opioid receptor, which binds , -endorphin. The A118G polymorphism in this gene affects , -endorphin binding such that the Asp40 variant (G allele) binds , -endorphin 3 times more tightly than the more common Asn40 variant (A allele). This study investigated the influence of the A118G polymorphism on cue reactivity after exposure to an alcoholic beverage in male heavy drinkers. Methods: Participants were either homozygous for the A allele (n=84) or carrying at least 1 copy of the G allele (n=24). All participants took part in a cue-reactivity paradigm where they were exposed to water and beer in 3-minute trials. The dependent variables of main interest were subjective craving for alcohol, subjective arousal, and saliva production. Results: G allele carriers reported significantly more craving for alcohol than the A allele participants (as indicated by the within-subject difference in craving after beer vs after water exposure). No differences were found for subjective arousal and saliva. Both groups did not differ in family history of alcoholism. Participants with the G allele reported a significantly higher lifetime prevalence of drug use than participants homozygous for the A allele. Conclusions: A stronger urge to drink alcohol after exposure to an alcoholic beverage might contribute to a heightened risk for developing alcohol-related problems in individuals with a copy of the G allele. The G allele might also predispose to drug use in general. [source]

    Recognition, diagnosis, and treatment of restless legs syndrome

    ARNP (Adult Nurse Practitioner, Jennifer E. Smith MSN, Manager of an Anticoagulation Clinic)
    Abstract Purpose: To review the symptoms, diagnosis, and treatment of restless legs syndrome (RLS) and its relevance to nurse practitioners (NPs). Data sources: Comprehensive review of the scientific literature on the diagnosis and treatment of RLS in adults. Conclusions: RLS is a chronic neurological disorder that, with varying degrees of severity, affects 5%,10% of the general population. Because of the circadian pattern of onset, the symptoms of RLS may be associated with significant sleep disturbance and may have a negative impact on quality of life. RLS is characterized by a compelling urge to move the legs and usually accompanied or caused by uncomfortable sensations in the legs. Symptoms begin or worsen during periods of rest or inactivity and are worse in the evening or at night. Other features supportive of a diagnosis include a family history, the presence of periodic leg movements in sleep, and the relief of symptoms after treatment with a dopaminergic therapy. Although the etiology of RLS is unknown, it is thought that symptoms result from a central dopaminergic dysfunction and dopamine agonists are considered first-line treatment for moderate-to-severe primary RLS. Nondopaminergic therapies and nonpharmacologic interventions may also be appropriate in the management of less severe cases of RLS. Implications for practice: NPs are often the first healthcare providers to see patients with RLS and therefore need to be able to accurately recognize and diagnose the disorder; this, in turn, will enable them to successfully manage the treatment of RLS. [source]

    Naltrexone and Cue Exposure With Coping and Communication Skills Training for Alcoholics: Treatment Process and 1-Year Outcomes

    ALCOHOLISM, Issue 11 2001
    Peter M. Monti
    Background: Promising treatments for alcoholics include naltrexone (NTX), cue exposure combined with urge-specific coping skills training (CET), and communication skills training (CST). This study investigated the effects of combining these elements as treatment adjuncts. Methods: A 2 × 2 design investigated the effects of CET combined with CST, as compared with an education and relaxation control treatment, during a 2-week partial hospital program (n= 165) followed by 12 weeks of NTX (50 mg/day) or placebo during aftercare (n= 128). Drinking outcomes were assessed at 3, 6, and 12 months after discharge from the partial hospital. Process measures included urge, self-efficacy (confidence about staying abstinent in risky situations), and self-reported coping skills. Medically eligible alcohol-dependent patients were recruited. Results: Among those compliant with medication on at least 70% of days, those who received NTX had significantly fewer heavy drinking days and fewer drinks on days that they drank than those receiving placebo during the medication phase but not during the subsequent 9 months. CET/CST-condition patients were significantly less likely to report a relapse day and reported fewer heavy drinking days at the 6- and 12-month follow-ups than patients in the control treatment. Interactions of medication with behavioral treatments were not significant. Process measures showed that NTX resulted in lower weekly urge ratings, and those in CET/CST used more of the prescribed coping skills after treatment, reported fewer cue-elicited urges, and reported more self-efficacy in a posttest role-play test. Drinking reductions at 3, 6, and 12 months correlated with more use of coping skills, lower urge, and higher self-efficacy. Conclusions: The results suggest the probable value of keeping alcoholics on NTX for longer periods of time and the importance of increasing compliance with NTX. They also support the earlier promising effects of CET and CST as adjuncts to treatment programs for alcoholics by maintaining treatment gains over at least a year. The value of the urge-specific and general coping skills and of self-efficacy and urge constructs was demonstrated in their association with drinking outcomes. [source]

