A meta-analysis on the effects of incarceration-based opioid substitution treatment.

Objective: Opioid substitution treatment (OST) is a common treatment for individuals who use opioids; however, empirical evidence on the effects of OST during incarceration is scarce. Our aim was to conduct a meta-analysis on the effects of incarceration-based OST on substance use, treatment engagement post-release and re-incarceration. Method: We searched for studies on individuals who were incarcerated and treated with OST, compared to a comparison group. Studies were only included if they reported data post-release. Results: N = 15 studies met the inclusion criteria. We found less opioid use, less other drug use, higher treatment engagement post-release and less re-incarceration among treated individuals compared to the comparison group. Moderator analyses showed some influence of length of follow-up period and study quality. Conclusions: Incarceration-based OST reduces drug use, re-incarceration and leads to higher treatment engagement after release. More research is needed on the effects of incarceration-based OST on secondary outcomes (e.g. health and social integration) and on factors that moderate these effects.

[EFFEKT-E: Effectiveness of a Prevention Programme for Children and their Depressed Mothers]. / EFFEKT-E: Wirksamkeit eines Präventionsprogramms für Kinder emotional belasteter Mütter.

The aim of this study was to develop an effective selective preventive programme for the risk group of children of depressed mothers. A universal parent and child training concept was adapted to the target group and to mother-child rehabilitation clinic conditions. A quasi-experimental design was implemented with 13 clinics. Evaluation of the results reveals that EFFEKT-E is an accepted, feasible selective programme which has the potential to enhance maternal competence and prevent children's emotional disruption.

Association between Obesity and History of Abuse among American Indians in Rural California.

OBJECTIVES: To explore factors associated with obesity among American Indians. METHODS: A cross-sectional survey of American Indian adults (N=459) was conducted at 13 rural reservation sites in California. Participants responded to a survey about their health and wellness perceptions. The Body Mass Index (BMI) was used to assess obesity. A predictive model for BMI was built using a generalized regression model. RESULTS: Having high blood pressure and having a history of verbal abuse in childhood were significant predictors of higher BMI. Participants with high blood pressure were likely to have 3.2 units of BMI higher on average than those who do not have high blood pressure (p-value <0.0001). Similarly, those with a history of childhood verbal abuse were likely to have 1.9 units higher BMI on average compared to those with no such history. Having a history of diabetes or sexual abuse in childhood trend towards increased BMI, although not statistically significant. CONCLUSION: Identifying childhood trauma and its impact on adult obesity rates among American Indians provides new avenues for intervention. Efforts to reduce over weight and obesity should include culturally sensitive interventions to ameliorate and repair what is lost through personal violations of stigma, abuse or neglect.

Resection of pulmonary metastases from colon and rectal cancer: factors to predict survival differ regarding to the origin of the primary tumor.

BACKGROUND: The purpose of the present study was to determine differences in prognostic factors for survival of patients with pulmonary metastases resected in curative intent from colon or rectum cancer. METHODS: Between 1980 and 2006, prognostic factors after resection of pulmonary metastases in 171 patients with primary rectum or colon tumor were evaluated. Survival of patients after surgical metastasectomy was compared with that of patients receiving standard chemotherapy by matched-pair analysis. RESULTS: Median survival after pulmonary resection was 35.2 months (confidence interval 27.3-43.2). One-, 3-, and 5-year survival for patients following R0 resection was 88.8, 52.1, and 32.9 % respectively. Complete metastasectomy (R0), UICC stage of the primary tumor, pleural infiltration, and hilar or mediastinal lymph node metastases are independent prognostic factors for survival. Matched-pair analysis confirmed that pulmonary metastasectomy significantly improved survival. Although no difference in survival for patients with pulmonary metastases from lower rectal compared to upper rectal or colon cancer was observed, factors to predict survival are different for patients with lower and middle rectal cancer (R0, mediastinal and/or hilar lymph nodes, gender, UICC stage) compared with patients with upper rectal or colon cancer (R0, number of metastases). CONCLUSIONS: Our results indicate that distinct prognostic factors exist for patients with pulmonary metastases from lower rectal compared with upper rectal or colon cancer. This supports the notion that colorectal cancer should not be considered as a single-tumor entity. Metastasectomy, especially after complete resection resulted in a dramatic improvement of survival compared with patients treated with chemotherapy alone.

Measles outbreak spreading from the community to an anthroposophic school, Berlin, 2011.

