A Systematic Review of Inequalities in the Mental Health Experiences of Black African, Black Caribbean and Black-mixed UK Populations: Implications for Action.

BACKGROUND: Measurable differences in the experience and treatment of mental health conditions have been found to exist between different racial categories of community groups. The objective of this research was to review the reported mental health of Black African-Caribbean communities in the UK, determinants of mental health, and interventions to enhance their experiences of mental health services. METHOD: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement was applied. To be included, papers must be published in a peer reviewed journal; report on adult populations (over 18) from any of Black African, Black Caribbean or Black mixed people in the UK; and assess (quantitative), or discuss (qualitative) mental health experiences, determinants of mental health, or interventions intended to enhance experiences of mental health services among the target population. The aims, inclusion criteria, data extraction, and data quality evaluation were specified in advance. Searches were conducted using EBSCO (PsychInfo; MEDLINE; CINAHL Plus; psychology and behavioural sciences collection). The search strategy included search terms relating to the aim. Risk of bias was assessed using a standard tool, records were organised using Endnote, and data were extracted and synthesised using Microsoft Excel. RESULTS: Thirty-six studies were included, of which 26 were quantitative and six reported exclusively on Black participants. Black populations were less likely to access mental health support via traditional pathways due to stigma and mistrust of mental health services. Black Africans especially, sought alternative help from community leaders, which increased the likelihood of accessing treatment at the point of crisis or breakdown, which in turn increased risk of being detained under the Mental Health Act and via the criminal justice system. DISCUSSION: Findings suggest a cycle of poor mental health, coercive treatment, stigma, and mistrust of services as experienced by Black communities. Evidence was limited by poorly defined ethnic categories, especially where Black populations were subsumed into one category. It is recommended that mental health services work collaboratively with cultural and faith communities in supporting Black people to cope with mental illness, navigate mental health pathways, and provide culturally appropriate advice. Protocol Registration Number PROSPERO CRD42021261510.

Bacterial mutagenicity screening in the pharmaceutical industry.

Genetic toxicity testing is used as an early surrogate for carcinogenicity testing. Genetic toxicity testing is also required by regulatory agencies to be conducted prior to initiation of first in human clinical trials and subsequent marketing for most small molecule pharmaceutical compounds. To reduce the chances of advancing mutagenic pharmaceutical candidates through the drug discovery and development processes, companies have focused on developing testing strategies to maximize hazard identification while minimizing resource expenditure due to late stage attrition. With a large number of testing options, consensus has not been reached on the best mutagenicity platform to use or on the best time to use a specific test to aid in the selection of drug candidates for development. Most companies use a process in which compounds are initially screened for mutagenicity early in drug development using tests that require only a few milligrams of compound and then follow those studies up with a more robust mutagenicity test prior to selecting a compound for full development. This review summarizes the current applications of bacterial mutagenicity assays utilized by pharmaceutical companies in early and late discovery programs. The initial impetus for this review was derived from a workshop on bacterial mutagenicity screening in the pharmaceutical industry presented at the 40th Annual Environmental Mutagen Society Meeting held in St. Louis, MO in October, 2009. However, included in this review are succinct summaries of use and interpretation of genetic toxicity assays, several mutagenicity assays that were not presented at the meeting, and updates to testing strategies resulting in current state-of the art description of best practices. In addition, here we discuss the advantages and liabilities of many broadly used mutagenicity screening platforms and strategies used by pharmaceutical companies. The sensitivity and specificity of these early mutagenicity screening assays using proprietary compounds and their concordance (predictivity) with the regulatory bacterial mutation test are discussed.

An assessment of endoscopic and concomitant management of acute variceal bleeding at a tertiary care centre.

