Assessing perceived need for mental health care in a community survey: development of the Perceived Need for Care Questionnaire (PNCQ)

Background: The Perceived Need for Care Questionnaire (PNCQ) was designed for the Australian National Survey of Mental Health and Wellbeing. The PNCQ complemented collection of data on diagnosis and disability with the survey participants' perceptions of their needs for mental health care and the meeting of those needs. The four-stage design of the PNCQ mimics a conversational exploration of the topic of perceived needs. Five categories of perceived need are each assigned to one of four levels of perceived need (no need, unmet need, partially met need and met need). For unmet need and partially met need, information on barriers to care is collected, Methods: Inter-rater reliabilities of perceived needs assessed by the PNCQ were examined in a study of 145 anxiety clinic attenders. Construct validity of these items was tested, using a multi-trait multi-method approach and hypotheses regarding extreme groups, in a study with a sample of 51 general practice and community psychiatric service patients. Results: The instrument is brief to administer and has proved feasible for use in various settings. Inter-rater reliabilities for major categories, measured by the kappa statistic, exceeded 0.60 in most cases; for the summary category of all perceived needs, inter-rater reliability was 0.62. The multi-trait multi-method approach lent support to the construct validity of the instrument, as did findings in extreme groups. Conclusions: The PNCQ shows acceptable feasibility, reliability and validity, adding to the range of assessment tools available for epidemiological and health services research.

The role of impulsivity in the development of substance use and eating disorders

Impulsivity is now widely viewed as a multidimensional construct consisting of a number of related dimensions. Although many measures of impulsivity are correlated, most recent factor analyses support at least a two-factor model. In the current paper, these two factors have been labelled reward sensitivity, reflecting one of the primary dimensions of Gray's personality theory, and rash-spontaneous impulsiveness. The evidence supporting the existence of two dimensions of impulsivity is reviewed in relation to substance misuse and binge eating. (C) 2004 Elsevier Ltd. All rights reserved.

Development and characterisation of recombinant hepatitis delta virus-like particles

Injection of particulate hepatitis B virus surface antigen (HBsAg) in mice leads to the induction of a HBsAg-specific class-I-restricted cytotoxic T lymphocyte (CTL) response. It is proposed that any protein internal to HBsAg will also be able to elicit a specific CTL response. In this study, several carboxy-terminal truncations of hepatitis C virus (HCV) core protein were fused to varying lengths of amino-terminal truncated large hepatitis delta antigen (L-HDAg). These constructs were analysed for their ability to be expressed and the particles secreted in the presence of HBsAg after transfection into HuH-7 cells. The secretion efficiency of the various HCV core-HDAg chimeric proteins was generally poor. Constructs containing full length HDAg appeared to be more stable than truncated versions and the length of the inserted protein was restricted to around 40 amino acids. Thus, the use of L-HDAg as a chimera to package foreign proteins is limited. Consequently, a polyepitope (polytope) containing a B-cell epitope from human papillomavirus (HPV 16) and multiple T-cell epitopes from the HCV polyprotein was used to create the construct, L-HDAg-polyB. This chimeric protein was shown to be reliant on the co-expression of HBsAg for secretion into the cell culture fluid and was secreted more efficiently than the previous HCV core-HDAg constructs. These L-HDAg-polyB virus-like particles (VLPs) had a buoyant density of similar to 1.2 g/cm(3) in caesium chloride and similar to 1.15 g/cm(3) in sucrose. The VLPs were also immunoprecipitated using an anti-HBs but not an anti-HD antibody. Thus, these recombinant VLPs have similar biophysical properties to L-HDAg VLPs.

Development of a measure of coping with multiple sclerosis caregiving

Development of a self-report measure of coping specific to multiple sclerosis (MS) caregiving is needed to advance our understanding of the role of coping in adaptation to caring for a person with MS and to contribute to a lack of empirical data on MS caregiving. A total of 213 MS caregivers and their care recipients completed a Coping with MS Caregiving Inventory (CMSCI) and measures of adjustment (psychological distress), appraisal and illness. A subsample (n = 64) also completed the Ways of Coping Checklist (WCC) and additional adjustment measures (depression, caregiving impact. dyadic adjustment, and relationship conflict and reciprocity). Factor analyses revealed 5 factors: Supportive Engagement, Criticism and Coercion, Practical Assistance, Avoidance, and Positive Reframing. Subscales had internal reliabilities comparable to similar scales and were empirically distinct. Preliminary construct validation data are consistent with recent MS caregiving research that links passive avoidant emotion-focused coping with poorer adjustment, and relationship-focused coping caregiving research that links greater reliance on positive relationship-focused coping and less reliance on criticism with better adjustment. Results extend this research by revealing new relations between coping and adaptation to MS caregiving. Convergent validation data suggest that although the inventory differs from the WCC, it does share certain conceptual similarities with this scale.

