Associations between Racing Thoroughbred Movement Asymmetries and Racing and Training Direction.

BACKGROUND: Racehorses commonly train and race in one direction, which may result in gait asymmetries. This study quantified gait symmetry in two cohorts of Thoroughbreds differing in their predominant exercising direction; we hypothesized that there would be significant differences in the direction of asymmetry between cohorts. METHODS: 307 Thoroughbreds (156 from Singapore Turf Club (STC)-anticlockwise; 151 from Hong Kong Jockey Club (HKJC)-clockwise) were assessed during a straight-line, in-hand trot on firm ground with inertial sensors on their head and pelvis quantifying differences between the minima, maxima, upward movement amplitudes (MinDiff, MaxDiff, UpDiff), and hip hike (HHD). The presence of asymmetry (≥5 mm) was assessed for each variable. Chi-Squared tests identified differences in the number of horses with left/right-sided movement asymmetry between cohorts and mixed model analyses evaluated differences in the movement symmetry values. RESULTS: HKJC had significantly more left forelimb asymmetrical horses (Head: MinDiff p < 0.0001, MaxDiff p < 0.03, UpDiff p < 0.01) than STC. Pelvis MinDiff (p = 0.010) and UpDiff (p = 0.021), and head MinDiff (p = 0.006) and UpDiff (p = 0.017) values were significantly different between cohorts; HKJC mean values indicated left fore- and hindlimb asymmetry, and STC mean values indicated right fore- and hindlimb asymmetry. CONCLUSION: the asymmetry differences between cohorts suggest that horses may adapt their gait to their racing direction, with kinematics reflecting reduced 'outside' fore- and hindlimb loading.

Disaggregating Asian-American Mortality in Drug-Related Overdoses and Behavioral Disorders: A Cross-Sectional Study.

Asian Americans have been historically underrepresented in the national drug overdose discourse due to their lower substance use and overdose rates compared to other racial/ethnic groups. However, aggregated analyses fail to capture the vast diversity among Asian-American subgroups, obscuring critical disparities. We conducted a cross-sectional study between 2018 and 2021 examining Asian-American individuals within the CDC WONDER database with drug overdoses as the underlying cause of death (n = 3195; ICD-10 codes X40-X44, X60-X64, X85, and Y10-Y14) or psychoactive substance-related mental and behavioral disorders as one of multiple causes of death (n = 15,513; ICD-10 codes F10-F19). Proportional mortality ratios were calculated, comparing disaggregated Asian-American subgroups to the reference group (Asian Americans as a single aggregate group). Z-tests identified significant differences between subgroups. Compared to the reference group (0.99%), drug overdose deaths were less prevalent among Japanese (0.46%; p < 0.001), Chinese (0.47%; p < 0.001), and Filipino (0.82%; p < 0.001) subgroups, contrasting with a higher prevalence among Asian Indian (1.20%; p < 0.001), Vietnamese (1.35%; p < 0.001), Korean (1.36%; p < 0.001), and other Asian (1.79%; p < 0.001) subgroups. Similarly, compared to the reference group (4.80%), deaths from mental and behavioral disorders were less prevalent among Chinese (3.18%; p < 0.001), Filipino (4.52%; p < 0.001), and Asian Indian (4.56%; p < 0.001) subgroups, while more prevalent among Korean (5.60%; p < 0.001), Vietnamese (5.64%; p < 0.001), Japanese (5.81%; p < 0.001), and other Asian (6.14%; p < 0.001) subgroups. Disaggregated data also revealed substantial geographical variations in these deaths obscured by aggregated analyses. Our findings revealed pronounced intra-racial disparities, underscoring the importance of data disaggregation to inform targeted clinical and public health interventions.

Administration, Billing, and Payment for Pharmacy Student-Based Immunizations to Medicare Beneficiaries at Mobile Medicare Clinics.

