Lindsay St. Claire

Caffeine abstinence: an ineffective and potentially distressing tinnitus therapy.

Abstract The effect of phased caffeine withdrawal and abstention on tinnitus severity was assessed using a pseudo-randomized, double-blinded, placebo-controlled crossover trial of 30 days duration. Sixty-six volunteers who experienced tinnitus and who usually consumed at least 150 mg/day of caffeine participated. The intervention was a direct replacement of usual caffeinated tea/coffee with double-blinded supplies, under one of two conditions. Condition 1: Maintenance followed by phased withdrawal. Condition 2: Phased withdrawal followed by reintroduction and maintenance. Tinnitus severity was measured by the total score of the Tinnitus Questionnaire on Days 1, 15, and 30. Secondary measures included twice daily self-rated symptoms relevant to tinnitus and caffeine withdrawal. Caffeine had no effect on tinnitus severity, the mean difference between caffeinated and decaffeinated days being –0.04 (95% confidence interval –1.99 to 1.93), p=0.97. Significant acute adverse symptoms of caffeine withdrawal were observed. No evidence was found to justify caffeine abstinence as a therapy to alleviate tinnitus, but acute effects of caffeine withdrawal might add to the burden of tinnitus. Sumario Se evaluó el efecto del retiro paulatino y la abstención de la cafeína sobre la severidad del acufeno mediante un ensayo clínico de 30 días, pseudo-aleatorio, doble ciego, con control de placebo y transversal. Participaron sesenta y seis voluntarios que experimentaban acufeno y que usualmente consumían al menos 150 mg/día de cafeína. La intervención fue un reemplazo directo de café y/o té cafeinado con suministros doble ciego bajo una de estas dos condiciones: Condición 1. Mantenimiento seguido de retiro paulatino. Condición 2. Retiro paulatino seguido de reintroducción y mantenimiento. La severidad del acufeno fue medida mediante la puntuación total del cuestionario de acufeno en los días 1, 15 y 30. Dentro de las mediciones secundarias se incluyó una autoevaluación de los síntomas relativos al acufeno y a la abstención de cafeína. La cafeína no tuvo efecto en la severidad del acufeno. La diferencia media entre los días con cafeína y sin ella fue de -0.04 (intervalo de confianza del 95% -1.99 a 1.93), P=0.97. Se observaron efectos adversos agudos significativos por la abstención de cafeína. No se encontró evidencia que justificara la abstinencia de cafeína como tratamiento para aliviar el acufeno, pero los efectos agudos del retiro de la cafeína puede agregarse a la carga del acufeno.

Exploring the influence of culture on hearing help-seeking and hearing-aid uptake

Abstract Objective: The purpose of this paper was to highlight the importance of cultural influence in understanding hearing-help seeking and hearing-aid uptake. Design: Information on audiological services in different countries and ‘theories related to cross-culture’ is presented, followed by a general discussion. Study sample: Twenty-seven relevant literature reviews on hearing impairment, cross-cultural studies, and the health psychology model and others as secondary resources. Results: Despite the adverse consequences of hearing impairment and the significant potential benefits of audiological rehabilitation, only a small number of those with hearing impairment seek professional help and take up appropriate rehabilitation. Therefore, hearing help-seeking and hearing-aid uptake has recently become the hot topic for clinicians and researchers. Previous research has identified many contributing factors for hearing help-seeking with self-reported hearing disability being one of the main factors. Although significant differences in help-seeking and hearing-aid adoption rates have been reported across countries in population studies, limited literature on the influence of cross-cultural factors in this area calls for an immediate need for research. Conclusions: This paper highlights the importance of psychological models and cross-cultural research in the area of hearing help-seeking and hearing-aid uptake, and consequently some directions for future research are proposed.

Illness perceptions and hearing difficulties in King-Kopetzky syndrome: what determines help seeking?

Abstract The present study explored illness perceptions of hearing difficulties amongst one hundred participants who reported experiencing hearing difficulties despite normal audiometric thresholds. This experience is referred to as King-Kopetzky syndrome (KKS), obscure auditory dysfunction (OAD), or auditory processing disorder (APD). Logistic regression was used to consider the associations between help-seeking and a range of audiological and illness perception measures. Results indicate that help-seekers present with poorer speech in noise thresholds than non help-seekers, and that coherent illness perceptions and a negative belief in the consequences of hearing difficulties are associated with help-seeking status, regardless of hearing sensitivity. Sumario El presente estudio exploró la percepción de la enfermedad y las dificultades auditivas entre cien participantes que reportaron experimentar dificultades auditivas a pesar de umbrales auditivos normales. Esta experiencia se refiere al Síndrome de King-Kopetzky (KKS), una disfunción auditiva oscura (OAD) o un trastorno del procesamiento auditivo (APD). Se utilizó una regresión logística para considerar las asociaciones entre la búsqueda de ayuda y un rango de medidas sobre la percepción audiológica y de la enfermedad. Los resultados indican que los que buscan ayuda se presentan con peores umbrales de lenguaje en ruido que quienes no buscan ayuda, y la coherencia en la percepción de la enfermedad asícomo la creencia negativa sobre las consecuencias de las dificultades auditivas se asocian con la condición de búsqueda de ayuda, sin importar la sensibilidad.