Between April and July 2011 there was an outbreak of measles virus, genotype D4, in Berlin, Germany. We identified 73 case-patients from the community and among students of an anthroposophic school, who participated in a 4-day school trip, as well as their family and friends. Overall, 27% were aged ≥ 20 years, 57% were female and 15% were hospitalized. Of 39 community case-patients, 38% were aged ≥ 20 years, 67% were female and 63% required hospitalization. Unvaccinated students returning from the school trip were excluded from school, limiting transmission. Within the group of 55 school-trip participants, including 20 measles case-patients, a measles vaccine effectiveness of 97.1% (95% confidence interval 83.4-100) for two doses was estimated using exact Poisson regression. Our findings support school exclusions and the recommendation of one-dose catch-up vaccination for everyone born after 1970 with incomplete or unknown vaccination status, in addition to the two-dose routine childhood immunization recommendation.

[The assessment and course of development of cognitive abilities in the elderly]. / Diagnostik und Verlauf von kognitiven Fähigkeiten bei älteren Menschen.

BACKGROUND: The assessment of the appropriate level of development in children belongs to the standard duties of physicians in the public health system. Due to a steady increase of dementia in Germany the assessment of cognitive abilities of the elderly is becoming more and more the focus of future activities. Such an assessment of cognitive functioning reveals whether the respective person is aging normally or whether the impaired cognitive functioning is probably based on a pathological process. OBJECTIVE: The aim of the present study is to present cognitive changes in the aged and 2 psychometric tests for the assessment of cognitive functioning: the Wechsler Adult Intelligence Scale (WAIS-IV) and the Short Cognitive Performance Test (SKT), a test for the assessment of memory impairments and impairment of attention. In addition, similarities and dissimilarities are presented. METHODS: As part of a multi-centre study in German-speaking countries the data of 504 cognitively healthy persons between the age of 60 and 90 were tested with the WAIS-IV and the SKT. RESULTS AND CONCLUSION: The results revealed a significant cognitive decline in the fluid and crystal intelligence depending on age. Only 2 subtests of the WAIS-IV (General Information and Block Design) showed no significant variation due to age. The SKT scores of memory and attention correlated significantly with almost all subtests of the WAIS-IV. The highest correlations were between the SKT attention score and the WAIS-IV subtests for processing speed, perceptual reasoning and working memory. The decline in cognitive abilities is mainly due to reduced capacities in speed of information processing and working memory.

[Resource activation in clinical psychology and psychotherapy: review of theoretical issues and current research]. / Ressourcenaktivierung in der klinischen Psychologie und Psychotherapie: Überblick über theoretische Hintergründe und aktuelle Forschungsansätze.

This review summarises theoretical issues and current research on working with clients' resources and strengths in clinical psychology and psychotherapy. Resource activation is considered as an important common factor in psychotherapy. In general, resource activation means an explicit focus on resources, strengths and potentials of the clients. After defining the term resources, considerations with regard to therapeutic attitude, principles of resource activation, approaches to resource diagnostics and different research strategies are presented. Current research focuses especially on the relation between resource activation and process variables in out-patient treatment.

Different patterns of boys' externalizing behavior and their relation to risk factors: a longitudinal study of preschool children.

Childrens' externalizing behaviors such as aggression, delinquency and impulsivity are serious problems in many societies. In previous person-oriented analyses we found two types of externalizing problems in boys. One pattern contained externalizing problems only, whereas the other type showed both externalizing and internalizing problems (anxiety, depression etc.). The present study addressed these two groups in a prospective longitudinal design. It was investigated whether the previous descriptive findings remained stable over time and, in particular, whether the two types differed in important risk factors for antisocial behavior. The sample consisted of 198 boys from the Erlangen-Nuremberg Development and Prevention Study. The first assessment took place in kindergarten and the second 3.4 years later in elementary school. The behavior problems were assessed by ratings of kindergarten teachers and elementary school teachers using the Social Behavior Questionnaire (SBQ). The risk factors were low socio-economic status of the family, birth complications, physical punishment in parenting behavior, difficult temperament, low intelligence, and aggression-prone social information processing of the child. Approximately 15% of the boys revealed externalizing behavior problems. A variable-oriented analysis showed significant stability over time. In a person-oriented Configural Frequency Analysis the 'externalizing only' and the 'combined externalizing and internalizing' pattern could be replicated. For five of the six risk factors we found significant differences between the boys with behavior problems and a non-deviant group. However, the two different patterns of externalizing problems differed only in intelligence (lower for the group with combined problems). The results confirm models of cumulative biological, psychological and social risks for antisocial behavior over time. Furthermore, specified analyses of the two types and their relation to proactive and reactive aggression are recommended.

[Psychoeducation for in-patient anxiety--the evaluation of the cognitive behavioral group programme "PAsta"]. / Psychoedukation Angst bei stationären Patienten--Evaluation des kognitiv-verhaltenstherapeutischen Gruppenprogramms "PAsta".

