Development of a mental health recovery module for the WHOQOL.

PURPOSE: The WHOQOL tools are widely used, multi-faceted, patient-rated, quality of life (QoL) measures, developed by the World Health Organization. The WHOQOL questionnaires are used to assess generic quality of life issues affected by all health problems. This study developed a module to use with the WHOQOL tools to improve their sensitivity to Health Related QoL issues relevant to mental health recovery. METHODS: Using a sequential mixed-methods approach, two research stages occurred. A qualitative stage invited 88 participants with experience of mental health recovery, into focus groups and importance rating activities, to identify candidate items for the new module. Following this, a quantitative stage involved 667 participants with, and without, mental health/addiction issues completing online or paper-based questionnaires to analyze which candidate items differentiated between those with and without mental health/addiction issues. Classical test theory and iterative Partial Credit Rasch Analysis were used to identify the most suitable candidate items for a reliable and valid mental health recovery module to be used with the WHOQOL tools. RESULTS: Seventeen candidate items captured important HRQoL facets relevant to mental health recovery. Rasch analysis removed 10 misfitting items. The final 7-item module, which demonstrated the best Rasch model fit, enquires about recovery beliefs, identifying strengths, self-awareness, acceptance, capacity to relate, feeling understood, and recovery progress. Ordinal-to-interval conversion tables have been developed to optimize measurement precision when using the module. CONCLUSIONS: Important HRQoL issues central to mental health recovery can be reliably evaluated by using the recovery module with the WHOQOL tools.

Ordinal-To-Interval Scale Conversion Tables and National Items for the New Zealand Version of the WHOQOL-BREF.

The World Health Organisation Quality of Life (WHOQOL) questionnaires are widely used around the world and can claim strong cross-cultural validity due to their development in collaboration with international field centres. To enhance conceptual equivalence of quality of life across cultures, optional national items are often developed for use alongside the core instrument. The present study outlines the development of national items for the New Zealand WHOQOL-BREF. Focus groups with members of the community as well as health experts discussed what constitutes quality of life in their opinion. Based on themes extracted of aspects not contained in the existing WHOQOL instrument, 46 candidate items were generated and subsequently rated for their importance by a random sample of 585 individuals from the general population. Applying importance criteria reduced these items to 24, which were then sent to another large random sample (n = 808) to be rated alongside the existing WHOQOL-BREF. A final set of five items met the criteria for national items. Confirmatory factor analysis identified four national items as belonging to the psychological domain of quality of life, and one item to the social domain. Rasch analysis validated these results and generated ordinal-to-interval conversion algorithms to allow use of parametric statistics for domain scores with and without national items.

Electron-phonon interaction and superconductivity in BaIr2P2.

Detailed calculations of the electronic structure, phonons and electron-phonon coupling of the superconducting compound BaIr2P2 were performed from first-principles. The electronic structure showed excellent agreement with the available experimental data. The total electron-phonon coupling constant was [Formula: see text] and the logarithmically averaged phonon frequency was [Formula: see text] K. From the Allen-Dynes formula, with [Formula: see text], the superconducting critical temperature was estimated to be [Formula: see text] K, which is in excellent agreement with the experiment. These results indicate that the electron-phonon coupling is of moderate strength and is easily capable of supporting the observed superconductivity.

Spiritual quality of life and spiritual coping: evidence for a two-factor structure of the WHOQOL spirituality, religiousness, and personal beliefs module.

BACKGROUND: The WHOQOL-SRPB has been a useful module to measure aspects of QOL related to spirituality, religiousness, and personal beliefs, but recent research has pointed to potential problems with its proposed factor structure. Three of the eight facets of the WHOQOL-SRPB have been identified as potentially different from the others, and to date only a limited number of factor analyses of the instrument have been published. METHODS: Analyses were conducted using data from a sample of 679 university students who had completed the WHOQOL-BREF quality of life questionnaire, the WHOQOL-SRPB module, the Perceived Stress scale, and the Brief COPE coping strategies questionnaire. Informed by these analyses, confirmatory factor analyses suitable for ordinal-level data explored the potential for a two-factor solution as opposed to the originally proposed one-factor solution. RESULTS: The facets WHOQOL-SRPB facets connected, strength, and faith were highly correlated with each other as well as with the religious coping sub-scale of the Brief COPE. Combining these three facets to one factor in a two-factor solution for the WHOQOL-SRPB yielded superior goodness-of-fit indices compared to the original one-factor solution. CONCLUSIONS: A two-factor solution for the WHOQOL-SRPB is more tenable, in which three of the eight WHOQOL-SRPB facets group together as a spiritual coping factor and the remaining facets form a factor of spiritual quality of life. While discarding the facets connectedness, strength, and faith without additional research would be premature, users of the scale need to be aware of this alternative two-factor structure, and may wish to analyze scores using this structure.

