Victimization and posttraumatic stress disorder among homeless adolescents

OBJECTIVE: To examine street victimization and posttraumatic stress symptoms among urban homeless adolescents and to test whether emotional numbing and avoidance represent distinct posttraumatic stress disorder (PTSD) symptom clusters. METHOD: Structured, private interviews were conducted with homeless adolescents (N = 374) in the Seattle metropolitan area (95% response rate) from 1995 to 1998. RESULTS: Eighty-three percent of street youths were physically and/or sexually victimized after leaving home. Approximately 18% of these youths met research criteria for PTSD. Results from a confirmatory factor analysis suggest that disaggregating symptoms of avoidance from symptoms of emotional numbing provides a better fit of the data than the current DSM-IV model in which these symptoms are combined in one factor. CONCLUSIONS: Sexual and physical victimization are serious threats for homeless adolescents, and those who are victimized are at risk for PTSD. Results challenge the belief that symptoms of avoidance and numbing represent one unified cluster in this population.     

The developmental, dimensional and diagnostic interview (3di): a novel computerized assessment for autism spectrum disorders

OBJECTIVE: Autism is a diagnostic spectrum of variable severity, with significant comorbidity. No existing standardized interview measures autistic features dimensionally. The authors aimed to develop a parental autism interview that could be administered to unselected clinical and general population samples that measures both symptom intensity and comorbidity across the full range of the autistic spectrum. METHOD: A computerized procedure was devised for administration by trained interviewers that generates symptom and diagnostic profiles for both autism and non-autistic conditions. Test-retest reliability and interrater reliability were assessed in unselected clinical (n = 50) and nonclinical (n = 30) populations. Concurrent validity (n = 120), discriminant validity (n = 120), and criterion validity (n = 29) were evaluated in autistic spectrum and non-autistic patients. RESULTS: Test-retest and interrater reliabilities were excellent (most intraclass correlation coefficients > 0.9). Concurrent validity (agreement with independent clinician formulation) was very good (mean kappa = 0.74). Criterion validity, a comparison with the Autism Diagnostic Interview, was excellent. Discrimination between autistic spectrum versus non-autistic subjects was almost perfect (sensitivity 1.0; specificity > 0.97). CONCLUSIONS: The Developmental, Dimensional and Diagnostic Interview (3di) provides an efficient and accurate means of assessing, in dimensional terms, the presence of autistic symptoms in both clinical and normal populations. It offers novel opportunities for those engaged in research and clinical practice.     

Conditional knockdown of tubedown-1 in endothelial cells leads to neovascular retinopathy

PURPOSE: Identification of novel proteins involved in retinal neovascularization may facilitate new and more effective molecular-based treatments for proliferative retinopathy. Tubedown-1 (Tbdn-1) is a novel protein that shows homology to the yeast acetyltransferase subunit NAT1 and copurifies with an acetyltransferase activity. Tbdn-1 is expressed in normal retinal endothelium but is specifically suppressed in retinal endothelial cells from patients with proliferative diabetic retinopathy. The purpose of this study was to investigate the importance of Tbdn-1 expression in retinal blood vessels in vivo. METHODS: A bitransgenic mouse model that enables conditional knockdown of Tbdn-1 specifically in endothelial cells was produced and studied using molecular, histologic, and immunohistochemical techniques and morphometric analysis. RESULTS: Tbdn-1-suppressed mice exhibited retinal and choroidal neovascularization with intra- and preretinal fibrovascular lesions similar to human proliferative retinopathies. Retinal lesions observed in Tbdn-1-suppressed mice increased in severity with prolonged suppression of Tbdn-1. In comparison to normal retina, the retinal lesions displayed alterations in the basement membrane of blood vessels and in the distribution of glial and myofibroblastic cells. Moreover, the pathologic consequences of Tbdn-1 knockdown in endothelium were restricted to the retina and the choroid. CONCLUSIONS: These results indicate that the maintenance of Tbdn-1 expression is important for retinal blood vessel homeostasis and for controlling retinal neovascularization in adults. Restoration of Tbdn-1 protein expression and/or activity may provide a novel approach for treating proliferative retinopathies.     

