Sex and gender differences in symptoms of early psychosis: a systematic review and meta-analysis

First-episode psychosis (FEP) can be quite variable in clinical presentation, and both sex and gender may account for some of this variability. Prior literature on sex or gender differences in symptoms of psychosis have been inconclusive, and a comprehensive summary of evidence on the early course of illness is lacking. The objective of this study was to conduct a systematic review and meta-analysis of the literature to summarize prior evidence on the sex and gender differences in the symptoms of early psychosis. We conducted an electronic database search (MEDLINE, Scopus, PsycINFO, and CINAHL) from 1990 to present to identify quantitative studies focused on sex or gender differences in the symptoms of early psychosis. We used random effects models to compute pooled standardized mean differences (SMD) and risk ratios (RR), with 95% confidence intervals (CI), for a range of symptoms. Thirty-five studies met the inclusion criteria for the systematic review, and 30 studies were included in the meta-analysis. All studies examined sex differences. Men experienced more severe negative symptoms (SMD =  - 0.15, 95%CI =  - 0.21, - 0.09), whereas women experienced more severe depressive symptoms (SMD = 0.21, 95%CI = 0.14, 0.27) and had higher functioning (SMD = 0.16, 95%CI = 0.10, 0.23). Women also had a lower prevalence of substance use issues (RR = 0.65, 95%CI = 0.61, 0.69). Symptoms of early psychosis varied between men and women; however, we were limited in our ability to differentiate between biological sex and gender factors. These findings may help to inform early detection and intervention efforts to better account for sex and gender differences in early psychosis presentation

Case 12 : Prioritizing Emerging and Re-Emerging Non-enteric Zoonotic Infectious Diseases: What Should we be Afraid of Next?

As time progresses, new zoonoses make their way to the forefront in the media, in healthcare systems, in government projects, and in the daily lives of Canadians. Prioritization exercises carried out by public health experts can provide an indication for which zoonoses we should be most afraid of next, and ultimately most prepared for, especially in light of impeding changes in climate. Blake O’Neil and Brock Jansen have recently transitioned to new positions with the Health Professionals Guidance Unit at the Centre for Food-borne, Environmental, and Zoonotic Infectious Diseases. Together, they plan to develop health professional guidance documents and tools to aid in the prevention, early diagnosis, and clinical management of various emerging and re-emerging non-enteric zoonotic infectious diseases. To maintain efficiency when creating guidance documents and tools, Blake and Brock have commenced a prioritization exercise to determine which emerging and re-emerging non-enteric zoonotic infectious diseases are of the greatest threat to the health of Canadians as a result of climate change. To date, Blake and Brock have reviewed previously conducted internal and external prioritization exercises; received consultation from the National Microbiology Lab in Winnipeg, Manitoba; undertaken a literature review to explore zoonoses relevant to the Canadian context; and organized an advisory committee composed of external stakeholders from various healthrelated specialties. With the results from the literature review and the input from various stakeholder organizations, Blake and Brock have developed a list of zoonoses to be included in the prioritization exercise. The upcoming federal election tenders a very constrained timeframe for Blake and Brock, specifically for engaging with stakeholders external to the Public Health Agency of Canada. As public servants, Blake and Brock need to ensure government resources are not used for partisan advantage. Therefore, any stakeholder engagement would need to be paused when electoral campaigning begins until a Prime Minister is elected and the Senate and House of Commons resume. Furthermore, prior to the federal election, Blake and Brock must produce a list of priority emerging and re-emerging non-enteric zoonotic infectious diseases so they can begin developing health professional guidance documents and tools. The pair has only been able to identify two prioritization criteria thus far: measuring the number of incident cases within Canada for each zoonosis and measuring the severity of illness associated with each zoonosis. However, because severity of illness is relatively challenging to define, the pair continues to search for a unit of analysis that adequately represents the criterion. In addition, they must tailor the incidence formula to sufficiently capture the status of the zoonoses in Canada. Blake and Brock are now at a standstill in terms of identifying three additional prioritization criteria, defining what each criterion entails, and how each criterion will be measured

Evidence of fibrinogen as a target of citrullination in IgM rheumatoid factor-positive polyarticular juvenile idiopathic arthritis

