Integrating yoga with psychological group-treatment for mixed depression and anxiety in primary healthcare: An explorative pilot study.

BACKGROUND AND PURPOSE: Yoga has shown promise as a treatment for depression and anxiety. The present pilot study investigated the feasibility of an eight-week grouptreatment integrating emotion-focused psychoeducation, compassion-focused therapy, and Virya yoga for depression and anxiety in primary healthcare. MATERIALS AND METHODS: Patients seeking treatment for depression and anxiety in a primary healthcare centre completed either an integrative group-treatment (N = 14) or treatment as usual (TAU, N = 17). Outcome measures were analysed pre- and posttreatment. Correlations in the intervention group were investigated between treatment outcomes and amount of yoga practice between sessions. RESULTS: Large within-group effect sizes on all outcome measures were found at posttreatment. Symptom reduction did not differ between groups (p = 0.155). Improvement in alexithymia correlated significantly (p < 0.05) with amount of yoga practice between sessions. CONCLUSION: Integrating yoga with a psychological group-treatment is a somewhat feasible approach to treatment for depression and anxiety in primary healthcare.

Acute Intoxications Involving α-Pyrrolidinobutiophenone (α-PBP): Results from the Swedish STRIDA Project.

INTRODUCTION: Many new psychoactive substances (NPS) introduced as recreational drugs have been associated with severe intoxication and death. METHODS: Blood and/or urine samples were collected from intoxicated patients treated at Swedish hospitals that participated in the STRIDA project, a nationawide effort to address the growing problem of NPS. In patients undergoing evaluation for drug overdose, α-PBP was identified using liquid chromatography-mass spectrometry. Demographic and clinical data were collected during Poisons Information Centre consultations and retrieved from medical records. RESULTS: From April 2013 to November 2015, 43 patients tested positive for α-PBP. However, α-PBP was never specifically mentioned during consultation but only confirmed analytically. The α-PBP concentrations ranged 2.0-13,200 ng/mL in urine and 2.0-440 ng/mL in serum. The patients were aged 19-57 (mean 34) years, 81% were men, and 73% were known drug addicts. All cases except 1 also involved other NPS and/or classical drugs. MDPV, α-PVP, and other pyrovalerone analogues were the most common other NPS (31 cases; 72%). CNS depressants were detected in 28 cases (65%), with benzodiazepines (16 cases) being most frequent. Main clinical characteristics were agitation/anxiety (59%), tachycardia (54%), and hypertension (37%), and 14 patients (33%) required monitoring in the intensive care unit of which 8 were graded as severe intoxications. No fatalities were reported. CONCLUSION: Patients with intoxication from α-PBP resembled those by NPS cathinones MDPV and α-PVP. As patients never specifically declared α-PBP intake and poly-drug intoxication was common, they may have been unaware of the actual substance taken.

Toxicity evaluation of α-pyrrolidinovalerophenone (α-PVP): results from intoxication cases within the STRIDA project.

