Effect of an intervention of exercise on sleep and seizure frequency in idiopathic epileptic dogs.

OBJECTIVE: The goal of this study was to compare sleep and seizure frequency between epileptic dogs prescribed a 20% activity increase and epileptic dogs not prescribed an activity increase. METHODS: Sixty-nine dogs receiving anti-epileptic drug therapy were enrolled in a 6-month prospective, randomised, placebo-controlled clinical trial with an intention-to-treat analysis. A canine activity monitoring device was used to measure activity levels and sleep scores. RESULTS: Using an intention-to-treat analysis, the treatment group had an average of 0.381 more seizures per month (95% CI: 0.09 to 0.68) compared with the control group, although the difference in seizure days per month was not statistically significant. In a subgroup analysis of dogs whose activity increased by at least 10%, partial compliers had 0.719 more seizures per month (95% CI: 0.22 to 1.22) and 0.581 seizure days per month (95% CI: 0.001 to 1.16) compared with the control group. Sleep scores increased by 1.2% in the treatment compared with the control group (95% CI: 0.2 to 2.3%). CONCLUSIONS: Seizure frequency and sleep score increased slightly, but significantly, in dogs with idiopathic epilepsy prescribed an increase in activity, compared with a control group.

A pilot evaluation of the SPARX-R gaming intervention for preventing depression and improving wellbeing among adolescents in alternative education.

AIM: The use of computerized mental health programs with vulnerable youth, such as early school leavers, remains relatively unstudied. This pilot study examined the feasibility of delivering a computerized cognitive behavioral therapy (cCBT) gaming intervention (SPARX-R) for young people (age 15-20 years) who have left school early and are attending Youthreach, an alternative education (AE) program in Ireland. METHOD: Students (n = 146) from twenty-one Youthreach Centers were randomized to SPARX-R and no-intervention control. All students within the group were included in the study whether or not they were exhibiting heightened levels of depression. Program impact was examined on both negative and positive indicators of mental health, including depression (primary outcome), generalized anxiety, general mental wellbeing, coping and emotion regulation. Assessments were conducted at baseline and post-intervention (7 weeks). Participants that provided data at post-assessment (n = 66) were included in the analysis. RESULTS: The participants completed on average 5.3 modules of SPARX-R with 30% (n = 9) completing the entire program. A significant improvement in emotion regulation strategies was detected, with expressive suppression decreasing significantly in the SPARX-R group in comparison to the control (- 2.97, 95% CI - 5.48 to - 0.46, p = 0.03). CONCLUSIONS: Findings suggest that SPARX-R has a positive impact on emotion regulation. The lack of significant findings on other outcome measures may be attributed to inadequate sample size, and therefore, further research with larger samples are required to establish the effectiveness of the program in reducing depression and anxiety and improving psychological wellbeing among young people attending AE.

Promotion of mental health and prevention of mental disorders: priorities for implementation.

There is compelling evidence from high-quality studies that mental health promotion and primary prevention interventions can reduce the risk of mental disorders, enhance protective factors for good mental and physical health, and lead to lasting positive effects on a range of social and economic outcomes. This paper reviews the available evidence in order to guide the implementation of mental health promotion and prevention interventions in the Eastern Mediterranean Region. The paper identifies a number of priority areas that can generate clear health and social gains in the population and be implemented and sustained at a reasonable cost. The interventions cover population groups across the lifespan from infancy to adulthood and include actions delivered across different settings and delivery platforms. "Best practices" were identified as interventions for which there is evidence not only of their effectiveness but also of their feasibility within resource constraints. The implications of the findings for capacity development are considered.

Promotion of mental health and prevention of mental disorders:priorities for implementation

There is compelling evidence from high-quality studies that mental health promotion and primary prevention interventions can reduce the risk of mental disorders, enhance protective factors for good mental and physical health,and lead to lasting positive effects on a range of social and economic outcomes. This paper reviews the available evidence in order to guide the implementation of mental health promotion and prevention interventions in the Eastern Mediterranean Region. The paper identifies a number of priority areas that can generate clear health and social gains in the population and be implemented and sustained at a reasonable cost. The interventions cover population groups across the lifespan from infancy to adulthood and include actions delivered across different settings and delivery platforms. "Best practices" were identified as interventions for which there is evidence not only of their effectiveness but also of their feasibility within resource constraints. The implications of the findings for capacity development are considered

