Understanding substance misuse amongst the mentally ill: an investigation of the context of, and motivations for, drug and alcohol use in an in-patient sample of individuals with psychotic illness

Background: Dual diagnosis (substance misuse and mental illness) is recognised as a significant clinical problem. However there is little evidence contributing to the understanding of what motivates people with psychotic illnesses to use drugs and alcohol, and in what social context. There is still less evidence concerning the correlates of dual diagnosis in in-patient settings including the relationship between mental health service settings and the initiation and maintenance of substance misuse. This study reports the prevalence, social context of, and motivations for substance use in a sample of in-patients with psychotic illnesses.;Methods and measures: Staff on 9 acute mental health wards and 2 psychiatric intensive care units in North London used a Clinician Drug and Alcohol Use Rating Scale to assess whether working age in-patients with psychotic illness also met the criteria for harmful alcohol or drug use, or dependence during the preceding six months. Those meeting the criteria for harmful use or dependence were then approached to participate in the study. Participants were interviewed and asked to report on the nature, extent, social context and attributions of their substance use, and whether they had continued to use whilst an in-patient. Measures used included an Inventory of Alcohol and Drug Use Situations, a Self-Medication Questionnaire, a demographic schedule and a structured set of questions concerning substance use history and it's relationship to mental health service settings.;Results: All working age adult in-patients (264) were screened for a current or recent substance use disorder. One hundred and twenty nine individuals met the study criteria (48.9%), whilst a further 39 (15%) had a substance use history, but no associated impairment of these, 102 agreed to take part in the study (response rate 79%). Those with dual diagnosis were younger on average and more likely to be male, than those with psychosis alone. The majority (76%) suffered from schizophrenia and were detained under the Mental Health Act (1983), with 19% being street homeless. A wide range of substances including opiates, stimulant substances and khat were used by participants, but alcohol, cannabis and cocaine (respectively) were the most frequently used substances. Eighty one percent of the participants reported using on the ward during their current admission, with almost half of the participants buying substances from other in-patients. Methods of using reflected the wide range of substance use reported, and included intravenous injection, chasing, and smoking. A third of participants reported feeling pressurised to buy, or use substances with other in-patients. For the majority substance use was clearly a social activity with three quarters of the participants reporting that they typically used or drank with others. Sixteen percent of the participants reported typically using with other mental health service users. Two principal components analyses of use situations and self medication data each revealed three factors, explaining 68% and 66% of the variance respectively. All factors had high mean scores, and elicited motivations for substance use. They were (use related to): negative personal and social states (48% variance), pleasant social conditions (13% variance), reward (7% variance), social interaction and boredom (41%) social acceptance (14% variance), and medication side effects (9% variance). An exploratory cluster analysis aimed at identifying sub-groups with distinctive patterns of motivations for use. Scores within clusters varied, with the membership of one cluster scoring highly on all factor items while other cluster members scored low on several items, clearly influencing their motivations for use. This exploratory analysis gives some indication that there are a number of distinctive patterns of use, including people who use in a wide range of situations with a variety of motivations, those who primarily use for relief of unpleasant feelings and social anxiety, and those whose use is predominantly social.;Conclusions: Substance misuse is a common problem in users of adult mental health services, and innovative solutions to understand and address these problems are needed. Although it was uncommon for individuals to directly medicate the symptoms of their illness with substances, their motivations for use reflected a range of social difficulties, isolation and other affective problems. Further investigation of demographic variables and substance use motivations in a larger sample may be an effective way of delineating sub groups with distinct motivations and of developing treatment strategies which take these motivations into account

In vitro-differentiated neural cell cultures progress towards donor-identical brain tissue

Multiple research groups have observed neuropathological phenotypes and molecular symptoms in vitro using induced pluripotent stem cell (iPSC)-derived neural cell cultures (i.e. patient-specific neurons and glia). However, the global differences/similarities that may exist between in vitro neural cells and their tissue-derived counterparts remain largely unknown. In this study, we compared temporal series of iPSC-derived in vitro neural cell cultures to endogenous brain tissue from the same autopsy donor. Specifically, we utilized RNA sequencing (RNA-Seq) to evaluate the transcriptional progression of in vitro-differentiated neural cells (over a timecourse of 0, 35, 70, 105 and 140 days), and compared this with donor-identical temporal lobe tissue. We observed in vitro progression towards the reference brain tissue, and the following three results support this conclusion: (i) there was a significant increasing monotonic correlation between the days of our timecourse and the number of actively transcribed protein-coding genes and long intergenic non-coding RNAs (lincRNAs) (P < 0.05), consistent with the transcriptional complexity of the brain; (ii) there was an increase in CpG methylation after neural differentiation that resembled the epigenomic signature of the endogenous tissue; and (iii) there was a significant decreasing monotonic correlation between the days of our timecourse and the percent of in vitro to brain-tissue differences (P < 0.05) for tissue-specific protein-coding genes and all putative lincRNAs. Taken together, these results are consistent with in vitro neural development and physiological progression occurring predominantly by transcriptional activation of downregulated genes rather than deactivation of upregulated genes

Molecular subtype analysis determines the association of advanced breast cancer in Egypt with favorable biology

