A systematic review of home-based interventions to prevent and treat postpartum depression

This systematic review evaluated randomized controlled trials assessing home-based psychological interventions to prevent and treat postpartum depression (PPD). Six studies meeting inclusion criteria were identified, five assessing treatments for PPD and one assessing a preventive intervention for PPD. Interventions used cognitive behavioral, psychodynamic, and non-directive counseling approaches. Of the six studies reviewed, four reported statistically significant treatment effects on PPD following the intervention. Each of the three types of psychological interventions were shown to reduce levels of maternal depression. Recommendations for future development and evaluation of home-based psychological interventions for PPD are discussed. These include identification of mediators and moderators of intervention efficacy, exploring strategies for prevention of PPD, and targeting high-risk groups.     

Early psychological responses to traumatic injury

Sixteen injured survivors of a terrorist act, hospitalized in a large medical center, were followed daily by a team of mental-health consultants. The survivors' rapidly changing mental states and the subsequent responses of their care-providers are described. Intrusive recollections of the event were experienced by all, however with various degrees of distress and arousal. Early psychological assistance was aimed at increasing the survivors' sense of self-control and their mastery over secondary stressors. Flexible and skilled therapeutic technique was required to meet the survivors' changing needs. The consultants' own emotional burden was addressed by structuring the interventions and providing opportunities for disclosure.Center for Traumatic Stress, Department of Psychiatry, Hadassah University Hospital, Jerusalem, Israel. Paper presented at the 144 Annual Meeting of the American Psychiatric Association, New Orleans, May 16, 1991.     

Lessons learned from non-medical industries: the tragedy of the USS Greeneville*

In February 200l the nuclear powered submarine USS Greeneville collided with the Japanese fishing trawler Ehime Maru, killing nine passengers. A series of small failures and hurried actions escalated into tragedy. This incident provides lessons learned that can be used by healthcare organizations to improve patient safety. Expertise, training, equipment, and procedures appeared to be adequate protection, yet the presence of multiple defences obscured their faulty functioning, just as they often do in medical settings. A number of other problems occurred aboard Greeneville which we also see in health care. The problem was the total breakdown of communication. The Greeneville team also failed to move from a rigid hierarchical structure to a more flexible adaptive structure. Communication often breaks down in healthcare settings, which are organized to maximize status and hierarchical differences, thus often impeding information flow needed to make decisions. Redundancy failed aboard Greeneville as it often does in medicine. Finally, the Captain of the Greeneville established an artificially hurried situation. Time constrained situations happen all the time in health care. We recommend strategies to mitigate the development of these kinds of processes.     

Professional-led versus family-led support groups: Exploring the differences

Support groups often help families cope more effectively with relatives' mental illnesses. This study examines the differences between support groups led by professionals and those led by family members, focusing specifically on group participation benefits and group content. Results indicate that participants of both professional and family-led groups reported that the groups provided them with needed information about mental illness and its treatment and that the groups improved their relationships with their ill relatives. Professional-led groups placed a greater emphasis on the relatives' problems and coping with emotions, and family-led groups placed a greater emphasis on advocacy. Suggestions are provided regarding increased collaboration between professional and family-led support groups.     

Malignant prolactinoma.

Malignant prolactinoma is a rare entity and only a few cases have been published. The diagnostic criteria and the clinical course remain unclear. We present a case of malignant prolactinoma in a woman with a 30-year duration of the disease. In the terminal stage of the disease the prolactinoma metastasized to the left eye, the prolactin level reaching 196000 mU/l. Bromocriptine in high doses was not effective. The response to pergolide was good in the first two years of treatment; thereafter an escape effect was observed. The patient died in a comatose state. A review of previously published cases follows.     

Increased risk of late‐onset,immune‐mediated,adverse reactions related to dermal fillers in patients bearing HLA‐B*08 and DRB1*03 haplotypes

Even though manufacturers claim that the dermal fillers are nontoxic and nonimmunogenic, adverse events may occur. Clinically and histologically, most of the late onset adverse events present as an inflammatory response. To assess whether HLA polymorphisms are associated with late‐onset inflammatory adverse events related to dermal fillers. A total of 211 patients were included, of whom 129 experienced late‐onset inflammatory adverse events to different fillers (Inflammation group) and 82 who did not (Reference group). Patients completed a standardized questionnaire and provided a blood sample or oral swap for HLA testing. The study population consisted of 188 (89%) women and 23 (11%) men. The two study groups were similar in the distributions of filler type, location of injecting, allergy, autoimmune disease, gender, age, ethnicity, and smoking status. Of the 211 patients in the sample, 25 had the combination of HLA subtype‐B*08 and HLA subtype‐DRB1*03. This was 16.3% of the inflammatory group and 4.9% of the reference group. This combination of HLA subtypes was associated with an almost 4‐fold increase in the odds of developing immune mediated adverse events (odds ratio = 3.79, 95% CI 1.25‐11.48). Genetic polymorphisms such as HLA combinations may identify patients at risk of developing late onset immune mediated adverse events to dermal fillers.     

