Asylee perspectives on psychotherapies for posttraumatic stress

Asylees (i.e., asylum seekers) have a higher prevalence of mental health concerns, particularly posttraumatic distress, than the general population due to both their exposure to traumatic experiences and prolonged uncertain status in a new country. Meta-analyses of randomized controlled trials with asylees have found that culturally adapted cognitive behavioral therapy (CA-CBT), eye movement desensitization and reprocessing (EMDR), and narrative exposure therapy (NET) are efficacious in treating trauma-related symptoms and posttraumatic stress disorder (PTSD); however, treatment utilization remains low. Thus, it is imperative to determine what PTSD interventions are effective, credible, and acceptable for asylees. We employed structured virtual interviews with 40 U.S. asylees from diverse countries living with one or more symptoms of PTSD. Participants were asked about treatment engagement, perceived barriers to treatment, goals for psychotherapy, and perceptions of the effectiveness and difficulty of engaging in CA-CBT, EMDR, NET, and (non–exposure-based) interpersonal therapy (IPT) for PTSD. Participants perceived IPT to be significantly less difficult than all exposure-based treatments, with medium effect sizes, ds = 0.55–0.71. A qualitative analysis of asylees’ comments provided valuable insights into how they think about these treatments. Ways in which these results can be considered when informing recommendations for improving interventions for asylees are discussed.     

Anti-amnesic effect of ACTH4-10: its independence of the nature of the amnesic agent and the behavioral test.

It was found previously that ACTH_4–10 is able to alleviate the CO₂-induced retrograde amnesia for a step-through passive avoidance response when injected into rats 1 hr prior to the retrieval test. The present investigation was undertaken to establish whether ACTH_4–10 has a similar effect if a different amnesia agent and a different behavioral task are used. It appeared that electroconvulsive shock induced amnesia for a one-trial thirst-motivated response. This amnesia could be reduced by administration of ACTH_4–10 1 hr prior to the retrieval test. Administration of ACTH_4–10 1 hr prior to the acquisition was ineffective. It was concluded that ACTH_4–10 exerts a retrieval-promoting effect independent of the nature of the amnesic agent and the behavioral task.     

Elucidation of CYP2D6 Genetic Diversity in a Unique African Population: Implications for the Future Application of Pharmacogenetics in the Xhosa Population

Genetic variation of the CYP2D6 gene has been associated with altered drug metabolism; however, limited studies have investigated CYP2D6 sequence diversity in African populations. We devised a CYP2D6 genotyping strategy to analyse the South African Xhosa population and genotype a Xhosa schizophrenia cohort, as CYP2D6 metabolises many antipsychotics and antidepressants. The entire CYP2D6 gene locus was sequenced in 15 Xhosa control individuals and the data generated were used to design a comprehensive genotyping strategy. Over 25 CYP2D6 alleles were genotyped in Xhosa controls and Xhosa schizophrenia patients using long‐range PCR, DNA sequencing and single nucleotide primer extension analysis. Bioinformatic algorithms were used to predict the functional consequences of relevant mutations and samples were assigned CYP2D6 activity scores. A unique allele distribution was revealed and two rare novel alleles, CYP2D6*73 and CYP2D6*74, were identified. No significant differences in allele frequencies were detected between Xhosa controls and schizophrenia patients. This study provides i) comprehensive data on a poorly characterised population, ii) a valuable CYP2D6 genotyping strategy and iii) due to their unique genetic profile, provides the basis for pharmacogenetic intervention for Xhosa individuals.     

Effect of media reporting of the suicide of a singer in Taiwan: the case of Ivy Li

Background  

Suicide attempters are known to be vulnerable to the influence of media reporting of suicide events. This study investigates possible influences of media reporting of a celebrity suicide on subsequent suicide attempts and associated risk factors among suicide attempters.     

Decreased shedding of Escherichia coli O157:H7 by cattle following vaccination with type III secreted proteins

Cattle are an important reservoir of Escherichia coli O157:H7 leading to contamination of food and water, and subsequent human disease. This pathogen colonizes its hosts by producing several proteins such as Tir and EspA that are secreted by a type III secretion system. These proteins play a role in colonization of the intestine, suggesting that they might be useful targets for the development of a vaccine to reduce levels of this organism in cattle. Vaccination of cattle with proteins secreted by E. coli O157:H7 significantly reduced the numbers of bacteria shed in feces, the numbers of animals that shed, and the duration of shedding in an experimental challenge model. Vaccination of cattle also significantly (P=0.04) reduced the prevalence of E. coli O157:H7 in a clinical trial conducted in a typical feedlot setting. This strategy suggests it is possible to vaccinate cattle to decrease the level of E. coli O157:H7 shedding for the purpose of reducing the risk of human disease.     

