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Medical-legal partnerships connect legal advocates to healthcare providers and settings. Maintaining effectiveness of medical-legal partnerships and consistently identifying opportunities for innovation and adaptation takes intentionality and effort. In this paper, we discuss ways in which our use of data and quality improvement methods have facilitated advocacy at both patient (client) and population levels as we collectively pursue better, more equitable outcomes.
Immune dysfunction is thought to be animportant pathway underlying the association of childhood traumatic events withearly-onset of bipolar disorder (BD). The study of gene-environmentinteractions are important to better understand the genetics of resilience orsusceptibility to this severe subform of BD. We thus explored the potentialinteraction of genetic variants of TLR2 and TLR4, major triggers of inflammatoryresponses in presence of pathogens, and the presence of childhood trauma on theage at onset of BD.
TLR2 and TLR4 risk genotype carrier state and history of childhood emotional, physical and sexual abuses were analyzed in relation to age at onset of BD in531 BD patients genotyped for TLR2 rs4696480and rs3804099 and TLR4 rs1927914 and rs11536891, 329 of which completed the Childhood TraumaQuestionnaire.
We report a combined effect of TLR2 rs3804099TT genotype and reported sexual abuse on determining an earlier age at onset of BD by means of a Kaplan-Meier survival curve (p= 0.02). Regression analysis was non-significant for the TLR2-CTQ sexual abuse interaction term.
The pathological effect of childhood adversity may be of greater importance in patients with an immuno-genetic susceptibility background. Further exploration of clinical characteristics of severity and immune phenotypes in BD may allow the development of innovative therapeutic interventions.
Peer relationships play a critical role in the development of adolescents, not only for the acquisition of social skills but also for the sense of personal identity and competence. Thus the quality of peer relationships influences actual and future mental health of the adolescent.
Objectives
SEYLE (Saving and Empowering Young Lives in Europe) is a randomized controlled trial, funded by the EU, evaluating interventions for mental health promotion and suicide prevention. The study comprised 12,395 high-school students from 11 European countries.
Aims
We investigated the differences on psychological problems between students with poor and good peer relationships.
Methods
1,195 adolescents (mean age 15.3 ± 0.6; 68% females) from the Molise region constituted the Italian sample. Adolescents were identified as with poor peer relationships if they never or just sometimes get along with people of their age, feel that peers like having them in the group and feel that peers were kind and helpful. Psychometric measures were used to assess mental health problems such as depression (Beck Depression Inventory II), anxiety (Zung Self-Assessment Anxiety Scale), well-being (WHO-5) and suicidal ideation (Paykel Suicide Scale).
Results
Adolescents who reported poor peer relationships scored significantly higher (p < .005) on the scales assessing depression, anxiety and suicidal ideation and significantly lower (p < .001) on the WHO-5.
Conclusions
Particularly in adolescence peer relationships may influence psychological well-being and vice versa mental health influences the openness to the others. So promoting mental health and contemporary improve social skills could lead adolescents to a better life.
Truancy is a serious public health problem that affects adolescents from all countries around the world. It negatively affects almost every aspect in the life, including physical, mental health, social and economical conditions. Young who are habitual truants are more likely to engage in at-risk behaviour like suicidal behaviours.
Objectives:
This analysis investigated the prevalence of truancy and suicidal behaviours in the Italian sample.
Aims:
to reduce truancy among European adolescents improving mental health in European high schools.
Methods:
the WE- STAY intervention carried out in 6 different European Countries. In Italy a sample of 2265 High school students (mean age 15.6±0,6; 64,4% females) was selected. Baseline evaluation of students' lifestyle, coping styles, at-risk truancy, suicidal behaviour and mental health issues was collected using a structured questionnaire.
Results:
6% has been absent from school for 7 days or more without a valid excuse during the past year (6.6% male); 20,3% as considered as truant student (three or more skipped days per month without a valid excuse in the past year). 4,6% have seriously considered taking own life during past 2 weeks have thought about suicide, and 1,2% tried to take own life in past 2 weeks. The analysis showed as correlation between skipped school and suicidal behaviour (p < .001)
Conclusions:
Teens engaging in risk behaviours are at increased odds of depression, suicidal ideation, and suicide attempts (Hallfors et al. 2004). The preliminary We-Stay data confirm the prevalence of at-risk behaviours is higher among truant students.
Truancy negatively affects almost every aspect in the life, including physical, mental health, social and economical conditions.
Objectives
To implement and evaluate outcomes of three different kinds of intervention against truancy. A mechanistic intervention to stop truancy will be used as control.
