Parent-adolescent relationship in youths with a chronic condition.

BACKGROUND: Suffering from a chronic disease or disability (CDD) during adolescence can be a burden for both the adolescents and their parents. The aim of the present study is to assess how living with a CDD during adolescence, the quality of parent-adolescent relationship (PAR) and the adolescent's psychosocial development interact with each other. METHODS: Using the Swiss Multicenter Adolescent Survey on Health 2002 (SMASH02) database, we compared adolescents aged 16-20 years with a CDD (n = 760) with their healthy peers (n = 6493) on sociodemographics, adolescents' general and psychosocial health, interparental relationship and PAR. RESULTS: Bivariate analyses showed that adolescents with a CDD had a poorer psychosocial health and a more difficult relationship with their parents. The log-linear model indirectly linked CDD and poor PAR through four variables: two of the adolescents' psychosocial health variables (suicide attempt and sensation seeking), the need for help regarding difficulties with parents and a highly educated mother that acted as a protective factor, allowing for a better parent-adolescent with a CDD relationship. CONCLUSION: It is essential for health professionals taking care of adolescents with a CDD to distinguish between issues in relation with the CDD from other psychosocial difficulties, in order to help these adolescents and their parents deal with them appropriately and thus maintain a healthy PAR.

Validation of a brief form of the Perceived Neighborhood Social Cohesion questionnaire.

The aim of this study was the validation of a brief form of the Perceived Neighborhood Social Cohesion questionnaire using data from 5065 men from the "Cohort Study on Substance-Use Risk Factors." A 9-item scale covering three factors was proposed. Excellent indices of internal consistency were measured (α = .93). The confirmatory factor analyses resulted in acceptable fit indices supporting measurement invariance across French and German forms. Significant correlations were found between the brief form of the Perceived Neighborhood Social Cohesion questionnaire, and satisfaction and self-reported health, providing evidence of the concurrent validity of the scale. Perceived neighborhood social cohesion, and depression and suicide attempts were negatively associated, sustaining the protective effect of perceived social cohesion.

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Sleep problems among detainees are common. Appropriate evaluation and treatment remain challenging in correctional settings. However, this is not primarily a problem of resources; rather, it is, to a great extent, an issue of adequate training. Correctional health professionals need appropriate education regarding insomnia evaluation and management. Guidelines should be based on the principle of equivalence of care and should take into account all evidence from research in the community and in correctional settings. Educational material from outside prisons exists and should be made available to detainees and health professionals (Falloon et al., 2011; Sateia & Nowell, 2004). Priority should be given to changes in prison conditions and to nonpharmacological treatment. There is no evidence-based justification to replace BZD prescriptions with antipsychotics or antidepressants. In correctional settings, prescriptions of antipsychotics and antidepressants for sleep problems can increase risk due to polypharmacy and higher suicide risks. Correctional physicians should monitor and document the evaluation and treatment practice concerning insomnia complaints to improve safe, evidence-based treatment.

Predictors of psychiatric hospitalization during 6 months of maintenance treatment with olanzapine long-acting injection: post hoc analysis of a randomized, double-blind study.

BACKGROUND: Hospitalization is a costly and distressing event associated with relapse during schizophrenia treatment. No information is available on the predictors of psychiatric hospitalization during maintenance treatment with olanzapine long-acting injection (olanzapine-LAI) or how the risk of hospitalization differs between olanzapine-LAI and oral olanzapine. This study aimed to identify the predictors of psychiatric hospitalization during maintenance treatment with olanzapine-LAI and assessed four parameters: hospitalization prevalence, incidence rate, duration, and the time to first hospitalization. Olanzapine-LAI was also compared with a sub-therapeutic dose of olanzapine-LAI and with oral olanzapine. METHODS: This was a post hoc exploratory analysis of data from a randomized, double-blind study comparing the safety and efficacy of olanzapine-LAI (pooled active depot groups: 405 mg/4 weeks, 300 mg/2 weeks, and 150 mg/2 weeks) with oral olanzapine and sub-therapeutic olanzapine-LAI (45 mg/4 weeks) during 6 months' maintenance treatment of clinically stable schizophrenia outpatients (n=1064). The four psychiatric hospitalization parameters were analyzed for each treatment group. Within the olanzapine-LAI group, patients with and without hospitalization were compared on baseline characteristics. Logistic regression and Cox's proportional hazards models were used to identify the best predictors of hospitalization. Comparisons between the treatment groups employed descriptive statistics, the Kaplan-Meier estimator and Cox's proportional hazards models. RESULTS: Psychiatric hospitalization was best predicted by suicide threats in the 12 months before baseline and by prior hospitalization. Compared with sub-therapeutic olanzapine-LAI, olanzapine-LAI was associated with a significantly lower hospitalization rate (5.2% versus 11.1%, p < 0.01), a lower mean number of hospitalizations (0.1 versus 0.2, p = 0.01), a shorter mean duration of hospitalization (1.5 days versus 2.9 days, p < 0.01), and a similar median time to first hospitalization (35 versus 60 days, p = 0.48). Olanzapine-LAI did not differ significantly from oral olanzapine on the studied hospitalization parameters. CONCLUSIONS: In clinically stable schizophrenia outpatients receiving olanzapine-LAI maintenance treatment, psychiatric hospitalization was best predicted by a history of suicide threats and prior psychiatric hospitalization. Olanzapine-LAI was associated with a significantly lower incidence of psychiatric hospitalization and shorter duration of hospitalization compared with sub-therapeutic olanzapine-LAI. Olanzapine-LAI did not differ significantly from oral olanzapine on hospitalization parameters.

