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Recovery in co-occurring mental health and substance use disorders often involves relationships with professional helpers, yet little is known about how these are experienced by service users. The aim of this study was to explore and describe behaviour and attributes of professional helpers that support recovery, as experienced by persons with co-occurring disorders. Within a collaborative approach, in-depth individual interviews with eight persons with lived experience of co-occurring disorders were analysed using systematic text condensation. The analysis yielded four categories of recovery-supporting behaviour and attributes of professional helpers and the ability to build trust cuts across all of them: Building trust through (a) hopefulness and loving concern, (b) commitment, (c) direct honesty and expectation and (d) action and courage. Services should allow for flexibility and continuity, and training should recognise the importance of establishing trust in order to reach out to this group. [ABSTRACT FROM AUTHOR]

Converging evidence indicates that self-disorders (SDs) selectively aggregate in schizophrenia spectrum conditions. The aim of this study was to test the discriminatory power of SDs with respect to schizophrenia and nonschizophrenia spectrum psychosis at first treatment contact. SDs were assessed in 91 patients referred for first treatment through the Examination of Anomalous Self-experience (EASE) instrument. Diagnoses, symptoms severity, and function were assessed using the Structural Clinical Interview for the DSM-IV, Structured Clinical Interview for the Positive and Negative Syndrome Scale, Calgary Depression Scale for Schizophrenia, Young Mania Rating Scale, and Global Assessment of Functioning-Split Version. Most patients found it highly relevant to talk about SDs. EASE total score critically discriminated between schizophrenia, bipolar psychosis, and other psychoses. The EASE total score was the only clinical measure that showed a significant and robust association with the diagnosis of schizophrenia. Systematic exploration of anomalous self-experiences could improve differential diagnosis in first-treatment patients. [ABSTRACT FROM AUTHOR]

Background: Little is known about ethnic disparities in mental health during late teens. The aim of this study was to compare changes in self reported mental health between adolescents with ethnic Norwegian and ethnic minority background aged 15-16 years followed for three years.Methods: The youth part of the Oslo Health Study constituted the baseline of this self-reported longitudinal study, carried out in schools in 2001 (n = 3811). The follow-up in 2004 was conducted partly in school and partly through mail. A total of 2489 (1112 boys and 1377 girls) participated in the follow-up. Twenty percent of the participants had an ethnic minority background. Mental health was measured by the Strengths and Difficulties Questionnaire (SDQ) and The Hopkins Symptom Checklist (HSCL-10).Results: Ethnic minority boys and girls reported poorer mental health than ethnic Norwegians of the same sex, both at baseline and follow-up. Exceptions were hyperactivity-inattention problems and prosocial behaviours where no differences were found. Consistent changes from baseline to follow-up were; an increase in mental distress and prosocial behaviour. No ethnic disparities were found for changes in mental health from ages 15 to 18 between the two groups. There was no different effect of perceived family economy, parents' marital status and socioeconomic region of residence in Oslo on change in mental health between ethnic Norwegian and ethnic minority boys and girls from age 15 to 18 years.Conclusions: Ethnic disparities in mental health remained the same from age 15-16 and throughout teenage years. Demographic factors adjusted for had no different impact on changes in mental health between host and immigrant adolescents. [ABSTRACT FROM AUTHOR]

Background Itch is a major symptom in dermatology but is little explored epidemiologically. Objective To describe the prevalence and the severity of itch, and to explore its relation to psychosocial factors. Methods The design was cross-sectional and population-based. A total of 40 880 adults in Oslo were invited to answer a questionnaire. Results Twenty-seven per cent report itch. Individuals reporting itch were younger, the majority were female, were non-Norwegian, had lower income, were more distressed, had experienced more negative life events and had poorer social support. Individuals with poor support who had experienced more negative life events reported more itch than individuals with good support (15. 6% compared to 10. 9%). The strong association with psychosocial factors was confirmed in a logistic regression. Conclusion There is a strong association between itch and psychosocial factors in the general population. [ABSTRACT FROM AUTHOR]

Objective: To examine the relationship between mental distress, academic performance and regular breakfast consumption across gender and immigration status.Design: Cross-sectional population-based study. Two four-page questionnaires were filled in during two school sessions.Setting: All junior high schools in Oslo, Norway using the classroom as the setting for the study.Subjects: All 10th grade students 15-16 years olds in 2000 and 2001. Of 8316 eligible students, 7343 (88.3%) participated in the study.Results: All immigrant groups, except the Western countries group, are skipping breakfast more often than Norwegian students, and girls more often than boys (27 versus 19%). After adjustment for possible confounding factors, the odds ratio (OR) for being mentally distressed when eating breakfast seldom/never compared with every day was 3.0 (2.0-4.5) for boys, 1.6 (1.2-2.1) for girls and 1.6 (1.5-2.6) for the immigrant group. The comparable OR for having low school grades was similar for boys and girls, 2.0 (1.3-3.0), and 1.6 (1.5-2.6) for the immigrant groups.Conclusions: Skipping breakfast is a common feature among 10th grade students. The implications of skipping breakfast on mental distress and academic performance are stronger for boys than girls and stronger for Norwegians compared with immigrants. [ABSTRACT FROM AUTHOR]

This paper is the first in a pair investigating potential mechanisms for ecological regime change in salinising wetlands. In this first paper, we investigated some of the factors responsible for the formation and maintenance of a macrophyte-dominated ecological regime by studying the germination and flowering of four submerged macrophyte species common in saline Western Australian wetlands; Ruppia polycarpa R. Mason, Ruppia megacarpa R. Mason, Lamprothamnium macropogon (A. Braun) Ophel and L. cf. succinctum (A. Braun in Ascherson) Wood, and by following the survival of adult R. polycarpa as salinities were increased to a range of endpoints (6, 15, 45, 70 and 100 ppt). Increased salinity led to a decrease in the number of germinating plants, an increase in the time to emergence of germinating plants and a decrease in the number of inflorescences (or fertile plants) produced by R. polycarpa, L. macropogon and L. cf. succinctum. Germination of R. megacarpa was low, providing limited information with regard to salinity response. The survival of adult plants also decreased as salinity increased and was negatively affected by faster rates of salinity increase. The upper salinity limits for germination, within the 70 day experiment, were 40–50 ppt for R. polycarpa and L. cf. succinctum, and 30–40 ppt for L. macropogon. Survival of adult R. polycarpa also declined markedly at above 45 ppt. [ABSTRACT FROM AUTHOR]

