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Background: The mental health impacts of climate change-related disasters are significant. However, access to mental health services is often limited by the availability of trained clinicians. Although building local community capability for the mental health response is often prioritised in policy settings, the lack of evidence-based programs is problematic. The aim of this study was to test the efficacy of the Skills for Life Adjustment and Resilience programme (SOLAR) delivered by trained local community members following compound disasters (drought, wildfires, pandemic-related lockdowns) in Australia.Method: Thirty-six community members were trained to deliver the SOLAR programme, a skills-based, trauma informed, psychosocial programme. Sixty-six people with anxiety, depression and/or posttraumatic stress symptoms, and impairment were randomised into the SOLAR programme or a Self-Help condition. They were assessed pre, post and two months following the interventions. The SOLAR programme was delivered across five 1-hourly sessions (either face to face or virtually). Those in the Self-Help condition received weekly emails with self-help information including links to online educational videos.Results: Multigroup analyses indicated that participants in the SOLAR condition experienced significantly lower levels of anxiety and depression, and PTSD symptom severity between pre - and post-intervention (T1 to T2), relative to the Self-Help condition, while controlling for scores at intake. These differences were not statistically different at follow-up. The SOLAR programme was associated with large effect size improvements in posttraumatic stress symptoms over time.Conclusion: The SOLAR programme was effective in improving anxiety, depression and posttraumatic stress symptoms over time. However, by follow-up the size of the effect was similar to an active self-help condition. Given the ongoing stressors in the community associated with compounding disasters it may be that booster sessions would have been useful to sustain programme impact.Trial registration: Australian New Zealand Clinical Trials Registry identifier: ACTRN12621000283875..
We tested the efficacy of a brief, skills-based psychosocial programme under randomised controlled conditions following compound disasters.The SOLAR programme was associated with improvements in anxiety, depression and posttraumatic stress symptoms across time.The SOLAR programme may benefit from booster sessions especially where there are ongoing impacts of disaster.
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Desastres , Resiliencia Psicológica , Humanos , Salud Mental , Australia , Ansiedad/terapiaRESUMEN
Background: Prolonged Exposure (PE), a trauma-focused therapy, is one of the most efficacious treatments available for PTSD. However, many people with PTSD do not lose their diagnosis following delivery of PE. The Unified Protocol (UP) for Transdiagnostic Treatment of Emotional Disorders is a non-trauma focused treatment that may offer an alternative treatment for PTSD. Methods: This paper describes the study protocol for IMPACT, an assessor-blinded randomized controlled trial that examines the non-inferiority of UP relative to PE for participants who meet DSM-5 criteria for current PTSD. One hundred and twenty adult participants with PTSD will be randomized to receive either 10 × 90-min sessions of UP or PE with a trained provider. The primary outcome is severity of PTSD symptoms assessed by the Clinician Administered PTSD Scale for DSM-5 (CAPS-5) at post-treatment. Discussion: While evidence-based treatments are available for PTSD, high levels of treatment dropout and non-response require new approaches to be tested. The UP is based on emotion regulation theory and is effective in treating anxiety and depressive disorders, however, there has been limited application to PTSD. This is the first rigorous study comparing UP to PE in a non-inferiority randomized controlled trial and may help improve clinical outcomes for those with PTSD. Trial registration: This trial was prospectively registered with the Australian New Zealand Clinical Trials Registry, Trial ID (ACTRN12619000543189).
