Standardized Map of Iodine Status in Europe.

Background: Knowledge about the population's iodine status is important, because it allows adjustment of iodine supply and prevention of iodine deficiency. The validity and comparability of iodine-related population studies can be improved by standardization, which was one of the goals of the EUthyroid project. The aim of this study was to establish the first standardized map of iodine status in Europe by using standardized urinary iodine concentration (UIC) data. Materials and Methods: We established a gold-standard laboratory in Helsinki measuring UIC by inductively coupled plasma mass spectrometry. A total of 40 studies from 23 European countries provided 75 urine samples covering the whole range of concentrations. Conversion formulas for UIC derived from the gold-standard values were established by linear regression models and were used to postharmonize the studies by standardizing the UIC data of the individual studies. Results: In comparison with the EUthyroid gold-standard, mean UIC measurements were higher in 11 laboratories and lower in 10 laboratories. The mean differences ranged from -36.6% to 49.5%. Of the 40 postharmonized studies providing data for the standardization, 16 were conducted in schoolchildren, 13 in adults, and 11 in pregnant women. Median standardized UIC was <100 µg/L in 1 out of 16 (6.3%) studies in schoolchildren, while in adults 7 out of 13 (53.8%) studies had a median standardized UIC <100 µg/L. Seven out of 11 (63.6%) studies in pregnant women revealed a median UIC <150 µg/L. Conclusions: We demonstrate that iodine deficiency is still present in Europe, using standardized data from a large number of studies. Adults and pregnant women, particularly, are at risk for iodine deficiency, which calls for action. For instance, a more uniform European legislation on iodine fortification is warranted to ensure that noniodized salt is replaced by iodized salt more often. In addition, further efforts should be put on harmonizing iodine-related studies and iodine measurements to improve the validity and comparability of results.

Challenges in Having an Infusion Center.

This article presents a comprehensive overview of the model, care, costs, and considerations necessary in having an outpatient infusion suite in a practice. It provides a real-life assessment of the challenges infusion centers face, including financial and clinical impacts. It is also patient centric, showing how a comfortable patient experience can improve care and increase patient compliance in an outpatient setting. Also included is a list of specialty infusions and indications, medication procurement options, an internal process for outside referrals, using nurse practitioners and physician assistants, and the complexities of working with insurance companies and the regulations and requirements necessary.

Trance state effects and imagery vividness before and during a hypnotic assessment: a preliminary study.

This preliminary study explored the relationship between imagery vividness before and during a hypnotic phenomenological assessment procedure, the Phenomenology of Consciousness Inventory-Hypnotic Assessment Procedure (PCI-HAP), while also assessing trance (hypnoidal) state effects and several other variables. The PCI-HAP allows the assessment of trance state effects associated with hypnotism to be quantified and statistically assessed. The 102 subjects completed the PCI-HAP along with several other questionnaire items. Correlational and regression analyses suggested that imagery vividness during hypnotism (hypnotic imagoic suggestibility) was predicted by combined imagery vividness before hypnotism and trance (altered) state effects during hypnotism. When measuring several additional variables, imagery vividness during hypnotism was found to be a function of self-reported hypnotic depth and additional other variables. The usefulness of these results for better understanding imagery vividness before and during hypnotism is discussed.

Suggestibility, expectancy, trance state effects, and hypnotic depth: I. Implications for understanding hypnotism.

This paper reviews the relationships between trance or altered state effects, suggestibility, and expectancy as these concepts are defined in the theorizing of Weitzenhoffer (2002), Holroyd (2003), Kirsch (1991), and others, for the purpose of demonstrating how these concepts can be assessed with the PCI-HAP (Phenomenology of Consciousness Inventory: Hypnotic Assessment Procedure; Pekala, 1995a, b). In addition, how the aforementioned variables may relate to the nature of hypnosis/hypnotism as a function of self-reported hypnotic depth are discussed, along with how the PCI-HAP may be used as a means to measure hypnotic responsivity from a more phenomenological state perspective, in contrast to more traditional behavioral trait assessment instruments like the Harvard, the Stanford C, or the HIP. A follow-up paper (Pekala, Kumar, Maurer, Elliott-Carter, Moon, & Mullen, 2010) will present research data on the PCI-HAP model and how this model can be useful for better understanding hypnotism.

