The Lived Experience of Informal Caregivers of People Who Have Severe Mental Illness and Coexisting Long-Term Conditions: A Qualitative Study.

BACKGROUND: People with severe mental illness (SMI) experience higher rates and poorer outcomes of physical long-term conditions (LTCs). The management of SMI and LTCs is highly complex and many people with SMI rely on informal carers for support, which may lead to high levels of caregiver burden, and caregiver burnout. Caregiver burnout can result in poor health outcomes for informal carers and a reduction in the quality of care they are able to provide. Therefore, it is important to understand the caring experience to identify and address factors that contribute to burden and burnout. METHODS: This paper reports a secondary qualitative analysis of semistructured interviews and focus groups conducted with informal carers of people who have coexisting SMI and LTCs. We recruited 12 informal carers in England between December 2018 and April 2019. The transcripts were coded and analysed thematically. RESULTS: We identified two overarching themes and five subthemes. The themes included 'Fighting on all fronts: Mounting strain between demands and resources', which described the challenge of providing care in the context of coexisting SMI and LTCs, and 'Safekeeping: The necessity of chronic hypervigilance', which captured how informal carers' roles were defined by managing high-risk situations, leading to hypervigilance and paternalistic approaches to care. CONCLUSION: The experience of informal carers for people with SMI and coexisting LTCs is marked by limited access to support and the management of significant risk, which could contribute to high caregiver burden. Further primary research is needed to understand how the experiences of the caregiver role for people with SMI and LTCs influence caregiver burden. PATIENT OR PUBLIC CONTRIBUTION: Our PPI panel DIAMONDS Voice provided guidance on this study from conception, design and development of interview guides and recruitment materials to final write-up. DIAMONDS Voice consists of service users and carers who have experience of SMI and LTCs. Three carer members reviewed the final manuscript, and two are credited as authors.

[Treatment of patients with HBV cirrhosis: successes, unsolved problems].

Annually 0.5-1 million people die from terminal liver injuries or hepatocellular carcinoma, which are associated with hepatitis B virus (HBV); 5-10% of liver transplantations are performed due to the outcomes of HBV infections. All patients with liver cirrhosis in the outcome of replication-phase chronic hepatitis B need antiviral therapy. At present, there is convincing evidence for amelioration of hepatic fibrosis and cirrhosis, a reduction in the risk for the decompensation of liver function and the development of hepatocellular carcinoma, and an increase in survival rates in patients with HBV cirrhosis long treated with nucleotide analogues. Adequate selection of patients to be treated with antiviral drugs from different groups enables the most successful results and optimizes the economic costs of treatment.

[Bacterial complexes of the fruiting bodies and hyphosphere of certain basidiomycetes].

The surface and internal tissues of the fruiting bodies of basidiomycetes were shown to be specific bacterial habitats characterized by varying diversity and structure of bacterial complexes. On the surface of fruiting bodies, gram-negative bacteria of the genera Pseudomonas, Xanthomonas, and Myxococcus prevailed, while in the internal tissues gram-positive bacteria of the genera Streptomyces, Bacillus, Arthrobacter, and Micrococcus were identified in addition. Bacterial complexes from the surface and inner tissues of the fruiting bodies of the studied basidiomycetes showed significant similarity to each other and differed from those from the hyphosphere and the reference soil. On the surface and in the internal tissues of the fruiting bodies, representatives of the genus Myxococcus were identified for the first time, which could indicate initial decay of the fruiting body.

[Modern ways of treating female genital infections].

In article various ways of increase of efficiency of treatment of is mixed the bacterial-virus infection of the bottom department of sexual ways at women by means of application in complex therapy of homologous bacteriophages, pectovit, antiviral -immunomodulation therapies and sated with oxygen (oxygenic) water solutions of antiseptic tanks are considered. The scientifically-practical urgency of this problem is represented and actual for the decision of an important social and economic problem of improvement of quality of life, decrease in number of infectious complications and perfection of the medical help to sick women with frequent recidives an infection of the bottom department of sexual ways.

