Better outcomes--a case study

It is estimated that mental health problems will affect more than 20% of the Australian adult population in their lifetime. The 2001 Australian Commonwealth budget provided dollars 120.4 million over 4 years to improve the quality of care provided through general practice to Australians with a mental health illness. The Better Outcomes in Mental Health Care (BOMHC) initiative--which forms part of the National Mental Health Strategy--began in 2001 and aimed to improve the quality of care provided through general practice to patients with a mental health problem. This article reviews the uptake of education and training initiatives of the BOMHC initiative and good uptake by general practitioners across Australia. Well over 3600 GPs have completed the first 'level' of training associated with the initiative, representing 16.5% of the GP population. Access by consumers to mental health trained and registered GPs also significantly improved, with one in four practices employing a GP registered with the BOMHC initiative.

Sexual offenders' perceptions of their early interpersonal relationships: an attachment perspective

The present study examined the perceptions of early interpersonal experiences of sexual offenders (child molesters and rapists) and two criminal comparison groups. A grounded theory approach was applied to a comprehensive list of responses provided by the participants to questions about their early interpersonal experiences. The raw data was collapsed into 14 basic categories by grouping together responses of similar meanings. The categories were responsiveness, consistency, acceptance, boundaries, emotional regulation, autonomy, self-evaluation, developmental trauma, sexual abuse and deviation, physical abuse, loss, conflict, safety, and positive mediating interactions. In the second part of the study, the four groups were compared using the categories and the differences noted. All four groups experienced significantly negative early interpersonal experiences.

Sexual offenders' perceptions of their early interpersonal relationships: an attachment perspective

The present study examined the perceptions of early interpersonal experiences of sexual offenders (child molesters and rapists) and two criminal comparison groups. A grounded theory approach was applied to a comprehensive list of responses provided by the participants to questions about their early interpersonal experiences. The raw data was collapsed into 14 basic categories by grouping together responses of similar meanings. The categories were responsiveness, consistency, acceptance, boundaries, emotional regulation, autonomy, self-evaluation, developmental trauma, sexual abuse and deviation, physical abuse, loss, conflict, safety, and positive mediating interactions. In the second part of the study, the four groups were compared using the categories and the differences noted. All four groups experienced significantly negative early interpersonal experiences.

Effect of long term treatment with azithromycin on disease parameters in cystic fibrosis: a randomised trial

BACKGROUND

Relentless chronic pulmonary inflammation is the major contributor to morbidity and mortality in patients with cystic fibrosis (CF). While immunomodulating therapies such as prednisolone and ibuprofen may be beneficial, their use is limited by side effects. Macrolides have immunomodulatory properties and long term use dramatically improves prognosis in diffuse panbronchiolitis, a condition with features in common with the lung disease of CF.

METHODS

To determine if azithromycin (AZM) improves clinical parameters and reduces inflammation in patients with CF, a 3 month prospective randomised double blind, placebo controlled study of AZM (250 mg/day) was undertaken in adults with CF. Monthly assessment included lung function, weight, and quality of life (QOL). Blood and sputum collection assessed systemic inflammation and changes in bacterial flora. Respiratory exacerbations were treated according to the policy of the CF Unit.

RESULTS

Sixty patients were recruited (29 men) of mean (SD) age 27.9 (6.5) years and initial forced expiratory volume in 1 second (FEV1) 56.6 (22.3)% predicted. FEV1% and forced vital capacity (FVC)% predicted were maintained in the AZM group while in the placebo group there was a mean (SE) decline of -3.62 (1.78)% (p=0.047) and -5.73 (1.66)% (p=0.001), respectively. Fewer courses of intravenous antibiotics were used in patients on AZM (0.37 v 1.13, p=0.016). Median C reactive protein (CRP) levels declined in the AZM group from 10 to 5.4 mg/ml but remained constant in the placebo group (p<0.001). QOL improved over time in patients on AZM and remained unchanged in those on placebo (p=0.035).

CONCLUSION

AZM in adults with CF significantly improved QOL, reduced CRP levels and the number of respiratory exacerbations, and reduced the rate of decline in lung function. Long term AZM may have a significant impact on morbidity and mortality in patients with CF. Further studies are required to define frequency of dosing and duration of benefit.

Is home peak expiratory flow monitoring effective for controlling asthma symptoms?

