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PubMed1996

Further exploration of a latent class typology of schizophrenia.

We previously derived a typology of schizophrenia from a latent class analysis of 447 first-contact non-affective functional psychotic patients from a defined catchment area. Here, using the same sample, we show that the three subtypes, 'neurodevelopmental' (Type A), 'paranoid' (Type B) and 'schizoaffective' (Type C) have different premorbid, phenomenological and treatment response characteristics. A canonical variate analysis of the three subtypes achieved partial separation between the first two subtypes, but the 'schizoaffective' type was less distinct.

Adult↗
PubMed2004

Systolic blood pressure: it's time to take control.

Once considered an inconsequential part of the aging process, an age-associated rise in systolic blood pressure (SBP) occurs as a consequence of increased arterial stiffness and contributes to a high prevalence of systolic hypertension after middle-age. Elevated SBP imparts a predilection toward the onset of vascular events, highlighting the importance of its control. Current philosophy ranks systolic pressure as the most relevant component of blood pressure (BP) for determining risk for cardiovascular and other events in hypertensive patients, particularly those >50 years of age. Despite its prognostic role, SBP remains more difficult to control than diastolic BP (DBP), and most middle-age and older hypertensive patients fail to achieve recommended targets. In part, the lack of strict control of SBP in the more aged population lies in the physiology of hypertension. Younger persons tend toward isolated diastolic hypertension or combined systolic-diastolic hypertension, primarily driven by increased peripheral resistance and more effectively treated by antihypertensive medications; whereas older persons develop isolated systolic hypertension (ISH) associated with increased arterial stiffness that appears to be less amenable to current therapies. Thus, diastolic pressure in hypertensive patients often plateaus as patients reach middle-age and subsequently declines, whereas systolic pressure consistently rises through the ensuing decades. Treatment approaches favoring control of DBP frequently result in residual high SBP, putting patients at greater risk for vascular complications. Improving patient outcomes relies on antihypertensive therapy that appropriately addresses control of SBP and pulse pressure, underscoring the importance of therapeutic options that effectively reduce arterial stiffness.

Age Factors↗
PubMed2004

Self-assessed changes in mental health and employment status as a result of unemployment training.

The main question addressed in this article is: What factors in an unemployment programme serve both the individual and society? Our research focuses on background variables and process variables and how these can be assumed to affect certain dependent variables in unemployment training. The current focus is on the dependent variable "subjective assessment of the effect of the training on mental health", together with the more objective dependent variable of "employment status after training". Self-confidence, well-being, faith in the future, level of initiative and personal development have been used as indicators of self-assessed "mental health". Data were collected from an unemployment training programme in Sweden and the variables combined to create a hypothetical model. The model was statistically tested and then modified with the aid of LISREL statistics, which helps to adjust the model to statistical acceptance. The findings show that the salient factors directly related to the subjective assessment of the effect of training on mental health are gender, attitude to skills development, perceived training requirements and formal educational background. The latter relationship was negative. Of indirect importance are the level of commitment of the teacher, the satisfaction of the trainee with the process, and the level of control. The duration of previous unemployment was the only independent variable, which directly affected the employment status after the training, and this was in the negative direction. Of indirect importance for this dependent variable were training requirement, satisfaction with the process, own level of control and attitude to skills development.

Adult↗
PubMed2006

Creating an organizational diversity vision: goals, outcomes, and future directions of the International Society of Psychiatric Nurses.

The aim of this article was to chronicle the development and status of a diversity vision within a psychiatric nursing organization. Organizational activities to support diversity and cultural competence, along with challenges to a full integration of these values, are presented. Psychiatric nurses need to be engaged in the process of developing personal and organizational cultural competence to eliminate barriers that contribute to disparities in effective mental health care.

Clinical Competence↗
PubMedDate not supplied

Assessing personality features and their relations with behavioral problems in adolescents: Tridimensional Personality Questionnaire and Junior Eysenck Personality Questionnaire.

This study examines the applicability for adolescents of the Tridimensional Personality Questionnaire (TPQ), which was originally designed for adults, as compared to the Junior Eysenck Personality Questionnaire (JEPQ). The study also evaluates their inter-relationship and associations with various behavioral problems as reported by parents using the Child Behavior Checklist (CBCL). In a representative community sample of 905 adolescents, the results of internal consistency, test-retest reliability, and factor analysis showed that both the Harm Avoidance (HA) and the Novelty Seeking (NS) scales of the TPQ have sound construct validity, although the Reward Dependence (RD) scale has less so. The intercorrelation and factor analysis of the two questionnaires showed that the TPQ and the JEPQ are not simply alternative descriptions of the same construct of personality. In their associations with various behavioral problems, the scales of the TPQ are relatively more specifically associated with behavioral problems than the scales of the JEPQ. Our results provide empirical support for the applicability of the NS and the HA scales of the TPQ in adolescents, particularly in relation to behavioral problems.

