The criminal justice/mental health system and the mentally retarded, mentally ill defendant

The mentally retarded, mentally ill defendant calls attention to problems in the relationship between the legal and the mental health systems. This study looks at what happens to a group of retarded offenders found incompetent to stand trial. The study examines differences in court processing and final disposition between mentally retarded and nonretarded defendants found incompetent to stand trial. Virtually all subjects were diagnosed as being psychotic. The mentally ill, retarded defendants spend significantly more time in the hospital, more time in the hospital waiting to be returned to jail, and more total time incarcerated in the criminal justice/mental health system. At a final disposition hearing mentally ill, retarded defendants were significantly more likely to be rehospitalized and less likely to be released to the community. No mentally ill, retarded defendant in this study went to prison. The longer periods of incarceration may stem from an underlying lack of understanding about the ability of retarded defendants to achieve competency. Differences in court disposition may result from a court/mental health professional tendency to select dispositions which are thought to be more 'humane'.     

Acculturation,Discrimination and 24-h Activity in Asian American Immigrant Women

Asian American immigrant (AAI) women may have suboptimal 24-h activity patterns due to traditional gender role and caregiving responsibilities. However, little is known about their objectively-measured activity. We measured AAI women’s 24-h activity patterns using accelerometry and examined cultural correlates of time in sedentary behavior (SB), light intensity physical activity (LIPA), moderate-to-vigorous physical activity (MVPA) and sleep. Seventy-five AAI women completed surveys on acculturation (years of U.S. residency and English proficiency), discrimination, and sleep quality, and 7 days of wrist- and hip-accelerometer monitoring. Linear regression was conducted controlling for age, BMI, and education. We also compared activity patterns across Asian subgroups (East, Southeast, South Asians). On average, AAI women had 33 min of MVPA, 6.1 h of LIPA, 10 h of SB, and 5.3 h of sleep per day. South Asian women had the longest SB and the shortest sleep and MVPA hours. English proficiency was negatively related to MVPA (p?=?0.03) and LIPA (p?<?0.01). Years of U.S. residency was positively related to SB (p?=?0.07). Discrimination was related to shorter (p?=?0.03) and poorer quality sleep (p?=?0.06). Culturally-tailored programs targeting SB and sleep and integrating coping strategies against discrimination could help optimize AAI women’s 24-h activity patterns.

     

Becoming a competent clinician: basic competencies in intervention

This article summarizes the results from the Intervention Work Group of the Competencies Conference: Future Directions in Education and Credentialing in Professional Psychology. The generic charge presented to the Intervention Work Group was "to address issues related to interventions." The Intervention Work Group identified four competency components of knowledge, skills, and abilities: (a). foundational competencies; (b). intervention planning; (c). intervention implementation; and (d). intervention evaluation competencies. A fifth component that included "practice management" was labeled as "others." Each component is discussed, including competencies that were deemed an essential knowledge, skill, and/or value. A discussion of training for intervention competence and assessing that intervention competence is included. Future directions for the science and practice of psychology in the intervention arena are summarized. This is one of a series of articles published in this issue of the Journal of Clinical Psychology. Several other articles that resulted from the Competencies Conference will appear in Professional Psychology: Research and Practice and The Counseling Psychologist.     

Cost analysis of fondaparinux versus enoxaparin as venous thromboembolism prophylaxis in hip fracture surgery

Hip fracture patients are at high risk of developing venous thromboembolic events (VTEs) postoperatively. Efficacy and safety data from a clinical trial comparing fondaparinux and enoxaparin as VTE prophylaxis were used to perform a cost assessment of these 2 agents. Incremental cost calculations demonstrate that enoxaparin offers advantages over fondaparinux when dosed for 7 days postoperatively in this patient population. Sensitivity analyses support this finding at the lower extreme; however, fondaparinux provides cost savings at the upper extreme. Cost per death averted and cost per life year gained are similar for these 2 agents in these patients.     