BACKGROUND: The object of this study is to develop and evaluate a psychoeducational programme that has been specifically designed for in-patients who suffer from heterogenous anxiety disorders. METHOD: 28 in-patients participated in psychoeducational group sessions in addition to psychiatric treatment as usual (TAU). This group was compared to a group of 13 patients who had received TAU without the group sessions. Using a pre-post design, the two groups were compared in terms of illness knowledge, mental health and self-efficacy. RESULTS: Analysis of the results showed a significant increase in knowledge of anxiety among participants of the psychoeducational group (d = 0.80). The effect sizes from 0.12 - 0.60 indicate clinical relevant improvement in depressive and anxiety symptoms, and a tendency towards improved self-efficacy (d = 0.20). CONCLUSIONS: The main objective of the group programme was achieved; that is, it increased illness knowledge. Despite the short measurement period, the importance of the psychoeducational group programme in the treatment of acute in-patients was confirmed.

The Alzheimer's disease activities of daily living international scale (ADL-IS).

BACKGROUND: Activities of daily living (ADL) deficits are integral components of dementia disorders, and ADL measures are among the most robust markers of the course of Alzheimer's disease (AD). Despite this acknowledged importance, no clearly useful ADL instrument for cross-cultural application in pharmacologic trials in the early stages of AD had been available. METHOD: An international effort was launched to develop an ADL scale for pharmacologic trials in early AD. Steps taken from 1990 to the present included: (1) international scientific working group meetings and reviews, (2) reviews of existing measures, (3) collating of existent, nonredundant items, (4) querying experts for new items, (5) interviews with informants and subjects in the USA, France, and Germany, toward the identification of potential new items, (6) identification of an item pool based upon these procedures, (7) creation of a trial instrument, (8) piloting of this instrument, and (9) refinement of the scale based upon statistical analysis of the pilot data. Final item selection was based upon: (1) relevance for > or = 80% of subjects in severity-stratified USA and German samples; (2) absence of gender and national biases; (3) significant (p <.05) discrimination between (a) normal versus mildly impaired and (b) mildly impaired versus moderately to moderately severely impaired subjects; and (4) Global Deterioration Scale (GDS) scores accounting for > or = 12% of variance in the item after controlling for age and gender. RESULTS: An ADL scale consisting of 40 items that correlate with the global and cognitive progress of AD is developed for international usage in pharmacologic trials in incipient, mild, moderate, and moderately severe AD. The scale contains 40 items falling within 13 ADL categories. The 40-item scale is shown to have .81 correlation with GDS staging, .81 with mental status assessment (Mini-Mental State Examination), and .81 with a psychometric test (the SKT) (p values < .001). CONCLUSION: This scale can be used to measure therapeutic response in AD.

Representation of acoustic communication signals by insect auditory receptor neurons.

Despite their simple auditory systems, some insect species recognize certain temporal aspects of acoustic stimuli with an acuity equal to that of vertebrates; however, the underlying neural mechanisms and coding schemes are only partially understood. In this study, we analyze the response characteristics of the peripheral auditory system of grasshoppers with special emphasis on the representation of species-specific communication signals. We use both natural calling songs and artificial random stimuli designed to focus on two low-order statistical properties of the songs: their typical time scales and the distribution of their modulation amplitudes. Based on stimulus reconstruction techniques and quantified within an information-theoretic framework, our data show that artificial stimuli with typical time scales of >40 msec can be read from single spike trains with high accuracy. Faster stimulus variations can be reconstructed only for behaviorally relevant amplitude distributions. The highest rates of information transmission (180 bits/sec) and the highest coding efficiencies (40%) are obtained for stimuli that capture both the time scales and amplitude distributions of natural songs. Use of multiple spike trains significantly improves the reconstruction of stimuli that vary on time scales <40 msec or feature amplitude distributions as occur when several grasshopper songs overlap. Signal-to-noise ratios obtained from the reconstructions of natural songs do not exceed those obtained from artificial stimuli with the same low-order statistical properties. We conclude that auditory receptor neurons are optimized to extract both the time scales and the amplitude distribution of natural songs. They are not optimized, however, to extract higher-order statistical properties of the song-specific rhythmic patterns.

Comparison of closely related orthopoxvirus isolates by random amplified polymorphic DNA and restriction fragment length polymorphism analysis.