The use of Visual Analog Scale in urogynecologic research: a psychometric evaluation

OBJECTIVE: The purpose of this study was to assess the validity of Visual Analog Scales in urogynecologic research. STUDY DESIGN: In phase I, 35 women completed short forms of the urogenital distress inventory, incontinence impact questionnaire, and Beck depression inventory fast screen using the Likert-type scale and Visual Analog Scale formats. Reliability was estimated with Spearman's correlations and Cronbach's alpha; construct validity was assessed with the use of factor analyses. In phase II, 101 women were recruited for the test-retest reliability assessment of the Visual Analog Scale formats of the urogenital distress inventory and incontinence impact questionnaire short forms. Reproducibility was analyzed with intraclass correlations. RESULTS: In phase I, correlations between the Likert-type scale and the Visual Analog Scale were good: urogenital distress inventory (0.748), incontinence impact questionnaire (0.787), and Beck depression inventory fast screen (0.852; P <.05). In phase II, intraclass correlations were 0.898 and 0.938 for the urogenital distress inventory and incontinence impact questionnaire scores, respectively ( P <.001). CONCLUSION: The Visual Analog Scale is a simple, reliable, and reproducible method for the assessment of quality of life in urogynecologic research.     

Fibroblastic foci in usual interstitial pneumonia: idiopathic versus collagen vascular disease

A histologic feature of usual interstitial pneumonia is the presence of fibroblastic foci. As some patients with usual interstitial pneumonia and an underlying collagen vascular disease have a better prognosis, we hypothesized that they would have fewer fibroblastic foci. Pathologists reviewed surgical lung biopsies from 108 patients with usual interstitial pneumonia (nine with collagen vascular disease) and assigned a score (absent 0, mild 1, moderate 2, and marked 3) for fibroblastic foci. Patients with idiopathic usual interstitial pneumonia had a higher median profusion of fibroblastic foci (1.75 vs. 1.0, p = 0.003). Baseline characteristics were similar, although patients with a collagen vascular disease were younger, had a shorter duration of symptoms, and had a higher percentage of predicted total lung capacity. Profusion of fibroblastic foci was the most discriminative feature for separating idiopathic from collagen vascular disease-associated usual interstitial pneumonia (odds ratio 8.31; 95% confidence interval, 1.98, 59.42; p = 0.002 for a one-unit increase in fibroblastic foci score). No deaths were noted in the collagen vascular disease-associated usual interstitial pneumonia group; 52 deaths occurred in the idiopathic usual interstitial pneumonia group (log rank; p = 0.005). We conclude that patients with collagen vascular disease-associated usual interstitial pneumonia have fewer fibroblastic foci and improved survival.     

Quantitative analysis of the admission electrocardiogram identifies patients with unstable coronary artery disease who benefit the most from early invasive treatment

OBJECTIVES: The aim of the present study was to evaluate whether the effect of an early invasive treatment strategy differed between patients sub-grouped according to their severity of myocardial ischemia, as evaluated by quantitative electrocardiographic (ECG) analysis at the time of presentation. The present study is a sub-study of the previously published Fast Revascularization during InStability in Coronary artery disease trial (FRISC-II). BACKGROUND: An early invasive treatment strategy has been shown to be the preferable treatment for non-ST-segment elevation acute coronary syndromes (ACS). The population of patients with unstable coronary artery disease is heterogeneous regarding both the underlying pathology and prognosis. Early risk stratification is important to select patient subgroups that will benefit the most from a given treatment. METHODS: In 2,201 patients with non-ST-segment elevation ACS, the ischemic burden at hospital admission was determined by quantitative measurements of ST-T-segment deviations on the ECG. The patients were subsequently sub-grouped in tertiles based on the amount of ST-segment deviation. The primary end point for this analysis was death or myocardial infarction (MI) within one year after study inclusion. RESULTS: The invasive treatment strategy produced a reduction of approximately 50% in death or MI among the patients with intermediate or major ST-segment deviation. The findings were independent of age, gender, or troponin T status. The patients with confounding factors precluding ST analysis had a poor outcome regardless of the treatment strategy. CONCLUSIONS: Ischemic burden on the admission ECG identifies patients with ACS who benefit the most from an invasive treatment strategy. When the standard ECG is scrutinized with complete quantitative measurements, it provides independent information on prognosis and benefit of treatment.     

Prognostic implications of physiologic and radiographic changes in idiopathic interstitial pneumonia

Idiopathic interstitial pneumonias are a diverse group of lung diseases with varied prognoses. We hypothesized that changes in physiologic and radiographic parameters would predict survival. We retrospectively examined 80 patients with usual interstitial pneumonia and 29 patients with nonspecific interstitial pneumonia. Baseline characteristics were examined together with 6-month change in forced vital capacity, diffusing capacity for carbon monoxide, and ground glass infiltrate and fibrosis on high resolution computed tomography. Patients with usual interstitial pneumonia were more likely to have a statistically significant or marginally significant decline in lung volume, diffusing capacity for carbon monoxide, and an increase in ground glass infiltrates (p < or = 0.08) compared with patients with nonspecific interstitial pneumonia. For patients with usual interstitial pneumonia, change in forced vital capacity was the best physiologic predictor of mortality (p = 0.05). In a multivariate Cox proportional hazards model controlling for histopathologic diagnosis, gender, smoking history, baseline forced vital capacity, and 6-month change in forced vital capacity, a decrease in forced vital capacity remained an independent risk factor for mortality (decrease > 10%; hazard ratio 2.47; 95% confidence interval 1.29, 4.73; p = 0.006). We conclude that a 6-month change in forced vital capacity gives additional prognostic information to baseline features for patients with idiopathic interstitial pneumonia.