Aims
To reduce truancy among European adolescents improving mental health in European high schools.
Methods
The WE- STAY intervention carried out in 6 different European Countries. In Italy a sample of 2265 High school students (mean age 15.6 ± 0,6; 64,4% females) was selected. The students were randomized into one of four different intervention arms. Baseline evaluation of students' lifestyle, coping styles, at-risk truancy, self-harm behaviours and mental health issues was collected using a structured questionnaire.
Results
6% has been absent from school for 7 days or more without a valid excuse during the past year. 55,0% of the sample has smoked cigarettes; 7,2% drank alcohol 4 or more time during the week (13,9% male and 3,4% female). About the use of drugs, 17,4% of them used drugs at least once in a lifetime. 16% of the students started a fight at least once in a lifetime.
Conclusions
Truancy is often related to mental health problems and at-risk behaviours. The truancy has been the focus of a different policy initiatives, often ended in failure. Through the implementation of WE-STAY is possible to acquire more data on truancy prevalence and its correlated psycho-social and psychiatric aspects, as well as information on school and parents attitudes toward this phenomenon.
According to previous studies the prevalence of adolescent depression is 4–8% both in the USA and Europe. the aim of the current study was to investigate the prevalence of adolescent depression separately in several European countries.
Method:
Data were drawn from the Saving and Empowering Young Lives in Europe (SEYLE) study, which included 11 countries (Austria, Estonia, France, Germany, Hungary, Ireland, Italy, Israel, Romania, Slovenia and Spain) and Sweden served as the coordinating centre. Depression was measured by the Beck Depression Inventory-II (BDI-II). Adolescents with a score of 20 or greater on the BDI-II were defined as depressed. Multiple imputations were conducted to address missing data.
Results:
Out of 14,115 students who consented to participate, finally 12,395 adolescents (5,568 (44.92%) boys and 6,827 (55.08%) girls) were enrolled into the study. the mean age of the students was 14.81 years (SD = .83). Significant differences were detected in the ratio of non-depressed and depressed adolescents among countries (χ2(20) = 385.352 p = .000). the prevalence of depressed adolescents ranged from 7.1% to 19.4%. the prevalence of depressed adolescents according to country in increasing order is: Hungary: 7.1%, Austria: 7.6%, Romania: 7.6%, Estonia: 7.9%, Ireland: 8.5%, Spain: 8.6%, Italy: 9.2%, Slovenia: 11.4%, Germany: 12.9%, France: 15.4%, Israel: 19.4%.
Conclusion:
Based on a screening tool our data underlines the importance of taking account country specific prevalence rates of adolescent depression.
Immune dysfunction is thought to play a critical role in the pathophysiology of bipolar disorder (BD). Better insight into the genetic control of innate immune responses is of importance due to possible interactions with environmental risk factors such as infectious agents, particularly early in life.
Objectives:
Given the importance of Toll-like receptors (TLRs) in innate immunity, we analysed the association of selected genetic variants of TLR-2 and TLR-4, both major sensors of pathogenic infectious and non-infectious structures, with BD.
Aims:
Explore possible implications of the innate arm of the immune response in BD.
Methods:
Genomic DNAs from 572 BD patients and 202 controls were analyzed for the distribution of polymorphisms on the TLR-2 and TLR-4 loci using TaqMan®. Associations were examined using Chi-square test.
Results:
We found that TLR-4 rs1927914 AA and rs11536891 TT genotypes were more frequent in BD patients than in controls (corrected p; pc = .02 and .02 respectively) particularly in early-onset BD (EOBD) patients (pc = .004 and .006) born during the summer season (pc = 02 and .002 respectively). We also found that TLR-2 rs3804099 TT and rs4696480 TT genotypes were significantly more prevalent in EOBD group as compared to the late-onset BD (LOBD) subset, the latter only after excluding patients with positive family history of psychiatric disorders (pc=0.024 and 0.002 respectively).
Conclusions:
We report an association between BD and TLR-2 and TLR-4 genetic variants suggesting an important role for pathogens in disease development.
Drawing on a landscape analysis of existing data-sharing initiatives, in-depth interviews with expert stakeholders, and public deliberations with community advisory panels across the U.S., we describe features of the evolving medical information commons (MIC). We identify participant-centricity and trustworthiness as the most important features of an MIC and discuss the implications for those seeking to create a sustainable, useful, and widely available collection of linked resources for research and other purposes.
