Racial and ethnic harassment and discrimination: in the eye of the beholder?

The nature, rate, and higher-order relationships among facets of racial/ethnic harassment (REH) and discrimination (RED) were examined across five racial/ethnic groups in a sample of 5,000 US military personnel. Using a hierarchical, multigroup confirmatory factor analysis approach, results suggest that the nature of REH and RED do not differ by race, with behavioral items equally representing REH and RED across the different groups. Further, higher-order relationships among the facets of REH and RED do not vary across race, with a single second-order factor accounting for the relationships. This single factor is theorized to represent a root intergroup prejudice that leads to harassment and discrimination. However, as anticipated, individuals from minority groups generally reported higher levels of REH and RED once measurement equivalence has been established. Together, the results suggest that both intergroup prejudice (which is multidirectional) and racism (which originates in powerful groups against other groups) are operating in REH and RED experiences.     

Insomnia and the eye of the beholder: are there clinical markers of objective sleep disturbances among adults with and without insomnia complaints?

Previous findings suggest that some who report insomnia sleep well, whereas some noncomplaining individuals sleep rather poorly. This study was conducted to determine if mood, anxiety, and sleep-related beliefs might relate to perceived sleep disturbance. Thirty-two women and 32 men (aged 40-79 years) with primary insomnia and an aged-matched sample of 61 normal sleepers (31 women, 30 men) completed 6 nocturnal sleep recordings, as well as the Beck Depression Inventory (BDI), the Trait portion of the State-Trait Anxiety Inventory (STAI-2), and the Dysfunctional Beliefs and Attitudes About Sleep Questionnaire. Sleep and interview data were used to subdivide the majority of the sample (n = 108) into objective normal sleepers and subjective insomnia sufferers who seemingly slept well and subjective normal sleepers and objective insomnia sufferers who slept poorly. The 2 subjective subgroups showed the most marked differences on most of the psychometric measures. The findings suggest that the psychological factors scrutinized in this study may mediate sleep satisfaction and/or predict objective sleep difficulties.     

Do SSRIs cause suicide in children? The evidence is underwhelming

After regulatory agencies in the United Kingdom and United States recommended severe restrictions on antidepressant use in children, many lessons were learned, although one was not that these drugs cause suicide. We learned that pharmaceutical companies selectively released data that reflected positively on their products and that combining suppressed and published data suggested that most of these medications had questionable efficacy. We also learned that the studies lacked uniformity both in which age groups constituted children and which behavior was considered suicidal. Several recent, large nonindustry studies indicated that rates of suicide and suicidal behavior were actually reduced in children who used antidepressants, despite piteous anecdotal tales in the popular press purporting that selective serotonin reuptake inhibitors (SSRIs) caused children to kill themselves. Patients in pharmaceutical trials probably do not represent typical patients in routine clinical practice. Emerging implications are that suicidal behavior-if it does occur-is most likely soon after starting antidepressant use and that prescribers must be both vigilant in educating patients and families about warning signs and available to manage worrisome behavior.     

Neurocognition as a predictor of response to evidence-based psychosocial interventions in schizophrenia: what is the state of the evidence?

Impairment in functional status is a hallmark of schizophrenia that has been linked to deficits in aspects of neurocognition (e.g., attention, memory, and problem-solving). A growing number of evidence-based behavioral interventions have been developed to address impairment in functional status, yet the relationships between these interventions and neurocognitive impairment are not well-understood. We conducted a synthetic, critical literature review of studies of performance on neurocognitive tests as a predictor of response to evidence-based behavioral treatment in schizophrenia. Behavioral treatments were selected based on the Patient Outcomes Research Team (PORT; Dixon et al., 2010) recommendations for practice and areas of emerging interest. Comprehensive searches of PsychINFO and MEDLINE/PUBMED databases identified 20 relevant studies. Results revealed that: (1) attention and memory measured at study entry were most frequently linked to proximal measures of progress in social skill training programs, (2) composite measures of neurocognitive function, as well as attention, memory and problem-solving, were linked to progress in work therapy and supported employment programs, and comprehensive, integrated programs of psychosocial rehabilitation, while (3) baseline impairment on neurocogntive tests was not shown to limit progress in treatment studies of cognitive-behavioral therapy. The relevance of these findings for clinical practice and future research is discussed.     

History and geography of suicide: could genetic risk factors account for the variation in suicide rates?

The current state of knowledge of genetic predisposition towards the suicidal behavior allows for a question whether genetic risk factors account for the variation in suicide rates through time and space. Accordingly, the presented paper will attempt to tackle the genetics behind suicidal behavior from the perspective of the populational genetics. First, the variability of suicide rates across Europe is discussed. This is followed by a brief discussion of the J curve (on a map of Europe, the countries with a higher suicide rate form a so-called J curve, which starts in Finland and extends down to Slovenia), which maps on to the second principal component identified for European gene distribution, representing the ancestral adaptation to cold climates and the Uralic language dispersion. Furthermore, we will discuss whether the group of people living within the J-curve could share genes, which may not tolerate excessive amounts alcohol, the combination of which is more likely to end in suicidal behavior. Further along we list possible ways in which suicidal behaviour could have been selected for genetically in populations and identify those specific populations in which it may have appeared. Finally, we point at other locations in the world where a similar interplay of genes and environment has probably occurred, Greenland being the best example of the malignant interaction of alcohol consumption and the trait-like characteristics, which might constitute the vulnerability to suicidal behaviour.     

