Community mental health care worldwide: current status and further developments

This paper aims to give an overview of the key issues facing those who are in a position to influence the planning and provision of mental health systems, and who need to address questions of which staff, services and sectors to invest in, and for which patients. The paper considers in turn: a) definitions of community mental health care; b) a conceptual framework to use when evaluating the need for hospital and community mental health care; c) the potential for wider platforms, outside the health service, for mental health improvement, including schools and the workplace; d) data on how far community mental health services have been developed across different regions of the world; e) the need to develop in more detail models of community mental health services for low‐ and middle‐income countries which are directly based upon evidence for those countries; f) how to incorporate mental health practice within integrated models to identify and treat people with comorbid long‐term conditions; g) possible adverse effects of deinstitutionalization. We then present a series of ten recommendations for the future strengthening of health systems to support and treat people with mental illness.     

Vegetation,herbivores and fires in savanna ecosystems: A network perspective

The dynamics of savanna ecosystems depends on the interplay between multiple factors such as grazing, browsing, fires, rainfall regime and interactions between grass and woody vegetation. In most modelling applications this interplay may not be fully understood because some of these drivers enter the models as dynamically independent factors. In this paper we consider such factors as dynamic variables. To analyze their interplay we focus on the structure of the interactive network of variables and exploit the properties of signed digraphs using the algorithm of Loop Analysis. Qualitative signed digraphs for the savanna ecosystem are developed and their predictions used to interpret patterns of abundance observed in case studies selected from the literature. The outcomes of this exercise unveil that: 1) the structure of the interactions is appropriate locus for the explanation of patterns observed in savannas; 2) signed digraph can help disentangling causative mechanisms by linking correlation patterns, source of change and network structure. This study highlights that central to the understanding of savanna dynamics is our ability to diagram the important relationships and understand how they interrelate with sources of variations to cause ecosystem change.     

Quantitative and antioxidative behavior of Trolox in rats’ blood and brain by HPLC‐UV and SMFIA‐CL methods

Trolox, a water‐soluble vitamin E analogue has been used as a positive control in Trolox equivalent antioxidant capacity and oxygen radical antioxidant capacity assays due to its high antioxidative effect. In this study, the ex vivo antioxidative effects of Trolox and its concentration in blood and brain microdialysates from rat after administration were evaluated by newly established semi‐microflow injection analysis, chemiluminescence detection and HPLC‐UV. In the administration test, the antioxidative effect of Trolox in blood and brain microdialysates after a single administration of 200 mg/kg of Trolox to rats could be monitored. The antioxidative effects in blood (12.0 ± 2.1) and brain (8.4 ± 2.1, × 10³ antioxidative effect % × min) also increased. Additionally, the areas under the curve (AUC)s_0–360 (n = 3) for blood and brain calculated with quantitative data were 10.5 ± 1.2 and 9.7 ± 2.5 mg/mL × min, respectively. This result indicates that Trolox transferability through the blood–brain barrier is high. The increase in the antioxidative effects caused by Trolox in the blood and brain could be confirmed because good correlations between concentration and antioxidative effects (r ≥ 0.702) were obtained. The fact that Trolox can produce an antioxidative effect in rat brain was clarified. Copyright © 2015 John Wiley & Sons, Ltd.     

Energy transfer between Ce3+ → Gd3+ or Tb3+ in KNaSO4 microphosphor

KNaSO₄ microphosphor doped with Ce,Gd and Ce,Tb and prepared by a wet chemical method was studied using X‐ray diffraction (XRD), scanning electron microscopy (SEM) and photoluminescence (PL) characterization. KNaSO₄ has a 5‐µm particle size detected by SEM. KNaSO₄:Ce³⁺,Tb³⁺ showed blue and green emission (at 494 nm, 557 nm, 590 nm) of Tb³⁺ due to ⁵D₄ → ⁷F_J (J = 4, 5, 6) transitions. KNaSO₄:Ce³⁺,Gd³⁺ showed luminescence in the ultraviolet (UV) light region at 314 nm for an excitation at 271 nm wavelength. It was observed that efficient energy transfer took place from Ce³⁺ → Gd³⁺ and Ce³⁺ → Tb³⁺ sublattices indicating that Ce³⁺ could effectively sensitize Gd³⁺ or Tb³⁺ (green emission). Ce³⁺ emission weakened and Gd³⁺ or Tb³⁺ enhanced the emission significantly in KNaSO₄. This paper discusses the development and understanding of photoluminescence and the effect of Tb³⁺ and Gd³⁺ on KNaSO₄:Ce³⁺. Copyright © 2015 John Wiley & Sons, Ltd.     