    A Social Proximity Explanation of the Reluctance to Assimilate

    C. Simon Fan
    SUMMARY The pursuit of migration is an extreme example of the severing of ties with, or a distancing from, one's friends and home. The ,failure' of migrants to assimilate cannot plausibly be attributed merely to an urge to stay close to their friends, or they might not have migrated to begin with. Non-assimilation arises from a fear of enhanced relative deprivation if they reduce their distance from the natives as a reference group. Fundamentally, migration is a change of those with whom people associate. But it would be wrong to infer that a change of associates crowds out a change of behavior, given the associates. Through their actions, migrants can elect to associate more with some groups, less with others. However, when actions to keep in check the weight accorded to the rich natives as a reference group are not viable, the very choice of migration destination could be affected in an unexpected way: a country that is not so rich could be preferable to a country that is rich; migrants will protect themselves from an unfavorable comparison by not migrating to where the comparison, when unavoidable, would be highly unfavorable. Relatedly, the variance in the assimilation effort of migrants across host countries could arise from the variance in the income distance with the natives: the richer the natives, the weaker the effort to assimilate, other things held the same. [source]

    Playing and resisting: rethinking young people's reading cultures

    LITERACY, Issue 3 2008
    Alex Kendall
    In this paper I will argue that while young adult readers may often be represented through ,othering' discourses that see them as ,passive', ,uncritical' consumers of ,low-brow', ,throw-away' texts, the realities of their reading lives are in fact more subtle, complex and dynamic. The paper explores the discourses about reading, identity and gender that emerged through discussions with groups of young adults, aged between 16 and 19, about their reading habits and practices. These discussions took place as part of a PhD research study of reading and reader identity in the context of further education in the Black Country in the West Midlands. Through these discussions the young adults offered insights into their reading cultures and the ,functionality' of their reading practices that contest the kinds of ,distinction[s]' that tend to situate them as the defining other to more ,worthy' or ,valuable' reading cultures and practices. While I will resist the urge to claim that this paper represents the cultures of young adult readers in any real or totalising sense I challenge the kinds of dominant, reductive representations that serve to fix and demonise this group and begin to draw a space within which playfulness and resistance are alternatively offered as ways of being for these readers. [source]

    Novel Biomarkers for Diagnosis and Therapeutic Assessment of Overactive Bladder: Urinary Nerve Growth Factor and Detrusor Wall Thickness

