Medication free treatment for people with psychosis: An explorative study of user perspectives on increased accept and support for patients choosing to discontinue anti-psychotic medication as treatment for psychosis

Bakgrunn: Medisinfri behandling for psykose i Norge er et resultat av et felles initiativ fra flere brukerorganisasjoner basert på den debatterte bruken av antipsykotiske medisiner, og ønsket om mer personsentrert behandling og større selvbestemmelse. Medisinfri behandling har som mål å øke pasientens autonomi, redusere medikamentell behandling og øke psykososiale støttemuligheter. Medikamentfri behandling var ikke utformet for å fremme ett behandlingsvalg fremfor et annet. I praksis står pasienter som velger dette behandlingsprogrammet fritt til å bruke eller ikke bruke medisiner etter deres behov, men må ha et klart mål om å redusere eller slutte med antipsykotisk medisinering. Mål: Denne studiens mål var å gi omfattende innsikt i brukerens og helsepersonells erfaringer med det medisinfrie behandlingsprogrammet i Bergen, Norge. Metoder: Dette er en kvalitativ studie som brukte dybdeintervjuer med personer med psykose, fokusgruppesamtaler med ansatte tilknyttet medisinfri behandling, og deltakende observasjon i musikkterapi. Fire erfaringseksperter ble invitert som medforskere. Funn: Pasientene beskrev sitt forhold til terapeutene som viktig og forbedret. Behandlingen ble en læringsprosess av deres personlige lidelsesmønstre. Motivasjon for å ta kontroll over egen tilfriskningsprosess var viktig. Terapeutene var opptatt av å forvalte ressurser; sin egen rolle i terapien; og ulike pasientvalg. Musikkterapi ble beskrevet som en fleksibel og recoveryorientert behandling. Konklusjoner: Medisinfri behandling la til rette for læringserfaringer angående behandlingsvalg med fokus på økt egenstyring og motivasjon. Behandlingen fremstår støttende for ulike pasientvalg, og ser ut til å forbedre forholdet mellom pasient og helsepersonell. Demokratisering av behandlingsvalg utfordrer nivået av faglig skjønn når helsepersonell og pasient har motstridende mål. Dette kan føre til at terapeuter føler seg maktesløse i og fremmedgjort fra arbeidet sitt. Musikkterapi tilbyr valg fortløpende, i samarbeid med terapeut, men også avhengig av omstendigheter. Det er et potensial for forbedret implementering.Background: Medication-free (MF) treatment for psychosis in Norway is the result of a joint initiative from several user organisations based on the debated use of anti-psychotic medication, and the wish for more person-centred care and greater self-determination. MF treatment aims to increase patient autonomy, reduce pharmacological treatment, and increase psychosocial support options. The medication-free treatment services were not designed to promote one treatment choice over another. In practical terms, patients choosing this treatment program are free to use or not use medications following their needs, but aims to reduce or discontinue their anti-psychotic medication. Objective: This study aimed to provide comprehensive insight into the user and provider experiences with the medication free treatment program in Bergen, Norway. Methods: This was a qualitative study using in-depth interviews with people with psychosis, focus group discussions with staff from the mental health care institutions, and participant observation in music therapy. Four experts by experience were invited as co-researchers. Findings: Patients described their relationship with therapists as improved and significant. Treatment was a learning process of their personal patterns of suffering, and motivation for self-agency in the recovery process was important. The therapists were preoccupied with managing resources; their role in the therapy; and patient choices. Music therapy was described as a flexible, recovery-oriented treatment. Conclusions: Medication-free treatment facilitated learning experiences regarding the choice of treatment, focusing on increased self-agency and motivation. It is supportive towards patient choices, and appears to improve the relationship between the patient and the caregiver. Democratization of treatment choices challenges the level of professional discretion when caregiver and patient have conflicting goals, possibly causing therapists to feel disempowered in and alienated from their work. Music therapy offers choices continuously, in collaboration with the therapist, but also contingent depending on circumstances. There is a potential for improved implementation.Doktorgradsavhandlin

Modelling BK Polyomavirus dissemination and cytopathology using polarized human renal tubule epithelial cells

