Mental health service user and staff perspectives on tobacco addiction and smoking cessation: A meta-synthesis of published qualitative studies.

WHAT IS KNOWN ON THE SUBJECT?: There are high rates of tobacco smoking in people living with mental illness, and rates are much higher than the general population. People living with mental illness experience high rates of cardiovascular disease and other physical health problems as a result of tobacco smoking. There is a lack of evidence on successful interventions for reducing the rates of smoking in people living with mental illness. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: A meta-synthesis of data from a number of studies to support mental health nurses to access data quickly and support the translation of findings into practice. Studies found staff working in mental health services expressed they did not have the confidence to adequately address smoking cessation for people living with mental illness. People living with mental illness would like support and encouragement support to help them achieve successful smoking cessation. People living with mental illness want support from mental health service staff to increase their confidence in smoking cessation rather than mainstream smoking cessation services. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Existing evidence-based interventions for smoking cessation has had limited impact on the smoking rates of people living with mental illness. Research is needed into innovative smoking cessation interventions and the service delivery of these interventions for people living with mental illness. Interventions to support people living with mental illness in smoking cessation could be part of mainstream mental health service delivery. Opportunities for smoking cessation training for mental health service staff could be provided. ABSTRACT: Introduction People with mental illness are up to three times more likely to smoke and experience greater challenges and less success when trying to quit and therefore have higher risk of smoking-related morbidity and mortality. There is a lack of evidence on successful interventions to reduce the smoking rates in people living with serve mental illness. A meta-synthesis was undertaken to summarize the data from multiple studies to inform the development of future smoking cessation intervention studies. Methods MEDLINE, PsycINFO, Embase and CINAHL were searched in March 2017. A total of 965 titles and abstracts were screened for inclusion with 29 papers reviewed in full and 15 studies that met inclusion criteria. Included studies were assessed for quality using the Critical Appraisal Skills Programme tool. Key data across studies were examined and compared, and a thematic analysis was conducted. Results Analysis and synthesis developed five analytical themes: environmental and social context, living with a mental health illness, health awareness, financial awareness and provision of smoking cessation support. Themes generated the interpretive construct: "Whose role is it anyway?" which highlights tensions between staff perspectives on their role and responsibilities to providing smoking cessation support and support service users would like to receive. Relevance to mental health nursing Routine smoking cessation training for mental health professionals and research on innovative smoking cessation interventions to support people living with mental illness are needed. The Cochrane tobacco group has not found sufficient direct evidence of existing evidence-based interventions that have beneficial effect on smoking in people living with mental illness. With this in mind, mental health professionals should be encouraged to engage in future research into the development of new interventions and consider innovative harm reduction strategies for smoking into their practice, to reduce the morbidity and mortality many people living with mental illness experience from tobacco smoking.

Nurse provision of support to help inpatients quit smoking.

Issue addressed Identification of the factors that facilitate nurses to provide smoking cessation advice to hospitalised patients. Method Six semistructured focus groups with 26 nurses were conducted in June 2015. Participants completed a structured survey to collect patient demographic data and assess attitudes towards their role in addressing smoking cessation among inpatients. Results Important themes that emerged from the qualitative data were: nurses' negative perceptions of smokers, nurses' confidence in their knowledge of smoking cessation care and nurses' uncertainty around whose role it is to provide smoking cessation care. Conclusion Nurses require training in order to confidently and competently address smoking among inpatients as part of routine care. Formal ways to document the smoking status of inpatients and the offer of smoking cessation support from a nurse to an inpatient would enhance the communication between nurses around which inpatients had been asked about their smoking status and which had not. For patients who are resistant to conventional cessation strategies, innovative ways are needed to reduce the harm caused to them by tobacco use. So what? Nurses need to be provided with education and training around smoking cessation to increase their confidence and skills to provide smoking cessation care to inpatients.

Characterization of a Pseudomonas putida allylic alcohol dehydrogenase induced by growth on 2-methyl-3-buten-2-ol.

