Blinded Interviews Research Articles

The School-Based Preventive Asthma Care Trial: Results of a Pilot Study

To test the feasibility and preliminary effectiveness of the School-Based Preventive Asthma Care Technology (SB-PACT) program, which includes directly observed therapy of preventive asthma medications in school facilitated by Web-based technology for systematic symptom screening, electronic report generation, and medication authorization from providers. We conducted a pilot randomized trial of SB-PACT versus usual care with 100 children (aged 3-10 years) from 19 inner-city schools in Rochester, New York. Outcomes were assessed longitudinally by blinded interviewers. Analyses included bivariate statistics and linear regression models, adjusting for baseline symptoms. There were data for 99 subjects for analysis. We screened all children using the Web-based system, and 44 of 49 treatment group children received directly observed therapy as authorized by their providers. Treatment group children received preventive medications 98% of the time they were in school. Over the school year, children in the treatment group experienced nearly 1 additional symptom-free day over 2 weeks versus the usual care group (11.33 vs 10.40, P = .13). Treatment children also experienced fewer nights with symptoms (1.68 vs 2.20, P = .02), days requiring rescue medications (1.66 vs 2.44, P = .01), and days absent from school due to asthma (0.37 vs 0.85, P = .03) compared with usual care. Further, treatment children had a greater decrease in exhaled nitric oxide (-9.62 vs -0.39, P = .03), suggesting reduction in airway inflammation. The SB-PACT intervention demonstrated feasibility and improved outcomes across multiple measures in this pilot study. Future work will focus on further integration of preventive care delivery across community and primary care systems.

Restless legs syndrome in sensory axonal neuropathy: A case-control study

IntroductionThe relation between neuropathy and restless legs syndrome (RLS) remains uncertain. Previous studies have analyzed heterogeneous neuropathic populations and findings have been to date inconsistent. Materials and methodsWe studied a neuropathic population consisting of 59 patients with acquired, mixed, small and large fiber sensory axonal neuropathy. We compared our findings to those of 59neurological controls with a similar age/gender distribution. International RLS Study Group criteria were used and severity assessed by International Restless Legs Syndrome Severity Scores (IRLSSS), by a single blinded telephone interviewer. Mimics were excluded as well as cases with infrequent (<5 days/month) symptoms. ResultsRLS was significantly more frequent in patients with neuropathy than in controls (28.8% versus 8.5%; P=0.008). Patients with neuropathy and RLS were significantly older (P=0.001), had later onset RLS (P=0.001), had more frequent RLS symptoms (P=0.009) and greater IRLSSS (P=0.019), than controls with RLS. There was no relation between presence of RLS in patients with sensory neuropathy and lower limb sensory electrophysiological findings. ConclusionsOur results suggest that acquired sensory axonal neuropathy may be associated with RLS. Further larger studies of homogeneous neuropathic populations are required in view of the potential therapeutic benefit specifically for RLS symptoms in patients with neuropathy.

OA11.03. Mediators of the effects of yoga and stretching on chronic low back pain (cLBP) outcomes: results from the YES RCT

Methods 228 persons with non-specific cLBP recruited from primary care and the general community were randomized to 12 weekly 75-minute classes of either yoga or intensive stretching, or to a self-care book. Back-related function (Roland-Morris Disability Scale), symptoms (0-10 score) and psychological mediators (fear avoidance, body awareness, self-efficacy, psychological distress, perceived stress, positive affect) were assessed at baseline and 6, 12, and 26 weeks later by blinded interviewers. Physical function was assessed at baseline and 12 weeks and saliva samples were collected for cortisol and DHEA analyses at baseline, 6 and 12 weeks. Open-ended questions were asked about benefits of yoga and stretching. Statistical analyses for mediators were conducted using the framework of Baron and Kenney.

Severity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication Adolescent Supplement.

