Using Arts-Based Therapies to Improve Mental Health for Children and Young People With Physical Health Long-Term Conditions: A Systematic Review of Effectiveness.

Background: Children with physical health long-term conditions (LTCs) have increased risk of mental health difficulties relative to healthy peers. However, availability of psychological support integrated into pediatric physical health settings is limited, and there are long waiting times for access to child mental health services. Arts-based therapies involve using creative media to develop a therapeutic relationship, and offer a potential alternative to talking-based therapies. The aim of this systematic review is to establish the effectiveness of arts-based therapies for improving the mental health of children with physical health LTCs. Methods: The review protocol was published on PROSPERO. Four electronic databases were searched (Medline, Embase, Cinahl, and PsycINFO), plus hand searches of two key journals and relevant reviews, and forward/back citations searches of selected articles were conducted. The Effective Public Health Practice Project (EPHPP) Quality Assessment Tool was used to assess bias in selected articles. Second reviewers completed 10% of article screening and 20% of bias assessments. The findings were synthesized narratively. Results: Sixteen studies met inclusion criteria and demonstrated some improvements on indicators of mental health and well-being including quality of life, coping behaviors, anxiety, self-concept, and mood. However, replication across interventions and outcomes was absent. Overall, the quality of evidence of effectiveness in the studies reviewed was moderate/weak. This was due to bias in study design; other limitations included a lack of detail on intervention components, e.g., use of a manual, and single recruitment sites. Conclusions: The heterogeneity of existing research evaluating arts-based therapies for children with physical health LTCs limits conclusions about effectiveness. Suggestions are made to inform the design of future research studies to help build a robust evidence base.

Implementing a Pediatric Camp Clinical for Pre-Licensure Education.

: This article describes the implementation and outcomes of a pediatric clinical education pilot project at a weekend overnight camp for children with special needs. Nine junior-level baccalaureate students participated in the immersion experience. The course skill inventory, an instructor-led postconference, a focus group session, and online forum entries were used to evaluate the experience. The evidence suggests that students gained a wide variety of psychomotor skills and patient-centered care attitudes. Although scheduling was challenging, we concluded the camp clinical was an enlightening and positive experience that offered opportunities not readily available in the hospital setting.

Using service-learning to develop health promotion and research skills in nursing students.

Health promotion skills are a key component of most nursing education programs. While many curricula center around a singular health promotion project contained in one course, this nursing program saw the opportunity to use service-learning as a vehicle for developing a range of both health promotion and research skills. This report details a service-learning research program involving second and third year nursing students. Students conducted a community needs assessment, and designed, implemented, and evaluated health promotion programs that were developed as a result of the community needs assessment. Students collected data on the effectiveness of their programs through pre- and post-test design. Once in their statistics and research courses, students analyzed the data and prepared the data for presentation, developing their research skills. Results from the community on pre- and post-tests indicated significant gains in knowledge regarding hypertension and diabetes risk factors, prevention strategies, and intent to change behavior. Student outcome data was also collected and showed students perceived they had increases in the following skill sets: health promotion, assessment, civic engagement, and research.

Isolation and in vitro cultivation of the insect pathogenic fungus Cordyceps unilateralis.

Cordyceps unilateralis, a fastidious insect pathogenic fungus, was found to produce red naphthoqinones, which possess anti-malarial activity. A method for the isolation and in vitro cultivation of this fungus was, therefore, developed in this study. Ascospores from ant cadavers were used as starting materials, and their secondary spores were allowed to germinate first on PDA for 2 d. Secondary spores were then transferred to Grace's Insect Cell Medium + 2 mM glutamine and 10% fetal bovine serum, incubated for 7 d, after which the formation of mycelia was stimulated by transfer to potato dextrose broth. As a result, the growth of C. unilateralis from the steps of secondary spore germination, blastospore formation and mycelial growth was successfully completed for the first time.

Blockade of attachment and fusion receptors inhibits HIV-1 infection of human cervical tissue.

Identification of cellular factors involved in HIV-1 entry and transmission at mucosal surfaces is critical for understanding viral pathogenesis and development of effective prevention strategies. Here we describe the evaluation of HIV-1 entry inhibitors for their ability to prevent infection of, and dissemination from, human cervical tissue ex vivo. Blockade of CD4 alone or CCR5 and CXCR4 together inhibited localized mucosal infection. However, simultaneous blockade of CD4 and mannose-binding C-type lectin receptors including dendritic cell-specific intercellular adhesion molecule-grabbing integrin was required to inhibit HIV-1 uptake and dissemination by migratory cells. In contrast, direct targeting of HIV-1 by neutralizing mAb b12 and CD4-IgG2 (PRO-542) blocked both localized infection and viral dissemination pathways. Flow cytometric analysis and immunostaining of migratory cells revealed two major populations, CD3(+)HLA-DR(-) and CD3(-)HLA-DR(+) cells, with a significant proportion of the latter also expressing dendritic cell-specific intercellular adhesion molecule-grabbing integrin. Bead depletion studies demonstrated that such HLA-DR(+) cells accounted for as much as 90% of HIV-1 dissemination. Additional studies using immature monocyte-derived dendritic cells demonstrated that although mannose-binding C-type lectin receptors and CD4 are the principal receptors for gp120, other mechanisms may account for virus capture. Our identification of the predominant receptors involved in HIV-1 infection and dissemination within human cervical tissue highlight important targets for microbicide development.

Comparative studies on the cytochrome p450-associated metabolism and interaction potential of selegiline between human liver-derived in vitro systems.