HPV+/-宫颈癌患者临床特点与预后的对比分析

目的:探讨HPV阴性与HPV阳性宫颈癌的临床特点及其和预后的关系。方法:选取住院手术的HPV呈阴性与阳性的宫颈癌患者各86例,且两组患者在年龄、FIGO临床分期相近。分析两组患者的年龄、肿瘤临床分期、病理分型、原发肿瘤大小、分化程度、基层浸润深度、淋巴结转移、治疗方案情况及其5年RFS和总生存时间。结果:两组间宫颈癌患者肿瘤分化程度、肌层浸润深度、淋巴结转移间差异有统计学意义(P0.05)。HPV阳性组和HPV阴性组随访时间分别为63(13~87)个月、61(9~90)个月,5年总生存率分别为70.4%和61.3%,平均总生存时间分别为(73.15±2.74)月和(62.72±3.03)月,差异有统计学意义(p0.05)。HPV阴性组和HPV阳性组5年RFS分别为52.3%和66.4%,平均RFS为(51.57±4.62)月和(58.83±3.46)月,差异有统计学意义(p0.05)。结论:HPV阴性宫颈癌瘤体倾向于低分化,易发生局部侵犯和淋巴结转移,其临床预后较差。     

聚乙二醇干扰素治疗对慢性乙型肝炎患者Th17/Treg的影响

目的:研究聚乙二醇干扰素抗病毒治疗对慢性乙型肝炎(CHB)患者Th17、Treg及Th17/Treg的影响,及Th17/Treg与表面抗原的关系。方法:30例HBe Ag阴性慢性乙型肝炎患者予聚乙二醇干扰素治疗,在治疗前与治疗后24周、48周时,检测外周血Th17、Treg的细胞频数及表面抗原定量,并与20例健康人的Th17、Treg的细胞频数进行比较,分析聚乙二醇干扰素对Th17、Treg的影响。结果:1CHB患者的Th17及Treg细胞频数较健康人的高,但Th17/Treg比例较健康人低。抗病毒治疗后24周时,Th17/Treg比例较治疗前升高,48周时Th17/Treg比例较24周时稍降低(P0.05),48周时与治疗前相比仍升高(P0.05)。2治疗结束时表面抗原阴转病人的Th17/Treg比未阴转病人高。3慢乙肝病人的Th17/Treg与表面抗原定量成负相关(r=-0.388,P0.05)。结论:CHB患者体内存在着Th17/Treg的失衡,干扰素可以调节CHB患者的免疫功能,有望实现表面抗原阴转。     

Genetic and epigenetic heterogeneity of epithelial ovarian cancer and the clinical implications for molecular targeted therapy

Epithelial ovarian cancer (EOC) is the most lethal gynaecological malignancy, and tumoural heterogeneity (TH) has been blamed for treatment failure. The genomic and epigenomic atlas of EOC varies significantly with tumour histotype, grade, stage, sensitivity to chemotherapy and prognosis. Rapidly accumulating knowledge about the genetic and epigenetic events that control TH in EOC has facilitated the development of molecular‐targeted therapy. Poly (ADP‐ribose) polymerase (PARP) inhibitors, designed to target homologous recombination, are poised to change how breast cancer susceptibility gene (BRCA)‐related ovarian cancer is treated. Epigenetic treatment regimens being tested in clinical or preclinical studies could provide promising novel treatment approaches and hope for improving patient survival.     

