Response

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/63163/1/154099904322836537.pd

Skin and Systemic Inflammation in Schnitzler's Syndrome Are Associated With Neutrophil Extracellular Trap Formation

Schnitzler's syndrome is a rare autoinflammatory disorder characterized by interleukin-1ß-mediated and neutrophil-dominated inflammation. Neutrophil extracellular traps (NETs) are web-like structures of decondensed chromatin, histones, and antimicrobial peptides released by neutrophils. NETs were initially described in the context of pathogen defense but are also involved in autoimmune-mediated skin diseases. Here, we assessed the role of neutrophil extracellular trap formation (NETosis) in Schnitzler's syndrome. Immunofluorescence co-staining of myeloperoxidase and subnucleosomal complex was performed on lesional skin samples from patients with Schnitzler's syndrome, other neutrophilic dermatoses (cryopyrin-associated periodic syndrome, Sweet syndrome, and pyoderma gangrenosum), urticarial vasculitis and chronic spontaneous urticaria as well as healthy control skin. Blood neutrophils from patients with Schnitzler's syndrome and controls were isolated, and NETosis was induced by phorbol 12-myristate 13-acetate (PMA). Also, NETosis of control neutrophils induced by symptomatic Schnitzler's syndrome sera, cytokines and sub-threshold PMA doses was studied. Immunofluorescence co-staining revealed widespread and substantial NET formation in lesional skin of Schnitzler's syndrome patients but absence of NETs in chronic spontaneous urticaria and control skin. Neutrophils undergoing NETosis were observed in the skin of other neutrophilic diseases too. Correspondingly, blood neutrophils from Schnitzler's syndrome patients showed significantly elevated NETosis rates compared to control neutrophils following stimulation with PMA. Increased NETosis correlated well with high levels of C-reactive protein (CRP). SchS patients with the lowest NETosis rates had persistent joint and bone pain despite IL-1 blockade. Stimulation of control neutrophils and sub-threshold PMA with sera of symptomatic Schnitzler's syndrome patients disclosed enhanced NETosis as compared to control sera. Our results suggest that the induction of NET formation by neutrophils contributes to skin and systemic inflammation and may support the resolution of local inflammation in Schnitzler's syndrome.</p

Depression during pregnancy: detection, comorbidity and treatment

Depression during pregnancy is common (∼15%). Routine prenatal depression screening coupled with the use of physician collaborators to assist in connecting women with care is critical to facilitate treatment engagement with appropriate providers. Providers should be aware of risk factors for depression – including a previous history of depression, life events, and interpersonal conflict – and should appropriately screen for such conditions. Depression during pregnancy has been associated with poor pregnancy outcomes including preeclampsia, insufficient weight gain, decreased compliance with prenatal care, and premature labor. Current research has questioned the overall benefit of treating depression during pregnancy with antidepressants when compared to the risk of untreated depression for mother and child. Published guidelines favor psychotherapy above medication as the first line treatment for prenatal depression. Poor neonatal adaptation or withdrawal symptoms in the neonate may occur with fetal exposure in late pregnancy, but the symptoms are mild to moderate and transient. The majority of mothers who decide to stop taking their antidepressants during pregnancy suffer relapsing symptoms. If depression continues postpartum, there is an increased risk of poor mother–infant attachment, delayed cognitive and linguistic skills in the infant, impaired emotional development, and behavioral problems in later life. Bipolar depression, anxiety and substance use disorders, and/or presence of severe psychosocial stress can lead to treatment-resistance. Modified and more complex treatment algorithms are then warranted. Psychiatric medications, interpersonal or cognitive-behavioral therapy, and adjunctive parent–infant/family treatment, as well as social work support, are modalities often required to comprehensively address all issues surrounding the illness.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/79238/1/j.1758-5872.2010.00051.x.pd

Raising the red flag for malaria elimination and integrated fever surveillance in the Brazilian amazon

In the past decade, Brazil has achieved considerable progress in malaria control, with 140 000 cases reported in 2015, the lowest numbers since 1980.1 Part of this success has been attributed to the establishment of a large network of around 3000 diagnostic and treatment units for malaria.1 A remarkable feature is that these services are provided for free as part of the public universal health-care system (Sistema Único de Saúde [SUS]) and cover rural and riverine areas in the Amazon region—where more than 83% of malaria transmission occurs

The Sensitivity and Psychometric Properties of a Brief Computer-Based Cognitive Screening Battery in a Depression Clinic

