The effect of intensive case management on the relatives of patients with severe mental illness

Objective: Relatives play a vital role in caring for patients with severe mental illness but receive inadequate support from psychiatric services. Evidence suggests that although intensive case management is directed primarily at patients, relatives may benefit a's well. This study examined whether relatives of patients who were receiving intensive case management had more contact with mental health professionals than relatives of patients who were receiving standard case management. It also examined whether relatives of patients receiving intensive case management appraised caregiving less negatively and experienced less psychological distress than relatives of patients receiving standard case management. Methods: The sample was drawn from the pool of patients participating in the UK700 randomized controlled trial of intensive case management. Prospective data on contact between case managers and the relatives of 146 patients were collected over a two-year period. At a two-year follow-up assessment, relatives of 116 patients were. interviewed with the Experience of Caregiving Inventory and the 12-item General Health Questionnaire. Results: Considerably more relatives of patients receiving intensive case management had contact with a case manager during the study period than relatives of patients receiving standard case management (70 percent compared with 45 percent). However, relatives of patients receiving intensive case management did not-appraise caregiving less negatively or experience less psychological distress than relatives of patients who were receiving. standard case management. Conclusions: Reducing case managers' caseloads alone. will not guarantee adequate support for relatives.. Instead, providing more support will need to be an explicit aim, and staff will require specific additional training to achieve it.

Relatives of patients with severe mental disorders: unique traits and experiences of primary, nonprimary, and lone caregivers

The authors examined caregivers' characteristics and experiences. Previously suggested principles for identifying the primary caregiver in 22 multiple-caregiver families were assessed, but none reliably distinguished the primary caregiver. The authors then compared primary (n = 22), nonprimary (n = 22), and lone caregivers' (n = 43) appraisals of caregiving and psychological distress. Lone and primary caregivers' experiences were similar. but nonprimary caregivers' experiences were less adverse. Despite these findings, greater psyhcological distress in primary caregivers indicated greater psychological distress in nonprimary caregivers.

Input and output modality effects in immediate serial recall

In immediate recall tasks, visual recency is substantially enhanced when output interference is low (Cowan, Saults, Elliott, & Moreno, 2002; Craik, 1969) whereas auditory recency remains high even under conditions of high output interference. Ibis auditory advantage has been interpreted in terms of auditory resistance to output interference (e.g., Neath & Surprenant, 2003). In this study the auditory-visual difference at low output interference re-emerged when ceiling effects were accounted for, but only with spoken output. With written responding the auditory advantage remained significantly larger with high than with low output interference. These new data suggest that both superior auditory encoding and modality-specific output interference contribute to the classic auditory-visual modality effect.

Local, national and imported foods: a qualitative study

The UK government is currently attempting to encourage consumers to buy more locally produced food. It is hoped that this will provide economic, environmental and social benefits to local areas, leading to more sustainable patterns of consumption. This qualitative study looks at the views and behaviour of consumers towards local foods with a particular focus on the barriers that prevent greater uptake of local produce. In total, four focus groups (n = 33) were conducted. Content analysis identified six relevant themes in relation to local, national and imported foods. These were cost, lifestyle, food quality, consumer ethnocentrism, choice and farmers. Overall, although participants reported buying few local products currently, there was widespread enthusiasm across socio-economic groups for local foods, with participants perceiving them as being of a higher quality than imported foods. They also generally endorsed the idea of supporting local farmers and their own national economy. The main barriers preventing participants from buying more local products were price and inconvenience. The results are discussed in relation to developing future strategies for encouraging people to buy more local food products. (c) 2007 Elsevier Ltd. All rights reserved.

Forty-eight hour access to primary care: practice factors predicting patients' perceptions

Background: The government has proposed a 48-hour target for GP availability. Although many practices are moving towards delivering that goal, recent national patient surveys have reported a deterioration in patients' reports of doctor availability. What practice factors contribute to patients' perceptions of doctor availability? Method: A cross sectional patient survey (11 000 patients from 54 inner London practices, 7247 (66%) respondents) using the General Practice Assessment Survey. We asked patients how soon they could be seen in their practice following non-urgent consultation requests and related their aggregated responses to the characteristics of their practice. Results: Three factors relating to practice administration and appointments systems operation independently predicted patients' reports of doctor availability. These were the proportion of patients asked to attend the surgery and wait to be seen, the proportion of patients seen using an emergency surgery arrangement, and the extent of practice computerization. Conclusion: Some practices may have difficulty in meeting the target for GP availability. Meeting the target will involve careful review of practice administrative procedures.

