Violent victimization of women and men: physical and psychiatric symptoms

BACKGROUND: Our objectives for this exploratory study were (1) to assess the prevalence in a family practice of violent victimization of women and men by partners, friends, families, and strangers, and (2) to compare the physical symptoms, depression, alcohol use problems, and social support of women and men who were or were not victimized in the previous 12 months. METHODS: We conducted a cross-sectional, multicenter study of family practice patients (1999-2000). One-thousand twenty-four patients, including 679 women and 345 men from 18 to 64 years of age completed a standard health history and a demographic questionnaire. The health history questionnaire included a question about violent victimization. RESULTS: Violent victimization was reported by 9.9% of the women and 10.9% of the men. Patients who were victimized were grouped into those who were victimized by partners (4.9% of women and 3.0% of men); by friends, or family, or strangers (2.3% of women and 5.0% of men); or by more than one category of persons other than partners (2.6% of women and 3.0% of men). Almost one third of patients victimized by partners were also victimized by another person. Women who were victimized had more physical symptoms than women who were not victimized. Women who were victimized and men who were victimized by their partners had more depressive symptoms than other women and men. Patients who were victimized by more than one category of other victimizers reported more alcohol use problems than other patients. Patients who were victimized reported less social support than patients who were not victimized. CONCLUSIONS: Both women and men report violent victimization in response to a screening question. Violence by partners and by others is related to physical and psychiatric symptoms in women and in men.     

Temporal integration in an anuran auditory nerve

We determined temporal integration in individual auditory nerve fibers of the arboreal frog, Eleutherodactylus coqui by measuring the change in rate threshold to tonal stimulation for tone burst durations from 20 to 450 ms. Temporal integration was quantified in two ways: (1) we calculated the temporal integration time constant of the fiber (tau), and (2) we calculated the shift in threshold per decade increment of the tone stimulus (dB/decade). In some cases, the procedure was repeated using a continuous, broadband noise masker (20-50 dB/Hz). Our results indicate that low frequency fibers (CF less than 0.50 kHz) have the longest mean integration time (274 ms), mid-frequency fibers (0.50 to 1.30 kHz) have the shortest mean integration time (183 ms) and high frequency fibers (CF greater than 1.3 kHz) have an intermediate mean integration time (235 ms). Continuous noise increased the integration times of some, but not all fibers, and caused some fibers which did not display temporal integration to do so. We investigated the possibility that these changes may be caused by a decrease in the slope of the rate-intensity function (measured between +5 and +15 dB re threshold) with the addition of the continuous noise masker. The slope of the rate-intensity function decreased (from 73 spikes/s/dB to 49 spikes/s/dB) with the addition of the continuous noise for those fibers (N = 28) that showed an increase in temporal integration with the addition of noise. However, the slopes of the rate-intensity functions also decreased by 30% for those fibers (N = 8) that did not show increasing temporal integration.     

Capillary whole blood testing by a new portable monitor. Comparison with standard determination of the international normalized ratio

We evaluated a new portable monitor (AvoSure PT PRO, Menarini Diagnostics, Firenze, Italy) developed to test the prothrombin time in capillary blood and plasma by comparing it with the standard laboratory determination. We studied 62 patients receiving acenocoumarol therapy. The international normalized ratio (INR) in capillary blood was analyzed by 2 methods: AvoSure PT PRO and Thrombotrack Nycomed Analyzer (Axis-Shield, Dundee, Scotland). Parallel studies were performed in plasma samples by a reference method using the Behring Coagulation Timer (Behring Diagnostics, Marburg, Germany). Plasma samples also were tested with the AvoSure PT PRO. Correlation was good for INR values for capillary blood and plasma samples by AvoSure PT PRO and our reference method (R2 = 0.8596) and for capillary blood samples tested by the AvoSure PT PRO and Thrombotrack Nycomed Analyzer (R2 = 0.8875). The correlation for INR in capillary blood and plasma samples by AvoSure PT PRO was 0.6939 (P < .0004). Capillary blood determinations are rapid and effective for monitoring oral anticoagulation therapy and have a high correlation to plasma determinations. AvoSure PT PRO is accurate for controlling INR in plasma and capillary blood samples, may be used in outpatient clinics, and has advantages over previous portable monitors.     

Patient‐incurred costs in a differentiated service delivery club intervention compared to standard clinical care in Northwest Tanzania