[Impact of small molecules on intermolecular interactions underlying the ligand technologies in laboratory diagnosis].

Hydrogen peroxide has been found to have a distorting effect on the quality of determination of the serological markers of hepatitis B and C, transglutaminase antibodies: an increase in the percent of false higher (anti-HBsAg, HBeAg, anti-HCV) and false lower (anti-HBeAg) values, and on the results of PCR-based diagnosis (PCR inhibition that was more pronounced especially in low viremia). A possibility of interference of measurement results in the blood metabolite pool should be taken into account in the use of high-technology methods of laboratory analysis. In particular, there may be changes in the detection of immunological and molecular biological methods in hyperpyruvatemia and hyperoxaloacetatemia, with elevated peroxide concentrations during pathological processes.

[AB0 blood group-associated biological variability in the content of metabolites].

The performed studies provided new evidence for biological variability in clinically important analytes, estimated a possible association of the metabolic features and the conservative genetic attribute--the ABO blood group. Certain features in the levels of protein, carbohydrate, lipid, and mineral metabolic parameters were revealed in relation to various blood groups.

[Role of alimentary factors in development of digestive system diseases].

In work the data are presented, which characterize the connection of a diet with disease of illnesses of digestive organs which rises in process of increase of products that contain gluten and meat reduction in diet. Immune reaction is found out, that shows the appearance of antibodies. A gladin and fabric transglutaminaze. Reaction characteristics are different in people with different blood groups.

[Immunohistochemical evaluation of the distribution of vascular endothelial growth factor in the placenta, placental bed in normal pregnancy and in women with preeclampsia].

VEGF expression was immunohistochemically studied in 35 placental fragments and 15 placental bed biopsy specimens in a control group and in 34 placental fragments and 16 biopsy specimens in women with preeclampsia. The female serum concentrations of VEGF and sFlt-I were measured in both groups. There was a drastic reduction in VEGF expression in the placenta (syncytiotrophoblast, free symplasts, syncytial kidneys); the placental bed biopsy specimens showed the impaired rearrangement of maternal-placental arteries with the lower VEGF expression in the cytotrophoblastic cells from women with preeclampsia. The blood displayed a 10-fold reduction in VEGF along with a 3.5-fold increase in SFlt-1 concentrations. Deficiency of free (circulating) VEGF-A that is so essential for normal endothelial function is likely to cause its structural changes that are united under the term "endotheliosis" as one of the leading mechanisms of the pathogenesis of gestosis.

[Clinical and morphological parallels and molecular aspects of the morphogenesis of adenomyosis].

The purpose of the study was to reveal clinical and morphological parallels and to define molecular mechanisms, the regulation of proliferation, apoptosis, neoangiogenesis, and the extent of abnormal tissue in adenomyosis (AM). The surgical material obtained from 492 patients of late reproductive age was examined. The data of clinico-anamnestic and instrumental diagnostic studies and a morphological study with hematoxylin and eosin staining were analyzed. An immunohistochemical study was carried out on serial paraffin sections (n = 115), by applying antibodies to Apo-CAS, Ki67, PCNA, CD-34, MMP-1, MMP-2, MMP-7, MMP-9, TIMP-1, TIMP-3, TIMP-4, and E-cadherin. The specific features of their morphological structure and the clinical course of the disease allowed identification of its active and inactive forms. Immunohistochemically active AM is characterized by high proliferation, diminished apoptosis, and increased expression of MMPs along with lower expression of TIMPs by glandular and stromal cells as compared with inactive AM. At the same time, there was a high activity of stromal cells in the foci of active AM. The results of the study may be used to predict the course of the disease and to elaborate target therapy for AM.

[The role of immune placental inflammation in the genesis of complicated pregnancy].