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BACKGROUND: During early treatment of haemorrhagic shock, cerebral perfusion pressure can be restored by small-volume resuscitation with vasopressors. Whether this therapy is improved with additional fluid remains unknown. We assessed the value of terlipressin and lactated Ringer's solution (LR) on early recovery of microcirculation, tissue oxygenation, and mitochondrial and electrophysiological function in the rat cerebral cortex. METHODS: Animals treated with LR replacing three times (3LR) the volume bled (n=26), terlipressin (n=27), terlipressin plus 1LR (n=26), 2LR (n=16), or 3LR (n=15) were compared with untreated (n=36) and sham-operated rats (n=17). In vivo confocal microscopy was used to assess cortical capillary perfusion, changes in tissue oxygen concentration, and mitochondrial membrane potential and redox state. Electrophysiological function was assessed by cortical somatosensory evoked potentials, spinal cord dorsum potential, and peripheral electromyography. RESULTS: Compared with sham treatment, haemorrhagic shock reduced the mean (SD) area of perfused vessels [82% (sd 10%) vs 38% (12%); P<0.001] and impaired oxygen concentration, mitochondrial redox state [99% (4%) vs 59% (15%) of baseline; P<0.001], and somatosensory evoked potentials [97% (13%) vs 27% (19%) of baseline]. Administration of terlipressin plus 1LR or 2LR was able to recover these measures, but terlipressin plus 3LR or 3LR alone were not as effective. Spinal cord dorsum potential was preserved in all groups, but no therapy protected electromyographic function. CONCLUSIONS: Resuscitation from haemorrhagic shock using terlipressin with small-volume LR was superior to high-volume LR, with regard to cerebral microcirculation, and mitochondrial and electrophysiological functions.
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Circulación Cerebrovascular/efectos de los fármacos , Fluidoterapia/métodos , Choque Hemorrágico/terapia , Terlipresina/uso terapéutico , Vasoconstrictores/uso terapéutico , Animales , Corteza Cerebral/irrigación sanguínea , Modelos Animales de Enfermedad , Evaluación Preclínica de Medicamentos/métodos , Estimación de Kaplan-Meier , Masculino , Potencial de la Membrana Mitocondrial/efectos de los fármacos , Potencial de la Membrana Mitocondrial/fisiología , Microcirculación/efectos de los fármacos , Microscopía Confocal , Mitocondrias/metabolismo , Oxidación-Reducción , Consumo de Oxígeno/efectos de los fármacos , Distribución Aleatoria , Ratas Sprague-Dawley , Lactato de Ringer/farmacología , Lactato de Ringer/uso terapéutico , Choque Hemorrágico/fisiopatología , Terlipresina/farmacología , Vasoconstrictores/farmacologíaRESUMEN
BACKGROUND/OBJECTIVES: Adolescents have unique nutrient requirements due to rapid growth and development. High rates of obesity in adolescents require a variety of diet interventions to achieve weight loss under clinical supervision. The aim of this study is to examine the nutritional adequacy of energy-restricted diets for adolescents. SUBJECTS/METHODS: Three popular diets were modelled for 7 days and assessed by comparing the nutrient profile to the Australian Nutrient Reference Values. Three diets were: (1) a standard energy restricted diet based on current dietary guidelines; (2) a modified carbohydrate diet; and (3) a modified alternate day fasting diet. RESULTS: Initial modelling revealed limiting nutrients (that is, not meeting the recommended intakes) across the diets. Subsequent modelling was required to achieve nutritional adequacy for all three diets. The dietary guidelines diet design met most nutrient targets except essential fatty acids before subsequent modelling, however this diet also provided the highest energy (8.8 vs 8.0 MJ and 6.8 MJ for the modified carbohydrate and modified alternate day fasting diet, respectively). CONCLUSIONS: Energy-restricted diets need careful consideration to meet nutritional requirements of adolescents. A variety of eating patterns can be adapted to achieve nutritional adequacy and energy restriction, however health practitioners need to consider adequacy when prescribing diet interventions for weight loss during adolescence.
