Stigma in families of individuals in early stages of psychotic illness: family stigma and early psychosis

Aim: Stigma is pervasive among families of individuals with psychotic disorders and includes both general and ‘associative’ stigma – that is, the process by which a person is stigmatized by virtue of association with another stigmatized individual. These forms of stigma may present a barrier to help seeking. However, little is known about stigma in the early stages of evolving psychotic disorder. Methods: Family members of 11 individuals at clinical high risk and of nine patients with recent‐onset psychosis were evaluated for generalized and associative stigma using the Opinions about Mental Illness (modified) and the Family Experiences Interview Schedule. Results: In this small study, the level of stigma was low, as families endorsed many supportive statements, forexample, patients should be encouraged to vote, patients want to work, mental illness should be protected legally as a disability and parity should exist in insurance coverage. Families also endorsed that both talking and a belief in God and prayer can help someone get better. Only ethnic minority families of individuals with recent‐onset psychosis endorsed a sense of shame and need to conceal the patient's illness. Conclusions: This preliminary study suggests that family stigma is low in the early stages of psychotic disorder, a finding that requires further investigation in a larger and more representative sample. This may be an opportune time to engage young people and families, so as to reduce duration of untreated illness. Ethnic differences in stigma, if replicated, highlight the need for cultural sensitivity in engaging individuals and their families in treatment.     

轴索生长抑制因子DNA疫苗安全有效地防治大鼠缺血性脑中风

目的评估轴索生长抑制因子DNA疫苗(pcDNA3.1(+)-neurite growth inhibitors,pcDNA-NGIs)防治缺血性脑中风的安全性和有效性。方法肌肉注射pcDNA-NGIs后,采用改良实验性自身免疫性脑髓鞘炎记分系统、改良神经病严重程度记分和逃避作业评估神经系统炎症、感觉运动和认知缺陷;采用生物素右旋糖胺追踪皮质红核投射的新生轴索。结果pcDNA-NGIs免疫不会引起神经系统炎症和感觉运动缺陷;阻塞大脑中动脉之前或之后进行pcDNA-NGIs免疫可增加皮质红核投射的新生纤维数(P=0.018)并削弱缺血性脑中风的感觉运动缺陷(P=0.042)。结论pcDNA-NGIs免疫不会使健康大鼠产生神经炎症和神经病症状,但可促进中风大鼠的神经再生和感觉运动功能恢复。     

Diffusion-weighted imaging and proton magnetic resonance spectroscopy in perinatal hypoxic-ischemic encephalopathy: association with neuromotor outcome at 18 months of age

We evaluated early diffusion-weighted imaging findings, the quantitative apparent diffusion coefficient, and magnetic resonance spectroscopy (the presence of lactate and ratios of N-acetylaspartate to total creatine and choline to total creatine) in the prediction of the 18-month neuromotor outcome of term newborns with hypoxic-ischemic encephalopathy. Conventional T1- and T2-weighted and diffusion-weighted imaging was performed in 20 asphyxiated term newborns, with additional basal ganglia magnetic resonance spectroscopy in 15 newborns between 2 and 18 days of life (mean 7.3 days). Neuromotor outcome was dichotomized into normal and abnormal for statistical analysis. Statistically significant differences in the ratios of N-acetylaspartate to total creatine, but not apparent diffusion coefficient values and ratios of choline to total creatine, were found between infants with a normal and an abnormal outcome (Mann-Whitney U-test, P = .010). There was a significant association between the presence of a lactate peak and an abnormal outcome (chi-square test, P = .017). The presence of a lactate peak for predicting an abnormal outcome had a sensitivity of 100% and a specificity of 80%, and the odds ratio was 37.4. Ischemic lesions were more conspicuous and/or extensive on diffusion-weighted imaging in all except one neonate. The presence of normal findings on both diffusion-weighted imaging and conventional magnetic resonance imaging is predictive of a normal neuromotor outcome, whereas lactate and a reduced ratio of N-acetylaspartate to total creatine in the basal ganglia, but not an apparent diffusion coefficient, are associated with an abnormal outcome at 18 months of age.     

Cytokines, nitric oxide, and cGMP modulate the permeability of an in vitro model of the human blood-brain barrier

The endothelial cells (EC) of the microvasculature in the brain form the anatomical basis of the blood-brain barrier (BBB). In the present study, the effects of agents that modify the permeability of a well-established in vitro model of the human BBB were studied. The monolayers formed by confluent human brain microvessel endothelial cell (HBMEC) cultures are impermeable to the macromolecule tracer horseradish peroxidase (HRP) and have high electrical resistance. Exposure of HBMEC to various cytokines including TNF-alpha, IL-1beta, interferon gamma (IFN-gamma), or lipopolysaccharide (LPS) decreased transendothelial electrical resistance (TEER) mainly by increasing the permeability of the tight junctions. Primary cultures of HBMEC express endothelial nitric oxide synthase (eNOS) and produce low levels of NO. Treatment with the NO donors sodium nitroprusside (SNP) and DETA NONOate or the cGMP agonist 8-Br-cGMP significantly increased monolayer resistance. Conversely, inhibition of soluble guanylyl cyclase with ODQ rapidly decreased the resistance, and pretreatment of HBMEC with Rp-8-CPT-cGMPS, an inhibitor of cGMP-dependent protein kinase, partially prevented the 8-Br-cGMP-induced increase in resistance. Furthermore, NO donors and 8-Br-cGMP could also reverse the increased permeability of the monolayers induced by IL-1beta, IFN-gamma, and LPS. These results indicate that NO can decrease the permeability of the human BBB through a mechanism at least partly dependent on cGMP production and cGMP-dependent protein kinase activation.     

