AATP Interactive

Virtual World For Addiction Cravings

Research funded by National Institutes of Health, the National Institute on Drug Abuse and the National Institutes for Alcohol Abuse and Alcoholism from University of Houston and published in Addictive Behaviors Journal, demonstrates that a virtual reality (VR) environment can provide the climate necessary to spark an alcohol craving so that patients can practice how to say "no" in a realistic and safe setting.

The lead author Patrick Bordnick points out that "as a therapist, I can tell you to pretend my office is a bar, and I can ask you to close your eyes and imagine the environment, but you’ll know that it’s not real, yet in this virtual environment you are at a bar or at a party or in a real-life situation. What we found was that participants had real-life responses."

Researchers studied 40 alcohol-dependent individuals who were not receiving treatment (32 men and eight women). Wearing a VR helmet, each was guided through 18 minutes of virtual social environments that included drinking. The participant’s drink of choice was included in each scene. Using a game pad, each rated his or her cravings and attention to the alcohol details in each room. Each then was interviewed following the experience. The study found that the VR environments were real enough that their cravings were intensified and demonstrates the value of using virtual reality as a tool for assessing and treating addictions. Future studies should explore the importance of environmental settings and other cues on cravings and relapse.

Journal Abstract

Human Brain Appears "Hard-Wired" for Hierarchy

Researchers at the National Institutes of Health have conducted imaging studies that have identified how the brain reacts to social status. They believe that social hierarchies strongly influence motivation as well as physical and mental health and that different brain regions are activated when a person moves up or down a pecking order or views perceived social superiors or inferiors.

To find out, the NIMH researchers created an artificial social hierarchy in which 72 participants played an interactive computer game for money. They were assigned a status that they were told was based on their playing skill. In fact, the game outcomes were predetermined and the other "players" were simulated by computer. While their brain activity was monitored by fMRI, participants intermittently saw pictures and scores of an inferior and a superior "player" they thought were simultaneously playing in other rooms.

Although they knew the perceived players' scores would not affect their own outcomes or reward — and were instructed to ignore them — participants' brain activity and behavior were highly influenced by their position in the implied hierarchy.

The researchers point out that the 'processing of hierarchical information seems to be hard-wired, occurring even outside of an explicitly competitive environment.'

Key study findings included:

* The area that signals an event's importance, called the ventral striatum, responded to the prospect of a rise or fall in rank as much as it did to the monetary reward, confirming the high value accorded social status.

* Just viewing a superior human "player," as opposed to a perceived inferior one or a computer, activated an area near the front of the brain that appears to size people up — making interpersonal judgments and assessing social status. A circuit involving the mid-front part of the brain that processes the intentions and motives of others and emotion processing areas deep in the brain activated when the hierarchy became unstable, allowing for upward and downward mobility.

* Performing better than the superior "player" activated areas higher and toward the front of the brain controlling action planning, while performing worse than an inferior "player" activated areas lower in the brain associated with emotional pain and frustration.

* The more positive the mood experienced by participants while at the top of an unstable hierarchy, the stronger was activity in this emotional pain circuitry when they viewed an outcome that threatened to move them down in status. In other words, people who felt more joy when they won also felt more pain when they lost.

The researchers are planning follow-up studies to explore brain activity in response to the experimental social hierarchy in patients with mental illnesses like schizophrenia or autism, which are marked by social and thinking deficits. The researchers will also be exploring whether particular gene variants might differentially affect brain responses in similar experiments.

Source: NIMH

Warnings For Online Health Record Systems

An article published in the New England Journal of Medicine, raises some concerns about using personal health records online and allowing them to be managed by third parties not bound by HIPAA regulations. The authors of the article point out that companies like Microsoft and Google are not bound by the privacy restrictions of the Health Insurance Portability and Accountability Act which was enacted in 1996 before Web-based health records systems like the ones Microsoft and Google offer were available.

According to a New York Times article, "the authors say that consumer control of personal data under the new, unregulated Web systems could open the door to all kinds of marketing and false advertising from parties eager for valuable patient information. Despite the warnings in the article, Drs Mandl and Kohane are enthusiastic about the potential benefits of Web-based personal health records, including a patient population of better-informed, more personally responsible health consumers."

NEJM Articles

Tectonic Shifts in the Health Information Economy (Abstract)
K. D. Mandl and I. S. Kohane

Electronic Health Records, Medical Research, and the Tower of Babel (abstract)
R. D. Kush, E. Helton, F. W. Rockhold, and C. D. Hardison

NJEM Commentary

Personally Controlled Online Health Data — The Next Big Thing in Medical Care?

Off the Record — Avoiding the Pitfalls of Going Electronic

VR for Paranoia

Research, funded by the Wellcome Trust and published in the British Journal of Psychiatry, demonstrates that suspicious or paranoid thoughts are much more common in the general population than was previously thought and that they are almost as common as anxiety and depression. Until now, researchers have been unable to study paranoia in laboratory settings, instead relying on questionnaires, which can be inaccurate.