Suggestibility, expectancy, trance state effects, and hypnotic depth: II. Assessment via the PCI-HAP.

This study sought to determine if self-reported hypnotic depth (srHD) could be predicted from the variables of the Phenomenology of Consciousness Inventory - Hypnotic Assessment Procedure (PCI-HAP) (Pekala, 1995a, 1995b; Pekala & Kumar, 2007; Pekala et al., 2010), assessing several of the processes theorized by researchers to be associated with hypnotism: trance (altered state effects), suggestibility, and expectancy. One hundred and eighty participants completed the PCI-HAP. Using regression analyses, srHD scores were predicted from the PCI-HAP pre-hypnotic and post-hypnotic assessment items, and several other variables. The results suggested that the srHD scores were found to be a function of imagoic suggestibility, expectancy (both estimated hypnotic depth and expected therapeutic efficacy), and trance state and eye catalepsy effects; effects that appear to be additive and not (statistically) interactive. The results support the theorizing of many investigators concerning the involvement of the aforementioned component processes with this particular aspect of hypnotism, the self-reported hypnotic depth score.

Positive affect, negative affect, and negative effects during a phenomenological hypnotic assessment within a substance abuse population.

Positive and negative affect generated while using the Phenomenology of Consciousness--Hypnotic Assessment Procedure (PCI-HAP) on a sample of drug and alcohol users were predicted using several variables. The results were then cross-validated on a second, smaller sample. The results suggest that, although some negative affect was reported, the PCI-HAP was more likely to generate positive, rather than negative, affect. Positive affect was related to the vividness of a suggested hypnotic dream during hypnosis and also hypnotic depth; these findings were replicated upon cross-validation. Although negative affect correlated with the Dissociative Experiences Scale scores and falling asleep, these results did not replicate upon cross-validation. Mild transient negative effects (e.g., headache) were reported by about 10% of the participants in a smaller, second sample. Implications of the results are discussed.

The impact of stress urinary incontinence on sexual activity in women.

In women, stress urinary incontinence is a common problem that may lead to sexual dysfunction. We review the epidemiological data, the pathophysiology, and the risk factors for these two "closet" disorders, how they are related, how we can get patients to talk about them, and how the treatment of stress urinary incontinence may affect sexual dysfunction.

A comparison of olanzapine versus risperidone for the treatment of schizophrenia: a meta-analysis of randomised clinical trials.

Objective This meta-analysis was carried out to compare the efficacy and safety of olanzapine with risperidone in the treatment of schizophrenia. Methods Data from randomised, double-blind studies were analysed according to short- (≤12 weeks) and longer-term (>12 weeks) treatment, and included all-doses analyses and a sensitivity analysis of clinically relevant doses. A range of efficacy and safety parameters was measured. Results Olanzapine produced statistically significant improvements in efficacy and safety parameters compared with risperidone over both the short and longer term. Anticholinergic use, study dropouts, changes in Positive and Negative Syndrome Scale and Brief Psychiatric Rating Scale scores, and Quality-of-Life Scale changes, were often significantly in favour of olanzapine. Results from the sensitivity analyses of only clinically relevant doses further favoured olanzapine compared with the all-doses analyses. Conclusion Small changes in the presence or severity of psychotic symptoms and side-effects can affect a patient's prognosis and quality of life. With this in mind, the efficacy and safety advantages of olanzapine suggested by this study may convey clinical relevance to certain aspects of schizophrenia. However, further research - especially into longer-term efficacy and safety - is needed to confirm the differences between the available antipsychotics.