We have been working to develop an enzymatic assay for the alcohol 2-methyl-3-buten-2-ol (232-MB), which is produced and emitted by certain pines. To this end we have isolated the soil bacterium Pseudomonas putida MB-1, which uses 232-MB as a sole carbon source. Strain MB-1 contains inducible 3-methyl-2-buten-1-ol (321-MB) and 3-methyl-2-buten-1-al dehydrogenases, suggesting that 232-MB is metabolized by isomerization to 321-MB followed by oxidation. 321-MB dehydrogenase was purified to near-homogeneity and found to be a tetramer (151 kDa) with a subunit mass of 37,700 Da. It catalyzes NAD+-dependent, reversible oxidation of 321-MB to 3-methyl-2-buten-1-al. The optimum pH for the oxidation reaction was 10.0, while that for the reduction reaction was 5.4. 321-MB dehydrogenase oxidized a wide variety of aliphatic and aromatic alcohols but exhibited the highest catalytic specificity with allylic or benzylic substrates, including 321-MB, 3-chloro-2-buten-1-ol, and 3-aminobenzyl alcohol. The N-terminal sequence of the enzyme contained a region of 64% identity with the TOL plasmid-encoded benzyl alcohol dehydrogenase of P. putida. The latter enzyme and the chromosomally encoded benzyl alcohol dehydrogenase of Acinetobacter calcoaceticus were also found to catalyze 321-MB oxidation. These findings suggest that 321-MB dehydrogenase and other bacterial benzyl alcohol dehydrogenases are broad-specificity allylic and benzylic alcohol dehydrogenases that, in conjunction with a 232-MB isomerase, might be useful in an enzyme-linked assay for 232-MB.

Evaluating sex chromosome content of sorted human sperm samples with use of dual-color fluorescence in situ hybridization.

OBJECTIVE: Although most methods for selecting the sex of offspring by sorting spermatozoa are ineffective at shifting the ratio of Y- to X-containing cells, some commercial sources continue to offer such services. Our objective was to evaluate commercially "sorted" samples with use of dual-color fluorescence in situ hybridization and to identify variations in assessment by comparing motile and total sperm populations, donors, observers, and fluorescence in situ hybridization probes. STUDY DESIGN: Cryopreserved sperm from seven anonymous donors were processed as for insemination. Sperm cells from each total sample or motile subfraction were prepared for fluorescence in situ hybridization by incubation with disulfide-reducing agents to expand sperm nuclei. Two sets of X and Y chromosome-specific, fluorophore-labeled deoxyribonucleic acid probes were used. At least 400 nuclei from each preparation were classified independently by three blinded observers. Hybridization efficiency, aneuploidy, and sex chromosome content were evaluated in subsets of five unsorted, five female-oriented, and five male-oriented samples. Total and motile subfractions were compared with eight samples. Fluorescence in situ hybridization probes were compared in five paired unsorted samples. RESULTS: No differences were detected between washed samples and paired motile subfractions. No differences in hybridization and aneuploidy were detected between groups of sorted samples. The Y/X ratio was significantly different between the sorted groups. However, male-oriented samples had a lower Y/X ratio than female-oriented samples did. Observer and probe choice accounted for small but significant variations that did not alter conclusions about the X/Y ratio for sorted samples. CONCLUSION: In a series of 10 sorted samples from one commercial source, dual-color fluorescence in situ hybridization demonstrated a small but significant shift in the sex chromosome ratios among samples. However, this shift was opposite to that expected by the orientation of the sorted samples.

Collection and normal levels of the amyloid precursor protein in plasma.

The amyloid precursor protein is contained in platelet alpha granules and released with degranulation. Methods are described to control for amyloid precursor protein release from platelets during blood collection and processing. In normal subjects (n = 97; age range, 44-84 years), the average plasma level of amyloid precursor protein was 6.5 +/- 1.8 ng/ml.

Asymmetries in the covert orienting of visual spatial attention to spatial and non-spatial cues in Alzheimer's disease.