Training student pharmacists to administer vaccinations requires a substantial investment in vaccines, supplies, and time. Few schools of pharmacy seek out or receive any reimbursement for the provision of vaccines, despite the fact it is a covered service. This study sought to implement, deliver, and demonstrate an innovative, financially sustainable curriculum-based immunization program by trained pharmacy students as part of their experiential learning. Thirty-nine community health clinics targeting Medicare beneficiaries were conducted throughout Northern/Central California during Medicare's fall open enrollment periods between 2014⁻2016. American Pharmacists Association (APhA)-trained student pharmacists (under licensed pharmacist supervision) administered 1777 vaccinations. Vaccines were billed via a secure Health Insurance Portability and Accountability Act of 1996 (HIPAA)-compliant web-based portal. The total net income was $11,905 and $8032 for 2015 and 2016, respectively. Return on investment was greatest for the influenza vaccine > Tdap > pneumococcal. Pharmacy students are already being trained to provide immunizations and can utilize their skills to deliver financially viable public health programs.

Quality of life in patients with adrenal disease: A systematic review.

BACKGROUND: Evaluating the patient with adrenal disease is challenging due to the lack of precise clinical and biochemical parameters for disease control. Quality of life (QOL) evaluation aims to measure the patient's subjective experience. OBJECTIVE: To describe how QOL is defined and measured in adrenal disease, critically appraise the use of QOL tools in published literature, discuss the implications of these findings and provide direction for further research in this field. MATERIALS AND METHODS: We searched the Cochrane library, EMBASE, Google Scholar, PsycINFO, PubMed, Web of Science databases to identify only primary studies where self-reported QOL was measured as a parameter in adults with confirmed adrenal disease, and results presented in English. Key data were independently extracted from each study and adherence to reporting guidelines evaluated. RESULTS: A total of 117 studies involving 13 717 subjects were included. The vast majority of studies did not define QOL. The most common approach was to combine generic and domain-specific tools, although disease-specific tools are increasingly being used. Adherence to reporting guidelines was variable. A narrative synthesis of the findings was performed. CONCLUSION: We present the first systematic review of QOL in adrenal disease. Quality of life is reduced in patients with adrenal disease, irrespective of adrenal hyperfunction or hypofunction. Quality of life improved with therapy but was not completely reversed despite biochemical remission. Authors should adhere to consistent reporting practices which are interpretable by clinicians. Further research is required to explain the mechanisms driving impaired QOL and value of QOL evaluations in the clinical context.

Evolution of electric communication signals in the South American ghost knifefishes (Gymnotiformes: Apteronotidae): A phylogenetic comparative study using a sequence-based phylogeny.

The electric communication signals of weakly electric ghost knifefishes (Gymnotiformes: Apteronotidae) provide a valuable model system for understanding the evolution and physiology of behavior. Apteronotids produce continuous wave-type electric organ discharges (EODs) that are used for electrolocation and communication. The frequency and waveform of EODs, as well as the structure of transient EOD modulations (chirps), vary substantially across species. Understanding how these signals have evolved, however, has been hampered by the lack of a well-supported phylogeny for this family. We constructed a molecular phylogeny for the Apteronotidae by using sequence data from three genes (cytochrome c oxidase subunit 1, recombination activating gene 2, and cytochrome oxidase B) in 32 species representing 13 apteronotid genera. This phylogeny and an extensive database of apteronotid signals allowed us to examine signal evolution by using ancestral state reconstruction (ASR) and phylogenetic generalized least squares (PGLS) models. Our molecular phylogeny largely agrees with another recent sequence-based phylogeny and identified five robust apteronotid clades: (i) Sternarchorhamphus+Orthosternarchus, (ii) Adontosternarchus, (iii) Apteronotus+Parapteronotus, (iv) Sternarchorhynchus, and (v) a large clade including Porotergus, 'Apteronotus', Compsaraia, Sternarchogiton, Sternarchella, and Magosternarchus. We analyzed novel chirp recordings from two apteronotid species (Orthosternarchus tamandua and Sternarchorhynchus mormyrus), and combined data from these species with that from previously recorded species in our phylogenetic analyses. Some signal parameters in O. tamandua were plesiomorphic (e.g., low frequency EODs and chirps with little frequency modulation that nevertheless interrupt the EOD), suggesting that ultra-high frequency EODs and "big" chirps evolved after apteronotids diverged from other gymnotiforms. In contrast to previous studies, our PGLS analyses using the new phylogeny indicated the presence of phylogenetic signals in the relationships between some EOD and chirp parameters. The ASR demonstrated that most EOD and chirp parameters are evolutionarily labile and have often diversified even among closely related species.

