Aggression and its Management in Adolescent Forensic Psychiatric Care

The overall goal of this study was to explore and identify good aggression management methods and on that basis to produce recommendations for aggression management in the adolescent forensic setting. The study was conducted in three phases. In Phase I, staff’s (n = 58) perception of adolescent aggressive behaviour and methods to manage it was examined. In Phase II, staff’s (n = 30) perception of treatment settings and treatment interventions available were studied. In Phase III, the effectiveness of an aggression management programme was evaluated. The data were collected during the period 2004-2007. Participants perceived adolescent aggressive behaviour in a similar way and described aggressive behaviour as being a comprehensible phenomenon. Management methods used to control aggressive situations were alike, although the practical solutions varied between the study units, especially regarding coercive methods. Staff members proposed more time and better opportunities to discuss and evaluate the aggression situation in order to improve the methods used. The treatment settings were similar in studied forensic units and interventions were primarily focused on psychological aspects, including management of aggressive behavior. A comprehensive aggression management programme proved to be effective in decreasing incidents of violence. The use of coercive methods in aggression situations decreased and injuries to the staff became less frequent. If staff members intend to apply high quality management methods in aggression situations they have to share a consistent understanding of aggressive behaviour and need to be aware of the various methods available. In addition, they should learn more about assessment methods in order to improve aggression management. International comparison of aggression, methods for managing it and service provision creates a starting point for developing equal care provision and realization within and between European countries.Aggressiivisen käyttäytymisen hallinta nuorten oikeuspsykiatrisessa hoidossa Tutkimuksen tavoitteena oli selvittää hyviä aggressionhallinnan käytäntöjä nuorten oikeuspsykiatrian yksiköissä ja tämän pohjalta ehdottaa suosituksia käytännön aggressionhallintaan. Tutkimus toteutettiin kolmessa vaiheessa. Ensimmäisessä vaiheessa kuvattiin hoitohenkilökunnan (n = 58) käsityksiä nuorten aggressiivisesta käyttäytymisestä ja sen hoitokeinoista. Toisessa vaiheessa selvitettiin hoitohenkilökunnan (n = 30) näkökulmasta nuorten oikeuspsykiatrian yksiköiden peruspiirteitä ja saatavilla olevia hoitokeinoja. Kolmannessa vaiheessa tutkittiin aggressiohallintaohjelman käyttöönoton tehokkuutta.Tutkimusaineisto kerättiin vuosina 2004-2007. Hoitohenkilökunta määritteli nuorten aggressiivisen käyttäytymisen samansuuntaisesti ja koki nuorten aggressiivisen käyttäytymisen ymmärrettävänä ilmiönä. Aggressiivisen käyttäytymisen hallintakeinot olivat samanlaisia eri yksiköissä, vaikka käytännön sovellukset vaihtelivat erityisesti pakkokeinojen käytössä. Henkilökunta ehdotti enemmän aikaa ja mahdollisuuksia aggressiotilanteiden arvioimiseen, jotta hallintakeinoja voisi kehittää. Oikeuspsykiatrian yksiköt olivat samankaltaisia toimintaperiaatteiltaan. Hoitokeinot kohdistuivat pääasiassa psykologiseen alueeseen, johon sisältyivät myös aggressionhallintakäytännöt. Aggressionhallintaohjelman käyttöönoton myötä aggressiotilanteet vähenivät osastolla. Pakkokeinojen käyttö aggressiotilanteissa väheni, jolloin myös henkilökuntaan kohdistuvat vahingot vähenivät. Eettisesti korkeatasoinen ja laadukas aggressionhallinta edellyttää, että hoitohenkilökunnalla on samansuuntainen käsitys aggressiivisuudesta ja että se on tietoinen erilaisista aggressionhallintakeinoista. Lisäksi aggressiivisen käyttäytymisen arviointimenetelmien käyttöönotto tukee aggressionhallinnan kehittämistä. Kansainvälinen vertailututkimus aggressiivisesta käyttäytymisestä, sen hallintakeinoista ja oikeuspsykiatristen palvelujen organisoinnista on ennakkoehto yhtäläisen palvelutarjonnan mahdollistamiselle Euroopassa.Siirretty Doriast