This paper is the second in a pair investigating potential mechanisms for ecological regime change in salinising wetlands. The first paper in this series focused on the responses of the salt-tolerant submerged macrophyte community to salinity. In this second paper, we investigated some of the environmental conditions required for initiation and dominance of benthic microbial communities using a combination of experimental and observational data. Two experiments were carried out. One investigated the importance of prior establishment of benthic microbial communities on their ability to maintain prevalence over macrophyte colonisation (‘persistence’ experiment), while the other investigated hydrology and its effect on sediment perturbation, potential nutrient release and subsequent benthic microbial community establishment (‘flooding’ experiment). The ‘persistence’ experiment measured the biomass of benthic microbial communities and emergence of macrophytes from sediments kept either wet or dry for 4 weeks then flooded at a range of salinities. Benthic microbial biomass was similar across all of the salinities tested (15, 45 and 70 ppt), with a slight increase at higher salinities, suggesting that none of these limited benthic microbial community development. Pre-wetting of sediments usually increased benthic microbial community biomass and reduced macrophyte germination, but the latter was attributed to the presence of anoxic sediments rather than the increased benthic microbial community biomass. Germinating macrophytes emerged through benthic microbial communities or dense heterotrophic bacterial blooms, demonstrating that they could become dominant even when another community was already established. Field data supported these results, suggesting that the development of benthic microbial communities is not limited by salinity alone, but includes other factors, such as the water regime. In the ‘flooding’ experiment, the largest differences in nutrient concentrations ultimately lay between the pre-wet and pre-dry treatments (due to the greater release of nutrients and development of anoxia in the latter) rather than those subjected to fast versus slow flooding. In response to this, highest benthic microbial community biomass was in treatments with pre-wet sediment, corresponding with lower phytoplankton biomass. [ABSTRACT FROM AUTHOR]

1. Land clearing in Australia's southwest has led to widespread salinisation of aquatic ecosystems. Four different ecological regimes (clear, submerged macrophyte-dominated; clear, benthic microbial community-dominated; turbid, phytoplankton-dominated; and turbid, sediment-dominated) have previously been identified in the salinising wetlands of this region. 2. Monitoring data from seven saline wetlands over an 18-month period were used to evaluate whether a continuum, simple threshold or alternative regimes conceptual model ( sensu Hydrobiologia, 200/201, 1990, 367; Hydrobiologia, 200/201, 1990, 475) most appropriately represented transitions between these ecological regimes. We also aimed to identify whether factors other than salinity played a major role in defining ecological regimes or causing shifts between them. 3. Ordination of biological variables revealed a separation of benthic microbial community-dominated from submerged macrophyte-dominated sites and times. The mean salinities of these two groups were very similar, suggesting that a salinity threshold was not responsible for benthic microbial versus macrophyte dominance. No other environmental variable was found to have a strong, direct influence on the groupings. 4. The dynamics of regime change in saline wetlands appear not to be driven by any single variable, but by the combined effects of salinity and water regime on species life histories and competitive abilities. Macrophytes were powerful competitors, able to germinate and establish under a range of salinities, turbidities and water depths, and were favoured by seasonal drying. 5. Data from the seven wetlands indicated that the continuum, simple threshold and alternative regimes conceptual models did not appropriately represent transitions between ecological regimes in seasonally drying wetlands. Macrophyte and benthic microbial regimes occurred at overlapping salinity levels, excluding both the continuum and threshold models, and the regular occurrence of drying appeared to preclude the alternative regimes model. Drying prevented the development of strong positive feedback mechanisms, which might otherwise have maintained the benthic microbial community-dominated regime. We hypothesise that an alternative regimes model might still be valid for salinising ecosystems holding permanent water. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The aim of this study was to describe differences among immigrant groups in bodily pain, and analyze its association with mental distress. METHOD: A population-based cross-sectional study was carried out involving tenth grade pupils in Oslo. Of the 7,343 pupils that participated, one-quarter were first- or second-generation immigrants. The Hopkins Symptom Checklist-10 was used to measure mental distress. All information on pain and mental distress was self-reported. RESULTS: Girls reported more bodily pain from all types of pain. Headache was the most prevalent pain site across gender and immigrant groups. Strong associations between mental distress and number of pain sites were found for all immigrant groups. Neck and shoulder pain yielded the highest odds ratio (OR) for mental distress among the majority of the immigrant groups. The Sub-Saharan African group had the highest adjusted OR for mental distress [OR=9.8 (1.1-82.7)] when reporting three or more pain sites, and the Indian Subcontinent the lowest [OR=4.0 (1.8-8.8)]. CONCLUSION: The differences in number and types of pain were small, though significant between the different immigrant groups. Adolescents from Sub-Saharan Africa seem to react with more mental distress to bodily pain than adolescents emigrating from the Indian Subcontinent. [ABSTRACT FROM AUTHOR]