Estimates of DSM-IV disorder prevalence are high; stringent criteria to define need for services are desired. To present US national data on the prevalence and sociodemographic correlates of 12-month serious emotional disturbance (SED), defined by the US Substance Abuse and Mental Health Services Administration, from the National Comorbidity Survey Replication Adolescent Supplement. The National Comorbidity Survey Replication Adolescent Supplement is a national survey of DSM-IV anxiety, mood, behavior, and substance disorders among US adolescents. Dual-frame household and school samples of US adolescents. Total of 6483 pairs of adolescents aged 13 to 17 (interviews) and parents (questionnaires). The DSM-IV disorders were assessed with the World Health Organization Composite International Diagnostic Interview and validated with blinded clinical interviews based on the Schedule for Affective Disorders and Schizophrenia for School-Age Children. Serious emotional disturbance was operationalized as a DSM-IV/Composite International Diagnostic Interview disorder with a score of 50 or less on the Children's Global Assessment Scale (ie, moderate impairment in most areas of functioning or severe impairment in at least 1 area). Concordance of Composite International Diagnostic Interview SED diagnoses with blinded Schedule for Affective Disorders and Schizophrenia for School-Age Children diagnoses was good. The estimated prevalence of SED was 8.0%. Most SEDs were due to behavior (54.5%) or mood (31.4%) disorders. Although respondents with 3 or more disorders made up only 29.0% of those with 12-month DSM-IV/Composite International Diagnostic Interview disorders, they constituted 63.5% of SEDs. Predictive effects of high comorbidity were significantly greater than the product of their disorder-specific odds ratios and consistent across disorder types. Associations of sociodemographic variables with SED were generally nonsignificant after controlling for disorder type and number. The high estimated 12-month prevalence of DSM-IV disorders among US adolescents is largely due to mild cases. The significant between-disorder differences in risk of SED and the significant effect of high comorbidity have important public health implications for targeting interventions.

The PSS‐SR as a screening tool for PTSD in first‐episode psychosis patients

We examined the validity of the PTSD Symptom Scale - Self-Report (PSS-SR) as a screening instrument for post-traumatic stress disorder (PTSD) in patients recovering from first-episode psychosis. Sixty-one patients from the Early Psychosis Intervention Programme in Singapore completed the PSS-SR questionnaire. The Clinician-Administered PTSD Scale was administered by a blinded interviewer as the 'gold standard' to identify patients with PTSD. The sensitivity, specificity and receiver operating characteristic curve were used to determine the screening performance of the PSS-SR. The score representing the optimal cut-off point for the PSS-SR was 14, with a sensitivity and specificity of 0.83 and 0.71, respectively. The area under the curve was determined to be 0.82 (95% CI: 0.70-0.95). These data suggest that the PSS-SR can be a useful screening instrument for PTSD in patients recovering from their first psychotic episode.

Prevalence, Persistence, and Sociodemographic Correlates of DSM-IV Disorders in the National Comorbidity Survey Replication Adolescent Supplement