Development of the HIV/AIDS stress scale

Development of a self-report measure of stress specific to HIV/AIDS is needed to advance our understanding of the role of stress in adaptation to HIV/AIDS: hence, the aim of this study was the development of the HIV/AIDS Stress Scale. A total of 132 homosexual/bisexual men with HIV/AIDS v ere interviewed and completed the HIV/AIDS Stress Scale and measures of coping strategies, appraisal, social support and adjustment (global distress, depression, social adjustment, number of HIV symptoms, and subjective health status) at three time points. Thirty-nine primary caregivers were interviewed and completed measures of stress and adjustment. Exploratory factor analyses of the HIV/AIDS Stress Scale items revealed three factors: Social, Instrumental and Emotional/Existential Stress. Factors had adequate internal reliabilities and were stable over 12 months. Construct validation data are consistent with recent stress/coping research that links higher levels of stress with more HIV symptoms. reliance on emotion-focused coping, lower social support, poorer levels of adjustment and higher levels of caregiver stress. Results extend this research by revealing new differential relations between various stress dimensions and stress/coping variables. Convergent validation data suggest that the HIV/AIDS Stress Scale shares conceptual similarity with threat appraisal. and differs from control liability and challenge appraisals. The HIV/AIDS Stress Scale shows potential for the elucidation of the role of stress in coping and adaptation to HIV/AIDS and disease progression in both research and clinical applications.

Explicit discrimination and health: development and psychometric properties of an assessment instrument

OBJECTIVE: To develop an instrument to assess discrimination effects on health outcomes and behaviors, capable of distinguishing harmful differential treatment effects from their interpretation as discriminatory events. METHODS: Successive versions of an instrument were developed based on a systematic review of instruments assessing racial discrimination, focus groups and review by a panel comprising seven experts. The instrument was refined using cognitive interviews and pilot-testing. The final version of the instrument was administered to 424 undergraduate college students in the city of Rio de Janeiro, Southeastern Brazil, in 2010. Structural dimensionality, two types of reliability and construct validity were analyzed. RESULTS: Exploratory factor analysis corroborated the hypothesis of the instrument's unidimensionality, and seven experts verified its face and content validity. The internal consistency was 0.8, and test-retest reliability was higher than 0.5 for 14 out of 18 items. The overall score was higher among socially disadvantaged individuals and correlated with adverse health behaviors/conditions, particularly when differential treatments were attributed to discrimination. CONCLUSIONS: These findings indicate the validity and reliability of the instrument developed. The proposed instrument enables the investigation of novel aspects of the relationship between discrimination and health.

Development and validation of a risk model for prediction of hazardous alcohol consumption in general practice attendees : the PredictAL study

Background: Little is known about the risk of progression to hazardous alcohol use in people currently drinking at safe limits. We aimed to develop a prediction model (predictAL) for the development of hazardous drinking in safe drinkers. Methods: A prospective cohort study of adult general practice attendees in six European countries and Chile followed up over 6 months. We recruited 10,045 attendees between April 2003 to February 2005. 6193 European and 2462 Chilean attendees recorded AUDIT scores below 8 in men and 5 in women at recruitment and were used in modelling risk. 38 risk factors were measured to construct a risk model for the development of hazardous drinking using stepwise logistic regression. The model was corrected for over fitting and tested in an external population. The main outcome was hazardous drinking defined by an AUDIT score >= 8 in men and >= 5 in women. Results: 69.0% of attendees were recruited, of whom 89.5% participated again after six months. The risk factors in the final predictAL model were sex, age, country, baseline AUDIT score, panic syndrome and lifetime alcohol problem. The predictAL model's average c-index across all six European countries was 0.839 (95% CI 0.805, 0.873). The Hedge's g effect size for the difference in log odds of predicted probability between safe drinkers in Europe who subsequently developed hazardous alcohol use and those who did not was 1.38 (95% CI 1.25, 1.51). External validation of the algorithm in Chilean safe drinkers resulted in a c-index of 0.781 (95% CI 0.717, 0.846) and Hedge's g of 0.68 (95% CI 0.57, 0.78). Conclusions: The predictAL risk model for development of hazardous consumption in safe drinkers compares favourably with risk algorithms for disorders in other medical settings and can be a useful first step in prevention of alcohol misuse.