A case in which a home peak expiratory flow (PEF) monitoring device was recommended led us to review the evidence examining this intervention. The clinical question to be answered was: should these devices be consistently recommended to all patients with asthma? A comprehensive search revealed eight randomized controlled trials, one review and one consensus report. Four trials provided all subjects with asthma education and compared patient-specific action plans based on symptoms to those based on PEF readings. Four trials compared usual asthma care to peak flow monitoring (PFM) and varied in both their content and intensity of asthma education. Six out of eight studies showed improvement in some selected markers of asthma morbidity with home PFM-based action plans. Improvements were also observed in patients using a symptom-based action plan. These studies did not demonstrate any obvious advantage of PFM compared with symptom-based monitoring but did suggest that a monitoring plan with predetermined actions based on PEF measurements or symptoms can lead to improved asthma control. Although not specifically studied, PFM may be more appropriate and effective for patients who have difficulty identifying worsening of asthma control through symptom monitoring.

High prevalence of celiac sprue-like HLA-DQ genes and enteropathy in patients with the microscopic colitis syndrome

OBJECTIVE

Celiac sprue is associated with specific HLA-DQ genes (mainly DQ2). Because there are epidemiological and histopathological similarities between celiac sprue and microscopic colitis, we hypothesized that these syndrome may share an HLA genetic predisposition and pathogenesis.

METHODS

The HLA-DQ genes of 25 patients with celiac sprue, 53 patients with the microscopic colitis syndrome, and 429 normal controls were typed and compared. Serum was analyzed for antigliadin and antiendomysial antibodies. Small intestinal biopsies were analyzed for signs of histopathology.

RESULTS

HLA-DQ2 or DQ1,3 (the latter as DQ1,7,DQ1,8, or DQ1,9) were seen more frequently in both patient groups relative to controls. In patients with the microscopic colitis syndrome, serological tests for celiac sprue were weakly positive in 17%; mild inflammation of the small intestine without villous atrophy was present in 43%, and inflammation plus partial or subtotal villous atrophy was present in 27%.

CONCLUSIONS

A shared set of predisposing HLA-DQ genes account for the epidemiological overlap of celiac sprue and microscopic colitis. Mild to moderate mononuclear cell inflammation of the small intestine, often accompanied by partial or subtotal villous atrophy, is frequent in patients with the microscopic colitis syndrome. Although further studies will be necessary to determine if this enteropathy is induced by dietary gluten, we speculate that the small intestinal but not colonic histopathology in patients with microscopic colitis is caused by immunological gluten sensitivity.

Precise, highly female-biased sex ratios in a social spider

It has been recognized for some time that the risk of producing maleless clutches should select for a lower than binomial variance in the sex ratio of organisms with female-biased sex ratios, small clutches and breeding groups containing the clutch of a single female. However, to date, precise sex ratios have only been reported for organisms with haplodiploid sex determination, a system which allows direct control of the sex of individual offspring. In contrast, under heterogametic sex determination chance is expected to play a crucial role in determining the sex composition of any one family, in particular when males are the heterogametic sex. Here, we present evidence of precise or underdispersed primary sex ratios in the Neotropical social spider Anelosimus domingo Levi. We show that this diplodiploid species with male heterogamety has not only beaten the odds of meiosis by producing mostly daughters, but has also attained relative precision in the proportion of sons and daughters produced in any one clutch. The latter finding suggests the existence of mechanisms that allow sorting of the two types of sperm in this spider species.

Inhibiting cadherin function by dominant mutant E-cadherin expression increases the extent of tight junction assembly

Previous studies have shown that induction of cadherin-mediated cell-cell adhesion leads to tight junction formation, and that blocking cadherin-mediated cell-cell adhesion inhibits tight junction assembly. Here we report analysis of tight junction assembly in MDCK cells overexpressing a mutant E-cadherin protein that lacks an adhesive extracellular domain (T151 cells). Mutant E-cadherin overexpression caused a dramatic reduction in endogenous cadherin levels. Despite this, tight junction assembly was extensive. The number of tight junction strands observed by freeze-fracture electron microscopy significantly increased in T151 cells compared to that in control cells. Our data indicate that the hierarchical regulation of junctional complex assembly is not absolute, and that inhibition of cadherin function has both positive and negative effects on tight junction assembly.