Our understanding of the complex relationship between schizophrenia symptomatology and etiological factors can be improved by studying brain-based correlates of schizophrenia. Research showed that impairments in value processing and executive functioning, which have been associated with prefrontal brain areas [particularly the medial orbitofrontal cortex (MOFC)], are linked to negative symptoms. Here we tested the hypothesis that MOFC thickness is associated with negative symptom severity.
Methods
This study included 1985 individuals with schizophrenia from 17 research groups around the world contributing to the ENIGMA Schizophrenia Working Group. Cortical thickness values were obtained from T1-weighted structural brain scans using FreeSurfer. A meta-analysis across sites was conducted over effect sizes from a model predicting cortical thickness by negative symptom score (harmonized Scale for the Assessment of Negative Symptoms or Positive and Negative Syndrome Scale scores).
Results
Meta-analytical results showed that left, but not right, MOFC thickness was significantly associated with negative symptom severity (βstd = −0.075; p = 0.019) after accounting for age, gender, and site. This effect remained significant (p = 0.036) in a model including overall illness severity. Covarying for duration of illness, age of onset, antipsychotic medication or handedness weakened the association of negative symptoms with left MOFC thickness. As part of a secondary analysis including 10 other prefrontal regions further associations in the left lateral orbitofrontal gyrus and pars opercularis emerged.
Conclusions
Using an unusually large cohort and a meta-analytical approach, our findings point towards a link between prefrontal thinning and negative symptom severity in schizophrenia. This finding provides further insight into the relationship between structural brain abnormalities and negative symptoms in schizophrenia.
Africa is experiencing a rapid increase in adult obesity and associated cardiometabolic diseases (CMDs). The H3Africa AWI-Gen Collaborative Centre was established to examine genomic and environmental factors that influence body composition, body fat distribution and CMD risk, with the aim to provide insights towards effective treatment and intervention strategies. It provides a research platform of over 10 500 participants, 40–60 years old, from Burkina Faso, Ghana, Kenya and South Africa. Following a process that involved community engagement, training of project staff and participant informed consent, participants were administered detailed questionnaires, anthropometric measurements were taken and biospecimens collected. This generated a wealth of demographic, health history, environmental, behavioural and biomarker data. The H3Africa SNP array will be used for genome-wide association studies. AWI-Gen is building capacity to perform large epidemiological, genomic and epigenomic studies across several African counties and strives to become a valuable resource for research collaborations in Africa.
Nanomedicine is yielding new and improved treatments and diagnostics for a range of diseases and disorders. Nanomedicine applications incorporate materials and components with nanoscale dimensions (often defined as 1-100 nm, but sometimes defined to include dimensions up to 1000 nm, as discussed further below) where novel physiochemical properties emerge as a result of size-dependent phenomena and high surface-to-mass ratio. Nanotherapeutics and in vivo nanodiagnostics are a subset of nanomedicine products that enter the human body. These include drugs, biological products (biologics), implantable medical devices, and combination products that are designed to function in the body in ways unachievable at larger scales. Nanotherapeutics and in vivo nanodiagnostics incorporate materials that are engineered at the nanoscale to express novel properties that are medicinally useful. These nanomedicine applications can also contain nanomaterials that are biologically active, producing interactions that depend on biological triggers. Examples include nanoscale formulations of insoluble drugs to improve bioavailability and pharmacokinetics, drugs encapsulated in hollow nanoparticles with the ability to target and cross cellular and tissue membranes (including the bloodbrain barrier) and to release their payload at a specific time or location, imaging agents that demonstrate novel optical properties to aid in locating micrometastases, and antimicrobial and drug-eluting components or coatings of implantable medical devices such as stents.
Although auditory verbal hallucinations (AVH) are a core symptom of schizophrenia, they also occur in non-psychotic individuals, in the absence of other psychotic, affective, cognitive and negative symptoms. AVH have been hypothesized to result from deviant integration of inferior frontal, parahippocampal and superior temporal brain areas. However, a direct link between dysfunctional connectivity and AVH has not yet been established. To determine whether hallucinations are indeed related to aberrant connectivity, AVH should be studied in isolation, for example in non-psychotic individuals with AVH.
Method
Resting-state connectivity was investigated in 25 non-psychotic subjects with AVH and 25 matched control subjects using seed regression analysis with the (1) left and (2) right inferior frontal, (3) left and (4) right superior temporal and (5) left parahippocampal areas as the seed regions. To correct for cardiorespiratory (CR) pulsatility rhythms in the functional magnetic resonance imaging (fMRI) data, heartbeat and respiration were monitored during scanning and the fMRI data were corrected for these rhythms using the image-based method for retrospective correction of physiological motion effects RETROICOR.
