Implementing a court diversion and liaison scheme in a remand prison by systematic screening of new receptions: a 6 year participatory action research study of 20,084 consecutive male remands.

BACKGROUND: A mental health needs assessment in the Irish prison population confirmed findings from other jurisdictions showing high prevalence of severe mental illness, including psychosis amongst those newly committed. We implemented a participatory action research approach in order to provide an integrated mental health prison in-reach and court liaison service for this population. RESULTS: Following extensive consultation, a two stage screening process was developed which was supplemented by an inter-agency referral management system. During the six years 2006-2011, all 20,084 new remands to the main remand prison serving 58% of the national population were screened. Following the first stage screen, 3,195 received a comprehensive psychiatric assessment. Of these 561 (2.8%) had symptoms of psychosis - corresponding to the prior research finding - and 572 were diverted from the criminal justice system to mental health services (89 to a secure forensic hospital, 164 to community mental health hospitals and 319 to other community mental health services). CONCLUSIONS: We have shown that it is possible to match research findings in clinical practice by systematic screening, to sustain this over a long period and to achieve consistent levels of diversion from the criminal justice system to appropriate mental health services. The sustained and consistent performance of the model used is likely to reflect the use of participatory action research both to find the most effective model and to achieve wide ownership and cooperation with the model of care.

Survival of dental implants among post-menopausal female dental school patients taking oral bisphosphonates: a retrospective study.

HYPOTHESIS: Osteoporotic patients who take oral bisphosphonates have a higher chance of developing osteonecrosis of the jaw if they receive dental implants. INTRODUCTION: Bisphosphonate treatment was first identified by Marx in 2003 as a possible contributor to osteonecrosis of the jaw, a serious dental-medical complication that is seen among individuals undergoing invasive dental procedures such as extractions and implant placement. Bisphosphonate-associated osteonecrosis of the jaw (BONJ) is defined as bone exposed for more than 8 weeks in the maxillofacial region with a negative history for radiation therapy. PATIENTS AND METHODS: A retrospective review of patient electronic health records (EHRs) at the University of Pittsburgh School of Dental Medicine identified 211 women who received 592 dental implants between January 2008 and August 2010. Each woman's EHR was searched for notation in the clinical record of evidence of osteonecrosis of the jaw. Only women taking oral bisphosphonates were included. RESULTS: Among the total 211 women, 120 exceeded age 50 and had received 347 implants. Twenty-two reported taking oral bisphosphonates as treatment for osteoporosis, one as treatment for osteoarthritis. Five additional women reported taking alternative medications instead of bisphosphonates as treatment for diagnosed osteoporosis. Seventy-five implants were placed in women self-reporting a history of oral bisphosphonates; seven implants were placed in osteoporotic women who did not self-report oral bisphosphonate treatment. There was no evidence of osteonecrosis of the jaw in the follow-up medical record of any patient. Only one implant did not osseointegrate and was replaced within 1 year. This 98.7% success rate is consistent with standard implant success rates. CONCLUSIONS: Oral bisphosphonate therapy did not appear to significantly affect implant success. Implant placement in osteoporotic women taking oral bisphosphonates in treatment for osteoporosis did not result in reported clinical evidence of osteonecrosis of the jaw. Nevertheless, because of the increasing number of osteoporotic patients being treated with bisphosphonates, a better understanding of the risks of implant placement in such patients would benefit both the clinician and patient.

Acute myelogenous leukemia with t(6;9)(p23;q34) and marrow basophilia: an overview.

Acute myelogenous leukemia (AML) with chromosomal translocation (6;9)(p23;q34) is a rare disease with poor prognosis and distinct clinical and morphologic features. t(6;9) results in a chimeric fusion gene between DEK (6p23) and CAN/NUP214 (9q34). FLT3-ITD mutation is one of the most frequent mutations in AML and correlates with poor clinical outcome. Prevalence of FLT3-ITD is as high as 70% among patients with t(6;9) AML, and patients with t(6;9) AML and FLT3-ITD mutations usually have higher white blood cell counts, higher bone marrow blasts, and significantly lower rates of complete remission. t(6;9) is most commonly associated with AML-FAB-M2 and is considered by some researchers to be a separate disease entity because of its distinct clinical and morphologic features and poor prognostic implication. Distinct morphologic features of this entity include marrow basophilia and myelodysplasia, and immunophenotypically, the blast cells are positive for CD9, CD13, CD33, and HLA-DR; are usually positive for CD45 and CD38; and may be positive for CD15, CD34, and terminal deoxynucleotidyl transferase.

Youth at risk: identifying correlates of violence in Bolivia.

