Elements of affective instability associated with suicidal behaviour in patients with borderline personality disorder

OBJECTIVE: To identify elements of affective instability associated with an increased likelihood of impulsivity and then to determine whether these elements characterize patients with borderline personality disorder (BPD) and suicidal behaviour. METHOD: We prospectively followed 82 individuals with BPD and a history of recurrent suicidal behaviour who recorded their current mood states, impulsivity, suicide ideation, and environmental stressors (triggers) 6 times daily over 3 weeks. RESULTS: Our results suggested that mood amplitude was correlated with impulsivity and that 4 subgroups defined by mean scores on mood amplitude and negative mood intensity significantly differed in the number of suicidal behaviours reported in the last year. CONCLUSIONS: A subgroup of BPD patients appears to be at elevated risk for suicidal behaviour based on high mood amplitude and mean negative mood intensity. Clinicians might target this group for monitoring and interventions to reduce the likelihood of suicidal behaviour.     

MRI for pelvic floor dysfunction: can the strain phase be eliminated?

Purpose

The purpose of the study was to determine if the strain phase of an MR defecography (MRD) protocol is redundant and can be eliminated without a loss of diagnostic information.

Materials and methods

Institutional review board approval was obtained and the requirement for informed consent was waived. A retrospective single-center review of 80 MRD examinations (68 female, 12 male, mean age 55 years old) was conducted. Two radiologists blinded to patient information evaluated in consensus the strain and evacuation phases separately and in a random order. Each phase was assessed for the presence and degree of posterior compartment descent, cystocele, urethral hypermobility, uterovaginal prolapse, rectocele, rectal intussusception, and enterocele. The degree of pelvic floor descent was compared using a paired t test and McNemar’s test was used to compare the proportion of abnormal findings.

Results

The evacuation phase identified all abnormalities identified on the strain phase and also identified both additional and more pronounced abnormalities, including an additional 34 cystoceles, 20 cases of urethral hypermobility, 13 uterovaginal prolapses, 36 rectoceles, 5 rectal intussusceptions, and 6 enteroceles (all p < 0.02). The mean posterior compartment descent was 24.1 mm greater on the evacuation phase than the strain phase (p < 0.0001).

Conclusion

The strain phase is redundant and we propose that it can be eliminated from a routine MRD protocol. This will help streamline the examination, simplify patient instructions, and reduce both imaging and reporting time.

     

Practical considerations in the assessment and treatment of pain in adults with physical disabilities

Adults aging with physical disabilities experience a variety of pain disorders that affect their functionality and QOL. It is important that clinicians caring for this population be knowledgeable about this common symptom and be able to perform a thorough history and physical examination. In addition, it is imperative to have a good working knowledge of the strengths and limitations of the treatments available.     

Effect of cholecalciferol supplementation on blood glucose in an experimental model of type 2 diabetes mellitus in spontaneously hypertensive rats and Wistar rats

BACKGROUND: Vitamin D might have an influence on glucose concentrations, due to the presence of VDR receptors on the pancreas. We established an experimental model of type 2 diabetes in spontaneously hypertensive rats (SHR) and Wistar rats in order to investigate the glycemic response. METHODS: SHR males (n=6) and Wistar rats (n=6) weighing approximately 89+/-5.5 g and 123.5+/-6.5 g, respectively, after 7 days of basal period, had the chow pattern substituted (350 kcal/100 g) for a hypercaloric/hyperlipidic (HC/HL) diet (490 kcal/100g) and then injected with 40 mg/kg (SHR) and 20 mg/kg (Wistar) streptozotocin I.P. After the creation of diabetes, the rats suffered daily gavage of cholecalciferol (12.5 microg/kg(-) (1)) for 14 days. The blood glucose was assessed twice a week with a glucometer. The data were analyzed by ANOVA. RESULTS: SHR and Wistar rats fed on a HC/HL diet gained 60 g and 32 g in once week, vs. the basal period, where they only gained 23 g and 13 g, respectively. The cholecalciferol supplementation did not change the glucose concentration in all of the SHR animals. About 40% of the group responded by treatment with reduction of about 60% in glucose concentrations. We did find a 40% of the blood glucose levels in all Wistar rats. CONCLUSIONS: Cholecalciferol is able to reduce blood glucose in this experimental diabetes model.     

An 8-step framework for implementing time-driven activity-based costing in healthcare studies

The European Journal of Health Economics - Micro-costing studies still deserving for methods orientation that contribute to achieve a patient-specific resource use level of analysis. Time-driven...     

Are resilience and perceived stress related to social support and housing stability among homeless adults with mental illness?