Adolescent↗
PubMedDate not supplied

Childhood adversity and frequent medical consultations.

We assessed possible psychological mediators of the relationship between childhood adversity and frequent medical consultations among new outpatients at neurology, cardiology, and gastroenterology clinics. We assessed whether these differed in patients with and without organic disease that explained their symptoms. At first clinic visit we recorded Hospital Anxiety and Depression scale (HADS--anxiety and depression subscale scores), Illness Perception Questionnaire (IPQ--four subscales: consequences, cure, identity, timeline), Health Anxiety Questionnaire (total score), and Symptom Amplification Scale (total score). Subjects were divided into two groups according to whether they had experienced any type of childhood adversity using the Childhood Experience of Care and Abuse Schedule. Outcome was the (log) number of medical consultations for 12 months before and 6 months after the index clinic visits. Multiple regression analysis was used to determine mediators; this was performed separately for patients with symptoms explained and not explained by organic disease. One-hundred and twenty-nine patients (61% response) were interviewed. Fifty-two (40.3%) had experienced childhood adversity; they made a median of 16 doctor visits compared with 10 for those without adversity (adjusted P=.026). IPQ identity score (number of symptoms attributed to the illness) and HAD depression scores were significantly associated with both childhood adversity and number of medical consultations and these variables acted as mediators between childhood adversity and frequency of consultation in the multiple regression analyses. This association was limited to patients with medically unexplained symptoms and was mediated by IPQ Identity Score (number of symptoms attributed to the patient's illness) and HAD depression score. Sexual abuse and overt neglect were the adversities most closely associated with frequent consultations. In patients with medically unexplained symptoms the association between childhood adversity and frequent medical consultations is mediated by the number of bodily symptoms attributed to the illness. Psychological treatments should be targeted at these patients with a view to reducing their frequent doctor visits.

Adult↗
PubMed2006

A leadership programme for critical care.

This paper describes the genesis, design and implementation of a leadership programme for critical care. This was an initiative funded by the National Health Service (NHS) Nursing Leadership Project and had at the core of its design flexibility to meet the needs of the individual hospitals, which took part in it. Participation was from the multi-disciplinary critical care team. Six NHS hospitals took part in the programme which was of 20 days duration and took place on hospital sites. The programme used the leadership model of as its template and had a number of distinct components; a baseline assessment, personal development, principles of leadership and critical case reviews. The programme was underpinned by three themes; working effectively in multi-professional teams to provide patient focussed care, managing change through effective leadership and developing the virtual critical care service. Each group set objectives pertinent to their own organisation's needs. The programme was evaluated by a self-reporting questionnaire; group feedback and feedback from stakeholders. Programme evaluation was positive from all the hospitals but it was clear that the impact of the programme varied considerably between the groups who took part. It was noted that there was some correlation between the success of the programme and organisational 'buy in' as well as the organisational culture within which the participants operated. A key feature of the programme success was the critical case reviews, which were considered to be a powerful learning tool and medium for group learning and change management.

Attitude of Health Personnel↗
PubMed2006

Physical activity for bone health in inactive teenage girls: is a supervised, teacher-led program or self-led program best?

PURPOSE: To investigate the effect of a six-month teacher-led osteogenic physical activity program, vs. a self-led activity program, on ultrasound measurements of bone in inactive teenage girls. METHODS: Ninety sedentary girls [mean (SD) age 16.3 (.6) years] were identified from 300 assessed for physical activity across five schools in southeast Ireland. Schools were matched and randomly assigned to a teacher-led physical activity (TLPA) program, a self-led physical activity (SLPA) program, or a control group. Broadband ultrasound attenuation (BUA), speed of sound (SOS), and os calcis stiffness index (OCSI) were measured using a portable ultrasound machine. Anthropometry, aerobic fitness, calcium intake, and physical activity were assessed, and focus groups held one month after program completion. Descriptive statistics, paired t-tests, and analysis of variance were used to analyze the data. RESULTS: Both intervention groups demonstrated significant improvements (p < .05) in BUA, SOS, OCSI and aerobic fitness, i.e., TLPA: +14.9%, +21.9%, + 15.9%, and +8.5%, respectively, and SLPA: +10.6%, +30.3%, + 15.6%, and +5.1%, respectively, with no change in controls. Differences between intervention groups and controls were significant for BUA and OCSI (p < .05). TLPA and SLPA groups engaged in an average of 4.5 and 3.4 hours/week of physical activity, respectively, over the intervention period. The SLPA group continued to exercise after the intervention had ceased, whereas the TLPA group did not. CONCLUSIONS: Previously inactive teenage girls can adhere to an osteogenic activity program whether supervised or directing their own activity. Longer-term, sustainable initiatives with this age group are needed and might focus on developing personal skills for physical activity.

