Factors associated with quality of services for marginalized groups with mental health problems in 14 European countries

This research was financially supported by DG-Sanco (contract: 800197; 2007-2010). The authors would like to thank all of the professionals and services who participated in the PROMO assessment of services. A PhD grant from Fundação para a Ciência e Tecnologia–Portugal (SFRH/BD/66388/2009) to the first author is acknowledged

Diagnostic accuracy of the primary care screener for affective disorder (PC-SAD) in primary care

Background: Depression goes often unrecognised and untreated in non-psychiatric medical settings. Screening has recently gained acceptance as a first step towards improving depression recognition and management. The Primary Care Screener for Affective Disorders (PC-SAD) is a self-administered questionnaire to screen for Major Depressive Disorder (MDD) and Dysthymic Disorder (Dys) which has a sophisticated scoring algorithm that confers several advantages. This study tested its performance against a ‘gold standard’ diagnostic interview in primary care. Methods: A total of 416 adults attending 13 urban general internal medicine primary care practices completed the PC-SAD. Of 409 who returned a valid PC-SAD, all those scoring positive (N=151) and a random sample (N=106) of those scoring negative were selected for a 3-month telephone follow-up assessment including the administration of the Structured Clinical Interview for DSM-IV-TR Axis I Disorders (SCID-I) by a psychiatrist who was masked to PC-SAD results. Results: Most selected patients (N=212) took part in the follow-up assessment. After adjustment for partial verification bias the sensitivity, specificity, positive and negative predictive value for MDD were 90%, 83%, 51%, and 98%. For Dys, the corresponding figures were 78%, 79%, 8%, and 88%. Conclusions: While some study limitations suggest caution in interpreting our results, this study corroborated the diagnostic validity of the PC-SAD, although the low PPV may limit its usefulness with regard to Dys. Given its good psychometric properties and the short average administration time, the PC-SAD might be the screening instrument of choice in settings where the technology for computer automated scoring is available

Good practice in health care for migrants: views and experiences of care professionals in 16 European countries

<p>Abstract</p> <p>Background</p> <p>Health services across Europe provide health care for migrant patients every day. However, little systematic research has explored the views and experiences of health care professionals in different European countries. The aim of this study was to assess the difficulties professionals experience in their service when providing such care and what they consider constitutes good practice to overcome these problems or limit their negative impact on the quality of care.</p> <p>Methods</p> <p>Structured interviews with open questions and case vignettes were conducted with health care professionals working in areas with high proportion of migrant populations in 16 countries. In each country, professionals in nine primary care practices, three accident and emergency hospital departments, and three community mental health services (total sample = 240) were interviewed about their views and experiences in providing care for migrant patients, i.e. from first generation immigrant populations. Answers were analysed using thematic content analysis.</p> <p>Results</p> <p>Eight types of problems and seven components of good practice were identified representing all statements in the interviews. The eight problems were: language barriers, difficulties in arranging care for migrants without health care coverage, social deprivation and traumatic experiences, lack of familiarity with the health care system, cultural differences, different understandings of illness and treatment, negative attitudes among staff and patients, and lack of access to medical history. The components of good practice to overcome these problems or limit their impact were: organisational flexibility with sufficient time and resources, good interpreting services, working with families and social services, cultural awareness of staff, educational programmes and information material for migrants, positive and stable relationships with staff, and clear guidelines on the care entitlements of different migrant groups. Problems and good care components were similar across the three types of services.</p> <p>Conclusions</p> <p>Health care professionals in different services experience similar difficulties when providing care to migrants. They also have relatively consistent views on what constitutes good practice. The degree to which these components already are part of routine practice varies. Implementing good practice requires sufficient resources and organisational flexibility, positive attitudes, training for staff and the provision of information.</p

Clustering of two fragile sites and seven homeobox genes in the 2q31-q32.12 human chromosome region.