Immune inflammation is a typical pathophysiological process caused by exogenous and endogenous factors. Fibrinoid necrosis and cell infiltrations are the morphological features of tissue lesion caused by immune inflammation. Tissue lesion in immune inflammation may be connected with immune complex (IC) formation or T-cell aggression. Lesion caused by antigen-antibody complexes develops as a result of direct IC formation in the tissue or their inflow from microcirculation. Potential sources of IC in the placenta are maternal blood flow, the formation of IC between maternal antibodies (AB) and embryonic antigens, and IC formation in fetal blood vessels. After sedimentation in the placenta, circulating IC can cross syncytiotrophoblast tissue with the participation of specific receptors to immunoglobulin Fc-fragment. The process of antifetal AB formation may start in the maternal organism, as a result of which it forms AB to embryonic and placental antigens, including paternal Rh, ABO, and HLA, and some trophoblast antigens. IC are able to initiate inflammatory process through interaction with the compliment system, through the activation of macrophages excreting cytokines (TNF-alpha and IL-1), and through influencing basophiles and thrombocytes (the liberation of vasoactive amines). Gestosis is associated with system inflammatory response with endothelial dysfunction as the main element. As the clinical features of gestosis do not develop before 20 weeks of pregnancy, its clinical manifestation is preceded by increased fetal blood-brain barrier permeability, elevation of the level of neurospecific proteins of fetal origin in maternal circulation, and the formation of specific IC causing acute endotheliosis.

[Detection rates of various serotypes of human papilloma virus in atypical glandular hyperplasia and adenocarcinoma of the endometrium and their immunomorphological features in virus-positive cases].

Various virus serotypes were found in 35.3% of cases and their detection rate frequency reducing with age. They were detectable in 35.3 -52.9% of cases of atypical glandular hyperplasia, highly and moderately differentiated adenocarcinoma of the endometrium and only in 17.6% of cases of poorly differentiated adenocarcinomas. Serotypes 58 and 51 were nearly twice more frequently, but serotypes 18 and 52 were not observed. Immunomorphologically virus-positive observations were characterized by pronounced infiltration with T-helper and T-suppressor/killer cells. The endometrium and tumors showed an increased significant proliferative activity (Ki-67 expression) and reduced expression of receptors to progesterone and, to a lesser degree, to estrogen in 47-83% of virus-positive cases. Expression of growth factors did not greatly differ.

[Pharmacological neuroprotection against experimental acute cerebral ischemia of neurons of sensomotor area of frontal cortex and hippocampus in rats].

Emoxypine, thiotriazoline, and NN-103 (a 4-hydrazinoquinasoline derivative) exhibit a pronounced neuroprotective action during acute cerebral stroke. Emoxypine and thiotriazoline are more effective in inhibiting death of neurons in the sensomotor area of the frontal cortex, while NN-103 is more active in the hippocampus. The ischemic death of neurons in the sensomotors area of the frontal cortex with equal probability takes place by karyopyknosis or cytolysis, while in the hippocampus, mainly by cytolysis. All preparations (except for piracetam) with antioxidants properties are powerful membranoprotective agents, which is confirmed by a considerable decrease in the rate of cytolysis both in the cortex and in the hippocampus. The use of piracetam in the case of acute cerebral stroke increases the rate of neuronal death in various areas of the cortex, up to complete destruction of nerve tissues with the formation of cysts (in hippocampus). The tested preparations exhibit different mechanism of neuroprotection: emoxypine and NN-103 (in the sensomotor area of the frontal cortex and hippocampus) and thiotriazoline (in the hippocampus) produce the neuroprotection action on the background of increased activity of transmissions and transcription processes, while thiotriazoline (in the sensomotor area of the frontal cortex) offers neuroprotection on the background of inhibited transcription and transmission activity.

[A complex approach to evaluation of human genome instability].

In this study, evaluation of genome instability in individuals exposed to chemical compounds included detection of the genetic polymorphism of some xenobiotic metabolic enzymes (CYP1A1, CYP1E1, PON1, GSTM1, GSTT1), as well as measurement of oxidative state chemiluminescent variables and the level of cytogenetic damage. According to the study, the level of chromosomal aberrations in peripheral blood lymphocytes shows a strong correlation with PON54 left allele and GSTM1 null genotype, and can be described by the polynomial function of blood plasma luminol-dependent chemiluminescence. The frequencies of micronuclei in buccal epithelium displayed a weak association with GSTT1 null genotype.