The effectiveness of the peer-delivered Thinking Healthy PLUS (THPP+) Program for maternal depression and child socioemotional development in Pakistan: study protocol for a randomized controlled trial

BackgroundThe negative effects of perinatal depression on the mother and child start early and persist throughout the lifecourse (Lancet 369(9556):145–57, 2007; Am J Psychiatry 159(1):43-7, 2002; Arch Dis Child 77(2):99–101, 1997; J Pak Med Assoc 60(4):329; J Psychosoma Res 49(3):207–16, 2000; Clin Child Fam Psychol Rev 14(1):1–27, 2011). Given that 10–35 % of children worldwide are exposed to perinatal depression in their first year of life (Int Rev Psychiatry 8(1):37–54, 1996), mitigating this intergenerational risk is a global public health priority (Perspect Public Health 129(5):221–7, 2009; Trop Med Int Health 13(4):579–83, 2008; Br Med Bull 101(1):57–79, 2012). However, it is not clear whether intervention with depressed women can have long-term benefits for the mother and/or her child. We describe a study of the effectiveness of a peer-delivered depression intervention delivered through 36 postnatal months, the Thinking Healthy Program Peer-delivered PLUS (THPP+) for women and their children in rural Pakistan.Methods/designThe THPP+ study aims are: (1) to evaluate the effects of an extended 36-month perinatal depression intervention on maternal and index child outcomes using a cluster randomized controlled trial (c-RCT) and (2) to determine whether outcomes among index children of perinatally depressed women in the intervention arm converge with those of index children born to perinatally nondepressed women. The trial is designed to recruit 560 pregnant women who screened positive for perinatal depression (PHQ-9 score ≥10) from 40 village clusters, of which 20 receive the THPP+ intervention. An additional reference group consists of 560 perinatally nondepressed women from the same 40 clusters as the THPP+ trial. The women in the nondepressed group are not targeted to receive the THPP+ intervention; but, by recruiting pregnant women from both intervention and control clusters, we are able to evaluate any carryover effects of the THPP+ intervention on the women and their children. Perinatally depressed women in the THPP+ intervention arm receive bimonthly group-based sessions. Primary outcomes are 3-year maternal depression and 3-year child development indicators. Analyses are intention-to-treat and account for the clustered design.DiscussionThis trial, together with the reference group, has the potential to further our understanding of the early developmental lifecourse of children of both perinatally depressed and perinatally nondepressed women in rural Pakistan and to determine whether intervening with women’s depression in the perinatal period can mitigate the negative effects of maternal depression on 36-month child development.

Trial registration

THPP-P ClinicalTrials.gov Identifier: {"type":"clinical-trial","attrs":{"text":"NCT02111915","term_id":"NCT02111915"}}NCT02111915 (registered on 9 April 2014).THPP+ ClinicalTrials.gov Identifier: {"type":"clinical-trial","attrs":{"text":"NCT02658994","term_id":"NCT02658994"}}NCT02658994 (registered on 21 January 2016).Sponsor: Human Development Research Foundation (HDRF).

Electronic supplementary material

The online version of this article (doi:10.1186/s13063-016-1530-y) contains supplementary material, which is available to authorized users.     

The relationship between chronotype and personality among patients with alcohol dependence syndrome: Pilot study

The study investigates the distribution of chronotypes among alcohol-dependent subjects and the relationship between personality and chronotype. Fifty-eight alcohol-dependent patients and 29 age-matched healthy controls were studied using Ogińska’s Chronotype Questionnaire (ChQ), Eysenck’s Personality Questionnaire – Revised (EPQ-R), Selzer’s Michigan Alcoholism Screening Test (MAST) and a sociodemographic status questionnaire designed by the authors. The alcohol-dependent patients tended to be morning type, based on the morningness–eveningness ChQ scale, with a weakly marked rhythm, based on the distinctness ChQ scale. Preference towards morningness was associated with older age, but no relation between chronotype and severity of alcohol dependence was found. A high amplitude of the rhythm was associated with higher neuroticism. Therefore, despite being in the minority, patients with a distinct circadian rhythm (i.e. with a high amplitude) are at greater risk of mood and anxiety disorders and hence should be given special consideration.