Absorptiometry, Photon↗
PubMed2005

Stability and discriminative power of the Young Schema-Questionnaire in a Dutch clinical versus non-clinical population.

In this study the temporal stability and general discriminative and classifying ability of the Young Schema-Questionnaire (YSQ) was examined in a clinical and non-clinical sample. To be able to cross-validate on the variables, two parallel subtests, drawn from the YSQ item pool, were utilized. Results suggest adequate rank order stability. However, mean scores tended to drop systematically over time, most likely caused by transient error. Therefore, to assess progress in therapy, the alternate utilization of the parallel parts is advised. Findings from discriminant analysis suggest high sensitivity of the YSQ and its subscales in predicting the presence or absence of psychopathology.

Adolescent↗
PubMed2006

Toxicity evaluation for the broad area of the asbestos mine of northern Greece.

The existing data regarding the quality of the environment in the asbestos mine of northern Greece (MABE) region related to the presence of asbestos are insufficient to determine the current pollution problem. In the present work, a first approach to this problem has been taken through a toxicity risk assessment. The environmental quality of an open air asbestos mine was evaluated over a long period of time by measuring and monitoring the concentration of asbestos fibres in air, soil and water. Air measurements were made to determine the concentration of asbestos fibres in the atmospheric air of the mine, the depositions and the nearby villages. The asbestos fibre concentration was also specified inside the building facilities of MABE. Analyses of soil, dust and water samples were carried out showing the presence of enormous quantities of chrysotile asbestos. The concentration of asbestos fibres in the atmospheric air was compared to older measurements that were taken at the same sampling points during the operation of the mine. The results of this work, in conjunction with individual researches that have been carried out in the past and with the evaluation of international standards of scientific and experience-based findings, provide a reliable framework with which to estimate the threat of MABE to its surrounding environment, and help to determine a basic criterion for the remediation and rehabilitation of the region. In addition, mathematical models based on human and animal studies were used to estimate the probability of a person developing cancer from breathing air containing asbestos fibres in the wider vicinity of the mine in order to define appropriate procedures for evaluating asbestos-related risk.

Air↗
PubMed2005

Factor structure and reliability of the Hungarian version of the Illness Intrusiveness Scale: invariance across North American and Hungarian dialysis patients.

OBJECTIVES: The objectives of this study were to compare the factor structure and to assess the reliability of the Hungarian version of the Illness Intrusiveness Rating Scale (IIRS), testing internal validity and employing simultaneous confirmatory factor analysis (SCFA) in two large samples of North American versus Hungarian patients with end-stage renal disease (ESRD). METHODS: Translation was conducted according to current recommendations. Following pilot testing, 365 maintenance haemodialysis patients completed the scale. Hungarian data were compared with IIRS data from North American ESRD patients undergoing maintenance hemodialysis to evaluate item bias (Group x Item ANOVA). RESULTS: Confirmatory factor analyses indicated a good fit between the previously hypothesized three-factor model ("relationships and personal development", "intimacy", and "instrumental" life domains) of the original English version and the Hungarian translation. Although statistically significant (P<.05), the effect size for the Groups x Items interaction was not substantial. Internal consistency was very good (Cronbach's alpha=.80) for the total score, and, although somewhat lower than ideal, it was still in the acceptable range for the subscales (.64-.67). These numbers are similar to values reported for the original English version. Test-retest reliability was also acceptable. CONCLUSION: The Hungarian translation of the IIRS has the same three-dimensional factor structure as the original English-language version does. Furthermore, it is sufficiently reliable for research applications. These features satisfy important requirements of cultural equivalence.

Cost of Illness↗
PubMed2006

Menopausal women's positive experience of growing older.