The ability to direct covert visual spatial attention to the left (LVF) and right visual field (RVF) was examined in 15 patients with mild to moderate Alzheimer's disease and 15 age- and education-matched controls using the covert orienting of visual spatial attention task (COVAT) modified to include both spatial and non-spatial cues. Subjects responded with a button press when they detected a target at a location 8 degrees to either the left or right of fixation. On 70% of trials a spatial cue was flashed at the target location before the target appeared. On 15% of trials the spatial cue was flashed at the location contralateral to where it would appear and on the remaining 15% of trials non-spatial diffuse cue preceded targets. The cue to target interval (CTI) varied between 150 and 550 ms. Mean reaction times for each cuetype in the RVF and LVF were calculated. Compared with controls, the percentage of trials excluded because of very slow reaction times was significantly greater in the Alzheimer's disease group for the 550 ms CTI. Analysis of the symmetry of reaction times to LVF and RVF targets for the 150 ms CTI enabled us to classify Alzheimer's disease subjects into three subgroups based on the hemifield of abnormally slow attentional biases. The first subgroup showed a significant slowing of reaction time to all LVF targets, the second showed a significant slowing of reaction time to all RVF targets and the third showed a significant slowing of reaction time to both LVF and RVF targets. Patients with Alzheimer's disease who showed an abnormal attentional bias performed significantly better on neuropsychological tests of memory, language and executive function than Alzheimer's disease patients with no attentional bias. Eight of the Alzheimer's disease subjects were assessed serially on at least six occasions over a 12-month period. The initial classification of abnormal attentional bias or no attentional bias was reliable for seven Alzheimer's disease subjects. One Alzheimer's disease subject, initially classified as having a slowed rightward attentional bias, in subsequent testing over the 12-month period was more consistent with symmetrical COVAT performance. Control subjects showed no attentional biases over the 12-month period and the magnitude of asymmetric attentional slowing over the 12-month period was significantly more variable in individual Alzheimer's disease subjects than in controls. The presence of subgroups of patients with Alzheimer's disease with qualitatively different COVAT performance indicates a large between-subject variability in attentional deficits in Alzheimer's disease. The presence of asymmetric attentional slowing and milder neuropsychological deficits in a subgroup of patients with Alzheimer's disease suggests that in these patients there is functional impairment of attentional areas in only one hemisphere rather than an asymmetric impairment of both hemispheres and that the neurodegenerative disease process may have been less advanced or in an earlier stage than that present in Alzheimer's disease patients with symmetric attentional performance and bilateral COVAT impairment. The preservation of asymmetric attentional slowing over time, together with the increased intra-subject variability in the magnitude of these asymmetries, suggests that asymmetrical COVAT performance represents a reliable reflection of underlying hemispheric function in Alzheimer's disease, although designation of asymmetrical attentional biases should be made on the basis of two or more sequential testing sessions.

Asymmetries in the covert orienting of visual spatial attention in schizophrenia.

The presence of attentional asymmetries in patients with schizophrenia was investigated with particular emphasis on the effects of stage of disease, medication status and clinical symptom severity. A modified version of Posner's covert orienting of visual attention task (COVAT) which included both spatial and non-spatial cues was administered to six volunteer samples of subjects which consisted of (i) 15 unmedicated and acutely psychotic male subjects with schizophrenia, (ii) 15 male subjects with schizophrenia who had been receiving medication for 14-21 days, (iii) 10 chronic male schizophrenic subjects who had been receiving medication for at least two years, (iv) 10 acutely psychotic male subjects with non-schizophrenic psychoses, (v) 15 subjects with unilateral brain frontal lobe (n = 6) or parietal lobe (n = 9) lesions, (vi) and 15 male control subjects. Measures of saccadic and pursuit eye movements were also obtained from unmedicated and recently medicated subjects with schizophrenia. COVAT attentional asymmetries were present in unmedicated subjects with schizophrenia for the 150 msec stimulus onset asynchrony (SOA). These asymmetries arose because reaction times (RTs) to right visual field targets were significantly slower than RTs to left visual field targets when targets followed invalid spatial or non-spatial cues. These asymmetries were qualitatively similar to those found in the patients with unilateral parietal lobe lesions. Attentional asymmetries partially resolved with brief periods of medication and completely resolved with long periods of medication. No asymmetries were found in controls nor in unmedicated subjects without schizophrenia. No asymmetries of ocular motor function were found. In schizophrenia, attentional asymmetries may reflect a deficit in the disengagement of visual attention from the right visual field and appear to be a stage marker for the disease. However this attentional deficit is dynamic and may reflect disruption to the neurocognitive network controlling attention at the level of the anterior cingulate cortex.

