'It's like they're learning what it is for the very first time': Clinician's accounts of self-compassion in clients whose parents experience mental illness.

OBJECTIVES: Individuals who have a parent with mental illness are more likely to experience mental illness than their contemporaries. As such, it is valuable to examine potential psychological resources, which might assist these individuals to experience good mental health throughout their lifespan. We aimed to learn how clinicians perceive self-compassion, and how it can be incorporated into therapy with clients who have parents with mental illness. DESIGN: A qualitative interview design was employed to explore clinicians' perspectives and experiences. METHODS: Eight mental health clinicians experienced in working with clients who have parents with mental illness were interviewed. Interpretative phenomenological analysis was used to establish themes representing the clinicians' perspectives and experiences of incorporating self-compassion into their work. RESULTS: This study found that clinicians were generally positive about incorporating self-compassion into interventions with clients who are children of parents with mental illness. The participants noted barriers to self-compassion for these clients, namely a poor sense of self and divided loyalty between self and family. Participants recommended taking time and care, building rapport and involving others when cultivating self-compassion with those who have parents with mental illness. CONCLUSIONS: This group of clinicians viewed self-compassion as relevant to clients whose parents have mental illness and believe it can be introduced therapeutically in various ways. Suggestions are made for tailoring self-compassion training to the needs and experiences of this group.

Experiences and perspectives of self-compassion from young adult children of parents with mental illness.

INTRODUCTION: In adolescents and young adults, self-compassion has been positively associated with wellbeing and negatively associated with psychological distress. One population of youth who may draw particular benefit from self-compassion are those who have parents with mental illness. This qualitative study explored the perspectives and experiences of self-compassion among a group of young adult children of parents with mental illness. METHODS: A purposive sample of ten Australian emerging adults aged 18-25 years (3 men, 6 women and 1 non-binary person) participated in individual semi-structured telephone interviews. Interpretative Phenomenological Analysis was used to examine and interpret participants' experiences and perspectives of self-compassion. RESULTS: Participants described self-compassion as personally relevant and beneficial, although difficult to engage in. Some participants had learnt about, and actively practiced self-compassion, and offered advice for others. Conversely, others described self-compassion as difficult to practice and outlined barriers to self-compassion, from society and family life. Although participants identified common negative social conceptions of self-compassion, they articulated how self-compassion could be valuable for those who have parents with mental illness. CONCLUSIONS: Results indicate the perceived importance of self-compassion along with barriers and facilitators of self-compassion for young adults who have parents with a mental illness. Implications for clinical practice and suggestions for future research are presented.

Prognostic Value of Serial ST2 Measurements in Patients With Acute Heart Failure.

BACKGROUND: Several clinical studies have evaluated the association between ST2 and outcome in patients with heart failure (HF). However, little is known about the predictive value of frequently measured ST2 levels in patients with acute HF. OBJECTIVES: This study sought to describe the prognostic value of baseline and repeated ST2 measurements in patients with acute HF. METHODS: In the TRIUMPH (Translational Initiative on Unique and novel strategies for Management of Patients with Heart failure) clinical cohort study, 496 patients with acute HF were enrolled in 14 hospitals in the Netherlands between 2009 and 2014. Repeated blood samples (7) were drawn during 1-year follow-up. ST2 and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels were measured in a central laboratory. The primary endpoint was the composite of all-cause mortality and HF rehospitalization. Associations between repeated biomarker measurements and the primary endpoint were assessed using a joint model. RESULTS: Median age was 74 years, and 37% of patients were women. The primary endpoint was reached in 188 patients (40%) during a median follow-up of 325 days (interquartile range: 85 to 401). The median baseline ST2 level was 71 ng/ml (interquartile range: 46 to 102). After adjustment for clinical factors and NT-proBNP, baseline ST2 was associated with an increased risk of the primary endpoint, and the hazard ratio per 1 SD increase of the baseline ST2 level (on the log2 scale) was 1.30 (95% confidence interval: 1.08 to 1.56; p = 0.005). When repeated measurements were taken into account, the adjusted hazard ratio per 1 SD increase of the ST2 level (on the log2 scale) during follow-up increased to 1.85 (95% confidence interval: 1.02 to 3.33; p = 0.044), adjusted for clinical factors and repeated measurements of NT-proBNP. Furthermore, ST2 levels appeared to elevate several weeks before the time of the primary endpoint. CONCLUSIONS: Repeated ST2 measurements appeared to be a strong predictor of outcome in patients with acute HF, independent of repeatedly measured NT-proBNP. Hence ST2 may be helpful in clinical practice for prognostication and treatment monitoring. (TRanslational Initiative on Unique and novel strategies for Management of Patients with Heart failure [TRIUMPH]; NTR1893).