At present, there is poor accuracy in assessing cognitive and vegetative symptoms in depression using clinician or self-rated measures, suggesting the need for development of standardized tasks to assess these functions. The current study assessed the psychometric properties and diagnostic specificity of a brief neuropsychological screening battery designed to assess core signs of depression; psychomotor retardation, attention and executive functioning difficulties, and impaired emotion perception within an outpatient psychiatry setting. Three hundred eighty-four patients with mood disorders and 77 healthy volunteers participated. A large percentage of patients met diagnostic criteria for Major Depressive Disorder alone (49%) or with another comorbid psychiatric disorder (24%). A brief, 25-min battery of computer-based tests was administered to control participants and patients measuring the constructs of inhibitory control, attention, visual perception, and both executive and visual processing speed. The patient groups performed significantly worse than the control group regardless of diagnosis on visual perception and attention accuracy and processing speed factors. Surprisingly, the anxiety disorder group performed better than several other psychiatric disorder groups in inhibitory control accuracy. Developing valid and reliable measures of cognitive signs in mood disorders creates excellent opportunities for tracking cognitive status prior to initiation of treatment, and allows for reliable retest following treatment

Edifício-monumento à Independência do Brasil (1823-1923): do planejamento ao uso, operação e manutenção

The monument-building is the result of sixty early years of efforts to build a commemorative landmark to the proclamation of Independence of Brazil, whose most effective developments led to the installation of the Paulista Museum. The goal of this article is to highlight the stakeholders and consenting parties’ efforts to plan, program, design, build, adapt, use, operate, and maintain the monument-building between 1823 and 1923. To this end, documentary research was developed from a historical series of the Revista do Museu Paulista and the Anais do Museu Paulista. As a result, evidence was obtained on important decision-making, such as (1) the option of an architectural monument instead of a sculptural one in the planning phase; (2) the application of the golden ratio in the design phase; (3) costs and deadlines in the construction phase; and (4) efforts to conserve, adapt, and improve the monument-building and surroundings in the phases of use, operation, and maintenance. This article is part of the studies related to the doctoral research of one of the authors, which seeks to better understand the facility management, related to operation and maintenance activities, with the potential to be implemented in the Novo Museu do Ipiranga.O edifício-monumento é resultado de sessenta anos de esforços para edificar um marco comemorativo à Proclamação de Independência do Brasil, cujos desdobramentos mais efetivos significaram a instalação do Museu Paulista. O objetivo deste artigo é evidenciar as iniciativas dos intervenientes e anuentes para planejar, programar, projetar, construir, adequar, utilizar, operar e manter o edifício-monumento entre 1823 e 1923. Para tanto, foi realizada uma pesquisa documental a partir de série histórica da Revista do Museu Paulista e dos Anais do Museu Paulista. Como resultado, obteve-se evidências sobre importantes tomadas de decisão, como (1) a opção de uma obra arquitetônica em vez de escultórica na fase de planejamento; (2) a aplicação da razão áurea na fase de projeto; (3) custos e prazos na fase de construção; e (4) as atividades de conservação, adequação e melhorias no edifício-monumento e no seu entorno nas fases de uso, operação e manutenção. Este artigo faz parte dos estudos relativos à pesquisa de doutorado de um dos autores, que visa compreender melhor o facility management, relacionado às atividades de operação e manutenção, com potencial de ser implementado no Novo Museu do Ipiranga.La construcción del monumento es el resultado de sesenta años de esfuerzos para construir un hito conmemorativo de la proclamación de la independencia de Brasil, cuyos desarrollos más efectivos significaron la instalación del Museu Paulista. El objetivo de este artículo es resaltar las iniciativas de las partes intervinientes y consentidas para planificar, programar, diseñar, construir, adaptar, usar, operar y mantener el (edificio) monumento desde el período de 1823 a 1923. Para tal efecto, se realizó un levantamiento documental basado en la serie histórica de la Revista do Museu Paulista y los Anais do Museu Paulista. Como resultado, se obtuvo evidencia sobre importantes tomas de decisiones, tales como: (a) la opción de una obra arquitectónica en lugar de una escultórica (en la fase de planeamiento); (b) la aplicación de la proporción áurea (en la fase de diseño); (c) costos y plazos (en la fase de construcción); y (d) las actividades de conservación, adecuación y mejora del edificio-monumento y su entorno (en las fases del uso, operación y mantenimiento). Este artículo forma parte de los estudios relacionados con la investigación doctoral de uno de los autores, con el objetivo de comprender mejor el Facility Management que se pretende implementar en el caso actual del Novo Museu do Ipiranga

Buddy-to-Buddy, a citizen soldier peer support program to counteract stigma, PTSD, depression, and suicide

Citizen soldiers (National Guard and Reserves) represent approximately 40% of the two million armed forces deployed to Afghanistan and Iraq. Twenty-five to forty percent of them develop PTSD, clinical depression, sleep disturbances, or suicidal thoughts. Upon returning home, many encounter additional stresses and hurdles to obtaining care: specifically, many civilian communities lack military medical/psychiatric facilities; financial, job, home, and relationship stresses have evolved or have been exacerbated during deployment; uncertainty has increased related to future deployment; there is loss of contact with military peers; and there is reluctance to recognize and acknowledge mental health needs that interfere with treatment entry and adherence. Approximately half of those needing help are not receiving it. To address this constellation of issues, a private–public partnership was formed under the auspices of the Welcome Back Veterans Initiative. In Michigan, the Army National Guard teamed with the University of Michigan and Michigan State University to develop innovative peer-to-peer programs for soldiers (Buddy-to-Buddy) and augmented programs for military families. Goals are to improve treatment entry, adherence, clinical outcomes, and to reduce suicides. This manuscript describes training approaches, preliminary results, and explores future national dissemination.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/79148/1/j.1749-6632.2010.05719.x.pd

