Ethnic differences in mental health service use among patients with psychotic disorders

BACKGROUND

There are concerns that ethnic minority patients are over-represented in inpatient mental health settings, but under-utilise community services. This study aims to compare the use of community mental health services between African-Caribbean and White patients with psychosis, before and after the introduction of new community services, and to investigate their impact on inpatient treatment.

METHODS

The sample was drawn from epidemiologically representative patients with psychotic disorders living in two catchment areas in South London, one of which was developing intensive community treatments. Service utilisation was measured at baseline and at 2-year follow-up using the Client Service Receipt Interview (CSRI). The mean number of contacts with specific services was compared between the two groups over time.

RESULTS

A total of 92 White and 48 African-Caribbean patients were compared. The latter were more likely to be younger (P = 0.004), have shorter illness duration (P < 0.001), and had more detentions under the Mental Health Act (P = 0.003). No significant differences were seen in use of community services over time. However, intensive treatment led to a significant reduction in hospital days for African Caribbean patients compared to White patients in the intensive sector and all patients in the standard sector.

CONCLUSIONS

Intensive community treatments reduced inpatient days in African Caribbean patients. Further effort is needed to improve the cultural sensitivity of community mental health services.

Sustainable waste management in the UK: the public health role

This paper discusses waste management in the UK and its relationship with health. It aims to outline the role of health professionals in the promotion of waste management, and argues for a change in their role in waste management regulation to help make the process more sustainable. The most common definition of sustainable development is that by the Brundtland commission, i.e. "development that meets the needs of the present without compromising the ability of future generations to meet their own needs". Managing waste sites in a manner that minimises toxic impacts on the current and future generations is obviously a crucial part of this. Although the management of waste facilities is extremely complex, the Integrated Pollution Prevention and Control regime, which requires the input of public health professionals on the regulation of such sites, means that all waste management installations should now be operating in a fashion that minimises any toxicological risks to human health. However, the impacts upon climate change, resource use and health inequalities, as well as the effects of waste transportation, are currently not considered to be part of public health professionals' responsibilities when dealing with these sites. There is also no requirement for public health professionals to become involved in waste management planning issues. The fact that public health professionals are not involved in any of these issues makes it unlikely that the potential impacts upon health are being considered fully, and even more unlikely that waste management will become more sustainable. This paper aims to show that by only considering direct toxicological impacts, public health professionals are not fully addressing all the health issues and are not contributing towards sustainability. There is a need for a change in the way that health professionals deal with waste management issues.

Gender differences in medically serious suicide attempts: a study from south India

Studying gender differences in suicidal behaviour is important in developing specific need-based service provisions. We aimed to identify gender-specific characteristics associated with attempted suicide in a general hospital sample in south India. Two hundred and three patients admitted to medical wards following suicide attempts were assessed using a detailed clinical interview, measures of suicide intent (Suicide Intent Scale), lethality (Risk Rescue Rating), depression (Montgomery-Asberg Depression Rating Scale) and recent stress (Presumptive Stressful Life Events Scale). The majority of men attempting suicide were single. Men were more likely to use organophosphate poisons in their attempt to kill themselves and had higher rates of mental illness than women. As compared with men, women were more likely to come from rural areas, had a lower educational status, and had lower rates of employment outside the home. In women, the most common method of suicide attempt was by using plant poisons. Suicide attempt by self-immolation was significantly higher among women. Men had higher suicidal intent than women, although lethality, depression and stress were comparable between the genders. Rural women were more disadvantaged in education; however, in urban areas, men had higher psychiatric morbidity. Our results emphasise the need for a gender-specific approach among people who have attempted suicide.

A flattening filter free photon treatment concept evaluation with Monte Carlo

In principle, the concept of flat initial radiation-dose distribution across the beam is unnecessary for intensity modulated radiation therapy. Dynamic leaf positioning during irradiation could appropriately adjust the fluence distribution of an unflattened beam that is peaked in the center and deliver the desired uniform or nonuniform dose distribution. Removing the flattening filter could lead to reduced treatment time through higher dose rates and reduced scatter, because there would be substantially less material in the beam; and possibly other dosimetric and clinical advantages. This work aims to evaluate the properties of a flattening filter free clinical accelerator and to investigate its possible advantages in clinical intensity modulated radiation therapy applications by simulating a Varian 2100-based treatment delivery system with Monte Carlo techniques. Several depth-dose curves and lateral dose distribution profiles have been created for various field sizes, with and without the flattening filter. Data computed with this model were used to evaluate the overall quality of such a system in terms of changes in dose rate, photon and electron fluence, and reduction in out-of-field stray dose from the scattered components and were compared to the corresponding data for a standard treatment head with a flattening filter. The results of the simulations of the flattening filter free system show that a substantial increase in dose rate can be achieved, which would reduce the beam on time and decrease the out-of-field dose for patients due to reduced head-leakage dose. Also close to the treatment field edge, a significant improvement in out-of-field dose could be observed for small fields, which can be attributed to the change in the photon spectra, when the flattening filter is removed from the beamline.

mTOR inhibition induces endothelial progenitor cell death

Immunosuppressants are necessary to prevent graft rejection after solid organ transplantation. However, they are also known to have significant side effects, including endothelial toxicity. Endothelial progenitor cells originate in the bone marrow and are recognized by their angiogenic and endothelial reparative properties. The effects of the immunosuppressants cyclosporine A (CyA), tacrolimus and rapamycin were analyzed on endothelial progenitor-like cells. Rapamycin induced rapid cell death, even at concentrations much lower than those used clinically, in peripheral blood mononuclear cells (PBMC) cultured to favor outgrowth of endothelial progenitors. Cyclosporine A and tacrolimus had no significant effects at clinical concentrations. The effect of rapamycin was specific to endothelial progenitor cells, in particular to the early stages of differentiation, as a lesser effect was observed in late outgrowth endothelial progenitors, mature aortic endothelial cells, and macrophages derived from the same PBMCs. The mechanism of cell death appeared to be apoptosis; however, its induction was probably multifactorial and did not depend on caspase or cathepsin activation. In conclusion, rapamycin induces endothelial progenitor cell death, possibly because it blocks survival signals given by growth factors critically required by these cells.

Monte Carlo study of backscatter in a flattening filter free clinical accelerator

In conventional linear accelerators, the flattening filter provides a uniform lateral dose profile. In intensity modulated radiation therapy applications, however, the flatness of the photon field and hence the presence of a flattening filter, is not necessary. Removing the filter may provide some advantages, such as faster treatments and smaller out-of-field doses to the patients. In clinical accelerators the backscattered radiation dose from the collimators must be taken into account when the dose to the target volume in the patient is being determined. In the case of a conventional machine, this backscatter is known to great precision. In a flattening filter free accelerator, however, the amount of backscatter may be different. In this study we determined the backscatter contribution to the monitor chamber signal in a flattening filter free clinical accelerator (Varian Clinac 21EX) with Monte Carlo simulations. We found that with the exception of very small fields in the 18-MV photon mode, the contribution of backscattered radiation to the monitor signal did not differ from that of conventional machines with a flattening filter. Hence, a flattening filter free clinical accelerator would not necessitate a different backscatter correction.