[Self-stigma and social support in patients with addiction problems]. / Zelfstigma en sociale steun bij patiënten met verslavingsproblematiek.

BACKGROUND: Patients with a substance use disorder often experience self-stigma. Support of the environment seems to decrease self-stigma, but little is known about the relationship with experienced and desired social support. AIMS: To gain insight in the relationships between experienced social support, desired social support and self-stigma, and to examine whether the severity of the substance use disorder plays a role in these relationships. METHOD: 83 outpatients with a substance use disorder completed the Social Support List and the Internalized Stigma of Mental Illness scale. RESULTS: Pearson correlations showed relationships between desired social support, experienced social support and self-stigma, but a multiple regression revealed only a relationship between desired social support and self-stigma. The relationship between social support and self-stigma was also found among patients with low severe substance use disorders, but among patients with a severe substance use a relationship was found with the experienced social support. CONCLUSIONS: Desired social support seems to be of more importance for self-stigma than experienced social support. However, among patients with high severe substance use disorders experienced social support seems to be more important.

[Vision on man, vision on addiction: a multiple view of problems and recovery]. / Visie op de mens, visie op verslaving: een meervoudige kijk op problematiek en herstel.

BACKGROUND: The way we look at addiction has changed dramatically over the past decades. Currently, the brain disease model is the leading model in the biomedical scientific literature. However, this model has been severely criticized and seems to apply mostly to people with a chronic form of addiction. When the ideas of the recovery movement are applied to the current understanding of addiction, the biopsychosocial (bps) model seems the most fitting. On the other hand, while 'meaningful existence' (or 'sense of meaning') is a focal element the model of recovery, this concept is not included in the bps model.
AIM: To explore whether addition of the concept of meaning to the bps model is usefull.
METHOD: Discussion of a case and evaluation of selected literature.
RESULTS: We advocate the addition of the concept 'sense of meaning' to the bps model, making it the bpsm model. A matter still to be resolved is whether this concept would become a fourth domain or considered either subjacent to or above the other three domains. We suggest that, while sense of meaning is not new in addiction care, adding this concept would underline the importance of the personal story behind the addiction.
CONCLUSION: Addition of the concept meaning to the bps model is Usefull in addiction care.

The effects of assertive community treatment including integrated dual diagnosis treatment on nuisance acts and crimes in dual-diagnosis patients.

We investigated whether Assertive Community Treatment (ACT) combined with Integrated Dual Diagnosis Treatment (IDDT) is associated with a decrease in nuisance acts and crime convictions in dual-diagnosis repeated offenders. Forty-three patients were monitored from 21 months before until 12 months after the start of ACT-IDDT, using police data and the Health of the Nation Outcome Scales (HoNOS). Results show that while nuisance acts and convictions increased in the 21 months before the start of ACT-IDDT, nuisance acts decreased and convictions stabilized during the next 12 months. The decrease in nuisance acts was associated with a decrease in substance abuse.

Corticotropin-releasing factor receptor types 1 and 2 are differentially expressed in pre- and post-synaptic elements in the post-natal developing rat cerebellum.

Corticotropin-releasing factor (CRF)-like proteins act via two G-protein-coupled receptors (CRF-R1 and CRF-R2) playing important neuromodulatory roles in stress responses and synaptic plasticity. The cerebellar expression of corticotropin-releasing factor-like ligands has been well documented, but their receptor localization has not. This is the first combination of a light microscopic and ultrastructural study to localize corticotropin-releasing factor receptors immunohistologically in the developing rat cerebellum. Both CRF-R1 and CRF-R2 were expressed in climbing fibres from early stages (post-natal day 3) to the adult, but CRF-R2 immunoreactivity was only prominent throughout the molecular layer in the posterior cerebellar lobules. CRF-R1 immunoreactivity was concentrated in apical regions of Purkinje cell somata and later in primary dendrites exhibiting a diffuse cytoplasmic appearance. In Purkinje cells, CRF-R1 immunoreactivity was never membrane bound post-synaptically in dendritic spines while CRF-R2 immunoreactivity was found on plasmic membranes of Purkinje cells from post-natal day 15 onwards. We conclude that the localization of these receptors in cerebellar afferents implies their pre-synaptic control of the release of corticotropin-releasing factor-like ligands, impacting on the sensory information being transmitted from afferents. Furthermore, the fact that CRF-R2 is membrane bound at synapses, while CRF-R1 is not, suggests that ligands couple to CRF-R2 via synaptic transmission and to CRF-R1 via volume transmission. Finally, the distinct expression profiles of receptors along structural domains of Purkinje cells suggest that the role for these receptors is to modulate afferent inputs.

Traumatic life events and suicide risk among jail inmates: the influence of types of events, time period and significant others.

Relationships between traumatic life events and suicide risk were studied in two samples of jail inmates with a low (N = 216) and a high (N = 51) suicide risk. Although nonsuicidal inmates reported a high prevalence of traumatic life events, suicidal inmates reported even higher prevalence rates. Suicidal inmates reported more episodes of sexual abuse, physical maltreatment, emotional maltreatment, abandonment, and suicide attempts by significant others. They also had experienced more traumatic life events during childhood, later life, and detention. It is concluded that traumatic life events are associated with suicide risk and that such an association remains in a population with a high prevalence of traumatic life events. It is also concluded that suicide risk is dependent of the type of life event, the timing of the event, and the type of persons involved in the event.