Most humans have a lifelong imperceptible BK Polyomavirus (BKPyV) infection in epithelial cells lining the reno-urinary tract. In kidney transplant recipients, unrestricted high-level replication of donor-derived BKPyV in the allograft underlies polyomavirus-associated nephropathy, a condition with massive epithelial cell loss and inflammation causing premature allograft failure. There is limited understanding on how BKPyV disseminates throughout the reno-urinary tract and sometimes causes kidney damage. Tubule epithelial cells are tightly connected and have unique apical and basolateral membrane domains with highly specialized functions but all in vitro BKPyV studies have been performed in non-polarized cells. We therefore generated a polarized cell model of primary renal proximal tubule epithelial cells (RPTECs) and characterized BKPyV entry and release. After 8 days on permeable inserts, RPTECs demonstrated apico-basal polarity. BKPyV entry was most efficient via the apical membrane, that in vivo faces the tubular lumen, and depended on sialic acids. Progeny release started between 48 and 58 hours post-infection (hpi), and was exclusively detected in the apical compartment. From 72 hpi, cell lysis and detachment gradually increased but cells were mainly shed by extrusion and the barrier function was therefore maintained. The decoy-like cells were BKPyV infected and could transmit BKPyV to uninfected cells. By 120 hpi, the epithelial barrier was disrupted by severe cytopathic effects, and BKPyV entered the basolateral compartment mimicking the interstitial space. Addition of BKPyV-specific neutralizing antibodies to this compartment inhibited new infections. Taken together, we propose that during in vivo low-level BKPyV replication, BKPyV disseminates inside the tubular system, thereby causing minimal damage and delaying immune detection. However, in kidney transplant recipients lacking a well-functioning immune system, replication in the allograft will progress and eventually cause denudation of the basement membrane, leading to an increased number of decoy cells, high-level BKPyV-DNAuria and DNAemia, the latter a marker of allograft damage

Different Relations Between Infarct Size and Occluded Bed Size in Barbiturate-Anesthetized Versus Conscious Dogs

The relation between infarct size and occluded bed size in barbiturate-anesthetized (n = 32) and conscious (n = 34) dogs was compared using models of the left anterior descending (n = 43) and circumflex (n = 23) coronary arteries with 2 day old infarcts. Infarct and occluded bed (postmortem coronary arteriography) masses were measured by computerized planimetry of weighed left ventricular rings. For either type of occlusion, infarcts were larger in anesthetized than in conscious dogs (56 versus 33% occluded bed, p < 0.001), with greater slopes of the linear regressions between infarct size and occluded bed size (p < 0,001) and less epicardial sparing (p < 0.05) on topographic mapping. Although arterial and left atrial pressures were similar in the two groups, heart rates were higher in the anesthetized dogs, both before (127 versus 88 beats/min, p < 0.001) and after (151 versus 109 beats/min, p < 0.001) occlusion. Myocardial blood flow distribution (radioactive microspheres, n = 33) favored the epicardium in anesthetized dogs, with lower endocardial-epicardial flow ratios pre- and postocclusion. Also, the level of total plasma catecholamines (radioenzymatic assay) was higher in barbiturate-anesthetized (n = 5) than in conscious (n = 5) dogs. Increasing the heart rate in conscious dogs (n = 18) to that of the anesthetized group (139 beats/min) by pacing produced larger infarcts and greater linear regression slopes, as seen in anesthetized dogs. Decreasing the heart rate in anesthetized dogs (n = 7) to that of the conscious group (98 beats/min) by sinoatrial node destruction and pacing resulted in smaller infarcts and lower linear regression slope, as seen in conscious dogs. Thus, the larger infarcts in barbiturate-anesthetized dogs appeared to be related mainly to the tachycardia, although transmural maldistribution of flow and increased circulating catecholamines might have contributed

Structure of Hordeum vulgare NADPH-dependent thioredoxin reductase 2. Unwinding the reaction mechanism