Results
In comparison with the control group, non-psychotic individuals with AVH showed increased connectivity between the left and the right superior temporal regions and also between the left parahippocampal region and the left inferior frontal gyrus. Moreover, this group did not show a negative correlation between the left superior temporal region and the right inferior frontal region, as was observed in the healthy control group.
Conclusions
Aberrant connectivity of frontal, parahippocampal and superior temporal brain areas can be specifically related to the predisposition to hallucinate in the auditory domain.
There is likely to be widespread agreement with much of the FDA’s rationale for approving BiDil (a combination of hydralazine hydrochloride and isosorbide dinitrate; H-I) as a treatment for heart failure. In particular, most would agree that the evidence of effectiveness provided by the African American Heart Failure Trial (A-HeFT) is compelling. Likewise, few health scientists would believe that it is either necessary or responsible to withhold therapies such as BiDil from those who might benefit until there is a full understanding of how they work. And although there is substantial concern that biomedical differences between racial groups are routinely misinterpreted as evidence of innate genetic differences (hence Jonathan Kahn’s call for all such claims to be supported by genetic evidence), most would concede that using race as a “descriptive” variable can help identify differences in health and access/response to treatment that might warrant further investigation or intervention.
A mono-energetic electron plasma is trapped in a one-dimensional parabolic potential well. In the undisturbed state a suitable background charge provides space-charge neutrality. It is shown that stationary disturbances of infinitesimal amplitude can exist in the plasma for certain critical values of the parameter $\Lambda \,=\,{4\bar{n}{{e}^{2}}}/{m{{\omega }^{2}}}\;\$, where $\bar{n}\$ is the mean electron density and ω/2π is the frequency of oscillation of the electrons in the well. The first few critical values are Λ = 0, 4·12, 8·2.
The boundary conditions at the end of the plasma are non-linear. As a result stationary disturbances of finite amplitude in a given mode, say the rth, require that Λ shall exceed Λr. Further it can be shown that disturbances of small amplitude in the rth mode are unstable when Λ exceeds Λr. This applies even for Λr = 0; in this case there exist nearby an unstable even and an unstable odd mode.
It seems likely that these results can be extended to all cases in which the potential well is symmetrical.
Linearized equations are derived for disturbances in an infinite plasma without an imposed magnetic field. It is shown that besides the electrostatic, or longitudinal, waves which are usually considered, there can also exist electromagnetic, or transverse, waves. The two sets of waves are generally coupled, but one can nevertheless classify the waves as either mainly longitudinal or mainly transverse. It turns out that a plasma which is stable to longitudinal waves will be unstable to transverse waves unless the velocity distribution of its particles satisfies some rather stringent conditions. In a practical case these conditions would require the distribution to be isotropic.
A dispersion relation is set up for transverse waves in a plasma with an ellipsoidal velocity distribution. It is shown that the most unstable wave has its wavenormal parallel to the shortest axis of the ellipsoid and its vector potential parallel or anti-parallel to the longest axis. The maximum possible amplification rate is then calculated. Ellipsoidal velocity distributions arise in any flow with an anisotropic pressure tensor. If the resulting instability leads to a microscopic redistribution of particle velocities, then the effective transport coefficients of the plasma are changed. In Particular it is shown that the effective viscosity is decreased, and becomes dependent on the local gradient of the macroscopic velocity.
It is shown that the interpenetration of two ionized streams is arrested, as a rule, not because of individual collisions between particles belonging to opposite streams, but because the whole system of charged particles is unstable. The smallest wavelength of an unstable oscillation is λmin where$\lambda_{min} = \surd \left(\frac {\pi m_0 U^2}{2N \epsilon^2}\right) \left(1 - \frac {U^2}{c^2} \right) ^{-\frac {3}{4}}$Here ± U are the velocities of the undisturbed streams, and N is the density of electrons in each.
A further calculation for the non-relativistic case deals with the amplification of the plasma oscillations present in two colliding streams. It is shown that these grow rapidly and that $\tau_{crit} \surd (m_0 U^2|\pi N \epsilon^2$ is the distance of interpenetration achieved before the counterstreaming of the electrons is brought to a halt. The value of τcrit depends only insensitively on the ratio of the internal plasma energy densities Tpl to the kinetic energy densities Tkin in the streams. For example, τcrit = 9·0 when Tpl:Tkin = 1:10, and τcrit = 19·0 when Tpl : Tkin = 1:105.