Family burdens, Chinese health beliefs, and the mental health of Chinese caregivers in Hong Kong

This study explored the types of family burdens, mental health and Chinese health beliefs of Chinese caregivers with relatives suffering from a serious mental illness. It also examined the impacts of these beliefs on caregivers' burdens and mental health. A structured questionnaire was administered to 125 Chinese caregivers in out-patient clinics in Hong Kong. Measures included distress (General Health Questionnaire), family burdens and belief in traditional Chinese medicine. Family burdens exerted a significant impact on the mental health of caregivers. Significant differences were found between believers and non-believers of traditional Chinese medical beliefs in terms of financial burdens, disruptions to family interactions and decline in physical health. No [corrected] moderating effect of Chinese health beliefs on family burdens and mental health was found. The lack of a moderating effect of health belief on family burdens may be related to caregivers' changes in perspectives from a traditional Chinese cultural perspective to a psychosocial and personality perspective. Implications for research and service development are discussed.     

Multiple acute cerebral infarcts on diffusion-weighted imaging and risk of recurrent stroke

Multiple acute cerebral infarcts (MACIs) detected by diffusion-weighted imaging (DWI) may indicate an unstable source of thromboembolism. The authors studied 119 consecutive acute ischemic stroke patients within 24 hours of onset with DWI. MACIs were present in 20 patients (16.8%). During the follow-up period, there were 15 recurrent strokes, 3 acute coronary syndromes, and 5 deaths. MACI was the only significant independent predictor for vascular events and death (odd ratio [OR]] = 4.34; p = 0.001) and stroke recurrence (OR = 5.93; p = 0.001).     

Quality-of-life assessment in Chinese families with food-allergic children

Background Caucasian families with food‐allergic children have a compromised quality of life (QoL) for fear of life‐threatening food reactions. Such data are limited in Asian children. Based on our recent questionnaire‐based survey, 8.1% of young children recruited from local nurseries and kindergartens had parent‐reported adverse food reactions (AFRs). Objective This study tested the robustness of the Chinese Food Allergy Quality of Life‐Parental Burden questionnaire (FAQL‐PB) and assessed QoL in families with childhood AFR. The correlations among FAQL‐PB items were evaluated by factor analysis. Methods Two hundred and ninety‐eight of 3677 children aged 2–7 years had parent‐reported AFR, and 197 (66.1%) of them completed the 17 items of our self‐administered FAQL‐PB. Six hundred and thirty‐nine (18.9%) children without AFR returned this questionnaire. Factor analysis was used to delineate the inter‐relationship among the FAQL‐PB items. Results Cronbach α for our Chinese FAQL‐PB was 0.976, and the median (interquartile range) FAQL‐PB scores of children with and without parent‐reported AFR were 0.10 (0.02–0.32) and 0 (0–0.18), respectively (P<0.001). Factor analysis confirmed excellent correlations between FAQL‐PB items. The 17 items were clustered into two factors, which explained 79.7% of the total variance. Among children with AFR, FAQL‐PB scores increased with increasing numbers of foods that caused AFRs (P<0.001 for trend). Thirty (15.2%) children had impaired QoL, defined as average item FAQL‐PB score 0.5. Impaired QoL was associated with AFR that was caused by >3 foods (P=0.001), current food avoidance (P=0.005) and AFR caused by peanut (P=0.003), egg (P=0.011) and cow's milk (P=0.028), and current flexural dermatitis (P=0.011). Conclusions FAQL‐PB is a robust measure of AFR‐specific parental QoL, which is impaired in Chinese children with parent‐reported AFR. Flexural dermatitis, current food voidance and AFR caused by multiple foods are independent risk factors for lower parental QoL.     

A web-based simulation of a longitudinal clinic used in a 4-week ambulatory rotation: a cohort study

Background  

Residency training takes place primarily on inpatient wards. In the absence of a resident continuity clinic, internal medicine residents rely on block rotations to learn about continuity of care. Alternate methods to introduce continuity of care are needed.     

Management of hydrocephalus in posterior fossa tumors: how,what, when?

Object The aim of this work is to analyze the current management of hydrocephalus associated with posterior fossa (PF) tumors.Methods The personal perspectives of experienced pediatric neurosurgeons were presented at a virtual round table.Discussion Preoperative hydrocephalus has been reported in about 80% of patients with PF tumors and postoperative treatment is required for persistent or progressive hydrocephalus in about 25–30% of the cases. Preoperative management includes external ventricular drainage (EVD), endoscopic third ventriculostomy (ETV), shunt insertion, and no treatment at all, while ETV and ventriculo-peritoneal (V-P) shunt are recommended as treatment after PF craniotomy.Conclusion There is no consensus on the way hydrocephalus should be managed before, during, and after PF surgery. While awaiting prospective multicenter trials of various management schemes the perioperative management of hydrocephalus in the context of posterior fossa tumors should be considered as options.