    LUTS, Issue 2009
    Hann-Chorng KUO
    Clinical diagnosis of overactive bladder (OAB) varies greatly and is based on subjective symptoms. A better way to diagnose and assess therapeutic outcome in patients who present with OAB needs to be developed. Evidence has shown that urinary proteins, such as nerve growth factor (NGF) and prostaglandin E2 (PGE2) levels increase in patients with OAB, bladder outlet obstruction (BOO) and detrusor overactivity (DO). Urinary NGF level increases physiologically in normal subjects at urge to void, but increases pathologically in OAB patients at small bladder volume and at urgency sensation. Patients with OAB dry and OAB wet have significantly higher urinary NGF levels compared to controls and patients with increased bladder sensation. Urinary NGF levels decrease after antimuscarinic therapy and further decrease after detrusor botulinum toxin injections in refractory OAB. A higher urinary NGF level could be a biomarker for sensory nerve-mediated DO. Urinary NGF levels could be a potential biomarker for diagnosis of OAB and serve for the assessment of the therapeutic effect of antimuscarinic therapy. Another potential biomarker for the diagnosis of OAB is detrusor wall thickness. It has been hypothesized that the bladder wall increases in thickness in patients with OAB. The thickened detrusor wall might decrease in response to antimuscarinic treatment, and measurement of detrusor wall thickness might be a useful biomarker for the evaluation of OAB. However, current investigations do not yet provide a uniform observation among various studies. [source]

    Definition of restless legs syndrome, how to diagnose it, and how to differentiate it from RLS mimics

    MOVEMENT DISORDERS, Issue S18 2007
    Heike Benes MD
    Abstract Restless legs syndrome (RLS) is a clinical diagnosis based primarily on self-reports of individuals. The International RLS Study Group has published diagnostic criteria that are essential for an operational diagnosis of RLS; further clinical features are considered by the group supportive for or associated with RLS. However, sensitivity and specificity are not perfect and "mimics" of RLS have been reported, i.e., other conditions like nocturnal cramps sometimes can appear to fulfill the essential diagnostic criteria indicating the need for more thorough understanding of the diagnostic criteria and better differential diagnoses. To contribute to the accuracy of diagnostic processes in RLS, we recapitulate the definition of RLS as an urge to move focused on the legs (and arms in some patients). This urge to move often but not always occurs together with dysesthesia, i.e. unpleasant abnormal sensations appearing without any apparent sensory stimulation. The urge to move and any accompanying dysesthesia must be engendered by rest, relieved by movement and worse in the evening or night. Succinctly, RLS can be summarized in medical terminology as a "movement-responsive quiescegenic nocturnal focal akathisia usually with dysesthesias." Empirical approaches to investigate the independence of the essential criteria "worsening at night" and "worsening at rest" are reported. Possible differential diagnoses of RLS are discussed under the perspective of the NIH diagnostic criteria of RLS. Standardized methods to assess a RLS diagnosis are presented which might improve differential diagnosis and in general the reliability and validity of RLS diagnosis. © 2007 Movement Disorder Society [source]

    Bladder dysfunction in Parkinsonism: Mechanisms, prevalence, symptoms, and management

    MOVEMENT DISORDERS, Issue 6 2006
    Kristian Winge MD
    Abstract The advent of functional imaging methods has increased our understanding of the neural control of the bladder. This review examines current concepts of the role of brain function in urinary control with particular emphasis on the putative role of dopamine receptors. Dopaminergic mechanisms play a profound role in normal bladder control and the dysfunction of these may result in symptoms of overactive bladder in Parkinsonism. The importance of this nonmotor disorder has been overlooked. We address the problem of bladder dysfunction as it presents to patients and their neurologist. The prevalence of bladder symptoms in Parkinson's disease is high; the most common complaint is nocturia followed by frequency and urgency. In multiple-system atrophy, the combination of urge and urge incontinence and poor emptying may result in a complex combination of complaints. The management of bladder dysfunction in Parkinsonism addresses treatment of overactive detrusor as well as incontinence. © 2006 Movement Disorder Society [source]

    Patient reported and anatomical outcomes after surgery for pelvic organ prolapse,,