The Olfactory Neuroecology of Herbivory, Hostplant Selection and Plant-Pollinator Interactions.

Plants experience often opposing energetic demands and selective pressures-for instance, where plants need to attract an insect that is both the pollinator and herbivore, or alternately, where plants attract prey (due to limited resources) and pollinators. Together, these selective pressures can modify the volatile signals available to the plant's mutualistic and antagonistic partners. Nevertheless, it remains an open question how changes in the information content of volatile signals modify behavioral responses in mutualists and antagonists, and what the underlying neural bases of these behaviors are. This review focuses on two systems to explore the impact of herbivory and resource availability on plant-pollinator interactions: hawkmoth-pollinated hostplants (where herbivory is common), and carnivorous bee-pollinated pitcher plants (where the plants differentially attract bee pollinators and other insect prey). We focus on (1) the volatile signals emitted from these plants because these volatiles operate as long-distance signals to attract, or deter, insect partners, (2) how this information is processed in the hawkmoth olfactory system, and (3) how volatile information changes spatiotemporally. In both the plants and their respective insect partner(s), volatile signaling, reception and behavior are dynamic and plastic, providing flexibility an ever-changing environment.

Molecular evolution of anthocyanin pigmentation genes following losses of flower color.

BACKGROUND: Phenotypic transitions, such as trait gain or loss, are predicted to carry evolutionary consequences for the genes that control their development. For example, trait losses can result in molecular decay of the pathways underlying the trait. Focusing on the Iochrominae clade (Solanaceae), we examine how repeated losses of floral anthocyanin pigmentation associated with flower color transitions have affected the molecular evolution of three anthocyanin pathway genes (Chi, F3h, and Dfr). RESULTS: We recovered intact coding regions for the three genes in all of the lineages that have lost floral pigmentation, suggesting that molecular decay is not associated with these flower color transitions. However, two of the three genes (Chi, F3h) show significantly elevated dN/dS ratios in lineages without floral pigmentation. Maximum likelihood analyses suggest that this increase is due to relaxed constraint on anthocyanin genes in the unpigmented lineages as opposed to positive selection. Despite the increase, the values for dN/dS in both pigmented and unpigmented lineages were consistent overall with purifying selection acting on these loci. CONCLUSIONS: The broad conservation of anthocyanin pathway genes across lineages with and without floral anthocyanins is consistent with the growing consensus that losses of pigmentation are largely achieved by changes in gene expression as opposed to structural mutations. Moreover, this conservation maintains the potential for regain of flower color, and indicates that evolutionary losses of floral pigmentation may be readily reversible.

Endocannabinoid regulation of nausea is mediated by 2-arachidonoylglycerol (2-AG) in the rat visceral insular cortex.

Cannabinoid (CB) agonists suppress nausea in humans and animal models; yet, their underlying neural substrates remain largely unknown. Evidence suggests that the visceral insular cortex (VIC) plays a critical role in nausea. Given the expression of CB1 receptors and the presence of endocannabinoids in this brain region, we hypothesized that the VIC endocannabinoid system regulates nausea. In the present study, we assessed whether inhibiting the primary endocannabinoid hydrolytic enzymes in the VIC reduces acute lithium chloride (LiCl)-induced conditioned gaping, a rat model of nausea. We also quantified endocannabinoid levels during an episode of nausea, and assessed VIC neuronal activation using the marker, c-Fos. Local inhibition of monoacylglycerol lipase (MAGL), the main hydrolytic enzyme of 2-arachidonylglycerol (2-AG), reduced acute nausea through a CB1 receptor mechanism, whereas inhibition of fatty acid amide hydrolase (FAAH), the primary catabolic enzyme of anandamide (AEA), was without effect. Levels of 2-AG were also selectively elevated in the VIC during an episode of nausea. Inhibition of MAGL robustly increased 2-AG in the VIC, while FAAH inhibition had no effect on AEA. Finally, we demonstrated that inhibition of MAGL reduced VIC Fos immunoreactivity in response to LiCl treatment. Taken together, these findings provide compelling evidence that acute nausea selectively increases 2-AG in the VIC, and suggests that 2-AG signaling within the VIC regulates nausea by reducing neuronal activity in this forebrain region.