OBJECTIVE: This paper aims to describe menopausal women's positive experience of growing older and becoming middle-aged. METHODS: Qualitative interviews with 24 menopausal women, selected on the basis of a questionnaire, covering a broad spectrum of Danish women in terms of experience of menopausal symptoms, treatment, contact with the health care system, and social background. RESULTS: The women expressed varied and many-facetted views on ageing and clearly connected the fact that they were menopausal to the ageing process. All, except one, mentioned positive aspects of growing older: 1. they had become more experienced and competent; 2. they had gained more freedom; 3. they perceived possibilities of personal development that made them able to hold on to their own opinions and better speak their minds. The described positive effects were the result of having lived a long life, of good and evil, not of the menopause itself. The women also mentioned negative aspects: 1. negative expectations; 2. negative experiences. Positive aspects, often of psychological or existential nature, seemed to outweigh the negative experiences which were mostly related to bodily changes or losses. CONCLUSION: This paper discusses the importance of avoiding unnecessary negative expectations of ageing and menopause and of focusing, instead, on the positive aspects of growing older. Health professionals should reconsider the necessity to talk about future risks with healthy women, and instead support the women's agenda when they try to cope with real-life problems.

Adaptation, Psychological↗
PubMed2006

The peer-professional interface in a community-based, breast feeding peer-support project.

OBJECTIVE: to explore key elements of the peer-professional interface within one breast feeding peer-support project. DESIGN: a descriptive, qualitative study design. Data were generated through focus-group discussions with volunteer peer supporters and health professionals. SETTING: the Breastfriends scheme was a community-based, peer-support project located in Doncaster, a town in the North of England. PARTICIPANTS: all of the volunteer peer supporters who were involved in the scheme at the time of data collection (n=7). In addition, a convenience sample of health professionals (community midwives and health visitors [n=9]) was also generated. ANALYSIS: thematic analysis of the data was undertaken. Two key themes that have relevance to understanding the peer-professional interface were derived: benefits of working together, and constraints on enabling working relationships. FINDINGS: benefits associated with participating in the breast feeding peer-support scheme were highlighted by volunteers and health professionals. Volunteers experienced enhanced social support and increased self-esteem and personal development. Health professionals benefited from being able to 'spread the load' of breast feeding support. Some health professionals were also able to learn from volunteers' specialist experiential and cultural knowledge. Health professionals were concerned about volunteers transgressing (poorly defined) boundaries. Both volunteers and health professionals described gate-keeping activities and surveillance behaviours practised by health professionals in an effort to control aspects of volunteers' access to, and work with, breast feeding women. DISCUSSION: as a cohort of peer supporters develops, members may derive benefits from their participation that extend beyond those predicted and planned for in the project. They may also exert a proactive influence upon the evolution of the peer-support project and upon the relationships between volunteers and health professionals. However, midwives and health professionals may also seek to exert influence over the work of peer supporters, preferring the volunteers to work for, rather than with, them as health professionals. It is at the peer-professional interface that any disjuncture between the project ideal and the reality of the group may be most evident and most problematic. CONCLUSION AND IMPLICATIONS FOR PRACTICE: in order to reduce tension at the peer-professional interface, and optimise relationships between volunteers and health professionals, an ongoing process of development involving volunteers and health professionals is essential. Such a process would need to proactively identify and diffuse professionals' concerns while addressing both volunteers' vulnerabilities and their potential for semi-autonomous development within and beyond the context of the peer-support scheme.

Adult↗
PubMed2026

Establishing a genetic mutation panel for predicting malignant transformation of oral leukoplakia: A prospective cohort study.

OBJECTIVE: To investigate somatic mutations in the whole genes of tissue samples from patients with oral leukoplakia (OLK), as the most typical precursor of oral cancer; and identify the specific genes as a mutational panel for predicting OLK malignant transformation. METHODS: A total of 123 consecutive OLK patients with long-term follow-up (median, 73&#xa0;months) were prospectively enrolled, and divided into training set (n&#xa0;=&#xa0;92) and independent test set (n&#xa0;=&#xa0;31) based on chronological order of enrollment. Genomic DNA was isolated from the fresh-frozen biopsy tissues and somatic mutations in all genes were measured by whole-exome sequencing. RESULTS: We constructed a 3-gene (TP53, CASP8, and CYP2B6) mutational panel for risk stratification (any mutation vs. no mutation) of OLK malignant transformation. Kaplan-Meier analysis showed that the prognostic power of the 3-gene panel (log-rank P&#xa0;<&#xa0;0.0001) for risk stratification in malignant progression was better than that of pathological grade in the training and test set, respectively. Multivariate Cox regression analysis revealed that this panel was an independent variable significantly associated with progression in the training (hazard ratio [HR]&#xa0;=&#xa0;8.05; P&#xa0;<&#xa0;0.001) and test set (HR&#xa0;=&#xa0;11.26; P&#xa0;=&#xa0;0.0421), respectively. The area under the curve (AUC) with 95&#xa0;% confidence interval was 0.770 (0.648-0.892) and 0.877 (0.705-1.000) in the training and test set, respectively, for predicting malignant transformation in OLK patients. CONCLUSIONS: We established a 3-gene (TP53, CASP8, and CYP2B6) mutational panel as risk stratification model could effectively predict OLK malignant transformation, outperforming pathological grading-based assessment. Such genetic markers may provide a foundation for developing personalized management strategies.

