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JAMA Psychiatry Jun 2023Motivational impairments in schizophrenia are by definition associated with poor outcome. It is postulated that the reduction of goal-directed behavior arises from... (Meta-Analysis)
Meta-Analysis
IMPORTANCE
Motivational impairments in schizophrenia are by definition associated with poor outcome. It is postulated that the reduction of goal-directed behavior arises from abnormal trade-offs between rewards and efforts.
OBJECTIVE
To examine whether schizophrenia is associated with impairments in effort-cost decision-making.
DATA SOURCES
For this systematic review and meta-analysis, the PubMed, ScienceDirect, PsycINFO, Embase, and ClinicalTrials.gov databases were searched from inception to July 2022 for studies that investigated effort-cost decision-making in schizophrenia. Search terms included effort, cost, and schizophrenia.
STUDY SELECTION
Consensual criteria for inclusion were peer-reviewed studies published in English that used a computerized effort-cost decision-making behavioral paradigm and compared individuals with schizophrenia with control individuals.
DATA EXTRACTION AND SYNTHESIS
The Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline was used for abstracting data. Data were extracted independently by 2 authors and then pooled using random-effects sizes and bayesian approaches.
MAIN OUTCOMES AND MEASURES
The main outcomes were performance on effort-cost decision-making tasks requiring an effort-reward trade-off, measured by Hedges g effect size. Effects of moderators were tested with meta-regressions and subgroup analyses.
RESULTS
Twenty studies involving 1503 participants were included: 837 individuals with schizophrenia (541 [64.6%] male; mean [SD] age, 35.89 [6.70] years) and 666 control individuals without schizophrenia (360 [54.1%] male; mean [SD] age, 34.16 [5.92] years). Participants with schizophrenia had significantly reduced willingness to expend effort for rewards compared with controls (k = 20; effect size, 0.43; 95% CI, 0.30-0.56; P < .001; I2 = 33.1%; Q test P = .08). The magnitude of the deficit was significantly greater for high-reward trials. The severity of negative symptoms was negatively associated with effort-cost decision-making (k = 8; effect size, -0.33; 95% CI, -0.50 to -0.15; P < .001), while participants with a high number of negative symptoms had a significantly larger impairment in effort-cost decision-making (k = 5; effect size, 0.47; 95% CI, 0.10-0.84; P = .01).
CONCLUSIONS AND RELEVANCE
In this systematic review and meta-analysis, schizophrenia was associated with deficits in effort allocation as indexed by effort-cost decision-making tasks. Understanding the cognitive and neurobiological mechanisms driving effort allocation impairments may assist in developing novel interventions.
Topics: Humans; Male; Adult; Female; Schizophrenia; Bayes Theorem; Motivation; Reward
PubMed: 37043223
DOI: 10.1001/jamapsychiatry.2023.0553 -
Behavioural Neurology 2022Attention is a basic and main mental task and can play an important role in the functioning of other brain abilities such as intelligence, memory, learning, and... (Review)
Review
Attention is a basic and main mental task and can play an important role in the functioning of other brain abilities such as intelligence, memory, learning, and perception, and its deficit occurs in 80% of patients with traumatic brain injury. The use of game-based tools for rehabilitation is rapidly expanding. Cognitive rehabilitation via video games is an emerging hot topic in cognitive science. Serious games serve a specific purpose in addition to entertainment. They can be more engaging than exercises since they replace reward and motivation systems with real-world motivations as a complement for rehabilitation activities. This study was aimed at identifying and categorizing serious computer games used for attention rehabilitation and evaluating their effects. Six electronic databases (Scopus, PubMed, ISI, Embase, IEEE, and Cochrane) were searched in August 2021. The search strategy consisted of three main concepts of "serious game", "cognitive deficits", and "cognitive rehabilitation". The inclusion criteria were (1) journal articles, (2) English language, (3) being published in the last 10 years, (4) human participants, and (5) game-based intervention. In the 30 included studies, 22 unique games were utilized for attention rehabilitation. Lumosity (20%), Brain Age (Dr. Kawashima's Brain Training) (10%), and MoHRS (6.66%) were the most common games among the studies. There were (57%) casual, (23%) action, (10%) simulation, and (10%) multiple genres. Of the 47 tools used in the studies, 5 utilized cross-modal oddball attention tasks, 4 utilized game performance, 3 utilized the paced auditory serial additional test (PASAT), and the rest employed other tools. A total of 73 outcome measures were related to attention, 42 measures did not have significant results, 30 were significantly improved, 1 was significantly deteriorated, and 4 articles did not have any specific measures for attention evaluation. Thus, the results revealed the positive effect of serious games on attention. However, issues such as absence of scientific teams, the variety of the disorders that cause defects, the variety of criteria, differences in measurements, lack of long-term follow-up, insufficient RCT studies, and small sample sizes should be considered when designing, developing, and using game-based systems to prevent bias.