    Ahmed S. El-Azab
    Abstract Aim Primary aim was to modify Pelvic Floor Distress Inventory (PFDI) and Pelvic Floor Impact Questionnaire (PFIQ) to assess pelvic organ prolapse (POP) in Arabic Muslim women. Secondary aim was to compare functional and anatomical outcomes of POP repair. Methods Questionnaire. A characteristic (prayer) was added to PFIQ. Linguistic validation of questionnaires was then done. Twenty cases were enrolled in a pilot study to test internal consistency and reliability. Subsequent study. Prospective study included women with symptomatic POP,,,stage II. History, examination by POP-Q, and administration of PFDI and PFIQ, were done before and 6 months after surgery. Results Questionnaire. Internal consistency of added question was good (Cronbach ,,=,0.78). Test,retest reliability of individual PFIQ items was variable. Subsequent Study. Between September 2004 and February 2007, 78 consecutive women were included. Cystocele, rectocele, and no site predominated in 74.4%, 17.9% and 7.7% of cases, respectively. Preoperatively 19.2%, 15.4% and 47.4% reported stress, urge, and mixed incontinence, respectively. Overall and individual urinary symptoms scores improved significantly after surgery. There were significant improvements in individual symptoms of constipation, splint to defecate and losing not well formed stools. Low self-esteem was most negative impact of prolapse on quality of life (QoL) followed by prayer. After surgery 90% of subjects had anatomical cure. After surgery, QoL issues are significantly related to anatomic location of prolapse as determined by POP-Q. Conclusions Modified PFIQ and PFDI are suitable to assess POP among Muslim women. Postoperatively, many prolapse-related symptoms and QoL significantly improve after surgery on the short term with an anatomic cure rate of 90%. Neurourol. Urodynam. 28:219,224, 2009. © 2008 Wiley-Liss, Inc. [source]

    Defining overactive bladder as hypersensitivity,

    Osamu Yamaguchi
    Abstract Overactive bladder (OAB), according to the International Continence Society (ICS) definition, is a symptom syndrome, with urgency as the cornerstone symptom. However, the word ,urgency' and its definition continue to be the subject of much debate and confusion. It is generally difficult for patients to differentiate urgency from normal urge, particularly when the desire to void is strong. To investigate the micturition behavior associated with OAB, we conducted a Patient Trust Study in 21 intelligent (i.e., to be ,trusted') female patients who could clearly and accurately discriminate between urgency and urge. The results showed that in 43% of patients seeking medical care, urgency episodes occurred less than once/day, and some patients had days without urgency. Our patients deferred voiding until bladder sensation was relatively strong, suggesting that coping was not common among these patients. Four of the 21 patients studied experienced spontaneous resolution of several urgency episodes. At volumes exceeding 40% of the maximum bladder volume (MBV), urgency episodes occurred frequently and independently of the bladder volume, indicating that 40% of the MBV may be a threshold of bladder volume to induce urgency. A linear relationship was observed between bladder volume and increasing bladder sensation. However, compared with normal subjects, urge sensation increased markedly at any given bladder volume among patients with OAB in our study. This hypersensitivity was observed in our patients regardless of urgency episodes. We therefore hypothesized that OAB may be more accurately defined as a hypersensitivity disorder rather than a syndrome characterized by urgency. Neurourol. Urodynam. 26:904,907, 2007. © 2007 Wiley-Liss, Inc. [source]

    Bladder diary patterns in detrusor overactivity and urodynamic stress incontinence,

    Matthew Parsons
    Abstract Aims Our aims were: (1) to describe and compare frequency-volume and incontinence episode patterns in patients with urodynamic stress incontinence (USI) and detrusor overactivity (DO) as measured by a hand-written and computer-analyzed bladder diary and (2) to compare degree of separation between these clinical groups produced by raw diary measurements and after age- and total-volume-adjustment against a reference population. Materials and Methods We studied 58 patients with USI, 29 with DO, and 22 with both USI and DO. From 3-day hand-written and computer-analyzed bladder diaries, we calculated average and maximum volume voided (Vol/Void), voiding frequency and volume voided over 24 hr, and number, size and type (whether accompanied by activity or urge) of incontinence episodes. Results Compared to the USI patients, the DO patients tended to have (1) higher voiding frequency, (2) lower Vol/Void, (3) more urge-related, than activity-related leaks, (4) smaller volume, and equally frequent leaks and (5) more severe incontinence symptoms. The age- and volume-adjusted percentiles better separated the USI and DO groups' frequency and volume measurements than did the raw measurements. Unexpectedly high percentages of our USI patients had low Vol/Void measurements, high voiding frequency, and predominantly urge-related leaks. A subgroup of 29 USI patients with "low" (average volume <30th reference population percentile) Vol/Void measurements had high incidences of urgency and urge-related leaks. Conclusions Reference population percentiles better separate the frequency/volume patterns of USI and DO than do the raw measurements. We found a subgroup of USI patients that had an OAB-like clinical picture. Neurourol. Urodynam. 26:800,806, 2007. © 2007 Wiley-Liss, Inc. [source]