How strong is the evidence that immunotherapy in children prevents the progression of allergy and asthma?

PURPOSE OF REVIEW: The purpose of this review is to describe the scientific evidence that specific immunotherapy can prevent the development of asthma in patients suffering from rhinoconjunctivitis as well as reduce the number of new allergies developing. RECENT FINDINGS: Proposed strategies for the prevention of the development of allergic rhinoconjunctivitis and asthma include allergen avoidance, pharmacological treatment (antihistamines and steroids) and specific immunotherapy. Long-term follow-up on immunotherapy studies demonstrates that specific immunotherapy for 3 years shows persistent long-term effects on clinical symptoms after termination of treatment and long-term, preventive effects on later development of asthma in children with seasonal rhinoconjunctivitis. It is so far the only treatment for allergic diseases that has been shown to be able to prevent worsening of disease and development of asthma. Also, specific immunotherapy seems to reduce the development of new allergic sensitivities as measured by the skin prick test as well as specific IgE measurements. SUMMARY: Specific immunotherapy is the only treatment that interferes with the basic pathophysiological mechanisms of the allergic disease and thereby carries the potential for changes in the long-term prognosis of respiratory allergy. Specific immunotherapy should be recognized not only as first-line therapeutic treatment for allergic rhinoconjunctivitis, but also as secondary preventive treatment for respiratory allergic diseases.     

Epicutaneous sensitization in the development of food allergy: What is the evidence and how can this be prevented?

There is increasing evidence regarding the importance of allergic sensitization through the skin. In this review, we provide an overview of the atopic march and immune mechanism underlying the sensitization and effector phase of food allergy. We present experimental models and human data that support the concept of epicutaneous sensitization and how this forms one half of the dual-allergen exposure hypothesis. We discuss specific important elements in the skin (FLG and other skin barrier gene mutations, Langerhans cells, type 2 innate lymphoid cells, IL-33, TSLP) that have important roles in the development of allergic responses as well as the body of evidence on environmental allergen exposure and how this can sensitize an individual. Given the link between skin barrier impairment, atopic dermatitis, food allergy, allergic asthma, and allergic rhinitis, it is logical that restoring the skin barrier and prevention or treating atopic dermatitis would have beneficial effects on prevention of related allergic diseases, particularly food allergy. We present the experimental and human studies that have evaluated this approach and discuss various factors which may influence the success of these approaches, such as the type of emollient chosen for the intervention, the role of managing skin inflammation, and differences between primary and secondary prevention of atopic dermatitis to achieve the desired outcome.     

The red blood cell as an oxygen sensor: what is the evidence?

The matching of oxygen supply with demand requires the existence of a mechanism within the tissue capable of both sensing tissue oxygen need and inducing alterations in vascular perfusion necessary to meet that need. Historically, localized sites within the tissue and the vessels themselves have been investigated with the sensor site failing to be determined. Within the last decade, studies have focused on the red blood cell, the efficient carrier of oxygen, as a possible candidate. The red blood cell is clearly capable of sensing oxygen levels, as its extent of haemoglobin desaturation (decrease in oxygen content) is intimately tied with tissue oxygen demand. In addition, numerous studies have indicated that the red blood cell is capable of releasing increased amounts of adenosine 5'-triphosphate (ATP) as oxygen content falls and its haemoglobin becomes desaturated. Within the vasculature, intraluminal ATP has been shown to induce a vasodilator response which is conducted along the vessels resulting in augmentation of tissue perfusion. While details of the red blood cell's role are still under investigation, evidence presented here supports the intriguing idea that the mobile red blood cell may itself be able to augment blood flow and oxygen delivery wherever and whenever the need might arise. Such a mechanism eliminates the requirement for a diverse network of sensing sites throughout the vasculature and should provide a more efficient means of appropriately matching oxygen supply with demand.     

The red blood cell as an oxygen sensor: what is the evidence?

The matching of oxygen supply with demand requires the existence of a mechanism within the tissue capable of both sensing tissue oxygen need and inducing alterations in vascular perfusion necessary to meet that need. Historically, localized sites within the tissue and the vessels themselves have been investigated with the sensor site failing to be determined. Within the last decade, studies have focused on the red blood cell, the efficient carrier of oxygen, as a possible candidate. The red blood cell is clearly capable of sensing oxygen levels, as its extent of haemoglobin desaturation (decrease in oxygen content) is intimately tied with tissue oxygen demand. In addition, numerous studies have indicated that the red blood cell is capable of releasing increased amounts of adenosine 5′‐triphosphate (ATP) as oxygen content falls and its haemoglobin becomes desaturated. Within the vasculature, intraluminal ATP has been shown to induce a vasodilator response which is conducted along the vessels resulting in augmentation of tissue perfusion. While details of the red blood cell’s role are still under investigation, evidence presented here supports the intriguing idea that the mobile red blood cell may itself be able to augment blood flow and oxygen delivery wherever and whenever the need might arise. Such a mechanism eliminates the requirement for a diverse network of sensing sites throughout the vasculature and should provide a more efficient means of appropriately matching oxygen supply with demand.     

