A study of antagonist affinities for the human histamine H2 receptor.

BACKGROUND AND PURPOSE: Ligand affinity has been a fundamental concept in the field of pharmacology and has traditionally been considered to be constant for a given receptor-ligand interaction. Recent studies have demonstrated that this is not true for all three members of the G(s)-coupled beta-adrenoceptor family. This study evaluated antagonist affinity measurements at a different G(s)-coupled receptor, the histamine H(2) receptor, to determine whether antagonist affinity measurements made at a different family of GPCRs were constant. EXPERIMENTAL APPROACH: CHO cells stably expressing the human histamine H(2) receptor and a CRE-SPAP reporter were used and antagonist affinity was assessed in short-term cAMP assays and longer term CRE gene transcription assays. KEY RESULTS: Nine agonists and seven antagonists, of sufficient potency at the H(2) receptor to examine in detail, were identified. Measurements of antagonist affinity were the same regardless of the efficacy of the competing agonist, time of agonist incubation, cellular response measured or presence of a PDE inhibitor. CONCLUSIONS AND IMPLICATIONS: Antagonist affinity at the G(s)-coupled histamine H(2) receptor obeys the accepted dogma for antagonism at GPCRs. This study further confirms that something unusual is indeed happening with the beta-adrenoceptors and is not an artefact related to the transfected cell system used. As the human histamine H(2) receptor does not behave in a similar manner to any of the human beta-adrenoceptors, it is clear that information gathered from one GPCR cannot be simply extrapolated to predict the behaviour of another GPCR. Each GPCR therefore requires careful and detailed evaluation on its own.

Adolescent girl's coping with an STD. Not enough problem solving and too much self-blame.

STUDY OBJECTIVE: Approximately three million teenagers are infected with an STD each year. The ways in which an adolescent girl copes with an STD may have implications for future risk and for psychological adjustment. The purpose of the current study was to compare whether coping with an STD was similar to coping with other stressors. SETTING: Urban, hospital-based adolescent medicine clinic. DESIGN AND PARTICIPANTS: Sixty-seven girls with a mean age of 15.9 (sexual debut was 13.8) yr completed the KIDCOPE in response to both an STD acquisition and an interpersonal stressor within the previous 6 months. RESULTS: Problem solving was used less often, and self-blame was used more often, in response to an STD acquisition. Frequency of use of self-blame was not correlated with perceived helpfulness. CONCLUSIONS: These findings suggest that clinicians need to help adolescent girls manage STD acquisition from the perspective of problem solving rather than self-blame.

Engaging community mental health stakeholders in pharmacy cost management.

To improve the cost-effectiveness of psychotropic medications, a process was established to involve all stakeholders in a seven-county public-sector behavioral health managed care plan in the development of formulary guidelines. After delineation of the issues and of possible strategies, proposed formulary guidelines were drafted and presented to the stakeholders in a series of meetings. The stakeholders were also educated about pharmacy cost management issues and possible strategies. The guidelines were modified on the basis of the feedback obtained from stakeholders, and the consensus formulary guidelines were adopted. Within ten weeks of implementation of the guidelines, monthly medication costs had declined by 3 percent from baseline, although the number of medication users increased by 3 percent over the same period. There were few complaints about the guidelines. Effective, consensus-driven, medication cost-containment strategies can be implemented through a process of engagement and education of stakeholders in a community mental health plan.

Reporter-gene systems for the study of G-protein-coupled receptors.

Reporter-gene assays offer an alternative to biochemical assays for following signal transduction pathways from receptors at the cell surface to nuclear gene transcription in living cells. Specific reporter-gene systems are now available for the study of ligand activity at G alpha(i/o), G alpha(s) and G alpha(q) G-protein-coupled receptors. In recent years reporter genes have been applied in academia and industry to the study of ligand efficacy and affinity in recombinant and primary cell lines using a variety of colour, fluorescent or luminescent read-outs.

Prevalence and identification of problems in daily functioning in a primary medicine clinic.

PURPOSE: This pilot study compares scores on a health status/functional assessment measure to clinician identification of problems in functioning and referrals for these problems, based on examination of information in the patient's medical chart. METHOD: A sample of 194 participants at a primary medicine clinic in an urban general hospital completed a measure of health status and functioning, the Medical Outcomes Trust Short Form 36 (SF-36). Chart reviews were conducted to assess whether problems in functioning were addressed by the primary care clinician. RESULTS: Overall, levels of functioning on the scales of the SF-36 were well below norms for the general US population from the Medical Outcomes Study. Older adults showed lower physical functioning and higher emotional functioning than younger adults. Participants with 1, 2, or 3 chronic conditions showed increasingly lower levels of physical functioning. For participants with functional assessment scale scores in the lowest quartile, problems in functioning noted in the chart ranged from 13%-28%. Only 6% 20% of participants with marked problems in functioning were referred for further assessment or treatment. CONCLUSIONS: Functional problems are frequently important indicators of risk of development of secondary complications and need for referral. Questionnaire screening may increase identification and referral for problems in functioning in primary care settings.