IntroductionPlacing all clients with a positive diagnosis for HIV on antiretroviral therapy (ART) has cost implications both for patients and health systems, which could, in turn, affect feasibility, sustainability and uptake of new services. Patient‐incurred costs are recognized barriers to healthcare access. Differentiated service delivery (DSD) models in general and community‐based care in particular, could reduce these costs. We aimed to assess patient‐incurred costs of a community‐based DSD intervention (clubs) compared to clinic‐based care in the Shinyanga region, Tanzania.MethodsCross‐sectional survey among stable ART patients (n = 390, clinic‐based; n = 251, club‐based). For each group, we collected socio‐demographic, income and expenditure data between May and August 2019. We estimated direct and indirect patient‐incurred costs. Direct costs included out‐of‐pocket expenditures. Indirect costs included income loss due to time spent during transport, accessing services and off work during illness. Cost drivers were assessed in multivariate regression models.ResultsOverall, costs were significantly higher among clinic participants. Costs (USD) per year for clinic versus club were as follows: 11.7 versus 4.17 (p < 0.001) for direct costs, 20.9 versus 8.23 (p < 0.001) for indirect costs and 32.2 versus 12.4 (p < 0.001) for total costs. Time spent accessing care and time spent in illness (hours/year) were 38.3 versus 13.8 (p < 0.001) and 16.0 versus 6.69 (p < 0.001) respectively. The main cost drivers included transportation (clinic vs. club: 67.7% vs. 44.1%) for direct costs and income loss due to time spent accessing care (clinic vs. club: 60.4% vs. 56.7%) for indirect costs. Factors associated with higher total costs among patients attending clinic services were higher education level (coefficient [95% confidence interval]) 20.9 [5.47 to 36.3]) and formal employment (44.2 [20.0 to 68.5). Differences in mean total costs remained significantly higher with formal employment, rural residence, in addition to more frequent visits among clinic participants. The percentage of households classified as having had catastrophic expenditures in the last year was low but significantly higher among clinic participants (10.8% vs. 5.18%, p = 0.014).ConclusionsCosts incurred by patients accessing DSD in the community are significantly lower compared to those accessing standard clinic‐based care. DSD models could improve access, especially in resource‐limited settings.     

Lenticular intermediate-sized filaments: biosynthesis and interaction with plasma membrane.

Electron microscopical features of the lens fiber plasma membrane-cytoskeleton complex are suggestive of an intimate association between the intermediate-sized filaments (IF) and the lipid bilayer. Biochemical analysis of this complex reveals the occurrence of an appreciable amount of vimentin as a protein subunit of lenticular IF. Additional evidence for association between IF and membranes is provided by the observation that newly synthesized vimentin is associated with plasma membranes added to a reticulocyte lysate programmed with lens polyribosomes. Concomitantly alpha-crystallin polypeptide chains (alpha A2) are also found associated with the plasma membrane together with a hitherto unidentified 47-kilodalton protein. Once associated with the lipid bilayer, the vimentin polypeptide resists urea treatment, suggesting that it has become an integral constituent associated with part of the membrane.     

Does low peritoneal glucose load protect from the development of left ventricular hypertrophy in peritoneal dialysis patients?

Background

Left ventricular hypertrophy (LVH) is a major predictor of the development of cardiovascular events that is considered the main cause of morbidity and mortality in peritoneal dialysis (PD) patients. This study aimed to evaluate retrospectively the impact of low peritoneal glucose load on left ventricular mass (LVM) in PD patients.

Methods

36 patients who were on continuous ambulatory PD for at least a period of 2 years enrolled in the study. Of them, 23 patients received only glucose-based solutions (GBS) [high peritoneal glucose load group (HPGL group)] from the start of PD, and 13 patients received AAS in combination with GBS when their serum albumin decreased to levels <3.5 g/dl [low peritoneal glucose load group (LPGL group)]. AAS was substituted with 1.36 % GBS when serum albumin rose to ≥3.5 g/dl and restarted when serum albumin fell to <3.5 g/dl. Medical history, physical findings, echocardiographic, laboratory and hydration status data from the first month of PD and after 24 months, were obtained from each patient’s medical records.

Results

Mean LVM index (LVMI) increased in both groups (p ≤ 0.010). The increment in mean LVMI was higher in HPGL group compared to LPGL group (p = 0.006). At 24 months: peritoneal glucose load index (PGLI), fluid overload, mean arterial pressure (MAP), HbA1c and hsCRP were higher in HPGL group (p ≤ 0.010), while 24 h ultrafiltration, weekly Kt/V, serum albumin levels and RRF were higher in LPGL group (p ≤ 0.025). The increment (Δ between the values of each parameter from the start of PD and after 24 months) in PGLI, fluid overload, MAP, HbA1c and hsCRP values were higher in HPGL group (p < 0.001).

Conclusions

Low peritoneal glucose load may be associated with a protective effect from the development of LVH in PD patients.

     

p38 MAPK is a critical regulator of the constitutive and the beta4 integrin-regulated expression of IL-6 in human normal thymic epithelial cells

Cytokines and adhesion receptors are key mediators in the dialog occurring between thymic epithelial cells (TEC) and thymocytes and regulating T cell maturation and epithelial embryonic differentiation. Among cytokines, IL-6 can be critical in the thymus, fostering proliferation, differentiation and/or survival of both TEC and thymocytes. We have previously reported in human normal TEC that clustering of the laminin receptor alpha6beta4 integrin induced by thymocyte contact or monoclonal antibody-mediated cross-linking regulates IL-6 gene expression via activation of NF-kappaB and NF-IL6 transactivators. Here we show that alpha6beta4 integrin activates p38 mitogen-activated protein kinase (MAPK) and that p38 is essential for IL-6 gene expression. In fact, beta4 cross-linking activated p38 and extracellular signal-regulated kinase (ERK) MAPK, Rac1, p21-activated protein kinase 1 (PAK1) and MAPK kinases (MKK) 3/MKK6. However, pharmacological blockade of p38 or ERK demonstrated that p38 inhibition abrogated both basal and beta4 integrin-induced production of IL-6 preventing NF-kappaB and NF-IL6 activation, whereas ERK inhibition reduced IL-6 production, hampering only NF-kappaB activation. Overall, our results indicate that p38 MAPK and alpha6beta4 integrin, expressed by TEC throughout their life, are critical regulators of the intrathymic availability of a cytokine controlling fate and functions of cells governing development and maintenance of thymic architecture and immune responses.