Chronic Psychosocial Stress and Hypertension

Genetic and behavioral factors do not fully explain the development of hypertension, and there is increasing evidence suggesting that psychosocial factors may also play an important role. Exposure to chronic stress has been hypothesized as a risk factor for hypertension, and occupational stress, stressful aspects of the social environment, and low socioeconomic status have each been studied extensively. The study of discrimination is a more recent and rapidly growing area of investigation and may also help to explain the well-known racial disparities in hypertension. Research regarding mechanisms underlying stress effects on hypertension has largely focused on cardiovascular reactivity, but delayed recovery to the pre-stress level is increasingly being evaluated as another possible pathway. Recent findings in each of these areas are reviewed, and directions for future research are discussed.     

Tapentadol hydrochloride: A centrally acting oral analgesic

Background: Tapentadol hydrochloride is a centrally acting oral analgesic approved by the US Food and Drug Administration in November 2008 for the treatment of moderate to severe acute pain. It is available as immediate-release 50-, 75-, and 100-mg tablets.Objective: The purpose of this article is to review animal studies, pharmacokinetic studies, drug-drug interaction studies, and Phase II/III trials of tapentadol in various conditions producing moderate to severe pain. Efficacy and tolerability data from these studies are summarized.Methods: A search of MEDLINE and International Pharmaceutical Abstracts was conducted from January 2005 through June 30, 2009. Search terms included tapentadol, tapentadol hydrochloride, and (?)-(1R,2R)-3-(3-Dimethylamino-1-ethyl-2-methyl-propyl)-phenol hydrochloride. Relevant information was extracted from the identified articles, and the reference lists of these articles were reviewed for additional pertinent publications. The manufacturer was contacted for clinical trials, abstracts, and poster presentations that were not identified by the literature search. ClinicalTrials.gov was searched to identify recently completed studies.Results: Tapentadol produces analgesia through a dual mechanism of action: μ-opioid-receptor activation and norepinephrine reuptake inhibition. Its efficacy has been reported in a number of animal studies, as well as in Phase II/III clinical trials. Primary pain disorders in which efficacy has been reported include dental extraction pain, pain after bunionectomy surgery, osteoarthritis pain of the knee and hip, and low back pain. Major adverse effects reported in Phase II/III trials primarily involved the gastrointestinal system (2%–66% of subjects) and the central nervous system (4%–65% of subjects). The occurrence of gastrointestinal adverse effects appeared to be less frequent in tapentadol recipients than in those receiving oxycodone.Conclusions: Tapentadol appears to be a well-tolerated and effective analgesic for the treatment of moderate to severe acute pain. Although not currently approved for the management of chronic pain, tapentadol has been reported to be effective in managing pain associated with osteoarthritis and low back pain.     

Long-term RNase P-mediated inhibition of HIV-1 replication and pathogenesis

Advances in genetic analysis and a greater understanding of human immunodeficiency virus (HIV) molecular pathogenesis have identified critical viral targets for gene interference strategies. RNase P molecules have been proposed as a novel approach for gene targeting based upon their potent catalytic activity, as well as versatile external guide sequence (EGS) which can be modified to specifically recognize almost any target mRNA. We designed a truncated EGS to specifically recognize the highly conserved U5 region of HIV-1 mRNA and mediate subsequent cleavage of hybridized mRNA by the RNase P enzyme component. The active U5-EGS (560), as well as a disabled U5 EGS (560D) control, were cloned into plasmids containing proviral constructs and transfected into a CD4(+) T cell line that was thereafter infected with HIV-1 MN. CD4(+) T cells treated with the active U5 EGS (560) were observed to maintain CD4(+) expression and did not produce HIV p24 gag antigen, form syncytia or undergo apoptosis up to 30 days after infection. Identical cells expressing the inactivated form of the U5 RNase P EGS completely down-regulated CD4 expression, produced elevated levels of HIV-1, formed large syncytia and underwent apoptosis similar to untreated cells. HIV-1 replication and related cytopathology can be effectively inhibited in CD4(+) T cells expressing a protective U5 EGS (560).