BACKGROUND: Several therapies have been demonstrated to be beneficial in the management of acute variceal bleeding (AVB). The aim of the present study was to characterize the use of these therapies at a Canadian tertiary care centre. PATIENTS AND METHODS: A comprehensive chart review was performed to assess the management of all adult cirrhotic patients with AVB who were admitted to a university-affiliated, tertiary care centre between April 2001 and March 2004. RESULTS: A total of 81 AVB patients were identified with a mean age of 53.7+/-13.2 years and a median model for end-stage liver disease score of 14. Endoscopy was performed within 8.2+/-7.6 h of admission. Variceal banding was performed for 87% of patients with esophageal varices, which were the most common source of bleeding (80%). Octreotide was used in 82% of patients for a mean duration of 74.3+/-35.4 h; prophylactic antibiotics were used in 25% of patients and beta-blockers were used in 24% of patients without any contraindications. Follow-up endoscopy was arranged for 46 of 71 (65%) survivors. Prophylactic antibiotic use was associated with the presence of ascites, while beta-blockers were used more often in the last year of the study. CONCLUSIONS: There is a disconnection between the use of evidence-based recommendations and routine clinical practices in the management of AVB. Deficiencies identified include the lack of use of prophylactic antibiotics and beta-blockers, variable use of octreotide and inadequate follow-up recommendations. There is a need to identify measures to improve the process of care for patients with AVB which would ensure optimal management of these patients.

Task-switching costs, Stroop-costs, and executive control: a correlational study.

Three correlational studies investigated the relationship between the time costs associated with Stroop stimuli (Stroop-costs) with the time costs associated with task-switching (switch-costs) obtained from colour-word stimuli and digit stimuli. In all studies, large and significant positive correlations were found between different measures of switch-costs. However, only small (and sometimes non-significant) correlations were obtained between the different measures of Stroop-costs and between measures of Stroop-costs and measures of switch-costs. The results are taken as evidence for the existence of some common or shared specialized mechanisms involved in task-switching, which are different from those used to overcome Stroop interference.

Impact of family history of diabetes on the assessment of beta-cell function.

Numerous factors impinge on beta-cell function, and include the genetic background and insulin sensitivity of the individual. The aim of the present study was to evaluate the impact of a family history of non-insulin-dependent diabetes mellitus (NIDDM) on beta-cell function and to determine whether the relationships between beta-cell function and insulin sensitivity and age are influenced by a family history of diabetes. Thirty-three healthy control subjects (CON), 20 normal glucose-tolerant first-degree relatives of known NIDDM patients (REL), and 12 nondiabetic identical twins with an identical twin with known NIDDM were studied. Insulin and C-peptide responses to an acute intravenous glucose (AIRg) and glucagon bolus (at euglycemia [AIR[G.GON]]) were measured, as well as each individual's insulin sensitivity. Fasting insulin and C-peptide levels were similar in all groups. AIRg was significantly reduced by 65% in the nondiabetic twins compared with the CON and REL groups, with the latter group being similar to CON, whereas for the AIR[G.GON], the insulin responses in the twin subjects were reduced only by 35% compared with CON. Following stepwise (default) multiple regression analysis, three independent variables (insulin sensitivity, 23%; family history of NIDDM, 20%; and fasting glucose, 7%) were identified, and these combined to fit a model for prediction of acute beta-cell responses to glucose that yielded an R2 (adjusted) value of 50%. Following analysis of covariance (ANCOVA), a positive family history of NIDDM and insulin sensitivity but not the age of the subject were confirmed as separate factors affecting AIRg. In conclusion, in subjects with normal or mild glucose intolerance, the individual's genetic background and insulin sensitivity are important determinants of insulin secretion.

Assessing the needs of the adult with spina bifida.

In recent years this society has heard of the plight of people with spina bifida who have graduated from childrens' to adult services, and of the lack of cohesive medical and counselling services offered to them. In the Manchester area, a joint clinic for adults has recently been set up, consisting of a Neurosurgeon, Nephrologist and Clinical Psychologist. Patients attending are those who attended the joint paediatric clinic who are now 16+ and new referrals from GPs and other consultants. 30 people of appropriate age to attend the clinic were identified, and these were contacted by mail to inquire about the sort of services they would like to receive and any problems they have or foresee for the future. 13 replies were received, 12 people indicating that a joint clinic would be of use to them. Results indicated that a total of 42 contacts with medical, paramedical and care services were lost, and 24 requests were received for contact to be resumed. Replies made it clear that guidance on work, education, social provision and sexual counselling were much in demand. Aids provided for mobility, and facilities for disabled people were not always appropriate for our respondents, who were quite vociferous about what they needed, but did not always know what was available. Conclusions to be drawn are that the joint clinic needs to include links with education, careers officers and counsellors, and that time needs to be made available to effectively meet the needs patients present. The clinic could act as a forum to collate experiences, and highlight the problems of the young disabled adult.