What is the most relevant standard of success in assisted reproduction? Redefining success in the context of elective single embryo transfer: evidence, intuition and financial reality

Treatment-related multiple pregnancy poses the biggest threat to the safety of IVF. Despite a double embryo transfer (DET) policy in most European centres, twin rates continue to be unacceptably high, at 20-35%. Elective single embryo transfer (SET) is an effective way to minimize twin pregnancies, but the debate surrounding its routine clinical use continues. A review of the literature was undertaken in order to seek evidence about the effectiveness of SET, and identify barriers to its acceptance in clinical practice. Data from randomized controlled trials (RCTs) indicate that SET results in lower live birth rates per fresh IVF cycle (odds ratio 0.53; 95% confidence interval 0.31-0.89; P = 0.02) in comparison with DET. Data on cumulative live birth rates are unavailable from RCTs, although the expectation is that these are comparable in the two groups. SET is unlikely to be suitable for all women undergoing IVF and outcomes may be sensitive to different laboratory protocols. The perceived effectiveness of SET is influenced by the way existing evidence is interpreted. Other factors affecting the routine use of SET include laboratory techniques, individual preferences and funding issues.     

Uterine stem cells: what is the evidence?

The mucosal lining (endometrium) of the human uterus undergoes cyclical processes of regeneration, differentiation and shedding as part of the menstrual cycle. Endometrial regeneration also follows parturition, almost complete resection and in post-menopausal women taking estrogen replacement therapy. In non-menstruating species, there are cycles of endometrial growth and apoptosis rather than physical shedding. The concept that endometrial stem/progenitor cells are responsible for the remarkable regenerative capacity of endometrium was proposed many years ago. However, attempts to isolate, characterize and locate endometrial stem cells have only been undertaken in the last few years as experimental approaches to identify adult stem/progenitor cells in other tissues have been developed. Adult stem cells are defined by their functional properties rather than by marker expression. Evidence for the existence of adult stem/progenitor cells in human and mouse endometrium is now emerging because functional stem cell assays are being applied to uterine cells and tissues. These fundamental studies on endometrial stem/progenitor cells will provide new insights into the pathophysiology of various gynaecological disorders associated with abnormal endometrial proliferation, including endometrial cancer, endometrial hyperplasia, endometriosis and adenomyosis.     

Viruses and other infections in stillbirth: what is the evidence and what should we be doing?

In Australia, as in other developed countries, approximately 40-50% of stillbirths are of unknown aetiology. Emerging evidence suggests stillbirths are often multifactorial. The absence of a known cause leads to uncertainty regarding the risk of recurrence, which can cause extreme anguish for parents that may manifest as guilt, anger or bewilderment. Further, clinical endeavours to prevent recurrences in future pregnancies are impaired by lack of a defined aetiology. Therefore, efforts to provide an aetiological diagnosis of stillbirth impact upon all aspects of care of the mother, and inform many parts of clinical decision making. Despite the magnitude of the problem, that is 7 stillbirths per 1000 births in Australia, diagnostic efforts to discover viral aetiologies are often minimal. Viruses and other difficult to culture organisms have been postulated as the aetiology of a number of obstetric and paediatric conditions of unknown cause, including stillbirth. Reasons forwarded for testing stillbirth cases for infectious agents are non-medical factors, including addressing all parents' need for diagnostic closure, identifying infectious agents as a sporadic cause of stillbirth to reassure parents and clinicians regarding risk for future pregnancies, and to reduce unnecessary testing. It is clear that viral agents including rubella, human cytomegalovirus (CMV), parvovirus B19, herpes simplex virus (HSV), lymphocytic choriomeningitis virus (LCMV), and varicella zoster virus (VZV) may cause intrauterine deaths. Evidence for many other agents is that minimal or asymptomatic infections also occur, so improved markers of adverse outcomes are needed. The role of other viruses and difficult-to-culture organisms in stillbirth is uncertain, and needs more research. However, testing stillborn babies for some viral agents remains a useful adjunct to histopathological and other examinations at autopsy. Modern molecular techniques such as multiplex PCR, allow searches for multiple agents. Now that such testing is available, it is important to assess the clinical usefulness of such testing.     

How robust is the evidence for viruses in the induction of type 1 diabetes?

Viruses associated with type 1 diabetes have eluded definition as causal, with the exception of rubella virus. False-negative results may have occurred due to the focus on subjects at symptomatic onset, who may be heterogeneous and differently affected by viruses. In addition, assays have not always been sufficiently sensitive to deal with transient infections, and pancreatic tissue is scarce. Longitudinal studies of at-risk subjects and more sensitive DNA techniques now reveal that at initiation of islet autoimmunity, enteroviruses have only a small role, but are more likely to be important at symptomatic onset. Rotaviruses remain associated with initiation of islet autoimmunity, and generate strong T cell responses in the young.