Community epidemiological data on the prevalence and correlates of adolescent mental disorders are needed for policy planning purposes. Only limited data of this sort are available. To present estimates of 12-month and 30-day prevalence, persistence (12-month prevalence among lifetime cases and 30-day prevalence among 12-month cases), and sociodemographic correlates of commonly occurring DSM-IV disorders among adolescents in the National Comorbidity Survey Replication Adolescent Supplement. The National Comorbidity Survey Replication Adolescent Supplement is a US national survey of DSM-IV anxiety, mood, behavior, and substance disorders among US adolescents based on face-to-face interviews in the homes of respondents with supplemental parent questionnaires. Dual-frame household and school samples of US adolescents. A total of 10,148 adolescents aged 13 to 17 years (interviews) and 1 parent of each adolescent (questionnaires). The DSM-IV disorders assessed with the World Health Organization Composite International Diagnostic Interview and validated with blinded clinical interviews based on the Schedule for Affective Disorders and Schizophrenia for School-Age Children. Good concordance (area under the receiver operating characteristic curve ≥0.80) was found between Composite International Diagnostic Interview and Schedule for Affective Disorders and Schizophrenia for School-Age Children diagnoses. The prevalence estimates of any DSM-IV disorder are 40.3% at 12 months (79.5% of lifetime cases) and 23.4% at 30 days (57.9% of 12-month cases). Anxiety disorders are the most common class of disorders, followed by behavior, mood, and substance disorders. Although relative disorder prevalence is quite stable over time, 30-day to 12-month prevalence ratios are higher for anxiety and behavior disorders than mood or substance disorders, suggesting that the former are more chronic than the latter. The 30-day to 12-month prevalence ratios are generally lower than the 12-month to lifetime ratios, suggesting that disorder persistence is due more to episode recurrence than to chronicity. Sociodemographic correlates are largely consistent with previous studies. Among US adolescents, DSM-IV disorders are highly prevalent and persistent. Persistence is higher for adolescents than among adults and appears to be due more to recurrence than chronicity of child-adolescent onset disorders.

Validation of diagnoses of distress disorders in the US National Comorbidity Survey Replication Adolescent Supplement (NCS‐A)

Research diagnostic interviews need to discriminate between closely related disorders in order to allow comorbidity among mental disorders to be studied reliably. Yet conventional studies of diagnostic validity generally focus on single disorders and do not examine discriminant validity. The current study examines the validity of fully-structured diagnoses of closely-related distress disorders (generalized anxiety disorder, post-traumatic stress disorder, major depressive episode, and dysthymic disorder) in the lay-administered Composite International Diagnostic Interview Version 3.0 (CIDI) with independent clinical diagnoses based on the Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS) in the US National Comorbidity Survey Replication Adolescent Supplement (NCS-A). The NCS-A is a national survey of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) among 10,148 adolescents. A probability sub-sample of 347 of these adolescents and their parents were administered blinded follow-up K-SADS interviews. Good concordance [area under the receiver operating characteristic curve (AUC)] was found between diagnoses based on the CIDI and the K-SADS for generalized anxiety disorder (AUC = 0.78), post-traumatic stress disorder (AUC = 0.79), and major depressive episode/dysthymic disorder (AUC = 0.86). Further, the CIDI was able to effectively discriminate among different types of distress disorders in the sub-sample of respondents with any distress disorder.

A randomised controlled trial linking mental health inpatients to community smoking cessation supports: a study protocol.

BackgroundMental health inpatients smoke at higher rates than the general population and are disproportionately affected by tobacco dependence. Despite the advent of smoke free policies within mental health hospitals, limited systems are in place to support a cessation attempt post hospitalisation, and international evidence suggests that most smokers return to pre-admission smoking levels following discharge. This protocol describes a randomised controlled trial that will test the feasibility, acceptability and efficacy of linking inpatient smoking care with ongoing community cessation support for smokers with a mental illness.Methods/DesignThis study will be conducted as a randomised controlled trial. 200 smokers with an acute mental illness will be recruited from a large inpatient mental health facility. Participants will complete a baseline survey and will be randomised to either a multimodal smoking cessation intervention or provided with hospital smoking care only. Randomisation will be stratified by diagnosis (psychotic, non-psychotic). Intervention participants will be provided with a brief motivational interview in the inpatient setting and options of ongoing smoking cessation support post discharge: nicotine replacement therapy (NRT); referral to Quitline; smoking cessation groups; and fortnightly telephone support. Outcome data, including cigarettes smoked per day, quit attempts, and self-reported 7-day point prevalence abstinence (validated by exhaled carbon monoxide), will be collected via blind interview at one week, two months, four months and six months post discharge. Process information will also be collected, including the use of cessation supports and cost of the intervention.DiscussionThis study will provide comprehensive data on the potential of an integrated, multimodal smoking cessation intervention for persons with an acute mental illness, linking inpatient with community cessation support.Trial RegistrationAustralian and New Zealand Clinical Trials Registry ANZTCN: ACTRN12609000465257

Does the Veterans Affairs Depression Performance Measure Predict Quality Care?