El suïcidi a Catalunya : una mirada teòrica i estadística

Endinsar-se en l’estudi de les tipologies i les estadístiques de suïcidis implica posarsobre la taula una problemàtica que durant els últims anys ha estat tabú fora delsarticles científics, ja que es tenia por que parlar d’aquest tema en mitjans decomunicació podria fomentar l’aparició de més suïcidis.Aquest article pretén realitzar una mirada estadística i comparativa del suïcidi aCatalunya els darrers dos anys i a la província de Girona els darrers 10 anys. Laintenció es desvetllar certs interrogants que, per manca d’informació, no estant al’abast de molta gent, com podrien ser: Quin gènere es suïcida més, homes o dones?A quina edat o franja d’edat hi ha més suïcidis? Aquestes dades són percentualmentiguals a tot arreu?Amb aquesta finalitat, i per intentar donar resposta a aquestes qüestions realitzaremun visió objectiva, comparativa i concreta dels resultats obtinguts, tenint present queés tan sols una fotografia determinada d’una població

Adaptive Dynamics of Resource Specialization

Ecological specialization in resource utilization has various facades ranging from nutritional resources via host use of parasites or phytophagous insects to local adaptation in different habitats. Therefore, the evolution of specialization affects the evolution of most other traits, which makes it one of the core issues in the theory of evolution. Hence, the evolution of specialization has gained enormous amounts of research interest, starting already from Darwin’s Origin of species in 1859. Vast majority of the theoretical studies has, however, focused on the mathematically most simple case with well-mixed populations and equilibrium dynamics. This thesis explores the possibilities to extend the evolutionary analysis of resource usage to spatially heterogeneous metapopulation models and to models with non-equilibrium dynamics. These extensions are enabled by the recent advances in the field of adaptive dynamics, which allows for a mechanistic derivation of the invasion-fitness function based on the ecological dynamics. In the evolutionary analyses, special focus is set to the case with two substitutable renewable resources. In this case, the most striking questions are, whether a generalist species is able to coexist with the two specialist species, and can such trimorphic coexistence be attained through natural selection starting from a monomorphic population. This is shown possible both due to spatial heterogeneity and due to non-equilibrium dynamics. In addition, it is shown that chaotic dynamics may sometimes inflict evolutionary suicide or cyclic evolutionary dynamics. Moreover, the relations between various ecological parameters and evolutionary dynamics are investigated. Especially, the relation between specialization and dispersal propensity turns out to be counter-intuitively non-monotonous. This observation served as inspiration to the analysis of joint evolution of dispersal and specialization, which may provide the most natural explanation to the observed coexistence of specialist and generalist species.