Using quality improvement teams to improve documentation in records at a community mental health center.

OBJECTIVE: A community mental health center sought a system for qualitative review of patients' records to improve the quality of documentation through the engagement of clinical staff in the review process. METHODS: The center developed a quality improvement system in which treatment team clinicians use a scored 30-item protocol to measure the quality of record documentation by peers. Questions address whether the record documents the full range of the psychiatric treatment process, including assessment and diagnosis, treatment planning, and provision of clinical services. Other questions address specific contractual or regulatory requirements, such as whether procedure codes are correct, and evaluate the physician's record of medication management. Each treatment team at the mental health center's six clinics has a quality improvement work group, composed of the team psychiatrist and at least one other team clinician. Each month the work group meets to review two randomly selected medical records from another treatment team at the same clinic and arrive at a consensus score. An administrative oversight team meets regularly with clinician-reviewers to foster uniform scoring of the protocol throughout the center. RESULTS: An analysis of the trend in protocol scores over a 21-month period suggests that the procedure improves the quality of the documentation in patients' records. CONCLUSIONS: A team-based quality review process appears to have a positive impact on the quality of medical record documentation. Improved documentation may improve continuity of care and improve the accuracy of record information used for other quality measurement systems.

Perceived ideological differences, job satisfaction and organizational commitment among psychiatrists in a community mental health center.

Physician turnover has long been a problem in community mental health centers. While explanations for the problem have been offered, there have been no systematic studies of factors associated with the high turnover. In this study, the Minnesota Satisfaction Questionnaire and the Organizational Commitment Questionnaire were given to psychiatrists employed by a community mental health center. Subjects were also asked to identify their treatment ideology, and to rate their perception of the ideology of other clinicians and administrators with whom they work. Psychiatrists perceived significant differences in many ideological areas. Analysis demonstrated a correlation between these differences and the commitment of the psychiatrists to the organization.

Relationship between perceived parental monitoring and young adolescent girls' sexual and substance use behaviors.

STUDY OBJECTIVE: The purpose of the study was to examine the independent effects of perceived parental monitoring on sexual experience, contraceptive, and substance use. DESIGN, SETTING, AND PARTICIPANTS: Adolescent females at an urban-based adolescent clinic (N = 174; 41% sexually experienced) rated the extent to which they were directly and indirectly monitored by their parents. MAIN OUTCOME MEASURES: These perceptions were compared with reported contraceptive use as well as substance use. Direct parental monitoring was best described using two dimensions: direct monitoring and direct monitoring when with peers. RESULTS: Direct monitoring was found to be associated with the use of hormonal birth control methods at last intercourse. Direct parental monitoring when with peers was found to be associated with less use of alcohol and cigarettes. CONCLUSIONS: These data suggest that parental monitoring is a relevant factor for primary care physicians to explore during treatment.

Photographic optical systems with nonrotational aspheric surfaces.

Sections of nonrotational aspheric surfaces can be useful in a variety of optical situations. In several examples, image-forming objectives, as for photographic or electronic camera products, are described in which suitably located asymmetric pairs of refractive surfaces are devised, such that relative rotation about a displaced axis of one with respect to the other can be used to produce a focusing effect that is satisfactory for imaging purposes over reasonable fields of view and for practicable apertures and achromatic corrections. Taylor expansions about assignable reference points in any given surface of a sequence, together with suitable coordinate systems, can be employed to relate performance to shape parameters.

Psychological aspects of sexually transmitted infection acquisition in adolescent girls: a developmental perspective.

PIP: Each year, 3 million US teenagers are infected with a sexually transmitted infection (STI). Given the variability present in female adolescents in terms of maturation (biological, cognitive, and psychosexual), sexual knowledge and experiences, interpersonal skills, and sociocultural contexts, programs targeted at this group must use a developmental perspective. This paper reviews the bidirectional impact of the relationships between these developmental factors. Sexual behavior in adolescence is determined by the individual's assessment of risk and regulated by consequences that are subjectively interpreted. Adolescent girls vary significantly in the extent to which they perceive they have control over STI preventive behaviors. A belief in control over one's fate is both developmental in nature and culturally specific. Adolescent girls who contract an STI are likely to react with emotion-focused coping strategies, including wishful thinking. Interventions aimed at this group must be multidisciplinary and address biomedical, behavioral/psychological, and cultural interventions.^ieng

Predicting follow-up functional outcomes in outpatient rehabilitation.