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Dieta , Dietética , Evaluación Nutricional , Necesidades Nutricionales , Obesidad/dietoterapia , Sobrepeso/dietoterapia , Adolescente , Australia , Restricción Calórica , Carbohidratos de la Dieta/administración & dosificación , Grasas de la Dieta/administración & dosificación , Fibras de la Dieta/administración & dosificación , Proteínas en la Dieta/administración & dosificación , Ayuno , Femenino , Humanos , Masculino , Micronutrientes/administración & dosificación , Política Nutricional , Pérdida de PesoRESUMEN
Live imaging of mitochondrial function is crucial to understand the important role played by these organelles in a wide range of diseases. The mitochondrial redox potential is a particularly informative measure of mitochondrial function, and can be monitored using the endogenous green fluorescence of oxidized mitochondrial flavoproteins. Here, we have observed flavoprotein fluorescence in the exposed murine cerebral cortex in vivo using confocal imaging; the mitochondrial origin of the signal was confirmed using agents known to manipulate mitochondrial redox potential. The effects of cerebral oxygenation on flavoprotein fluorescence were determined by manipulating the inspired oxygen concentration. We report that flavoprotein fluorescence is sensitive to reductions in cortical oxygenation, such that reductions in inspired oxygen resulted in loss of flavoprotein fluorescence with the exception of a preserved 'halo' of signal in periarterial regions. The findings are consistent with reports that arteries play an important role in supplying oxygen directly to tissue in the cerebral cortex, maintaining mitochondrial function.
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Corteza Cerebral/metabolismo , Flavoproteínas/análisis , Mitocondrias/fisiología , Oxígeno/metabolismo , Animales , Hipoxia de la Célula , Fluorescencia , Ratones , Ratones Endogámicos C57BLRESUMEN
High concentrations of specific catechins [epigallocatechin gallate (EGCG), epigallocatechin (EGC) and epicatechin gallate (ECG)] inhibit the proliferation of many different cancer cell lines. The aim of this work was to determine if low concentrations of catechins with and without 4-hydroxytamoxifen (4-OHT) co-treatment would cause significant cytotoxicity in estrogen receptor-positive (ERalpha+) and -negative (ERalpha-) human breast cancer cells. Therefore, MCF-7, T47D, MDA-MB-231 and HS578T cells were incubated with EGCG, EGC or ECG (5-25 microM) individually and in combination with 4-OHT for 7 days. Cell number was determined by the sulforhodamine B cell proliferation assay. As single agents, none of the catechins were cytotoxic to T47D cells, while only EGCG (20 microM) elicited cytotoxicity in MCF-7 cells. Additionally, no benefit was gained by combination treatment with 4-OHT. ERalpha- human breast cancer cells were more susceptible as all three catechins were significantly cytotoxic to HS578T cells at concentrations of 10 microM. In this cell line, combination with 4-OHT did not increase cytotoxicity. However, the most striking results were produced in MDA-MB-231 cells. In this cell line, EGCG (25 microM) produced a greater cytotoxic effect than 4-OHT (1 microM) and the combination of the two resulted in synergistic cytotoxicity. In conclusion, low concentrations of catechins are cytotoxic to ERalpha- human breast cancer cells, and the combination of EGCG and 4-OHT elicits synergistic cytotoxicity in MDA-MB-231 cells.
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Neoplasias de la Mama/tratamiento farmacológico , Neoplasias de la Mama/patología , Catequina/análogos & derivados , Catequina/toxicidad , Tamoxifeno/toxicidad , Protocolos de Quimioterapia Combinada Antineoplásica/toxicidad , Línea Celular Tumoral , Proliferación Celular/efectos de los fármacos , Relación Dosis-Respuesta a Droga , Sinergismo Farmacológico , HumanosRESUMEN
Quetiapine, a new atypical antipsychotic, was added to ongoing treatment of bipolar I outpatients (n=15) for symptoms of illness (mood lability, irritability, psychosis and/or difficulty sleeping). All evaluations were prospectively obtained, with the majority of patients (n=9) showing much or very much improvement on the Clinical Global Impression for Bipolar Disorder (CGI-BP). Somatic complaints were limited. Mean (SD) duration before changes in medication regimens was 134 (100) days. Studies of the use of quetiapine in maintenance treatment of bipolar disorder are warranted.