The mental health of graduate students at the Federal University of São Paulo: a preliminary report

We present data regarding the care provided to graduate level health professionals at the mental health center of the Federal University of São Paulo. From September 1996 to September 2003, 146 graduate students (99 in the Master's degree program and 47 in the Doctoral program) were attended. This population was predominantly female (68.5%), with a mean (± SD) age of 28.6 ± 4.42 years, not married (71.9%). Most of the subjects were professionals who had not graduated from the Federal University (78.1%). The students who sought help for psychological and/or psychiatric problems were classified into two categories: situational-adaptive crises and psychopathological crises. The main diagnoses were depression and anxiety disorders (44%) causing 4.5% of the subjects to be temporarily suspended from their graduate studies; 19.2% reported that they had used psychotropic drugs within the previous month, and 47.9% referred to sleep disturbances. Suicidal tendencies were mentioned by 18% of those interviewed. Students with emotional disturbances and academic dysfunctions should be recognized at an early stage, and it is fundamental for them to have access to mental health programs that provide formal, structured and confidential care. Thus, it is important that professors and advisors in graduate programs build a warm and affective learning environment. If we consider the expressive growth in Brazilian scientific production resulting from the implementation of an extensive national system of graduate education, it is important to focus efforts on enhancing and upgrading the mental health care system.

Tragedian tarina. Nuoren itsemurhaan päättynyt elämä vanhemman kertomana

Tutkimuksessa tarkastellaan suomalaisnuorten itsemurhia teon inhimillisen ja sosiaalisen ulottuvuuden näkökulmasta. Tutkimustehtävänä on itsemurhan tehneen lapsen vanhempien subjektiivisten kokemusten tavoittaminen. Tarkoituksena on selvittää (1) millaisia sisältöjä ja merkityksiä nuoren elämä ja itsemurha saavat vanhempien kertomuksissa, (2) millä tavoin vanhemmat ovat ennakoineet nuoren tulevaa itsemurhaa ja millaisiksi varjelevat tekijät muodostuvat vanhempien ennakointien pohjalta sekä (3) miten auttamistyö merkityksellistyy osana ennusmerkkeihin ja varjeleviin tekijöihin liittyviä kertomuksia. Tutkimus on suunnattu edistämään itsemurhien ehkäisyä. Tutkimustyyppinä on narratiivinen laadullinen tutkimus. Pääaineistona on 14 lapsen itsemurhakuoleman kokeneen vanhemman kerronnallista haastattelua. Nuorten kuoliniän vaihteluväli on 15–31 vuotta. Täydentävä aineisto koostuu vanhempien kanssa käydyistä sähköpostikeskusteluista sekä heidän antamasta kirjallisesta lisämateriaalista, johon lukeutuu vanhempien omia muistelmia, heidän itsemurhan tehneiden lasten päiväkirjamerkintöjä ja jäähyväiskirjeitä. Analysointi on väljästi ymmärrettynä aineistolähtöinen. Analyysi perustuu narratiivisuuden ja sisällönanalyysin suomiin mahdollisuuksiin tukeutuen myös elämäkerralliseen näkökulmaan. Elämä ja kuolema ovat toistensa vastakohtia ja tiloja, jotka ovat jatkuvassa vuorovaikutuksessa keskenään. Itsensä surmaamisessa merkityksellistyy tavoitteellinen toiminta, jolla on korostuneesti yhteys nuoren sosiaaliseen ympäristöön suhteineen ja tapahtumineen. Ennusmerkit, eli vanhempien jälkikäteen näkemät vihjeet ennen lapsen itsemurhaa, liittyvät useisiin samanaikaisesti tapahtuneisiin prosesseihin, joissa elämään yleisesti liittyvät osa-alueet ovat yhdistyneet toisiinsa ja sekoittuneet keskenään. Varjelevat tekijät rakentuvat ennusmerkkien kääntöpuolina eli sisältöinä, joita vanhemman näkökulmasta nuoren eläessä olisi pitänyt tapahtua. Kyse voi olla myös seikoista, joista vanhempi on jälkeenpäin pohtinut, että tämä jonkun olisi pitänyt ymmärtää tai tehdä toisin. Vanhemmat kritisoivat laajasti auttamistyötä. Kritiikki kohdistui palvelujärjestelmään ja auttamistyötä toteuttaneiden tahojen toimintaan. Vanhempien kriittinen toimijuus tekee näkyväksi yksilön ja yhteiskunnan välisen kompleksisen suhteen. Palvelujärjestelmää on kehitettävä kokemusperäisen tiedon näkökulmasta. Ammattikäytännöissä korostuu psykososiaalisen työn merkitys. Tutkimus osoittaa, että sensitiivisten aiheiden tutkiminen on tärkeää ja laadullisen kulttuurisen kontekstin huomioivain itsemurhatutkimuksen tarve on suuri.