Perceived stress has been associated with adverse health outcomes. Although people experiencing homelessness often report multiple acute and chronic stressors, research on resilience and perceived stress on the general homeless population is limited. This longitudinal study examined homeless adults with mental illness who were part of a 24‐month trial of Housing First to explore: (a) changes in levels of resilience and perceived stress during the trial, and (b) the association between levels of resilience and perceived stress with measures of social support, social functioning and percentage of days stably housed over the study period. This longitudinal study (2009–2013) that used trial data included 575 participants in Toronto, Ontario. Of these individuals, 507 were included in this study. Connor‐Davidson Resilience Scale and Perceived Stress Scales (PSS) measured the two outcomes, resilience and perceived stress. Time (baseline, 12 and 24 months), housing stability and three measures of social support and social functioning were the main predictors. A longitudinal analysis was done with repeated measures analysis of resilience and perceived stress using linear mixed models with random intercepts. Mean resilience scores increased (baseline: 5.1 [95% CI: 4.9, 5.2], 12 months: 5.5 [95% CI: 5.3, 5.7], 24 months: 5.6 [95% CI: 5.4, 5.8]), and PSS scores decreased (baseline: 22.3 [95% CI: 21.5, 23.0], 24 months: 18.6 [95% CI: 17.9, 19.4]). In the multivariable analyses, increased resilience was associated with higher scores on the three social support and social functioning measures, (estimates = 0.12, 0.04, 0.02) but not percentage days stably housed. Lower PSS scores were associated with higher scores on all three social support and social functioning measures (?0.20, ?0.33, ?0.21) and higher percentages of days stably housed (?0.015). Strong social support and social functioning may minimise the harmful effects of stressful life events on homeless individuals by increasing resilience and reducing stress. Interventions to help homeless people build appropriate support networks should be delivered in parallel to efforts that increase housing stability.     

Pediatric glioblastoma cell line shows different patterns of expression of transmembrane ABC transporters after in vitro exposure to vinblastine

Background  Resistance to drug is a major cause of treatment failure in pediatric brain cancer. The multidrug resistance (MDR) phenotype can be mediated by the superfamily of adenosine triphosphate-binding cassette (ABC) transporters. The dynamics of expression of the MDR genes after exposure to chemotherapy, especially the comparison between pediatric brain tumors of different histology, is poorly described. Objective  To compare the expression profiles of the multidrug resistance genes ABCB1, ABCC1, and ABCG2 in different neuroepithelial pediatric brain tumor cell lines prior and following short-term culture with vinblastine. Methods  Immortalized lineages from pilocytic astrocytoma (R286), anaplasic astrocytoma (UW467), glioblastoma (SF188), and medulloblastoma (UW3) were exposed to vinblastine sulphate at different schedules (10 and 60 nM for 24 and 72 h). Relative amounts of mRNA expression were analyzed by real-time quantitative polymerase chain reaction. Protein expression was assessed by immunohistochemistry for ABCB1, ABCC1, and ABCG2. Results  mRNA expression of ABCB1 increased together with augmenting concentration and time of exposure to vinblastine for R286, UW467, and UW3 cell lines. Interestingly, ABCB1 levels of expression diminished in SF188. Following chemotherapy, mRNA expression of ABCC1 decreased in all cell lines other than glioblastoma. ABCG2 expression was influenced by vinblastine only for UW3. The mRNA levels showed consistent association to protein expression in the selected sets of cell lines analyzed. Conclusions  The pediatric glioblastoma cell line SF188 shows different pattern of expression of multidrug resistance genes when exposed to vinblastine. These preliminary findings may be useful in determining novel strategies of treatment for neuroepithelial pediatric brain tumors. Financial support: FAPESP (grant 2007/04065-9).     

Working at night and work ability among nursing personnel: when precarious employment makes the difference

Purpose  To test the association between night work and work ability, and verify whether the type of contractual employment has any influence over this association. Methods  Permanent workers (N = 642) and workers with precarious jobs (temporary contract or outsourced; N = 552) were interviewed and filled out questionnaires concerning work hours and work ability index. They were classified into: never worked at night, ex-night workers, currently working up to five nights, and currently working at least six nights/2-week span. Results  After adjusting for socio-demography and work variables, current night work was significantly associated with inadequate WAI (vs. day work with no experience in night work) only for precarious workers (OR 2.00, CI 1.01–3.95 and OR 1.85, CI 1.09–3.13 for those working up to five nights and those working at least six nights in 2 weeks, respectively). Conclusions  Unequal opportunities at work and little experience in night work among precarious workers may explain their higher susceptibility to night work.