Selegiline was used as a model compound in a project aimed at comparing, evaluating, and integrating different in vitro approaches for the prediction of cytochrome p450 (p450)-catalyzed hepatic drug metabolism in humans (EUROCYP). Metabolic predictions were generated using homology modeling, cDNA-expressed p450 enzymes, human liver microsomes, primary cultured human hepatocytes, and precision-cut human liver slices. All of the in vitro systems correctly indicated the formation of two dealkylated metabolites, desmethylselegiline and methamphetamine. The metabolic instability of selegiline was demonstrated by all of the in vitro systems studied. Estimates of clearance varied from 16 l/h to 223 l/h. With the exception of one approach, all systems underpredicted the in vivo clearance in humans (236 l/h). Despite this, all approaches successfully classified selegiline as a high clearance compound. Homology modeling suggested the participation of CYP2B6 in the demethylation of selegiline and of CYP2D6 in the depropargylation of the drug. Studies with recombinant expressed enzymes and with human hepatic microsomal fraction supported the involvement of CYP2B6 but not of CYP2D6. These techniques also suggested the involvement of CYP1A2, CYP2C8, and CYP2C19 in the biotransformation of selegiline. In vitro, CYP2B6 was the most active form of p450 involved in selegiline metabolism. Metabolism by several enzymes operating in parallel implies a low interaction potential for the drug. None of the techniques alone was able to predict all aspects of the metabolic and kinetic behavior of selegiline in vivo. However, when used as an integrated package, all significant characteristics were predictable.

Cytotoxicity against insect cells of entomopathogenic fungi of the genera Hypocrella (anamorph Aschersonia): possible agents for biological control.

Extracts from entomopathogenic fungi of the genus Hypocrella (7 species) and its anamorph Aschersonia (11 species) were screened for cytotoxicity to Sf9 and C6/36 insect cells and L929, BHK(21)C13 and HepG2 mammalian cells. Cytotoxic extracts to insect cells (ID50's < or = 10 microg ml(-1)) but not to mammalian cells (ID50's > or = 10 microg ml(-1)) conformed to the criteria of the project and were considered 'lead' extracts for further investigation. 'Leads' were found in two of the Hypocrella species: H. discoidea, and H. tamurai and in three of the Aschersonia species: A. samoensis, A. badia, and A. tamurai. Bioassay-guided fractionation of the cell extract of the fungus A. samoensis BCC 1393 led to the identification of two known anthraquinone dimers, (+)rugulosin (1) and skyrin (2) which showed selective toxicity towards insect cells. (+)Rugulosin (1) and skyrin (2) exhibited strong cytotoxic activity against the insect cell line Sf9 with respective ID50 values of 1.2 and 9.6 microg ml(-1), but showed weak activity toward mammalian cells. This first report of (+)rugulosin (1) and skyrin (2) in A. samoensis is confirmed and demonstrated in another four strains of A. samoensis isolated in Thailand. The preferential cytotoxicity against Sf9 insect cells gives evidence that these insect-pathogenic fungi of the Hypocrella/Aschersonia group might be useful as an agent for pest control.

Induction of cytochrome P450 enzymes in cultured precision-cut human liver slices.

Precision-cut human liver slices obtained from 11 donors were cultured for 72 h in a defined medium (serum free Williams' medium E) supplemented with 0.1 microM insulin and 0.1 microM dexamethasone (DEX). Liver slices were treated with 50 microM concentrations of beta -naphthoflavone (BNF), lansoprazole, rifampicin (RIF), DEX and methylclofenapate and 500 microM sodium phenobarbital (NaPB). The relative apoprotein levels of 12 cytochrome P450 (P450) enzymes were determined in liver slice microsomes using a panel of antipeptide antibodies. Treatment with BNF significantly induced mean levels of CYP1A2 apoprotein to 160% of levels in 72-h control (no test compound) human liver slice microsomes. NaPB significantly induced levels of CYP3A4 apoprotein to 255% of control and RIF significantly induced levels of CYP2C19 and CYP3A4 apoproteins to 265 and 330% of control, respectively. In addition, treatment with RIF increased levels of CYP2A6 apoprotein to 205% of control, and treatment with both NaPB and RIF increased levels of CYP2B6 apoprotein to 370 and 615% of control, respectively. However, these increases were not statistically significant, owing to a variable response between liver slice preparations from different subjects, this being apparent for all inducible P450s. In contrast, none of the compounds examined significantly increased levels of CYP2C8, CYP2C9, CYP2D6, CYP2E1, and CYP4A11 apoproteins. Levels of CYP1A1 apoprotein were not detected in any liver slice sample, either before or after treatment with the model inducers. Overall, these results demonstrate the utility of cultured human liver slices for assessing the effects of chemicals on P450 enzymes.

Negative Symptoms in Patients With Alzheimer's Disease.

This study applies the concept of "negative symptoms," previously used in schizophrenia, to dementia of the Alzheimer type (DAT) and examines the relationship of negative symptoms to cognitive deficits and depression. The negative symptom subscale of the Positive and Negative Symptom Scale (PANSS-N), the Hamilton Depression Scale (Ham-D), and the Mini-Mental State Examination (MMSE) were administered to 26 patients with DAT and to 13 normal control subjects. The mean PANSS-N score in DAT patients was significantly higher than in control subjects. DAT patients demonstrated significant correlation between negative symptoms and cognitive deficits. Ham-D scores did not significantly correlate with MMSE or PANSS-N scores. These results indicate that negative symptoms are prevalent in DAT and do not result from depression.