The reliability and reproducibility of random amplified polymorphic DNA analysis (RAPD) was compared with restriction fragment length polymorphism (RFLP) by analysing three virus strains isolated from zoo animals in Berlin and three isolates which were cultivated from pets from Northern Germany. The RAPD technique was evaluated as a reliable tool with good reproducibility of the patterns for each virus strain investigated. Problems of interpretation due to inconsistent intensity of bands in different polymerase chain reaction runs may arise for less experienced personnel. The RAPD analysis can be performed within one working day and needs less DNA compared with RFLP so costs will be reduced. The obvious advantage of RFLP is that the pattern can be traced to the recognition site of the restriction enzyme whereas the RAPD primer sequence is not present in the orthopoxvirus genome at all. To the authors knowledge, the RAPD technique has never been applied in DNA viruses before and they conclude that this technique is a useful tool for the discrimination of closely related cowpoxviruses.

The p300/CBP acetyltransferases function as transcriptional coactivators of beta-catenin in vertebrates.

Wnt growth factors regulate a variety of developmental processes by altering specific gene expression patterns. In vertebrates beta-catenin acts as transcriptional activator, which is needed to overcome target gene repression by Groucho/TLE proteins, and to permit promoter activation as the final consequence of Wnt signaling. However, the molecular mechanisms of transcriptional activation by beta-catenin are only poorly understood. Here we demonstrate that the closely related acetyltransferases p300 and CBP potentiate beta-catenin-mediated activation of the siamois promoter, a known Wnt target. beta-catenin and p300 also synergize to stimulate a synthetic reporter gene construct, whereas activation of the cyclin D1 promoter by beta-catenin is refractory to p300 stimulation. Axis formation and activation of the beta-catenin target genes siamois and Xnr-3 in Xenopus embryos are sensitive to the E1A oncoprotein, a known inhibitor of p300/CBP. The C-terminus of beta-catenin interacts directly with a region overlapping the CH-3 domain of p300. p300 could participate in alleviating promoter repression imposed by chromatin structure and in recruiting the basal transcription machinery to promoters of particular Wnt target genes.

Intravenous titration with morphine for severe cancer pain: report of 28 cases.

BACKGROUND: In a multicenter study, 28 patients with cancer pain and insufficient pain relief with analgesic treatment according to step II of the guidelines of the World Health Organization (WHO) were switched to oral slow-release morphine. METHODS: Patients received intravenous morphine through a patient-controlled pump (PCA) for the first 24 hours (bolus = 1 mg, lockout interval = 5 minutes, maximum dose = 12 mg/hour). From day 2 patients were treated with oral slow-release morphine. Daily doses were calculated from the requirements of the day before. Breakthrough pain was treated with PCA until stable doses were reached (<2 boluses/day) and then with oral immediate-release morphine solution. Pain intensity was reported in a diary four times a day, in addition to mood, activity, and quality of sleep once daily. RESULTS: Mean duration until adequate pain relief reported (<30 on a 101-step numerical scale; NRS) was 5 hours (range = 80-620 minutes). Mean pain intensity was reduced from 67 NRS to 22 NRS. Mean doses of oral morphine were 133 mg/day initially and then 154 mg/day on day 14. Serious adverse events such as respiratory depression were not observed. Two patients terminated the study due to progressive symptoms of gastrointestinal obstruction. Seventy-five percent of the patients evaluated the effectiveness of the analgesic regime as good. CONCLUSIONS: Dose finding with intravenous PCA may be appropriate for a small minority of patients with severe pain. Higher treatment costs and the risk of complications are drawbacks of this method compared with conventional oral titration.

How voltage-dependent conductances can adapt to maximize the information encoded by neuronal firing rate.

Information from the senses must be compressed into the limited range of responses that spiking neurons can generate. For optimal compression, the neuron's response should match the statistics of stimuli encountered in nature. Given a maximum firing rate, a nerve cell should learn to use each available firing rate equally often. Given a set mean firing rate, it should self-organize to respond with high firing rates only to comparatively rare events. Here we derive an unsupervised learning rule that continuously adapts membrane conductances of a Hodgkin-Huxley model neuron to optimize the representation of sensory information in the firing rate. Maximizing information transfer between the stimulus and the cell's firing rate can be interpreted as a non-Hebbian developmental mechanism.

The use of albuterol in hospitalized infants with bronchiolitis.