The African studies course of the Instituto de Estudos Superiores Militares. An analysis of the correlations and conflictive character inside the triangle - Development, environment and security - in Africa’s Nigeria

Relatório de Estágio de Mestrado em Ciência Política e Relações Internacionais Globalização e Ambiente

Development of population-specific function assessment intrument in Lebanon

RESUMO: Contexto: O funcionamento tem sido reconhecido como um dos principais indicadores de resultados para avaliar se as pessoas beneficiam das intervenções destinadas a melhorar a sua saúde mental. O funcionamento refere-se à forma como um indivíduo consegue responder às suas tarefas e solicitações, dos seus familiares e da sua comunidade, de acordo com os requisitos do local e a cultura em que vive (eg, tarefa de cozinhar e limpar para as mulheres em algumas culturas ). O funcionamento é altamente dependente da cultura - por isso, tem sido recomendado o desenvolvimento de medidas de funcionamento específicas de cada cultura. Desenvolver localmente os instrumentos de medida evita problemas de adequação, associados com a adaptação de instrumentos ocidentais. Embora os instrumentos criados desta forma sejam específicos de um meio cultural, eles são simultaneamente "transculturais", no sentido em que cada um se refere às tarefas mais importantes para a população local . Esta abordagem mostrou-se útil para investigadores e agências de ajuda (eg, ONGs) que trabalham em países não-ocidentais . Este estudo descreve o trabalho da agência International Medical Corps (IMC) na criação e validação de um questionário de funcionamento específico nas dimensões cultura e gênero, no Líbano, destinado a avaliar eventuais melhorias em pessoas que receberam intervenções de para problemas de saúde mental, a nível dos cuidados primários de saúde. Método: O instrumento foi desenvolvido usando um método que é uma alternativa à abordagem existente de adaptação de instrumentos ocidentais a outras culturas e situações; esta abordagem é rápida e exequível, tendo já demonstrado ser útil no desenvolvimento de instrumentos válidos e fidedignos. Inicialmente, foi solicitado que as pessoas identificassem, de uma lista livre, as tarefas mais importantes para cuidar de si próprias, da sua família e da sua comunidade; as tarefas identificadas foram posteriormente usadas como base para um instrumento de avaliação de funcionamento culturalmente válido. A partir daqui, foram desenvolvidos questionários específicos da comunidade em questão, posteriormente testados no terreno nas vertentes da validade (de conteúdo, facial e de constructo) e da fiabilidade (teste-reste e inter-entrevistadores). Resultados. O estudo resultou na criação e validação de um questionário de funcionamento específico de cultura e gênero capaz de medir efectivamente a capacidade de execução de tarefas importantes do quotidiano,como parte da avaliação de resultados levada a cabo por profissionais da CSP previamente treinados na identificação, suporte e encaminhamento de pessoas com problemas de saúde mental no Líbano. Conclusão. Neste trabalho descreve-se o desenvolvimento de um questionário de funcionamento específico de cultura e gênero, orientado para a avaliação de resultados, num contexto mais lato de um sistema abrangente de avaliação e monitorização de um serviço comunitário. --------------ABSTRACT: Background. Functioning has been recognized as one of the most important key outcomes to assess whether people benefit from interventions aimed to improve their mental health. Functioning refers to how well na individual can complete the tasks and demands for themselves, their family, and their community which are required by them depending on the setting and the culture they live in (e.g. task of cooking and cleaning for women in some cultures). Functioning is highly dependent on culture. Therefore, it has been recommended to develop culture-specific measures of function. Developing instruments locally avoids the problems of limited local relevance and appropriateness associate with adapting western instruments. Although each instrument created in this way is culturally bound, they are “cross cultural” in the sense that each refers to the tasks most important to local people. This approach proves useful for both researchers and aid agencies working in non-western countries. This study describes International Medical Corps’ (IMC) work in Lebanon to create and validate a culture and gender specific functioning questionnaire to assess improvements in people who received treatment interventions for mental health problems at the primary health care (PHC) level. Method. The measure was developed using a method that is an alternative to the existing approach of adapting western function instruments to other cultures and situations; an approach which has been demonstrated as rapid, feasible and which can yield valid and reliable instruments. Function was assessed by first asking local people what tasks are important to care for themselves, their family and their community using free listing, then using these tasks as the basis for a culturally valid function assessment instrument. Community specific function questionnaires based on these tasks were then created, and field-tested for validity using content, face and construct validity methods, and also field tested for reliability using inter-rater and test retest reliability methods. Results. The study resulted in the creation and validation of a culture and gender specific functioning questionnaire that would effectively measure the ability to do tasks important to daily existence, as part of assessing client level outcomes where PHC providers were trained in the identification, management and referral of people with mental health problems in Lebanon. Conclusion. The paper describes a successful pilot for developing culture and gender specific functioning questionnaires that evaluate client level outcomes as part of a more comprehensive system for monitoring and evaluation of community based case management supports and services.