Thioredoxins (Trxs) are protein disulfide reductases that regulate the intracellular redox environment and are important for seed germination in plants. Trxs are in turn regulated by NADPH-dependent thioredoxin reductases (NTRs), which provide reducing equivalents to Trx using NADPH to recycle Trxs to the active form. Here, the first crystal structure of a cereal NTR, HvNTR2 from Hordeum vulgare (barley), is presented, which is also the first structure of a monocot plant NTR. The structure was determined at 2.6 Å resolution and refined to an R (cryst) of 19.0% and an R (free) of 23.8%. The dimeric protein is structurally similar to the structures of AtNTR-B from Arabidopsis thaliana and other known low-molecular-weight NTRs. However, the relative position of the two NTR cofactor-binding domains, the FAD and the NADPH domains, is not the same. The NADPH domain is rotated by 25° and bent by a 38% closure relative to the FAD domain in comparison with AtNTR-B. The structure may represent an intermediate between the two conformations described pre­viously: the flavin-oxidizing (FO) and the flavin-reducing (FR) conformations. Here, analysis of interdomain contacts as well as phylogenetic studies lead to the proposal of a new reaction scheme in which NTR–Trx interactions mediate the FO to FR transformation

Farmer opinion on the process of health and welfare planning in Austria, Denmark, Germany, Norway and Switzerland

This report serves as a deliverable from the ANIPLAN project, with the original title ‘Evaluation report on state of the art regarding animal health and welfare planning in the participating countries’ (Deliverable 5.1). We chose to focus on the farmers’ perspective in each country, and ask the farmers who had participated in our project how they perceived the process of animal health and welfare planning. We did that using a questionnaire which each participant used in an interview with the farmer, asking some specific questions with the aim to evaluate how the farmers had experienced the ANIPLAN approach. We found that this focus was important as a supplement to other outcomes from the project, such as reduction of medicines (Ivemeyer et al., 2011) and improvement of animal based parameters (Gratzer et al., 2011). Furthermore potential scenarios for implementation of this concept into practice can be developed from the farmers responses

The dialogue with farmers

This report covers the project outcome Deliverable 4.2 ‘Analysis completed after a joint effort to identify possibilities in each country as how to facilitate the best possible dialogue regarding animal health and welfare’ as part of the European CORE Organic project ‘Minimising medicine use in organic dairy herds through animal health and welfare planning.’ The work was intended to understand the processes and was analysed from the perspective of the key animal health and welfare (AHW) planning principles developed as part of the project. The analysis was completed on transcripts of interviews of facilitators and advisors who had participated in the ANIPLAN project, some of them as partners in the project group. If animal health and welfare planning is to gain widespread use among organic farmers, communication between farmers and between farmers and advisors and other actors in the organic farming environment is crucial. Whilst other forms of communication regarding the role and benefits of AHW assessment systems, such as benchmarking, may be the motivational catalyst needed to encourage engagement in the process, a creative dialogue with the individual farmer is necessary when identifying goals and planning means to reach the desired goals. In order to understand how this dialogue works in practice, and what issues arise, a series of interviews were conducted in all of the ANIPLAN participating countries, involving persons directly involved and those with other experiences. The analysis of the interviews was based on a theoretical framework concerning learning, knowledge and empowerment and a functional framework based on the animal health and welfare principles developed as an output from the ANIPLAN project

Planning for better animal health and welfare, Report from the 1st ANIPLAN project workshop, Hellevad, October 2007

’Minimising medicine use in organic dairy herds through animal health and welfare planning’, ANIPLAN, is a CORE-Organic project which was initiated in June 2007. The main aim of the project is to investigate active and well planned animal health and welfare promotion and disease prevention as a means of minimising medicine use in organic dairy herds. This aim will be met through the development of animal health and welfare planning principles for organic dairy farms under diverse conditions based on an evaluation of current experiences. This also includes application of animal health and welfare assessment across Europe. In order to bring this into practice the project also aims at developing guidelines for communication about animal health and welfare promotion in different settings, for example, as part of existing animal health advisory services or farmer groups such as the Danish Stable School system and the Dutch network programme. The project is divided into the following five work packages, four of which comprise research activities with the other focused on coordination and knowledge transfer, through meetings, workshops and publications. These proceedings represent our first results in terms of presented papers and discussions at our first project workshop in Hellevad Vandmølle as well as a review of Animal Health Planning in UK. The content of the workshop proceedings reflect the aim and starting points of all work packages, both in terms of analyses prior to the workshop, and developments during the workshop emanating from group work. Besides a general introduction to the project and the ideas of the project, Christoph Winckler provides an overview of the use of animal based parameters based on the results of the WelfareQuality project. Christopher Atkinson and Madeleine Neale presented concepts, principles and the practicalities of Animal Health Planning and Animal Health Plans based on UK experiences. Pip Nicholas from The University of Wales, Aberystwyth produced a report reviewing the current use of animal health and welfare planning. The entire document is included in these workshop proceedings. This was supplemented through presentations from all countries regarding animal health and welfare planning processes and research. These are summarised together with the concepts developed through dialogue at the workshop in the paper by Nicholas, Vaarst and Roderick. Finally, the Danish Stable School principles were presented by Mette Vaarst followed by discussion on different approaches of communication in farmer groups and at the individual level between farmers and advisors. One important outcome from this workshop is a set of preliminary principles for a good health planning process. We concluded through group discussions followed by a plenary session that a health planning process should aim at continuous development and improvement, and should incorporate health promotion and disease handling, based on a strategy where the current situation is evaluated and form basis for action, which is then reviewed in a new evaluation. It is important that any health plan is farm specific and based on farmer ownership, although an external person(s) should be involved, as well as external knowledge. The organic principles should form the framework for any action (meaning that a systems approach is needed), and the plan should be written. The good and positive aspects on each farm – things that other farmers potentially can learn from. The work and studies in dairy farms within the project will be based on these principles and comprise evaluation and review using animal based parameters as well as finding ways of communication with farmers about animal health and welfare