In 2000, the Department of Veterans Affairs (VA) instituted a performance measure to improve the quality of depression care. The measure evaluated adequacy of follow-up for depressed patients but was removed from clinic directors' performance plans in fiscal year (FY) 2009 because it had not been empirically validated. The VA depression performance measure was compared with an empirically validated model for assessing adherence to important depression treatment processes. VA medical centers (VAMCs) whose performance on the VA depression measure was in the top or bottom quartile nationally for all four quarters in FY2008 were selected for inclusion. A blinded interviewer attempted to contact clinical directors of both primary care and mental health at each VAMC and conducted telephone interviews using a protocol designed to employ the 3-Component Model (3CM) fidelity measure, which assesses domains of evidence-based depression care. There were 9 sites in the "high-performing" group and 10 sites in the "low-performing" group. At least one interview was completed at 8 of the 9 sites in the high-performing group and 9 of the 10 sites in the low-performing group. There was a significant difference in the percentage of patients meeting the VA depression performance measure between the high- and low-performing groups (47.5% versus 14.7%; chi2 = 837.5, p < .001). The adapted version of the 3CM fidelity scale detected a significant difference in process of depression care between the high- and low-performing sites (82.3 versus 71.4; z = 2.4, p = .018). The highest-performing sites on the VA depression performance measure adhered to important care processes more often than did the lowest-performing sites.

A New Parenting-Based Group Intervention for Young Anxious Children: Results of a Randomized Controlled Trial

Despite recent advances, there are still no interventions that have been developed for the specific treatment of young children who have anxiety disorders. This study examined the impact of a new, cognitive-behaviorally based parenting intervention on anxiety symptoms. Families of 74 anxious children (aged 9 years or less) took part in a randomized controlled trial, which compared the new 10-session, group-format intervention with a wait-list control condition. Outcome measures included blinded diagnostic interview and self-reports from parents and children. Intention-to-treat analyses indicated that children whose parent(s) received the intervention were significantly less anxious at the end of the study than those in the control condition. Specifically, 57% of those receiving the new intervention were free of their primary disorder, compared with 15% in the control condition. Moreover, 32% of treated children were free of any anxiety diagnosis at the end of the treatment period, compared with 6% of those in the control group. Treatment gains were maintained at 12-month follow-up. This new parenting-based intervention may represent an advance in the treatment of this previously neglected group.

Implementing the Illness Management and Recovery Program in Japan

Implementing the Illness Management and Recovery Program in Japan

The Effect of Blinded Versus Nonblinded Interviews in the Resident Selection Process

To evaluate whether resident applicants' academic performance biases the assessment of nonacademic qualities. In this prospective, descriptive study, 2 blinded (personal statement only) and 1 nonblinded (application) 30-minute interviews were compared for candidates ranking into Top 10, Upper Third, Middle Thirds, Lower Third, and Do Not Rank classes. A total of 234 candidates were interviewed from 2005 to 2007. The association between blinded interviewers for the categories was 87%, 63%, 68%, 73%, and 90% (P = .0000), respectively. Comparing blinded to nonblinded interviewers showed an association of 75% (63%), 71% (86%), 68% (58%), 66% (79%), and 72.7% (82%) (P = .0000), respectively. A strong degree of agreement (Cohen κ, 0.75) for the 2 ranking scores resulted in 90% agreement for Top 10 and Upper Third and 85% for Middle Third and Lower Third categories. No correlation was found between United States Medical Licensing Examination scores and final ranking; moderate agreement was found between ranking and deans' letters (Cohen κ, 0.59, P = .0000). Candidate rankings on nonacademic attributes were not affected by interview type.

