Cost-effectiveness of cognitive remediation and supported employment for people with mental illness: a randomized controlled trial.

BACKGROUND: Little is known about the economic benefits of cognitive remediation and supported employment (CR + SE). The present study aimed to investigate the cost-effectiveness of CR + SE compared with traditional vocational services (TVS). METHOD: Individuals with mental illness and low cognitive function were recruited at six sites in Japan. A total of 111 participants were randomly allocated to the CR + SE group or the TVS group. Clinical and vocational outcomes were assessed at baseline and 12-month follow-up. Service utilization data were collected monthly. The data on outcomes and costs were combined to examine cost-effectiveness. RESULTS: The data were obtained from a total of 92 participants. The CR + SE group resulted in better vocational and clinical outcomes (employment rate, 62.2%; work tenures, 78.6 days; cognitive improvement, 0.5) than the TVS group (19.1%, 24.9 days and 0.2). There was no significant difference in mean total costs between the groups (CR + SE group: $9823, s.d. = $6372, TVS group: $11 063, s.d. = $11 263) with and without adjustment for covariates. However, mean cost for medical services in the CR + SE group was significantly lower than that in the TVS group after adjusting covariates (Β = -$3979, 95% confidence interval -$7816 to -$143, p = 0.042). Cost-effectiveness acceptability curves for vocational outcomes illustrated the high probabilities (approximately 70%) of the CR + SE group being more cost-effective than TVS when society is not willing to pay additional costs. CONCLUSIONS: CR + SE appears to be a cost-effective option for people with mental illness who have low cognitive functioning when compared with TVS.

Protective effects of interleukin-10 on diaphragm muscle in a septic animal model.

The effects of Interleukin (IL)-10 intravenous injection after endotoxin administration on diaphragm muscle were studied using Wistar rats. The animals were divided into two treatment groups: A saline + endotoxin group as control and an IL-10 + endotoxin group. E. coli endotoxin (10 mg/kg) was injected intraperitoneally 5 minutes after saline or IL-10 (1250 U, 0.25 mg) injection. The force-frequency curves, twitch kinetics and fatigability were measured at 0 and 4 hours after endotoxin injection. In the saline + endotoxin group, the force-frequency curves and half relaxation time were significantly decreased at 4 hours (p < 0.001 and p < 0.05, respectively) compared to those at 0 hour. In the IL-10 + endotoxin group, the decrement in the force-frequency curves by endotoxin was prevented at 4 hours compared to that at 0 hour. Nicotinamide adenine dinucleotide phosphate (NADPH) diaphorase histochemistry showed positive staining in the saline + endotoxin at 4 hours, but there was no significant staining at 0 or 4 hours in the IL-10 + endotoxin group. These data suggest that IL-10 prevents the deterioration of contraction induced by endotoxin by inhibiting nitric oxide production in the diaphragm muscle.

Effect of Bordetella bronchiseptica and serotype D Pasteurella multocida bacterin-toxoid on the occurrence of atrophic rhinitis after experimental infection with B. bronchiseptica and toxigenic type AP. multocida.

In efficacy tests, 7 primary specific-pathogen-free piglets vaccinated with the Bordetella bronchiseptica and type D Pasteurella multocida bacterin-toxoid were challenged with B. bronchiseptica and type A P. multocida. Severe or moderate nasal turbinate atrophy was produced in the non-vaccinated pigs, whereas, only one of the 4 pigs in the vaccinated group had slight turbinate atrophy. Other immune sera against crude toxin of P. multocida type A or D were cross neutralized. The results of the present study show that the P. multocida serotype D bacterin-toxoid is effective against atrophic rhinitis caused by toxigenic P. multocida serotype A as well as toxigenic P. multocida serotype D.

Oligonucleotide probes for Bordetella bronchiseptica based on 16S ribosomal RNA sequences.

Bordetella bronchiseptica 16S ribosomal RNA (rRNA) gene was cloned and identified. On the basis of information from computer-assisted sequence comparison of the B. bronchiseptica 16S RRNA sequences with that of other bacterial species, we constructed B. bronchiseptica-specific oligonucleotide probes complementary to variable regions in the 16S rRNA molecule. Specificity of these 32P-labeled oligo-nucleotide probes was tested in a RNA/DNA hybridization with B. bronchiseptica strains and other bacterial strains. Probe BB4 was more specific than three other oligonucleotide probes. This probe BB4 was sensitive enough to be able to detect 10(4) bacterial cells.

Detection of glycosylated protein in renal tissues and dermal vascular vessels in the microalbuminuric stage of diabetic nephropathy using the nitro blue tetrazolium reaction.

