Parental Deployment and Healthcare Utilization in Adolescents with Migraines and Other Somatic Symptoms

Somatic symptoms in adolescents are associated with psychosocial stress. Parental military deployment can function as a stressor for adolescents. A retrospective cohort study was developed exploring relationships between health care utilization, a proxy for symptomatology, and sponsor deployment in adolescents with somatic symptoms. Data was obtained from the Military Health System Data Repository. Migraine headaches was the most common somatic symptom diagnosis. Parental deployment was overall associated with a 27% decrease in visits for somatic symptoms. For adolescents whose sponsor was female, deployment was associated with a 34% decrease in visits. This pattern is inconsistent with prior research on somatic symptoms and psychosocial stressors. Potential causes of this discrepancy are discussed in the context of military family life

Abnormal response to negative feedback in depression

Background. Recent studies have suggested that subjects with depression suffer a diagnosis-specific motivational deficit, characterized by an abnormal response to negative feedback that endures beyond clinical recovery. Furthermore, it has been suggested that negative feedback may motivate non-depressed controls, but not depressed patients, to improve their performance in neuropsychological tests. Methods. We describe two studies. The first compared performance on the simultaneous and delayed match to sample (SDMS) task from the CANTAB neuropsychological test battery, in 20 patients with severe depression with 20 with acute schizophrenia, 40 with chronic schizophrenia and 40 healthy controls. The second examined the performance of depressed patients with diurnal variation in symptoms and cognitive function. Results. All patients groups showed impairments on the simultaneous and delayed match to sample task compared to controls. Depressed patients did not show an abnormal response to negative feedback. Controls did not show a motivational effect of negative feedback. Depressed patients with diurnal variation showed no variation in their response to perceived failure. There was no evidence of abnormal response to negative feedback in any patient group using the ‘runs test’ or of a motivational effect in controls. Conditional probability analysis was not independent of the total number of errors made in the SDMS task. Conclusions. Further studies are suggested to examine whether an abnormal response to negative feedback characterizes particular subgroups of patients suffering from depression

Implementing and managing self-management skills training within primary care organisations: a national survey of the expert patients programme within its pilot phase

A key element of the United Kingdom (UK) health policy reform in relation to chronic disease management is the introduction of a national programme seeking to promote self-care from within the National Health Service (NHS). The mainstay of the Expert Patients Programme (EPP) is a six-week training course that provides the opportunity for anyone with a long-term condition to develop new skills to manage their condition better on a day-to-day basis. The course forms part of the NHS self-care support programme, is administered by Primary Care Trusts (PCTs) and delivered by people who have personal experience of living with a long-term condition. The NHS' official Expert Patients Programme website presently states that, "Pilot EPP courses began at 26 NHS PCT sites across England in May 2002, and by May 2004 approximately 300 PCTs had either actively implemented pilot courses or had committed to joining. The majority of PCTs are now coming to the end of the pilot phase, with many implementing plans to make EPP sustainable for the long-term." The NHS website heralds the pilot "a success." A national, postal survey of PCT EPP Leads was undertaken in order to examine both the evolvement of EPP during its pilot stage and future plans for the programme. A questionnaire was sent out to the 299 PCTs known to have committed to the EPP pilot, and an excellent 100% response rate was obtained over a 3-month period (April-July 2005). One marker of success of the Expert Patients Programme implementation is the actual running of courses by the Primary Care Trusts. This paper explores the extent to which the implementation of the pilot can indeed be viewed as a "success," primarily in terms of the number of courses run, and considers the extent to which PCTs have carried out all that they were committed to do. Findings suggest that the more time an EPP Lead dedicates to the Programme, the more likely it is that EPP has run successfully in the past, and the more likely it is that it will continue to run successfully in the future. Other factors indicating future EPP success include collaborating across PCTs to share co-ordinators, tutors, and funding

Promoting patient engagement with self-management support information: a qualitative meta-synthesis of processes influencing uptake

