A network analysis of two conceptual approaches to the etiology of PTSD

Two prominent conceptual models of posttraumatic stress disorder (PTSD) are the cognitive model, associated with cognitive processing therapy (CPT; Resick & Schnicke, 1992), and the functional contextualist model, underlying acceptance and commitment therapy (ACT; Hayes et al., 1999). Network analysis was used to examine dynamic interactions among cognitive (relating to CPT) and functional contextualistic (relating to ACT) variables and PTSD symptoms in a sample of 722 trauma-exposed adults. Results from the cognitive networks highlighted the importance of maladaptive beliefs about threat in maintaining the co-occurrence of PTSD symptoms and cognitive variables. Additionally, PTSD symptoms were more likely to lead to cognitive variables, rather than the reverse direction. Results from the functional contextualist networks identified numerous associations amongst variables that contribute to the co-occurrence of PTSD symptoms and psychological inflexibility. Findings from this study may help generate causal hypotheses that can be tested further using a longitudinal study design.     

Does smoking cannabis affect work commitment?

Aims This study aimed to examine the associations between cannabis use and work commitment Design We used a 25‐year panel survey initiated in 1985 with follow‐ups in 1987, 1989, 1993, 2003 and 2010. Registered data from a range of public registers were matched with individual responses for the entire period. Setting The panel survey was a nation‐wide study set in Norway. Participants A total of 1997 respondents born between 1965 and 1968 were included in the panel. Measurements Work involvement scale (WIS) was used to assess work commitment. Involvement with cannabis was based on self‐reported smoking of cannabis within the last 12 months and exposure to cannabis through friends. This information was categorized into ‘abstaining’, ‘exposed’, ‘experimented’ and ‘involved’. Control measures included socio‐economic background, mental health (HSCL‐10), education, work satisfaction, unemployment, receipt of social assistance, consumption of alcohol, alcohol‐related problems and use of other illicit drugs. Findings The level of work commitment was associated with involvement with cannabis. In 1993, when the respondents were in their mid‐20s, those who were involved or had experimented with cannabis displayed lower levels of work commitment than those who were abstaining or merely exposed to cannabis through friends (P < 0.05). Work commitment among those who experimented with cannabis converged towards the levels reported by abstainers and the exposed as they grew older, whereas those involved reported decreasing work commitment into adulthood (P < 0.001). Using linear regression models for panel data, an association with continued use of cannabis across the life‐course and a lowering of work commitment was established. Results remained significant even when controlling for a range of other factors known to be related to work commitment, such as socio‐economic background, education, labour market experiences, mental health and family characteristics (P < 0.05). Conclusions In Norway the use of cannabis is associated with a reduction in work commitment among adults.     

Differential induction of helper and killer T cells from isolated CD4+CD8+ thymocytes in suspension culture

Thymocytes of T cell receptor transgenic mice with nonselecting and RAG-2^−/− backgrounds were developmentally arrested at the CD4⁺CD8⁺ stage before positive selection. These thymocytes underwent lineage commitment upon transient stimulation with a combination of ionomycin, a calcium ionophore, and phorbol 12-myristate 13-acetate (PMA), a protein kinase C activator, in suspension culture. The effective drug doses were limited within narrow ranges and much lower than those which induce proliferation of mature T cells. The doses corresponded to those which inhibit glucocorticoid-induced apoptosis in these thymocytes. CD4 lineage commitment required longer duration, higher intensity of the stimulation, or both, than CD8 lineage commitment. Functional helper T cells (Th1 and Th2) were induced from the CD4 lineage-committed cells upon secondary stimulation with a combination of ionomycin and PMA followed by lymphokine treatment. Cytotoxic T cells were induced from the CD8 lineage-committed cells upon incubation with concanavalin A and irradiated splenic dendritic cells, but not with the combination of ionomycin and PMA. These results indicate that positive selection is mimicked by the pharmacological stimulation in the absence of other cell types, but that final maturation of CD8 T cells may require a different signal.     

Importancia del compromiso del personal sanitario para la satisfacción de los pacientes en Atención Primaria

Conocer en qué medida el compromiso organizativo de los profesionales sanitarios de Atención Primaria es importante para la satisfacción de los pacientes. Estudio observacional, de corte transversal, cuantitativo, retrospectivo, y no controlado. Cuarenta centros de Atención Primaria pertenecientes al área de salud de Gran Canaria. Atención primaria. Seiscientos diecisiete profesionales sanitarios (46% médicos y 54% enfermeros) y 1.537 usuarios de los centros de Atención Primaria (35,39% hombres y 64,60% mujeres). Muestreo no probabilístico por conveniencia. Para evaluar el compromiso organizativo se usó un cuestionario autoadministrado a profesionales sanitarios de centros de Atención Primaria. La satisfacción de los pacientes se obtuvo mediante encuesta telefónica y las variables de control a partir de fuentes secundarias. Los datos se analizaron mediante regresión lineal múltiple. Para profundizar en los resultados se usaron también entrevistas semiestructuradas. El entorno socioeconómico de los centros de salud no influye en la satisfacción de los pacientes. El compromiso organizativo de los trabajadores influye positivamente en la satisfacción de los usuarios de los centros de salud. También se encontró que los profesionales más comprometidos tienen menos disponibilidad en sus agendas para citas a corto plazo. Las entrevistas sugieren que se debe a que dedican más tiempo a sus pacientes, lo cual hace que estén más satisfechos. El compromiso organizativo afectivo de los profesionales sanitarios es una actitud que permite mejorar la satisfacción de los pacientes, por ello, los gestores sanitarios deberían emplear prácticas dirigidas a fortalecer dicha actitud.Palabras clave: Satisfacción del paciente, Compromiso organizativo, Calidad asistencial, Atención primaria, Gestión de personal     

Maintenance of T cell specification and differentiation requires recurrent notch receptor-ligand interactions

Notch signaling has been shown to play a pivotal role in inducing T lineage commitment. However, T cell progenitors are known to retain other lineage potential long after the first point at which Notch signaling is required. Thus, additional requirements for Notch signals and the timing of these events relative to intrathymic differentiation remain unknown. Here, we address this issue by culturing subsets of CD4 CD8 double negative (DN) thymocytes on control stromal cells or stromal cells expressing Delta-like 1 (Dll1). All DN subsets were found to require Notch signals to differentiate into CD4+ CD8+ T cells. Using clonal analyses, we show that CD44+ CD25+ (DN2) cells, which appeared committed to the T cell lineage when cultured on Dll1-expressing stromal cells, nonetheless gave rise to natural killer cells with a progenitor frequency similar to that of CD44+ CD25- (DN1) thymocytes when Notch signaling was absent. These data, together with the observation that Dll1 is expressed on stromal cells throughout the thymic cortex, indicates that Notch receptor-ligand interactions are necessary for induction and maintenance of T cell lineage specification at both the DN1 and DN2 stages of T cell development, suggesting that the Notch-induced repression of the B cell fate is temporally separate from Notch-induced commitment to the T lineage.