Perceptions of psychological content in the GP consultation - the role of practice, personal and prescribing attributes

Objective: The aim of the present study was to determine the relationship between the characteristics of general practices and the perceptions of the psychological content of consultations by GPs in those practices. Methods: A cross-sectional survey was conducted of all GPs (22 GPs based in nine practices) serving a discrete inner city community of 41 000 residents. GPs were asked to complete a log-diary over a period of five working days, rating their perception of the psychological content of each consultation on a 4-point Likert scale, ranging from 0 (no psychological content) to 3 (entirely psychological in content). The influence of GP and practice characteristics on psychological content scores was examined. Results: Data were available for every surgery-based consultation (n = 2206) conducted by all 22 participating GPs over the study period. The mean psychological content score was 0.58 (SD 0.33). Sixty-four percent of consultations were recorded as being without any psychological content; 6% were entirely psychological in content. Higher psychological content scores were significantly associated with younger GPs, training practices (n = 3), group practices (n = 4), the presence of on-site mental health workers (n = 5), higher antidepressant prescribing volumes and the achievement of vaccine and smear targets. Training status had the greatest predictive power, explaining 51% of the variation in psychological content. Neither practice consultation rates, GP list size, annual psychiatric referral rates nor volumes of benzodiazepine prescribing were related to psychological content scores. Conclusion: Increased awareness by GPs of the psychological dimension within a consultation may be a feature of the educational environment of training practices.

Chestnut and mimosa tannin silages: Effects in sheep differ for apparent digestibility, nitrogen utilisation and losses

This paper reports effects of chestnut and mimosa tannins on N utilisation in sheep. Tannins were added to grass either at ensilage or incorporated into grass silage at feeding. The study used an 8 × 5 incomplete Latin Square design with eight mature wether sheep and five 21-day periods. Tannin additions reduced in vivo apparent digestibilities of dry matter (DM), organic matter (OM) and neutral detergent fibre (aNDFom) compared with the untreated control silage (P<0.001). Reductions ranged from 7.6% for DM to 8.5% for aNDFom. Chestnut compared to mimosa tannin silages produced higher values for DM intake (734 g/day versus 625 g/day) and in vivo digestibility for DM, OM and aNDFom (0.66, 0.68 and 0.69 versus 0.61, 0.63 and 0.62; P<0.001). A substantial shift occurred in the pattern of N excretion in sheep fed the tannin versus control silages. As a proportion of daily N intake, urinary N losses were lower (56.4 g/100 g N versus 65.1 g/100 g N intake) and faecal N losses were higher (40.2 g/100 g N versus 29.8 g/100 g N intake) for sheep fed the tannin silages compared with those fed the control grass silage (P<0.001). Nitrogen intake was higher in sheep fed the chestnut compared to mimosa tannin silages (16.2 g/day versus 13.4 g/day; P<0.001), reflecting the lower DM intake of sheep fed the mimosa silages. However, faecal N loss was lower for chestnut compared to mimosa tannin silage fed sheep (38.2 g/100 g N versus 42.1 g/100 g N intake; P<0.01), resulting in higher N retentions with the chestnut compared to the mimosa silage fed sheep (5.49 g/100 g N versus 1.38 g/100 g N intake). Faecal N losses were also higher when tannins were added during ensiling rather than at feeding (P<0.05). Although there was no overall effect of tannins on N retention in mature wether sheep, it is likely that productive ruminants with higher protein requirements would retain more N from silages containing chestnut tannins. Tannins added externally to grass silages may generate some benefits on N utilisation and environmental N excretions in sheep fed the silages.

Extracts of tropical African spices are active against Plutella xylostella

Extracts from Piper guineense, Aframomum melegueta, Aframomum citratum and Afrostyrax kamerunensis were investigated for their antifeedant, lethal and developmental effects against Plutella xylostella larvae through laboratory dual-choice tests and topical application. Water and ethanol extracts of P. guineense were dose-dependent antifeedants at concentrations ≥300 and 500 ppm, respectively, whilst methanol extracts required ≥1,000 ppm. Methanol and hexane extracts of A. melegueta acted at ≥100 ppm and water extracts at ≥300 ppm, but ethanol extracts were deterring feeding only slightly at ≥1,000 ppm. Hexane and methanol extracts of A. citratum inhibited feeding at ≥300 ppm and water extracts did so at ≥500 ppm. None of the Afrostyrax kamerunensis extracts deterred feeding at any of the concentrations tested. No mortality was observed at any of the concentrations after topical application of the extracts on the larvae. However, the effects on larval development varied with extract concentration and larval age. Ingestion of the water and ethanol extracts of P. guineense caused 100% mortality of second instars at ≥100 ppm two to three days after infestation (DAI). Methanol and water extracts of A. melegueta and A. citratum, respectively, achieved ≥80% mortality of larvae at concentrations of ≥500 ppm and ≥1,000 ppm, respectively. With third instars, the mortalities were significantly lower; however, the P. guineense water or ethanol extracts caused 100% mortality two to four DAI. Larvae that survived till pupation had significantly longer larval periods compared with the control after application of A. melegueta extracts. We concluded that potent extracts from Aframomum melegueta, Aframomum citratum and especially P. guineense could be used as complementary measures in the management of P. xylostella by subsistence farmers.