Trans-vessel gradient of myeloperoxidase in coronary artery disease.

BACKGROUND: Coronary artery disease (CAD) may reflect generalized inflammation. We evaluated leucocyte activation in subjects with and without CAD in different vascular compartments. MATERIALS AND METHODS: Patients were divided in two groups; subjects without CAD (controls; n = 25) and with stable CAD (n = 52) based on coronary angiography. After blood sampling from vessels, cardiovascular risk factors and leucocyte activation markers CD11b, CD66b and cytoplasmatic myeloperoxidase (MPO) were determined by flow cytometry. RESULTS: Myeloperoxidase (MPO) was higher in patients with CAD at all sites compared with controls (188 ± 7 vs. 210 ± 12 au for venous (P < 0.05), 178 ± 7 vs. 212 ± 12 au for femoral artery (P = 0.08), 166 ± 7 vs. 195 ± 12 au for abdominal artery (P < 0.05), 166 ± 6 vs. 189 ± 14 au for left coronary (P = 0.08) and 163 ± 6 vs. 193 ± 12 au for the right coronary artery (P < 0.05)). Other markers did not differ between the groups. A gradient of inflammation from peripheral vessels to the coronaries was found by differences in MPO in both groups; from 210 ± 12 au in the venous compartments towards 189 ± 14 and 193 ± 12 au, in the left and right coronaries, respectively, for the controls (P = 0.001), and from 188 ± 7 au in the venous compartment towards 166 ± 6 and 163 ± 6 au in the left and right coronaries, respectively, for the patients (P = 0.007). Other leucocyte activation markers did not show such a gradient. CONCLUSIONS: There is a generalized inflammatory neutrophil gradient for MPO from peripheral vessels towards the coronaries in both patients with CAD and controls. However, patients with CAD show a higher degree of inflammation, mostly in the coronaries. These data strengthen the role of activated neutrophils in CAD.

Complete AV-block secondary to lithium-clozapine therapy and relapsing multiple sclerosis in a bipolar patient.

A complete atrioventricular block (CAVB) can be a lethal complication when it is not treated directly with isoprenaline and pacemaker therapy. The overall incidence of CAVB varies between 4 to 8 per cent with a mortality OR of 3.2 within 30 days if untreated. Main causes of CAVB are inferior myocardial infarction, congenital AV node malformation, mitral valve insufficiency and valve surgery, metabolic disorders and intoxications. The authors describe a case with a CAVB due to lithium-clozapine therapy and relapsing multiple sclerosis.

Electrocardiographic characteristics in low atrial septum pacing.

AIM: The aim of the study was to compare P-wave morphology and duration in pacing from the low right atrial septal wall and the high right atrial appendage (RAA). METHODS: The electrocardiogram (ECG) of 50 patients with low atrial septum (LAS) pacing and that of 50 patients with RAA pacing were compared with their electrocardiogram during sinus rhythm. RESULTS: In the frontal plane, patients with LAS pacing showed a superior P-wave axis between -60 degrees and -90 degrees . In all patients with RAA pacing, a P-wave axis between 0 degrees and +90 degrees was observed as in sinus rhythm. In the horizontal plane, all patients with LAS pacing had an anterior P-wave axis between +90 degrees and +210 degrees , whereas all patients with RAA pacing had a posterior P-wave axis between -30 degrees and -90 degrees . The terminal part of biphasic P waves in lead V 1 in LAS pacing was always positive, a pattern that was never observed in P waves of sinus origin or in RAA pacing. P-wave duration was longer with RAA pacing compared with LAS pacing (115 +/- 19 vs 80 +/- 14 milliseconds [ P < .01]). CONCLUSION: The total atrial activation time during LAS pacing is shorter than that during RAA pacing. The electrical atrial activation sequences in LAS pacing and RAA pacing are significantly different. The morphology of biphasic P waves in lead V1 during LAS pacing suggests that the initial part of activation occurs in the left atrium and the terminal part in the right atrium.