Reliability and Validity of the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID)

To investigate the concurrent validity and reliability of the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID), a short structured diagnostic interview for DSM-IV and ICD-10 psychiatric disorders in children and adolescents. Participants were 226 children and adolescents (190 outpatients and 36 controls) aged 6 to 17 years. To assess the concurrent validity of the MINI-KID, participants were administered the MINI-KID and the Schedule for Affective Disorders and Schizophrenia for School Aged Children-Present and Lifetime Version (K-SADS-PL) by blinded interviewers in a counterbalanced order on the same day. Participants also completed a self-rated measure of disability. In addition, interrater (n = 57) and test-retest (n = 83) reliability data (retest interval, 1-5 days) were collected, and agreement between the parent version of the MINI-KID and the standard MINI-KID (n = 140) was assessed. Data were collected between March 2004 and January 2008. Substantial to excellent MINI-KID to K-SADS-PL concordance was found for syndromal diagnoses of any mood disorder, any anxiety disorder, any substance use disorder, any ADHD or behavioral disorder, and any eating disorder (area under curve [AUC] = 0.81-0.96, kappa = 0.56-0.87). Results were more variable for psychotic disorder (AUC = 0.94, kappa = 0.41). Sensitivity was substantial (0.61-1.00) for 15/20 individual DSM-IV disorders. Specificity was excellent (0.81-1.00) for 18 disorders and substantial (> 0.73) for the remaining 2. The MINI-KID identified a median of 3 disorders per subject compared to 2 on the K-SADS-PL and took two-thirds less time to administer (34 vs 103 minutes). Interrater and test-retest kappas were substantial to almost perfect (0.64-1.00) for all individual MINI-KID disorders except dysthymia. Concordance of the parent version (MINI-KID-P) with the standard MINI-KID was good. The MINI-KID generates reliable and valid psychiatric diagnoses for children and adolescents and does so in a third of the time as the K-SADS-PL.

Randomized Controlled Trial of Illness Management and Recovery in Multiple-Unit Supportive Housing

This study evaluated the effects of the illness management and recovery program on mental illness and functional outcomes of persons with serious mental illness who were receiving supportive housing services. A randomized controlled trial was conducted with 104 persons with serious mental illness who were assigned either to illness management classes for six months or to a waitlist control group, with follow-up assessments conducted six months posttreatment. Assessments included self-reports, nonblinded clinical ratings, and blinded interview ratings and included the domains of illness management, symptoms, psychosocial functioning, hospitalizations, and substance abuse and dependence. Participants assigned to the program showed significantly greater improvements than the control group in self-reported and clinician ratings of illness management, interview-based ratings of symptoms on the Brief Psychiatric Rating Scale, and interview-based ratings of psychosocial functioning on the abbreviated Quality of Life Scale. Participants in both groups improved in self-ratings of symptom distress and had low rates of hospitalization and substance abuse over the course of the study. The results suggest that the program was effective at improving illness management and functional outcomes for persons with serious mental illness who were receiving supportive housing services.

The correlation and difference of childhood traumatic experiences in personality disorders