(Electron) microscopic observations on tissue integration of collagen-immobilized polyurethane.

The foreign body reactions to collagen-immobilized polyurethane (PU-CI) films during subcutaneous implantation in rats were characterized. The underlying concept is that collagen-immobilization will improve the tissue integration. Since the method of collagen-immobilization involves the covalent coupling of collagen to an acrylic acid (AA) based surface graft, both non-modified PU and PU-AA were used as controls. Bare PU has a flat surface, whereas both PU-AA and PU-CI displayed a slightly roughened surface. Implantation showed that PU-CI induced early after implantation a far more intense foreign body reaction than PU and PU-AA. This reaction consisted of increased presence of fibrin, granulocytes and macrophages. Roughening of the surface as with PU-AA induced only a small increase in fibrin formation and cellular migration. At day 5 the reaction to PU-CI had slowed down; giant cell formation now slowly started but was decreased compared to PU and PU-AA. At day 10 capsules around each type of material looked similar, but in contrast to PU. PU-CI films could no longer be dissected from their capsules. Only at week 3 this also occurred with PU, at which time point again similar capsules with the three materials were observed. At week 6, of the three materials PU-CI showed the thinnest capsule with most immediate adherence of connective tissue. These results show that collagen-immobilization of PU increased the early tissue reaction and therefore the tissue integration. The thin capsule observed at 6 weeks may be beneficial in e.g. infectious circumstances, when easy access for immune reactions is needed. This, and the long-term performance of PU-CI will be a matter of future investigations.

Self-esteem and outcome fairness: differential importance of procedural and outcome considerations.

Results of a survey of 222 detainees in Dutch jails and police stations showed that outcome-fairness judgments of individuals with high self-esteem were more strongly related to outcome considerations than to procedural considerations, whereas outcome-fairness judgments of individuals with low self-esteem were more strongly related to procedural considerations than to outcome considerations. It was proposed that these differences were due to the fact that (a) procedures more strongly express a social evaluation than outcomes and (b) individuals with low self-esteem are more concerned with social evaluations than individuals with high self-esteem. The implications of the results for other individual-differences factors and other populations than detainees are discussed.

Electronmicroscopical evaluation of short-term nerve regeneration through a thin-walled biodegradable poly(DLLA-epsilon-CL) nerve guide filled with modified denatured muscle tissue.

The aim of this study was to evaluate short-term peripheral nerve regeneration across a 15-mm gap in the sciatic nerve of the rat, using a thin-walled biodegradable poly(DL-lactide-epsilon-caprolactone) nerve guide filled with modified denatured muscle tissue (MDMT). The evaluation was performed using transmission electron microscopy and morphometric analysis. Evaluation times ranged from 3 to 12 weeks after reconstruction. Already, 3 weeks after reconstruction, myelinated nerve fibers could be observed in the distal nerve stump. Twelve weeks after reconstruction, the number of (non)myelinated nerve fibers had significantly increased in the distal nerve stump. From this study, we can conclude that a thin-walled biodegradable poly(DL-lactide-epsilon-caprolactone) nerve guides filled with MDMT can be successfully applied in the reconstruction of severed nerves in the rat model. Furthermore, we showed fast nerve regeneration across the 15-mm nerve gap and found that the use of MDMT functioned as a mechanical support preventing a collapse of this thin-walled nerve guide.

Ultrastructure of the endolymphatic sac in two-phase endolymphatic hydrops in the guinea pig.

Two-phase endolymphatic hydrops is a subtle experimental model for Meniere's disease. Chronic dysfunction of the endolymphatic sac, induced by dissection of the most distal part without causing damage to the intermediate part, is combined with increased endolymph production induced by administration of aldosterone which stimulates the N/K-ATPase in the stria vascularis. A transmission electron microscopic study was performed on the endolymphatic sacs of four groups of guinea pig cochleas: controls: non-operated aldosterone-treated cochleas; operated (dissection of the endolymphatic sac) cochleas; operated and aldosterone-treated cochleas. Light and electron microscopy showed a normal morphology in the controls. Aldosterone treatment had no visible effect. Dissected ears revealed severe deviations. The epithelium of the intermediate sac was low, showed dilated lateral intercellular spaces indicating elevated fluid transport and displayed serious degenerative processes. Distally, the endolymphatic sac was completely blocked by newly formed bone. Additional aldosterone treatment had no cumulative effect on the dissected ears.

Police custody detainees and forensic medicine: use of medical resources in the cell block.