Selon des preuves irréfutables issues d'études de haute qualité, la promotion de la santé mentale et les interventions de prévention primaire permettent de réduire le risque de troubles de santé mentale, de renforcer les facteurs protecteurs pour une bonne santé mentale et physique et de produire des effets positifs durables sur un éventail de problèmes socioéconomiques. Le présent article examine les preuves disponibles afin d'orienter la mise en œuvre d'interventions pour la promotion et la prévention de la santé mentale dans la Région de la Méditerranée orientale. Il identifie un certain nombre de domaines prioritaires qui peuvent générer de nettes améliorations sanitaires et sociales dans la population et être mis en œuvre puis pérennisés pour un coût raisonnable. Les interventions couvrent des groupes de population de tout âge,de la petite enfance à l'âge adulte et comprennent des actions menées dans des milieux variés et à partir de plateformes de prestation différentes. "Les meilleures pratiques" ont été identifiées comme étant des interventions pour lesquelles non seulement l'efficacité, mais aussi la faisabilité ont été prouvées dans un contexte de compression des ressources. Les implications des résultats en matière de renforcement des capacités sont en cours d'étude

Developing a scale to measure trust in health promotion partnerships.

Developing and sustaining partnerships for promoting health has been identified as an important strategy for addressing the health challenges that face society. Trust is one of the most important factors that help partnerships function effectively. In health promotion partnerships, trust is an under-researched and poorly understood phenomenon. This study was designed to identify how trust is conceptualized in health promotion partnerships and to develop a trust measurement tool. Five focus groups were organized with 36 health promotion partners in order to explore how trust is conceptualized in their partnerships. Participants represented health, community, education, arts, sports and youth sectors. A content analysis was carried out on the transcripts and a 14-item, five-point scale, was developed from the findings. This scale was incorporated into an overall questionnaire on partnership functioning which was posted to 469 partners in 40 health promotion partnerships. A response rate of 72% was achieved (n= 337) for the postal survey. The trust scale was subjected to reliability and validity tests. Principal Component Analysis yielded two components, named positive trust and mistrust, explaining 59% of the variance. Coefficients ranged from 0.845 to 0.511 with eigenvalues before rotation of 6.58 and 1.66. Cronbach's alpha was 0.91. Further research is required to establish whether the scale can be used with other types of partnerships.

Diabetes and impaired fasting glucose in rural and urban populations in Futa Jallon (Guinea): prevalence and associated risk factors.

AIM: The authors present the results of the first survey conducted among the population of the Futa Jallon province in Guinea on the prevalence of diabetes mellitus (DM) and impaired fasting glucose (IFG) and associated risk factors for diabetes. METHOD: A random sample of the study population selected by cluster house sampling method included 1537 Guineans (807 women and 730 men) aged 35 years and above in urban (Labé) and rural (Fellö Koundoua-Tougué) areas. Participants were examined and administered a capillary whole blood glycemia test. RESULTS: The mean age of subjects was 49.4 years. Participation rate was 77%. Overall crude diabetes and IFG prevalence were 6.1% and 13.4%, respectively. The age-adjusted prevalence of diabetes using the standardized age distribution of Segi was 6.7% (95% CI: 5.5-7.9%). Subjects in the urban area had twice as much DM as in the rural area (OR 2.0, 95% CI: 1.3-3.2). Out of the 94 subjects with DM, 66 had no prior history of disease. Urban location, age, waist to hip ratio, excess waist circumference, hypertension, raised systolic and diastolic blood pressures were significantly positively associated with DM. In multivariate analysis, only age (P=0.002) and waist circumference (P<0.05) remained independently associated with DM. CONCLUSION: The prevalence of DM was higher than expected in urban and rural areas. The data support the conclusion that prevalence of DM is expected to increase with the aging of the population. The factors associated with diabetes are potentially modifiable. Therefore, primary prevention through lifestyle modifications may play a critical role in the control of DM.

Comparative histological and biometric study of the coronary, radial and left internal thoracic arteries.