Objectives – The A3243G mutation of mitochondrial DNA (mtDNA) has been associated with maternally inherited diabetes and deafness (MIDD) in a number of reports; however, the involvement of the nervous system has rarely been mentioned, prompting this exploration of the manifestation of neurological disorders in MIDD cases. Material and methods – We investigated four generations of a large Taiwanese family in which MIDD is manifest. We conducted a series of clinical examinations, including computed tomography (CT) and magnetic resonance imaging (MRI) of the head, brain 99mTc-HMPAO single photon emission computed tomography (SPECT), cognitive function tests, and nerve conduction velocity (NCV) studies. Blood levels of creatine kinase (CK) and lactate, pathology of muscle biopsy samples and proportions of mutant mtDNA in blood cells, hair follicles, muscle and skin were also analyzed. Mean follow-up period was 4 years. Results – The patients exhibited the clinical features of diabetes mellitus including sensorineural hearing loss, short stature, and/or histories of spontaneous abortion. No stroke-like episodes were reported. Analysis for mtDNA revealed that the A3243G mutation existed in 11 members (6 symptomatic and 5 asymptomatic members) of this MIDD-prone family, with the proportion of mutant mtDNA ranging from 21% to 47% in leukocytes. Head CT revealed diffuse brain atrophy for all 6 (100%) patients examined and bilateral basal ganglia calcification in 4 of 6 (67%) patients. Brain 99mTc-HMPAO SPECT revealed diminished uptake in the bilateral parieto-occipital or occipital regions for all 6 tested patients, cognitive function for these patients was normal. Results of head CT and SPECT were normal in one asymptomatic member of the family. One muscle biopsy revealed abundant ragged-red fibers with modified Gomori-trichrome stain. Muscle-enzyme activity and serum-lactate levels were normal. Conclusion – We have demonstrated that a wide spectrum of sub clinical pathologies of the central nervous system and muscle are present for this MIDD-prone family, none of whom developed typical MELAS during the 4-year period of follow-up study. [ABSTRACT FROM AUTHOR]

Background: Itch as the most common symptom in dermatology has been shown to be related to psychological factors such as stress, anxiety and depression. Moreover, associations were found between perceived stigmatization and itch. However, studies investigating the differences between patients with dermatoses with and without itch regarding perceived stress, stigmatization, anxiety and depression are missing. Therefore, one of the aims of the second study of the European Society for Dermatology and Psychiatry (ESDaP study II) was to investigate these relationships in a large cohort of patients with different itchy dermatoses. Results: 3399 patients with 14 different itchy dermatoses were recruited at 22 centres in 17 European countries. They filled in questionnaires to assess perceived stigmatization, stress, signs of clinically relevant anxiety or depression, itch‐related quality of life, the overall health status, itch duration, frequency and intensity. The most significant association between the severity of itching and the perception of stress was observed among individuals with rosacea (correlation coefficient r = 0.314). Similarly, the strongest links between itch intensity and experiences of stigmatization, anxiety, and depression were found in patients with seborrheic dermatitis (correlation coefficients r = 0.317, r = 0.356, and r = 0.400, respectively). Utilizing a stepwise linear regression analysis, it was determined that within the entire patient cohort, 9.3% of the variation in itch intensity could be accounted for by factors including gender, levels of anxiety, depression, and perceived stigmatization. Females and individuals with elevated anxiety, depression, and perceived stigmatization scores reported more pronounced itch intensities compared to those with contrary attributes. Conclusion: This study underscores the connection between experiencing itch and its intensity and the psychological strain it places on individuals. Consequently, psychological interventions should encompass both addressing the itch itself and the interconnected psychological factors. In specific cases, it becomes imperative for dermatologists to direct individuals towards suitable healthcare resources to undergo further psychological assessment. [ABSTRACT FROM AUTHOR]

Background Objectives Methods Results Conclusions Dysmorphic concern is an overconcern with an imagined or slight defect in physical appearance that can be a symptom of body dysmorphic disorder (BDD). Appearance‐related concerns are frequently reported by people with dermatological conditions. However, relatively little remains known about the relationship between dysmorphic concern and other variables within persons with different skin conditions.The aim of this multicentre, cross‐sectional study was to investigate gender differences regarding dysmorphic concern and the prevalence of BDD in a large sample of patients with skin conditions, in relation to sociodemographic, clinical and psychological variables.Participants aged ≥18 years with skin conditions were consecutively enrolled in dermatological clinics of 22 European centres. Dysmorphic concern and the possible presence of BDD were measured using the Dysmorphic Concern Questionnaire (DCQ) and compared between men and women in relation to sociodemographic, clinical and psychological variables, and separately for each skin condition.The DCQ questionnaire was completed by 5290 dermatological patients. In all categories, mean scores were significantly higher in women than in men. Mean DCQ scores were also higher in women for most skin conditions, with the highest effect size in vitiligo. The percentage of patients who screened positive for BDD on the DCQ was 10.5%, 7.7% of men and 12.7% of women. The prevalence of BDD positive was 6.9% in patients with mild clinical severity, 11.1% for moderate and 19.1% for severe condition. In the multivariate model in patients with mild skin condition, the presence of BDD was positively associated with stress and stigma both in men and in women.Dysmorphic concern and BDD were more frequent in women than in men with skin conditions. Both received and actual stigmatization might have an impact on body‐related concerns, in particular in women, who may be more at risk for sociocultural reasons. [ABSTRACT FROM AUTHOR]

Background Depression, anxiety, excessive alcohol use and trauma history are associated with elevated levels of pro-inflammatory cytokines. Few have investigated cytokines prospectively during psychiatric treatment. We aimed to explore predictors of change in cytokine levels during treatment. Methods Serum blood samples and psychometric scores were collected from baseline (T0), 5 weeks (T1) and 12 weeks (T2) from 147 inpatients during their stay at Modum Psychiatric Center, Norway. Trauma history, mental distress (HSCL-90R), antidepressants and anti-inflammatory medication were recorded. Levels of cytokines Il1- β , IL-1RA, MCP-1 and TNF- α were analyzed. Results Levels of HSCL-90R were highest at T0, but fell with treatment for all groups. The cytokines fell in parallel, except in patients with PTSD diagnosis where cytokines rose throughout treatment. The levels of Il-1RA ( p = 0.016) and TNF- α ( p = 0.031) were higher among the PTSD patients. Also, the pattern of cytokine development over time among the PTSD patients was different for MCP-1 ( p = 0.003) and TNF- α ( p = 0.019) compared to other patients. Conclusions All patients achieved symptom relief with cytokine levels declining correspondingly, except for the PTSD patients, who showed increasing cytokine levels. This may indicate that traumatized patients may have a distinct neuroimmune mechanism of recovery. [ABSTRACT FROM AUTHOR]

An abstract of the article "RV dysfunction by MRI is associated with elevated transpulmonary gradient and poor prognosis in patients with sickle cell associated pulmonary hypertension," by Kim-Lien L. Nguyen and colleagues is presented.

