Strain differences in the neurochemical response to chronic restraint stress in the rat: relevance to depression

The neurochemical basis of depression focuses on alterations in the monoaminergic and amino acid neurotransmitter systems. Moreover, decreases in serum levels of the neurotrophin brain-derived neurotrophic factor (BDNF) have led to the more recent neurotrophic hypothesis of depression. Chronic stress is one of the major predisposing factors to developing the disorder and thus we investigated the impact of chronic restraint stress on the levels of several neurotransmitters and their metabolites in a genetic animal model of depression, the Wistar Kyoto (WKY) rat. Behavioural analysis of WKY rats indicated both a depressive and anxiety-like phenotype compared to their Sprague Dawley (SD) controls. WKY animals showed similar stress-induced decreases in hippocampal GABA, noradrenaline and dopamine as their SD counterparts while exhibiting a divergent decrease in 5-HT, 5-HIAA and DOPAC. WKY rats also showed a stress-dependant increase in GABA concentrations in the amygdala compared to the SD animals. Moreover, WKY but not SD rats had a chronic stress-induced decrease in serum BDNF levels. Together these data show that there are specific strain-dependent changes in neurotransmitter and neurotrophin levels in response to chronic stress which may predispose WKY animals to a depressive-like phenotype.     

A Post-Trial Assessment of Factors Influencing Study Drug Adherence in a Randomized Biomedical HIV-1 Prevention Trial

High adherence and maintenance of blinding are critical for placebo-controlled efficacy trials of HIV-1 biomedical prevention strategies. We assessed adherence to study drug and factors affecting adherence, including perceived randomization group, in a post-trial questionnaire of participants who completed HPTN 039, a randomized, placebo-controlled trial of HSV-2 suppression with twice-daily acyclovir to reduce HIV-1 acquisition. Of the 3172 trial participants, 2003 (63%) completed the post-trial questionnaire. Of these 2003, 72% reported missing a dose of study drug less than twice a week. Study drug adherence was not compromised by perceived randomization or genital ulcer symptoms during the study. Alcohol use was cited as an adherence barrier in some populations. Assessment of study drug adherence during and at the end of trials can evaluate perceptions of randomization and adherence by randomization arm, help to better understand barriers to and motivations for adherence, and develop interventions to increase adherence for future trials.     

Young People’s Experience of ADHD and Stimulant Medication: A Qualitative Study for the NICE Guideline

Background: The NICE ADHD Guideline Group found a lack of research evidence on young people’s experiences with stimulant medications. The present study was commissioned to help fill this gap in the evidence base and to inform the Guideline. Method: Focus groups and 1:1 interviews with 16 UK young people with ADHD. Results: Young people were positive about taking medication, feeling that it reduced their disruptive behaviour and improved their peer relationships. Young people experienced stigma but this was related more to their symptomatic behaviours than to stimulant drug medication. Conclusions: The study’s findings helped to inform the NICE guideline on ADHD by providing evidence that young people’s experiences of medication were in general more positive than negative. All NICE Guidelines involving recommendations for the treatment of young people should draw on research evidence of young people’s experiences of treatments.     

Potential role of Calogen as an oral contrast medium in the evaluation of the gastric wall at MRI

Evaluation of gastric wall pathology using cross-sectional imaging has proved difficult, particularly in the imaging of early, localized disease. The properties of Calogen as a negative oral contrast agent for the evaluation of the upper gastro-intestinal tract and retroperitoneum in CT has been well described. We assess the suitability of this agent as an oral contrast medium for use in MRI examination of the gastric wall, finding the mean scores for Calogen and water with regard to gastric distension to be 8.46 and 5.49, respectively (P<0.01). Concerning obliteration of mucosal detail, the respective scores are 8.48 and 3.84 (P<0.01). Calogen is also statistically superior to water with regard to prevention of peristalsis and homogeneity (mean scores 8.15 vs. 5.74 and 8.69 vs. 6.30, respectively). Oral Calogen, therefore, is superior to water as an oral contrast agent for MRI examination of the gastric wall. Its ingestion allows identification of the gastric wall with fat intensity material on both sides, further aiding characterisation of subtle mural anomalies.     