Using feedback from patient-reported outcome measures in mental health services: a scoping study and typology.

OBJECTIVE: Routine evaluation of mental health services has become widespread, and the use of patient-reported outcome measures (PROMs) as clinical aids or discussion tools has been receiving increasing attention. The purpose of this scoping study was to provide a typology of the diverse ways in which studies reporting on PROM use in mental health services have utilized PROMs. METHODS: Iterative scoping searches of the literature identified articles reporting on the use of PROM feedback in mental health settings, which were then categorized to develop a typology along a dimension of intensity of use of PROM feedback, ranging from no feedback to patient and clinician to clinician-patient discussion that followed a formalized structure. RESULTS: Of the 172 studies that were identified, 27 were grouped into five categories, ranging from studies in which there was no PROM feedback to clinician or patient to studies in which a formalized structure was available by which PROM feedback could be discussed between clinician and patient. Of the 11 studies in the category with formalized feedback, nine reported some significant effects of feedback compared with a control condition, and two reported partial significant effects. CONCLUSIONS: The proposed procedural typology helps explain the diversity of results from studies reporting on the effects of PROM feedback, by highlighting that PROM feedback appears to be more effective when integrated in a formalized and structured manner. Future work is required to isolate these effects from common procedural correlates, such as monitoring of the therapeutic alliance.

Calculating electron momentum densities and Compton profiles using the linear tetrahedron method.

A method for computing electron momentum densities and Compton profiles from ab initio calculations is presented. Reciprocal space is divided into optimally-shaped tetrahedra for interpolation, and the linear tetrahedron method is used to obtain the momentum density and its projections such as Compton profiles. Results are presented and evaluated against experimental data for Be, Cu, Ni, Fe3Pt, and YBa2Cu4O8, demonstrating the accuracy of our method in a wide variety of crystal structures.

Validation of the WHOQOL-BREF quality of life questionnaire for general use in New Zealand: confirmatory factor analysis and Rasch analysis.

PURPOSE: The present study validated the abbreviated version of the World Health Organization Quality of Life (WHOQOL-BREF) questionnaire for general use in New Zealand. METHODS: A random postal sample from the national electoral roll was used, and 808 questionnaires were returned. Psychometric properties of the instrument were assessed, including tests of the four-domain factor structure using confirmatory factor analysis and Rasch analysis. RESULTS: Goodness-of-fit from the confirmatory factor analysis were good, and the overall conclusion of the Rasch analysis supported the confirmatory factor analysis (CFA) findings after dealing with problems of threshold ordering, local dependency, and differential item functioning (DIF). CONCLUSIONS: The WHOQOL-BREF is valid for general use in New Zealand. In the future work, the WHOQOL-BREF domain scores should either be analyzed using non-parametric statistics or data should be fitted to the Rasch model to derive interval person estimates.

The New Zealand World Health Organization Quality of Life (WHOQOL) Group.

With the approval of the World Health Organization (WHO), AUT University has established a new centre to develop and promote the use of the World Health Organization Quality of Life (WHOQOL) assessment instruments for health and health-related studies in New Zealand. The purpose of this paper is to introduce the NZ WHOQOL Group and to describe the structure and properties of the questionnaires in order to help the reader decide whether the instruments are suitable for their research and their use.

Anti-depressant and anti-nociceptive effects of 1,4-benzodiazepine-2-ones based cholecystokinin (CCK(2)) antagonists.

Various 1,4-benzodiazepines were synthesized around a Diazepam, Oxazepam and the n-propyl-1,4-benzodiazepine template. SAR studies of CCK(2) binding affinity were performed and selected examples of each series were tested in vivo in mice. In addition to an anxiolytic effect, antidepressant effects were discovered using 8 standard CNS assays in mice. Finally, the cocomittant administration of the 1,4-benzodiazepine based CCK antagonists enhanced the response to pain with a low dose of morphine, significantly.