CONTEXT: An increasing number of new psychoactive substances (NPS) of different chemical classes have become available through marketing and sale over the Internet. This report from the Swedish STRIDA project presents the prevalence, laboratory results, and clinical features in a series of intoxications involving the stimulant NPS α-pyrrolidinovalerophenone (α-PVP), a potent dopamine re-uptake inhibitor, over a 4-year period. STUDY DESIGN: Observational case series of consecutive patients with admitted or suspected intake of NPS presenting to hospitals in Sweden from 2012 to 2015. PATIENTS AND METHODS: In the STRIDA project, blood and urine samples are collected from intoxicated patients with admitted or suspected intake of NPS or unknown drugs presenting to hospitals over the country. Analysis of NPS is performed by mass spectrometry multicomponent methods. Clinical data are collected when caregivers consult the Swedish Poisons Information Centre (PIC), and retrieved from medical records. The severity of poisoning is graded retrospectively using the Poisoning Severity Score (PSS). The inclusion criteria for this study included absence of other stimulants than α-PVP. RESULTS: During the 4-year study period, 23 intoxications were originally coded as "α-PVP related" out of a total 3743 NPS-related inquiries (0.6%) at the PIC. The present study covered 42 analytically confirmed cases in which α-PVP was the only stimulant detected. The age range of patients was 20-58 (median 32) years, of which 79% were males. The α-PVP concentration in serum was 4.0-606 (median 64; n = 42) ng/mL and 2.0-41,294 (median 1782; n = 25) ng/mL in urine. There was no statistically significant association between the serum α-PVP concentration and urinary α-PVP/creatinine ratio in 25 cases, where both sets of data were available. In 14/42 (33%) cases, α-PVP was the only psychoactive substance identified. In the remaining cases, additional substances comprised opioids, benzodiazepines, and ethanol. The main clinical manifestations were tachycardia (80%), agitation (70%), hypertension (33%), hallucinations (20%), and delirium (18%). Classification of poisoning severity yielded 25 (60%) moderate (PSS 2), 7 (17%) severe (PSS 3), and 2 fatal cases (PSS 4). CONCLUSIONS: In analytically confirmed α-PVP intoxication cases involving no other stimulant drugs, the urine and serum concentrations showed high variability. The clinical features were consistent with a severe sympathomimetic toxidrome. The results further demonstrated that α-PVP prevailed as a drug of abuse after being classified as a narcotic substance, and despite a high incidence of severe poisonings and fatalities. However, the low prevalence of α-PVP cases registered at the PIC suggested that many were unaware of the actual substance they had taken.

Intoxications involving MDPV in Sweden during 2010-2014: Results from the STRIDA project.

CONTEXT: In the recent years, there have been an increasing number of new psychoactive substances (NPS) available through marketing and sale on the Internet. The stimulant 3,4-methylenedioxypyrovalerone (MDPV) is a potent dopamine reuptake inhibitor, which can cause serious intoxications requiring intensive care and even fatality. This report from the STRIDA project presents the prevalence, laboratory results, and clinical features in a series of intoxications involving MDPV over a 5-year period. STUDY DESIGN: Observational case series of consecutive patients with admitted or suspected intake of NPS presented at hospitals in Sweden from 2010 to 2014. PATIENTS AND METHODS: Blood and/or urine samples were collected from intoxicated patients with admitted or suspected intake of NPS presenting at hospitals over the country. Analysis of NPS was performed by a liquid chromatography-tandem mass spectrometry multicomponent method. Clinical data were collected when caregivers consulted the Swedish Poisons Information Centre and also retrieved from medical records. The severity of poisoning was graded retrospectively using the poisoning severity score. RESULTS: During the 5-year study period, the number of MDPV-related inquiries to the Poisons Information Centre was 662 out of a total ∼4500 suspected NPS-related inquiries (∼15%), and 201 analytically confirmed MDPV intoxications were enrolled in the study. The study period covered the period when the use of MDPV in Sweden was at its peak and also the decline to an almost zero level. The age range of patients was 18-68 (mean 36, median 35) years, and 71% were males. The MDPV concentrations in serum ranged between 1.0 ng/mL and 1509 ng/mL (mean 63.6, median 20) and between 1.0 ng/mL and 81 000 ng/mL (mean 3880, median 1160) in urine. The urinary values were also creatinine corrected for variation in urine dilution, and the MDPV/creatinine ratio ranged between 0.10 ng/mmol and 2480 ng/mmol (mean 247, median 92.6). There was a statistically significant association between the serum MDPV concentration and the urinary MDPV/creatinine ratio, for 118 cases where both data were available (r = 0.764; p < 0.0001, Spearman's rank correlation). In 30 (15%) cases, MDPV was the single psychoactive substance identified in the serum or urine specimens. In the other 171 cases, other psychoactive substances were detected together with MDPV. The additional substances (n = 61) comprised of both conventional drugs of abuse, other NPS (n = 39), pharmaceuticals, and ethanol. The cathinone-derivative alpha-pyrrolidinovalerophenone (α-PVP) was the most frequent other NPS, and was detected in 58 (29%) cases, followed by methylone in 14 (7%) cases. The main clinical manifestations reported in patients testing positive for MDPV included agitation, tachycardia (≥100/min), and hypertension (systolic blood pressure ≥140 mmHg), which were observed in 130 (67%), 106 (56%), and 65 (34%) cases, respectively. Other symptoms included hallucinations (n = 31, 16%), delirium (n = 29, 15%), hyperthermia (>39°C/102.4°F; n = 18, 10%), and rhabdomyolysis (n = 16, 8%). In MDPV intoxications with serum levels >100 ng/mL, the cases were graded as more severe and hyperthermia was less common. CONCLUSIONS: In a large number of analytically confirmed MDPV intoxications from mostly polydrug users, the urine and serum MDPV concentrations showed a high variability. The clinical features were consistent with a severe sympathomimetic toxidrome. The results also demonstrated that MDPV prevailed as a drug of abuse for a long time, after its classification as a narcotic substance and despite a high incidence of severe poisonings.