<p>Abstract</p> <p>Background</p> <p>Several studies have noted the significance of measuring anti-cyclic citrullinated peptide (CCP) antibodies in juvenile idiopathic arthritis (JIA) as an important indicator for destructive disease, as is the case in rheumatoid arthritis (RA). While the role of anti-CCP antibodies in RA and JIA has become better understood, the identity of the target proteins of this modification has remained elusive. In this study, we evaluated serum from patients with various subtypes of JIA to investigate the presence of anti-deiminated (citrullinated) fibrinogen and anti-citrullinated α-enolase antibodies, and their association with RF and anti-CCP antibody isotypes.</p> <p>Methods</p> <p>Sera were obtained from 96 JIA patients, 19 systemic lupus erythematosus (SLE) patients, and 10 healthy children. All sera were measured for antibodies against citrullinated and native fibrinogen and α-enolase by an enzyme linked immunosorbent assay (ELISA). In addition, all sera were assayed for anti-CCP antibody isotypes and rheumatoid factor (RF) isotypes by ELISA. The relationship between anti-citrullinated fibrinogen and anti-α-enolase antibodies and disease activity and joint damage were also investigated. All results were correlated with clinical and laboratory parameters using Spearman's rho correlation coefficient. Multiple logistic regression analysis was utilized to identify which variables were associated with joint erosions and diagnosis of JIA.</p> <p>Results</p> <p>Thirty-one JIA patients (32%) demonstrated reactivity to citrullinated fibrinogen and 9 (9%) to citrullinated α-enolase. Reactivity to citrullinated fibrinogen and α-enolase was predominantly found in IgM RF-positive polyarthritis patients. Fourteen JIA patients reacted with native α-enolase and a higher percentage of SLE patients reacted with citrullinated α-enolase when compared to JIA patients. Anti-citrullinated fibrinogen antibodies correlated with the presence of IgG anti-CCP antibodies and IgA and IgM RF. The presence of anti-citrullinated α-enolase antibodies correlated with IgA anti-CCP antibodies. IgG anti-CCP antibodies were significantly associated with joint damage and anti-citrullinated fibrinogen antibodies were strongly associated with JIA when compared to control groups. Anti-citrullinated fibrinogen antibodies demonstrated high sensitivity (81%) for IgM RF-positive polyarticular JIA. IgG anti-CCP antibodies had the highest specificity (95%) for JIA, with anti-citrullinated fibrinogen antibodies, IgA anti-CCP antibodies and IgA RF all following at 84%.</p> <p>Conclusions</p> <p>JIA patient sera exhibited strong reactivity to anti-citrullinated fibrinogen antibodies and demonstrated high sensitivity and specificity for JIA, primarily in IgM RF-positive polyarthritis patients. Fibrinogen is one of several protein targets for citrullination in JIA.</p

Prevalence and Correlates of HIV-Risk Behaviors among Homeless Adults in a Southern City

This paper aims to describe the prevalence and correlates of HIV-risk behaviors among adults receiving transitional and emergency housing services in Memphis, Tennessee. A cross-sectional, interviewer-administered survey was conducted with a convenience-based sample (N=116) of homeless adults. Sex without a condom, sex while on drugs or drunk, and sex with an unknown person emerged as the three most prevalent HIV-risk behaviors. Sex while drunk or high on drugs was also assessed as a significant predictor for sex without a condom and sex with an unknown person. Multivariate logistic regressions revealed that mental health status, duration of homelessness, incarceration history, and sex while drunk or high on drugs were significant predictors of HIV-risk behaviors. Consideration of these important correlates in designing HIV prevention programs for this vulnerable sub-group of adults is warranted

A Multidisciplinary Childrens Airway Center: Impact on the Care of Patients With Tracheostomy

BACKGROUND: Children with complex airway problems see multiple specialists. To improve outcomes and coordinate care, we developed a multidisciplinary Children's Airway Center. For children with tracheostomies, aspects of care targeted for improvement included optimizing initial hospital discharge, promoting effective communication between providers and caregivers, and avoiding tracheostomy complications. METHODS: The population includes children up to 21 years old with tracheostomies. The airway center team includes providers from pediatric pulmonology, pediatric otolaryngology/head and neck surgery, and pediatric gastroenterology. Improvement initiatives included enhanced educational strategies, weekly care conferences, institutional consensus guidelines and care plans, personalized clinic schedules, and standardized intervals between airway examinations. A patient database allowed for tracking outcomes over time. RESULTS: We initially identified 173 airway center patients including 123 with tracheostomies. The median number of new patients evaluated by the center team each year was 172. Median hospitalization after tracheostomy decreased from 37 days to 26 days for new tracheostomy patients <1 year old discharged from the hospital. A median of 24 care plans was evaluated at weekly conferences. Consensus protocol adherence increased likelihood of successful decannulation from 68% to 86% of attempts. The median interval of 8 months between airway examinations aligned with published recommendations. CONCLUSIONS: For children with tracheostomies, our Children's Airway Center met and sustained goals of optimizing hospitalization, promoting communication, and avoiding tracheostomy complications by initiating targeted improvements in a multidisciplinary team setting. A multidisciplinary approach to management of these patients can yield measurable improvements in important outcomes

Welcome to the University Libraries Poster Session!