Positive and negative symptoms in neuroleptic-free psychotic inpatients.

Andreasen's scales for the assessment of positive (SAPS) and negative (SANS) symptoms and the Brief Psychiatric Rating Scale (BPRS) were administered to a group of 70 neuroleptic-free psychotic inpatients. Individual ratings from the SAPS and SANS, together with the 18-item BPRS, were examined to identify clusters of symptoms. The findings, consistent with our previous studies using medicated patients, did not support a simple positive-negative dichotomy. Independent syndromes representing negative symptoms and thought disorder were apparent, although within the negative syndrome there were three related sub-syndromes of flat affect, alogia and social dysfunctions. Hallucinations and delusions did not form a homogeneous group of symptoms. Paranoia emerged as a distinct syndrome, and the remaining symptoms could be subdivided into hallucinations, grandiose delusions, and 'loss of boundary' delusions (e.g., thought broadcasting, mind reading). These syndromes, with the exception of loss of boundary delusions, which consisted of SAPS delusions alone, correspond to syndromes of psychosis identified by Lorr and his colleagues thirty years ago. It is concluded that the currently popular 'three syndrome' model does not adequately represent the diversity of psychotic symptoms.

Abnormalities of visual spatial attention in HIV infection and the HIV-associated dementia complex.

Covert orienting of visuospatial attention (COVAT) was examined in 88 homosexual or bisexual men: 12 with mild HIV-associated dementia complex (ADC), 30 neurologically intact with AIDS (NI-AIDS), 23 asymptomatic HIV+ (HIV+ASX), and 23 HIV-negative control subjects. In mild ADC, COVAT was normal for spatial but impaired for nonspatial cues; 17% of NI-AIDS and HIV+ASX subjects had similar COVAT impairment patterns and also showed cognitive deficits. HIV+ subjects with normal COVAT showed normal cognitive performance. Impairment of nonspatial attentional processing in the ADC subjects and subgroups of the neurologically intact HIV+ subjects may reflect early subcortical dysfunction caused by HIV infection. COVAT assessment may be sensitive for detection of early subclinical neurological impairment in HIV infection.

Neuropsychological characterization of the AIDS dementia complex and rationalization of a test battery.

OBJECTIVE: To define the neuropsychological deficits present in mild human immunodeficiency virus type 1 (HIV-1) associated with the acquired immunodeficiency syndrome (AIDS) dementia complex (ADC) and to develop a rational neuropsychological test battery for its diagnosis. DESIGN: Survey. SETTING: Subjects were recruited from large metropolitan hospital outpatient clinics and were all living independently in the general community. PATIENTS: Three volunteer samples of homosexual-bisexual men: (1) 15 patients who met clinical and research criteria for mild ADC; (2) 27 HIV-seronegative (HIV-) controls; and (3) 17 patients with AIDS who were neurologically intact (NI-AIDS) who were matched with the ADC subjects by CD4 lymphocyte counts for severity of systemic HIV disease. MAIN OUTCOME MEASURES: Neuropsychological test performance; z score comparisons were made with the HIV-control group using 2.25-SD cutoffs for abnormality. RESULTS: Compared with NI-AIDS subjects, performance of patients with mild ADC was markedly worse in the cognitive areas of executive function, memory, and complex attention but not in affect or the cognitive areas of simple motor function, orientation, language, or visuospatial construction. Within the areas of executive function, memory, and complex attention, all of the HIV-controls and 95% of the NI-AIDS subjects had impaired test performance in a maximum of one area only. In marked contrast, 14 (93%) of the 15 patients with mild ADC had abnormal test performances in all three of these cognitive areas. Using a criterion of abnormal performance in at least two of the cognitive areas of executive function, memory, and complex attention, all patients with mild ADC could be differentiated from HIV-controls with 100% sensitivity and specificity and from NI-AIDS subjects matched for disease severity by CD4 lymphocyte count with 100% sensitivity and 94% specificity, which increased to 100% with the requirement of impairment in all three cognitive areas. CONCLUSIONS: If time constraints or patient compliance limit neuropsychometric testing, examination to detect mild ADC first should be directed to the areas of executive function, memory, and complex attention. This pattern of neuropsychological deficits in patients with mild ADC is suggestive of subcortical dementia.