Background Multiple sclerosis (MS) is the most common inflammatory demyelinating disease of the central nervous system. Few studies focused on the relationship between septicemia and MS. Aim To evaluate the potential impact of septicemia on risk for MS. Design Two cohorts of patients with septicemia and without septicemia were followed up for the occurrence of MS. Methods Patients of 482 790 with septicemia was enrolled from the National Health Insurance Research Database between 2001 and 2011 as the study group to match the 1 892 820 individuals, as the control group, by age and gender. Incidence of MS in both groups was calculated. Cox proportional-hazards regressions were performed for investigating hazard ratios (HR) for MS between groups. Results Septicemia patients had a 3.06-fold (95% CI: 2.16–4.32, P  < 0.001) greater risk of developing MS than the matched group. In addition, higher severity of septicemia was associated with higher risk of developing MS (moderate: HR = 4.03, 95% CI: 2.53–6.45, P  < 0.001; severe: HR = 11.1, 95% CI: 7.01–17.7, P  < 0.001). Similar results also occurred in both male and female patients with septicemia (male: HR = 4.06, 95% CI: 2.17–7.58, P  < 0.001; female: HR = 2.72, 95% CI: 1.79–4.11, P  < 0.001). Patients without counterpart comorbidities had a significantly higher risk of MS than the controlled group (HR = 3.02, 95% CI: 2.10–4.35, P  < 0.001). Conclusion The results indicated septicemia is linked to an increased risk for MS. Aggressively preventing and treating septicemia may be warranted for one of precautionary strategies of MS. [ABSTRACT FROM AUTHOR]

Background Generic instruments measuring health-related quality of life (HRQoL), like EQ5D™, enable comparison of skin diseases with healthy populations and nondermatological medical conditions, as well as calculation of utility data. Objectives To measure HRQoL in patients with common skin diseases and healthy controls across Europe using the EQ5D. Methods This multicentre observational cross-sectional study was conducted in 13 European countries. Each dermatology clinic recruited at least 250 consecutive adult outpatients to complete questionnaires, including the EQ5D. Results There were 5369 participants (4010 patients and 1359 controls). Mean ± SD self-rated health state reported by patients was 69·9 ± 19·7; for controls it was 82·2 ± 15·5. When adjusted for confounding factors, including comorbidity, mean patient EQ visual analogue scores were 10·5 points lower than for controls (standardized β = −0·23). Odds ratio with 95% confidence interval for impairment in all five dimensions of EQ5D adjusted for confounders was doubled for patients compared with controls. Patients with hidradenitis suppurativa (HS), blistering conditions, leg ulcers, psoriasis and eczemas had the highest risk for reduction in HRQoL in most dimensions (2-10-fold). Data on differences of impairment by dimensions offer new insights. Conclusions This study confirms the large impact skin conditions have on patients' well-being, differentiating between aspects of HRQoL. Patients with HS, blistering diseases, leg ulcers, infections and most chronic skin diseases reported reduced HRQoL compared with patients with chronic obstructive lung disease, diabetes mellitus, cardiovascular disease and cancers. These findings are important in the prioritization of resource allocation between medical fields and within dermatological subspecialities. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study is to examine the possible changes in depressive symptoms related to various adverse experiences, based on a three-year follow-up among adolescents. Methods: All 10th graders invited to enter the youth section of the Oslo Health Study 2001 (n = 3,811) constituted a baseline of a longitudinal study. A high level of mental distress (Hscl-10 score ≥1.85) according to the different life experiences was compared, at baseline (15 years) and follow-up (18 years). Results: All adverse experiences were associated with a high Hscl-10 score except parents not living together and death of a close person at 15 and 18 years for boys, and death of a close person at 18 years of age for girls. A development from high Hscl-10 score at baseline to low score at follow up was defined as recovery from mental distress. The proportion of the youth that had a high Hscl-10 score related to reporting adverse life experiences at age 15, followed by a low Hscl-10 score three years later proved to be between 44% and 89% among boys and between 16% and 31% among girls. Conclusions: From a three year longitudinal perspective the recovery from mental distress is substantial and higher among boys than among girls. However, mental distress seems to persist in a considerable proportion of the adolescents. Consequently, it is insufficient to brush aside traumas and hurt and rely on a time healing process only. [ABSTRACT FROM PUBLISHER]

Objective This study used the Taiwan Stroke Registry data to evaluate the efficacy and safety of intravenous tissue plasminogen activator (tPA) in treating acute ischemic stroke in patients with renal dysfunction. Design We identified 3525 ischemic stroke patients and classified them into two groups according to the estimated glomerular filtration rate (eGFR) at the emergency department: ≥60, and <60 ml/min/1.73 m2 or on dialysis and by the propensity score from August 2006 to May 2015. The odds ratio of poor functional outcome (modified Rankin Scale ≥2) was calculated for patients with tPA treatment (N  = 705), compared to those without tPA treatment (N  = 2820), by eGFR levels, at 1, 3 and 6 months after ischemic stroke. We also evaluated the risks of intracerebral hemorrhage, upper gastrointestinal bleeding, mortality, between the two groups by eGFR levels. Results Among patients with eGFR levels of <60 ml/min/1.73 m2, tPA therapy reduced the odds ratio of poor functional outcome to 0.60 (95% confidence interval = 0.42–0.87) at 6 months after ischemic stroke. The tPA therapy was not associated with increased overall risk of upper gastrointestinal bleeding, but with increased risk of intracerebral hemorrhage. The low eGFR was not a significant risk factor of intracerebral hemorrhage among ischemic stroke patients receiving tPA treatment. Conclusions tPA for acute ischemic stroke could improve functional outcomes without increasing the risks of upper gastrointestinal bleeding for patients with or without renal dysfunction. The low eGFR was not a significant risk factor for intracerebral hemorrhage among patients receiving tPA treatment. [ABSTRACT FROM AUTHOR]