Objective To explore the relationship between childhood traumatic experiences and personali-ty disorders. Methods 1511 clients were sampled randomly from Shanghai Psychological Counseling Center. Per-sonality Diagnostic Questionnaire (PDQ+4) was administered to 1402 clients to screen personality disorders. Childhood Trauma Questionnaire(CTQ) and Blind semi-structure interviews using Structured Clinical Interview for DSM-Ⅳ Axis Ⅱ (SCID-Ⅱ) were conducted to screened subjects whose PDQ + 4 test was defined as positive. Re-suits Correlation analysis revealed that the total score of CTQ had a strong association with all the of personality disorders. Using partial correlations,the significant relationships between Cluster-B personality disorders and all the CTQ factors except physical neglect were demonstrated. Emotional abuse positively correlate with Ciuster-A per-sonality disorders(r=0.139, P<0.001 ), Cluster-C could be related to none of the early life experiences. Using Kruskal Wallis test,all the groups of subjects had significantly difference in emotional abuse,physical abuse,sexual abuse,physical neglect(P<0.01). Stepwise regression analysis showed that emotional abuse,emotional neglect en-tered the regression equation of Cluster-A and Cluster-B of personality disorders,standardized regression coefficient was 0.135 and 0.119(Cluster-A) ,0. 200 and 0. 084(Cluster-B) ,emotional neglect entered the regression equa-tion of Cluster-C of personality disorders, standardized regression coefficient was 0.077 and 0.141 (Cluster-C). Conclusion Childhood traumatic experiences might contribute to individuals susceptibility to personality disor-ders. The effect of the Cluster-B personality disorders are the most obviously. Childhood traumatic experiences in 3 clusters of personality disorders are different. Key words: Personality disorders; Childhood traumatic experiences; Client; Abuse; Neglect

Procalcitonin-Guided Antibiotic Use vs a Standard Approach for Acute Respiratory Tract Infections in Primary Care

Acute respiratory tract infections are the most common reason for antibiotic therapy in primary care despite their mainly viral etiology. A laboratory test measuring procalcitonin levels in blood specimens was suggested as a tool to reduce unnecessary prescribing of antibiotics. We consider whether antibiotic therapy guided by procalcitonin reduces the use of antibiotics without increasing the restrictions experienced by patients by more than 1 day. Fifty-three primary care physicians recruited 458 patients, each patient with an acute respiratory tract infection and, in the physician's opinion, in need of antibiotics. Patients were centrally randomized to either a procalcitonin-guided approach to antibiotic therapy or to a standard approach. For patients randomized to procalcitonin-guided therapy, the use of antibiotics was more or less strongly discouraged (procalcitonin level, < or =0.1 or < or =0.25 microg/L, respectively) or recommended (procalcitonin level, >0.25 microg/L). Follow-up data were collected at 7 days by treating physicians and at 14 and 28 days by blinded interviewers. Adjusted for baseline characteristics, the mean increase at 14 days in days in which activities were restricted was 0.14 with procalcitonin-guided therapy (95% confidence interval [CI], -0.53 to 0.81 days), which met our criterion of an increase in days in which activities were restricted by no more than 1 day. With procalcitonin-guided therapy, the antibiotic prescription rate was 72% lower (95% CI, 66%-78%) than with standard therapy. Both approaches led to a similar proportion of patients reporting symptoms of ongoing or relapsing infection at 28 days (adjusted odds ratio, 1.0 [95% CI, 0.7-1.5]). As an adjunct to guidelines, procalcitonin-guided therapy markedly reduces antibiotic use for acute respiratory tract infections in primary care without compromising patient outcome. In practice, this could be achieved with 1 to 2 procalcitonin measurements in patients for whom the physician intends to prescribe antibiotics.

Effect of Prior Stimulant Treatment for Attention-Deficit/Hyperactivity Disorder on Subsequent Risk for Cigarette Smoking and Alcohol and Drug Use Disorders in Adolescents

To examine the effects of early stimulant treatment on subsequent risk for cigarette smoking and substance use disorders (SUDs) in adolescents with attention-deficit/hyperactivity disorder (ADHD). Case-controlled, prospective, 5-year follow-up study. Massachusetts General Hospital, Boston. Adolescents with and without ADHD from psychiatric and pediatric sources. Blinded interviewers determined all diagnoses using structured interviews. Intervention Naturalistic treatment exposure with psychostimulants for ADHD. We modeled time to onset of SUDs and smoking as a function of stimulant treatment. We ascertained 114 subjects with ADHD (mean age at follow-up, 16.2 years) having complete medication and SUD data; 94 of the subjects were treated with stimulants. There were no differences in SUD risk factors between naturalistically treated and untreated groups other than family history of ADHD. We found no increased risks for cigarette smoking or SUDs associated with stimulant therapy. We found significant protective effects of stimulant treatment on the development of any SUD (hazard ratio [HR], 0.27; 95% confidence interval [CI], 0.13-0.60; chi(2)(113) = 10.57, P = .001) and cigarette smoking (HR, 0.28; 95% CI, 0.14-0.60; chi(2)(111) = 10.05, P = .001) that were maintained when controlling for conduct disorder. We found no effects of time to onset or duration of stimulant therapy on subsequent SUDs or cigarette smoking in subjects with ADHD. Stimulant therapy does not increase but rather reduces the risk for cigarette smoking and SUDs in adolescents with ADHD.

