Violence by Persons with Serious Mental Illness Toward Family Caregivers and Other Relatives: A Review.

ABSTRACT: Persons living with serious mental illness (SMI) are at a modestly increased risk of committing violence and are disproportionately likely to target family members when they do commit violence. In this article, we review available evidence regarding violence by persons with SMI toward family members, many of whom are caregivers. Evidence suggests that a sizable minority of family members with high levels of contact with persons with SMI have experienced violence, with most studies finding rates of past year victimization to be 20% or higher. Notable risk factors for family violence pertaining specifically to persons with SMI include substance use, nonadherence to medications and mental health treatment, history of violent behavior, and recent victimization. Notable risk factors pertaining specifically to the relationships between persons with SMI and family members include persons with SMI relying on family members for tangible and instrumental support, family members setting limits, and the presence of criticism, hostility, and verbal aggression. As described in qualitative studies, family members often perceive violence to be connected to psychiatric symptoms and inadequate treatment experiences. We argue that promising strategies for preventing violence by persons with SMI toward family members include (1) better engaging persons with SMI in treatment, through offering more recovery-oriented care, (2) strengthening support services for persons with SMI that could reduce reliance on family members, and (3) supporting the capabilities of family members to prevent and manage family conflict. The available interventions that may be effective in this context include McFarlane's Multifamily Group intervention and the Family-to-Family educational program.

Trypanosoma cruzi Produces the Specialized Proresolving Mediators Resolvin D1, Resolvin D5, and Resolvin E2.

Trypanosoma cruzi is a protozoan parasite that causes Chagas disease (CD). CD is a persistent, lifelong infection affecting many organs, most notably the heart, where it may result in acute myocarditis and chronic cardiomyopathy. The pathological features include myocardial inflammation and fibrosis. In the Brazil strain-infected CD-1 mouse, which recapitulates many of the features of human infection, we found increased plasma levels of resolvin D1 (RvD1), a specialized proresolving mediator of inflammation, during both the acute and chronic phases of infection (>100 days postinfection) as determined by enzyme-linked immunosorbent assay (ELISA). Additionally, ELISA on lysates of trypomastigotes of both strains Tulahuen and Brazil revealed elevated levels of RvD1 compared with lysates of cultured epimastigotes of T. cruzi, tachyzoites of Toxoplasma gondii, trypomastigotes of Trypanosoma brucei, cultured L6E9 myoblasts, and culture medium containing no cells. Lysates of T. cruzi-infected myoblasts also displayed increased levels of RvD1. Lipid mediator metabolomics confirmed that the trypomastigotes of T. cruzi produced RvD1, RvD5, and RvE2, which have been demonstrated to modulate the host response to bacterial infections. Plasma RvD1 levels may be both host and parasite derived. Since T. cruzi synthesizes specialized proresolving mediators of inflammation, as well as proinflammatory eicosanoids, such as thromboxane A2, one may speculate that by using these lipid mediators to modulate its microenvironment, the parasite is able to survive.

Clinical manifestations of chikungunya among university professors and staff in Santo Domingo, the Dominican Republic.

OBJECTIVE: To further characterize chikungunya virus infection and its associated clinical manifestations, using a sample of university professors and staff in Santo Domingo, the Dominican Republic. METHODS: A cross-sectional study with quota sampling by department was performed to obtain a convenience sample of professors (n = 736) and staff (n = 499) at the Universidad Autónoma de Santo Domingo. Surveys were used to collect demographic and infection data during the fall term of 2014. Univariate and bivariate analyses were carried out to quantify infection and clinical manifestation prevalence and to assess relationships of these outcomes with age, sex, and acute phase duration. RESULTS: Of 1 236 participants, 49% reported infection (professors = 41%; staff = 61%). Of these, 53% also reported the presence of chronic effects, largely arthralgia (48%). Significant relationships were observed between reported infection and sex (P = 0.023), age (P < 0.001), and occupation (P < 0.001). More headache (P = 0.008) and edema (P < 0.001) in females, more headache (P = 0.005) in younger subjects, and more myalgia (P = 0.006) in those with longer acute symptoms were found. Additionally, more chronic arthralgia (P < 0.001; P = 0.003) and chronic edema (P < 0.001; P = 0.001) in females and older subjects, and more chronic myalgia (P = 0.041) and chronic edema (P = 0.037) in those with longer acute symptoms were observed. CONCLUSIONS: To the authors knowledge, this is the first population-based chikungunya prevalence study in the Dominican Republic, and the first to explore clinical manifestations in a university setting. The findings reflect results from studies following the 2005 - 2006 Reunion Island outbreak: prevalence of infection and chronic arthralgia, as well as associations with sex, age, and acute intensity. Longitudinal research can provide further insight into these effects.