The subfornical organ: a novel site of action of cholecystokinin.

The subfornical organ (SFO) is an important sensory circumventricular organ implicated in the regulation of fluid homeostasis and energy balance. We investigated whether the SFO is activated by the hormone cholecystokinin (CCK). CCK1 and CCK2 receptors were identified in the SFO by RT-PCR. Dissociated SFO neurons that responded to CCK (40/77), were mostly depolarized (9.2 ± 0.9 mV, 30/77), but some were hyperpolarized (-7.3 ± 1.1 mV, 10/77). We next examined the responses of SFO neurons in vivo to CCK (16 µg/kg ip), in the presence and absence of CCK1 or CCK2 receptor antagonists (devazepide; 600 µg/kg and L-365,260; 100 µg/kg, respectively), using the functional activation markers c-Fos and phosphorylated extracellular signal-related kinase (p-ERK). The nucleus of the solitary tract (NTS) served as a control for CCK-induced activity. There was a significant increase in c-Fos expression in the NTS (259.2 ± 20.8 neurons) compared with vehicle (47.5 ± 2.5). Similarly, in the SFO, c-Fos was expressed in 40.5 ± 10.6 neurons in CCK-treated compared with 6.6 ± 2.7 in vehicle-treated rats (P < 0.01). Devazepide significantly reduced the effects of CCK in the NTS but not in SFO. L-365,260 blocked the effects of CCK in both brain regions. CCK increased the number of p-ERK neurons in NTS (27.0 ± 4.0) as well as SFO (18.0 ± 4.0), compared with vehicle (8.0 ± 2.6 and 4.3 ± 0.6, respectively; P < 0.05). Both devazepide and L-365,260 reduced CCK-induced p-ERK in NTS, but only L-365,260 reduced it in the SFO. In conclusion, the SFO represents a novel brain region at which circulating CCK may act via CCK2 receptors to influence central autonomic control.

Rasch analysis of the SAMHSA recovery inventory for Chinese (SAMHSA-RIC).

AIMS: To generate a short version of a newly developed inventory that adopted the conceptual framework of the Substance Abuse and Mental Health Services Administration (SAMHSA) consensus statement on recovery. METHODS: Through Rasch analysis, this paper presents how this recovery inventory (SAMHSA-RIC), with its original 111 items, can be reduced to a much shorter version with only 41 items. RESULTS: Although internal consistency is slightly lowered because of item reduction, the short version maintains satisfactory and significant correlations with quality of life measures. Overall, the canonical correlation between the scale and WHOQOL-BREF was virtually the same, with only a 0.2% decrease. CONCLUSIONS: SAMHSA-RIC (short version) has strong potential to become a general tool for evaluating rehabilitative services for persons with persistent and severe mental illness. A validation study of the short version with clinical samples is warranted.

Modeling self-agency among people with schizophrenia: empirical evidence for consumer-based recovery.

BACKGROUND: Self-agency--the awareness of one's own capacity to make decisions and to engage in deliberate action - is often interfered with or lost during the course of severe mental illness. Most existing literature on self-agency is either of experimental or qualitative nature, and empirical evidence is scanty. SAMPLING AND METHODS: This paper draws on a subset of empirical data from a larger recovery study that involved 204 people with schizophrenia in the community. Structural equation models are built to contrast the models with and without the contribution of self-agency. RESULTS: The self-agency factor loads significantly on variables from five major areas of recovery (hope, empowerment, resilience, self-responsibility and self-mastery). Structural equation models show that the incorporation of this self-agency construct has vastly improved the modeling of the adverse effect of stigma on the quality of life of these subjects. The model with self-agency fitted the criteria better, and explained more total variance (increased from 56 to 80%) for the quality of life of these subjects. CONCLUSIONS: Cross-sectional empirical findings appear to support the claim that self-agency is an important construct that cuts through many dimensions of recovery. Initial discussions are made on the nature and function of self-agency, and its relations with recovery concepts and components.