Valuing health care using willingness to pay: a comparison of the payment card and dichotomous choice methods

This paper compares willingness to pay (WTP) estimates generated from the dichotomous choice (DC) and payment card (PC) approaches. In a split-sample WTP experiment concerned with allocating scarce health care resources across three health care interventions, the DC approach is shown consistently to generate larger welfare estimates than the PC. Observed difference between PC and DC experiments cannot be explained by the inclusion of non-demanders or methods of statistical analysis but may be partly explained by "yea-saying". No evidence of range bias or mid-point bias was found with PC responses. Data were also collected on respondents' ordinal rankings of the three interventions and person-trade-offs (PTOs). Neither of these approaches converged with WTP. Future work must address the decision heuristics individuals employ when responding to valuation experiments.     

Issues and concerns of couples presenting for preimplantation genetic diagnosis (PGD)

BACKGROUND: The use of preimplantation genetic diagnosis (PGD) to select genetically 'normal' human embryos and to transfer them to the uterus of a woman has generated considerable controversy. Debate has occurred over the implications of PGD, sex selection, safety of embryonic manipulation and eugenics. This study evaluates a range of social and moral concerns of couples towards PGD and assisted reproductive technologies (ART) prior to treatment to obtain unbiased authentic attitudes independent of the treatment cycle and the outcome. METHODS: A total of 121 subjects were administered a structured questionnaire after each couple's in vitro fertilization (IVF) or genetic counselling session. Group A consisted of 41 subjects presenting for PGD of single gene disorders (PGD-SG) and group B consisted of 48 subjects undertaking PGD for aneuploidy screening (PGD-AS). A control group consisted of 32 subjects that were about to commence their first IVF cycle. RESULTS AND DISCUSSION: All groups found PGD to be a highly acceptable treatment. They expressed little concern about its extension to testing non-disease states such as sex and they were strongly in favour of a shared decision-making model in which couples have considerable autonomy over decisions about the embryo(s) to transfer. Differences between the groups included issues surrounding the transfer of embryos, restrictions to PGD and the destruction of embryos.     

Overcoming the challenges of neuropathic pain

Neuropathic pain can originate from a variety of conditions. Early treatment is vital. Nurses have an important role in initiating treatment and providing ongoing pain management and support for patients.     

A multicentre comparative evaluation: washable pants with an integral pad for light incontinence

The Continence Product Evaluation Network (CPE network) is funded by the Medical Devices Agency (MDA) of the Department of Health, to undertake comparative evaluations of continence products. There are a wide variety of continence products on the UK market and very little information is available to aid product selection. The aim of this study was to evaluate washable pants with integral pads for women with light incontinence. A randomized multiple cross-over design was used. Seventy-two women tested each of the 10 products that were available on the UK market at the time of the evaluation. Both subjective and objective outcome measures were used to evaluate the products. Products performed similarly in terms of leakage but there were statistically significant differences in other performance aspects, e.g. fit and discreteness. This study should be valuable in enabling purchasers, carers and users to make informed decisions when purchasing products.     

Do nurses know enough about percutaneous endoscopic gastrostomy?

An audit of nurses in a district general hospital found that there were gaps in their knowledge about the management of percutaneous endoscopic gastrostomy. The author suggests ways in which their knowledge could be updated and patient care improved.     

Smallpox: the disease and strategies for its control

Smallpox was once one of the most severe infectious diseases and was endemic throughout the world for most of recorded history. It no longer exists in nature, having been declared extinct in 1980 following a global eradication campaign led by the World Health Organization. However, recent news reports on the vaccination of key health workers in the event of deliberate release of smallpox as part of a biological attack, and the deployment of Regional Smallpox Diagnosis and Response Teams, are stimulating demand for knowledge of the disease. This article provides an overview of the smallpox virus, including signs and symptoms, treatment and transmission, and vaccination and control in the event of deliberate release.