Using a virtual reality subway ride, researchers studied 200 volunteers broadly representative of the general population walked around a virtual London subway car in a four-minute journey between station stops. The car contained neutral computer people (avatars) that breathed, looked around, and sometimes met the gaze of the participants. One avatar read a newspaper, another would occasionally smile if looked at. A soundtrack of a train was played.

The researchers found that the participants interpreted the same computer characters very differently. The most common reaction was to find the virtual reality characters friendly or neutral, but almost 40 per cent of the participants experienced at least one paranoid thought. The participants were extensively assessed before entering the train ride, and it was found that those who were anxious, worried, focused on the worst-case scenarios and had low self-esteem were the most likely to have paranoid thoughts.

According to lead author, Daniel Freedman, ‘in the past, only those with a severe mental illness were thought to experience paranoid thoughts, but now we know that this is simply not the case. About one-third of the general population regularly experience persecutory thoughts. This shouldn’t be surprising. At the heart of all social interactions is a vital judgment whether to trust or mistrust, but it is a judgment that is error-prone. We are more likely to make paranoid errors if we are anxious, ruminate and have had bad experiences from others in the past.’

Dr Freeman believes that paranoid thoughts are more likely to develop in settings such as on public transport, where people can feel trapped and observed, and cannot hear what others are saying. People who feared terrorism on the subway tended to report more paranoid thoughts in the virtual train. However, the researchers also found that people who regularly used the subway experienced less paranoid thoughts in the virtual train.

Press release from King's College, London

Abstract - British Journal of Psychiatry

BBC Article with video

Smartphones As A Clinical Tool

More and more physicians are using smartphones not just to manage phone calls and email but to use them in clinical practice. Unlike laptops and tablet PCs, smartphones are small enough to carry everywhere, their battery life lasts longer than a clinical shift and they have no standby or hibernation waiting times.

Although very convenient, many physicians are reluctant to carry and learn how to use smartphones in their medical practice. Others find it difficult to enter data into the devices and a additional barrier is that hospital IT departments must provide support for doctors using the devices.

There has been an increased interest in smartphones in the last few months. Epocrates recently announced the availability of its drug reference software for BlackBerrys, while Skyscape announced the release of all its medical textbooks for the BlackBerry platform. Thomson Healthcare has been providing medical software for BlackBerry devices since 2006.

The publicity surrounding the release of Apple's iPhone prompted yet another wave of companies pledging support for its platform. eClinicalWorks practice management software is designed for Web browsers, including those operating on iPhone, as is the American Academy of Family Physicians' CEND Personal Health Record Web site and Life Record's electronic health records software. Of course, this is in addition to the software that is already available on the Palm and Windows PDAs

Getting accurate data on how many physicians use smartphones in their practice is difficult because the term "use" can be defined in a broad range from taking practice-related phone calls to data storage, computing and Internet research. According to Thomson Healthcare research, about 31% of physicians in this country use smartphones in their practice. The Diffusion Group, a consulting firm specializing in IT, estimates higher -- that nearly half (49%) of U.S. doctors used smartphones in 2006.

Leaders in both the medical and information industries predict smartphone use in physicians' practices will grow rapidly across the globe. DataDyne predicts African countries will be among the most rapid adopters of wireless smartphone technology because of the relative dearth of land-based computing options.

In the United States, according to research by the Diffusion Group, smartphone use by physicians will increase to 70% over the next three years.

Source: iHealthbeat.org

Children and Social Networks

According to a survey published in the UK today(Ofcom), almost half of children online use social network sites. Over a quarter of eight to 11-year-olds in the UK have a profile on a social network Sites such as Bebo, MySpace and Facebook. These sites do set a set a minimum age of between 13 and 14 to create a profile but none actively enforce the age limit.

Ofcom surveyed 5,000 adults and 3,000 children found 49% of those between eight and 17 have a profile. According to the survey authors, "social networks are clearly a very important part of people's lives and are having an impact on how people live their lives. Children's lives are very different from what they were 20 years ago. Social networks are a way of creating a social bond."

In the UK, the Home Office has been working with social networking firms and is expected to publish a set of guidelines for the sites around best practice, security and privacy. The report is expected to recommend that profiles created by children are set to private by default, or are only viewable by friends nominated by the user.It also suggests that social sites maintain a distinct contact page listing contact numbers that children can use to get help.

The three leading social networks, MySpace, Bebo and Facebook, all say they remove profiles of users that are found to be too young on their sites. But at present no technology is used to actively verify the age of users.

The new guidelines are set to encourage social networking sites to investigate age verification technologies and to give better signposting to users about privacy settings, and warnings about the implications of posting personal details.

Source BBC

Office of Communications (Ofcom)

Link to full Report (pdf)
Social Networking: A quantitative and qualitative research report into
attitudes, behaviours and use