OBJECTIVES: To determine whether the use of albuterol by nebulization enhances physiologic or clinical recovery in hospitalized infants with moderate bronchiolitis. METHODS: This prospective, double-blind, placebo-controlled, randomized clinical trial was performed from December 1995 to March 1996. A total of 52 patients <24 months of age with a diagnosis of moderately severe, acute viral bronchiolitis were enrolled and assigned to receive nebulized albuterol or normal saline placebo for 72 hours under a standardized protocol. Primary outcome measures included improvement in oxygen saturation (SaO2) during hospitalization and survival analysis to assess the time required to reach preestablished discharge criteria on three measures: SaO2, accessory muscle use, and wheezing. An additional secondary outcome measure was actual length of hospital stay. Adverse outcomes also were compared between treatment groups. RESULTS: There was no significant difference in mean SaO2 between albuterol and placebo at baseline, 24 hours, or maximum SaO2 achieved during hospitalization. Both groups showed significant improvement in oxygen saturation over time, but there was no significant difference in improvement between the two groups. The study had a power of 90% to detect a difference in mean percentage point improvement of 2% SaO2. There was no difference in time to reach discharge criteria as defined by SaO2, accessory muscle use, or wheezing. There was no difference in length of hospital stay or in the frequency of adverse outcomes. CONCLUSIONS: Nebulized albuterol therapy does not appear to enhance recovery or attenuate severity of illness in infants hospitalized with acute, moderate bronchiolitis, as evidenced by improvement in oxygen saturation, time to meet standardized discharge criteria, or length of hospital stay.

Duration of lithium treatment and brain lithium concentration in patients with unipolar and schizoaffective disorder--a study with magnetic resonance spectroscopy.

Twenty psychiatric patients on lithium medication were examined with 7-Li-magnetic resonance spectroscopy of the brain. Patients on long-term lithium treatment (> 6 months) were compared with a short-term group who had been taking lithium for between 4 and 8 weeks. Patients met DSM-III-R criteria for either recurrent unipolar depressive disorder (DSM-III-R 296.3x) or schizoaffective disorder, depressive type (DSM-III-R 295.70). The brain:serum lithium ratio was 0.76 +/- 0.26; there was no significant difference between short-term and long-term treatment. In the group of long-term treatment patients there was a positive correlation between lithium dose per day and brain lithium concentration (R = .72, p < .01), and between lithium plasma concentration and brain lithium concentration (R = .65, p < .05). In the short-term group, however, there was no significant correlation for these parameters. No differences between unipolar and schizoaffective disorder were found.

Pharmacokinetics of intraarterial mitomycin C in the chemoembolisation treatment of liver metastases.

1. The pharmacokinetics of mitomycin C (MMC) were investigated in 12 colorectal cancer patients with liver metastases undergoing chemoembolisation. Hepatic artery branches were embolized using polyvinylalcohol microspheres (150-250 microns) before applying 20 mg MMC in 4-8 min. 2. Serum MMC concentrations were determined from peripheral venous blood samples by reverse-phase HPLC using ultraviolet detection. Pharmacokinetic parameters were computed assuming an open two-compartment model. 3. Pharmacokinetic parameters were similar to values given in the literature for intravenous (IV) or intraarterial (IA) bolus MMC injections (Tmax = 7.0 min following the beginning of MMC infusion, Vss = 0.57 1/kg, C1 = 8.9 ml/min.kg, T1/2 alpha = 8.3 min, T1/2 beta = 58.6 min). 4. The area under the serum concentration-time-curve (AUC), standardized by the MMC amount injected, was similar to values reported in the literature for IV or IA bolus injections. There is no evidence for reduced systemic MMC exposure following the embolization procedure used.

Mitomycin-C concentration in human ocular aqueous humor after topical administration during trabeculectomy.

UNLABELLED: The concentration of the antitumor antibiotic mitomycin (CAS 50-07-7, mitomycin C, MMC), used in ophthalmic surgery for its antiproliferative effects, was measured in the aqueous humor of 7 glaucoma patients undergoing trabeculectomy. Sponges soaked with MMC-solution (100 microliters of MMC-solution 0.2 mg/ml: 20 micrograms) were applied intraoperatively on the scleral flap for 5 min. 100 to 200 microliters of aqueous humor were drawn with a needle 10 min following the end of topical MMC-treatment. Samples were assayed for MMC using a reverse-phase HPLC-system with ultraviolet detection (C18-column, elution: phosphate buffer (0.01 mol/l, pH: 6.5): methanol, v:v = 70:30, 365 nm). Swabs were extracted in phosphate-buffer (0.1 mol/l, pH: 7.0) before HPLC-analysis. External calibration was used for MMC quantitation. Quantitation limit was 10 ng/ml. In all aqueous humor samples MMC-concentration was below 10 ng/ml. MMC in the swabs amounted to 37% of the MMC amount applied. CONCLUSION: After intraoperative topical application, the MMC concentration in the aqueous humor of patients is very low. The substantial loss of MMC from the swabs used for the topical MMC-treatment suggests 1. rapid systemic absorption of MMC and/or 2. a loss through irrigation of the operative field following topical MMC-application.