Childhood abuse in adults in primary care: Empirical findings and clinical implications.

In the healthcare setting, adult patients with histories of childhood abuse are of significant concern and are frequently encountered in the primary care setting. However, there is a dearth of studies investigating the relationships between psychopathology, overall health, healthcare utilization, physician ratings of patient difficulty, and childhood abuse. The present study examines these relationships in primary care patients with (N = 45) and without (N = 129) histories of childhood abuse (physical, sexual, and both). Findings revealed that adult patients with histories of childhood abuse generally scored significantly higher on measures of psychopathology, emergency room use, and doctor-patient relationship difficulty, and lower on a measure of mental and physician-rated physical health. In a multiple regression analysis, income and a history of childhood sexual abuse significantly predicted overall mental health. In a second multiple regression analysis, income, depression, somatization, borderline personality disorder, and difficult doctor-patient relationship ratings significantly predicted physician-rated physical health. Overall, these findings suggest that a history of childhood abuse is associated with a host of negative health outcomes. Findings also suggest that negative feelings about a patient may help physicians identify patients with histories of childhood abuse. It is especially important for physicians to routinely include an assessment of childhood abuse during the psychosocial portion of the medical interview or through screening instruments.

Whole blood, flow-chamber studies in real-time indicate a biphasic role for thymosin ß-4 in platelet adhesion.

BACKGROUND: Thymosin beta 4 (Tß(4)) is a major actin sequestering peptide present in most mammalian cells. It also acts as an anti-inflammatory agent and promotes corneal wound healing. METHODS: In the present study, we constructed a four channel cylindrical flow chambers out of polydimethylsiloxane (PDMS) on microscope coverslips. The platelet-binding proteins-fibrinogen and collagen-were immobilized onto the middle ~25% of the inner cylindrical surface. The flow method introduced here was employed to determine the effect of Tß(4), on the deposition of ADP-activated platelets onto fibrinogen cross-linked flow chambers. RESULTS: The binding data from the flow chambers indicated that the both the rate constant of platelet deposition (average: 0.026±0.0015s(-1), corresponding to a half-life of 26.7s) and the total number of deposited platelets were independent of the platelet binding protein and the activating agent. Our results show that low concentrations of Tß(4) (0.2 µM to 0.5 µM) increased both the rate constant of platelet deposition by ~1.5-fold (i.e. half-life decreased from 26.7s to 17.6s) and the total number of deposited platelets by ~3-fold. However at higher concentrations (>1 µM) the Tß(4)-potentiating effect was diminished to near control levels. Tß(4) did interact with fibrinogen with an estimated K(D) of ~126±18nM or 66±20nM under equilibrium or flow, respectively. CONCLUSION: These results suggest that Tß(4) could potentially increase the affinity of platelet receptors for their ligands thus promoting platelet deposition. Tß(4) could also bind to fibrinogen and as its concentration increased would prevent platelet-fibrinogen interactions resulting in the attenuation of platelet deposition. GENERAL SIGNIFICANCE: This work suggests that Tß(4) might have a dual role in platelet function.