Einfluss einer vorhergehenden Influenza A Virus Infektion auf die angeborene Immunität gegenüber der sekundären Pneumokokkenpneumonie in humanem Lungengewebe

Sekundäre bakterielle Infektionen im Verlauf oder in Folge einer Infektion mit Influenza A Viren (IAV) steigern oftmals die Schwere des Krankheitsverlaufes, was besonders während der IAV Pandemien von 1918, 1968 und 2009 deutlich wurde. Genaue mechanistische Ursachen, welche dieser gesteigerten Kopathogenität zugrunde liegen wurden überwiegend in Tierversuchsmodellen adressiert und sind immunologisch unvollständig. Aufgrund organstruktureller und immunfunktioneller Speziesunterschiede ist ungewiss, inwieweit eine Übertragbarkeit der Daten zwischen Mensch und Maus besteht. Fokus der Arbeit bildete die Analyse potentieller IAV assoziierter Änderungen der angeborenen Immunität, welche sekundäre Pneumokokkeninfektionen in humanem ex vivo Lungengewebe begünstigen. Dafür wurden zentrale Zyto - bzw. Chemokine als Reaktion auf Einzelinfektionen mit dem saisonalen IAV Pan/99(H3N2) sowie Streptococcus pneumoniae D39 mit denen subsequenter viral-bakteriellen Koinfektion verglichen. Ausgelöst durch die antivirale Interferonantwort erfolgte die Reduktion der pneumokokkeninduzierten Bildung von IL-1β und GM-CSF auf translationaler und transkriptioneller Ebene. Vermutlich beeinflussen Typ I und II Interferone die IL-1β Bildung, welches über parakrine Wechselwirkungen an der GM-CSF Regulation beteiligt ist. Auf zellulärer Ebene verursachte IAV die Freisetzung von Typ I, II und III Interferonen aus primären humanen Alveolarepithelzellen vom Typ II. In humanen Alveolarmakrophagen unterdrückten Typ I und II Interferone die pneumokokkeninduzierte IL-1β Freisetzung. Folglich unterblieb die IL-1β-regulierte GM-CSF Sekretion aus Alveolarepithelzellen vom Typ II. Die Ergebnisse zeigen, dass influenzainduzierte Interferone durch die Unterdrückung der IL-1β regulierten Bildung von GM-CSF in humanem Lungengewebe beitragen. Damit unterstützt sie das Verständnis immunologischer Faktoren, welche diesem Krankheitsbild im Menschen pathophysiologisch zugrunde liegen können.Secondary bacterial infections, which occur during or following an IAV infection, exaggerate the severity of the course of disease up to a lethal outcome, clearly recognizable during the fatal IAV pandemics from 1918, 1968 or 2009. Particular mechanisms underlying this exaggerated viral-bacterial copathogenity were almost solely addressed using animal models and are immunologically incomplete. Due to structural and immunofunctional interspecies differences the transferability of data between human and mice remains indeterminate. The study mainly purposed to investigate IAV associated modulations of innate immunity, which potentially facilitates secondary pneumococcal pneumonia in primary human ex vivo lung tissue. Hence secretion of central cyto- and chemokines initiated by single infection with the seasonal IAV Pan/99(H3N2) or the bacterium Streptococcus pneumoniae D39 were compared to subsequent viral-bacterial coinfection. In context of an antiviral interferon response the pneumococcal induced translation and transcription of IL-1β and GM-CSF were reduced. Probably type I and type II interferons affect generation of IL-1β, which participates in the regulation of GM-CSF by paracrine interactions. On a cellular basis the infection of primary human alveolar epithelial cells type II (AECII) with IAV triggered the release of interferon type I, II and III. In human alveolar macrophages type I and II interferons suppressed the pneumococcal induced release of IL-1β. Consequently, the IL-1β regulated generation of GM-CSF in AECII was impeded. The present study indicates, that influenza related induction of interferons suppresses the IL-1β related release of GM-CSF in human lung tissue. Thereby it takes part in contributing to pathophysiological comprehension of immunological factors underlying this copathogenity