Lengthened Predelivery Stay and Antepartum Complications in Women with Depressive Symptoms During Pregnancy

Background: It is crucial to understand the timing and mechanisms behind depression's effect on peripartum stay because attempts to intervene will vary based on the time period involved. We designed this study to compare predelivery and postdelivery length of stay in women with and without elevated depressive symptoms during pregnancy. Methods: This study involved secondary data analysis of a larger study exploring antepartum depression. Each subject completed the Center for Epidemiological Studies Depression Scale (CES-D) during pregnancy at a mean of 25.8 weeks' gestation. We used time-stamped data to compare total peripartum, predelivery, and postdelivery lengths of stay in women with and without elevated depressive symptoms during pregnancy. In addition, we used a Cox proportional hazards regression model to evaluate potential mechanisms for depression's effect on length of stay. Results: The study sample included 802 pregnant women. Overall, 18% of study subjects scored >=16 on the CES-D. Bivariate analyses demonstrated a significant association between elevated depressive symptoms and longer predelivery stays (time from admission to delivery). Interaction analyses demonstrated a significant interaction effect between depressive symptoms and parity, such that depressive symptoms were significantly associated with predelivery length of stay in multiparas but not so in primiparous subjects. In a multivariate model of multiparous subjects, depression's effect on length of stay was partially influenced by sociodemographic confounders but remained significant until antepartum complications were added to the model. Conclusions: Depressive symptoms during pregnancy are significantly associated with a subsequent increase in predelivery length of stay, and this association is mediated in part by antepartum complications, even after controlling for sociodemographic factors. These longer hospital stays can present significant burdens to the patient, her family, and the healthcare system. Future studies should evaluate whether interventions for depression during pregnancy can impact this relationship among depressive symptoms during pregnancy, antepartum complications, and extensive predelivery hospitalizations.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/90486/1/jwh-2E2010-2E2380.pd

Rates and Correlates of Alcohol Use Among Pregnant Women in Obstetrics Clinics

The purpose of this study was to demonstrate feasibility of screening and to identify rates and correlates of alcohol use in a large, demographically representative sample of pregnant women across a number of obstetrics clinics, extending previous studies of single or high-risk settings. Identification of harmful alcohol use during pregnancy and of associated factors is critical for the design and implementation of secondary prevention strategies. Methods : A total of 1131 pregnant women age 18 and older were screened in the waiting areas of eight obstetrics clinics in Southeastern Michigan using a brief (10 min) screening questionnaire. This survey consisted of direct and indirect (TWEAK) measures of alcohol use, as well items assessing demographic characteristics, use of tobacco, and whether participants’ physicians discussed alcohol use behavior with them. Women ranged in age from 18 to 46, with a mean age of 28.7 (SD = 5.3). The racial/ethnic distribution of our sample suitably reflects the various racial segments of the Michigan population. Results : We found that 15.1% of the total sample ( n = 169) reported any alcohol use during pregnancy, with the majority of those women reporting relatively low levels of alcohol use. One hundred and forty-seven women (13%) scored above the cutoff on the TWEAK (i.e., above a score of 2). Based on multivariate analyses, higher risk alcohol use (defined as binge drinking or greater than one standard drink per week) during pregnancy was predicted by smoking and earlier stage of pregnancy. Caucasian race, smoking, psychological distress, and greater number of drinks during pregnancy predicted scores above a cutoff of 2 on the TWEAK. Conclusion : This study demonstrated that screening in busy obstetrics clinics is feasible and acceptable to women and that it may be optimal to use both indirect and direct measures of alcohol use. In addition, brief assessments should be conducted throughout pregnancy and may be targeted or intensified for smokers and for women earlier in their pregnancy.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/66431/1/j.1530-0277.2003.tb02725.x.pd

The integration of behavioral health consultants within a state-wide psychiatry consultation program: a community case study

This paper describes the integration and role of masters-prepared behavioral health consultants (BHCs) within a state-wide psychiatry consultation program for children, adolescents, and perinatal women. Data from the Michigan Clinical Consultation and Care (MC3) program are reviewed, with attention to the role that BHCs play in the consultation process, integrated care, screening, and their dual roles with Community Mental Health Services Programs (CMHSPs) in Michigan. Approximately 82% of MC3 services are provided by the BHCs and involve resources or integrated care. BHCs play a role in managing provider consultations and connecting patients and providers to resources in the MC3 program