MENTAL DISORDERS AND LIVER TRANSPLANTATION: A 2-YEAR COHORT STUDY.

BACKGROUND: Psychosocial assessment is a key component in evaluation for liver transplantation and may affect survival rates and outcomes. OBJECTIVE: The primary aim of this study was to investigate the impact of previous mental disorders and impulsivity on the 2-year surviving rate after liver transplantation. METHODS: We performed a prospective cohort study assessing end-stage liver disease individuals with and without psychiatric comorbidities for 2 years post-transplant. Psychiatric diagnosis was carried out through Mini-Plus 5.0.0 and impulsivity by using Barratt Impulsiveness Scale in the pre-transplant phase. We followed patient's status for 2 years after transplantation. The main outcome was death. We used a logistic regression to evaluate the association of psychiatric comorbidities with death and performed a survival analysis with Kaplan-Meier and Cox regression models. RESULTS: Between June 2010 and July 2014, 93 out of 191 transplant candidates received transplants. From the 93 transplant patients, 21 had psychiatric comorbidities and 72 had not. 25 patients died during the study. The presence of psychiatric comorbidities (P=0.353) and high impulsivity (P=0.272) were not associated to 2-year post transplant death. CONCLUSION: This study found no evidence that the presence of mental disorders and impulsivity worsened prognosis in post-liver transplantation.

Transtorno mental e transplante hepático: um estudo de coorte de 2 anos / Mental disorders and liver transplantation: a 2-year cohort study

ABSTRACT Background Psychosocial assessment is a key component in evaluation for liver transplantation and may affect survival rates and outcomes. Objective The primary aim of this study was to investigate the impact of previous mental disorders and impulsivity on the 2-year surviving rate after liver transplantation. Methods: We performed a prospective cohort study assessing end-stage liver disease individuals with and without psychiatric comorbidities for 2 years post-transplant. Psychiatric diagnosis was carried out through Mini-Plus 5.0.0 and impulsivity by using Barratt Impulsiveness Scale in the pre-transplant phase. We followed patient's status for 2 years after transplantation. The main outcome was death. We used a logistic regression to evaluate the association of psychiatric comorbidities with death and performed a survival analysis with Kaplan-Meier and Cox regression models. Results: Between June 2010 and July 2014, 93 out of 191 transplant candidates received transplants. From the 93 transplant patients, 21 had psychiatric comorbidities and 72 had not. 25 patients died during the study. The presence of psychiatric comorbidities (P=0.353) and high impulsivity (P=0.272) were not associated to 2-year post transplant death. Conclusion: This study found no evidence that the presence of mental disorders and impulsivity worsened prognosis in post-liver transplantation.

RESUMO Contexto: A avaliação psicossocial é essencial na avaliação para transplante hepático; ela pode afetar as taxas de sobrevida e outros desfechos. Objetivo: O objetivo principal deste estudo foi investigar o impacto de transtornos mentais prévios e impulsividade nos índices de sobrevivência após o transplante hepático. Métodos: Foi realizado um estudo prospectivo de coorte com indivíduos em estágio avançado da doença hepática com e sem comorbidades psiquiátricas no pré-transplante, acompanhados por 2 anos após o transplante. Na fase pré-transplante foi realizado o diagnóstico psiquiátrico através do Mini-Plus 5.0.0 e avaliada a impulsividade através da Escala de Impulsividade Barratt. Os pacientes foram acompanhados por 2 anos após o transplante. O desfecho principal foi óbito. Foi utilizada regressão logística para avaliar a associação entre comorbidades psiquiátricas e óbito. Também foi realizada análise de sobrevida com Kaplan-Meier e modelo de regressão Cox. Resultados: Entre junho de 2010 e julho de 2014 foram transplantados 93 pacientes entre os 191 candidatos. Dos 93 pacientes transplantados, 21 tinham comorbidade psiquiátrica e 72 não tinham. Durante o período de acompanhamento houve 25 óbitos. A presença de comorbidade psiquiátrica (P=0.353) e alta impulsividade (P=0.272) não foram associadas a óbito pós-transplante até segundo ano de cirurgia. Conclusão: Este estudo não encontrou evidências de que a presença de transtorno mental e impulsividade pioram o prognóstico pós-transplante hepático.

Ten years of implementing screening, brief intervention, and referral to treatment (SBIRT): Lessons learned.