Owning Russia: The Struggle over Factories, Farms, and Power by Andrew Barnes (review)

772 SEER, 86, 4, OCTOBER 2008 financial flows do not reflect the real flow of resources and economic legisla tion has litde effect on economic activity or even perverse effects. She con cludes on an understated note: 'Despite the fact that advances have been made in these areas since the 1990s, it is clear that the spiritof accountability and disclosure inRussia is far from sufficient' (p. 162). The famed tolkach of the Red Director, according to Ledeneva, has become a specialist who ' bridges the gap between the formal rules and the informalworkings of the system' (p. 178). She cites the fact that, in 1998, 2,500 banks and 72,000 commercial organizations had their own security services. In other countries, such services might protect clients in market transactions, but in contemporary Russia they are associated with debt collection and other activities resulting from the high levels of personal risk and corruption. Ledeneva has written an authoritative account of how contemporary Russia works. It is essential reading for those contemplating doing business in Russia and for scholars of theRussian transition. She shows a strong current of continuity from the Soviet period, which is only natural because contem porary Russia is run by the same persons who ran it in the Soviet period. The research was likely done before the takeover of the economy's assets by Putin's allies. But the forces she describes appear to apply to his regime as well. The author makes a strong point that what we observe in contemporary Russia owes much to the Soviet legacy. She clearly points to the unsatisfac toryworking of formal institutionsand their limited effecton the real flow of resources. What ismissing is a feel for the long run equilibrium. Is what she describes forRussia the long-run outcome or are there forces thatwill push Russian political and business institutions in thedirection ofmore formal rules and transparency? There are some signs of flux such as the sharp reduction in barter after the 1998 crisis. A second question iswhether contemporary Russia differs in significantways from other countries that operate at a similar level of corruption? If a researcher, such as Ledeneva, were to conduct blind interviews with businessmen and politicians from five countries that rank the same as Russia on corruption indexes, would she be able to distinguish Russian practices from the rest?This would be the ultimate testof the role of initial conditions on contemporary Russia. Our profession produces too few works of this type. It takes considerable skill, tact and interpretative powers to draw general conclusions from unstruc tured interviews.Moreover, the work has high costs in terms of time and effort.Ledeneva is to be lauded for thisproductive effort. Department of Economics,Universityof Houston, TX Paul R. Gregory andHoover Institution, Stanford University, CA Barnes, Andrew. Owning Russia: The StruggleOver Factories,Farms, and Power. Cornell University Press, Ithaca, NY and London, 2006. xvii + 273 pp. Tables. Notes. Bibliography. Index. $35.00: ?19.95. Most of the social science literature on the transformation of the state social ist systemshas been framed in terms of the 'transition to democracy and the market'. Proponents of transformation adopt the mantle of enlightened reviews 773 reformers, and dub their opponents as die-hard 'hardliners'. Andrew Barnes is critical of these divisions and suggests that at the core of developments in post-Soviet Russia lies a struggle for property. This conflict has shaped the contours of federal and regional politics as well as the relationship between the state and the major economic players. Rather than focusing on 'optimists' for, or 'pessimists' against reform, the author suggests that we consider actors' access to property. In this context the book outlines in considerable detail the different stages of property seizure and transfer: 'spontaneous' privatization, mass voucher privatization, loans for shares and other sales and subsequent transfers. It details quite well the changing legal basis of ownership. The book has the advantage of considering the quest for assets both in industry and agriculture. It also defines the major players in the process: these were repre sented by workers and the public, the oligarchs and other economic groups, the state in both itsfederal and local forms, and managerial executives in the...