<p>Abstract</p> <p>Background</p> <p>Patient information has been viewed as a key component of self-management. However, little attention has been given to methods of dissemination or implementation of effective information strategies. Previous problems identified with the use and implementation of patient information point to the need to explore the way in which patients engage with and use information to support self-management for chronic conditions.</p> <p>Methods</p> <p>Four published qualitative studies from a programme of research about self-management were analysed as a group; these included studies of the management of inflammatory bowel disease (IBD); self-help in anxiety and depression (SHADE); menorrhagia, treatment, information, and preference (MENTIP) study; and self-help for irritable bowel syndrome (IBS). For the analysis, we used an adapted meta-ethnographic approach to the synthesis of qualitative data in order to develop an evidence base.</p> <p>Results</p> <p>The ontological status and experience of the condition in everyday life was the most dominant theme to emerge from this synthesis. This, coupled with access to and experience of traditional health services responses, shaped the engagement with and use of information to support self-management. Five key elements were found which were likely to influence this: the perception and awareness of alternative self-management possibilities; the prior extent and nature of engagement with information; the extent of and ability to self-manage; opportunities for use of the information and the stage of the illness career; and congruence and synergy with the professional role.</p> <p>Conclusion</p> <p>People with chronic conditions need support from providers in both supply and engagement with information, in a way which gives legitimacy to the person's own self-management strategies and possible alternatives. Thus, a link could usefully be made between information offered, as well as patients' past experiences of self-management and engagement with services for their condition. The timeliness of the information should be considered, both in terms of the illness career and the type of condition (<it>i.e</it>., before depression gets too bad or time to reflect on existing knowledge about a condition and how it is to be managed) and in terms of the pre-existing relationship with services (<it>i.e</it>., options explored and tried).</p> <p>More considered use of information (how it is provided, by whom, and at what point it should be introduced) is key to facilitating patients' engagement with and therefore use of information to support self-management.</p

Depalmitoylated Ras traffics to and from the Golgi complex via a nonvesicular pathway

Palmitoylation is postulated to regulate Ras signaling by modulating its intracellular trafficking and membrane microenvironment. The mechanisms by which palmitoylation contributes to these events are poorly understood. Here, we show that dynamic turnover of palmitate regulates the intracellular trafficking of HRas and NRas to and from the Golgi complex by shifting the protein between vesicular and nonvesicular modes of transport. A combination of time-lapse microscopy and photobleaching techniques reveal that in the absence of palmitoylation, GFP-tagged HRas and NRas undergo rapid exchange between the cytosol and ER/Golgi membranes, and that wild-type GFP-HRas and GFP-NRas are recycled to the Golgi complex by a nonvesicular mechanism. Our findings support a model where palmitoylation kinetically traps Ras on membranes, enabling the protein to undergo vesicular transport. We propose that a cycle of depalmitoylation and repalmitoylation regulates the time course and sites of Ras signaling by allowing the protein to be released from the cell surface and rapidly redistributed to intracellular membranes

The Case for Coordinating Efforts to Establish Program Guidelines and Strengthen Physiology Undergraduate Degree Programs

Undergraduate degree programs named “Physiology” have existed for over 50 yr. The number of programs and enrolled students have been growing since ~2005 (5, 9). There are many thousands of students currently enrolled in physiology pro- grams across the United States and indeed across the world. Despite the long history and current popularity of the physiol- ogy major, there is no coordinated plan articulated for the design, administration, or assessment of degree programs in physiology at the undergraduate level. Although several professional societies have invested in under- graduate physiology education in various ways, none has under- taken the task of developing programmatic guidelines at the level of a degree program. This paper outlines the work being done by multiple stakeholders in physiology undergraduate education in the hopes of building a collaboration among interested parties. A large-scale collaboration could result in establishing consensus national programmatic guidelines. Through coordinated efforts, we ensure that entities with common educational interests are working together, and we collectively strengthen our programs to help our students succeed. The goals of this paper are to: 1) draw attention to the lack of national, program-level guidelines for physiology under- graduate degree programs; 2) share ongoing efforts by stake- holders in physiology undergraduate education; 3) suggest a mechanism for coordination among stakeholders; and 4) dis- cuss challenges and considerations for development of pro- grammatic guidelines for physiology programs