Various Dutch reports show that medical usage among those detained in police cells is many times higher than among the average population. Many visits by forensic physicians (some 36%) are due to the fact that many police custody detainees are addicted. Also, many visits are carried out as a result of the fact that the police must frequently put into custody individuals who suffer intoxications and/or injuries (some 13%) or psychiatric problems (6%-17%). In addition, many visits are for the benefit of detainees who cannot cope with conditions during their detention (21%-30%). Only a minority of the visits are to help police custody detainees who are (chronically) ill. Because of all this, a forensic physician's work mainly consists of writing repeat prescriptions, prescribing methadone, referring detainees to other assistance services and giving advice to guards or police officers on duty. This makes forensic medicine a profession in a class of its own.

Tissue reactions to bacteria-challenged implantable leads with enhanced infection resistance.

Tissue reactions to implantable pacemaker leads were investigated in an early infection model in rabbits. Both standard leads and surface-modified leads were used. The surface modification technique was applied to achieve controlled release of the antibiotic gentamicin. The insulating polyurethane tubing material of the leads was provided with an acrylic acid/acrylamide copolymer surface graft and then loaded with gentamicin. Implantation periods varied from day 4, to week 3 1/2, to week 10. We investigated tissue reactions in the absence of an infectious challenge and also the efficacy of surface-modified leads in preventing infection after challenge with Staphylococcus aureus was evaluated. It was demonstrated that the applied surface modification did not induce adverse effects although during early postimplantation an increase in infiltration of granulocytes and macrophages and wound fluid and fibrin deposition were observed. After bacterial challenge, standard leads were heavily infected at each explantation period, denoted by abscesses, cellular debris, and bacterial colonies. In contrast, little or no infection was observed, either macroscopically or by bacterial cultures, with the surface-modified leads. Microscopy showed little evidence of the bacterial challenge, and that primarily at day 4. It was concluded that the applied surface modification demonstrated enhanced infection resistance and thus represents a sound approach to the battle against infectious complications with biomaterials.

Modulation of the tissue reaction to biomaterials. II. The function of T cells in the inflammatory reaction to crosslinked collagen implanted in T-cell-deficient rats.

Unwanted tissue reactions are often observed resulting in events such as early resorption of the biomaterial, loosening of the implant, or a chronic (immunologic) response. From immunologic studies it is known that inflammatory reactions can be modulated by use of (anti)-growth factors or anti-inflammatory drugs. Before this can be employed with respect to biomaterials, the role of individual factors (humoral and cellular) has to be studied. In this part of the investigation, the role of T cells was studied by use of T-cell-deficient (nude) rats and control (AO) rats. Hexamethylenediisocyanate-crosslinked dermal sheep collagen (HDSC) was selected as the test material. The results showed that T cells or T cell-related factors played a prominent role in the attraction of macrophages and the formation of giant cells, their antigen presentation, and their phagocytotic capacity. As a consequence, degradation of HDSC was strongly delayed. This study also showed that infiltration of fibroblasts and creation of stromal areas in HDSC was restricted to areas subjected to degradation. However, in time, absence of T cells resulted in increased formation and maturation of autologous rat collagen. Results obtained suggest that the inflammatory reaction to biomaterials might be modulated by controlling T-cell activation.

Suicides and other deaths in police custody.

This article presents data from a study on 59 deaths in Dutch police stations in the period 1983-1993. Twenty deaths were caused by suicide, 19 by intoxications, 8 by natural causes, and 12 by other or unknown causes. The mortality rate, suicide rate, and poisoning rate in police stations were higher than in penitentiary institutions and in the general population. The morality rate was lower in large police stations than in small police stations. Identification of deviant detainees seemed less problematic than handling these deviant detainees. It is argued that exceptional detainees without serious charges should be transferred to Health Care services. Other structural preventive measures are also discussed.

Progesterone receptors in arachnoid cysts. An immunocytochemical study in 2 cases.

We report 2 cases of arachnoid cysts, one with a retrocerebellar and the other with a left temporal localization, in which immunohistochemical studies had been conducted. The results of the immunohistochemistry on the presence of carcino-embryonic antigen (CEA) and glial fibrillary acidic protein (GFAP), and of the scanning- and transmission electron microscopy revealed the cyst lining to be identical to subdural neurothelium. Progesterone receptors were found in the nuclei of cells lining the cyst, which also suggests the similarity of the cyst lining to arachnoid granulations and meningiomas as derivatives of subdural neurothelium, which also possess progesterone receptors.

Deaths and medical attention in police custody.

This article presents data from a study on the medical and monitoring procedures surrounding all 59 deaths in Dutch police stations in the period 1983-1993. In many cases, the medical procedures and monitoring procedures were not in accordance with the Dutch ministerial guidelines. Notification of physicians, transference to hospitals, medical examinations, and monitoring procedures showed several shortcomings. Based on the findings, several measures for the prevention of deaths in police custody are discussed.

Prevention of suicides in Penal Institutions in The Netherlands.

As in other countries, suicides are a matter of great concern in The Netherlands. This article addresses suicide-prevention measures in prisons in The Netherlands. It focuses primarily on screening, monitoring, incapacitation, psychological support, and transferal to specialized institutions. In addition, it asks which practices are common, which can be improved, and the limitations of certain strategies. Relatively speaking, The Netherlands does not appear to be doing too badly in terms of preventive measures, although there is room for improvement.