Divergence in androgen sensitivity contributes to population differences in sexual dimorphism of electrocommunication behavior.

Weakly-electric fish (Apteronotidae) produce highly diverse electrocommunication signals. Electric organ discharges (EODs) vary across species, sexes, and in the magnitude and direction of their sexual dimorphism. Gonadal steroid hormones can modulate EODs, and differences in androgen sensitivity are hypothesized to underlie variation in the degree of sexual dimorphism across species. In this study, we asked whether variation in androgen sensitivity explained variation in sexual dimorphism of EODs within species, at the population level. We examined two populations of black ghost knifefish (Apteronotus albifrons), one from the Orinoco and the other from the Amazon River Basin. EOD frequency (EODf) and chirp rates were measured to characterize diversity in sexual dimorphism across populations. The magnitude of sexual dimorphism in EODf differed significantly across populations, and was more pronounced in the Orinoco population than in the Amazon population. Chirp rates were sexually monomorphic in both populations. 11-Ketotestosterone (11-kT) was administered over a two-week period to assess population differences in sensitivity to androgens. 11-kT masculinized EODf significantly more in the population with the greater degree of sexual dimorphism. 11-kT had no effect on the sexually monomorphic chirping rates. We conclude that population divergence in androgen sensitivity contributes to variation in sexual dimorphism of EODf in A. albifrons.

Substrate-Selective Inhibition of Cyclooxygenase-2: Development and Evaluation of Achiral Profen Probes.

Cyclooxygenase-2 (COX-2) oxygenates arachidonic acid and the endocannabinoids 2-arachidonoylglycerol (2-AG) and arachidonoylethanolamide (AEA). We recently reported that (R)-profens selectively inhibit endocannabinoid oxygenation but not arachidonic acid oxygenation. In this work, we synthesized achiral derivatives of five profen scaffolds and evaluated them for substrate-selective inhibition using in vitro and cellular assays. The size of the substituents dictated the inhibitory strength of the analogs, with smaller substituents enabling greater potency but less selectivity. Inhibitors based on the flurbiprofen scaffold possessed the greatest potency and selectivity, with desmethylflurbiprofen (3a) exhibiting an IC(50) of 0.11 µM for inhibition of 2-AG oxygenation. The crystal structure of desmethylflurbiprofen complexed to mCOX-2 demonstrated a similar binding mode to other profens. Desmethylflurbiprofen exhibited a half-life in mice comparable to that of ibuprofen. The data presented suggest that achiral profens can act as lead molecules toward in vivo probes of substrate-selective COX-2 inhibition.

The impact of pandemic influenza A (H1N1) 2009 on the circulation of respiratory viruses 2009-2011.

Surveillance of respiratory viruses has been conducted for many years at the public health laboratory in Hong Kong. With the occurrence of pandemic influenza A (H1N1) 2009, we observed a change in the seasonality of influenza activity with a seemingly corresponding change in the activity of respiratory syncytial virus, parainfluenza virus, and adenovirus during 2009-2011. This phenomenon could most likely be explained by virus interference.

Sex differences in the electrocommunication signals of the electric fish Apteronotus bonapartii.

The South American weakly-electric knifefish (Apteronotidae) produce highly diverse and readily quantifiable electrocommunication signals. The electric organ discharge frequency (EODf), and EOD modulations (chirps and gradual frequency rises (GFRs)), vary dramatically across sexes and species, presenting an ideal opportunity to examine the proximate and ultimate bases of sexually dimorphic behavior. We complemented previous studies on the sexual dimorphism of apteronotid communication signals by investigating electric signal features and their hormonal correlates in Apteronotus bonapartii, a species which exhibits strong sexual dimorphism in snout morphology. Electrocommunication signals were evoked and recorded using a playback paradigm, and were analyzed for signal features including EOD frequency and the structure of EOD modulations. To investigate the androgenic correlates of sexually dimorphic EOD signals, we measured plasma concentrations of testosterone and 11-ketotestosterone. A. bonapartii responded robustly to stimulus playbacks. EODf was sexually monomorphic, and males and females produced chirps with similar durations and amounts of frequency modulation. However, males were more likely than females to produce chirps with multiple frequency peaks. Sexual dimorphism in apteronotid electrocommunication signals appears to be highly evolutionarily labile. Extensive interspecific variation in the magnitude and direction of sex differences in EODf and in different aspects of chirp structure suggest that chirp signals may be an important locus of evolutionary change within the clade. The weakly-electric fish represent a rich source of data for understanding the selective pressures that shape, and the neuroendocrine mechanisms that underlie, diversity in the sexual dimorphism of behavior.

