The Search for Meaning: Eventfulness in the Lives of Homeless Mentally Ill Persons in the Skid Row District of Los Angeles

In the past two decades, the field ofpsychiatry has seen the once dominantpsychoanalytic theories overtaken by biologicalexplanations and approaches to severe mentalillness. With this change in perspective, thesignificance of fantasies and delusions havebeen reduced to being merely symptoms ofpsychopathology rather than reflections ofhuman needs and motivations. Usingethnographic evidence from a long-term researchproject, this paper explores one method bywhich mentally ill homeless individuals in theSkid Row district of Los Angeles attempted towrest meaningful lives for themselves out of anenvironment that featured disaffiliation,violence, boredom, and extreme poverty.     

Disparities in Oral Cancer Survival among Mentally Ill Patients

Background

Many studies have reported excess cancer mortality in patients with mental illness. However, scant studies evaluated the differences in cancer treatment and its impact on survival rates among mentally ill patients. Oral cancer is one of the ten most common cancers in the world. We investigated differences in treatment type and survival rates between oral cancer patients with mental illness and without mental illness.

Methods

Using the National Health Insurance (NHI) database, we compared the type of treatment and survival rates in 16687 oral cancer patients from 2002 to 2006. The utilization rate of surgery for oral cancer was compared between patients with mental illness and without mental illness using logistic regression. The Cox proportional hazards model was used for survival analysis.

Results

Oral cancer patients with mental disorder conferred a grave prognosis, compared with patients without mental illness (hazard ratios [HR] = 1.58; 95% confidence interval [CI] = 1.30–1.93; P<0.001). After adjusting for patients’ characteristics and hospital characteristics, patients with mental illness were less likely to receive surgery with or without adjuvant therapy (odds ratio [OR] = 0.47; 95% CI = 0.34–0.65; P<0.001). In multivariate analysis, oral cancer patients with mental illness carried a 1.58-times risk of death (95% CI = 1.30–1.93; P<0.001).

Conclusions

Oral cancer patients with mental illness were less likely to undergo surgery with or without adjuvant therapy than those without mental illness. Patients with mental illness have a poor prognosis compared to those without mental illness. To reduce disparities in physical health, public health strategies and welfare policies must continue to focus on this vulnerable group.     

Struggling with Imaginaries of Trauma and Trust: The Refugee Experience in Switzerland

This article discusses some effects of migration politics on asylum seekers and refugees and on the Swiss health services. It is based on multisited ethnographic research that tracked interpretative concepts of the refugee experience. Following a grounded theory approach, it identifies imaginaries of trauma and trust as key categories in the field of transnational migration and health. The psychiatric concept of trauma and a more popularized discourse of traumatic memory are strongly emphasized in all of the investigated field sites: the providers of primary health care and psychosocial services and representatives of social welfare agencies and law-making bodies use this "diagnosis" extensively. This leads refugees to develop tactics of a) identifying with the trauma discourse in order to become "good refugees" and achieve legal status in Switzerland; b) struggling with the ascribed pathologies and suffering from retraumatizing effects of these predominant trauma policies; and c) trying to refuse or subvert them by emphasizing the existence of structural violence in the receiving countries. An analysis of the interactions of health providers and refugees shows that it takes place in an environment of social and economic insecurity and in a shared imaginary of (mis)trust, putting at stake the moral economy of recent migration politics and the refugee experience.     

Investigation of Hepatitis B Virus and Human Immunodeficiency Virus Transmission among Severely Mentally Ill Residents at a Long Term Care Facility

Background

A high prevalence of hepatitis B virus (HBV) and human immunodeficiency virus (HIV) infections have been reported among persons with severe mental illness. In October, 2009, the Cook County Department of Public Health (CCDPH) initiated an investigation following notification of a cluster of HBV infections among mentally ill residents at a long term care facility (LTCF).

Methods

LTCF staff were interviewed and resident medical records were reviewed. Residents were offered testing for HBV, HCV, and HIV. Serum specimens from residents diagnosed with HBV or HIV infection were sent to the Centers for Disease Control and Prevention (CDC) for analysis.

Results

Eleven newly diagnosed HBV infections were identified among mentally ill residents at the LTCF. Of these 11 infections, 4 serum specimens were available for complete HBV genome sequencing; all 4 genomes were found to be closely related. Four newly diagnosed HIV infections were identified within this same population. Upon molecular analysis, 2 of 4 HIV sequences from these new infections were found to be nearly identical and formed a tight phylogenetic cluster.

Conclusions

HBV and HIV transmission was identified among mentally ill residents of this LTCF. Continued efforts are needed to prevent bloodborne pathogen transmission among mentally ill residents in LTCFs.     

Intellectual Disability among Dutch Homeless People: Prevalence and Related Psychosocial Problems

Background

There is a higher prevalence of intellectual disability (ID) among homeless people than in the general population. However, little is known about the additional psychosocial problems faced by homeless people with ID. We describe the prevalence of ID in a cohort of homeless people in the Netherlands, and report relationships between ID and psychosocial problems in terms of psychological distress, substance (mis)use and dependence, as well as demographic characteristics in this cohort.