HST UV Spectroscopy of the Dwarf Starburst Galaxy Pox 186

Studying the galaxies responsible for reionization is often conducted through local reionization-era analogs; however, many of these local analogs are too massive to be representative of the low-mass star-forming galaxies that are thought to play a dominant role in reionization. The local, low-mass dwarf starburst galaxy Pox 186 is one such system with physical conditions representative of a reionization-era starburst galaxy. We present deep ultraviolet (UV) spectroscopy of Pox 186 to study its stellar population and ionization conditions and to compare these conditions to other local starburst galaxies. The new Cosmic Origins Spectrograph data are combined with archival observations to cover $\sim$1150-2000 A and allow for an assessment of Pox 186's stellar population, the relative enrichment of C and O, and the escape of ionizing photons. We detect significant Ly$\alpha$ and low-ionization state absorption features, indicative of previously undetected neutral gas in Pox 186. The C/O relative abundance, log(C/O) = -0.62$\pm$0.02, is consistent with other low-metallicity dwarf galaxies and suggests a comparable star formation history in these systems. We compare UV line ratios in Pox 186 to those of dwarf galaxies and photoionization models, and we find excellent agreement for the ratios utilizing the intense C III], O III], and double-peaked C IV lines. However, the UV and optical He II emission is faint and distinguishes Pox 186 from other local starburst dwarf galaxies. We explore mechanisms that could produce faint He II, which have implications for the low-mass reionization-era galaxies which may have similar ionization conditions.Comment: 22 pages, 9 figures, accepted for publication in The Astrophysical Journa

Fourteen Draft Genome Sequences for the First Reported Cases of Azithromycin-Resistant Neisseria gonorrhoeae in Ireland

Here, we report the draft genome assemblies of 14 azithromycin-resistantNeisseria gonorrhoeaeclinical isolates, representing the first such strains identified in Ireland. Among these isolates are the first reported highly resistant strains (MIC >256mg/liter), which both belonged to the ST1580 sequence type

General practitioners' views on reattribution for patients with medically unexplained symptoms: a questionnaire and qualitative study

Background: The successful introduction of new methods for managing medically unexplained symptoms in primary care is dependent to a large degree on the attitudes, experiences and expectations of practitioners. As part of an exploratory randomised controlled trial of reattribution training, we sought the views of participating practitioners on patients with medically unexplained symptoms, and on the value of and barriers to the implementation of reattribution in practice. Methods: A nested attitudinal survey and qualitative study in sixteen primary care teams in north-west England. All practitioners participating in the trial (n = 74) were invited to complete a structured survey. Semi-structured interviews were undertaken with a purposive sub-sample of survey respondents, using a structured topic guide. Interview transcripts were used to identify key issues, concepts and themes, which were grouped to construct a conceptual framework: this framework was applied systematically to the data. Results: Seventy (95%) of study participants responded to the survey. Survey respondents often found it stressful to work with patients with medically unexplained symptoms, though those who had received reattribution training were more optimistic about their ability to help them. Interview participants trained in reattribution (n = 12) reported that reattribution increased their confidence to practice in a difficult area, with heightened awareness, altered perceptions of these patients, improved opportunities for team-building and transferable skills. However general practitioners also reported potential barriers to the implementation of reattribution in routine clinical practice, at the level of the patient, the doctor, the consultation, diagnosis and the healthcare context. Conclusion: Reattribution training increases practitioners' sense of competence in managing patients with medically unexplained symptoms. However, barriers to its implementation are considerable, and frequently lie outside the control of a group of practitioners generally sympathetic to patients with medically unexplained symptoms and the purpose of reattribution. These findings add further to the evidence of the difficulty of implementing reattribution in routine general practice