RESUMEN
OBJECTIVES: Mental illness and homelessness are often associated with each other. The study aim was to describe the care trajectories of psychiatric inpatients admitted from precarious housing or homelessness. METHODS: An anonymized data collection was performed at two psychiatric hospitals in North Rhine-Westphalia. RESULTS: Of 76 identified patients, every other was discharged to unsecured housing or homelessness. An unresolved housing situation delayed discharge in almost every third case. Upon discharge outpatient somatic or psychiatric treatment was not secured in more than 30%, and in more than 40% of cases, resp. CONCLUSION: Improvement of the housing situation is possible in a minority of cases for psychiatric inpatients admitted from unsecured housing. The unresolved housing situation was seen as an obstacle to discharge in every third case.
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Personas con Mala Vivienda , Trastornos Mentales , Enfermos Mentales , Humanos , Vivienda , Hospitales Psiquiátricos , Alemania , Trastornos Mentales/diagnóstico , Trastornos Mentales/epidemiología , Trastornos Mentales/terapiaRESUMEN
AIM OF THE STUDY: Implementation and evaluation of a cross-sectoral complex care model for persons with severe mental illness (SMI). METHODS: The care model was implemented at a psychiatric-psychotherapeutic specialized clinic. Within this patient-centered and needs-oriented complex care model, intensive case management was applied to transition persons with SMI between inpatient and outpatient mental health care. Evaluation was conducted using a matched control group design (nâ=â46/21). RESULTS: According to clinical assessment, two thirds of the patients benefited from the care model. In the course of treatment, the patients showed a significant reduction in the use of inpatient psychiatric care structures and an improvement in clinical symptoms. CONCLUSION: For people with SMI, there is a care gap in the in the transition from inpatient to outpatient care, which could be partially closed.
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Trastornos Mentales , Servicios de Salud Mental , Humanos , Hospitales Psiquiátricos , Alemania , Trastornos Mentales/terapia , Trastornos Mentales/psicología , Atención Dirigida al PacienteRESUMEN
BACKGROUND: Within the last five years the number of homeless persons in Germany has more than doubled, with many suffering from mental illnesses that require treatment. Whether the mental illness itself led to losing shelter or whether the state of being homeless increased the likelihood of developing symptoms of a mental disorder remains unclear. The current study assessed the interaction of homelessness and mental illness from a care provider perspective. METHODS: We conducted a retrospective analysis of inpatient routine data from 20 psychiatric hospitals in North Rhine-Westphalia (NRW), Germany, over a period of four years (N = 366,767 inpatient treatment cases). Patients were considered "homeless" if they had no fixed unique address. RESULTS: About 2.4% of the analyzed cohort was classified as homeless, with increasing tendency over the study period (+14% from 2016 to 2019). The percentage of homeless patients varied broadly between the hospitals (0.2-6.3%). Homeless patients were more often male and on average eight years younger than patients with a fixed address. Homeless patients experienced more involuntary measures (admission and restraint), had a shorter course of treatment and were more often discharged within one day. Every second homeless case was diagnosed with a substance use disorder and every third homeless case with a psychotic disorder, whereas affective disorders were diagnosed less frequently in this group. Psychiatric comorbidity occurred more often in homeless patients whereas somatic diseases did not. CONCLUSIONS: Multiple patient-related sociodemographic and local factors are associated with homelessness of psychiatric inpatients. In addition, clinical factors differ between homeless and non-homeless patients, pointing to more severe mental illness and treatment complications (e.g., coercive measures) in homeless persons. Thus, homelessness of psychiatric inpatients can imply special challenges that need to be considered by healthcare providers and politicians, with the goal of optimizing mental and social care and the mental health outcomes of homeless persons.
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Personas con Mala Vivienda , Trastornos Mentales , Trastornos Psicóticos , Análisis de Datos , Personas con Mala Vivienda/psicología , Humanos , Pacientes Internos , Masculino , Trastornos Mentales/terapia , Trastornos Psicóticos/epidemiología , Estudios RetrospectivosRESUMEN
The nervous system is the primary target for low-levels of lead (Pb) exposure and the developing brain appears to be especially vulnerable to Pb neurotoxicity. Chronic low-level Pb exposure causes growth retardation and intellectual impairment. In the present study the protective effect of melatonin during exposure to low-levels of Pb in human SH-SY5Y neuroblastoma cell cultures was assessed. The cells were exposed to Pb (0.01 to 10 microM) for 48 h. Pb inhibited the proliferation of neuroblastoma cells significantly in a concentration-dependent manner. A 50% inhibition (IC50) of cell proliferation was observed at about 5 microM Pb. Pb decreased (16% to 62%) the levels of total cellular glutathione (GSH) in a concentration (0.1 to 10 microM)-dependent manner. Exposure of cells to Pb (5 microM) for 48 h resulted in an eightfold increase in caspase-3 activity and prostaglandin E2 (PGE2) level. Pretreatment with melatonin (10 microM) blocked the effects of Pb on GSH content and caspase-3 activity, and showed significant improvement in reducing the level of PGE2. The results suggest that some of the neurotoxic effects of Pb may be partly mediated by apoptosis and pretreatment with melatonin can prevent these effects. The present study asserts the neuroprotective effect of melatonin in conditions of Pb-induced toxicity in neuroblastoma cell cultures.