In an attempt to elucidate the causes of occlusion of radial arteries used for coronary artery bypass grafts and to improve the results of these procedures, we studied the biometry and histology of the coronary, radial and left internal thoracic arteries. These arteries were harvested from 20 cadavers (13 males, 7 females). The specimens were calibrated to the various bypass graft sites using coronary calibrators, and were then submitted to histological examination to determine the structure and innervation of the vessel wall. No correlation was observed between the internal calibers of these various arteries, with the exception of the anterior interventricular and right coronary arteries. Intimal changes and the presence of atheromatous plaque were observed in coronary and radial arteries, but never in the internal thoracic artery. Like the coronary arteries and their branches, the radial artery is a muscular artery. Aging of muscular arteries results in thickening of the intima, which becomes fibrotic due to migration of myocytes from the media and duplication of the internal elastic lamina. The media becomes fibrous, hypertrophic or atrophic. The walls of the radial and coronary arteries contain several adventitial nerves (sympathetic and parasympathetic nerve fibers), but these nerve fibers were not observed in the wall of the left internal thoracic artery. In contrast, the internal thoracic artery, like the aorta, is an elastic artery. Aging of elastic arteries is first observed between the ages of 20 and 29 years and is characterized by loss of one or several elastic laminae of the media and more marked intimal thickening, over a variable length. Even if a radial artery's caliber is similar to that of the coronary artery, histological evolution and graft patency depend on its muscular identity.

A community needs assessment for rural mental health promotion.

This paper describes the needs assessment phase of a mental health promotion programme for rural communities in Ireland. As part of a larger study encompassing four rural communities, a cross-sectional study of the mental health beliefs and perceptions of 1014 people was carried out. Employing a combination of interviewer-administered questionnaire and the vignette method, the needs assessment explores the levels of awareness, current practices, attitudes and stigma concerning depression and suicide among a randomly selected quota sample of community members. Lower levels of awareness, less confidence in dealing with mental health issues, negative attitudes to help-seeking and social stigma emerge as particular issues for men and the under 40 age group. Women were found to have more positive attitudes generally, were more likely to use informal social support networks and were more open about discussing mental health matters. The predominant interpretation of the depression vignette was to view it as a mental health problem with good prospects for recovery given appropriate help. Social relationships, negative thinking patterns and social stresses were perceived as being particularly important in explaining the origins of depression. The implications of the findings for planning the intervention phase of the project are considered.

Death education: knowledge, attitudes, and perspectives of Irish parents and teachers.

This article reports on a cross-sectional survey of the knowledge, attitudes and perspectives of Irish parents and school teachers concerning children's grief and the concept of death education. The sample comprised 119 parents and 142 teachers of Irish Primary-school children (5-12 years of age) who completed a self-administered questionnaire. Both parents and teachers reported high levels of understanding of the nature of children's grief and strongly supported the view that death should be discussed with children before they encounter it. Although discussions of death were reported in the classroom and in the home, both teachers and parents, particularly men, reported being uncomfortable talking to children about death. There was general support for inclusion of death education in the school curriculum, with both teachers and parents supporting the need for further teacher training to undertake its delivery. There were few significant differences between the expressed attitudes of parents and teachers. However, teachers were more likely than parents to agree that death education would take away from parental responsibility. The implications of the findings for further work in this area are considered.

Film-screen versus digitized mammography: assessment of clinical equivalence.

OBJECTIVE: The purpose of this study was to determine whether diagnostic accuracy and callback rates using digitized film images are equivalent to those using film-screen mammograms. MATERIALS AND METHODS: Sixty sets of mammograms (four views per case) were digitized at a spatial resolution of 100 microm. The images were reviewed by seven mammographers. Five regions were evaluated in each breast. Each region was scored on a scale of 0 100% for suspicion of malignancy, and a receiver operating characteristic analysis was performed. Callback rates were calculated using a published lexicon scale. RESULTS: The observers' mean diagnostic accuracies using films and digitized images were 0.872 and 0.848, respectively. The upper 95% confidence boundary on the difference in accuracy was 0.066. The mean callback rate for normal, benign, and malignant areas using films versus digitized images was 0.048 versus 0.055, 0.498 versus 0.441, and 0.786 versus 0.737, respectively. The upper 95% confidence boundary for the absolute difference in callback rates was 0.037, 0.026, and 0.130 for normal, benign, and malignant areas, respectively. CONCLUSION: The diagnostic accuracies of the digitized images and films were similar; however, an increase in callback rates of 0.037 (i.e., upper 95% confidence boundary) for normal results and a reduction in the callback rates of 0.130 for malignant lesions is important. The use of digitized film images, at a spatial resolution of 100 microm, may compromise patient treatment in clinical practice.