Impact of beta-blockers on sleep in patients with mild hypertension: a randomized trial between nebivolol and metoprolol

Sleep is an innate and essential part of human life. Various aspects of sleep are negatively affected by beta-blockers. We compared the impact of two beta-blockers, metoprolol succinate (extended release) and nebivolol, on sleep quality in patients with stage 1 hypertension. This was a prospective, randomized, open-label, parallel-group study. Eligible patients were administered the Pittsburgh Sleep Quality Index (PSQI) questionnaire by a blinded interviewer and were randomized to receive metoprolol (starting dose 25 mg) or nebivolol (starting dose 2.5 mg) once daily for 6 weeks. The first dose was administered before patients left the clinic. Visits were scheduled for 1, 2, 4, and 6 weeks after the initiation of therapy. At the end of the study, patients were readministered the PSQI questionnaire by the same interviewer, as before blinded to treatment allocation. A total of 22 patients in the nebivolol group and 17 patients in the metoprolol group completed the study and were included in the data analysis (mean age of patients, 40.7 years). At study entry, systolic blood pressure (BP), diastolic BP, and PSQI scores were similar in the two groups. Over 6 weeks of treatment, systolic and diastolic BP normalized in both groups. Global PSQI score improved significantly in patients in the nebivolol group, whereas it worsened in the metoprolol group. The difference in effect of two beta-blockers was statistically significant (P<0.001). Nebivolol was associated with improved sleep (as assessed by the PSQI), whereas metoprolol was associated with a worsening of sleep characteristics.

P3-039: Performance of the long and short Brazilian versions of the IQCODE as screening for dementia in low-educated elderly

To assess the performance of the Long (L) (26 items) and Short (S) (16 items) Brazilian versions of the “Informant Questionnaire on Cognitive Decline in the Elderly” (IQCODE), compared to the Mini-mental State Examination (MMSE) as screening for dementia in low educated elderly. To assess the internal consistency of the versions in Portuguese and useful items for diagnosing Alzheimer's Disease patients with low level of education. Thirty-four patients with mild and moderate dementia, diagnosed according to the ICD-10 criteria were evaluated. Patients and controls were divided into three groups, regarding their socioeconomic status and level of education (high, middle and low). Patients were evaluated with the MMSE and the informants were interviewed using the Long and Short versions of the IQCODE by blind interviewers for the clinical diagnosis. Descriptive analysis, ROC (Receiver Operating Characteristics) curve analysis and logistic regression were presented. There was a significant correlance between education and the MMSE in the control group (r=0,280; p=0,031) Education had influence in the results of MMSE, but there was not significant correlation with the IQCODE S and L. The performance of the 3 instruments, evaluated by the ROC curves, was very similar (MMSE=0,93; IQCODE-L=0,94; IQCODE-C=0,96), and all of them had good internal consistency (Cronbach′s alpha=0,97). The items that helped very little in the diagnosis were 15 and 16 and the tree best questions were 14, 10 and 5. Two new versions in Portuguese were tested; one with15 items (0,958) and another with 17 items (0,959), and both were similar to the 16 original items (0,956). On the logistic regression analysis, MMSE classified correctly 85,7% of the subjects (sensitivity 70,6% and specificity 94,7%). On the other hand, the two IQCODE versions classified correctly 91,2% of the subjects (sens.= 85,3% and spec.= 94,7%), with results superior to the MMSE. The results suggest that the long and short version of IQCODE can be used as screening for mild and moderate demented patients in Brazil. IQCODE, in both versions, does not suffer influence of schooling, and it seems to be an adequate instrument for samples with low schooling.