<p>Abstract</p> <p>Background</p> <p>Prognostic markers and molecular breast cancer subtypes reflect underlying biological tumor behavior and are important for patient management. Compared to Western countries, women in North Africa are less likely to be prognosticated and treated based on well-characterized markers such as the estrogen receptor (ER), progesterone receptor (PR) and Her2. We conducted this study to determine the prevalence of breast cancer molecular subtypes in the North African country of Egypt as a measure of underlying biological characteristics driving tumor manifestations.</p> <p>Methods</p> <p>To determine molecular subtypes we characterized over 200 tumor specimens obtained from Egypt by performing ER, PR, Her2, CK5/6, EGFR and Ki67 immunohistochemistry.</p> <p>Results</p> <p>Our study demonstrated that the Luminal A subtype, associated with favorable prognosis, was found in nearly 45% of cases examined. However, the basal-like subtype, associated with poor prognosis, was found in 11% of cases. These findings are in sharp contrast to other parts of Africa in which the basal-like subtype is over-represented.</p> <p>Conclusions</p> <p>Egyptians appear to have favorable underlying biology, albeit having advanced disease at diagnosis. These data suggest that Egyptians would largely profit from early detection of their disease. Intervention at the public health level, including education on the benefits of early detection is necessary and would likely have tremendous impact on breast cancer outcome in Egypt.</p

um cuidado especializado do enfermeiro obstetra

Observa-se, hoje em dia, que algumas práticas na maternidade tendem a ignorar as preferências das mulheres em trabalho de parto, uniformizando os cuidados com prejuízo para o bem-estar e a qualidade de vida das famílias. As práticas em Obstetrícia têm vindo a tornar-se cada vez mais repletas de intervenção, focando-se apenas nos resultados físicos (mortalidade e morbilidade) e descurando as vivências das parturientes e família, assim como as consequências psicossociais de um parto traumático. O presente Relatório de Estágio pretende refletir os cuidados em maternidade na perspetiva EEESMOG, que se visa holística, centrada no cliente e baseada na evidência. Da mesma forma, espelha as aprendizagens efetuadas em contexto do Estágio com Relatório inserido no 6º CMESMO da ESEL. Foram escolhidos como referenciais teóricos norteadores os modelos de Nola Pender – Modelo de Promoção da Saúde, e a Teoria de Empowerment em Saúde de Nelma Shearer. Foi também realizada uma Revisão Sistemática da Literatura que visou responder à seguinte questão de investigação: “Quais os cuidados do EEESMOG promotores do empowerment das mulheres direcionado para uma tomada de decisão informada relativa ao trabalho de parto?”. Adicionalmente, foi efetuado um registo da interação durante a prestação de cuidados no decorrer do estágio, sobre os quais foi efetuada uma reflexão e confrontação com os resultados da RSL. Concluiu-se que os cuidados que o EEESMOG presta que são promotores de uma tomada de decisão informada para o trabalho de parto se inserem dentro de três grandes temas, nomeadamente Competências da esfera relacional, Competências da esfera da prática clínica e Competências da esfera científica, com especial referência para os cuidados que se relacionam com o Estabelecimento de Relação Terapêutica, a Educação para a Saúde, o Cuidado da Mulher em trabalho de parto, a Promoção do exercício do Consentimento Informado e a Prática baseada na Evidência

BSalhia_et_al_Methylation_Data_Archive

<p>The brain is a common site of metastatic disease in patients with breast cancer, which has few therapeutic options and dismal outcomes. The purpose of our study was to identify common and rare events that underlie breast cancer brain metastasis. We performed deep genomic profiling, which integrated gene copy number, gene expression and DNA methylation datasets on a collection of breast brain metastases. This dataset includes array-based DNA methylation data on 32 breast brain metastasis samples, 12 non-neoplastic breast and 15 non-neoplastic brain samples using the Infinium HumanMethylation27 BeadArray (Illumina, San Diego, CA) Gene expression (GSE52604) and aCGH (Figshare) microarray data are also available.</p

B Salhia et al Methylation Metadata Spreadsheet for Breast Brain Metastasis

<p>DNA Methylation Analysis using the Infinium HumanMethylation27 BeadArray (Illumina) for 32 Breast Brain Metastasis samples, 15 Non-Neoplastic Brain samples, and 12 Non-Neoplastic Breast samples</p> <p> </p

B Salhia et al Array-Based Comparative Genomic Hybridization (aCGH) Data Archive

<p>The brain is a common site of metastatic disease in patients with breast cancer, which has few therapeutic options and dismal outcomes. The purpose of our study was to identify common and rare events that underlie breast cancer brain metastasis. We performed deep genomic profiling, which integrated gene copy number, gene expression and DNA methylation datasets on a collection of breast brain metastases. This dataset includes array-based comparative genomic hybridization (aCGH) on 15 breast brain metastasis samples using the Agilent SurePrint G3 Human CGH Microarray Kit, 1x1M. Gene expression (GSE52604) and DNA methylation (Figshare) microarray data are also available.</p

B Salhia et al Array-Based Comparative Genomic Hybridization (aCGH) Metadata Spreadsheet for Breast Brain Metastasis

<p>Array-Based Comparative Genomic Hybridization (aCGH) using the Agilent SurePrint G3 Human CGH Microarray Kit, 1x1M for 15 Breast Brain Metastasis samples.</p