The US Surgeon General recently issued a comprehensive report indicating that substance use is a major public health concern that must be addressed using a number of strategies. Screening, brief intervention, and referral to treatment (SBIRT) is one such strategy. SBIRT Colorado, funded by the Substance Abuse and Mental Health Services Administration (SAMHSA), has implemented a statewide initiative for the past 10 years that has provided ample opportunities to identify key components for successful implementation. Successful implementation requires (1) strong clinical and management advocates; (2) full integration of services into practices' workflow utilizing technology whenever possible; (3) interprofessional team approaches; (4) appropriate options for the small proportion of patients screening positive for a possible substance use disorder; (5) cannabis screening that accounts for legalization, and interventions that acknowledge differences between alcohol and cannabis use; (6) incorporating SBIRT into standard health care professionals' training; and (7) addressing the significant issues regarding reimbursement through private and public payers for SBIRT services. Implementing and sustaining SBI as a standard of integrated care is essential to reduce the burden of substance use. Interdisciplinary approaches, technology, and training to increase practitioner confidence and skill are fundamental.

The impact of employee assistance services on workplace outcomes: Results of a prospective, quasi-experimental study.

Employee Assistance Programs (EAPs) are widely used to help employees experiencing personal or work-related difficulties that impact work productivity. However, rigorous research on the effectiveness of programs to improve work-related outcomes is lacking. The current study represents a major advance in EAP research by using a prospective, quasi-experimental design with a large and diverse employee base. Using propensity scores calculated from demographic, social, work-related, and psychological variables collected on baseline surveys, we matched 156 employees receiving EAP to 188 non-EAP employees. Follow-up surveys were collected from 2 to 12 months post-baseline (M = 6.0). At follow-up, EAP employees had significantly greater reductions in absenteeism (b = -.596, p = .001) and presenteeism (b = -.217, p = .038), but not workplace distress (b = -.079, p = .448), than did non-EAP employees. Tests of moderation of baseline alcohol use, depression, anxiety, and productivity indicate that for the most part, the program works equally well for all groups. However, EAP did more to reduce absenteeism for those who began with lower severity of depression and anxiety at baseline. Results provide the scientific rigor needed to demonstrate EAP impact on improved work outcomes. In the first study of its kind, findings confirm the value of EAPs to help employees address personal and work-related concerns that are affecting job performance. (PsycINFO Database Record

Impact of Employee Assistance Services on Depression, Anxiety, and Risky Alcohol Use: A Quasi-Experimental Study.

OBJECTIVE: To test the impact of Employee Assistance Programs (EAPs) on reducing employee depression, anxiety, and risky alcohol use, and whether improvements in clinical symptoms lead to improved work outcomes. METHODS: The study used a prospective, quasi-experimental design with propensity score matching. Participants (n = 344) came from 20 areas of state government. EAP (n = 156) and non-EAP (n = 188) employees were matched on baseline demographic, psychosocial, and work-related characteristics that differentiate EAP from non-EAP users. Follow-up surveys were collected 2 to 12 months later (M = 6.0). RESULTS: EAP significantly reduced symptoms of depression and anxiety, but not at-risk alcohol use. EAP reductions in depression and anxiety mediated EAP-based reductions in absenteeism and presenteeism. CONCLUSIONS: EAPs provide easy-to-access work-based services that are effective at improving employee mental health.

Determinants of self-medication with NSAIDs in a Portuguese community pharmacy.

BACKGROUND: Non-steroid anti-inflammatory drugs (NSAIDs) are a widely used therapeutic group in the world, and particularly in the Portuguese population. OBJECTIVE: To compare NSAID's use by prescription and self-medication acquisition and to determine the pattern of indication of NSAIDs, their usage profile and possible implications for patients' safety. METHODS: A cross-sectional design was used where individuals presenting at a community pharmacy requesting NSAIDs during the study period (one month) were invited to answer a face-to-face interview where socio-demographic characteristics, the indication pattern and previous experience of side effects were assessed. A follow-up interview was performed one week later to assess the incidence of adverse effects. The study was ethically approved. RESULTS: A sample of 130 NSAIDs users was recruited, comprising mostly women (n=87; 66.9%), actively employed (n=77; 59.2%) and presenting a mean age of 49.5 years old (SD=20.49). An equal proportion of individuals acquired NSAIDs by self-medication and with medical prescription (n=65; 50%). Over 4/5 of patients (n=57; 87.7%) acquiring NSAIDs without a prescription were self-medicated by their own initiative, and only 10.8% (n=7) had been advised by the pharmacist. The most commonly acquired active substances were ibuprofen and diclofenac. Self-medicated users more frequently resorted to topical NSAIDs following short term treatments. The major underlying condition motivating NSAIDs sought were musculoskeletal disorders (45.0%), regardless of the regimen. An important proportion of prevalent users of NSAIDs reported previous experience of adverse effects (11.3%). One week after initiating NSAID therapy, a small proportion of patients reported incidence of adverse effects. CONCLUSION: Self-medication with NSAIDs is sought for numerous medical conditions. Reported adverse effects (prevalent and incident) confirm the need for a more rational use of NSAIDs and ongoing pharmacovigilance.