Conserved worldwide linkage disequilibrium in the human factor XI gene.

We have identified, in four diverse human populations, five common single-nucleotide polymorphisms (SNPs) in the coding region of the gene for the blood coagulation protease factor XI. Each SNP has an allele frequency >5% in at least one population. Three of the SNPs (C472T, A844G, and T1234C), spread out over approximately 10 kb of genomic DNA, are in marked linkage disequilibrium (LD) with one another (P < 10(-4)). Interestingly, haplotypes associated with the linked SNPs are conserved across all populations studied, despite significantly different allele frequencies between populations. The presence of such common, widely dispersed haplotypes could complicate the interpretation of LD studies and emphasizes the need for a better understanding of general patterns of LD to facilitate identification of genes for common disorders.

Combinations of variations in multiple genes are associated with hypertension.

The genetic analysis of hypertension has revealed complex and inconsistent results, making it difficult to draw clear conclusions regarding the impact of specific genes on blood pressure regulation in diverse human populations. Some of the confusion from previous studies is probably due to undetected gene-gene interactions. Instead of focusing on the effects of single genes on hypertension, we examined the effects of interactions of alleles at 4 candidate loci. Three of the loci are in the renin-angiotensin-system, angiotensinogen, ACE, and angiotensin II type 1 receptor, and they have been associated with hypertension in at least 1 previous study. The fourth locus studied is a previously undescribed locus, named FJ. In total, 7 polymorphic sites at these loci were analyzed for their association with hypertension in 51 normotensive and 126 hypertensive age-matched individuals. There were no significant differences between the 2 phenotypic classes with respect to either allele or genotype frequencies. However, when we tested for nonallelic associations (linkage disequilibrium), we found that of the 120 multilocus comparisons, 16 deviated significantly from random in the hypertensive class, but there were no significant deviations in the normotensive group. These findings suggest that genetic interactions between multiple loci rather than variants of a single gene underlie the genetic basis of hypertension in our study subjects. We hypothesize that such interactions may account for the inconsistent findings in previous studies because, unlike our study, prior studies almost always examined single-locus effects and did not consider the effects of variation at other potentially interacting loci.

Issues of access: what is going on in health care?

Our nation spends more per capita on health care than any other nation, yet there are still approximately 37 million Americans without health insurance. Why has this happened? What are some barriers that prevent Americans from attaining access to adequate health care?

Dopamine not effective for treatment of hypotension in chlorpromazine overdose: first case report.

Dopamine is a popular and effective vasopressor agent. However, in the event of overdose with a potent alpha 1-receptor blocker, dopamine may not be effective in treatment of hypotension. A vasopressor that stimulates only alpha-receptors, such as norepinephrine or phenylephrine, may be more appropriate. In our case, dopamine was clearly ineffective, whereas norepinephrine worked well. Our case also demonstrates the importance of carefully monitoring the effectiveness of any vasopressor therapy.

Adenoid cystic carcinoma of the sublingual gland--an unusual presentation.

A case of adenoid cystic carcinoma of the sublingual salivary gland presenting as recurrent submandibular salivary gland swelling is described. The obstructive symptoms were due to involvement of the ipsilateral submandibular duct by the tumour. A review of the literature suggests that this is the first such case to be reported. The importance of intra-oral examination when investigating swellings of the neck is emphasised.

