Short stature and growth hormone therapy. A national study of physician recommendation patterns

OBJECTIVE: To determine current expert opinion and recommendations regarding the controversial issue of the use of growth hormone (GH) to treat short children who do not have classical GH deficiency (non-GHD children). STUDY DESIGN: Analysis of a national survey mailed to 534 US physician experts on the management of short stature (pediatric endocrinologists) with a response rate of 81.3%. MAIN OUTCOME MEASURE: The experts' GH treatment recommendations. RESULTS: The physicians reported that approximately 58% of their current patients undergoing GH therapy have classical GH deficiency, while 42% have other conditions. The proportion of physicians who recommended GH treatment of short non-GHD children ranged from 1% to 74% over all case scenarios presented. The likelihood of GH being recommended depended on the physiological growth characteristics of the child (ie, the child's height, growth rate, and predicted adult height), contingency factors (ie, strong family wishes or a reduction in GH cost), and physician beliefs (ie, the impact of short stature on well-being, the effectiveness of GH therapy). Each of these factors exerted highly significant, independent, and additive effects on decisions to recommend GH. CONCLUSION: Our results indicate that many pediatric endocrinologists consider GH treatment appropriate for selected short non-GHD children, going beyond current Food and Drug Administration-approved indications for GH. Decisions to recommend GH for a non-GHD child rest on a combination of medical, social, and perceptual factors; variations in treatment patterns stem from variations in these influences. Future GH use will likely be determined not only by the results of controlled trials, but also by family preferences, producer pricing, and physician perceptions of the value of height and GH therapy.     

Information processing by schizophrenics when task complexity increases

Compared the performance of 30 paranoid schizophrenics, nonparanoid schizophrenics, and tuberculosis patients (controls) in a VA Hospital on motor, perceptual, and cognitive tasks of increasing complexity. The data are examined within the context of comparing differential predictions made by input and central processing theories of information-processing deficit. Results indicate that paranoid schizophrenics were comparable to nonschizophrenics in the amounts of information they could process, while nonparanoid schizophrenics reached a stage of information overload with tasks of relatively less complexity. (27 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

False Memories in Schizophrenia.

In prior studies, it was observed that patients with schizophrenia show abnormally high knowledge corruption (i.e., high-confident errors expressed as a percentage of all high-confident responses were increased for schizophrenic patients relative to controls). The authors examined the conditions under which excessive knowledge corruption occurred using the Deese-Roediger-McDermott paradigm. Whereas knowledge corruption in schizophrenia was significantly greater for false-negative errors relative to controls, no group difference occurred for false-positive errors. The groups showed a comparable high degree of confidence for false-positive recognition of critical lure items. Similar to findings collected in elderly participants, patients, but not controls, showed a strong positive correlation between the number of recognized studied items and false-positive recognition of the critical lure. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Insurance coverage, physician recommendations, and access to emerging treatments: growth hormone therapy for childhood short stature

CONTEXT: There is concern in both the medical community and the general public about mechanisms of medical decision making and the interplay of physician and insurer decisions in determining access to care. OBJECTIVE: To examine the medical process influencing access to growth hormone (GH) therapy for childhood short stature by comparing coverage policies of US insurers with the treatment recommendations of US physicians. DESIGN AND PARTICIPANTS: Independent national representative surveys were mailed to insurers (private, Blue Cross/Blue Shield, health maintenance organizations, programs for Children with Special Health Care Needs, and Medicaid programs, n=113), primary care physicians (n=1504), and pediatric endocrinologists (n=534) with response rates of 75%, 60%, and 81%, respectively. Each survey included identical case scenarios. Primary care physicians were asked decisions about referrals to pediatric endocrinologists. Endocrinologists were asked GH treatment recommendations. Insurers were asked coverage decisions for GH therapy. MAIN OUTCOME MEASURES: Insurer coverage decisions for GH in specific case scenarios were compared with the recommendations of primary care physicians and pediatric endocrinologists. RESULTS: Physician recommendations and insurance coverage decisions differed strikingly. For example, while 96% of pediatric endocrinologists recommended GH therapy for children with Turner syndrome, insurer policies covered GH therapy for only 52% of these children. Overall, referral and treatment decisions by physicians resulted in recommendations for GH therapy in 78% of children with GH deficiency, Turner syndrome, or renal failure; of those recommended for treatment, 28% were denied coverage by insurers. Similarly, GH therapy would be recommended by physicians for only 9% of children with idiopathic short stature, but insurers would not cover GH for the vast majority of these children. Furthermore, the data indicated considerable variation among insurers regarding coverage policies for GH (P<.01). CONCLUSIONS: Access to GH therapy differs depending on the type of insurance coverage. The deep discord between physician recommendations and insurance coverage decisions, exemplified by these findings, represents a major challenge to mechanisms of health care decision making, access, and costs.     