Editorial

To say that working on this issue of Migration and Society has been a challenge would be an understatement. For all of us, from the members of the editorial team to our guest editors, contributors, ever-important reviewers, and the publishing team, 2020 has brought significant barriers. We have feared for the safety of our loved ones; grieved unbearable losses, often from afar; faced different forms of containment; and sought to, somehow, find the time and energy to care for our loved ones, our selves, and one another while navigating unsustainable work commitments and responsibilities

Resting heart rate in 2-year old Standardbreds in training

En användbar metod för att påvisa träningseffekter är att mäta hjärtfrekvensen. Hos människa ses en sänkt vilopuls som ett resultat av en konditionsförbättring. På häst finns det få studier om ett samband mellan en vilopulssänkning och konditionsförbättring. Genom evolutionen har hästen utvecklats till en extraordinär atlet, för att undkomma predatorer krävdes snabbhet och för att färdas långa distanser i sökandet efter vatten och föda krävdes uthållighet. Ett antal fysiologiska anpassningar kan förklara hästens atletiska kapacitet, dessa påverkas i vissa fall inte av träning som till exempel lungstorleken medan andra som blodvolymen visar på en träningsrespons. Hästen har ett stort hjärta och det utgör ungefär 0,9-1% av kroppsvikten. Vilopulsen varierar mellan 25-50 slag/min med ett genomsnitt på 35 slag/min och beror av storlek, ras, ålder och temperament på hästen. Förbättrad kondition medför en ökad förmåga att utföra en given nivå av träning, hjärtfrekvensen under arbetet sjunker och återhämtningen efter går snabbare. Vid träning är även mängden laktat i blodet ett användbart mått för att bedöma hästens kondition. Hos en frisk häst kan en sänkning i blodlaktatkoncentrationen ses efter en träningsperiod. Syftet med studien var att se om en konditionsförbättring leder till en sänkning av vilopulsen hos häst. I studien som pågick under 31 veckor ingick 16 tvååriga varmblodiga travhästar, alla valacker. Med hjälp av digitala pulsmätare registrerades pulsen under vila och arbete samt efter arbete. Vid tre tillfällen efter arbete togs det även prov på hästarnas laktatkoncentration i blodet och vid ett tillfälle mättes även hästarnas hjärtstorlek. Medellufttemperaturen vid mättillfällena bestämdes utifrån data från Sveriges meteorologiska och hydrologiska institut. Resultaten i studien visade att hästarna förbättrade sin kondition under studiens gång genom att sänka sin återhämtningspuls jämfört med studiens start men en sänkning av vilopulsen uteblev. Vilopulsen visade sig dock vara positivt korrelerad med laktatkoncentrationen i blodet efter arbete och lufttemperaturen. Slutsatsen är att studien varken har kunnat påvisa eller förkasta ett samband mellan en konditionsförbättring och en sänkning i vilopuls.A useful method to detect effects of training is to measure the heart rate. In humans, a decreased resting heart rate may be observed as a result of training. There are few studies on horses about a possible relationship between a lowered resting heart rate and a fitness improvement. The horse has evolved into an extraordinary athlete through the evolution, to escape predators it required speed and to travel long distances in the search of water and feed it needed stamina. A number of physiological adaptions may explain the athletic capacity of the horse, both those who may not be affected of training, such as the lung size, while others such as the blood volume shows a training response. The horse has a big heart and it represents about 0.9 to 1% of the body weight. The resting heart rate varies between 25-50 beats per minute with an average of 35 beats per minute and it depends on the size, breed, age and temperament of the horse. Improved fitness increase the ability to perform a given level of exercise, heart rate during work decreases and the recovery after exercise is faster. To measure the amount of lactate in the blood after exercise is also a useful method to evaluate fitness of the horse. In a healthy horse, a reduction in blood lactate can be seen after a period of exercise. The aim of this study was to investigate a possible correlation between a lowered resting heart rate and a fitness improvement. The study included 16 two-year old Standardbred trotters, all geldings, and lasted 31 weeks. The heart rate at rest and during exercise was recorded with digital heart rate monitors. Also, lactate concentration in the blood after exercise was measured for three occasions and at one occasion were the heart size of the horses measured. The average air temperatures at the test occasions were calculated from data from the Swedish Meteorological and Hydrological Institute. The result showed that the horses improved their fitness during the study by lowering their recovery heart rate post exercise but a decrease in the resting heart rate did not occur. However, the heart rate at rest was positively correlated with the lactate concentration in the blood after exercise and air temperature. The conclusion is that the study has not been able to detect or reject a connection between an improvement in fitness and a reduction in resting heart rate