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Antipsicóticos/uso terapéutico , Trastorno Bipolar/tratamiento farmacológico , Dibenzotiazepinas/uso terapéutico , Antipsicóticos/efectos adversos , Dibenzotiazepinas/efectos adversos , Relación Dosis-Respuesta a Droga , Humanos , Estudios Prospectivos , Escalas de Valoración Psiquiátrica , Fumarato de Quetiapina , Resultado del TratamientoRESUMEN
Six and a half years after adoption. 6- to 12-year-old children reared in Romanian orphanages for more than 8 months in their first years of life (RO. n = 18) had higher cortisol levels over the daytime hours than did early adopted (EA, < or = 4 months of age, n = 15) and Canadian born (CB, n = 27) children. The effect was marked, with 22% of the RO children exhibiting cortisol levels averaged over the day that exceeded the mean plus 2 SD of the EA and CB levels. Furthermore, the longer beyond 8 months that the RO children remained institutionalized the higher their cortisol levels. Cortisol levels for EA children did not differ in any respect from those of CB comparison children. This latter finding reduces but does not eliminate concerns that the results could be due to prenatal effects or birth family characteristics associated with orphanage placement. Neither age at cortisol sampling nor low IQ measured earlier appeared to explain the findings. Because the conditions in Romanian orphanages at the time these children were adopted were characterized by multiple risk factors, including gross privation of basic needs and exposure to infectious agents, the factor(s) that produced the increase in cortisol production cannot be determined. Nor could we determine whether these results reflected effects on the limbic-hypothalamic-pituitary-adrenal axis directly or were mediated by differences in parent-child interactions or family stress occasion by behavioral problems associated with prolonged orphanage care in this sample.
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Adopción , Trastornos de la Conducta Infantil/psicología , Cuidados en el Hogar de Adopción/psicología , Hidrocortisona/análisis , Saliva/química , Niño , Trastornos de la Conducta Infantil/etnología , Familia/psicología , Femenino , Humanos , Sistema Hipotálamo-Hipofisario/fisiología , Institucionalización , Masculino , Sistema Hipófiso-Suprarrenal/fisiología , Rumanía/etnología , Factores de TiempoRESUMEN
BACKGROUND: Device selection has historically been supported by minimal comparative data. Since 1994, we have implanted 43 patients with the CardioWest Total Artificial Heart (CW), 23 with the Novacor Left Ventricular Assist System (N), and 26 with the Thoratec Ventricular Assist System (T). This experience provides a basis for our device selection criteria. METHODS: We reviewed retrospectively the results for survival, stroke, and infection in the CW, N, and T groups. Statistical methods included the Student's t-test, chi2 analysis, and Kaplan-Meier actuarial survival curves. RESULTS: The T group patients were younger and smaller sized than the CW or N group. The CW group had the highest mean central venous pressure (CVP) and lowest mean cardiac index. Survival to transplantation was 75% for CW, 57% for N, and 38% for T. Multiple organ failure postimplant caused most deaths in the CW and T groups. Right heart failure and stroke caused most N deaths. Linearized stroke rates (event/patient-month) were 0.03 for CW, 0.28 for N, and 0.08 for T. Serious infections were found in 20% of CW, 30% of N, and 8% of T patients, but linearized rates showed little difference and death from infection was rare. CONCLUSIONS: The N device should be used in "stable" patients with body surface area (BSA) greater than 1.7 m2 and with minimal right heart failure. Unstable patients with biventricular failure should receive a CW if the BSA is greater than 1.7 m2 or a T if they are smaller.
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Insuficiencia Cardíaca/cirugía , Trasplante de Corazón , Corazón Artificial , Cuidados Preoperatorios , Adolescente , Adulto , Anciano , Diseño de Equipo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Diseño de Prótesis , Estudios RetrospectivosRESUMEN
Tarsal tunnel intracompartment pressures were determined in 10 fresh-frozen normal human adult cadaver specimens. With the foot and ankle held in mild plantarflexion and neutral eversion-inversion, mean tarsal tunnel pressure was minimal (2 +/- 1 mmHg). However, when the foot and ankle were positioned in full eversion, mean tarsal tunnel pressure increased to 32 +/- 5 mmHg (P < or = 0.005); in full inversion, mean pressure increased to 17 +/- 5 mmHg (P < or = 0.05). There was no significant difference in mean tarsal tunnel pressure between the everted and inverted positions. These results support the hypothesis that increased pressure within the tarsal tunnel when the foot is moved into the everted or inverted position may aggravate posterior tibial nerve entrapment. These findings may also provide an explanation for clinically observed aggravation of symptoms in these positions, night pain, and improvement of symptoms with neutral immobilization in some patients with tarsal tunnel syndrome.
