Interpreting standardized and idiographic outcome measures in CAMHS: What does change mean and how does it relate to functioning and experience?

Patient Reported Outcome Measures (PROMs) are increasingly being used in Child and Adolescent Mental Health Services (CAMHS). The aim of the present research was to explore change in standardized and idiographic outcome measures in CAMHS using naturalistic, routinely collected data. We explored change in psychosocial difficulties and impact on daily life as evaluated by a broad standardised measure, the Strengths and Difficulties Questionnaire (SDQ) (Goodman, 1997), and progress toward goals as evaluated by a personalised idiographic measure, the Goal Based Outcomes tool (GBO) (Law, 2011) in a sample of N = 137 CAMHS attenders. Psychosocial difficulties and impact on daily life showed less change over the course of treatment than progress toward goals in the present study. Change in psychosocial difficulties and impact on daily life also showed fewer significant associations with change in clinician-reported functioning and satisfaction with care at time two than change in progress toward goals. Findings of the present research may support previous studies in which service users and clinicians report that idiographic measures are more capable than standardised measures of capturing relevant change for individuals

Chronic Obstructive Pulmonary Disease and Lung Cancer: Underlying Pathophysiology and New Therapeutic Modalities

Chronic obstructive pulmonary disease (COPD) and lung cancer are major lung diseases affecting millions worldwide. Both diseases have links to cigarette smoking and exert a considerable societal burden. People suffering from COPD are at higher risk of developing lung cancer than those without, and are more susceptible to poor outcomes after diagnosis and treatment. Lung cancer and COPD are closely associated, possibly sharing common traits such as an underlying genetic predisposition, epithelial and endothelial cell plasticity, dysfunctional inflammatory mechanisms including the deposition of excessive extracellular matrix, angiogenesis, susceptibility to DNA damage and cellular mutagenesis. In fact, COPD could be the driving factor for lung cancer, providing a conducive environment that propagates its evolution. In the early stages of smoking, body defences provide a combative immune/oxidative response and DNA repair mechanisms are likely to subdue these changes to a certain extent; however, in patients with COPD with lung cancer the consequences could be devastating, potentially contributing to slower postoperative recovery after lung resection and increased resistance to radiotherapy and chemotherapy. Vital to the development of new-targeted therapies is an in-depth understanding of various molecular mechanisms that are associated with both pathologies. In this comprehensive review, we provide a detailed overview of possible underlying factors that link COPD and lung cancer, and current therapeutic advances from both human and preclinical animal models that can effectively mitigate this unholy relationship

The human acute-phase serum amyloid A gene family: structure, evolution and expression in hepatoma cells.

Serum amyloid A (SAA) proteins are a group of phylogenetically conserved acute-phase reactants. Evidence is presented here for the existence of four genetic loci for the human serum amyloid A (SAA) genes. The first locus was defined by three contiguous lambda clones spanning approximately 30 kb which contained a single SAA gene encoding apoSAA1 beta. Allelic variants were isolated at the second locus: a novel clone encoding apoSAA2 alpha was distinguished from SAA2 beta (previously known as SAAg9, Ref.1) by a His/Arg polymorphism at residue 71.SAA1 and SAA2 found in the high density lipoprotein fraction of acute-phase plasma were approximately 90% homologous at the nucleotide level. Homology in the 5' flanking regions was reflected functionally with similar transcriptional responses to inflammatory cytokines in transfected hepatoma cells. A further novel gene, SAA4, was isolated from a cosmid library and mapped 10 kb downstream of SAA2. The locus defining SAA3 has been described elsewhere. Polymorphisms were detected at both SAA1 and SAA2 loci by Southern analysis and the entire SAA region mapped to discrete fragments by pulsed field analysis. The four genes account for all the hybridizing bands present on Southern analyses in a Caucasian population