Development and validation of the mental health professional culture inventory.

AIMS: No instrument has been developed to explicitly assess the professional culture of mental health workers interacting with severely mentally ill people in publicly or privately run mental health care services. Because of theoretical and methodological concerns, we designed a self-administered questionnaire to assess the professional culture of mental health services workers. The study aims to validate this tool, named the Mental Health Professional Culture Inventory (MHPCI). The MHPCI adopts the notion of 'professional culture' as a hybrid construct between the individual and the organisational level that could be directly associated with the professional practices of mental health workers. METHODS: The MHPCI takes into consideration a multidimensional definition of professional culture and a discrete number of psychometrically derived dimensions related to meaningful professional behaviour. The questionnaire was created and developed by a conjoint Italian-Canadian research team with the purpose of obtaining a fully cross-cultural questionnaire and was pretested in a pilot study. Subsequently, a validation survey was conducted in northern Italy and in Canada (Montreal area, Quebec). Data analysis was conducted in different steps designed to maximise the cross-cultural adaptation of the questionnaire through a recursive procedure consisting of performing a principal component analysis (PCA) on the Italian sample (N = 221) and then testing the resulting factorial model on the Canadian sample (N = 237). Reliability was also assessed with a test-retest design. RESULTS: Four dimensions emerged in the PCA and were verified in the confirmatory factor analysis: family involvement, users' sexuality, therapeutic framework and management of aggression risk. All the scales displayed good internal consistency and reliability. CONCLUSIONS: This study suggests the MHPCI could be a valid and reliable instrument to measure the professional behaviour of mental health services workers. The content of the four scales is consistent with the literature on psychosocial rehabilitation, suggesting that the instrument could be used to evaluate staff behaviour regarding four crucial dimensions of mental health care.

Factor analysis of the French version of the shorter 12-item Perception of Aggression Scale (POAS) and of a new modified version of the Overt Aggression Scale (MOAS).

Psychiatric staff perceptions of aggression by psychiatric patients may affect the therapeutic relationship between care providers and patients in institutions. Attitudes to and the subjective experience of violence may also differ substantially between members of a single care team. This study seeks to validate the French versions of scales of staff attitudes to and subjective experience of institutional violence: a new, modified version of the Overt Aggression Scale (MOAS) to measure the subjective perception of the frequency of aggression in the ward; and the Perception of Aggression Scale (POAS) to assess attitudes to the expression of violence by psychiatric patients. Frontline staff (n = 362) from eight French-language psychiatric institutions in the province of Quebec were surveyed. Factor analyses were performed to determine the validity of the French-language MOAS and POAS. As expected, a four-factor structure emerged for the MOAS. For the 12-item POAS, a three-factor structure was found: (1) 'Aggression as a dysfunctional/undesirable phenomenon'; (2) 'Aggression as a positive expression'; and (3) 'Aggression as a protective measure'. This study supports use of the French MOAS and POAS in assessing staff attitudes to and subjective experience of aggression in future projects to explore the perception and management of inpatient violence.

Rosiglitazone reverses increased duodenal inhibitory response in spontaneously hypertensive rats.

BACKGROUND: Thiazolidinediones (TZDs) including rosiglitazone (ROSI) are insulin sensitizing agents with beneficial gastrointestinal effects. However, no studies are available on TZDs effect in gastrointestinal motility. We evaluated the effects of ROSI on gastrointestinal inhibitory neurotransmission focusing on the modulatory roles of nitric oxide synthase/nitric oxide (NOS/NO) and heme oxygenase/carbon monoxide (HO/CO) pathways. METHODS: Spontaneously hypertensive rats (SHR) were used as model of insulin resistance. Duodenal strips were obtained from vehicle-treated SHR, ROSI-treated SHR (5 mg kg(-1) by gavage daily per 6 weeks), and Wistar Kyoto (WKY). Inhibitory responses to electrical field stimulation (EFS) were evaluated in the presence of HO inhibitor zinc protoporphyrin IX (ZnPPIX, 10 µmol L(-1)) or NOS inhibitor N(G)-nitro-L-arginine (L-NNA, 100 µmol L(-1)), alone and in combination. Protein levels of HO and NOS isoforms were evaluated by immunohistochemistry and western blot analysis. KEY RESULTS: Basal responses to EFS were significantly increased in duodenum strips from vehicle-treated SHR vs WKY. This effect was reversed in ROSI-treated SHR. The EFS-mediated relaxation was comparably reduced by ZnPPIX in WKY and SHR, but not in ROSI-treated SHR animals. The L-NNA reduced EFS response to a similar extent in WKY and ROSI -treated SHR, but its effect was significantly higher in vehicle-treated SHR. Expression of HO-1 protein was significantly lower, whereas HO-2 protein levels were unchanged in ROSI-treated SHR with respect to vehicle-treated SHR. Finally, increased levels of nNOS in vehicle-treated SHR were reduced in ROSI-treated SHR. CONCLUSIONS & INFERENCES: Chronic ROSI treatment reverses increased SHR duodenal inhibitory response acting on CO and NO components.

