Exploring change processes in compassion focused therapy in psychosis: results of a feasibility randomized controlled trial.

OBJECTIVES: Compassion focused therapy (CFT) was developed to stimulate capacities for soothing and affiliation to self and others as a way to regulate the threat system. This feasibility study aimed to assess the safety, the acceptability, the potential benefits, and associated change processes of using group CFT with people recovering from psychosis. DESIGN: A prospective, randomized, open-label, blinded end point evaluation design was used. METHOD: Forty adult patients with a schizophrenia-spectrum disorder were randomized to CFT plus treatment as usual (TAU; n = 22) or to TAU alone (n = 18). Group CFT comprised 16 sessions (2 hr each, 1 x week). Participants were assessed prior to randomization and at the end of treatment. Assessments included semi-structured interviews to elicit narratives of recovery from psychosis and self-report measures. At the end of treatment, participants were rated on the Clinical Global Impression Scale. Narratives were coded using the Narrative Recovery Style Scale to provide measures of change in compassion and avoidance. Change processes were correlated with changes in depression, personal beliefs about illness, fear of recurrence, and positive and negative affect. RESULTS: Group CFT was associated with no adverse events, low attrition (18%), and high acceptability. Relative to TAU, CFT was associated with greater observed clinical improvement (p < 0.001) and significant increases in compassion (p = 0.015) of large magnitude. Relative to TAU, increases in compassion in the CFT group were significantly associated with reductions in depression (p = 0.001) and in perceived social marginalization (p = 0.002). DISCUSSION: Findings support the feasibility of group CFT in psychosis and suggest that changes in compassion can be achieved, which appear to reduce depression in particular. This is the first randomized controlled evaluation of CFT. CONCLUSION: Compassion focused therapy appears as a safe, acceptable, promising, and evolving intervention for promoting emotional recovery from psychosis.

UK Renal Registry 12th Annual Report (December 2009): chapter 11: blood pressure profile of prevalent patients receiving dialysis in the UK in 2008: national and centre-specific analyses.

INTRODUCTION: The UK Renal Registry (UKRR) assesses blood pressure (BP) control annually for patients receiving renal replacement therapy (RRT) at renal centres in England, Wales and Northern Ireland. METHODS: Patients alive and receiving RRT on 31st December 2008 with a BP reading in either the fourth or third quarter of 2008 were included. Summary statistics were calculated for each renal centre, nation and primary renal disease (PRD) category. Longitudinal analyses were performed to assess the long-term impact of treatment modality and PRD on BP control for incident and prevalent patients. RESULTS: In 2008, only 26.3% of peritoneal dialysis (PD) and 27.4% of transplant (Tx) patients achieved the Renal Association (RA) guidelines standard of BP <130/80 mmHg. Since the cessation of BP targets for haemodialysis (HD) patients, there has been a reduction (compared to 2007) in the number of HD patients achieving BP <130/80 mmHg. In 2008, 43.1% of patients achieved BP <140/90 mmHg pre-HD and 46.8% BP <130/ 80 mmHg post-HD. BP control varied significantly between renal centres for each treatment modality (p < 0.001). Adjusted mean systolic BP fell significantly during the first year on dialysis (6 mmHg for PD and 8 mmHg for HD). Hypertension was more common in HD patients with vascular disorders such as diabetes and renovascular disease (59.0%) than in patients with glomerulonephritis (51.9%) or tubular disorders (46.7%). CONCLUSIONS: In 2008, a minority of patients on RRT achieved the recommended BP standards. There remained a significant variation in achievement of standards between UK renal centres. Since the removal of specific BP targets for HD patients, there has been an increase in systolic BP pre-and post-HD. BP falls significantly during the first year after starting dialysis and patients with vascular disorders have significantly worse BP control.

UK Renal Registry 11th Annual Report (December 2008): Chapter 11 Blood pressure profile of prevalent patients receiving dialysis in the UK in 2007: national and centre-specific analyses.

INTRODUCTION: Blood pressure (BP) control is assessed annually from patients on Renal Replacement Therapy at renal centres in England, Wales and Northern Ireland by the UK Renal Registry. METHODS: Patients alive and receiving RRT on 31st December 2007 with a BP reading in either the fourth or third quarter of 2007 were included. Summary statistics were calculated for each renal centre, nation and renal disease category. Linear regression analyses were performed for prevalent patients between 2000 and 2007. RESULTS: Significantly more haemodialysis patients achieved the BP standard (44.6% pre-HD and 48.8% post-HD) than peritoneal dialysis (32.8%) or renal transplant patients (26.7%). Median BP fell significantly between 2000 and 2007 for each treatment modality. There was significant variability in BP control between renal centres (p < 0.0001) for haemodialysis and transplant patients. Hypertension was significantly more common in haemodialysis patients with vascular disorders such as diabetes and renovascular disease (56.8%) than in glomerulonephritis (51.0%) or tubular disorders (45.1%). The effect was less prominent in peritoneal dialysis and not evident in transplant patients where few achieved the BP standard. CONCLUSION: A minority of patients on RRT achieved BP standards in 2007. There remained a significant variation in achievement of standards between renal centres.