Clinical manifestations of chikungunya among university professors and staff in Santo Domingo, the Dominican Republic / Manifestaciones clínicas del chikungunya en profesores y personal universitario de Santo Domingo (República Dominicana)

Objective. To further characterize chikungunya virus infection and its associated clinical manifestations, using a sample of university professors and staff in Santo Domingo, the Dominican Republic. Methods. A cross-sectional study with quota sampling by department was performed to obtain a convenience sample of professors (n = 736) and staff (n = 499) at the Universidad Autónoma de Santo Domingo. Surveys were used to collect demographic and infection data during the fall term of 2014. Univariate and bivariate analyses were carried out to quantify infection and clinical manifestation prevalence and to assess relationships of these outcomes with age, sex, and acute phase duration. Results. Of 1 236 participants, 49% reported infection (professors = 41%; staff = 61%). Of these, 53% also reported the presence of chronic effects, largely arthralgia (48%). Significant relationships were observed between reported infection and sex (P = 0.023), age (P < 0.001), and occupation (P < 0.001). More headache (P = 0.008) and edema (P < 0.001) in females, more headache (P = 0.005) in younger subjects, and more myalgia (P = 0.006) in those with longer acute symptoms were found. Additionally, more chronic arthralgia (P < 0.001; P = 0.003) and chronic edema (P < 0.001; P = 0.001) in females and older subjects, and more chronic myalgia (P = 0.041) and chronic edema (P = 0.037) in those with longer acute symptoms were observed. Conclusions. To the authors knowledge, this is the first population-based chikungunya prevalence study in the Dominican Republic, and the first to explore clinical manifestations in a university setting. The findings reflect results from studies following the 2005 – 2006 Reunion Island outbreak: prevalence of infection and chronic arthralgia, as well as associations with sex, age, and acute intensity. Longitudinal research can provide further insight into these effects.

Objetivo. Caracterizar de manera más detallada la infección por el virus del chikungunya y sus manifestaciones clínicas, a partir de una muestra de profesores y personal universitario de Santo Domingo (República Dominicana). Métodos. Se realizó un estudio transversal con muestreo por cuotas según los departamentos, a fin de obtener una muestra de conveniencia de profesores (n = 736) y otro personal (n = 499) de la Universidad Autónoma de Santo Domingo. Se recopilaron mediante encuestas los datos demográficos y la información sobre las infecciones durante el semestre de otoño del 2014. Se realizaron análisis univariante y bivariante para cuantificar la prevalencia de las infecciones y de las manifestaciones clínicas, así como para evaluar la relación entre estos resultados y la edad, el sexo y la duración de la fase aguda. Resultados. El 49% de los 1 236 participantes indicaron haber padecido la infección (profesores, 41%; otro personal, 61%), de los cuales el 53% también refirieron la presencia de efectos crónicos, principalmente artralgias (48%). Se observaron relaciones significativas entre la infección y el sexo (P = 0,023), la edad (P < 0,001) y la ocupación (P < 0,001). Las mujeres refirieron más cefaleas (P = 0,008) y edemas (P < 0,001); los jóvenes refirieron más cefaleas (P = 0,005); y los sujetos con síntomas agudos de mayor duración refirieron más mialgias (P = 0,006). Además, las mujeres y los sujetos de mayor edad refirieron más artralgias crónicas (P < 0,001; P = 0,003) y edemas crónicos (P < 0,001; P = 0,001), en tanto que los sujetos con síntomas agudos de mayor duración refirieron más mialgias crónicas (P = 0,041) y edemas crónicos (P = 0,037). Conclusiones. Hasta donde saben los autores, este es el primer estudio poblacional sobre la prevalencia del chikungunya en la República Dominicana y el primero en el que se exploran las manifestaciones clínicas en un entorno universitario. Los resultados reflejan lo observado en los estudios posteriores al brote del 2005 y el 2006 en la isla Reunión: prevalencia de la infección y artralgias crónicas, así como asociaciones con el sexo, la edad y la intensidad de la fase aguda. Con investigaciones longitudinales se podría arrojar más luz sobre estos efectos.