Synthesis of substituted 3-anilino-5-phenyl-1,3-dihydro-2H-1,4-benzodiazepine-2-ones and their evaluation as cholecystokinin-ligands.

3-Amino-1,4-benzodiazepines as well as chemically related diverse amines were prepared from oxazepam and subsequently screened on the cholecystokinin receptor in a radiolabel binding assay. Oxazepam 2 was activated via its 3-chloro-1,4-benzodiazepine intermediate 3 and was reacted with a large series of aliphatic and aromatic amines. The substituted 3-anilino-1,4-benzodiazepine structure was identified as lead structure in a diverse series of 3-amino-1,4-benzodiazepines 4-38 and the full SAR (structure-activity relationship) optimisation provided 3-anilinobenzodiazepines 16-38 with CCK1 receptor selectivity to CCK2. The compounds 18, 24, 28 and 33 have shown affinities at the CCK1 receptor of 11, 10, 11 and 9 nM, respectively. These equipotent CCK1 ligands were fully evaluated in behaviour pharmacological essays. An antidepressant effect was identified in the tail suspension- and the Porsolt swimming-test. The ED50 values for 24 and 28 were determined in these assays as 0.46 and 0.49 mg/kg. The mixed antagonist 37 showed in addition to the antidepressant effects anxiolytic properties.

Effect of changing to a self-selected vegetarian diet on anthropometric measurements in UK adults.

BACKGROUND: Vegetarians are often a little leaner compared with nonvegetarians and suffer less from obesity and its associated complications than nonvegetarians. Whether this is because of not eating meat specifically is unclear. OBJECTIVE: We investigated whether changing to a self-selected vegetarian diet resulted in changes to anthropometric measurements. Design Subjects (n = 33; seven males and 26 females) who were in the earliest stages of becoming vegetarian were observed for 6 months. Data on dietary intake, using a 3-day estimated dietary diary, and body composition were obtained at baseline and after 6 months of following a self-selected vegetarian diet. RESULTS: Dietary calculations showed that on changing to a self-selected vegetarian diet, there was a significant reduction (P < 0.05) in energy intake (8.9 MJ day(-1) versus 8.1 MJ day(-1)), and in the proportion of energy from saturated fatty acids (12.9% versus 11.3%) and a significant increase (P < 0.05) in the proportion of energy from carbohydrates (44.9% versus 47.5%) and in intake of nonstarch polysaccharides (NSP) (1.6 g MJ(-1) versus 2.0 g MJ(-1)). Significant reductions in mid-upper arm circumference, calculated body fat, biceps and triceps skinfolds and waist and hip circumferences were observed. No reduction in body weight was observed. CONCLUSION: The findings of our study suggest that significant dietary changes, helping people to conform more closely to current dietary recommendations, occurred when people became vegetarian. In this study we did not find any significant change in body weight, but significant reductions were observed in skinfold thickness and waist : height ratio which imply that on changing to a self-selected vegetarian diet, the subjects became leaner.

Separation of bovine plasma lipoproteins by a rapid ultracentrifugation method.

The recently described method of centrifugation with iodixanol for the rapid separation of human plasma lipoproteins was adapted to separate bovine plasma lipoproteins. Density gradients were generated by mixing plasma with iodixanol 12% (w/v), followed by centrifugation at 350,000 g and 16 degrees C for 3 h 10 min in a vertical rotor. Gradients were unloaded dense-end first into 10 fractions. Human very low density lipoprotein (VLDL; density < 1.011 g/ml), low density lipoprotein (LDL; density = 1.016-1.039 g/ml) and high density lipoprotein (HDL; density = 1.039-1.090 g/ml) were resolved well at densities considerably lower than those traditionally reported in salt gradients. In gradients generated from 12% iodixanol, bovine LDL and HDL exhibited even lower densities (1.016-1.028 and 1.016-1.048 g/ml, respectively) with all lipoproteins occurring at the lower density region of the gradient. In contrast, density gradients generated from layers of equal volumes of 6% and 12% iodixanol readily separated bovine HDL from VLDL, whilst LDL still overlapped with HDL. The latter accounts for >80% of all bovine lipoproteins and exists as two populations, namely light and heavy HDL. Gradients generated from two layers of iodixanol recovered bovine HDL in five fractions. The hypercholesterolaemia associated with lactation resulted in a modest shift in the profile of HDL cholesterol towards lipoprotein particles of lower density (light HDL). Significant between-farm differences were also detected in the density profiles of bovine plasma cholesterol. This new method is suitable for use in research and diagnosis in relation to lipoprotein metabolism disorders in cows.