Prediction of dysfunctional job behaviors among law enforcement officers

This study examined the predictability of dysfunctional job behaviors among law enforcement officers using 3 scales (Responsibility, Socialization, and Self-Control) of the California Psychological Inventory (H. G. Gough, 1995) that were hypothesized to assess the construct of conscientiousness, and 3 construct-oriented life history indices (drug use, criminal, work). Law enforcement officers were classified into disciplinary and control groups (n = 109 each), using a matched-case control study design. Mean differences between the 2 criterion groups on the 6 predictor variables were all statistically significant and in the hypothesized direction. The results are discussed in the context of conscientiousness as an explanatory construct, the relationship between life history and personality constructs, and methodological concerns in the development of construct-oriented life history indices.     

Increased hindsight bias in schizophrenia.

An underlying theme common to prominent theoretical accounts of cognition in schizophrenia is that information processing is disproportionately influenced by recently/currently encountered information relative to the influence of previously learned information. In this study, the authors tested this account by using the hindsight bias or knew-it-all-along (KIA) paradigm, which demonstrates that newly acquired knowledge influences recall of past events. In line with the account that patients with schizophrenia display a disproportionately strong influence of recently encountered information relative to the influence of previously learned information, patients displayed a KIA effect that was significantly greater than in controls. This result is discussed in the context of the cognitive underpinnings of the KIA effect and delusion formation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Everyday life memory deficits in pregnant women.

Converging evidence indicates that pregnant women report experiencing problems with memory, but the results of studies using objective measures are ambiguous. The present study investigated potential reason(s) for the discrepancy between findings of subjective and objective memory deficits, as well as potential source(s) of pregnant women's problems with memory. Sixty-one pregnant and 24 nonpregnant women completed a series of memory tests which included field and laboratory measures of prospective memory. Three standardized questionnaires were used to assess subjective aspects of memory. The influence of cortisol, depressed mood, anxiety, physical symptoms, sleep/fatigue, and busyness on pregnancy-related deficits was also examined. The findings revealed objective pregnancy-related deficits on two of the field measures of prospective memory. Pregnancy-related subjective deficits were also detected on all of the questionnaires. In contrast, no objective pregnancy-related deficits were found on the laboratory measures of memory. Increased physical symptoms accounted for one of the objective deficits in memory, while depressed mood and physical symptoms accounted for two of the subjective memory deficits. Collectively, these findings suggest that pregnant women experience everyday life problems with memory that are not readily detected in the laboratory environment. The predominant use of laboratory tests may explain the myriad of previous failures to detect objective deficits in pregnant women's memory. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Anxiety, locus of control, type of preparatory information, and adjustment to dental surgery.

Evaluated the effects of 2 types of preparatory information (general, specific), given prior to dental surgery, on state anxiety and adjustment in the dental situation for 63 19-74 yr old dental patients who differed in locus of control orientation and generalized level of dental anxiety. N. L. Corah's Dental Anxiety Scale, administered an average of 24 days presurgery, predicted differential elevations in state anxiety in the dental situation. This finding is discussed in terms of the need to develop situation-specific trait anxiety measures for physical threat situations. Internal Ss viewing the specific information tape showed better adjustment during surgery than internals who viewed the general tape. The converse was true of external Ss, who responded more favorably to the general information tape. Findings are discussed in terms of the locus of control construct and are viewed as supporting the need for the development of differential treatment strategies for homogeneous patient groups. (36 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)