Modulation of heme oxygenase/carbon monoxide system affects the inhibitory neurotransmission involved in gastrointestinal motility of streptozotocin-treated diabetic rats.

Alterations in gastrointestinal motility of diabetic patients have been linked to degenerative changes induced by glucose abnormalities in the peripheral nervous system. The heme oxygenase/carbon monoxide (HO/CO) signalling represents one of the non-adrenergic/non-cholinergic (NANC) neurotransmission pathways involved in regulation of physiological peristalsis. To investigate the role of HO/CO system in intestinal motility under diabetic conditions, the response to electrical field stimulation (EFS) and western blot analysis of HO/CO pathway components were studied on duodenum longitudinal smooth muscle strips isolated from streptozotocin (STZ)-treated diabetic rats (65 mg kg(-1), i.p.) and respective controls (CTRL), 6 weeks after the onset of diabetes. When compared to CTRL, the ability of CO releasing molecule (CORM-3) (100-400 micromol L(-1)) to enhance NANC relaxation was significantly impaired in STZ-treated rats (P < 0.05). Conversely, in vitro incubation with the HO inhibitor ZnPPIX (10 micromol L(-1), 60 min) significantly reduced EFS-induced relaxation in CTRL (P < 0.05), but not in STZ-treated rats. Interestingly, the ability of ZnPPIX to inhibit EFS-induced relaxation was partially restored in STZ-treated rats co-administered in vivo with the HO-1 inducer cobalt protoporphyrin IX (CoPPIX) (0.5 mg per 100 g body weight weekly). Expression of inducible HO-1 protein was increased in homogenates from STZ-treated rats (vs CTRL, P < 0.01), and further increased in STZ-treated rats receiving CoPPIX (P < 0.05). Taken together, our data underline the essential role of HO/CO system in regulation of inhibitory NANC neurotransmission in the duodenum and suggest that dysregulation of HO/CO activity may represent one mechanism by which gastrointestinal motility is altered in diabetes.

Transgenic models for studying expression and function of axonal adhesive glycoproteins.

In this study, by using two transgenic models, we address the general topic of the significance of axonal glycoproteins regulated expression in nervous tissue maturation. The immunoglobulin superfamily components F3/Contactin (F3) and TAG-1 are used as the molecular models in this respect. First, a minigene including the relevant regulatory sequences of the F3 gene, deduced by a previous in vitro study, has been fused to an EGFP (Enhanced Green Fluorescent Protein) reporter and expressed in transgenic mice, which provided information about the profile of F3 gene developmental activation. In a complementary model, transgenic mice have been generated which express the F3 cDNA under control of a selected regulatory region from the TAG-1 gene. While leading to ectopic expression of F3, this perturbed neuronal precursor proliferation and differentiation. The arising effects were even stronger than those coming from the overall suppression of the F3 or, respectively, TAG-1 genes, thus supporting the hypothesis that the mechanisms underlying axonal glycoprotein regulated expression are themselves endowed with a key significance in neural development.

The dual role of endothelial differentiation-related factor-1 in the cytosol and nucleus: modulation by protein kinase A.

Endothelial differentiation-related factor (EDF)-1 is involved in the repression of endothelial cell differentiation and is the first studied calmodulin (CaM)-binding protein in endothelial cells. Here we report that (i) EDF-1 is in vitro and in vivo phosphorylated by protein kinase A (PKA); (ii) EDF-1/CaM interaction is modulated by the phosphorylation of EDF-1 by PKA; (iii) forskolin stimulates nuclear accumulation of EDF-1, and (iv) PKA phosphorylation enhances EDF-1 interaction with the TATA-binding protein. CaM modulates the activity of several enzymes, among which is nitric oxide synthase (NOS). EDF-1, but not phosphorylated EDF-1, inhibits the activity of NOS. Accordingly, we detected an increase in NOS activity in cells that express low amounts of EDF-1. Our results indicate that EDF-1 serves two main functions in endothelial cells: (i) it regulates CaM availability in the cytosol, and (ii) it acts in the nucleus as a transcriptional coactivator.

Transgenic mice expressing F3/contactin from the transient axonal glycoprotein promoter undergo developmentally regulated deficits of the cerebellar function.