Hormonal and behavioral correlates of morphological variation in an Amazonian electric fish (Sternarchogiton nattereri: Apteronotidae).

The weakly electric fish from the main channel of the Amazon river, Sternarchogiton nattereri, offers a striking case of morphological variation. Females and most males are toothless, or present only few minute teeth on the mandible, whereas some males exhibit exaggerated, spike-like teeth that project externally from the snout and chin. Androgens are known to influence the expression of sexually dimorphic traits, and might be involved in tooth emergence. In this study we assess the relationship in S. nattereri between morphological variation, 11 ketotestosterone (11-KT) and testosterone (T). We also examine relationships of morphology and androgen levels with electric organ discharge (EOD) frequency, reproductive condition, and seasonality. Our main finding is that male morph categories differed significantly in plasma concentrations of 11-KT, with toothed males showing higher levels of 11-KT than toothless males. By contrast, we did not detect statistical differences in T levels among male morph categories. Reproductive condition, as measured by gonadosomatic indexes (GSI), differed across two sample years, increased as the season progressed, and was higher in toothed males than in non-toothed males. EOD frequency was higher in toothed males than in either toothless males or females. Taken together, our findings suggest that S. nattereri male sexual characters are regulated by 11-KT levels, and that both morphology and androgens interact with reproductive condition and EOD frequency in ways that vary within and across reproductive seasons.

Antisecretory effects of neuropeptide Y in the mouse colon are region-specific and are lost in DSS-induced colitis.

Regulation of water movement in the gut is an important homeostatic event that is critical to normal intestinal function. We assessed the effect of neuropeptide Y (NPY) on epithelial ion transport in the normal and inflamed mouse colons. Colitis was induced by dextran sodium sulfate (DSS, 4% wt./vol.) administered in the drinking water for 5 days followed by 3 days of regular water. Segments of proximal and distal colons were excised and short-circuit current (I(SC)) was measured in Ussing chambers to assess net electrogenic active ion transport. NPY Y(1) receptor (Y(1)R) expression was measured by quantitative real-time PCR and immunohistochemistry. Challenge of distal colon from normal mice with NPY (10(-7)M) evoked a drop in I(SC) (51.4±9.1 µA/cm(2)), which was dependent on Cl(-) flux, was insensitive to neural blockade with tetrodotoxin and was mediated primarily through the Y(1)R. In contrast, the proximal colon was largely unresponsive to NPY, expressing ~ten-fold less Y(1)R mRNA compared to the distal colon. These findings confirm that specific regional regulation of ion transport occurs in the colon. Segments of proximal and distal colons from mice with DDS-induced colitis were virtually unresponsive to NPY, expressed less Y(1)R mRNA than tissues from control mice and displayed loss of Y(1)R protein expression in the colonic epithelium. This hypo-responsiveness to an antisecretory stimulus adds to the well-documented loss of responsiveness to pro-secretory agents during inflammation, attesting to a profound loss of control of active ion transport during enteric inflammatory disease.

Effectiveness of a knowledge-contact program in improving nursing students' attitudes and emotional competence in serving people living with HIV/AIDS.