A comparative study of isradipine and nifedipine in the monotherapy of mild to moderate hypertension in the Ghanaian

Clinical experience with the new dihydropyridine calcium antagonist; isradipine; is reported. Isradipine was compared with nifedipine in a multicentre open; parallel group; clinical therapeutic trial involving 70 patients with mild to moderate hypertension. A four week placebo washout period was followed by a 12 week active treatment period during which patients were randomized to receive either 2.5mg isradipine twice daily (n=40) or 10mg nifedipine three times daily (n=30). Isradipine significantly reduced sitting systolic/diastolic blood pressures from 176.7+/-21.0/106.7+/-7.0mmHg to 142.9+/-15/93.1+/-7.7mmHg (p0.001) at the end of 12 weeks. Similarly; nifedipine reduced sitting systolic/diastolic blood pressures from 170.1+/-19.5/106.2+/-7.4mmHg to 139.1+/-9.7/92.1+/-7.8mmHg (p0.001). Normalisation (diastolic 90mmHg) rates were 67 per cent and 60 per cent for isradipine and nifedipine respectively while good response (diastolic fall 10mmHg) rate was over 85 per cent on either drug. Heart rate did not significantly change with either treatment. Three (3) patients taking isradipine experienced headache and 7 patients taking nifedipine had drug related adverse effects (5 had headache; 1 insomnia and 1 first dose hypotension). Therapy was withdrawn in 4 patients taking nifedipine and 1 taking isradipine. It is concluded that isradipine is comparable to nifedipine and is an effective and well tolerated antihypertensive agent in the Ghanaian

Disseminated cutaneous sporotrichosis associated with anergic immuno-suppression due to miliary tuberculosis.

A 52-years-old policeman suffering from tuberculous meningitis, developed pseudo-umbilicated nodular skin lesions which increased rapidly in size during the course of his illness. Histology revealed cutaneous sporotrichosis. Human immuno-deficiency virus infection was excluded by absence of history of exposure and repeated negative serological test for HIV antibodies. The tuberculin test was also negative. Anti-tuberculous therapy failed to prevent a fatal outcome 3 months after admission to hospital. The possibility that the usually presentation of disseminated cutaneous sporotrichosis was an opportunistic infection facilitated by immuno-deficiency accompanying anergy of miliary tuberculosis is discussed.

Red sea coral contact dermatitis.

Six of nine adults who developed Red Sea coral contact dermatitis had seafood allergies. Contact with the "fire" coral was followed by a series of skin eruptions starting with an immediate pruritic urticaria-like lesion which forced the victims out of the water. Within minutes the affected area became erythematous and edematous with eventual blister formation approximately 6 hours after the initial contact. The blisters resolved, leaving violaceous papules and plaques in a streaky fashion corresponding to where the coral brushed the skin. The lesions became shiny and lichenoid in 3 weeks while pruritus persisted. Treatment with topical corticosteroids and oral antihistamines reduced the severity of the disease but did not stop its evolution to the lichenoid stage. Complete resolution usually occurred after 15 weeks, leaving residual hyperpigmented macules.

Serological and immunochemical specificity of a human autoanti-Gerbich-like antibody.

An 85-year-old male with cardiac failure secondary to anaemia had an apparent anti-Ge2 (Ge = Gerbich) in his serum which did not agglutinate his own red cells even though they were Ge-positive in tests with alloanti-Ge. The direct antiglobulin test was negative; however, an antibody with apparent anti-Ge2 specificity was eluted from his red cells. The patient's autoantibody was shown in immunoblotting experiments to react with an antigenic determinant on beta-sialoglycoprotein. This case illustrates that an autoanti-Ge can masquerade as an alloantibody, thereby complicating antibody identification, and implies that the immunochemical specificity of autoanti-Ge2 is different from that of alloanti-Ge2.

Evidence that olfactory bulbectomy does not influence testicular regression in golden hamsters on short photoperiod by altering pineal melatonin production.

A recent study has shown that olfactory bulbectomy (BX) will prevent reproductive regression associated with short photoperiod in male golden hamsters. The results of experiments reported in this paper show that bulbectomized hamsters on long or short photoperiod still show a large nocturnal elevation in pineal melatonin production and that BX inhibits the reproductive regression induced by exogenous melatonin in pinealectomized hamsters. The data therefore indicate that BX does not inhibit short photoperiod induced testicular regression by altering melatonin secretion.