Quality of DNA extracted from saliva samples collected with the Oragene™ DNA self-collection kit.

BACKGROUND: Large epidemiological studies in DNA biobanks have increasingly used less invasive methods for obtaining DNA samples, such as saliva collection. Although lower amounts of DNA are obtained as compared with blood collection, this method has been widely used because of its more simple logistics and increased response rate. The present study aimed to verify whether a storage time of 8 months decreases the quality of DNA from collected samples. METHODS: Saliva samples were collected with an OrageneTM DNA Self-Collection Kit from 4,110 subjects aged 14-15 years. The samples were processed in two aliquots with an 8-month interval between them. Quantitative and qualitative evaluations were carried out in 20% of the samples by spectrophotometry and genotyping. Descriptive analyses and paired t-tests were performed. RESULTS: The mean volume of saliva collected was 2.2 mL per subject, yielding on average 184.8 µg DNA per kit. Most samples showed a Ratio of OD differences (RAT) between 1.6 and 1.8 in the qualitative evaluation. The evaluation of DNA quality by TaqMan®, High Resolution Melting (HRM), and restriction fragment length polymorphism-PCR (RFLP-PCR) showed a rate of success of up to 98% of the samples. The sample store time did not reduce either the quantity or quality of DNA extracted with the Oragene kit. CONCLUSION: The study results showed that a storage period of 8 months at room temperature did not reduce the quality of the DNA obtained. In addition, the use of the Oragene kit during fieldwork in large population-based studies allows for DNA of high quantity and high quality.

Interaction of stannous chloride leads to alteration in DNA, triphosphate nucleotides and isolated bases.

Stannous chloride (SnCl2) is a reducing chemical agent used in several man-made products. SnCl2 can generate reactive oxygen species (ROS); therefore, studies have been carried out in order to better understand its damaging action in biological systems. In this work, calf thymus DNA, triphosphate nucleotides and isolated bases were incubated with SnCl2 and the results were analyzed through UV spectrophotometry. The presence of stannous ions altered the absorption spectra of all three isolates. The amount of stannous ions associated to DNA was measured by atomic absorption spectrophotometry. Data showed that more than 40% of the initial SnCl2 concentration was present in the samples. Our results are in accordance with the damaging potential of this salt and present evidence that stannous ions can complex with DNA, inducing ROS in its vicinity, which may be responsible for the observed lesions.

Survival and growth of goat primordial follicles after in vitro culture of ovarian cortical slices in media containing coconut water.

The development of culture systems to support the initiation of growth of primordial follicles is important to the study of the factors that control the earliest stages of folliculogenesis. We investigated the effectiveness of five culture media, two supplements and three culture periods on the survival and growth of goat primordial follicles after culturing ovarian cortex. The media were based on minimal essential minimum (MEM) and coconut water solution (CWS) added in the proportion of 0, 25, 50, 75 or 100%. The two supplements were none versus supplemented with insulin-transferrin-selenium, pyruvate, glutamine, hypoxanthine, and BSA. Pieces of goat ovarian cortex were cultured in the media for 1, 3 or 5 days and representative samples were evaluated at day 0 as non-cultured controls. The replicates were the two ovaries of five mixed breed goats. The number of primordial, intermediate, primary and secondary follicles at each period of culture and the number of degenerated follicles were evaluated. Mitotic activity of granulosa cells was studied by immunolocalization of proliferating cell nuclear antigen (PCNA). The number of follicles in each stage and degenerated follicles were statistically analyzed by ANOVA using a factorial design and the significance of differences assessed using Tukey test. Chi-square test was used to compare the percentage of follicles with PCNA positive granulosa cells. As the culture period progressed, the number of primordial follicles fell and there was a significant increase in the number of primary follicles. The fall in the number of primordial follicles was particularly marked after 1 day culture. No effect of media on the number of primordial and primary follicles was observed after culture, but MEM as well as supplements increased the number of intermediate follicles. Follicular degeneration was kept at the same level after culture in the media tested, except for pure CWS that increased the number of degenerated follicles. In contrast, addition of supplements to culture media reduced follicular degeneration. In non-cultured tissue, PCNA was expressed in granulosa cells of 31.6% of the growing follicles. This percentage had not significantly changed after 5 days culture in the various media, indicating the maintenance of proliferation activity of granulosa cells during culture. In conclusion, it is shown that goat primordial follicles may be successfully activated after in vitro culture in all media tested. However, when pure CWS is used the follicular degeneration is enhanced, but the addition of supplements to culture media decrease follicular degeneration.