Clinical manifestations of chikungunya among university professors and staff in Santo Domingo, the Dominican Republic / Manifestaciones clínicas del chikungunya en profesores y personal universitario de Santo Domingo (República Dominicana)

ABSTRACT Objective To further characterize chikungunya virus infection and its associated clinical manifestations, using a sample of university professors and staff in Santo Domingo, the Dominican Republic. Methods A cross-sectional study with quota sampling by department was performed to obtain a convenience sample of professors (n = 736) and staff (n = 499) at the Universidad Autónoma de Santo Domingo. Surveys were used to collect demographic and infection data during the fall term of 2014. Univariate and bivariate analyses were carried out to quantify infection and clinical manifestation prevalence and to assess relationships of these outcomes with age, sex, and acute phase duration. Results Of 1 236 participants, 49% reported infection (professors = 41%; staff = 61%). Of these, 53% also reported the presence of chronic effects, largely arthralgia (48%). Significant relationships were observed between reported infection and sex (P = 0.023), age (P < 0.001), and occupation (P < 0.001). More headache (P = 0.008) and edema (P < 0.001) in females, more headache (P = 0.005) in younger subjects, and more myalgia (P = 0.006) in those with longer acute symptoms were found. Additionally, more chronic arthralgia (P < 0.001; P = 0.003) and chronic edema (P < 0.001; P = 0.001) in females and older subjects, and more chronic myalgia (P = 0.041) and chronic edema (P = 0.037) in those with longer acute symptoms were observed. Conclusions To the authors knowledge, this is the first population-based chikungunya prevalence study in the Dominican Republic, and the first to explore clinical manifestations in a university setting. The findings reflect results from studies following the 2005 - 2006 Reunion Island outbreak: prevalence of infection and chronic arthralgia, as well as associations with sex, age, and acute intensity. Longitudinal research can provide further insight into these effects.

RESUMEN Objetivo Caracterizar de manera más detallada la infección por el virus del chikungunya y sus manifestaciones clínicas, a partir de una muestra de profesores y personal universitario de Santo Domingo (República Dominicana). Métodos Se realizó un estudio transversal con muestreo por cuotas según los departamentos, a fin de obtener una muestra de conveniencia de profesores (n = 736) y otro personal (n = 499) de la Universidad Autónoma de Santo Domingo. Se recopilaron mediante encuestas los datos demográficos y la información sobre las infecciones durante el semestre de otoño del 2014. Se realizaron análisis univariante y bivariante para cuantificar la prevalencia de las infecciones y de las manifestaciones clínicas, así como para evaluar la relación entre estos resultados y la edad, el sexo y la duración de la fase aguda. Resultados El 49% de los 1 236 participantes indicaron haber padecido la infección (profesores, 41%; otro personal, 61%), de los cuales el 53% también refirieron la presencia de efectos crónicos, principalmente artralgias (48%). Se observaron relaciones significativas entre la infección y el sexo (P = 0,023), la edad (P < 0,001) y la ocupación (P < 0,001). Las mujeres refirieron más cefaleas (P = 0,008) y edemas (P < 0,001); los jóvenes refirieron más cefaleas (P = 0,005); y los sujetos con síntomas agudos de mayor duración refirieron más mialgias (P = 0,006). Además, las mujeres y los sujetos de mayor edad refirieron más artralgias crónicas (P < 0,001; P = 0,003) y edemas crónicos (P < 0,001; P = 0,001), en tanto que los sujetos con síntomas agudos de mayor duración refirieron más mialgias crónicas (P = 0,041) y edemas crónicos (P = 0,037). Conclusiones Hasta donde saben los autores, este es el primer estudio poblacional sobre la prevalencia del chikungunya en la República Dominicana y el primero en el que se exploran las manifestaciones clínicas en un entorno universitario. Los resultados reflejan lo observado en los estudios posteriores al brote del 2005 y el 2006 en la isla Reunión: prevalencia de la infección y artralgias crónicas, así como asociaciones con el sexo, la edad y la intensidad de la fase aguda. Con investigaciones longitudinales se podría arrojar más luz sobre estos efectos.