The mental health needs of people with a learning disability detained in police custody

Few research studies examine the prevalence or mental health needs of people with a Learning Disability (LD) detained in police custody. This paper describes the population of detainees with an LD who presented to an inner city inter-agency police liaison service during a three-year period. Two forensically trained Community Mental Health Nurses (CMHNs) screened all custody record forms (n=9014) for evidence of a mental health problem or LD. The CMHNs interviewed positively screened detainees (n=1089) using a battery of measures designed to assess mental health status, risk-related behaviour and alcohol or drug abuse. Almost one-in-ten of those interviewed (95/1089) were judged to have a possible or definite LD. Fifty-two per cent were cases on the General Health Questionnaire (GHQ) whilst 61% attained 'above threshold' Brief Psychiatric Rating Scale (BPRS) scores. The majority (63%) had a history of causing harm to others while 56 per cent had a history of self-harm. More than half (56%) regularly consumed harmful levels of alcohol while one-in-four (27%) reported abusing drugs. Higher than expected numbers of detainees have a learning disability and most have complex mental health needs. A police liaison service offers a way of identifying people with LD and connecting them with appropriate health and social care agencies.     

The ‘healthy brothel’: The context of clinical services for sex workers in Hillbrow,South Africa

Conventional health services often present barriers to sex workers seeking health care resulting in untreated sexually transmitted infections (STI) and increased risk of HIV infection. A brothel‐based clinic was established to provide STI treatment for sex workers who worked in the inner city suburb of Hillbrow, South Africa. Qualitative research demonstrated that the clinic was acceptable to women in terms of service quality, accessibility, and efficacy, and positively influenced health‐seeking behaviours, health awareness, and condom use. The intervention also transformed the image of the hotels from sites of ‘dirt and disease’ into ‘healthy brothels’. The paper concludes that clinical services offered on site are a viable alternative to the provision of conventional clinical services.

Résumé

Les travailleuses du sexe en recherche de soins sont souvent confrontées à certains obstacles dans les services de soins conventionnels. Il en résulte des infections sexuellement transmissibles (IST) non traitées et une augmentation des risques de contamination par le VIH. Un centre de soins a été installé dans un bordel de la banlieue déshéritée de Hillbrow en Afrique du Sud, pour dispenser des traitements des IST aux travailleuses du sexe exerçant localement. Une étude qualitative a démontré que ce centre était acceptable aux yeux de ces femmes, en termes de qualité des services, d'accessibilité et d'efficacité, et qu'il influait positivement sur les comportements de recherche de soins, la sensibilisation à la santé et l'usage du préservatif. L'intervention a aussi transformé l'image de ces lieux «sales et remplis de maladies» en celle de «bordels sains». L'article conclut que les services de soins sur sites sont une alternative viable aux services de soins conventionnels.

Resumen

Los servicios tradicionales de la salud muchas veces ponen trabas a las trabajadoras sexuales que piden ayuda médica lo que implica que no se traten las infecciones de transmisión sexual y aumente el riesgo de infección del VIH. En un centro de un suburbio de la ciudad de Hillbrow, en Sudáfrica, se creó una clínica dentro de un burdel para ofrecer tratamiento contra las enfermedades de transmisión sexual a las trabajadoras sexuales. En un estudio cualitativo se demostró que la clínica era aceptable para las mujeres en lo referente a calidad de servicios, accesibilidad y eficacia y además influenciaba positivamente en actitudes tales como pedir ayuda médica, interesarse por la salud y usar preservativos. Esta intervención también transformó la imagen de los hoteles que pasaron de ser sitios “sucios y con riesgo de enfermedades” a “burdeles sanos”. Terminamos el artículo defendiendo que los servicios clínicos ofrecidos en estos lugares son una alternativa viable a los servicios clínicos convencionales.