Topics: Brain; Humans; Learning; Motivation; Neuropsychological Tests; Video Games
PubMed: 35256889
DOI: 10.1155/2022/2017975 -
Journal of Behavioral Addictions Mar 2023Craving is one of the main criteria for the diagnosis of substance use disorder according to the DSM-5; however, it is not included in the main criteria for gambling... (Review)
Review
BACKGROUND AND OBJECTIVES
Craving is one of the main criteria for the diagnosis of substance use disorder according to the DSM-5; however, it is not included in the main criteria for gambling disorder (GD). In the present systematic review, we aimed to evaluate the available body of knowledge regarding gambling craving to help step forward to a consensus regarding this topic.
DATA SOURCES
PsycINFO/PsycARTICLES and PubMed/Medline were used.
STUDY ELIGIBILITY CRITERIA, PARTICIPANTS, AND INTERVENTIONS
(1) individuals of both genders who had a clinical diagnosis of GD in which the presence of gambling craving were studied by means of tasks or self-report tools; (2) we included three types of studies: (a) validation articles of craving psychometric tools in which GD was assessed; (b) articles in which craving-GD association was explored; and (c) treatment articles for GD in which craving was assessed.
RESULTS
n = 63 studies were finally included in the systematic review. Some studies described an association between craving- and gambling-related factors, and craving was also described as a predictor of GD severity, gambling episodes, chasing persistence and income-generating offenses. Gambling craving also seems to be associated with emotional states and negative urgency. Finally, some studies implemented specific interventions for GD and assessed its impact on reducing gambling craving.
CONCLUSIONS
There is a growing body of knowledge on the relevant role of craving in gambling behavior and GD. Further studies are needed to reach a consensus on the diagnostic criterion for GD.
Topics: Humans; Male; Female; Gambling; Craving; Substance-Related Disorders; Emotions; Self Report
PubMed: 36787136
DOI: 10.1556/2006.2022.00080 -
Maternal & Child Nutrition Apr 2014This systematic review investigates the relationship between maternal obesity and breastfeeding intention, initiation, intensity, duration and milk supply. A... (Review)
Review
This systematic review investigates the relationship between maternal obesity and breastfeeding intention, initiation, intensity, duration and milk supply. A comprehensive search was performed through three major databases, including Medline, Cochrane Library and Cumulative Index For Nursing and Allied Health Literature, and by screening reference lists of the relevant publications. Selection criteria were: report of original research, studies on low-risk obese mothers and the comparison with normal weight mothers which met at least two of the following primary outcomes: breastfeeding intention; initiation; intensity; duration and/or milk supply. Furthermore, the included reports had to contain a clear definition of pre-pregnant obesity, use compensation mechanisms for potential confounding factors, have a prospective cohort design and had to have been published between 1997 and 2011 and in English, French or Dutch. Effects of obesity on breastfeeding intention, initiation, intensity, duration and milk supply were analysed, tabulated and summarised in this review. Studies have found that obese women are less likely to intend to breastfeed and that maternal obesity seems to be associated with a decreased initiation of breastfeeding, a shortened duration of breastfeeding, a less adequate milk supply and delayed onset of lactogenesis II, compared with their normal weight counterparts. This systematic review indicates therefore that maternal obesity is an adverse determinant for breastfeeding success.
Topics: Breast Feeding; Female; Humans; Intention; Lactation; Obesity; Observational Studies as Topic; Pregnancy
PubMed: 22905677
DOI: 10.1111/j.1740-8709.2012.00439.x -
BMC Health Services Research Dec 2008A key constraint to achieving the MDGs is the absence of a properly trained and motivated workforce. Loss of clinical staff from low and middle-income countries is...
BACKGROUND
A key constraint to achieving the MDGs is the absence of a properly trained and motivated workforce. Loss of clinical staff from low and middle-income countries is crippling already fragile health care systems. Health worker retention is critical for health system performance and a key problem is how best to motivate and retain health workers. The authors undertook a systematic review to consolidate existing evidence on the impact of financial and non-financial incentives on motivation and retention.
METHODS
Four literature databases were searched together with Google Scholar and 'Human Resources for Health' on-line journal. Grey literature studies and informational papers were also captured. The inclusion criteria were: 1) article stated clear reasons for implementing specific motivations to improve health worker motivation and/or reduce medical migration, 2) the intervention recommended can be linked to motivation and 3) the study was conducted in a developing country and 4) the study used primary data.