Functional outcomes at an average of six months after outpatient rehabilitation were investigated in a pilot study with a sample of 42 patients receiving physical therapy for low back, neck, and other musculoskeletal problems. Logistic regression analyses were used to study variables related to the achievement of a predetermined level of physical functioning or to whether improvement occurred from initial to follow-up assessment. Scales used in the analyses were obtained from two measures of functioning, the Medical Outcomes Trust Short Form 36 (SF-36) and the Medical Rehabilitation Follow Along (MRFA instrument). Demographic and program characteristic variables obtained from clinic records were also included in the analyses. The independent variables entered into two groups of regression equations included age, gender, presenting problem, workers' compensation coverage, functioning at initial assessment, number of visits, length of program, and intensity of program. For the SF-36, the General Health scale and presenting problem predicted above or below a level greater than one standard deviation less than the mean on the Physical Functioning scale at follow-up. The combination of the Role Physical and Role Emotional scales predicted follow-up level on the Physical Component Summary (PCS) scale. The interaction of age and intensity of treatment was predictive for both the Physical Functioning and PCS scales. For predicting improvement or no improvement using the SF-36 scales, General Health and the interaction between age and intensity were predictive of change on the Physical Functioning scale, whereas age and the interaction between age and number of visits were predictive of change on the PCS scale. For the MRFA instrument, the interaction between age and the intensity of treatment was predictive for both a predetermined level of physical functioning and amount of improvement in physical functioning at follow-up. An intensity rating of pain and a measure of affective distress at initial assessment both improved the identification of patients at risk for not reaching a given level of functioning, whereas treatment intensity improved the identification of those patients at risk for not showing improvement at follow-up. Length of time between the end of outpatient therapy and follow-up assessment was generally not related to follow-up physical functioning. Interpretation and implications of these findings, as well as applications of this analytic approach to outcomes assessment, are discussed.

The development of prejudice towards gays and lesbians by adolescents.

The authors studied the development of gay and lesbian prejudice in white, suburban adolescents in grades 7, 9, and 11. Results parallel several major findings with adults: males were more prejudiced than females; this difference was greater towards gay males than lesbians; and same-sex prejudice was greater than opposite-sex prejudice. For males and females prejudice increased between grades 7 and 9, but from grades 9 to 11 it decreased for females and increased for males. These differences were explained by the increased vulnerability of males to defensive reactions in response to the prospect of intimate relationships. None of the personality measures were significantly correlated with prejudice.

A spreadsheet method for calculating maximum caseload and intake capacity for CMHC psychiatrists.

OBJECTIVE: A method was sought to help administrators of community mental health centers determine a level of psychiatric staffing that is both cost-efficient and ensures high quality of care. METHODS: A survey of staff psychiatrists was conducted at a large community mental health center with seven outpatient clinics. The survey measured variables that can affect staffing requirements, including the number of hours psychiatrists have available for direct care, their preferred intervals between a patient's return visits, and the duration of appointments for an initial psychiatric assessment and for medication maintenance. A computer spreadsheet was developed to calculate the caseload capacity and intake capacity for clinics of the center. RESULTS: The survey indicated that the psychiatrists at the center had an average of 33 hours a week available for direct care. The mean preferred time between a patient's medication maintenance visits was 7.3 weeks. The mean time required for a psychiatric assessment was 80 minutes, and for a medication maintenance visit it was 33 minutes. With these data, the spreadsheet method was used to calculate intake and caseload capacity for psychiatric staff at three of the center's clinics. CONCLUSIONS: The data-based approach to calculating capacity can be modified to meet local needs. It brings objectivity to decision making about staffing, and the methods can improve resource management and enhance relationships between stakeholders and physicians.

A brief outpatient functional assessment measure: validity using Rasch measures.

The Medical Rehabilitation Follow Along (MRFA(TM)) is a brief outpatient functional assessment measure that was developed using Rasch analysis. The MRFA currently has musculoskeletal, neurologic, multiple sclerosis, cardiac, and pulmonary forms. Using Rasch scoring and selected scales, the 31-item musculoskeletal form of the MRFA was compared with and contrasted to a measure of general health status, the Medical Outcomes Trust SF-36. Content, construct, and criterion validity were addressed using scale scores before and after outpatient rehabilitation, as well as therapist ratings of improvement. The results supported the validity of inferences made from the MRFA scales using Rasch measures for persons with musculoskeletal problems. Rasch and raw scoring provided similar results with respect to the validity of the MRFA scales. Implications for the use of Rasch and raw scoring approaches with the MRFA are discussed.