The Global Task Force for Chronic Pain in People with HIV (PWH):Developing a research agenda in an emerging field

Chronic pain is a common comorbidity in people with HIV (PWH), with prevalence estimates of 25-85%. Research in this area is growing, but significant gaps remain. A Global Task Force of HIV experts was organized to brainstorm a scientific agenda and identify measurement domains critical to advancing research in this field. Experts were identified through literature searches and snowball sampling. Two online questionnaires were developed by Task Force members. Questionnaire 1 asked participants to identify knowledge gaps in the field of HIV and chronic pain and identify measurement domains in studies of chronic pain in PWH. Responses were ranked in order of importance in Questionnaire 2, which was followed by a group discussion. 29 experts completed Questionnaire 1, 25 completed Questionnaire 2, and 21 participated in the group. Many important clinical and research priorities emerged, including the need to examine etiologies of chronic pain in PWH. Pain-related measurement domains were discussed, with a primary focus on domains that could be assessed in a standardized manner across various cohorts that include PWH in different countries. We collaboratively identified clinical and research priorities, as well as gaps in standardization of measurement domains, that can be used to move the field forward

Typology of adults diagnosed with mental disorders based on socio-demographics and clinical and service use characteristics

<p>Abstract</p> <p>Background</p> <p>Mental disorder is a leading cause of morbidity worldwide. Its cost and negative impact on productivity are substantial. Consequently, improving mental health-care system efficiency - especially service utilisation - is a priority. Few studies have explored the use of services by specific subgroups of persons with mental disorder; a better understanding of these individuals is key to improving service planning. This study develops a typology of individuals, diagnosed with mental disorder in a 12-month period, based on their individual characteristics and use of services within a Canadian urban catchment area of 258,000 persons served by a psychiatric hospital.</p> <p>Methods</p> <p>From among the 2,443 people who took part in the survey, 406 (17%) experienced at least one episode of mental disorder (as per the Composite International Diagnostic Interview (CIDI)) in the 12 months pre-interview. These individuals were selected for cluster analysis.</p> <p>Results</p> <p>Analysis yielded four user clusters: people who experienced mainly anxiety disorder; depressive disorder; alcohol and/or drug disorder; and multiple mental and dependence disorder. Two clusters were more closely associated with females and anxiety or depressive disorders. In the two other clusters, males were over-represented compared with the sample as a whole, namely, substance abuses with or without concomitant mental disorder. Clusters with the greatest number of mental disorders per subject used a greater number of mental health-care services. Conversely, clusters associated exclusively with dependence disorders used few services.</p> <p>Conclusion</p> <p>The study found considerable heterogeneity among socio-demographic characteristics, number of disorders, and number of health-care services used by individuals with mental or dependence disorders. Cluster analysis revealed important differences in service use with regard to gender and age. It reinforces the relevance of developing targeted programs for subgroups of individuals with mental and/or dependence disorders. Strategies aimed at changing low service users' attitude (youths and males) or instituting specialised programs for that particular clientele should be promoted. Finally, as concomitant disorders are frequent among individuals with mental disorder, psychological services and/or addiction programs must be prioritised as components of integrated services when planning treatment.</p

In-vitro-Exposition von humanen Nasenschleimhautzellen und Lymphozyten mit Glycerin als Bestandteil des Shisha-Tabaks

Die Effekte von Shisha-Tabakkonsum auf die humanen Zielzellen der Kanzerogenese im oberen Aerodigestivtrakt sind bisher weitgehend unerforscht. In der vorliegenden Arbeit werden zyto- und genotoxische Effekte von Glycerin, dem wichtigsten Feuchthaltemittel im Shisha-Tabak, auf humane Nasenschleimhautzellen und Lymphozyten dargestellt. Lymphozyten und Nasenschleimhautzellen von jeweils 10 Patienten wurden für eine Stunde unterschiedlichen Glycerin-Konzentrationen (0,001 bis 6,0 mol/l) exponiert. Zytotoxische Wirkungen wurden durch eine Trypanblau-Färbung, genotoxische durch den Comet Assay erfasst. Eine Vitalität unter 90% wurde sowohl bei Nasenschleimhautzellen als auch bei Lymphozyten ab einer Konzentration von 3,0 mol/l erreicht. Die höchste genotoxische Schädigung lag sowohl bei Lymphozyten als auch bei Nasenschleimhautzellen bei einer Konzentration von 3,0 mol/l vor und war somit auch höher als die jeweiligen Positiv-Kontrollen (200 uM MMS). In den Versuchen waren zytotoxische (je ab 3,0 mol/l) und genotoxische (je ab 1,0 mol/l) Wirkungen erst bei deutlich höheren Konzentrationen zu beobachten als sie beim Shisha-Rauchen auftreten. Limitationen der Arbeit sind u.a. die kurze Expositionsdauer, das flüssige Expositionsmedium sowie die Expositionstemperatur bei 37 °C. Aufgrund des stochastischen Risikos genotoxischer Effekte werden derzeit weitere Endpunkte auf chromosomaler Ebene untersucht, um auf diese Weise die aktuelle gesellschaftspolitische Diskussion wissenschaftlich fundieren zu können.Der Erstautor gibt keinen Interessenkonflikt an

Treatment goals of depressed outpatients: A qualitative investigation of goals identified by participants in a depression treatment trial

Treatment goals and preferences of depressed patients are important, but they are rarely empirically studied. Although clinicians are likely to discuss goals with individual patients, research that clarifies overall patterns in the treatment goals of depressed patients could be useful in informing new interventions for depression. Such research could also potentially help address problems such as poor adherence and psychotherapy drop-out. In this preliminary qualitative investigation, we examined treatment goals established by depressed outpatients in the context of a trial of behaviorally oriented psychotherapy. The treatment goals that were most commonly articulated included improving social and family relationships, increasing physical health behaviors, finding a job, and organizing one\u27s home. These results underscore the fact that, in addition to improvement in the symptoms of depression, functional improvements are viewed as key treatment goals by depressed individuals. Copyright © 2010 Lippincott Williams & Wilkins Inc

The importance of interpersonal treatment goals for depressed inpatients

Increased understanding of the treatment goals of depressed patients may lead to improved treatments and assist researchers and program evaluators in choosing clinically relevant outcome measures. To characterize patients\u27 depression treatment goals, we interviewed hospitalized depressed patients about their treatment goals. Common responses included improving relationships, decreasing sadness or anxiety, and finding a job or improving job performance. On a written questionnaire, patients also ranked decreasing suicidal thoughts highly. These results suggest that for many severely depressed individuals, primary treatment goals include improvements in social and occupational functioning in addition to symptomatic improvement. © 2008 Lippincott Williams & Wilkins, Inc