RESULTS
Twenty articles met the inclusion criteria. They consisted of a mixture of qualitative and quantitative studies. Seven major motivational themes were identified: financial rewards, career development, continuing education, hospital infrastructure, resource availability, hospital management and recognition/appreciation. There was some evidence to suggest that the use of initiatives to improve motivation had been effective in helping retention. There is less clear evidence on the differential response of different cadres.
CONCLUSION
While motivational factors are undoubtedly country specific, financial incentives, career development and management issues are core factors. Nevertheless, financial incentives alone are not enough to motivate health workers. It is clear that recognition is highly influential in health worker motivation and that adequate resources and appropriate infrastructure can improve morale significantly.
Topics: Community Health Services; Developing Countries; Emigration and Immigration; Employee Incentive Plans; Global Health; Health Workforce; Humans; Job Satisfaction; Motivation; Personnel Loyalty
PubMed: 19055827
DOI: 10.1186/1472-6963-8-247 -
NPJ Primary Care Respiratory Medicine Jun 2021Primary Care Providers (PCPs) often deal with patients on daily clinical practice without knowing anything about their smoking status and willingness to quit. The aim of... (Review)
Review
Primary Care Providers (PCPs) often deal with patients on daily clinical practice without knowing anything about their smoking status and willingness to quit. The aim of this metasynthesis is to explore the PCPs and patients who are smokers perspectives regarding the issue of smoking cessation within primary care settings. It relies on the model of meta-ethnography and follows thematic synthesis procedures. Twenty-two studies are included, reporting on the view of 580 participants. Three main themes emerge: (i) What lacks, (ii) Some expectations but no request, and (iii) How to address the issue and induce patients' motivation. Our results reveal a global feeling of a lack of legitimacy among PCPs when it comes to addressing the issue of tobacco and smoking cessation with their patients, even though they have developed creative strategies based on what is at the core of their practice, that is proximity, continuity, long-term and trustworthy relationship.
Topics: Humans; Motivation; Primary Health Care; Smokers; Smoking; Smoking Cessation
PubMed: 34075057
DOI: 10.1038/s41533-021-00245-9 -
The Cochrane Database of Systematic... Oct 2009There is evidence suggesting that people with serious mental illness are less responsive to everyday social rewards such as praise. Motivation and performance in social... (Review)
Review
BACKGROUND
There is evidence suggesting that people with serious mental illness are less responsive to everyday social rewards such as praise. Motivation and performance in social situations can be poor. Rewarding of tasks with money improves motivation to complete the tasks in everyday life. Careful use of targeted monetary rewards could also help people with troublesome symptoms of schizophrenia.
OBJECTIVES
To assess the effect of monetary incentive/rewards for people with schizophrenia or schizophrenia-like illness.
SEARCH STRATEGY
We searched the Cochrane Schizophrenia Group's Register (June 2008).
SELECTION CRITERIA
All relevant randomised controlled trials comparing monetary rewards with standard care or no monetary rewards.
DATA COLLECTION AND ANALYSIS
Working independently, we selected studies for quality assessment and extracted relevant data. We analysed on an intention-to-treat basis. Where possible and appropriate we calculated the Relative Risk (RR) and their 95% confidence intervals (CI). For continuous data we calculated weighted mean differences (MD) and their 95% confidence intervals.
MAIN RESULTS
Five trials are excluded that investigate one type of monetary reward over another and may be included in a future update. We did include one study, carried out over 40 years ago, randomising a total of 25 very chronically ill people who had been in hospital an average of 20 years. The targeted task that was being encouraged was assembly of dolls. People allocated to the payment group produced less dolls than those not paid at all although this difference did not reach conventional levels of statistical significance (MD -0.80 CI -1.44 to -0.16).
AUTHORS' CONCLUSIONS
Monetary rewards have been the topic for sporadic evaluative research for decades and this review shows that randomised studies are possible. We suggest a design for a future informative trial.
Topics: Humans; Motivation; Reward; Schizophrenia; Schizophrenic Psychology
PubMed: 19821433
DOI: 10.1002/14651858.CD007626.pub2 -
Health Policy (Amsterdam, Netherlands) Nov 2023Human behavior and more specifically behavioral insight-based approaches to vaccine uptake have often been overlooked. While there have been a few narrative reviews... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Human behavior and more specifically behavioral insight-based approaches to vaccine uptake have often been overlooked. While there have been a few narrative reviews indexed in Medline on behavioral interventions to increase vaccine uptake, to our knowledge, none have been systematic reviews and meta-analyses covering not just high but also low-and-middle income countries.
METHODS
We included 613 studies from the Medline database in our systematic review and meta-analysis categorizing different behavioral interventions in 9 domains: education campaigns, on-site vaccination, incentives, free vaccination, institutional recommendation, provider recommendation, reminder and recall, message framing, and vaccine champion. Additionally, considering that there is variability in the acceptance of vaccines among different populations, we assessed studies from both high-income countries (HICs) and low- to middle-income countries (LMICs), separately.
