Attention Deficit Hyperactivity Disorder Presentations to The Child and Adolescent Mental Health Urgent Consult Clinic.

OBJECTIVE: The objective of the present study is to compare and contrast demographic and clinical characteristics of patients diagnosed with and without ADHD referred to the Child and Adolescent Mental Health Urgent Consult Clinic (CAMHUCC) in order to identify any differences between the patient groups and potentially improve care of these patients in the community. METHODS: This is retrospective cohort study of all children and adolescents, who were referred to the CAMHUCC between 2012 and 2014. Using data routinely collected at the clinic, individuals with ADHD were compared to individuals without ADHD. Data analysis was conducted using frequencies, percentages, means and standard deviations to describe participant demographic and clinical information, and comparisons between individuals with and without ADHD was made using Mann-Whitney U statistics. RESULTS: Of the 803 urgent assessments at the clinic, 367 (45.7%) were diagnosed with ADHD. Individuals with ADHD were statistically significantly more likely to be younger, male, referred for aggression, and not living with both parents. Individuals with ADHD were also more likely to be referred for follow-up than those without ADHD, and were more likely to have had at least one previous admission to the CAMHUCC. CONCLUSIONS: Individuals with ADHD account for a significant proportion of child and adolescent presentations to CAMHUCC. Provision of urgent psychiatric care to young people with ADHD represents a significant utilization of resources on health care in terms of initial assessment, higher rates of follow up care, need for risk assessment and referral to CMHA.

OBJECTIF: L'objectif de la présente étude est de comparer et de contraster les caractéristiques démographiques et cliniques des patients diagnostiqués avec et sans trouble de déficit d'attention avec hyperactivité (TDAH) qui sont adressés à la clinique de consultation d'urgence pour santé mentale d'enfants et d'adolescents (CCUSMEA) afin de distinguer toute différence entre les groupes de patients et de potentiellement améliorer les soins de ces patients dans la communauté. MÉTHODES: C'est une étude de cohorte rétrospective de tous les enfants et adolescents qui ont été aiguillés à la CCUSMEA entre 2012 et 2014. À l'aide des données recueillies régulièrement à la clinique, les personnes souffrant de TDAH ont été comparées avec les personnes sans TDAH. L'analyse des données a été menée à l'aide des fréquences, des pourcentages, des moyennes et des écarts types pour décrire les données démographiques et cliniques des participants, et les comparaisons entre les personnes avec et sans TDAH ont été faites à l'aide du test U statistique de Mann-Whitney. RÉSULTATS: Sur les 803 évaluations d'urgence à la clinique, 367 (45,7 %) ont été diagnostiquées avec le TDAH. Les personnes souffrant du TDAH étaient statistiquement plus significativement susceptibles d'être plus jeunes, de sexe masculin, aiguillées pour une agression, et ne vivant pas avec leurs deux parents. Les personnes souffrant du TDAH étaient également plus susceptibles d'être adressées à un suivi que celles sans TDAH, et étaient plus susceptibles d'avoir eu plus d'une admission précédente à la CCUSMEA. CONCLUSIONS: Les personnes souffrant du TDAH représentent une proportion significative des présentations d'enfants et d'adolescents à la CCUSMEA. L'offre de soins psychiatriques d'urgence aux jeunes gens souffrant du TDAH représente une utilisation significative des ressources des soins de santé en ce qui concerne l'évaluation initiale, les taux plus élevés des soins de suivi, le besoin d'une évaluation de risque et l'aiguillage à CMHA.

Induction of acquired drug resistance in endothelial cells and its involvement in anticancer therapy.

BACKGROUND: Multidrug resistance (MDR) is one of the major problems in the treatment of cancer. Overcoming it is therefore expected to improve clinical outcomes for cancer patients. MDR is usually characterized by overexpression of ABC (ATP-binding cassette) protein transporters such as P-gp, MRP1, and ABCG2. Though the importance of ABC transporters for cancer cells is recognized, few studies have looked at its implications for the endothelial cells that are essential to tumor angiogenesis. This study investigated the expression and functions of these ABC transporters in endothelial cells in vitro and their potential contribution to cancer growth in mice. METHODS: Human micro vessel endothelial cells (HMEC-1) and human umbilical vein endothelial cells (HUVEC) were exposed to increasing doses of Doxorubicin (Dox) to induce ABC gene expression. Cell viability was then quantified by (3)H-thymidine and MTS assay. Flow cytometry, qPCR, and western blot were used to detect mRNA and the protein expression of P-gp, MRP1, and ABCG2. The intracellular accumulation of Rhodamine 123 (Rho) was used to evaluate drug efflux function and the inhibitors for P-gp, ABCG2, and MRP1 were used to verify their respective roles in vitro. In an attempt to evaluate drug resistance in endothelial cells in vivo, athymic mice were treated with Dox for 15 days before a MDA-MB-435 tumor graft to observe subsequent changes in the inhibition curves of tumor growth in response to Dox treatment. Furthermore, endothelial cells from multiple sites in these mice were also isolated to estimate their P-gp expression by flow cytometry. RESULTS: Drug resistance in HMEC-1 and HUVEC was successfully induced by the addition of Dox to the culture media. Two stabilized subcell lines of HMEC1 (HMECd1 and HMECd2) showed 15- and 24-fold increases in resistance. Tests also showed that these induced endothelial cells were cross-resistant to the structurally unrelated drugs Daunorubicin, Vinblastine, and Etoposide. P-gp protein levels increased four and six fold in HMECd1 and HMECd2 as revealed by western blot. The qPCR demonstrated 3.4- and 7.2-fold increases in P-gp, and a slight increase in ABCG2, gene expression. The Rho accumulation within these cells was inversely correlated with the expression levels of P-gp. The inhibitors of P-gp, but not of ABCG2 or MRP1, were able to block the induced endothelial cell resistance to Dox. Furthermore, we also showed that injecting Dox into healthy mice induced an increase in P-gp expression in endothelial cells. Using these pretreated mice in a tumor growth experiment, we observed a dramatic diminution in the therapeutic efficiency of Dox treatment, suggesting implications for drug resistance in mice endothelial cells supporting tumor growth. CONCLUSIONS: ABC transporter expression can be induced in endothelial cells in vitro. This study also indicates that P-gp plays an important role in the acquisition of resistance to Dox in endothelial cells and that this reduces the efficiency of chemotherapy.

Coping and schizophrenia: a re-analysis.

Standard notions of coping have not been particularly fruitful in the study of schizophrenia. However, facilitation of adaptive coping with serious mental illnesses such as schizophrenia is an important part of mental health care in general and of psychiatric nursing in particular. This study explored factors of coping and examined their relation with symptom severity and with quality of life of outpatients with schizophrenia. Data were analyzed from a previous cross-sectional study, using the Ways of Coping Checklist, the Positive and Negative Syndrome Scale, and the Wisconsin Quality of Life Index. A principal component factor analysis was performed on the Ways of Coping Checklist scores, and the resulting six coping factors were then tested for correlations with Positive and Negative Syndrome Scale and Wisconsin Quality of Life Index scores. Factors conceptually linked with emotion-focused coping were more strongly associated with symptom severity and with quality of life than were factors conceptually linked with problem-focused coping. The emotion-focused versus problem-focused coping framework was only partly explanatory. It may be fruitful to study whether supportive counseling enhances beneficial factors conceptually linked with emotion-focused coping of individuals with schizophrenia.