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Apoptosis/efectos de los fármacos , Plomo/toxicidad , Melatonina/farmacología , Fármacos Neuroprotectores/farmacología , Caspasa 3/metabolismo , Línea Celular Tumoral , Proliferación Celular/efectos de los fármacos , Dinoprostona/metabolismo , Glutatión/metabolismo , Humanos , Neuroblastoma , Estrés Oxidativo/efectos de los fármacosRESUMEN
Leucine-rich repeat receptor-like kinases (LRR RLKs) comprise the largest group within the plant receptor-like kinase (RLK) superfamily, and the Arabidopsis genome alone contains over 200 LRR RLK genes. Although there is clear evidence for diverse roles played by individual LRR RLK genes in Arabidopsis growth and development, the evolutionary mechanism for this functional diversification is currently unclear. In this study, we focused on the LRRII RLK subfamily to investigate the molecular mechanisms that might have led to the functional differentiation of Arabidopsis LRR RLK genes. Phylogenetic analysis of 14 genes in this subfamily revealed three well-supported groups (I, II, and III). RT-PCR analysis did not find many qualitative differences in expression among these 14 genes in various Arabidopsis tissues, suggesting that evolution of regulatory sequences did not play a major role in their functional divergence. We analyzed substitution patterns in the predicted ligand-binding regions of these genes to examine if positive selection has acted to produce novel ligand-binding specificities, using the nonsynonymous/synonymous rate ratio (d (N)/d (S)) as an indicator of selective pressure. Estimates of d (N)/d (S) ratios from multiple methods indicate that nonsynonymous substitutions accumulated during divergence of the three lineages. Positive selection is likely to have occurred along the lineages ancestral to groups II and III. We suggest that positive selection on the ligand-binding sites of LRRII RLKs promoted diversification of ligand-binding specificities and thus contributed to the functional differentiation of Arabidopsis LRRII RLK genes during evolution.
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Proteínas de Arabidopsis/genética , Arabidopsis/genética , Evolución Molecular , Proteínas Quinasas/genética , Selección Genética , Secuencia de Aminoácidos , Sitios de Unión , Leucina/genética , Modelos Genéticos , Datos de Secuencia Molecular , Filogenia , Homología de Secuencia de AminoácidoRESUMEN
Exposure to low-levels of lead (Pb) during early development has been implicated in behavioral abnormalities and cognitive deficits in children. The present study is focused on developmental changes in hippocampus and cerebellum of rats following perinatal exposure to Pb. Pregnant rats were exposed to 0.2% Pb-acetate from gestation day 6 (GD 6) through postnatal day (PND) 21 and the activity levels of acetylcholinesterase (AChE) were estimated in cerebellum and hippocampus of pups at specific time points for 5 weeks. In both the brain regions, Pb-exposure decreased AChE activity with an increase in age. Histochemical observations conducted in 35 days old rat brain showed decreased AChE activity conspicuously in stratum oriens and dentate gyrus of hippocampus, and molecular and granule cell layers of cerebellum. In vitro studies conducted in 35 days old rat brain showed a considerable decrease in the specific activity of AChE at high concentrations (50-100 microM) of Pb in a concentration-dependent manner. However, at low concentrations (5-20 microM), Pb failed to produce such changes. In the presence of eserine (physostigmine), the specific inhibitor of AChE, the inhibitory effect of Pb was potentiated and this was more pronounced at low-concentrations of Pb. The behavioral responses in open-field also showed a significant decrease in both Pb exposed as well as eserine administered rats. These data suggest that low-level perinatal Pb-exposure induces alterations in cholinergic system in the cerebellum and hippocampus of developing brain even after the withdrawal of Pb-exposure, that may contribute to behavioral and learning deficits.