Assessment of cytotoxicity assays as predictors of ocular irritation of pharmaceuticals.

We have evaluated the use of cytotoxicity assays in vitro as an alternative to predicting ocular irritation potential in animals. Three different measures of cytotoxicity--leucine incorporation into protein, MTT dye reduction, and neutral red uptake--were measured in a presumed target cell, corneal epithelial cells from rabbit, as well as in a nontarget cell, V79 (Chinese hamster lung fibroblasts). An IC50 value was determined for each endpoint in one or both target cells for a series of 27 commercially available compounds and 56 in-house materials from a variety of chemical classes (carbonitriles, imidazoles, substituted benzenes, aromatic acids, peptides, phenols, esters, etc.). Analysis of the data by Spearman rho rank correlation and Pearson's correlation indicated that none of the endpoint-target cell combinations used here accurately predicts in vivo irritation potential for this group of compounds. The MTT dye reduction endpoint gave the best overall correlation, regardless of target cell, but still had a correlation coefficient below -0.5. We conclude that the measurement of cytotoxicity is of limited value as an alternative assay for the classes of materials studied here.

Practical application of methods for in vivo assessment of insulin secretion and action.

In vivo measurement of insulin sensitivity can be made using the glucose clamp technique or the intravenous glucose tolerance test (IVGTT) with minimal model analysis. The glucose clamp provides a direct, readily understandable measure of insulin action but is more demanding for investigators and subjects. Assessment of insulin secretion must be made by a separate test. The IVGTT is easier to perform but the data are more difficult to analyse and the value for insulin sensitivity is a derived rather than direct measure. As well as insulin sensitivity, glucose mediated glucose disposal and insulin secretion are measured by the IVGTT. In fact the IVGTT technique relies on adequate endogenous insulin secretion whereas the glucose clamp does not. The choice between these two techniques depends on the study to be performed and the available laboratory facilities.

Assessment of milk transfer coefficients for use in prediction models of radioactivity transport.

The transfer coefficient (Fm) which is widely used to predict the fraction of ingested radionuclides found in milk is an important parameter for modelling. The accuracy of estimates can be improved by considering the following factors that influence the Fm; (1) the physical-chemical form of the radionuclide in the feed of cows, (2) the hay to concentrate ratio of cows diets and (3) correcting for a steady state situation for feed intake and milk concentrations. Factors such as stable element intake, soil intake, milk production rate, metabolic rate and inhalation do not appear to have significant effects upon the transfer coefficient.

Use of streptomycin and isoniazid during a tuberculosis epizootic in a rhesus and cynomolgus breeding colony.

An epizootic of tuberculosis occurred following the addition of new cynomolgus monkeys to a nonhuman primate breeding colony. A total of 5/47 cynomolgus and 51/148 rhesus became tuberculin positive (reactors). Mycobacterium tuberculosis was cultured from reactors which were euthanatized and monkeys which died spontaneously. The isolates were sensitive to the standard antitubercular agents. Rhesus reactors and their unweaned infants were quarantined and given streptomycin and isoniazid by intramuscular injection. Isoniazid was added to the drinking water quarantined and given streptomycin and isoniazid by intramuscular injection. Isoniazid was added to the drinking water of the remainder of the breeding colony to curtail the outbreak. Isoniazid toxicity was observed in both infants and adults with an overall incidence of 3%. Forty-eight rhesus reactors and their infants born before the outbreak were alive and healthy at the end of the treatment period. In addition, nine surviving infants were born during the 6 month treatment period. Tuberculin tests were still positive in many of the treated reactors following treatment. In this epizootic, the institution of quarantine and chemotherapy instead of euthanasia resulted in significant savings.

Beef production options and requirements for fossil fuel.

A large percentage of the feed resources used in beef production cannot be used by man or most other animals. These noncompetitive feeds could be used in different ways to increase beef production, but fossil fuel consumption by the beef industry would not be greatly reduced.