Summary Objective: A large number of structurally and functionally diverse compounds act as substrates or modulators of p-glycoprotein (p-gp). Some of them possess multiple drug resistance (MDR)-reversing activity, but only a small number of them have entered clinical study. In order to uncover the factors which exert a significant impact on the interaction between substrates/modulators and p-gp, we have performed structure–activity relationship (SAR) analyses, including molecular modelling, two-dimensional (2D) and three-dimensional (3D) parameter-frame-setting analysis, quantitative structure activity relationship (QSAR) analysis among substrates/modulators, as well as clinically promising MDR-reversing agents. Methods: The physicochemical parameters C log P , CMR and all regression equations were derived by using C log P version 4·0 and the latest CQSAR software, respectively. Molecular modelling and all other parameter calculations were performed by using HyperChem version 5·0 program, after geometry optimization and energy minimization using the AM1 semiempirical method. Results: SAR analyses indicate that MDR reversal activity is correlated with the lipophilicity (C log P ), molecular weight (log M w ), longest chain (N lc ) of the molecule and the energy of the highest occupied orbital (E homo ). In addition, the presence of a basic tertiary nitrogen atom in the structure is also an important contributor to p-gp inhibitory activity. Some separation in space is achieved for different subsets of p-gp substrates and inhibitors using N lc , C log P and E homo as three independent parameters in the 3D-parameter-frame setting. Conclusion: A highly effective p-gp modulator candidate should possess a log P value of 2·92 or higher, 18-atom-long or longer molecular axis, and a high E homo value, as well as at least one tertiary basic nitrogen atom. The results... [ABSTRACT FROM AUTHOR]

Background and purpose: Studies on using antiplatelet agents for secondary prevention in ischaemic stroke patients with renal dysfunction are limited. The Taiwan Stroke Registry database was used to compare the efficacy of antiplatelet agents. Methods: From the Taiwan Stroke Registry data, 39 174 acute ischaemic stroke patients were identified and were classified into three groups by antiplatelet agent: aspirin, clopidogrel and dual antiplatelet therapy (DAPT) with a combination of aspirin and clopidogrel. The re‐stroke incidence and 1‐year mortality were stratified by estimated glomerular filtration rate (eGFR) levels at admission: ≥90, 60–89 and <60 ml/min/1.73 m2 or on dialysis. Results: Compared to the aspirin group, the re‐stroke differences were not statistically significant for the clopidogrel group [adjusted subhazard ratio 0.95, 95% confidence interval (CI) 0.84–1.08] and the DAPT group (adjusted subhazard ratio 1.03, 95% CI 0.77–1.39) after controlling for the competing risk of death. The mortality rate increased as the eGFR level declined. In addition, compared to patients taking aspirin, there was no statistically significant difference in overall 1‐year mortality for the clopidogrel group (adjusted hazard ratio 1.11, 95% CI 0.95–1.29) and for the DAPT group (adjusted hazard ratio 1.01, 95% CI 0.67–1.54). The results were consistent in different subgroups stratified by eGFR levels. Conclusions: There was no difference in the risks of recurrent stroke and 1‐year mortality amongst ischaemic stroke patients with or without renal dysfunction receiving antiplatelet agents with aspirin, clopidogrel or dual agents with a combination of aspirin and clopidogrel, regardless of their renal dysfunction status. [ABSTRACT FROM AUTHOR]

Background: Hair diseases play an important burden on patients' lives, causing significant emotional and psychosocial distress. However, the impairment due to different hair conditions, such as alopecia areata (AA) and androgenetic alopecia (AGA), has rarely been compared. Objective: The aim of this study was to assess the psychological burden of subgroups of patients with different hair diseases and to compare them to a healthy population. Methods: In this study, we analysed a subgroup of patients with hair diseases from patients of a large multicentre study including 3635 dermatological patients and 1359 controls from 13 European countries. In the subgroup of patients with hair diseases, we analysed the socio‐demographic characteristics, the stress level, and the impact of hair diseases on quality of life (QoL), anxiety, and depression and we compared them among patients with AA, AGA and healthy controls. Results: The study population included 115 patients (77% women, 23% men) with hair diseases, 37 of whom with AA and 20 with AGA. Patients with hair diseases had a lower education level than healthy controls (medium educational level: 43% vs. 28%). Overall, 41% of the patients reported stressful life events during the last 6 months compared with 31% of the controls. Patients with the same age, sex, depression level and comorbidities had a worse QoL when suffering from AA than from AGA (Mean Dermatology Life Quality Index score: 5.8 vs. 2.5). Conclusion: Patients with hair diseases are more anxious, depressed and have a lower QoL than controls. [ABSTRACT FROM AUTHOR]

Background: Prurigo is defined by the presence of chronic pruritus and multiple localized or generalized pruriginous lesions. Objective: The aim of this study was to assess the psychological burden of prurigo in patients of European countries. Methods: In this multicentre European study, 3635 general dermatology outpatients and 1359 controls were included. Socio‐demographic data and answers to questionnaires (regarding quality of life, general health, anxiety and depression and suicidal ideation) were collected. Results: There were 27 patients with prurigo; of these, 63% were men, and the mean age was 58.6 years. Among patients with prurigo, 10 of 27 (37%) suffered from anxiety and 8 of 27 (29%) from depression. Suicidal ideation was reported in 5 of 27 (19%) patients, and for four of these five patients, suicidal ideation was related to their skin disease. These frequencies were higher in the 10 commonest dermatological diseases (including psoriasis, atopic dermatitis and leg ulcers). The impact on quality of life was severe, with a mean Dermatologic Life Quality Index (DLQI) of 12.4, with an extreme impact on quality of life for 23% of patients and a very large impact for 27% of patients. Conclusion: The psychological comorbidities of prurigo are common, greater than those of other skin diseases, and their impact on quality of life is significant. Thus, it is important to study this condition and to find new treatments. [ABSTRACT FROM AUTHOR]