Changing from a mixed to self-selected vegetarian diet--influence on blood lipids.

OBJECTIVE: To observe any changes in serum concentrations of lipids, when UK meat-eaters switch to a self selected vegetarian diet for 6 months. DESIGN: Observational study using capillary blood samples and 3-day estimated dietary diary. SETTING: Free-living subjects in the North-West of England. SUBJECTS: Twelve male and 31 female adult volunteers aged between 18 and 42 years. OUTCOME MEASURES: Serum lipids; nutrient intake and anthropometric measurements at baseline and 6 months after switching to a self-selected vegetarian diet. RESULTS: Total energy intake and amount of energy derived from saturated fatty acids decreased significantly after changing to a vegetarian diet (P < 0.05) whereas energy derived from carbohydrate, and intakes of nonstarch polysaccharide intake increased. On switching to a vegetarian diet, total cholesterol and triacylglycerol concentrations were not significantly changed, but HDL-C was 21% higher than at baseline (1.21 mmol L(-1) vs. 1.47 mmol L(-1); P = 0.001). CONCLUSIONS: These results suggest that beneficial changes to diet occurred on changing to a self-selected vegetarian diet. Changing to a self-selected vegetarian diet appears to be one way of achieving a better blood lipid profile.

Synthesis and evaluation of asperlicin analogues as non-peptidal cholecystokinin-antagonists.

The SAR of Asperlicin analogues is reported, leading to bioactive 1,4-benzodiazepine-2-ones, which were prepared in a 3 step reaction sequence. The Asperlicin substructure was built up using Tryptophan and readily available 2-amino-acetophenones. This template, containing a 1,4-benzodiazepin-2-one moiety with a 3-indolmethyl side chain, was transformed into mono- and di-substituted 3-indol-3'-yl-methyl-1,4-benzodi-azepine-2-ones by selective alkylation and acylation reactions. The SAR optimization of the 1,4-benzodiazepine scaffold has included variations at the 5-, 7-, 8-position, at the N1, N-indole nitrogen and the configuration of the C3-position. The most active Asperlicin analogue, having an IC50 of 1.6 microM on the CCKA receptor subtype, was obtained from Tryptophan in only 3 steps in an overall yield of 48%.

Preliminary in vitro toxicological evaluation of a series of 2-pyridylcarboxamidrazone candidate anti-tuberculosis compounds III.

We have evaluated the cytotoxicity of a series of novel anti-tubercular 2-pyridyl carboxamidrazones through incubation with human mononuclear leucocytes (MNL), with and without a rat microsomal metabolising system. Isoniazid (INH), the closest structurally related agent, was used as a positive control. Incubation of the 3-benzyloxy-benzylidene, dimethylpropyl-benzylidene and 4-phenyl-benzylidene with MNL showed no significant toxicity in comparison with either INH or DMSO vehicle control. However, the 4-N,N-dimethylamino-1-naphthylidene derivative exerted more than sevenfold greater toxicity compared with INH, while the 4-N,N-dimethylamino-1-naphthylidene, 2-benzyloxy-3-methoxy-benzylidene, 2-t-butylthio-benzylidene and 4-i-propyl-benzylidene derivatives showed toxicity which ranged from five to fourfold that of INH. In the presence of either rat microsomes with or without NADPH, the 3-benzyloxy-benzylidene, dimethylpropyl-benzylidene and 4-phenyl-benzylidene derivatives showed no metabolically-mediated cytotoxicity. The latter two derivatives showed a combination of low toxicity and considerabe efficacy against Mycobacteria tuberculosis in vitro and show promise for future development.

Dietary supplementation with aged garlic extract inhibits ADP-induced platelet aggregation in humans.