[The congenital morphogenetic variants and genetic polymorphism of the system of xenobiotic detoxication in children living in dioxin-contaminated regions of South Vietnam].

The presence of dioxins and dioxin-containing ecotoxicants (DCE) in human environment leads to multi-level homeostasis disbalance and, eventually, dioxin pathology (DP) develops. This was demonstrated for the adult population of South Vietnam (1), who had suffered from the use of military chlorphenoxiherbicides to which dioxins had been added. The subjects of this study were children who belonged to the second generation of the inhabitants of DCE-polluted South Vietnam areas. In this sample, the frequency of malformations depending on two factors, genes GSTMI, GSTT1, CYP1A1 genotypes, and DCE exposure, were estimated. The study demonstrates that an increased level of congenital morphogenetic variants per one child is associated with the presence of DCE in the environment, as well as the fact that this parameter is influenced by genotypes of xenobiotic detoxication genes.

[Correlation between proliferation and apoptosis in different histological types of uterine leiomyoma].

75 cases of simple, cellular and mitotically active leiomyoma (LM) were studied immunohistochemically with the use of monoclonal antibodies against bcl-2 ("DAKO", 1:80), bax ("Calbiochem, 1:80), c-myc ("Novocastra", 1:100), CD 95 ("Dianova, 1:50), Ki67 ("Dianova", 1:40), PCNA ("Novacastra", 1:100). Apoptosis was assessed by the Tunnel method (ENZO Apop Detek Cell Death Assay System). Simple LM is characterized by apoptosis domination over proliferation in leiomyocytes. Size increase of such a tumor is probably the result of hypertrophy of leiomyocytes and stromal elements proliferation as well as secondary changes. Cellular LM is characterized by about similar level of tumor cell proliferation and apoptosis. Size increase of cellular LM is related to hypertrophy and leiomyocytes number increase probably due to their life lengthening. Mitotically active LM is characterized by domination of proliferation over apoptosis of tumor cells this being main condition of this tumor growth. Various types of LM differ by their stroma composition: fibrocyte prevailing in a simple LM, angiogenesis in mitotically active LM. Combination of adenomyosis with endometrium hyperplasia results in enhancement of proliferation and apoptosis of tumor cells.

[Morpho- and angiogenetic characteristics of uterine leiomyoma].

Ordinary and cellular leiomyomas of 147 patients (age 23 - 65 years) were studied histologically and immunomorphologically. Five females with rapidly growing tumors were operated after therapy with gonadotropines blockers. Variants with weak and pronounced proliferative activity of neoplastic myocytes and various activity of neoangiogenesis were distinguished. The latter may be either phases of development or different tumour types. Use of gonadotropine blockers inhibits myocyte proliferation and activates formation of stroma.

[The viral and bacterial nature of dysplasia and of cervical carcinoma]. / Virusno-bakterial'naia priroda displazii i raka sheiki matki.

The role of the infection component in etiopathogenesis of dysphasia and cervical carcinoma as well as optimization of their diagnosis and treatment schemes are discussed in the paper. On the basis of published data and authors' independent examinations, a tense relationship between the presence of dysphasia and cervical carcinoma, on the one hand, and sexually-transmitted genital infection and/or bacterial vaginosis present in the medial history, on the other hand, was verified. An intensity of vagina-microflora dysbacteriosis in genital clamidiosis and in dysphasia of cervical carcinoma as observed in women as well as an evaluation of immunoglobulins' levels in vaginal secretions can be a prognosticating criteria for a conducted treatment. A high efficiency and feasibility were shown of adding the recombinant alpha2-interferon to the combined treatment of genital clamidiosis and to preventing it from being chronic as well as to correcting the dysplastic impairments an to preventing the malignant neoplasms in the neck of uterus.