Summary: Background: It was recently demonstrated that a significant number of patients with common skin diseases across Europe are clinically depressed and anxious. Studies have shown that physicians not trained as psychiatrists underdiagnose depression. This has not been explored among dermatologists. Objectives: To estimate the concordance between clinical assessment of depression and anxiety by a dermatologist and assessment with the Hospital Anxiety and Depression Scale (HADS). Methods: The study was an observational cross‐sectional multicentre study of prevalent cases of skin diseases in 13 countries in Europe. Consecutive patients were recruited in outpatient clinics and filled in questionnaires prior to clinical examination by a dermatologist who reported any diagnosis of skin disease and signs of mood disorders. Results: Analysis of the 3635 consultations showed that the agreement between dermatologist and HADS was poor to fair (lower than 0·4) for all diagnosis categories. The true‐positive rate (represented by the percentage of dermatologists recognizing signs of depression or anxiety in patients with depression or anxiety as defined by a HADS value ≥ 11) was 44·0% for depression and 35·6% for anxiety. The true negative rate (represented by the percentage of dermatologists not detecting signs of depression or anxiety in non‐depressed or non‐anxious patients defined by HADS‐value < 11) was 88.8% for depression and 85.7% for anxiety. Conclusions: Dermatologists in Europe tend to underestimate mood disorders. The results suggest that further training for dermatologists to improve their skills in diagnosing depression and anxiety might be appropriate. When present, the psychological suffering of patients with dermatological conditions needs to be addressed. [ABSTRACT FROM AUTHOR]

Background and purpose Physical activity is associated with a reduced incidence of first-time stroke. However, few studies have examined the effect of pre-stroke physical activity on post-stroke complications and clinical outcomes. Methods A total of 39 835 cases of stroke registered in the nationwide stroke registry system of Taiwan between 2006 and 2009 were analyzed according to five levels of severity as determined by National Institutes of Health Stroke Scale score upon hospital admission. Pre-stroke physical activity was defined in the Taiwan Stroke Registry as dedicated leisure-time physical activity for at least 30 min/day for 3 days/week for more than 6 months. A Cox model was used to compare complications and outcomes between active and inactive groups. Results The active and inactive groups were similar in age distribution and stroke type distribution, but the active group had better National Institutes of Health Stroke Scale scores upon admission. The active group also had significantly fewer post-stroke complications. Active patients had lower hospital mortality and better functional outcomes upon discharge as per the modified Rankin Scale. Improved functional status in the active group was significant at 1, 3 and 6 months post-stroke. Conclusion Dedicated leisure-time physical activity for at least 30 min/day, at least three times per week for more than 6 months was associated with decreased stroke severity, fewer post-stroke complications, lower mortality and better outcomes. [ABSTRACT FROM AUTHOR]

There is scant data on immune function in the context of AUD and MD comorbidity. We aimed to determine and compare levels of circulating cytokines in AUD patients with and without MD. This is a cross-sectional study of 176 patients seeking treatment for their AUD from 8 treatment centers in Nepal. The Composite International Diagnostic Instrument was used to diagnose AUD and MD, and alcohol use parameters included frequent weekly alcohol use (>4 days) and 10 + drinks consumed per typical drinking day. We used ELISA to determine circulating levels of the cytokines IL-6, TNF- α , INF- γ , and IL-10. The Mann–Whitney U-test was employed to observe differences in cytokine levels across groups. The sample was 89% male with a mean age of 36 years, and 45% had comorbid MD. Patients with comorbid MD had elevated levels of IL-6 ( p = 0.019), TNF- α ( p = 0.020) and IFN- γ ( p = 0.001) compared to patients without MD. Significantly elevated levels of all cytokines were also observed among AUD patients with MD with less frequent weekly alcohol use (<4 days) and lower typical quantity of drinks (<10 drinks), compared to AUD patients with MD with more alcohol use. Higher levels of circulating cytokines among AUD patients with MD compared to those without suggests MD contributes to changes in immune function in the context of AUD, and alcohol use severity may modulate this contribution. [ABSTRACT FROM AUTHOR]

Hopelessness is predictive in the development of coronary heart disease (CHD) and can persist in patients after a CHD event, adversely affecting recovery. Hopelessness may represent a temporary response (state) or a chronic outlook (trait). Common hopelessness measures fail to differentiate state from trait hopelessness, a potentially important differentiation for treatment. The State–Trait Hopelessness Scale (STHS) was developed and pilot tested with two groups of college students (n = 39 and 190) and patients with CHD (n = 44). The instrument was then used with 520 patients, confirming reliability (Cronbach’s α) for the State (.88) and Trait (.91) subscales and concurrent and predictive validity. Separate exploratory factor analyses showed two factors (hopelessness present or hopelessness absent) for the State and Trait subscales, accounting for 58.9% and 57.3% of variance, respectively. These findings support future use of the tool in clinical settings and in intervention studies focused on hopelessness. [ABSTRACT FROM PUBLISHER]

Background: The Weight Loss Maintenance Trial tested strategies for maintenance of weight loss. Personal contact was superior to interactive technology and self-directed conditions. Purpose: We aimed to identify behavioral mediators of the superior effect of personal contact vs. interactive technology and of personal contact vs. self-directed arms. Methods: Overweight/obese adults at risk for cardiovascular disease ( n = 1,032) who lost at least 4 kg were randomized to personal contact, interactive technology, or self-directed. After 30 months, 880 participants had data on weight and behavioral strategies. Results: Reported increase of intake of fruits and vegetables and physical activity and more frequent self-weighing met criteria as mediators of the better outcome of personal contact vs. interactive technology. Increased intake of fruits and vegetables, more frequent self-weighing, and decreased dessert consumption were mediators of the difference between personal contact vs. self-directed. Conclusion: Inducing changes in the identified behaviors might yield better outcomes in future weight loss maintenance trials. (ClinicalTrials.gov number NCT00054925) [ABSTRACT FROM AUTHOR]