Computer-administered visual analogue mood scales: rapid and valid assessment of mood in HIV positive individuals.

Studies of cognition in patients with the human immunodeficiency virus must take into account the effects of mood. Standardised mood-rating questionnaires are oftentimes consuming and fatiguing for such patients and so may be omitted from experiments. Visual analogue rating scales for affective state are rapidly administered and are quite acceptable to subjects. In 64 HIV seropositive homosexual or bisexual males, measures of anxiety and depression derived from two computer-administered visual analogue scales were compared with anxiety and depression ratings from the Spielberger State-Trait Anxiety Inventory and the Center for Epidemiological Studies-Depression. Analogue ratings of anxiety correlated .80 with STAI State anxiety and .58 with STAI Trait anxiety measures and analogue ratings of depression correlated .78 with CES-Depression measures. Analogue ratings may differentiate situational anxiety and depression more effectively and so are valid tools in assessment of anxiety and depression in HIV seropositive subjects. These may be of particular value when limitations of time or patient illness require a rapid assessment of mood variables in neuropsychiatric research.

Selective impairment of express saccade generation in patients with schizophrenia.

When a temporal gap is introduced between the offset of a central fixation point and the onset of a peripheral saccadic target, normal subjects generate an increased number of short latency (90-150 ms) saccades, termed express saccades, and the profile of express saccade frequency across different gap sizes for any individual subject, even if untrained in the task, shows a high test-retest reliability. In patients with schizophrenia, the generation of express saccades was also normal for gap sizes of 200-300 ms or in an overlap task (gap = 0 ms). However, for temporal gaps of 50-150 ms, the generation of express saccades was significantly impaired in the schizophrenic subjects. This selective deficit appeared to be independent of the patients' neuroleptic medication status and did not correlate with the severity of schizophrenic symptoms. It is postulated that the successful execution of an express saccade requires that the cognitive operations of disengagement of visual attention and selection of the appropriate motor command to generate a saccade both be commenced or completed during the temporal gap between fixation offset and peripheral target onset. Our results suggest that, in schizophrenia, there is an impairment in the cortical/subcortical neural network that generates express saccades and controls these cognitive operations. Potential sites for such dysfunction in schizophrenia include the parietal cortex and the GABA-ergic function of the superior colliculus.

Dopamine uptake by platelets from subjects with schizophrenia: a correlation with the delusional state of the patient.

The uptake of 3H-dopamine by platelets from patients with a number of psychiatric disorders has been compared with that by platelets from normal volunteers. Overall, 3H-dopamine uptake by platelet-rich plasma (PRP) from 25 schizophrenic subjects did not differ from 3H-dopamine uptake by PRP from 22 nonschizophrenic patients and 61 normal volunteers. In the schizophrenic group, however, there was an increased spread of results with seven values falling outside the range of results observed in the control group. Furthermore, of the patients rated, only for the schizophrenic patients was there an inverse correlation between 3H-dopamine uptake by platelets and the rating for delusions on the Scale for the Assessment of Positive Symptoms. Thus, 3H-dopamine uptake by platelet seems, in some way, to be linked to be delusional state of the patient. Further study of 3H-dopamine uptake by platelets is warranted in a larger and more diverse group of patients to determine the significance of altered dopamine uptake by platelets from some schizophrenic subjects and the correlation between platelet 3H-dopamine uptake and the delusional state of these subjects.