In this study we have used FISH to examine the relationship between a group of homeobox genes, namely DLX1/DLX2, EVX2 and four HOXD genes (10, 11, 12, 13), that map to region q31 on chromosome 2, and the FRA2G and FRA2H fragile sites located at 2q31 and 2q32.1 respectively. Our results indicate that these homeobox genes lie between the two fragile regions I.F.: 2,2

Ordered mapping of FRA1H common fragile site, ADPRT and 5S rRNA genes at human chromosomal region 1q42.

In this work we have orderly mapped three markers localised in chromosome region 1q42: the human gene encoding poly(ADP-ribosyl) transferase (ADPRT or PARP), the main cluster of 5S rRNA genes and a DAPI-inducible common fragile site that cytologically corresponds to the 5-azacytidineinducible site FRA1H. ADPRT is a chromatin-associated protein that is thought to play an important role in several basic cellular processes including DNA replication and repair, recombination and maintenance of genomic integrity . The major 5S locus has been assigned to the chromosome region 1q42.1 and is constituted by approximately 150–180 repeats of the 5S unit. Common fragile sites on human chromosomes are particular regions that express gaps or breaks when the cells are exposed to specific chemical agents or conditions of culture. Some time ago, we identified in DAPI, a non-intercalating fluorochrome that binds preferentially to the AT bases of DNA, a compound capable of inducing the expression of a family of common fragile sites. DAPI has been added to human lymphocyte cultures to obtain metaphase spreads expressing the FRA1H common fragile site. Preparations have been simultaneously hybridized (FISH) with two DNA probes consisting of an ADPRT cDNA fragment and a 5S repeat unit. Our results show that the three markers analysed are localised at the region 1q42.1 in the following order: cen–FRA1H-ADPRT-5S–tel

Study of the relationships between fragile sites, chromosome breaks and sister chromatid exchanges.

This paper reports the results of an investigation into the relationship between common fragile sites and sister chromatid exchanges (SCE). Human leukocyte cultures were grown in two different media, one complete (RPMI 1640) and one deficient in folic acid and thymidine (199M). Some of the cultures were treated with DAPI, a non-intercalating compound which binds preferentially to the AT bases of DNA and is capable of inducing fragile sites. Bromodeoxyuridine (BrdU) was added to all the cultures for SCE analysis. Chromomycin A3 was used for mapping lesions and SCEs by R-banding. A total of 400 cells was examined. The main results show that: BrdU, probably by re-equilibrating the unbalanced nucleotide pool of the 199 culture medium, interferes with the synergism between this culture medium and DAPI in inducing the expression of fragile sites; the SCE frequency per cell is not increased by DAPI in both culture media, therefore this compound does not seem to cause any damage to the DNA and seems merely to act by inhibiting the normal condensation of a subset of fragile sites that possess DAPI-specific base sequences; even in the absence of chromosomal lesions, the fragile sites are significantly preferred as SCE sites to non-fragile sites, whereas in the presence of a lesion, both fragile and non-fragile sites have the same likelihood of undergoing SCE. All this indicates that the presence of a lesion strongly favours SCE formation and that common fragile sites are probably chromosome regions preferentially damaged during the S phase

Assignment of FRA1H common fragile site to human chromosome band 1q42.1 proximal to the nuclear NAD+ ADP-ribosyltransferase gene (ADPRT) and to the main 5S rRNA gene locus

This is a more precise localization of FRA1H and ADPRT previously mapped to 1q42 (Sutherland et al., 1985; Baumgartner et al., 1992), and an ordered mapping of these two markers and of the main 5S rRNA locus mapped to 1q42.13 (Lomholt et al., 1995). I.F.: 2.2

Visualizing human 5S rDNA

[No abstract available

Cytogenetic mapping of five YAC clones to human chromosome region 2q31--q32.1 in relation to the FRA2G common fragile site.

In this work, five YAC clones have been mapped by fluorescent in situ hybridization (FISH) to human chromosome region 2q31→q32.1 and ordered in relation to each other and to the FRA2G common fragile site. YAC clones that span the fragile site have been identified.Moreover a deleted HOXD 13 gene has been identified on the 942D2 YAC. I.F.: 2.1