Tuberculosis (TB) is caused by Mycobacterium tuberculosis and is a major cause of morbidity and mortality worldwide. Many candidate genes have been investigated for a possible association with TB. Toll-like receptors (TLRs) are known to play important roles in human innate immune systems. Polymorphisms in and functions of TLRs have been investigated to identify associations with specific infectious diseases, including TB. Here, we examined whether single-nucleotide polymorphisms (SNPs) in TLRs and genes in TLR signaling were associated with TB susceptibility in Indonesian and Vietnamese populations. A statistically significant association was observed between TB susceptibility in a classified Indonesian female group and rs352139, an SNP located in the intron of TLR9, using the genotype ( P = 2.76E-04) and recessive (AA vs AG+GG, P = 2.48E-04, odds ratio = 1.827, 95% confidence interval = 1.321-2.526) models. Meta-analysis of the Indonesian and Vietnamese populations showed that rs352139 was significantly associated with TB in the recessive model. This finding indicated that a TLR9 polymorphism might have an important role in the susceptibility to M. tuberculosis in Asian populations. [ABSTRACT FROM AUTHOR]

This paper presents a transactional specification framework (T-spec) for describing a datapath and the tool T-piper to synthesize automatically an in-order pipelined implementation with arbitrary user-specified pipeline-stage boundaries. T-spec abstractly views a datapath as executing one transaction at a time, computing the next system states based on the current ones. The synthesized pipeline maintains this semantics, yet allows concurrent execution of multiple overlapped transactions in different pipeline stages, where each stage performs a part of the next-state computation of each transaction. T-spec makes the state reading and writing events in a datapath explicit to enable T-piper to perform exact read-after-write (RAW) hazard analysis between the overlapped transactions. T-piper can automatically generate the pipeline control not only to ensure the correctness of the pipelined executions but also to minimize (using forwarding and speculation) the performance loss due to pipeline stalls in the presence of RAW dependencies. This paper reports design case studies applying T-spec and T-piper to reduced instruction set computing and complex instruction set computing processor pipeline development. In the latter, we report the results from a rapid design space exploration of 60 generated x86-subset pipelines, varying in pipeline depth, forwarding, and speculative execution, all starting from a single T-spec. [ABSTRACT FROM PUBLISHER]

Allele and haplotype frequencies of the human leukocyte antigens (HLA) were studied in the Kinh Vietnamese population. We analyzed 170 unrelated healthy individuals. DNA-based HLA typing was performed using a microsphere-based array genotyping platform with sequence-specific oligonucleotide probes to distinguish HLA-A, -B, -C, -DRB1 and -DQB1 alleles. A total of 21 HLA-A, 37 HLA-B, 18 HLA-C, 25 HLA-DRB1, and 14 HLA-DQB1 alleles were identified. HLA-A*1101, A*2402, A*3303, B*1502, B*4601, Cw*0102, Cw*0702, Cw*0801, DRB1*1202, DQB1*0301, DQB1*0303, and DQB1*0501 were found with frequencies higher than 10%. Two representative haplotypes bearing two to five HLA loci were A*1101-B*1502 and A*3303-B*5801 for HLA-A-B; Cw*0801-B*1502 and Cw*0102-B*4601 for HLA-C-B; B*1502-DRB1*1202 and B*4601-DRB1*0901 for HLA-B-DRB1; DRB1*1202-DQB1*0301 and DRB1*0901-DQB1*0303 for HLA-DRB1-DQB1; A*1101-Cw*0801-B*1502 and A*3303-Cw*0302-B*5801 for HLA-A-C-B; A*1101-B*1502-DRB1*1202 and A*2901-B*0705-DRB1*1001 for HLA-A-B-DRB1, A*1101-Cw*0801-B*1502-DRB1*1202-DQB1*0301 and A*2901-Cw*1505-B*0705-DRB1*1001-DQB1*0501 for HLA-A-C-B-DRB1-DQB1. Allele distribution and haplotype analysis demonstrated that the Vietnamese population shares HLA patterns with southern Chinese, Thai, Javanese and Micronesians, while it also retains unique characteristics. [ABSTRACT FROM AUTHOR]

From the deductive point of view, neurotransmitter receptors can be divided into categories such as cholinergic (muscarinic, nicotinic), adrenergic ( α- and β-), dopaminergic, serotoninergic (5-HT1∼5-HT5), and histaminergic (H1 and H2). Selective agonists and antagonists of each receptor subtype can have specific useful therapeutic applications. For understanding the molecular mechanisms of action, an inductive method of analysis is useful. The aim of the present study is to examine the structure–activity relationships of agents acting on G-protein coupled receptors. Representative sets of G-PCR agonists and antagonists were identified from the literature and Medline [P.M. Walsh (2003) Physicians’ desk reference; M.J. O'Neil (2001) The Merck index]. The molecular weight (MW), calculated logarithm of octanol/water partition coefficient (C log P) and molar refraction (CMR), dipole moment (DM), Elumo (the energy of the lowest unoccupied molecular orbital, a measure of the electron affinity of a molecule and its reactivity as an electrophile), Ehomo (the energy of the highest occupied molecular orbital, related to the ionization potential of a molecule, and its reactivity as a nucleophile), and the total number of hydrogen bonds ( Hb) (donors and receptors), were chosen as molecular descriptors for SAR analyses. The data suggest that not only do neurotransmitters share common structural features but their receptors belong to the same ensemble of G-protein coupled receptor with seven to eight transmembrane domains with their resultant dipoles in an antiparallel configuration. Moreover, the analysis indicates that the receptor exists in a dynamic equilibrium between the closed state and the open state. The energy needed to open the closed state is provided by the hydrolysis of GTP. A composite 3-D parameter frame setting of all the neurotransmitter agonists and antagonists are presented using MW, Hb and μ as independent variables. It appears that all neurotransmitters examined in this study operate by a similar mechanism with the G-protein coupled receptors. [ABSTRACT FROM AUTHOR]