Biomarkers in equine bone and joint disorders

The purpose with this literature study was to summarize the research on biomarkers in equine bone and joint diseases and to get more knowledge about how these markers are affected by the diseases, exercise, age, sex and breed. Bone and joint diseases are a common cause of loss of performance in the athletic horse. Osteochondrosis (OC) is a disease of articular cartilage development and is a common cause of lameness in young horses, leading to decreased athletic potential. Osteoarthritis (OA) is characterized by damage to and loss of articular cartilage matrix components, along with reduced joint function. Disorders in horses have a large economical impact on the horse industry through loss of breeding potential and reduced market value of the affected horses. Disease prevention and pain reduction are general aims of animal welfare within animal husbandry. It would therefore be welcome with any improvement in prevention, diagnosis, treatment and prognostication in these areas and biomarkers may be helpful tools. Molecules that are normal products and byproducts of the metabolic processes that are taking place within the skeletal tissues are often used as markers. Biomarkers are good tools for the prediction and detection of diseases without performing major procedure on the horse. The research is not yet at a stage of having a “magic marker” to diagnose the degree of articular cartilage or bone disease in a single joint with 100% accuracy. Though, many biomarkers have the potential to predict and distinguish the diseases but more research is needed to get higher reliability of these markers

Primary and acquired resistance mechanisms to immune checkpoint inhibition in Hodgkin lymphoma

Hodgkin lymphoma is a B cell derived malignancy characterized by a low number of tumor cells within an environment consisting of inflammatory cells. Recently, immune checkpoint blockade targeting the PD-1-PD-L1 axis has shown to be a great success in relapsed and refractory Hodgkin lymphoma patients. However, complete responses are scarce and median progression-free survival is limited to around 11-15 months. Efficiency of PD-1 blockade in HL might be dependent on CD4 + T cells, but also tumor associated macrophages (TAMs) and NK cells are implicated. The aim of this review is to highlight currently known prominent immune evasion strategies and discuss their possible contribution to primary or acquired resistance to immune checkpoint blockade in Hodgkin lymphoma. These include T cell dependent mechanisms such as shaping of the inflammatory infiltrate, lack of presentation of antigens and neoantigens and production of molecules involved in suppression of T cell functionality such as other immune checkpoints, indoleamine 2,3-dioxygenase and adenosine. Moreover, the role of NK cells and TAMs in efficient PD-1 blockade will be discussed. Targeting these mechanisms in parallel to PD-1 may potentially increase efficiency of PD-1 blockade therapy

Stakeholder engagement and the diffusion of childbirth knowledge: experiences of the COST project.

Poster presenting the diverse actions in various European countries, participating in the project COST IS0907, to promote improvement in childbirth procedures and conditions. Seminars were organized between 2011 and 2013 as an offshoot of COST Action IS0907, “Childbirth Cultures, Concerns and Consequences: Creating a Dynamic EU Framework for optimal maternity care”. The aim of these events was to engage various stakeholders in exchanging research and experiences related to the improvement of maternity practice in each country setting. Different approaches were pursued. This installation aims to share what took place at the seminars.info:eu-repo/semantics/publishedVersio