Age differences in the identification of psychosocial problems among hospitalised patients in Israel: social worker and client perceptions

The type of services and the way they are provided by the helping professions may be affected by the helpers' biases in relation to socioeconomic characteristics of groups of clients. Some studies have shown that when clients are older adults, social workers have characteristically focused on procedural matters, often neglecting emotional dimensions of client need and care provision, as well as the role of patients in decision making. This paper examines these issues in the context of research conducted in a large medical centre in Israel Findings about the ways in which services were offered in 120 social work cases included worker and client perceptions of the types of psychosocial problems dealt with. These cases were categorised in 2 groups, one including patients under 65 and the other including patients aged 65 and over. Differences in the findings were analysed with reference to this age-related case classification. Implications for the provision of care in the acute care setting are discussed.     

Parental Anxiety Following Discharge From Hospital of Their Very Low Birth Weight Infants*

The uncertainty regarding the future well‐being of very low birth weight infants is a source of considerable anxiety for parents, even after discharge from the hospital. We identify factors related to postdischarge anxiety levels of parents of 65 infants. Infant's weight relative to gestational age; the presence of central nervous system complications; informational support; and a warm, caring attitude by hospital staff explained 35% of the variance in mothers' anxiety levels. Father's age, infant's gender, perception of the infant as problematic, and the availability of child care support explained 33% of the variance in fathers' anxiety levels. Practice implications, including both identification of high‐risk groups and interventions aimed at bringing about change in specific factors, are discussed.     

High beta integrin expression is differentially associated with worsened pancreatic ductal adenocarcinoma outcomes

Outcomes in pancreatic ductal adenocarcinoma (PDAC) are known to be worse in tumors with high integrin β1 expression, but targeted monotherapy against this integrin has not been effective. Seven other beta integrins are expressed in mammalian biology and they are known to have overlapping and compensatory signaling in biological systems. However, their roles in PDAC are poorly understood and have not been systematically compared to integrin β1 biology. In this study, we analyzed the clinical outcomes against beta integrin 1-8 (ITGB1-8) expression in PDAC samples from two large independent cohorts, The Cancer Genome Atlas (TCGA) and {"type":"entrez-geo","attrs":{"text":"GSE21501","term_id":"21501"}}GSE21501. Biological function and tumor microenvironment composition were studied using Gene Set Enrichment Analysis and xCell. Expression of all eight beta integrins is significantly increased in PDACs relative to normal pancreatic tissues (all P<0.001). ITGB1, 2, 5, and 6 have similarly enriched gene patterns related to transforming growth factor (TGF)-β, epithelial mesenchymal transition, inflammation, stemness, and angiogenesis pathways. Homologous recombination defects and neoantigens are increased in high-ITGB4, 5, and 6 tumors, with decreased overall survival in high-ITGB1, 5, and 6 tumors compared to low expression tumors (hazard ratios 1.5-2.0). High-ITGB1, 2, and 5 tumors have increased fibroblast infiltration (all P<0.01) while endothelial cells are increased in high-ITGB2 and 3 tumors (all P<0.05). Overall, beta integrin expression does not correlate to immune cell populations in PDACs. Therefore, while all beta integrins are overexpressed in PDACs, they exert differential effects on PDAC biology. ITGB2, 5, and 6 have a similar profile to ITGB1, suggesting that future research in PDAC integrin therapy needs to consider the complementary signaling profiles mediated by these integrins.     

Adolescent Intimate Heterosexual Relationships: Measurement Issues

During adolescence, individuals develop increased ability to have emotionally and physically intimate relationships. The type of intimate relationship will make a difference as to whether the adolescent engages in protective behaviors or avoids risky behaviors. However, in reviewing the literature on the association of relationship type and sexual risk and protective behaviors, four methodological challenges were noted. These challenges limit our understanding of the impact of relationship type. These four challenges are: (a) inconsistent definitional frameworks; (b) lack of adolescent voices; (c) lack of consideration of gender; and (d) poor differentiation between individual and relationship risk. These issues direct the course of future work in this area and are necessary to advance the field of adolescent sexual health, particularly with regard to the development and testing of appropriate interventions designed to reduce untoward outcomes of adolescent sexuality.     

A randomized, controlled trial of cognitive behavioral social skills training for middle-aged and older outpatients with chronic schizophrenia

OBJECTIVE: The number of older patients with chronic schizophrenia is increasing. There is a need for empirically validated psychotherapy interventions for these patients. Cognitive behavioral social skills training teaches cognitive and behavioral coping techniques, social functioning skills, problem solving, and compensatory aids for neurocognitive impairments. The authors compared treatment as usual with the combination of treatment as usual plus cognitive behavioral social skills training. METHOD: The randomized, controlled trial included 76 middle-aged and older outpatients with chronic schizophrenia, who were assigned to either treatment as usual or combined treatment. Cognitive behavioral social skills training was administered over 24 weekly group sessions. Blind raters assessed social functioning, psychotic and depressive symptoms, cognitive insight, and skill mastery. RESULTS: After treatment, the patients receiving combined treatment performed social functioning activities significantly more frequently than the patients in treatment as usual, although general skill at social functioning activities did not differ significantly. Patients receiving cognitive behavioral social skills training achieved significantly greater cognitive insight, indicating more objectivity in reappraising psychotic symptoms, and demonstrated greater skill mastery. The overall group effect was not significant for symptoms, but the greater increase in cognitive insight with combined treatment was significantly correlated with greater reduction in positive symptoms. CONCLUSIONS: With cognitive behavioral social skills training, middle-aged and older outpatients with chronic schizophrenia learned coping skills, evaluated anomalous experiences with more objectivity (achieved greater cognitive insight), and improved social functioning. Additional research is needed to determine whether cognitive insight mediates psychotic symptom change in cognitive behavior therapy for psychosis.     

A partial uterine perforation (type 2) by a copper-T IUD: sonographic diagnosis and management

The case reported in this paper demonstrates the difficulties in establishing the diagnosis of type 2 uterine perforation incident to the use of an IUD. A type 2 perforation is considered to have occurred when the IUD is entirely within the myometrium, no part of the IUD can be detected in the uterine cavity, and no part can be visually detected in the peritoneal cavity. The patient, a 28-year old gravida 3, para 2, had an IUD inserted 18 months prior to admittance, 7 weeks after her 2nd delivery. 1 year later she became pregnant. During a therapeutic abortion, the IUD string was removed without the device, which was considered to be outside and behind the uterus. Ultrasonography revealed that the IUD was inside the posterior uterine wall, parallel to the endometrial mucosal lining, with no connection to the uterine cavity. Other diagnostic methods used in this case included plain abdominal films, hysterography, and hysteroscopy; however, neither these methods nor uterine palpation suggested that there was an IUD in the uterus. The original diagnosis was later confirmed by intraoperative radiography, and the IUD was removed through a small incision on the posterior uterine wall. This case demonstrates the useful role of ultrasonography in the work-up of a woman with a missing IUD. It is suggested that ultrasonography be used following difficult IUD insertions or postpartum insertions, since most perforations occur in such cases. Partial and complete uterine perforation is considered more likely when the IUD is inserted during the 1st 3 months postpartum.