The polymorphism of the serotonin-2A receptor T102C is associated with age

Epidemiological investigations suggest that T102C polymorphism of gene 5-HT2A may be associated with mean life span because diseases and behaviors related to this polymorphism, such as schizophrenia, suicide, aggression, and addiction, may potentially shorten mean life span. A sample of 687 individuals without previous neuropsychiatric disease was genotyped and separated into 3 groups according to their gender and age: 14-45 years old, 46-64 years old and 65-100 years old. Molecular genotyping was performed using the technique of polymerase chain reaction followed by restriction fragment length polymorphism using HpaII restriction enzyme. 5-HT2A genotype frequencies were: TT = 21.5% (148), CC = 16.6% (114) and TC = 61.9% (425) and allele frequencies were T = 52.5% and C = 46.5%. Significant differences were found between mean age of the TT genotype carriers (60.27 ± 12.60 years) and TC genotype carriers (56.80 ± 13.18 years) of T102C polymorphism of gene 5-HT2A (P = 0.026) as well as the age groups (P = 0.012). Carriers of genotype TT were older than the other two genotypes, whereas carriers of genotype CC had an intermediate age compared with TT and CC subjects. The present results demonstrate an association between T102C polymorphism of gene 5-HT2A and age. Our results suggest that T102C polymorphism of gene 5-HT2A is associated with mean life span, and thus this gene becomes a possible candidate for the group of adaptive genes to meat consumption proposed in the literature. Further studies should be conducted in order to elucidate this association.

Plasticity of neutrophils reveals modulatory capacity

Neutrophils are widely known as proinflammatory cells associated with tissue damage and for their early arrival at sites of infection, where they exert their phagocytic activity, release their granule contents, and subsequently die. However, this view has been challenged by emerging evidence that neutrophils have other activities and are not so short-lived. Following activation, neutrophil effector functions include production and release of granule contents, reactive oxygen species (ROS), and neutrophil extracellular traps (NETs). Neutrophils have also been shown to produce a wide range of cytokines that have pro- or anti-inflammatory activity, adding a modulatory role for this cell, previously known as a suicide effector. The presence of cytokines almost always implies intercellular modulation, potentially unmasking interactions of neutrophils with other immune cells. In fact, neutrophils have been found to help B cells and to modulate dendritic cell (DC), macrophage, and T-cell activities. In this review, we describe some ways in which neutrophils influence the inflammatory environment in infection, cancer, and autoimmunity, regulating both innate and adaptive immune responses. These cells can switch phenotypes and exert functions beyond cytotoxicity against invading pathogens, extending the view of neutrophils beyond suicide effectors to include functions as regulatory and suppressor cells.

Randomized controlled trials of serotonin-norepinephrine reuptake inhibitor in treating major depressive disorder in children and adolescents: a meta-analysis of efficacy and acceptability

New generation antidepressant therapies, including serotonin-norepinephrine reuptake inhibitor (SNRIs), were introduced in the late 1980s; however, few comprehensive studies have compared the benefits and risks of various contemporary treatments for major depressive disorder (MDD) in young patients. A comprehensive literature search of PubMed, Cochrane, Embase, Web of Science, and PsycINFO databases was conducted from 1970 to January 2015. Only clinical trials that randomly assigned one SNRI or placebo to patients aged 7 to 18 years who met the diagnostic criteria for major depressive disorder were included. Treatment success, dropout rate, and suicidal ideation/attempt outcomes were measured. Primary efficacy was determined by pooling the risk ratios (RRs) of treatment response and remission. Acceptability was determined by pooling the RRs of dropouts for all reasons and for adverse effects as well as suicide-risk outcomes. Five trials with a total of 973 patients were included. SNRIs were not significantly more effective than placebo for treatment response but were for remission. The comparison of patients taking SNRIs that dropped out for all reasons and those taking placebo did not reach statistical significance. Significantly more patients taking SNRIs dropped out for adverse effects than those taking placebo. No significant difference was found in suicide-related risk outcomes. SNRI therapy does not display a superior efficacy and is not better tolerated compared to placebo in these young patients. However, duloxetine has a potential beneficial effect for depression in young populations, showing a need for further research.