GABAB autoreceptor-mediated cell type-specific reduction of inhibition in epileptic mice

GABA_B receptors (GABA_BRs) mediate slow inhibitory effects on neuronal excitability and synaptic transmission in the brain. However, the GABA_BR agonist baclofen can also promote excitability and seizure generation in human patients and animals models. Here we show that baclofen has concentration-dependent effects on the hippocampal network in a mouse model of mesial temporal lobe epilepsy. Application of baclofen at a high dose (10 mg/kg i.p.) reduced the power of γ oscillations and the frequency of pathological discharges in the Cornu Ammonis area 3 (CA3) area of freely moving epileptic mice. Unexpectedly, at a lower dose (1 mg/kg), baclofen markedly increased γ activity accompanied by a higher incidence of pathological discharges. Intracellular recordings from CA3 pyramidal cells in vitro further revealed that, although at a high concentration (10 µM), baclofen invariably resulted in hyperpolarization, at low concentrations (0.5 µM), the drug had divergent effects, producing depolarization and an increase in firing frequency in epileptic but not control mice. These excitatory effects were mediated by the selective muting of inhibitory cholecystokinin-positive basket cells (CCK⁺ BCs), through enhanced inhibition of GABA release via presynaptic GABA_BRs. We conclude that cell type–specific up-regulation of GABA_BR-mediated autoinhibition in CCK⁺ BCs promotes aberrant high frequency oscillations and hyperexcitability in hippocampal networks of chronic epileptic mice.Neuronal activity in the hippocampus shows oscillations in behavior-relevant frequency ranges including γ frequencies (30–80 Hz) (1). γ activity is prominent in the aroused brain and has been implicated in higher-level brain functions, such as sensory binding, perception (2), and storage and recall of information (3, 4). At the same time, γ frequency oscillations are also prevalent in epileptic patients and are most often observed at seizure onset during in depth EEG recordings (5). The GABAergic system plays a pivotal role in the generation of γ oscillations (6–8). However, it remains to be resolved how distinct GABAergic receptor subtypes, in particular GABA_B receptors (GABA_BRs), contribute to the generation and modulation of pathological network oscillatory activity.GABA_BRs mediate slow inhibitory effects and control synaptic transmission and the excitability of neurons in cortical networks. GABA_BRs are expressed both postsynaptically in somato-dendritic compartments and presynaptically in axon terminals, in excitatory principal cell and inhibitory interneurons (9–11). The effects of GABA_BR activation on the network are dominated by inhibition leading to an overall dampened population activity. However, if GABAergic interneurons are effected dominantly, as observed for example, during high-frequency stimulation, GABA_BR activation can produce disinhibition in principal cells (12, 13). Accordingly, the role of GABA_BRs in epilepsy and seizure generation remains ambiguous. GABA_BRs are expected to have an overall antiepileptic effect, and indeed, the receptor KO animals show an epileptic phenotype (14). However, there is also evidence that the receptor agonist baclofen can induce seizures in patients after intrathecal application (15, 16). The picture is further complicated by the fact that GABA_BR expression can be altered in both epileptic patients, e.g., in mesial temporal lobe epilepsy (mTLE) (17), and animal models (18). Thus, cell type–specific alterations in GABA_BR expression may change network excitability during the progression of mTLE.Using a chronic kainate (KA) model of mTLE, which reproduces major electrophysiological and histopathological characteristics of human mTLE (19, 20), we studied the role of GABA_BRs in altered hippocampal network activity. Our results suggest that enhanced and persistent GABA_BR activation in epileptic mice suppresses the inhibitory output from hippocampal interneurons, in particular cholecystokinin (CCK)-expressing basket cells (BCs) onto pyramidal cells (PCs). This reduction in the inhibitory output of interneurons, in turn, leads to disinhibition in hippocampal networks, enhances γ activity, and promotes the transition to pathological hyperexcitability.     