Over the past eight years, the UNLV Libraries have led and contributed to campus initiatives to revise the undergraduate curriculum and student learning outcomes at UNLV. Through formal and informal leadership roles, librarians helped to create the University Undergraduate Learning Outcomes (UULOs) in the areas of Intellectual Breadth and Lifelong Learning, Communication, Inquiry and Critical Thinking, Global/Multicultural Knowledge and Awareness, and Citizenship and Ethics and a revised model for general education. In Fall 2011, the Faculty Senate approved a vertical pathway of key courses, which serve to integrate and assess the UULOs from a student’s first year of college through graduation . The Libraries have partnered to implement this model through faculty development initiatives, design of assignments to teach and assess the inquiry and critical thinking UULO, and curriculum mapping in academic programs. In addition, the creation of co-curricular programs, such as a workshop program for Libraries student employees, and the updating of our teaching and learning spaces underscore our important role as partners in education at UNLV

Methods to Describe Referral Patterns in a Canadian Primary Care Electronic Medical Record Database: Modelling Multilevel Count Data

Background:  A referral from a family physician (FP) to a specialist is an inflection point in the patient journey, with potential implications for clinical outcomes and health policy. Primary care electronic medical record (EMR) databases offer opportunities to examine referral patterns. Until recently, software techniques were not available to model these kinds of multi-level count data. Objective:  To establish methodology for determining referral rates from FPs to medical specialists using the Canadian Primary Care Sentinel Surveillance Network (CPCSSN) EMR database. Method: Retrospective cohort study, mixed effects and multi-level negative binomial regression modelling with 87,258 eligible patients between 2007 and 2012. Mean referrals compared by patient sex, age, chronic conditions, FP visits, and urban/rural practice location.  Proportion of variance in referral rates attributable to the patient and practice levels. Results:  On average, males had 0.26, and females 0.31 referrals in a 12-month period.  Referrals were significantly higher for females, increased with age, FP visits, and number of chronic conditions (p<.0001). Overall, 14% of the variance in referrals could be attributed to the practice level, and 86% to patient level characteristics. Conclusions:  Both patient and practice characteristics influenced referral patterns. The methodologic insights gained from this study have relevance to future studies on many research questions that utilize count data, both within primary care and broader health services research. The utility of the CPCSSN database will continue to increase in tandem with data quality improvements, providing a valuable resource to study Canadian referral patterns over time

A randomised controlled trial of cognitive behaviour therapy versus non-directive reflective listening for young people at ultra high risk of developing psychosis:The detection and evaluation of psychological therapy (DEPTh) trial

Background: Intervention trials for young people at ultra high risk (UHR) for psychosis have shown cognitive behaviour therapy (CBT) to have promising effects on treating psychotic symptoms but have not focused on functional outcomes. We hypothesized that compared to an active control, CBT would: (i) reduce the likelihood of, and/or delay, transition to psychosis; (ii) reduce symptom severity while improving social functioning and quality of life, whether or not transition occurred. Method: This was a single-blind randomised controlled trial for young people at UHR for psychosis comparing CBT to an active control condition, Non Directive Reflective Listening (NDRL), both in addition to standard care, with a 6 month treatment phase and 12 months of follow-up. Statistical analysis is based on intention-to-treat and used random effect models to estimate treatment effects common to all time-points. Results: Fifty-seven young people (mean age = 16.5 years) were randomised to CBT (n = 30) or NDRL (n = 27). Rate of transition to psychosis was 5%; the 3 transitions occurred in the CBT condition (baseline, 2 months, 5 months respectively). The NDRL condition resulted in a significantly greater reduction in distress associated with psychotic symptoms compared to CBT (treatment effect = 36.71, standard error = 16.84, p = 0.029). There were no significant treatment effects on frequency and intensity of psychotic symptoms, global, social or role functioning. Conclusion: Our sample was higher functioning, younger and experiencing lower levels of psychotic like experiences than other trials. The significantly better treatment effect of NDRL on distress associated with psychotic symptoms supports the recommendations for a stepped-care model of service delivery. This treatment approach would accommodate the younger UHR population and facilitate timely intervention