Desesperança, ideação suicida e depressão em pacientes renais crônicos em tratamento por hemodiálise ou transplante

Introdução: Sintomas de desesperança, ideação suicida e depressão influenciam na qualidade e expectativa de vida de doentes renais crônicos. Objetivo: Avaliar se existe diferença nos sintomas de desesperança, ideação suicida e depressão entre pacientes renais crônicos em hemodiálise ou transplantados. Analisamos também se variáveis sociodemográficas como atividade laboral, ter dependentes, sexo e estado civil interferem nesses sintomas. Métodos: Estudo comparativo, de corte transversal, em que 50 pacientes em hemodiálise crônica e 50 transplantados renais, clinicamente estáveis, sem psicopatologias, pareados por sexo e idade, foram selecionados aleatoriamente. Instrumentos -Beck Hopelessness Scale (BHS), Beck Scale for Suicide Ideation (BSI) e Beck Depression Inventory (BDI). Resultados: BHS: 2% de cada grupo tiveram escore > 8 (p = 1,00). BSI: 4% em hemodiálise e 6% dos transplantados tinham escore > 1 (p = 1,00). BDI: 20% em hemodiálise e 12% dos transplantados apresentaram escore > 14 (p = 0,275). Não houve relação entre as variáveis testadas e os sintomas de desesperança e ideação suicida. Não exercer atividade laboral implicou mais sintomas depressivos (escore médio BDI: 10,5 vs. 7,3, p = 0,027). Transplantados de doadores falecidos apresentaram mais sintomas depressivos comparados aos receptores de doadores vivos (escore médio BDI: 11,0 vs. 6,7, p = 0,042). Conclusão: Não houve diferença na intensidade dos sintomas de desesperança, ideação suicida e depressão entre pacientes estáveis em hemodiálise e transplantados. Não exercer atividade laboral e receber transplante de doador falecido levou a mais sintomas depressivos. A prevalência de ideação suicida e sintomas depressivos, nas duas modalidades, merece atenção e indica a necessidade de monitorização e cuidados nesses pacientes.

Phylogenetic Analysis of Avidins and Expression of Novel Avidins from Lactrodectus hesperus and Hoeflea phototrophica

Avidins (Avds) are homotetrameric or homodimeric glycoproteins with typically less than 130 amino acid residues per monomer. They form a highly stable, non-covalent complex with biotin (vitamin H) with Kd = 10-15 M (for chicken Avd). The best-studied Avds are the chicken Avd from Gallus gallus and streptavidin from Streptomyces avidinii, although other Avd studies have also included Avds from various origins, e.g., from frogs, fishes, mushrooms and from many different bacteria. Several engineered Avds have been reported as well, e.g., dual-chain Avds (dcAvds) and single-chain Avds (scAvds), circular permutants with up to four simultaneously modifiable ligand-binding sites. These engineered Avds along with the many native Avds have potential to be used in various nanobiotechnological applications. In this study, we made a structure-based alignment representing all currently available sequences of Avds and studied the evolutionary relationship of Avds using phylogenetic analysis. First, we created an initial multiple sequence alignment of Avds using 42 closely related sequences, guided by the known Avd crystal structures. Next, we searched for non-redundant Avd sequences from various online databases, including National Centre for Biotechnology Information and the Universal Protein Resource; the identified sequences were added to the initial alignment to expand it to a final alignment of 242 Avd sequences. The MEGA software package was used to create distance matrices and a phylogenetic tree. Bootstrap reproducibility of the tree was poor at multiple nodes and may reflect on several possible issues with the data: the sequence length compared is relatively short and, whereas some positions are highly conserved and functional, others can vary without impinging on the structure or the function, so there are few informative sites; it may be that periods of rapid duplication have led to paralogs and that the differences among them are within the error limit of the data; and there may be other yet unknown reasons. Principle component analysis applied to alternative distance data did segregate the major groups, and success is likely due to the multivariate consideration of all the information. Furthermore, based on our extensive alignment and phylogenetic analysis, we expressed two novel Avds, lacavidin from Lactrodectus Hesperus, a western black widow spider, and hoefavidin from Hoeflea phototrophica, an aerobic marine bacterium, the ultimate aim being to determine their X-ray structures. These Avds were selected because of their unique sequences: lacavidin has an N-terminal Avd-like domain but a long C-terminal overhang, whereas hoefavidin was thought to be a dimeric Avd. Both these Avds could be used as novel scaffolds in biotechnological applications.

Monitieteisiä näköaloja itsemurhaan

Kirjallisuusarvostelu

Aerial view of the Hutton Sports Center, Chapman College, Orange, California

Aerial view of the Hutton Sports Center, 219 E. Sycamore Street, Chapman College, Orange, California. The Harold Hutton Sports Center, completed in 1978, is named in honor of this former trustee, and made possible by a gift from his widow, Betty Hutton Williams. Renovated in the mid-1990s.