Suicidal ideation and behaviors among youths in juvenile detention

OBJECTIVE: To examine suicidal ideation, suicide attempts, lethality of suicide attempts, and the relationship between psychiatric disorder and recent attempts in newly detained juveniles. METHOD: The sample included 1,829 juveniles, ages 10 to 18 years, sampled after intake to a detention center in Chicago. Interviewers administered the Diagnostic Interview Schedule for Children to assess for thoughts of death, suicidal ideation, suicide plans, lifetime suicide attempts, number of attempts, age at first attempt, attempts within the past 6 months, method of suicide attempts, and psychiatric disorder. RESULTS: More than one third of juvenile detainees and nearly half of females had felt hopeless or thought about death in the 6 months before detention. Approximately 1 in 10 (10.3%, 95% confidence interval: 7.7%-12.8%) juvenile detainees had thought about committing suicide in the past 6 months, and 1 in 10 (11.0%, 95% confidence interval: 8.3%-13.7%) had ever attempted suicide. Recent suicide attempts were most prevalent in females and youths with major depression and generalized anxiety disorder. CONCLUSIONS: Fewer than half of detainees with recent thoughts of suicide had told anyone about their ideation. Identifying youths at risk for suicide, especially those suffering from depressive and anxiety disorders, is a crucial step in preventing suicide.     

Exposure to Both Radiation and Chemotherapy Increases the Risk of Barrett’s and Multilayered Epithelium

The relationship between radiation and/or chemotherapy and the development of Barrett’s and/or multilayered epithelium has not been investigated before. We ascertained a group of patients exposed to radiation and/or chemotherapy and an unexposed group to compare the prevalence rates of Barrett’s epithelium and multilayered epithelium at the time of endoscopy in these two groups. Barrett’s epithelium was found in ten of the 19 (53%) exposed patients, compared to eight of 38 (21%) unexposed subjects (P = 0.02). Six of 19 (32%) exposed patients had multilayered epithelium, compared to four of 38 (11%) unexposed subjects (P = 0.06). Twelve of the 19 exposed patients (63%) had either Barrett’s or multilayered epithelium, in contrast to ten of 38 (26%) unexposed subjects (P = 0.01). Those with exposure to both chemotherapy and radiation had a significant increase in the risk for Barrett’s and/or multilayered epithelium (P = 0.003). This study suggests a relationship between exposure to a combination of radiation and chemotherapy and the development of Barrett’s and/or multilayered epithelium.     

Patient Selection for Treatment with Conservative Surgery and Radiation Therapy

There is now general agreement that treatment with conservative surgery and radiation therapy yields survival equal to mastectomy with the advantage of organ preservation for properly selected patients. When competently performed, such treatment gives highly satisfactory cosmetic results and acceptably low rates of local tumor recurrence. However, there remain numerous controversies concerning patient selection for this treatment option. The factors involved in patient selection may be grouped into three categories: patient factors; clinical factors; and pathologic factors. This article reviews their use. Because breast cancer has a long natural history, long follow up of patients is required for ultimate proof of the relative merits of different selection or treatment policies. However, due to the increasing numbers of patients being treated with conservative surgery and radiotherapy, it appears likely that many of these questions will be answered within the next decade.     

Environmental stress factors affecting survival and virulence of Campylobacter jejuni

Enteric pathogens are constantly exposed to stressful conditions in their natural habitat in the host and even more in the extra-host environment, including food processing. The aim of this study was to evaluate the effect of selected environmental stress factors: temperature shift, starvation and atmospheric oxygen concentration on culturability/viability of two Campylobacter jejuni isolates. Additionally, after stress exposure, in an in vitro cell culture model using Caco-2 cells, the adhesion, invasion and intracellular survival of C. jejuni were studied. Nutrient insufficiency was the most powerful stress factor which significantly affected C. jejuni culturability and viability, as well as, adhesion and invasion properties. Temperature elevation induced a transient growth arrest, and temporary loss of pathogenic potential as indicated by impaired adhesion and invasion efficiency of C. jejuni. However, bacteria recovered within 24-48h inside the Caco-2 cells. Oxidative stress neither affected C. jejuni growth nor reduced the binding and invasion into Caco-2 cells. Only 5h oxygen exposure increased the invasion capability and intraepithelial survival of the clinical isolate. Modulation of C. jejuni virulence in response to environmental stress factors may have further implications in the pathogenesis of campylobacteriosis.     

Acceptability of a patient decision aid for women aged 70 and older with stage I,estrogen receptor-positive,HER2-negative breast cancer

ObjectivesA comprehensive decision aid (DA) for women ≥70 years with Stage I ER+/HER2-negative breast cancer was developed to support locoregional and systemic treatment decision-making. We aimed to test the acceptability of this novel DA in women newly-diagnosed with breast cancer.Materials and MethodsWomen ≥70 diagnosed with Stage I, ER+/HER2- breast cancer were recruited from three Boston-area hospitals. They underwent baseline interviews after initial surgical consultation, reviewed the DA, and were surveyed <2 weeks later to determine DA acceptability (e.g., was it helpful?), changes in decisional conflict, stage of decision-making, and knowledge. Participants could optionally complete a three-month follow-up. Paired t-tests and McNemar's tests were used for statistical comparisons, and thematic analyses were conducted to identify themes in participants' open-ended comments.ResultsThirty-three of 56 eligible patients approached completed the baseline and acceptability surveys, and 25 completed the three-month follow-up. Participants' mean age was 74.7 years (±3.8). Nearly all participants (n = 31, 94%) strongly agreed that the DA was helpful and felt that the DA prepared them for treatment decision-making, with a mean decision preparation score of 4.1 (out of 5.0); 6% (n = 2) found it very anxiety provoking. Knowledge improved with a mean of 9.0 out of 14 questions correct at baseline to 10.6 correct on the acceptability survey (p < 0.0001).ConclusionsA DA tailored to women ≥70 with Stage I, ER+, HER2- breast cancer increased knowledge and was perceived to be helpful by older women. A randomized controlled trial is needed to evaluate its efficacy.