FINDINGS
Our results showed that behavioral interventions can considerably improve vaccine uptake in most settings. All domains that we examined improved vaccine uptake with the highest effect size associated with provider recommendation (OR: 3.4 (95%CI: 2.5-4.6); Domain: motivation) and on-site vaccination (OR: 2.9 (95%CI: 2.3-3.7); Domain: practical issues). While the number of studies conducted in LMICs was smaller, the quality of studies was similar with those conducted in HICs. Nevertheless, there were variations in the observed effect sizes.
INTERPRETATION
Our findings indicate that "provider recommendation" and "on-site vaccination" along with other behavioral interventions can be employed to increase vaccination rates globally.
Topics: Humans; Vaccination; Vaccines; Motivation; Health Facilities; Databases, Factual
PubMed: 37714082
DOI: 10.1016/j.healthpol.2023.104894 -
Human Resources For Health Jan 2021Poor health worker motivation, and the resultant shortages and geographic imbalances of providers, impedes the provision of quality care in low- and middle-income... (Review)
Review
Poor health worker motivation, and the resultant shortages and geographic imbalances of providers, impedes the provision of quality care in low- and middle-income countries (LMICs). This systematic review summarizes the evidence on interventions used to motivate health workers in LMICs. A standardized keyword search strategy was employed across five databases from September 2007 -September 2017. Studies had to meet the following criteria: original study; doctors and/or nurses as target population for intervention(s); work motivation as study outcome; study design with clearly defined comparison group; categorized as either a supervision, compensation, systems support, or lifelong learning intervention; and conducted in a LMIC setting. Two independent reviewers screened 3845 titles and abstracts and, subsequently, reviewed 269 full articles. Seven studies were retained from China (n = 1), Ghana (n = 2), Iran (n = 1), Mozambique (n = 1), and Zambia (n = 2). Study data and risk of bias were extracted using a standardized form. Though work motivation was the primary study outcome, four studies did not provide an outcome definition and five studies did not describe use of a theoretical framework in the ascertainment. Four studies used a randomized trial-group design, one used a non-randomized trial-group design, one used a cross-sectional design, and one used a pretest-posttest design. All three studies that found a significant positive effect on motivational outcomes had a supervision component. Of the three studies that found no effects on motivation, two were primarily compensation interventions and the third was a systems support intervention. One study found a significant negative effect of a compensation intervention on health worker motivation. In conducting this systematic review, we found there is limited evidence on successful interventions to motivate health workers in LMICs. True effects on select categories of health workers may have been obscured given that studies included health workers with a wide range of social and professional characteristics. Robust studies that use validated and culturally appropriate tools to assess worker motivation are greatly needed in the Sustainable Development Goals era.
Topics: Cross-Sectional Studies; Developing Countries; Humans; Motivation; Nurses; Physicians
PubMed: 33407597
DOI: 10.1186/s12960-020-00522-7 -
Psychology of Addictive Behaviors :... Aug 2018Reduced motivation is often noted as a consequence of cannabis use. However, prior studies examining this association have suboptimally operationalized motivation and...
Reduced motivation is often noted as a consequence of cannabis use. However, prior studies examining this association have suboptimally operationalized motivation and have yielded mixed findings. This review discusses motivation and the closely related construct of reward sensitivity. We summarize the available literature examining associations between motivation and cannabis use, addressing the following questions: (a) Is there evidence for decreased motivation among cannabis users? (b) Is there evidence that lack of motivation among cannabis users is specific to their use of cannabis (rather than to use of other addictive drugs)? and (c) Is there evidence suggesting a causal relationship between cannabis use and motivation? Using PubMed, PsycINFO, and WebofScience, we conducted a literature search of studies examining nonacute effects of cannabis use on motivation, apathy, amotivation, effort, and reward sensitivity in humans. This search yielded 22 studies, which were reviewed in detail. We conclude that, although cross-sectional evidence of a cannabis-specific effect on motivation is equivocal, there is partial support from longitudinal studies for a causal link between cannabis use and reduced motivation. Additionally, we propose that reward sensitivity and motivation represent distinct yet related constructs and that reductions in one may not always lead to reductions in the other. Future work should longitudinally examine associations between cannabis use, motivation, and reward sensitivity; carefully define and operationalize these constructs; and control for the influence of potential confounding factors. (PsycINFO Database Record
Topics: Cannabis; Cross-Sectional Studies; Humans; Marijuana Abuse; Marijuana Use; Motivation; Reward; Substance-Related Disorders
PubMed: 29963875
DOI: 10.1037/adb0000380