Formation of highly porous aerosol particles by atmospheric freeze-drying in ice clouds

The cycling of atmospheric aerosols through clouds can change their chemical and physical properties and thus modify how aerosols affect cloud microphysics and, subsequently, precipitation and climate. Current knowledge about aerosol processing by clouds is rather limited to chemical reactions within water droplets in warm low-altitude clouds. However, in cold high-altitude cirrus clouds and anvils of high convective clouds in the tropics and midlatitudes, humidified aerosols freeze to form ice, which upon exposure to subsaturation conditions with respect to ice can sublimate, leaving behind residual modified aerosols. This freeze-drying process can occur in various types of clouds. Here we simulate an atmospheric freeze-drying cycle of aerosols in laboratory experiments using proxies for atmospheric aerosols. We find that aerosols that contain organic material that undergo such a process can form highly porous aerosol particles with a larger diameter and a lower density than the initial homogeneous aerosol. We attribute this morphology change to phase separation upon freezing followed by a glass transition of the organic material that can preserve a porous structure after ice sublimation. A porous structure may explain the previously observed enhancement in ice nucleation efficiency of glassy organic particles. We find that highly porous aerosol particles scatter solar light less efficiently than nonporous aerosol particles. Using a combination of satellite and radiosonde data, we show that highly porous aerosol formation can readily occur in highly convective clouds, which are widespread in the tropics and midlatitudes. These observations may have implications for subsequent cloud formation cycles and aerosol albedo near cloud edges.Aerosol particles are modified and age during their atmospheric lifetime, resulting in changes in their optical and hygroscopic properties that subsequently determine the aerosols’ radiative characteristics and their ability to affect cloud properties via nucleation of ice particles and water droplet formation. Outside of clouds, aerosol particles undergo changes in size, composition, volatility, and concentration following gas–particle partitioning, oxidative aging induced by photochemistry, and heterogeneous uptake of gas-phase reactive trace gases (1). Varying conditions of temperature and ambient relative humidity (RH) affect the aerosols’ hygroscopic growth and phase state, further changing their properties (2, 3).In haze, fog, and cloud droplets, aerosols can also be modified following aqueous-phase reactions (such as oxidation, nitration, and acid–base reactions) (1, 4). Studies of aerosol processing by clouds have predominantly focused on warm clouds and aqueous-phase reactions (4) that lead to the formation of secondary organic aerosol material (5) and modify the size and composition of the resulting particles (6).Despite the importance of tropospheric ice clouds to Earth’s radiative balance and climate (7, 8) and extensive efforts to understand many of the processes within cirrus clouds (9), little attention has been given to the processing of aerosols by the cloud ice phase. As clouds continually form and dissipate, it is likely that aerosol particles undergo cycles of freezing and drying during ice crystal formation and subsequent ice sublimation when exposed to dry, subsaturated conditions outside of the cloud. Such conditions occur in the lower parts of cirrus clouds (10), in the outflow of high convective clouds (11, 12), and when clouds are injected into the dry lower stratosphere (13). Here we show that the atmospheric conditions for such aerosol processing are likely to occur readily in deep convective clouds that are common in the tropics and midlatitudes and reach the upper troposphere and tropical tropopause layer. We hypothesize that aerosols may undergo significant modifications following such freeze-drying cycles. In contrast to chemical aging, the modifications to the aerosols in a freeze-drying cycle may be induced by changes in the thermodynamic state of the aerosol particles, which may lead to unexplored phenomena with regard to aerosol particle morphology and phase.Organic material and sulfates are prevalent in high-altitude interstitial aerosol and ice crystal residues of cirrus clouds throughout the tropics, subtropics, and midlatitudes (14, 15). Recent studies have proposed that atmospheric organic aerosol particles may be in an amorphous glassy state, depending on the temperature and liquid water content (16, 17). The glassy state affects ice nucleation capability (18–20) and water uptake and release (18, 19, 21) and slows down chemical aging of atmospheric particles due to slower diffusion of water and reactants into the particle (22). Previous studies suggested that glassy aerosols emanating from deep convective clouds act as potential ice nuclei in the upper troposphere and tropical tropopause layer (23, 24).The experiments in this study simulate the atmospheric freeze-drying cycle for organic and mixed organic/sulfate aerosol. We follow how this ice cloud process affects the phase, size, and morphology of the processed aerosol particles and assess experimentally how changes in these parameters affect their cloud condensation nucleation activity and optical properties.