Summary: 最近的一项研究表明,欧洲各地大量患有常见皮肤病的患者在临床上表现出抑郁和焦虑。然而,皮肤科医师虽然接受过诊断皮肤病的培训,但不一定学过如何诊断和治疗患者的皮肤病引发的心理健康问题。在本研究中,来自13个欧洲国家/地区的3635名皮肤科门诊患者填写了详细的调查问卷,通过HADS评分标准接受了抑郁和焦虑评估。然后,研究人员让记录皮肤诊断的皮肤科医师对每位患者进行了检查,并回答了以下两个问题:“您是否在患者身上看到了抑郁的迹象?”以及“您是否在患者身上看到了焦虑的迹象?”可选答案为“是”或“否”。最后,研究人员将患者填写的调查问卷结果与医生对这两个问题的回答进行比较后发现,皮肤科医师在会诊时分别低估了5.8%和11.2%的抑郁和焦虑。但是,皮肤科医师在会诊时也分别高估了10%和11.8%的抑郁和焦虑。作者得出结论,总体而言,临床医生和患者对情绪症状的评估很难达成一致,这表明皮肤科医师在日常护理环境中很容易漏诊情绪症状。 [ABSTRACT FROM AUTHOR]

Summary: Recent research has suggested that a significant number of patients with common skin diseases across Europe are clinically depressed and anxious. However, dermatologists are trained to diagnose skin diseases but are not necessarily trained in diagnosing and treating mental health concerns that might be triggered by their patients’ skin diseases. In this study, 3635 patients attending dermatology clinics in 13 European countries completed detailed questionnaires, using a scale called HADS, designed to assess depression and anxiety. Each patient was then examined by a dermatologist who recorded the skin diagnosis and also answered the following two questions: ‘Do you see depressive signs in the patient?’ and ‘Do you see anxiety signs in the patient?’. The possible answers were ‘yes’ or ‘no’. Comparing the results of the questionnaires completed by the patients with the responses to these two questions by the doctors, the dermatologists underestimated depression in 5.8% of the consultations and anxiety in 11.2% of the consultations. On the other hand, dermatologists overestimated depression and anxiety in 10% and 11.8% of the consultations, respectively. The authors conclude that overall the agreement between clinician and patient assessment of mood symptoms was poor, suggesting that mood symptoms are under‐recognized by dermatologists in a routine care setting. [ABSTRACT FROM AUTHOR]

Background: Human enteroviruses are classified into four species (A, B, C and D) and include over 100 serotypes. Since 1997, Enterovirus 71(EV71) usually causes self-limited infections with non-specific symptoms and manifests hand-food-month disease (HFMD) or herpangina in children. EV71 have caused severe lifethreatening outbreaks in young children in Asian. EV71 circulation among Vietnamese children was first documented in 2005. Methods & Materials: In 2011, there is a big outbreak of EV71 in Vietnam with more than 5,000 inpatients in Children Hospital No.1 (CH1), and 32 fetal cases. National Health Research Institutes cooperates with CH1 to establish hospital-based surveillance of enterovirus in HCM City in 2011. Children <10 years of age who develop HFMD and were admitted to HCM CH1 were collected throat swabs and sera. Throat swabs were used for virus isolation and Sera were used to measure neutralizing antibody against EV71 in Taiwan NHRI. Results: Enterovirus isolate rate with HFMD-related inpatients including 38.9% (21/54) in 2011, 19.3% (79/409) in 2012, 42.0% (173/412) in 2013 and 12% (12/100) on June, 2014. Among them, EV71 positive rate from 2011 to June, 2014 were 29.6%, 6.8%, 16.0% and 5%, respectively. The age-specific seropositive rates increase from 15.2% at <0.5 years of age to 17.2, 24.0, 29.4, 58.6, 62.3, 66.1, 77.6% at 0.5-0.9, 1-1.9, 2-2.9, 3-3.9, 4-4.9, 5-5.9 and 6-6.9 years of age, respectively. Conclusion: The predominant genotype shifted from C4 in 2011 to B5 in 2013. Risk of EV71 infections in Vietnam increased after 6 months of age. Vietnamese children in HCM City acquired EV71 infections at early age and vaccine development in Vietnam should target young children. [ABSTRACT FROM AUTHOR]

Background: Selection bias is a threat to the internal validity of epidemiological studies. In light of a growing number of studies which aim to provide DNA, as well as a considerable number of invitees who declined to participate, we discuss response rates, predictors of lost to follow-up and failure to provide DNA, and the presence of possible selection bias, based on five samples of adolescents.Methods: We included nearly 7,000 adolescents from two longitudinal studies of 18/19 year olds with two corresponding cross-sectional baseline studies at age 15/16 (10th graders), and one cross-sectional study of 13th graders (18/19 years old). DNA was sampled from the cheek mucosa of 18/19 year olds. Predictors of lost to follow-up and failure to provide DNA were studied by Poisson regression. Selection bias in the follow-up at age 18/19 was estimated through investigation of prevalence ratios (PRs) between selected exposures (physical activity, smoking) and outcome variables (general health, mental distress, externalizing problems) measured at baseline.Results: Out of 5,750 who participated at age 15/16, we lost 42% at follow-up at age 18/19. The percentage of participants who gave their consent to DNA provision was as high as the percentage that consented to a linkage of data with other health registers and surveys, approximately 90%. Significant predictors of lost to follow-up and failure to provide DNA samples in the present genetic epidemiological study were: male gender; non-western ethnicity; postal survey compared with school-based; low educational plans; low education and income of father; low perceived family economy; unmarried parents; poor self-reported health; externalized symptoms and smoking, with some differences in subgroups of ethnicity and gender. The association measures (PRs) were quite similar among participants and all invitees, with some minor discrepancies in subgroups of non-western boys and girls.Conclusions: Lost to follow-up had marginal impact on the estimated prevalence ratios. It is not likely that the invitation to provide DNA influenced the response rates of 18/19 year olds. Non-western ethnicity, male gender and characteristics related to a low social class and general and mental health problems measured at baseline are associated with lost to follow-up and failure to provide DNA. [ABSTRACT FROM AUTHOR]