Evaluating a workshop designed to help medical students improve their skills in communicating about cancer: Methodological considerations—and worries

Increasingly, communication skills training is being introduced into medical schools. Evaluations of post-training assessments document its success and add momentum to this movement. In addition, evaluations of student feedback shape course content and teaching methods. Two types of self-selection might bias evaluations and hence, lead to erroneous decisions: (1) students who attend a course may differ from nonattenders; and (2) students who give feedback may differ from those who do not. These two types of bias were examined in the context of a workshop designed to help medical students talk to patients about cancer. Overall, the need for communication skills training was endorsed. However, sex and experiential differences between attenders and non-attenders were identified and if replicated, could confound post-training evaluations. Similarly, differences between students who were more and less willing to provide feedback suggested that decisions based on student evaluations might systematically shape c...

How Can Respectfulness in Medical Professionals Be Increased? A Complex But Important Question

Respectfulness is demanded of doctors and predicts more positive patient health-related outcomes, but research is scarce on ways to promote it. This study explores two ways to conceptualize unconditional respect from medical students, defined as respect paid to people on the basis of their humanity, in order to inform strategies to increase it. Unconditional respect conceptualized as an attitude suggests that unconditional respect and conditional respect are additive, whereas unconditional respect conceptualized as a personality trait suggests that people who are high on unconditional respect afford equal respect to all humans regardless of their merits. One hundred and eighty-one medical students completed an unconditional respect measure then read a description of a respect-worthy or a non-respect-worthy man and indicated their respect towards him. The study found a main effect for unconditional respect and a main effect for target respect-worthiness but no interaction between the two when respect paid to the target was assessed, supporting the attitude-based conceptualization. This suggests that unconditional respect can be increased through relevant interventions aimed at increasing the relative salience to doctors of the human worth of individuals. Interventions to increase unconditional respect are discussed.

Respect for a young male with and without a hearing aid: A reversal of the “hearing-aid effect” in medical and non-medical students?

Abstract Objective: To investigate, in line with the “hearing-aid effect”, whether medical students would have less respect for a young male with a hearing aid than without when he was described as either respectworthy (i.e. as deserving respect) or non-respectworthy, and whether their attitudes differed from non-medical students. The interaction between the presence/absence of a hearing aid and respectworthiness on respect level was also explored. Design: Participants were shown a photograph and a written description of a young male. They were pseudo-randomly assigned to one of four core conditions reflecting the presence or absence of a hearing aid and the young mans respectworthiness, and completed questions regarding their behaviours, beliefs, and feelings of respect towards him. Study sample: One hundred and eighty-one medical students and a control group of 92 non-medical students. Results: Results showed more respect for the young male with a hearing aid than without from female participants, and for the young male described as respectworthy compared to non-respectworthy in medical and in non-medical students. However, medical students had more respect for the young male with and without a hearing aid than non-medical students. Conclusions: Findings were contrary to the “hearing-aid effect”. Possible explanations are given and implications are discussed.

Causal attributions in King-Kopetzky syndrome

Abstract At least 10% of people who present for help with hearing difficulties will be found to have normal hearing thresholds. These cases are clinically categorized as King-Kopetzky syndrome (KKS), obscure auditory dysfunction (OAD), or auditory processing disorder (APD). While recent research has focussed on the possible mechanistic basis for these difficulties, the perceptions of the hearing difficulties that lead people to seek help have not hitherto been identified. This study presents findings from an observational survey of causal attributions of hearing difficulties from 100 people with KKS. The findings suggest that participants regard immunity and risk related causes of hearing difficulties as pre-dominant. Psychological factors were not considered to be causal for hearing difficulties. These factors were not affected by diagnostic classification. These findings inform audiologists about their patient beliefs for the first time. The authors suggest that clinicians take care to ensure that their counselling is responsive to these beliefs. Sumario Al menos el 10% de quienes piden ayuda por problemas auditivos tienen umbrales auditivos normales. Estos casos se caracterizan clínicamente como síndrome de King Kopetzky (KKS), Disfunción Auditiva Obscura (OAD) o Problema de Procesamiento Auditivo (APD). Mientras que la investigación reciente se ha enfocado a las posibles bases mecanicistas de estas dificultades, las percepciones sobre los problemas auditivos que impulsan a que la gente busque ayuda, no han sido identificadas hasta ahora. Este estudio presenta hallazgos de una encuesta observacional sobre la atribución de causas de problemas auditivos en 100 personas con KKS. Los hallazgos sugieren que ellos consideran como causas, la inmunidad y los riesgos de problemas auditivos, como predominantes. Los factores psicológicos no fueron tomados en cuenta como causa de problemas auditivos. Estos factores no se afectaron por la clasificación diagnóstica. Los hallazgos informan por primera vez, a los audiólogos, sobre las percepciones de sus pacientes. Los autores sugieren que los clínicos tengan cuidado en asegurar que su orientación sea sensible a esas percepciones.