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Tobillo/fisiología , Pie/fisiología , Síndrome del Túnel Tarsiano/fisiopatología , Adulto , Fenómenos Biomecánicos , Cadáver , Humanos , Modelos Biológicos , Presión , Síndrome del Túnel Tarsiano/terapiaRESUMEN
Attachment and indiscriminately friendly behavior were assessed in children who had spent at least 8 months in a Romanian orphanage (RO) and two comparison groups of children: a Canadian-born, nonadopted, never institutionalized comparison group (CB) and an early adopted comparison group adopted from Romania before the age of 4 months (EA). Attachment was assessed using 2 measures: an attachment security questionnaire based on parent report, and a Separation Reunion procedure that was coded using the Preschool Assessment of Attachment. Indiscriminately friendly behavior was examined using parents' responses to 5 questions about their children's behavior with new adults. Although RO children did not score differently from either CB or EA children on the attachment security measure based on parent report, they did display significantly more insecure attachment patterns than did children in the other 2 groups. In addition, RO children displayed significantly more indiscriminately friendly behavior than both CB and EA children, who did not differ in terms of indiscriminate friendliness. RO children's insecure attachment patterns were not associated with any aspect of their institutional environment, but were related to particular child and family characteristics. Specifically, insecure RO children had more behavior problems, scored lower on the Stanford-Binet Intelligence Scale, and had parents who reported significantly more parenting stress than RO children classified as secure.
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Adopción/psicología , Niño Institucionalizado/psicología , Cuidados en el Hogar de Adopción/psicología , Relaciones Interpersonales , Apego a Objetos , Ajuste Social , Ansiedad de Separación , Canadá , Niño , Trastornos de la Conducta Infantil/etiología , Trastornos de la Conducta Infantil/psicología , Preescolar , Métodos Epidemiológicos , Salud de la Familia , Femenino , Humanos , Masculino , Relaciones Padres-Hijo , Padres/psicología , Rumanía/etnología , Estrés Psicológico/etiología , Factores de TiempoRESUMEN
Atypical odontalgia is a distressing and unusual chronic orofacial pain condition. It is often difficult to diagnose because it is associated with a lack of clinical and radiographic abnormalities. The condition is poorly understood on a pathophysiological basis, and patients often undergo repetitive and unnecessary dental procedures in attempts to alleviate pain. In this study, 50 patients diagnosed with odontalgia were evaluated by pharmacological procedures, including topical anesthetic application and phentolamine infusion. Results of these pharmacological procedures suggest that atypical odontalgia is a neuropathic pain of the oral cavity that may have a component of sympathetically maintained pain. Therapeutic trials of topical capsaicin were carried out to assess its efficacy for pain reduction. Topical capsaicin was effective in most patients.
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Dolor Facial/tratamiento farmacológico , Odontalgia/tratamiento farmacológico , Administración Tópica , Adulto , Anciano , Anciano de 80 o más Años , Anestésicos Combinados/administración & dosificación , Anestésicos Locales/administración & dosificación , Capsaicina/administración & dosificación , Distribución de Chi-Cuadrado , Enfermedad Crónica , Dolor Facial/etiología , Femenino , Humanos , Infusiones Intravenosas , Lidocaína/administración & dosificación , Combinación Lidocaína y Prilocaína , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Fentolamina/administración & dosificación , Prilocaína/administración & dosificación , Distrofia Simpática Refleja/complicaciones , Distrofia Simpática Refleja/tratamiento farmacológico , Factores Sexuales , Método Simple Ciego , Encuestas y Cuestionarios , Simpaticolíticos/administración & dosificación , Trastornos de la Articulación Temporomandibular/complicaciones , Odontalgia/etiologíaRESUMEN
Certain polyunsaturated fatty acids can selectively kill tumor cell lines while causing little to no harm to normal cell lines. However, the mechanism of this cytotoxicity is only partially understood. Antioxidants such as vitamin E have been shown to be capable of completely blocking the cytotoxic response when administered concomitantly with the fatty acid. We report here that when vitamin E was added as late as 6 days following fatty acid treatment, at a time point when the process of cell death was well underway, any further development of cell death was blocked. This implies that the mechanism of fatty acid induced cytotoxicity does not involve a gradual compromising of the cell over the 5-7 day time course of cell death. Instead, the event triggering cell death is an oxidative phenomenon occurring over a short time span of minutes or hours, not days, and is completely blocked by vitamin E.