Laboratory and clinical evaluation of on-site urine drug testing.

AIM: Products for on-site urine drug testing offer the possibility to perform screening for drugs of abuse directly at the point-of-care. This is a well-established routine in emergency and dependency clinics but further evaluation of performance is needed due to inherent limitations with the available products. METHODS: Urine drug testing by an on-site product was compared with routine laboratory methods. First, on-site testing was performed at the laboratory in addition to the routine method. Second, the on-site testing was performed at a dependency clinic and urine samples were subsequently sent to the laboratory for additional analytical investigation. RESULTS: The on-site testing products did not perform with assigned cut-off levels. The subjective reading between the presence of a spot (i.e. negative test result) being present or no spot (positive result) was difficult in 3.2% of the cases, and occurred for all parameters. The tests performed more accurately in drug negative samples (specificity 96%) but less accurately for detecting positives (sensitivity 79%). Of all incorrect results by the on-site test the proportion of false negatives was 42%. The overall agreement between on-site and laboratory testing was 95% in the laboratory study and 98% in the clinical study. CONCLUSION: Although a high degree of agreement was observed between on-site and routine laboratory urine drug testing, the performance of on-site testing was not acceptable due to significant number of false negative results. The limited sensitivity of on-site testing compared to laboratory testing reduces the applicability of these tests.

Age of recipient and number of doses differentially impact human B and T cell immune memory responses to HPV vaccination.

Vaccination is one of the most effective medical interventions. However, optimization of existing as well as design of new vaccines is still mostly conducted empirically; a rational approach to vaccine design is largely prohibited by the lack of insight into the relevant mechanisms underlying immune-mediated protection. To delineate the impact of variables on immune memory formation following vaccination, we took advantage of a trial assessing the role of the age of the recipient and the number of administered doses of the quadrivalent HPV vaccine in a well-characterized longitudinal cohort of girls and young women. We found that age of the recipient and the number of doses administered differentially impact the development of B and T cell memory. Specifically, age of the recipient significantly impacted generation of HPV 18-specific B cell memory, while the number of vaccine doses displayed a significant effect on the development of HPV-specific T cell memory. Our data indicate that rational design of vaccines has to be tailored according to the desired induction of B and/or T cell memory.

Number of different purging behaviors used among women with eating disorders: psychological, behavioral, self-efficacy and quality of life outcomes.