Detection of glycosylated protein in renal and dermal tissues was performed in patients in the microalbuminuric stage of diabetic nephropathy using the nitro blue tetrazolium (NBT) reaction. The intensity of NBT staining in glomeruli and dermal vascular vessels was marked in the microalbuminuric stage as well as in the overtly proteinuric stage. The NBT staining in the renal and dermal vascular walls in both stages was significantly stronger than in the samples of control autopsy patients. It appeared that nonenzymatic glycosylation in various tissues, i.e. kidneys and dermal vascular vessels, had already progressed in the microalbuminuric stage in patients with diabetic nephropathy.

Experimental pneumonia of pigs infected with Aujeszky's disease virus and Actinobacillus pleuropneumoniae.

Experimental infections were induced out to examine whether Aujeszky's disease virus (ADV) infection in pigs results in a severe pneumonia by Actinobacillus pleuropneumoniae. Intranasal inoculation of ADV (10(6.9) median tissue culture infective dose/head) in 4-month-old primary specific-pathogen-free pigs was followed by the inoculation of A. pleuropneumoniae type 1 (10(3.1) or 10(5.1) colony-forming-units/head). The pigs inoculated with ADV alone developed clinical signs of Aujeszky's disease but not pneumonia, and those inoculated with A. pleuropneumoniae (10(3.1) CFU/head) alone did not develop clinical symptoms and lung lesions. Whereas all the pigs inoculated dually with ADV and A. pleuropneumoniae (10(3.1) CFU/head) showed severe or very severe clinical symptoms and moderate or severe pneumonia and one of them died. The pigs inoculated with A. pleuropneumoniae (10(5.1) CFU/head) alone had severe clinical symptoms and one of the 2 pigs died acutely. Furthermore, all of the 3 pigs inoculated with ADV and A. pleuropneumoniae (10(5.1) CFU/head) showed clinical symptoms and moderate or severe pneumonic lesions and one pig died of disease. It was concluded that the clinical symptoms of A. pleuropneumoniae became severer by concomitant infection with ADV.

Toxigenic type A Pasteurella multocida as a causative agent of nasal turbinate atrophy in swine.

Although no clinical signs of atrophic rhinitis (AR) were recognized in 2- and 5-week-old pigs, approximately 60% of 2- to 6-month-old pigs showed clinical signs of AR in an affected pig farm. None of the pigs had normal turbinate at slaughter. Bordetella bronchiseptica was not isolated from any of the pigs before onset and incipient stage of the outbreak (2-week to 2-month-old). Pasteurella multocida of capsular type D was not isolated from any of those pigs. However, toxigenic P. multocida of capsular type A was isolated from a number of the pigs immediately before onset and incipient stage of the outbreak. Thirty-six-day-old primary specific-pathogen-free pigs were inoculated intranasally with a toxigenic type A P. multocida isolated from a 5-week-old pig. Severe nasal turbinate atrophy was observed in those pigs which were necropsied at 3 weeks post-inoculation. This is the first report on outbreak of severe nasal turbinate atrophy induced by toxigenic type A P. multocida in Japan.

Experimental atrophic rhinitis in 2 and 4 month old pigs infected sequentially with Bordetella bronchiseptica and toxigenic type D Pasteurella multocida.

Experimental infections with Bordetella bronchiseptica and/or toxigenic type D Pasteurella multocida were studied in 2- and 4-month-old primary specific-pathogen-free pigs. None of the 2-month-old pigs inoculated with B. bronchiseptica or P. multocida alone developed turbinate atrophy. All the pigs inoculated with B. bronchiseptica (10(7) CFU/head) and P. multocida (10(9) CFU/head for 5 consecutive days) together, however, developed clinical and post-mortem signs of atrophic rhinitis (AR) similar to the naturally occurring disease. Slight to severe turbinate atrophy was observed in the 4-month-old pigs inoculated with B. bronchiseptica and P. multocida (at the same concentration as above) at necropsy.

Construction and functional characterization of mutants of the bovine leukaemia virus trans-activator protein p34tax.