Humans↗
PubMed2026

Ligand-based directed differentiation to produce granulosa-like cells expressing steroidogenic enzyme genes.

The ovarian granulosa cells are responsible for producing hormones and supporting oocytes through maturation and meiotic resumption. There is a need to generate granulosa-like cells (GLCs) from human induced pluripotent stem cells (hiPSCs) to better model human gonadal development and to test the effects of exogenous or pharmaceutical compounds on the ovary. Here we report a rapid ligand-based protocol for differentiating hiPSCs into cells that express markers of the transient developmental lineages and steroidogenic pathway genes. Single-cell RNA-sequencing (scRNA-seq) analysis identified canonical granulosa cell genes were expressed in a subset of cells and identified new genes of interest that were significantly associated with computationally modeled pseudotime. HSD17B1 was expressed in resulting GLCs but at low levels, suggesting an immature granulosa cell phenotype. The GLCs were produced using a simple culture method that could be augmented for granulosa cell functions such as sustaining oocyte growth. Producing GLCs through protocols such as this one is a first step toward designing large-scale ovarian endocrinology assays and developing personalized cell-based fertility and hormone restoration technologies in the future. This rapid protocol produced cells that express steroidogenic enzyme genes etoc blurb. Kubo and colleagues present a 5-day rapid protocol to generate immature granulosa-like cells from hiPSCs. Cells differentiated with inhibition of DKK1, a WNT signaling target gene, expressed gonadal ridge markers and FOXL2 transcripts and protein. Additionally, steroidogenic enzyme genes were expressed. A small population of differentiated cells were identified as expressing early-stage granulosa cell genes by single-cell RNA-seq.

Female↗
PubMedDate not supplied

Is a new tuberculosis vaccine necessary and feasible? A Cuban opinion.

Mycobacterium tuberculosis kills more human beings worldwide than any other pathogen. An estimated two billion people are already infected with the bacterium. In 2006, tuberculosis (TB) will kill nearly one million more people than in 1992. In Cuba, TB is not a serious health problem any more and we are striving to eliminate it in the near future. The most widely applied human vaccine in the world is BCG. It is also a safe vaccine except when it is applied to immunocompromised persons. Its protective efficacy is a controversial topic. In spite of this, more than 80 years of experience with this vaccine has demonstrated that BCG is effective, at least in significantly preventing childhood TB, including the meningeal and disseminated forms of the disease, but does not protect against the predominant pulmonary form of the disease in adults, which means that our best TB vaccine now is inadequate; we therefore need a new vaccine. The following facts, apart from the experience with BCG, support discussion about the feasibility of a new and better TB vaccine: Less than 10% of the 2 billion TB infected persons develop active disease. It has been demonstrated that HIV + TB co-infection increases 30 times the risk of contracting active TB and it increases the risk of being killed by the bacterium. Some new vaccine candidates, now under development and evaluation, are showing promising results in preclinical studies, and a few of them have entered clinical trials. There seems to be a consensus that a new TB vaccine will be feasible, but some challenging issues must be positively solved, such as, the lack of universally accepted correlates for protection, improved diagnostics, and final vaccine efficacy evaluation conducted on large phase III clinical trials in underdeveloped countries. The ethical, economical, organizational and scientific questions involved in this global task are enormous, but feasible.

AIDS-Related Opportunistic Infections↗
PubMed2006

Human outbreak of trichinellosis in the Mediterranean island of Sardinia, Italy.

Trichinella sp. infection has been documented in both humans and animals in most Mediterranean countries, yet in the past 60 years no infections have been reported on the Mediterranean islands. We describe the first outbreak of Trichinella sp. infection to have been reported on the island of Sardinia. The outbreak occurred in two villages in 2005 and involved 11 persons who had eaten raw sausages made from the same free-ranging sow. All 11 persons developed signs and symptoms of trichinellosis and seroconverted within 48 days of consuming the infected meat. The etiological agent was Trichinella britovi. Sardinia, like all Mediterranean islands, had been considered to be Trichinella-free. The present report, together with a recent report of T. britovi infection in animals on the nearby island of Corsica (France), raises questions as to the validity of the concept of Trichinella-free areas or regions.

Animals↗