This study compared the effectiveness of an AIDS knowledge-only program (knowledge) with a combined program of AIDS knowledge and contact with people having HIV/AIDS (PHA) (knowledge-contact) in reducing nursing students' stigma and discrimination towards PHA and in enhancing their emotional competence to serve PHA. Eighty-nine nursing students from two universities in Hong Kong were randomly assigned to either the knowledge or the knowledge-contact condition. All participants completed measures of AIDS knowledge, stigmatizing attitudes, fear of contagion, willingness to treat, positive affect, and negative affect at pre-test, post-test, and six-week follow-up. Findings showed that in both groups, significant improvement in AIDS knowledge, stigmatizing attitudes, fear of contagion, willingness to treat, and negative affect were found at post-test. The effects on AIDS knowledge, fear of contagion, willingness to treat, and negative affect were sustained at follow-up for both groups. Intergroup comparisons at post-test showed that the effectiveness of knowledge-contact program was significantly greater than knowledge program in improving stigmatizing attitudes. No significant difference between the two groups was found at follow-up. Findings showed the short-term effect of contact in improving nursing students' attitudes and emotional competence in serving PHA. Implications for research and training of nursing staff were discussed.

Recovery components as determinants of the health-related quality of life among patients with schizophrenia: structural equation modelling analysis.

OBJECTIVE: The Substance Abuse and Mental Health Services Administration (SAMHSA) National Consensus Statement on Mental Health Recovery proposed 10 recovery components as guiding principles for fostering recovery among people with severe mental illness. Although researchers have recognized a close association between patient-oriented recovery and health-related quality of life (HRQOL), the relation between the recovery components and patients' self-reported HRQOL is still unknown. The purpose of the present study was therefore to use structural equation modelling to predict HRQOL of schizophrenia outpatients from the recovery components proposed by SAMHSA. METHODS: The recovery status of 201 outpatients with schizophrenia, schizophreniform, or schizoaffective disorder was measured using 12 variables that indicate the outcome of 10 recovery components. Canonical correlation analysis was applied to screen variables that are highly correlated with HRQOL. Valid variables were then used to build a structural model that predicted individuals' HRQOL as indicated by the World Health Organization Quality of Life Measure Abbreviated (WHOQOL-BREF (HK)). RESULTS: The bestfit model was able to explain 80.7% of the variance in WHOQOL-BREF outcome. The model demonstrated significant direct and indirect effects of five recovery components on HRQOL. The effect of psychosocial symptoms on HRQOL was highest (total beta = -0.64), followed by sense of personal agency (total beta = 0.58), sense of optimism (total beta = 0.54), perceived support (total beta = 0.47), and internal stigma (total beta = -0.42). CONCLUSION: The recovery components proposed by the SAMHSA consensus statement provided a useful framework to explain HRQOL of outpatients with schizophrenia. The present model indicated a moderate to large effect of five major recovery components on HRQOL. It showed that patients' perceptions of support, optimism, and personal agency were influenced by psychosocial symptoms and internal stigma. This empirical study supported the use of recovery principles, such as resilience building or mastery-based intervention to improve the QOL of community dwellers with schizophrenia.

Operationalization of the SAMHSA model of recovery: a quality of life perspective.

PURPOSE: To test empirically the Substance Abuse and Mental Health Services Administration (SAMHSA) recovery model. METHODS: Two hundred and four attendants aged 18-60, with schizophrenia spectrum disorder, from two participating outpatient clinics were interviewed with a number of inventories, including health-related quality of life measure (WHOQOL-BREF (HK)). Canonical correlation analysis was performed on two sets of variables (SAMHSA recovery components and QoL domain scores). RESULTS: There were significant correlations between most recovery components proposed in the SAMHSA recovery statement and the health-related quality of life measure. Age, duration of untreated psychosis, the degree of social support, the interaction of singlehood and the number of confidants, engagement in competitive careers, and the duration of participation in community support services were all found to be important predictors. CONCLUSIONS: The SAMHSA consensus statement appeared to contain valid concepts for Chinese subjects. It presented new challenges for psychiatric rehabilitation and reminded the policy makers that there is much more psychiatric rehabilitation can achieve beyond symptom control and patient management. It also demonstrated that resolve and the commitment of resources to combat stigma, develop resilience, and foster patient empowerment were very much needed in Hong Kong and perhaps in Asia and elsewhere.