The p34tax protein [p38tax, p34, p38(XBL), XBL-I] of bovine leukaemia virus (BLV) activates transcription from the BLV long terminal repeat (LTR) promoter. To analyse the functional properties of this protein, inframe insertions and internal deletions were systematically introduced in a plasmid-encoded copy of the p34tax gene. The abilities of wild-type and mutant genes to activate gene expression from the LTR promoter linked to the chloramphenicol acetyltransferase gene and to inhibit trans-activation by the wild-type protein were studied. The trans-activating activity of 14 of the 18 mutants tested was completely abolished, but four mutants each containing a lesion in the internal portion of the polypeptide retained activity. Taken together, these results suggest the presence of an internal region of the polypeptide where structural integrity is less strictly required for the functional activity of this protein. Among the mutants incompetent in the transactivation assay, only two with mutations in the N-terminal region of the polypeptide inhibited transactivation by the wild-type protein in a dose-dependent manner. These results facilitate understanding of the physiological function of the tax protein family.

[A study on the therapy and prognosis of pemphigus vulgaris].

The treatment and, in particular, the prognosis of 32 patients with pemphigus were studied. All cases were classified according to treatment, for example, corticosteroid only, corticosteroid + immune-suppressive agents, plasma exchange + corticosteroid and/or immune-suppressive agents, and other treatments. Results showed that with the plasma exchange group skin lesions disappeared the quickest, the percentage of disappearance was the highest and a long standing remission was able to be maintained. With the plasma exchange group, many cases were severe and had complications which were not able to be resolved by corticosteroid or immune-suppressive agents. Therefore, plasma exchange may be considered as a very significant form of treatment of pemphigus vulgaris.

Increased neutral protease and collagenase activity in recessive dystrophic epidermolysis bullosa.

The enzyme activities of normal-looking skin and blister fluid from a patient with recessive dystrophic epidermolysis bullosa (RDEB) were measured. Of the hydrolytic enzymes measured, both collagenase and neutral protease activities were considerably increased in the skin and blister fluid samples compared with values found in normal control skin and in blister fluid from a patient with a burn. In addition, skin from a healthy person cultured with RDEB blister fluid showed dermal-epidermal separation. These findings suggest that collagenase and neutral protease may be involved in the formation of blisters in RDEB.

The histochemical demonstration of protein-bound sulfhydryl groups and disulfide bonds in human hair by a new staining method (DACM staining).

A new fluorogenic maleimide DACM, i.e., N(7-dimethyl amino-4-methyl coumarinyl) maleimide, does not fluoresce by itself. It is specifically combined with --SH groups and becomes fluorescent (lambda ex: 400 nm, lambda em: 485 nm). At this range of excitation the frozen skin section has no native fluorescence because the emission maximum of DACM does not overlap with any of aromatic residues of proteins such as tryptophane. S--S groups can be demonstrated with DACM by inhibiting native --SH and then reducing SS to --SH. --Sh was generally abundant at the bulb region. --SH of hair cortex was more concentrated at keratogenous zone. Further up in the follicle, --SH of hair cortex was gradually decreased, although at the region of isthmus, --SH reaction of the hair cortex was still moderately strong. Outer root sheath had --SH from the upper bulb to the surface of the epidermis. One the other hand, no S--S was demonstrable at the bulb region. At the level of keratogenous zone, however, S--S linkages of hair cortex and inner root sheath began to appear and further up in the follicle S--S linkages were increased gradually. Outer root sheath had no S--S linkages by DACM staining up until it is keratinized along the hair canal in the upper follicle. The concentration of --SH and S--S thus seemed to be reciprocal; --SH is found in non-keratinized tissues, whereas S--S is abundant in keratinized areas. These findings are at some variance with conventional data, which suggest, for example, that --SH groups disappear suddenly above the keratogenous zone.

The histochemical distribution of protein bound sulfhydryl groups in human epidermis by the new staining method.

Recently, we synthesized a new fluorescent thiol reagent, N-(7-dimethylamino-4-methylcoumarinyl)-maleimide (DACM) which is nonfluorescent by itself but will react readily with -SH groups to form highly fluorescent addition products. By the use of this reagent, we studied the localization and concentration of -SH groups and S--S linkages in the human epidermis. The distribution of -SH groups in living layers was abundant in cytoplasm but not in nuclei. The fluorescence was concentrated on the cell membrane or intercellular spaces (MIC parts) and was increased at the spino-granular junction. In the horny layer, the fluorescence of the MIC parts appeared brilliantly in the lower layers and decreased gradually. On the other hand, the fluorescence of cytoplasm in keratinized cells in the stratum corneum was faint. The localization of S--S linkages was not a characteristic of the living layers, but appeared abruptly at the junction of living and horny layers. The fluorescence was localized to the MIC parts and disappeared gradually. The distribution of S--S linkages appeared to be very low in the cytoplasm of keratinized cells. No substantial fluorescence was localized on keratohyalin granules even after reduction.