Methods

This cross-sectional study is part of a cohort study among homeless people in the four major cities of the Netherlands. Data were derived from 387 homeless people who were interviewed and screened for ID six months after the baseline measurement. Multivariate logistic regression analyses and χ² tests were performed to analyze relationships between ID, psychosocial problems and demographic characteristics.

Findings

Of all cohort members, 29.5% had a suspected ID. Participants with a suspected ID had a higher mean age, were more likely to be male and to fall in the lowest category of education than participants without a suspected ID. Having a suspected ID was related to general psychological distress (OR  = 1.56, p<0.05), somatization (OR  = 1.84, p<0.01), depression (OR  = 1.58, p<0.05) and substance dependence (OR  = 1.88, p<0.05). No relationships were found between a suspected ID and anxiety, regular substance use, substance misuse and primary substance of use.

Conclusion

The prevalence of ID among Dutch homeless people is higher than in the general population, and is related to more psychosocial problems than among homeless people without ID. Homeless people with a suspected ID appear to be a vulnerable subgroup within the homeless population. This endorses the importance of the extra attention required for this subgroup.     

The Word on the Street: Homeless Men in Las Vegas

The Word on the Street: Homeless Men in Las Vegas. Kurt Borchard. Las Vegas: University of Nevada Press, 2005. 232 pp.     

Struggling with Development: The Politics of Hunger and Gender in the Philippines

Struggling with Development: The Politics of Hunger and Gender in the Philippines. Lynn M. Kwiatkowski. Boulder, CO: Westview Press. 1998. 350 pp.     

Empirical Evidence for Synchrony in the Evolution of TB Cases and HIV+ Contacts among the San Francisco Homeless

The re-emergence of tuberculosis (TB) in the mid-1980s in many parts of the world, including the United States, is often attributed to the emergence and rapid spread of human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS). Although it is well established that TB transmission is particularly amplified in populations with high HIV prevalence, the epidemiology of interaction between TB and HIV is not well understood. This is partly due to the scarcity of HIV-related data, a consequence of the voluntary nature of HIV status reporting and testing, and partly due to current practices of screening high risk populations through separate surveillance programs for HIV and TB. The San Francisco Department of Public Health, TB Control Program, has been conducting active surveillance among the San Francisco high-risk populations since the early 1990s. We present extensive TB surveillance data on HIV and TB infection among the San Francisco homeless to investigate the association between the TB cases and their HIV+ contacts. We applied wavelet coherence and phase analyses to the TB surveillance data from January 1993 through December 2005, to establish and quantify statistical association and synchrony in the highly non-stationary and ostensibly non-periodic waves of TB cases and their HIV+ contacts in San Francisco. When stratified by homelessness, we found that the evolution of TB cases and their HIV+ contacts is highly coherent over time and locked in phase at a specific periodic scale among the San Francisco homeless, but no significant association was observed for the non-homeless. This study confirms the hypothesis that the dynamics of HIV and TB are significantly intertwined and that HIV is likely a key factor in the sustenance of TB transmission among the San Francisco homeless. The findings of this study underscore the importance of contact tracing in detection of HIV+ individuals that may otherwise remain undetected, and thus highlights the ever-increasing need for HIV-related data and an integrative approach to monitoring high-risk populations with respect to HIV and TB transmission.     

Mitochondria are direct targets of the lipoxygenase inhibitor MK886. A strategy for cell killing by combined treatment with MK886 and cyclooxygenase inhibitors

We have investigated the mitochondrial and cellular effects of the lipoxygenase inhibitor MK886. Low concentrations (1 microM) of MK886 selectively sensitized the permeability transition pore (PTP) to opening, whereas higher concentrations of MK886 (10 microM) caused depolarization through combination of an ionophoretic effect with inhibition of respiration. MK886 killed prostate cancer PC3 cells only at the higher, toxic concentration (10 microM), whereas the lower concentration (1 microM) had no major effect on cell survival. However, 1 microM MK886 alone demonstrably induced PTP-dependent mitochondrial dysfunction; and it caused cell death through the mitochondrial pathway when it was used in combination with the cyclooxygenase inhibitor, indomethacin, which had no effects per se. Treatment with 1 microM MK886 plus indomethacin sensitized cells to killing by exogenous arachidonic acid, which induces PTP opening and cytochrome c release (Scorrano, L., Penzo, D., Petronilli, V., Pagano, F., and Bernardi, P. (2001) J. Biol. Chem. 276, 12035-12040). Combination of MK886 and cyclooxygenase inhibitors may represent a viable therapeutic strategy to force cell death through the mitochondrial pathway. This approach should be specifically useful to kill cells possessing a high flux of arachidonic acid and its metabolites like prostate and colon cancer cells.