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Antioxidantes/farmacología , Vitamina E/farmacología , Ácido gammalinolénico/antagonistas & inhibidores , Ácido gammalinolénico/toxicidad , Neoplasias de la Mama/tratamiento farmacológico , Neoplasias de la Mama/patología , Muerte Celular/efectos de los fármacos , Fluorescencia , Humanos , Factores de Tiempo , Células Tumorales Cultivadas/efectos de los fármacos , Vitamina E/farmacocinética , Ácido gammalinolénico/farmacocinéticaAsunto(s)
Sistemas de Liberación de Medicamentos/economía , Bombas de Infusión/normas , Sistemas de Medicación en Hospital/economía , Canadá , Ahorro de Costo , Análisis Costo-Beneficio , Sistemas de Liberación de Medicamentos/instrumentación , Sistemas de Liberación de Medicamentos/normas , Humanos , Bombas de Infusión/economía , Sistemas de Medicación en Hospital/normas , Servicio de Farmacia en Hospital/economía , Servicio de Farmacia en Hospital/normasRESUMEN
The purpose of this study was to assess the relationship between two theoretically distinct aspects of children's emotional responses (Lewis & Michalson, 1983), their emotional experience (via verbal report) and emotional state (via nonverbal expression), in response to emotion-evoking stimuli. A related objective was to assess the concordance of these two verbal and nonverbal measures as indices of empathy, i.e., affective responses consistent with those of stimulus persons. Facial expressions of 60 10-year-old girls were unobtrusively videotaped while they individually viewed six stimulus vignettes. Half of these children pressed a button to indicate awareness of emotional arousal while viewing stimuli; half served as controls. Results indicated that emotional and empathic responses were not affected by the button press procedure, or by a social desirability response set. Expressive responses at button presses were microanalytically analyzed using AFFEX. Postviewing interviews assessed children's reported emotions and the affect match (empathy) between children's reported emotion for themselves and stimulus characters. Results indicated modest associations between the emotions children reported and those facially displayed and similar associations between children's verbal and facial empathy scores. Results address the concurrent validity of different measures of children's emotions, and contribute to the small number of extant multimethod studies on children's emotional responses and empathy.
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Emociones , Empatía , Expresión Facial , Conducta Verbal , Concienciación , Niño , Femenino , Humanos , Determinación de la PersonalidadAsunto(s)
Indización y Redacción de Resúmenes , Sistemas de Información en Hospital/organización & administración , Sistemas de Registros Médicos Computarizados/organización & administración , Registros Médicos/clasificación , Recolección de Datos , Hong Kong , Almacenamiento y Recuperación de la Información , Proyectos Piloto , Proyectos de Investigación , Programas InformáticosRESUMEN
The mechanism by which tumour cells may be killed in vitro by exogenous polyunsaturated fatty acids may involve lipid peroxidation. Gamma-linolenic acid caused a dose and time-dependent reduction in ZR-75-1 cell growth. However, altering either the incubator temperature (35, 37 and 39 degrees C) or the oxygen content (16, 21 and 26%) had little effect on either the growth of cells in the presence of gamma-linolenic acid or on thiobarbiturate reactive material levels over a 7 day period. Thus, small changes in cell culture conditions do not affect 18:3n-6 cytotoxicity or markers of lipid peroxidation.