Measuring university-to-work success: development of a new scale

Purpose – The purpose of this paper is to develop a subjective multidimensional measure of early career success during university-to-work transition. Design/methodology/approach – The construct of university-to-work success (UWS) was defined in terms of intrinsic and extrinsic career outcomes, and a three-stage study was conducted to create a new scale. Findings – A preliminary set of items was developed and tested by judges. Results showed the items had good content validity. Factor analyses indicated a four-factor structure and a second-order model with subscales to assess: career insertion and satisfaction, confidence in career future, income and financial independence, and adaptation to work. Third, the authors sought to confirm the hypothesized model examining the comparative fit of the scale and two alternative models. Results showed that fits for both the first- and second-order models were acceptable. Research limitations/implications – The proposed model has sound psychometric qualities, although the validated version of the scale was not able to incorporate all constructs envisaged by the initial theoretical model. Results indicated some direction for further refinement. Practical implications – The scale could be used as a tool for self-assessment or as an outcome measure to assess the efficacy of university-to-work programs in applied settings. Originality/value – This study provides a useful single measure to assess early career success during the university-to-work transition, and might facilitate testing of causal models which could help identify factors relevant for successful transition.

Development of advanced cell/tissue culture systems, based on enhanced polymeric scaffolds and sophisticated bioreactors, for tissue engineering applications

Programa Doutoral em Engenharia Biomédica

The design and development of heat extraction technologies for the utilisation of compost thermal energy

A composting Heat Extraction Unit (HEU) was designed to utilise waste heat from decaying organic matter for a variety of heating application The aim was to construct an insulated small scale, sealed, organic matter filled container. In this vessel a process fluid within embedded pipes would absorb thermal energy from the hot compost and transport it to an external heat exchanger. Experiments were conducted on the constituent parts and the final design comprised of a 2046 litre container insulated with polyurethane foam and kingspan with two arrays of qualpex piping embedded in the compost to extract heat. The thermal energy was used in horticultural trials by heating polytunnels using a radiator system during a winter/spring period. The compost derived energy was compared with conventional and renewable energy in the form of an electric fan heater and solar panel. The compost derived energy was able to raise polytunnel temperatures to 2-3°C above the control, with the solar panel contributing no thermal energy during the winter trial and the electric heater the most efficient maintaining temperature at its preset temperature of 10°C. Plants that were cultivated as performance indicators showed no significant difference in growth rates between the heat sources. A follow on experiment conducted using special growing mats for distributing compost thermal energy directly under the plants (Radish, Cabbage, Spinach and Lettuce) displayed more successful growth patterns than those in the control. The compost HEU was also used for more traditional space heating and hot water heating applications. A test space was successfully heated over two trials with varying insulation levels. Maximum internal temperature increases of 7°C and 13°C were recorded for building U-values of 1.6 and 0.53 W/m2K respectively using the HEU. The HEU successfully heated a 60 litre hot water cylinder for 32 days with maximum water temperature increases of 36.5°C recorded. Total energy recovered from the 435 Kg of compost within the HEU during the polytunnel growth trial was 76 kWh which is 3 kWh/day for the 25 days when the HEU was activated. With a mean coefficient of performance level of 6.8 calculated for the HEU the technology is energy efficient. Therefore the compost HEU developed here could be a useful renewable energy technology particularly for small scale rural dwellers and growers with access to significant quantities of organic matter

Integration and development in schizotypy research : an introduction to the special supplement