Garlic has been widely reported to protect against cardiovascular disease by reducing serum cholesterol concentrations and blood pressure and by inhibiting platelet aggregation. However, most of these studies have been performed in hypercholesterolemic subjects or in animal models. We performed a 13-wk study in normolipidemic subjects who ingested 5 mL of aged garlic extract (AGE, Kyolic) per day. Blood was drawn from these subjects at the beginning and end of the study. Aggregation of platelet-rich plasma was induced by ADP; full lipid profiles and liver function tests were determined on serum, and plasma concentrations of eicosanoids were also measured. Dietary supplementation with AGE significantly inhibited both the total percentage and initial rate of platelet aggregation at concentrations of ADP up to 10 micromol/L. The K:(M) for ADP-induced aggregation were approximately doubled after supplementation with AGE, whereas the maximum rate of aggregation was unaffected. No significant changes in plasma thromboxane B(2) and 6-ketoprostaglandin F(1alpha) concentrations or serum lipid profiles were observed. We conclude that AGE, when taken as a dietary supplement by normolipidemic subjects, may be beneficial in protecting against cardiovascular disease as a result of inhibiting platelet aggregation.

The use of orbital morphine for postoperative analgesia in pterygium surgery.

A prospective double-blind study compared the analgesic effectiveness of peribulbar lignocaine with peribulbar morphine and lignocaine for postoperative analgesia in pterygium surgery. Twenty patients were randomly divided to receive a peribulbar injection preoperatively of either 1% lignocaine 2 ml or 1% lignocaine 1.6 ml and 4 mg morphine. Effects on pain at injection and pain at 24 hours and 48 hours postoperatively were measured with a visual analog pain scale. Effects of the injections on sedation, pupil size and unwanted side-effects were also recorded. The groups were comparable for age, weight and surgical technique. There was a significantly lower pain score at 24 hours after operation in the morphine group (P = 0.035). There were no significant differences in sedation or side-effects between the groups. The physiological effects of morphine on the eye are reviewed. The study suggests that orbital morphine may be an effective and safe form of analgesia for corneal surgery and further investigation is warranted.

A new amidrazone derivative with antimycobacterial activity.

Of a series of pyridine-2-carboxamidrazone derivatives with activity against mycobacteria, the N(1)-[4-(1,1-dimethylpropyl)benzylidene] derivative reported here, C(18)H(22)N(4), is one of the most active. The predicted E isomer about the C11=N12 double bond is confirmed and intramolecular hydrogen bonding involving both amino H atoms helps to keep the molecule flat. The same donor and acceptor atoms also form intermolecular hydrogen bonds.

Synthesis and biological evaluation of carbocyclic analogues of lipid X: new nonpolar antagonists of LPS induced TNF production.

We have synthesised a number of analogues of lipid X, a precursor in the biosynthesis of LPS, some of which exhibit marked antagonism of LPS induced TNF production in vivo. These compounds provide new non-polar leads in the search for a therapy for endotoxic shock.

Treatment with aged garlic extract protects against bromobenzene toxicity to precision cut rat liver slices.

Precision-cut liver slices from phenobarbital-induced rats were incubated for 6 h with the model hepatotoxin bromobenzene (BB) at a final concentration of 1 mM. Severe toxicity was indicated by a decreased K+, adenosine triphosphate and glutathione (GSH) content of the slices, increased release of alanine aminotransferase and lactate dehydrogenase into the medium, and increased formation of thiobarbituric acid reacting substances. Pretreatment of animals for 7 days with aged garlic extract (AGE) (Kyolic) at doses of 2 and 10 ml/kg/day dramatically reduced the toxicity of BB in a dose-dependent manner. The GSH content of liver slices from rats treated with AGE at 2 or 10 ml/kg/day increased by 50 and 80%, respectively. The BB-induced decrease in GSH content was less in slices derived from AGE-treated rats compared with slices from control rats. Pretreatment with AGE did not affect cytochrome P450 when assayed as 7-ethoxycoumarin O-deethylase and 7-pentoxyresorufin O-depentylase activities in hepatic microsomes. Thus, the mechanism by which pretreatment with AGE protects against BB hepatotoxicity involves both an elevation of hepatic GSH content, and a GSH sparing effect, possibly due to conjugation of organosulphur compounds in AGE with toxic BB metabolites. Only this GSH sparing effect was seen in our earlier study on the in vitro hepatoprotective effect of AGE [Wang et al., 1998. Toxicology 126, 213-222].