Effect of aerobic exercise and low-carbohydrate high-fat diet on glucose tolerance and android/gynoid fat in overweight/obese women: A randomized controlled trial

The study was designed to compare the effects of weight loss induced by a low-carbohydrate-high-fat diet or a normal diet, with and without exercise, on glucose tolerance measured as area under the curve (AUC), and android (A) and gynoid (G) fat distribution. The study was registered at clinicaltrials.gov; NCT04100356. In total, 57 women classified as overweight or obese (age 40 ± 3.5 years, body mass index 31.1 ± 2.6 kg/m2) were randomly assigned and completed a 10-week intervention using a low-carbohydrate high-fat diet or a normal diet, with or without aerobic interval exercise. An equal deficit of 700 kcal/day was prescribed, either restricting the diet only, or moderately restricting diet and including three 50-min high-intensity bicycle sessions per week. There were thus four groups: normal diet (NORM); low-carbohydrate-high-fat diet (LCHF); normal diet with exercise (NORM-EX); and low-carbohydrate-high-fat diet with exercise (LCHF-EX). Linear mixed models was used to assess differences between groups. With all groups pooled, the intervention resulted in a weight loss of 6.7 ± 2.5% (p < 0.001). The intervention did not result in differences between groups in AUC glucose, nor in fasting glucose or indicis for insulin resistance such as Homeostatic Model Assessment, Matsuda Insulin Sensitivity Index, insulinogenic index and disposition index. Post-intervention android fat was lower in LCHF than NORM (3,223 ± 727 vs. 2,533 ± 535 g, p = 0.041). LCHF reached a lower A/G ratio than NORM (0.94 ± 0.12 vs. 1.04 ± 0.09, p = 0.011) and LCHF-EX (0.94 ± 0.12 vs. 1.09 ± 0.09, p < 0.001) after the intervention. LCHF resulted in lower android fat mass compared to NORM and the lowest A/G ratio compared to the other matched groups, but with no accompanying improvement in AUC glucose. In conclusion, although all groups achieved improvements in glucose tolerance, no superior effect was observed with the LCHF diet, neither with nor without exercise.publishedVersio

Animal health and welfare planning in organic dairy cattle farms

Continuous development is needed within the farm to reach the goal of good animal health and welfare in organic livestock farming. The very different conditions between countries call for models that are relevant for different farming types and can be integrated into local practice and be relevant for each type of farming context. This article reviews frameworks, principles and practices for animal health and welfare planning which are relevant for organic livestock farming. This review is based on preliminary analyses carried out within a European project (acronym ANIPLAN) with participants from seven countries. The process begins with gathering knowledge about the current status within a given herd as background for making decisions and planning future improvements as well as evaluating already implemented improvements. Respectful communication between the owner of the herd and other farmers as well as animal health and welfare professionals (veterinarians and advisors) is paramount. This paper provides an overview of some current animal health and welfare planning initiatives and explains the principles of animal health and welfare planning which are being implemented in ANIPLAN partner countries, in collaboration with groups of organic farmers and organisations