BACKGROUND: Although violence is one of the leading causes of mortality worldwide, in Latin America the prevalence of violence and factors associated with violent behavior among youth are largely unknown. OBJECTIVE: We describe the prevalence of carrying a weapon among Bolivian adolescent males and identify risk factors associated with weapon carrying. METHODS: The Youth Risk Behavior Survey was administered to a sample of teenagers 13-18 years of age (394 males and 182 females) from randomly selected schools in La Paz, Bolivia. The study is limited to males because of the small sample size for females. Frequencies and chi-square tests were calculated and logistic regression was used to identify factors associated with carrying a weapon in the past 30 days. RESULTS: Among the sample population, one-quarter of adolescent boys reported carrying a weapon in the previous 30 days. Ever having used cigarettes was the risk factor most strongly associated with weapon carrying. Additional risk factors included having participated in a physical fight, having used cocaine, and sniffing glue or other inhalants. CONCLUSION: Our results showed a link between weapon carrying and other risk behaviors, including smoking, drug use and fighting. Understanding the factors associated with carrying weapons among youth is an essential step in determining which risk behaviors should be included in comprehensive programs focused on youth violence prevention.

Standardizing global gene expression analysis between laboratories and across platforms.

To facilitate collaborative research efforts between multi-investigator teams using DNA microarrays, we identified sources of error and data variability between laboratories and across microarray platforms, and methods to accommodate this variability. RNA expression data were generated in seven laboratories, which compared two standard RNA samples using 12 microarray platforms. At least two standard microarray types (one spotted, one commercial) were used by all laboratories. Reproducibility for most platforms within any laboratory was typically good, but reproducibility between platforms and across laboratories was generally poor. Reproducibility between laboratories increased markedly when standardized protocols were implemented for RNA labeling, hybridization, microarray processing, data acquisition and data normalization. Reproducibility was highest when analysis was based on biological themes defined by enriched Gene Ontology (GO) categories. These findings indicate that microarray results can be comparable across multiple laboratories, especially when a common platform and set of procedures are used.

No associations between Parkinson's disease and polymorphisms of the quinone oxidoreductase (NQO1, NQO2) genes.

Reactive oxygen species derived from dopamine metabolism can induce oxidative stress and thus may contribute to Parkinson's disease (PD) pathogenesis. The quinone oxidoreductases, nicotinamide adenine dinucleotide (phosphate) (NAD[P]H): quinone oxidoreductase 1 (NQO1) and dihydronicotinamide riboside (NRH): quinone oxidoreductase 2 (NQO2) detoxify quinones and quinonoid compounds. We investigated associations of genetic polymorphisms of NQO1 (C609T) and NQO2 (I/D, 29 base pairs) with PD in a population-based case-control study of 190 idiopathic PD cases and 305 unrelated controls matched on age and sex. No associations were detected for either gene variant or for any allele combinations.

Genetic factors and asthma in aluminum smelter workers.

An asthma-like condition has been reported among aluminum smelter potroom workers. The pathophysiologic mechanisms and the causative agent involved are unknown. Inasmuch as gene polymorphisms are associated with asthma in the general population, the authors of this case-control study examined whether polymorphisms were associated with the development of potroom asthma. Genotyping was performed for the beta2-adrenoreceptor, high-affinity Ig (immunoglobulin) E receptor, and Tumor Necrosis Factor on potroom workers who developed a new asthma-like condition and on individuals who did not develop respiratory problems. No associations were found between potroom asthma case status and genotype. The asthma-like condition associated with potroom work remains poorly understood. Future investigations of genetic susceptibility and occupational asthma may provide pathophysiologic insights into these work-related conditions, but larger numbers of subjects will be required.

Co-regulation of CYP3A4 and CYP3A5 and contribution to hepatic and intestinal midazolam metabolism.

We recently demonstrated that a variant allele of CYP3A5 (CYP3A5*3) confers low CYP3A5 expression as a result of improper mRNA splicing. In this study, we further evaluated the regulation of CYP3A5 in liver and jejunal mucosa from white donors. For all tissues, high levels of CYP3A5 protein were strongly concordant with the presence of a wild-type allele of the CYP3A5 gene (CYP3A5*1). CYP3A5 represented greater than 50% of total CYP3A content in nearly all of the livers and jejuna that carried the CYP3A5*1 wild-type allele. Overall, CYP3A5 protein content accounted for 31% of the variability in hepatic midazolam hydroxylation activity. Improperly spliced mRNA (SV1-CYP3A5) was found only in tissues containing a CYP3A5*3 allele. Properly spliced CYP3A5 mRNA (wt-CYP3A5) was detected in all tissues, but the median wt-CYP3A5 mRNA was 4-fold higher in CYP3A5*1/*3 livers compared with CYP3A5*3/*3 livers. Differences in wt-CYP3A5 and CYP3A4 mRNA content explained 53 and 51% of the interliver variability in CYP3A5 and CYP3A4 content, respectively. Hepatic CYP3A4 and CYP3A5 contents were not correlated when all livers were compared. However, for CYP3A5*1/*3 livers, levels of the two proteins were strongly correlated (r = 0.93) as were wt-CYP3A5 and CYP3A4 mRNA (r = 0.76). These findings suggest that CYP3A4 and CYP3A5 genes share a common regulatory pathway for constitutive expression, possibly involving conserved elements in the 5'-flanking region.