A mediational model of quality of life for individuals with severe mental health problems.

BACKGROUND: Despite the increasing importance of quality of life in the mental health field, the theoretical conceptualization of the construct remains poorly developed. A proposed mediational model of quality of life, which links subjective quality of life with self-related constructs, is examined with a group of long-term psychiatric hostel residents. The present study aims to develop a measure of quality of life based on the proposed model, to explore the data and their implications for service development and finally to conduct a preliminary analysis of the model's predictions. METHODS: A cross-sectional research design was employed. Quality of life interviews, using a modified version of Lehman's Quality of Life Interview, were carried out with 54 psychiatric residents in Greece. The model's predictions were examined by using a series of regression analyses. RESULTS: The results indicate that perceived improvements in lifestyle, greater autonomy and positive self-concept are significantly and directly associated with better quality of life. In contrast, a direct relationship between objective indicators and subjective quality of life was not found. CONCLUSIONS: The traditional two-part quality of life model that includes objective indicators of life circumstances and subjective indicators is extended to included the constructs of self-concept and perceived autonomy. The present extended mediational model of quality of life for individuals with long-term mental health problems appears to have important implications for the planning and delivery of mental health programmes.

From Leros asylum to community-based facilities: levels of functioning and quality of life among hostel residents in Greece.

The pattern of mental health care in Greece is undergoing a major transformation. The Leros Projects I and II supported the development of 13 community hostels located throughout the Greek mainland. These hostels provide residential care to more than 100 former psychiatric inpatients, mainly from Leros asylum. The present study evaluates the impact of the resettlement process on the residents' perceived quality of life (QoL) together with an examination of the residents' psychiatric and behavioural functioning four years after the move from hospital. The target sample (n = 99) comprised of individuals who may be considered 'chronic' psychiatric patients with a long history of institutionalisation and many are socially deprived with few family ties. The residents' functioning profile indicates a range of different levels of abilities. The QoL findings show that the majority of residents (70%) perceived the movement from the traditional hospital regime to the community hostels as being a positive change and expressed their satisfaction (74%) with the new living situation. This study demonstrates that even the most dependent, chronic psychiatric patients in Greece can be maintained in community settings and are able to articulate generally reliable and valid responses concerning the impact of service changes.

Quality of life as an outcome measure in evaluating mental health services: a review of the empirical evidence.

This paper addresses the question of how well quality of life measures function as valid and sensitive outcome indicators of mental health services. Findings from the major empirical studies of quality of life in the mental health area over the last 15 years are reviewed. The extent to which existing studies provide evidence of the ability of quality of life measures to discriminate the impact of service interventions on the well-being of psychiatric clients is examined. Findings from cross-sectional, comparative, repeated-measures and randomised studies are presented. The available empirical evidence is critically examined and the methodological and theoretical implications of current findings for future work are considered.

Characterization of a small variable surface glycoprotein from Trypanosoma vivax.

Several biochemical properties of a variant surface glycoprotein (VSG) from the parasite Trypanosoma (Duttonella) vivax have been determined. ILDat 2.1 VSG is approximately 40 kDa in size making this the smallest trypanosome VSG described to date. The glycolipid anchor of ILDat 2.1 VSG is resistant to treatment with T. brucei-derived phospholipase C and data based on lectin affinity chromatography, incorporation of radiolabelled sugar and treatment with endoglycosidase H suggest that the T. vivax VSG bears little carbohydrate. cDNA to ILDat 2.1 VSG mRNA has been cloned and the encoded protein sequence includes the N-terminal amino acid peptide sequence derived from native VSG. The molecular weight of the VSG predicted from the translated cDNA sequence is similar to that of the native molecule and in support of the biochemical data it is devoid of sites for N-linked glycosylation. Examination of the deduced ILDat 2.1 VSG protein sequence reveals that it is most similar to T. congolense VSGs in the distribution of Cys residues and like the former it does not contain any of the defined VSG C-terminal domain types. However, unlike T. congolense VSGs it does not readily fit into the currently described VSG N-terminal domain types. Our studies suggest that ILDat 2.1 VSG is distinct from any of the previously characterized VSGs.