In its fifth decade of existence, the construct of schizotypy is recapturing the early scientific interest it attracted when Paul E. Meehl (1920-2003), who coined the term, pioneered the field of schizotypy research. The International Lemanic Workshop on Schizotypy, hosted at the University of Geneva in December 2013, recently offered an opportunity to address some of the fundamental questions in contemporary schizotypy research and situate the construct in the greater scheme of future scientific projects on schizophrenia and psychological health research. What kind of knowledge has schizotypy research provided in furthering our understanding of schizophrenia? What types of questions can schizotypy research tackle, and which are the conceptual and methodological frameworks to address them? How will schizotypy research contribute to future scientific endeavors? The International Lemanic Workshop brought together leading experts in the field around the tasks of articulating the essential findings in schizotypy research, as well as providing some key insights and guidance to face scientific challenges of the future. The current supplement contains 8 position articles, 4 research articles, and 1 invited commentary that outline the state of the art in schizotypy research today

Development of a T Cell Receptor Targeting an HLA-A*0201 Restricted Epitope from the Cancer-Testis Antigen SSX2 for Adoptive Immunotherapy of Cancer.

The clinical success of adoptive immunotherapy of cancer relies on the selection of target antigens that are highly expressed in tumor cells but absent in essential normal tissues. A group of genes that encode the cancer/testis or cancer germline antigens have been proposed as ideal targets for immunotherapy due to their high expression in multiple cancer types and their restricted expression in immunoprivileged normal tissues. In the present work we report the isolation and characterization of human T cell receptors (TCRs) with specificity for synovial sarcoma X breakpoint 2 (SSX2), a cancer/testis antigen expressed in melanoma, prostate cancer, lymphoma, multiple myeloma and pancreatic cancer, among other tumors. We isolated seven HLA-A2 restricted T cell receptors from natural T cell clones derived from tumor-infiltrated lymph nodes of two SSX2-seropositive melanoma patients, and selected four TCRs for cloning into retroviral vectors. Peripheral blood lymphocytes (PBL) transduced with three of four SSX2 TCRs showed SSX241-49 (KASEKIFYV) peptide specific reactivity, tumor cell recognition and tetramer binding. One of these, TCR-5, exhibited tetramer binding in both CD4 and CD8 cells and was selected for further studies. Antigen-specific and HLA-A*0201-restricted interferon-γ release, cell lysis and lymphocyte proliferation was observed following culture of TCR engineered human PBL with relevant tumor cell lines. Codon optimization was found to increase TCR-5 expression in transduced T cells, and this construct has been selected for development of clinical grade viral vector producing cells. The tumor-specific pattern of expression of SSX2, along with the potent and selective activity of TCR-5, makes this TCR an attractive candidate for potential TCR gene therapy to treat multiple cancer histologies.

FRAX® International Task Force of the 2010 Joint International Society for Clinical Densitometry & International Osteoporosis Foundation Position Development Conference.

Osteoporosis is a serious worldwide epidemic. FRAX® is a web-based tool developed by the Sheffield WHO Collaborating Center team, that integrates clinical risk factors and femoral neck BMD and calculates the 10 year fracture probability in order to help health care professionals identify patients who need treatment. However, only 31 countries have a FRAX® calculator. In the absence of a FRAX® model for a particular country, it has been suggested to use a surrogate country for which the epidemiology of osteoporosis most closely approximates the index country. More specific recommendations for clinicians in these countries are not available. In North America, concerns have also been raised regarding the assumptions used to construct the US ethnic specific FRAX® calculators with respect to the correction factors applied to derive fracture probabilities in Blacks, Asians and Hispanics in comparison to Whites. In addition, questions were raised about calculating fracture risk in other ethnic groups e.g., Native Americans and First Canadians. The International Society for Clinical Densitometry (ISCD) in conjunction with the International Osteoporosis Foundation (IOF) assembled an international panel of experts that ultimately developed joint Official Positions of the ISCD and IOF advising clinicians regarding FRAX® usage. As part of the process, the charge of the FRAX® International Task Force was to review and synthesize data regarding geographic and race/ethnic variability in hip fractures, non-hip osteoporotic fractures, and make recommendations about the use of FRAX® in ethnic groups and countries without a FRAX® calculator. This synthesis was presented to the expert panel and constitutes the data on which the subsequent Official Positions are predicated. A summary of the International Task Force composition and charge is presented here.