    The tension free vaginal tape operation for women with mixed incontinence: Do preoperative variables predict the outcome?

    Sigurd Kulseng-Hanssen
    Abstract Aims The aims of our study were (1) to investigate subjective and objective outcomes after tension free vaginal tape (TVT) operations in mixed incontinent women, (2) to detect if preoperative subjective and objective variables predict the outcome, and (3) to evaluate whether the surgical outcome is different for women who preoperatively find stress incontinence, urge incontinence, or urge and stress incontinence equally the predominant bother. Methods A prospective cohort study was performed on 450 mixed incontinent women. A short-form disease-specific validated questionnaire, 24-hr pad test, standardized stress test, residual urine, and maximum urinary flow were used before and after a TVT operation. "Cure" was defined as a condition where the women were very satisfied with the TVT operation and had negative stress- and 24 hr pad tests. Results Preoperatively 69% had stress incontinence, 7% urge incontinence, and 24% urge and stress incontinence equally as the predominant bother. Cure rates were 80%, 52%, and 60%, respectively, in these groups. Postoperatively 43% of the women had no urge incontinence, while 49% were less, and only 8% were more bothered by urge incontinence. A higher preoperative urge incontinence index was correlated with significantly higher postoperative bother for all indices and leakage during 24-hr pad test. Conclusions Mixed incontinent women with predominant stress incontinence had a better cure rate than those with predominant urge incontinence and those who were equally bothered by urge and stress incontinence. This point needs to be addressed when informing mixed incontinent women before a TVT operation. Neurourol. Urodynam. © 2006 Wiley-Liss, Inc. [source]

    External anal sphincter contraction during cough: Not a simple spinal reflex,

    Xavier Deffieux
    Abstract Aims: To assess whether the anal contraction during voluntary coughing is a simple spinal reflex-mediated activity or not. To address this question we studied the external intercostal (EIC) muscle activity and external anal sphincter (EAS) response to cough. Materials and Methods: Electromyographic recordings were made from pre-gelled disposable surface electrodes. EAS electromyographic recordings were made from the EAS of the pelvic floor in 15 continent women all suffering from urgency and/or frequency without urge or stress urinary incontinence, and referred for urodynamic investigation. Electromyographic signal was immediately integrated (EMGi). The abdominal pressure was recorded with bladder and rectal pressure. EAS EMGi was recorded during successive voluntary cough. In three women, we have also recorded EIC EMGi activity since it is synchronous with diaphragmatic EMG activity during cough initiation. Results: In all subjects, EAS EMGi activity precedes the onset of the abdominal pressure increase. The mean latency of EAS EMGi was 615 msec (±278). In the three subjects whose EMGi activity was recorded both on EAS and EIC, the onset of EAS EMGi activity occurred before the EIC EMGi activity (latency ranging from 40 to 780 msec) and before the increase in the abdominal pressure. Conclusions: The present study suggests that during coughing, EAS EMG activity increases before external intercostal muscle EMGi activity. The contraction of the EAS preceding the activation of muscles involved in coughing indicates that this response is not a result of a simple spinal reflex, but more likely the result of a more intricate reflex involving complex integrative centers. Neurourol. Urodynam. 25:782,787, 2006. © 2006 Wiley-Liss, Inc. [source]