We have shown that transgenic transient axonal glycoprotein (TAG)/F3 mice, in which the mouse axonal glycoprotein F3/contactin was misexpressed from a regulatory region of the gene encoding the transient axonal glycoprotein TAG-1, exhibit a transient disruption of cerebellar granule and Purkinje cell development [Development 130 (2003) 29]. In the present study we explore the neurobehavioural consequences of this mutation. We report on assays of reproductive parameters (gestation length, litter size and offspring viability) and on somatic and neurobehavioural end-points (sensorimotor development, homing performance, motor activity, motor coordination and motor learning). Compared with wild-type littermates, TAG/F3 mice display delayed sensorimotor development, reduced exploratory activity and impaired motor activity, motor coordination and motor learning. The latter parameters, in particular, were affected also in adult mice, despite the apparent recovery of cerebellar morphology, suggesting that subtle changes of neuronal circuitry persist in these animals after development is complete. These behavioural deficits indicate that the finely coordinated expression of immunoglobulin-like cell adhesion molecules such as TAG-1 and F3/contactin is of key relevance to the functional, as well as morphological maturation of the cerebellum.

Alternative promoters drive the expression of the gene encoding the mouse axonal glycoprotein F3/contactin.

F3/Contactin is a neuronal glycoprotein which mediates axonal growth control via complex interactions with a number of cell surface or matrix components. As part of this developmental role, its expression undergoes differential regulation during the maturation of definite neuronal populations within the central and peripheral nervous tissue. To elucidate the underlying molecular mechanisms we study here the organization of the regulatory region of the mouse F3/Contactin gene. We show that this region displays peculiar features in that it spans more than 80 kb, bears very large introns and includes four untranslated exons which undergo complex splicing events leading to 11 potential arrangements of the F3/Contactin mRNA 5' end. Within this region we identify three alternative neurospecific promoters which, as deduced from the developmental profile of the associated 5' exons (A1,C1,0), drive two different patterns of F3/Contactin gene expression. The activity of the A1 exon-associated promoter displays only minor developmental changes and is likely to contribute to the basal level of the F3/Contactin gene expression; by contrast, the activities of the exon C1- and exon 0-associated promoters are significantly upregulated at the end of the first postnatal week. The data indicate that differential regulation of the F3/Contactin expression during development may depend upon alternative utilization of distinct promoter elements and may involve complex splicing events of the 5' untranslated exons. Several consensuses for homeogene transcription factors are scattered within the identified regulatory region, in agreement with the general assumption of homeotic gene regulation of neural morphoregulatory molecules.

Cloning and characterization of murine EDF-1.

Murine endothelial differentiation-related factor (mEDF-1) encodes a basic intracellular protein of 148 amino acids which is highly homologous to the human and rat polypeptides. mEDF-1 is expressed in most murine tissues tested and is evolutionary conserved. mEDF-1 expression is modulated in mouse development, since its expression is high early in development and decreases thereafter. Because EDF-1 has been isolated as a gene differentially expressed by exposure of endothelial cells to the Tat protein of HIV, we evaluated mEDF-1 expression in different cell lines derived from tumors which spontaneously develop in Tat transgenic mice. Cells isolated from adenocarcinomas and leiomyosarcomas express very high amounts of EDF-1, independently from their capability to secrete Tat. Tat transgenic mice also develop skin lesions which closely resemble human Kaposi's sarcoma. Since Kaposi spindle cells, which are the proliferative component of the sarcoma, differentiate from an endothelial precursor, it is noteworthy that spindle cells derived from Kaposi-like lesions of the Tat transgenic mice downregulate EDF-1 when compared to microvascular endothelial cells isolated from the same tissue.

Interaction between endothelial differentiation-related factor-1 and calmodulin in vitro and in vivo.

Calmodulin (CaM) is the principal Ca(2+) receptor protein inside the cell. When activated by Ca(2+), CaM binds and activates target proteins, thus altering the metabolism and physiology of the cell. Under basal conditions, calcium-free CaM binds to other proteins termed CaM-binding proteins. Recently, we described endothelial differentiation-related factor (EDF)-1 as a protein involved in the repression of endothelial cell differentiation (Dragoni, I., Mariotti, M., Consalez, G. G., Soria, M., and Maier, J. A. M. (1998) J. Biol. Chem. 273, 31119-31124). Here we report that (i) EDF-1 binds CaM in vitro and in vivo; (ii) EDF-1 is phosphorylated in vitro and in vivo by protein kinase C; and (iii) EDF-1-CaM interaction is modulated by the concentrations of Ca(2+) and by the phosphorylation of EDF-1 by protein kinase C both in vitro and in vivo. In addition, 12-O-tetradecanoylphorbol-13-acetate treatment of human umbilical vein endothelial cell stimulates the nuclear translocation of EDF-1. On the basis of the high homology of EDF-1 with multiprotein bridging factor-1, a transcriptional coactivator that binds TATA-binding protein (TBP), we also demonstrate that EDF-1 interacts with TBP in vitro and in human endothelial cells. We hypothesize that EDF-1 serves two main functions in endothelial cells as follows: (i) to bind CaM in the cytosol at physiologic concentrations of Ca(2+) and (ii) to act in the nucleus as a transcriptional coactivator through its binding to TBP.