The effect of condensed tannins in fresh sainfoin (Onobrychis viciifolia) on in vivo and in situ digestion in sheep

This study focused on effects of structure, content and biological activity of condensed tannins (CT) in leaves, stems and whole plant of sainfoin (Onobrychis viciifolia) on its in vivo and in situ digestive characteristics in sheep. Sainfoin was studied as fresh forage during the first vegetation cycle at two phenological stages (i.e., end of flowering and green seeds) and during the second vegetation cycle (i.e., start of flowering). The feeding experiment used 12 sheep; with six dosed, through the rumen cannula, with polyethylene glycol (PEG) to neutralise CT effects. Organic matter digestibility (OMD), total tract N disappearance and N balance were measured in sheep fed the whole plant. The residues of dry matter (DM) and N from nylon bags suspended in the rumen were determined on leaves and stems. Intestinal digestibility was measured using other, intestinally fistulated sheep. PEG addition and vegetation cycle increased total tract N digestibility (P<0.001) but PEG affected OMD only at the end of flowering. PEG inactivated the CT and increased urinary N excretion (P<0.05) but this was offset by lower faecal N excretion (P<0.001). Feeding sainfoin can be used to alter the form of excreted N (i.e., urine vs faeces) and thus potentially reduce environmental N pollution without affecting body N retention. Kinetic studies of total N, ammonia N (NH3-N) and volatile fatty acids (VFA) in rumen fluid were made before and 1.5, 3 and 6 h after feeding. Sainfoin CT decreased rumen fluid soluble N (P<0.05) and NH3-N (P<0.01). Ruminal N disappearance (DisN) of leaves or stems was lower in the presence of active CT compared to PEG-inactivated CT (P<0.001) for both vegetation cycles. PEG also increased intestinal digestibility (P<0.05) of leaves and stems. Leaves had lower ruminal DisN, but higher N disappearing from intestine than stems. The biological activity and content of CT in the whole plant decreased as phenological stage increased. Prodelphinidin:procyanidin (PD:PC) ratios of leaves varied with vegetation cycle and phenological stage. The molecular size of CT in the whole plant, as indicated by their mean degree of polymerisation (mDP), was lowest at the start of flowering and coincided with the higher biological activity and content of CT.

In situ analysis and structural elucidation of sainfoin (Onobrychis viciifolia) tannins for high-throughput germplasm screening

A rapid thiolytic degradation and cleanup procedure was developed for analyzing tannins directly in chlorophyll-containing sainfoin (Onobrychis viciifolia) plants. The technique proved suitable for complex tannin mixtures containing catechin, epicatechin, gallocatechin, and epigallocatechin flavan-3-ol units. The reaction time was standardized at 60 min to minimize the loss of structural information as a result of epimerization and degradation of terminal flavan-3-ol units. The results were evaluated by separate analysis of extractable and unextractable tannins, which accounted for 63.6−113.7% of the in situ plant tannins. It is of note that 70% aqueous acetone extracted tannins with a lower mean degree of polymerization (mDP) than was found for tannins analyzed in situ. Extractable tannins had between 4 and 29 lower mDP values. The method was validated by comparing results from individual and mixed sample sets. The tannin composition of different sainfoin accessions covered a range of mDP values from 16 to 83, procyanidin/prodelphinidin (PC/PD) ratios from 19.2/80.8 to 45.6/54.4, and cis/trans ratios from 74.1/25.9 to 88.0/12.0. This is the first high-throughput screening method that is suitable for analyzing condensed tannin contents and structural composition directly in green plant tissue.

Binding of pentagalloyl glucose to two globular proteins occurs via multiple surface sites

The interaction between pentagalloyl glucose (PGG) and two globular proteins, bovine serum albumin (BSA) and ribulose-1,5-bisphosphate carboxylase oxygenase (rubisco), was investigated by isothermal titration calorimetry (ITC). ITC data fit to a binding model consisting of two sets of multiple binding sites, which reveal similarities in the mode of binding of PGG to BSA and rubisco. In both cases, the interaction is characterized by a high number of binding sites, which suggests that binding occurs by a surface adsorption mechanism that leads to coating of the protein surface, which promotes aggregation and precipitation of the PGG-protein complex. This model was confirmed by turbidimetry analysis of the PGG-BSA interaction. Analysis of tryptophan fluorescence quenching during the interaction of PGG with BSA suggests that binding of PGG leads to some conformational changes that are energetically closer to the unfolded state of the BSA structure, because small red shifts in the resulting emission spectra were observed.