Quality of life as an evaluative measure in assessing the impact of community care on people with long-term psychiatric disorders.

BACKGROUND: The impact of community resettlement on the quality of life of people with long-term psychiatric disorders, is evaluated in a longitudinal study. METHOD: A repeated measures design was used to examine the sensitivity of an adapted version of Lehman's Quality of Life Interview in evaluating change. Completed interviews were carried out with 29 of the original cohort at one year post-discharge. The relationship between quality of life and ratings of client functioning is explored. RESULTS: Significant changes in the objective quality of life indices include improved living conditions (F = 40.00, P < 0.001), higher levels of social contact (F = 29.52, P < 0.01) and increased leisure activities (F = 4.57, P < 0.05). Apart from increased satisfaction with living situation (F = 6.94, P < 0.01), there were no significant changes in the subjective indices. Ratings of psychiatric state and social functioning did not significantly correlate with global quality of life at one year post-discharge. CONCLUSIONS: Concerns in relation to the sensitivity of life satisfaction ratings in evaluating programme interventions are raised.

Sequencing and modeling of anti-DNA immunoglobulin Fv domains. Comparison with crystal structures.

Models for the three-dimensional structures of the combining regions of six DNA-binding antibodies have been derived from the sequence data for their Fv domains presented here. Using the amino acid sequences and the canonical structure classes described by Chothia and Lesk (Chothia, C., and Lesk, A.M. (1987) J. Mol. Biol. 196, 901), model loops were selected from immunoglobulin domains of known structure for five of the six antibody hypervariable regions. Models for the third complementarity-determining region of the heavy chain were constructed from known immunoglobulin loops of similar length and sequence. Comparison of three of the models with the respective crystal structure indicates that this procedure can generate a working model of the antibody combining region that provides useful information on the nature of the interactions between antibodies and nucleic acids. As part of our continuing investigation into the structural basis of antibody-DNA recognition, the observed and predicted models for the combining regions of nucleic acid-binding antibodies have been examined. In general, single strand-specific antibodies have deep clefts where the antigen might bind, whereas duplex-specific antibodies present a relatively flat surface. In addition, on the basis of both sequence and structure, there is little to distinguish autoimmune antibodies from those produced by immunization. Testable hypotheses for how these antibodies might interact with single- and double-stranded nucleic acids are presented.

Cloning and expression of an autoimmune DNA-binding single chain Fv. Only the heavy chain is required for binding.

Hed 10 is a murine autoimmune antibody which binds tightly to the single-stranded DNA, poly(dT). The heavy and light chain variable region genes of Hed 10 were cloned and then joined by a 42 base-pair linker with the aid of a PCR ligation technique to produce a single chain Fv gene. After insertion into an expression vector the single chain Fv protein (scFv Hed 10) was produced in high yield and was purified by chromatography on an oligo (dT) cellulose column. The binding of scFv Hed 10 to poly (dT) was measured by fluorescence quenching and a binding constant of 3.2 x 10(6) M-1 was calculated. Previously [Lee et al. (1982) Biochemistry 21, 4940-4945] the binding constant of Fab Hed 10 to poly (dT) was found to be 12.7 x 10(6) M-1. In addition the Vh gene of Hed 10 was expressed independently as well as another scFv which contained the Vh region of Hed 10 linked to the light chain variable region of Jel 42, an antibody specific for Hpr protein of E. coli (scFv 10 H.42 L). Both of these proteins had binding constants for poly (dT) in the range of 6 x 10(6) M-1. Therefore, the light chain of Hed 10 contributes little to the binding of this autoimmune antibody to DNA.

Sequences of the variable regions of three monoclonal antibodies specific for histidine-containing protein of the bacterial phosphoenolpyruvate:sugar phosphotransferase system.

The variable regions of three monoclonal antibodies, Jel 42, Jel 44, and Jel 324, specific for the histidine-containing protein of the bacterial phosphoenolpyruvate:sugar phosphotransferase system have been sequenced from their respective mRNAs. The Vh gene families were deduced from the percent homology to the concensus gene sequences and the J gene and D gene usage was also analysed.