Factors which may influence cardiovascular disease in dialysis and transplant patients--blood pressure (chapter 10).

Many renal units still fail to return blood pressure data to the Renal Registry. In England, Northern Ireland and Wales, the percentage of HD patients achieving the combined blood pressure standard (<140/90 pre-dialysis) averages 43% (inter unit range 16-60%) and post-dialysis (<130/80) average 48% (range 22-66%). On average 27% (range 12-48%) of PD patients achieve the standard of <130/80 and 26% of renal transplant patients (range 16-40%). Over the last 8 years there has been no significant change in systolic or diastolic blood pressure achievement. Better comorbidity data returns are required by the Registry to perform blood pressure survival analyses.

Combined Use of Rituximab and Intravenous Immunoglobulin for Severe Autoimmune Cicatricial Conjunctivitis-An Interventional Case Series.

PURPOSE: Despite the availability of systemic immunosuppressants, cicatricial conjunctivitis (CC) remains a potentially blinding ocular surface disease. We aim to describe the combined use of rituximab (RTX) and intravenous immunoglobulin (IVIg) for severe recalcitrant autoimmune CC. METHODS: In this single-center retrospective interventional case series with follow-up between 32 and 65 months, 3 cases with mucous membrane pemphigoid (patients 1-3) and 1 case with linear IgA disease (patient 4) were included. Initial conventional immunosuppressive therapy regimens included systemic steroids, dapsone, and mycophenolate. At the time of initiation of RTX and IVIg, all patients had only one eye with good visual acuity or good visual potential. Treatment included 1 to 2 cycles of RTX (1000 mg twice at an interval of 2 weeks apart), and 2 to 9 monthly courses of IVIg (2 g/kg over 3 days). Outcome measures were blindness, as defined by best spectacle-corrected visual acuity <0.05 on a decimal scale, and clinical staging of cicatricial disease (Rowsey and Foster staging). RESULTS: In 4 presented cases, progression of cicatricial disease was stopped as assessed by the Foster grading scale and visual acuity was stabilized in all patients. Conjunctival scarring was stabilized in 2 cases and continued to progress in 2 cases. One patient developed septicemia 6 weeks after RTX infusion, which was successfully treated. CONCLUSIONS: Combination therapy of RTX and IVIg is a potent treatment regimen for recalcitrant autoimmune CC. Further prospective controlled studies on efficacy and safety are warranted before widespread clinical application.

Breathless in houston: a political ecology of health approach to understanding environmental health concerns.

A political ecology approach to the study of environmental health problems can provide a comprehensive analytical framework with which to understand geographical and social disparities in health status. To date, however, political ecology has remained limited in its application to health problems, and where health has been addressed, biomedical models have prevailed, with little attention to differing explanatory models of health and disease. By integrating political ecology with an interpretive critical medical anthropology, one can better understand the ways in which health and environment intersect, and the differing social responses to environmental practices that affect human health. In this paper I summarize these theoretical issues and then discuss how this theory can be applied toward an analysis of air quality and health in Houston, Texas. This research suggests that local understandings of respiratory health often contradict public health concepts of environmental health and, in turn, differentially shape people's interactions with the environment.

Informing education policy on MMR: balancing individual freedoms and collective responsibilities for the promotion of public health.

The recent decrease in public confidence in the measles, mumps and rubella vaccine has important implications for individuals and public health. This article presents moral arguments relating to conflicts between individual autonomy and collective responsibilities in vaccination decisions with a view to informing and advising health professionals and improving the effectiveness of education policies in avoiding resurgence of endemic measles. Lower population immunity, due to falling uptake, is hastening the need for greater public awareness of the consequences for the population. Vaccination refusals go hand in hand with responsibilities owed to future generations and society in not knowingly contributing to preventable harms. Issues such as parents' rights are considered and balanced against: collective responsibilities for public health; permissibility of 'free-riding'; conflicting duties of health professionals; and possible enforcement of vaccination. It is suggested that the arguments may form a persuasive tool for the practice of health professionals involved in informing and supporting parents' vaccination decisions.