The objective of this study was to examine differences between a number of different purging behaviors used and outcome measures among eating disorder patients. Among 211 females who received inpatient or partial hospitalization eating disorder treatment, analyses of covariance and cross-tabulations identified associations among a number of different purging behaviors (vomiting, laxative use, diuretic use) used and psychological, behavioral, self-efficacy and quality of life measures at follow-up. Most patients (80.1%) reported purging for weight control. Use of different purging behaviors was significantly associated at follow-up with lower self-esteem, greater depression, higher state and trait anxiety, higher BMI, poorer self-efficacy for normative eating and body image, compromised quality of life, greater dietary restraint, and eating, shape and weight concerns. Furthermore, a higher percentage of those who used purging behaviors met criteria for a subthreshold or threshold eating disorder at follow-up compared to their non-purging peers. Eating disorder patients who use different purging behaviors are more compromised at follow-up than patients who do not purge. Due to the severe medical complications associated with different purging behaviors, future research should address best practices for clinical intervention and prevention.

Food system access, shopping behavior, and influences on purchasing groceries in adult Hmong living in Minnesota.

PURPOSE: To investigate influences on shopping and eating behavior of Hmong adults living in St. Paul/Minneapolis, Minnesota. DESIGN AND SETTING: Conducted a mapping project, food surveys, food frequency questionnaire (FFQ), and focus groups (n = 11). SUBJECTS: Subjects were assigned to three groups. The B-TL(1) group was made up of subjects who were born in Thailand/Laos and had lived in the US < or =5 years (n = 19). The B-TL(2) group was made up of subjects who were born in Thailand/Laos, had food memories, and had lived in the US >5 years (n = 20). The B-US group was made up of subjects who were born and/or raised in the US (n = 30). METHODS: Using Geographical Informational Systems software, 15 grocery stores were mapped and surveyed. Food prices were compared with the consumer price index (CPI). The FFQ assessed food consumption patterns. Focus group transcripts were evaluated for themes and coded. Degree of acculturation was assessed by adapting a previously developed instrument. RESULTS: The population is concentrated in St. Paul, coinciding with store density. Limited foods had CPIs and some CPIs were outdated. B-US had significantly higher levels of dietary acculturation than B-TL(2) and B-TL(1), with B-TL(2) also having a higher dietary acculturation level compared with B-TL(1). Acculturation of the Hmong into the American food system, determinants of store type, and Hmong food's having a mainstream factor were identified themes. CONCLUSIONS: B-US and B-TL(2) shopped at American stores more than did B-TL(1) because of convenience, one-stop shopping, and increased English fluency. Hmong foods have entered the American food system and are sold at Asian and American stores.

Differences in stature, BMI, and dietary practices between US born and newly immigrated Hmong children.

This study investigated how acculturation influences diet, cultural practices related to cooking and food preparation knowledge, and stature and body mass index (BMI) of Hmong children. Focus groups (n=12) were conducted during the spring of 2008 in St. Paul/Minneapolis, Minnesota with those born in the US and 9-13 years old (n=22), those born in the US and 14-18 years old (n=25), and those born in Thailand or Laos, who had lived in the US< or =5 years, and 14-18 years old (n=21). Respondents also completed a survey instrument to assess acculturation level which was evaluated by questions about social connections, language use, and dietary habits. Compared to those born in the US, those born in Thailand or Laos were significantly shorter and leaner. Those born in the US also showed elevated acculturation levels in language use, social connections, and gender-oriented tasks compared to those born in Thailand or Laos. Themes from focus group discussions were mealtime patterns, determinants of food health, future health concerns, and changing cultural traditions. Acculturation, years lived in the US, and birth place may play an important role in stature and BMI, food and physical activity habits, cooking and food preparation knowledge, and perceptions of health.

Acculturation and environmental change impacts dietary habits among adult Hmong.

Focus groups (n=65) were conducted with Hmong adults in St. Paul/Minneapolis, MN to determine how environmental factors, acculturation, and food insecurity influence dietary behavior, body mass index (BMI), and health. Acculturation was assessed by examining linguistic, social, and eating behavior, length of time in the US, and BMI for B-TL(1) (born in Thailand/Laos and in US < or =5 years), B-TL(2) (in Thailand/Laos through adolescence, had food memories, and in US >5 years), and B-US (born in US or in Thailand/Laos less than 8 years and no food memories from there). Acculturation was associated with years lived in the US, household size and income, and food assistance usage. Years lived in the US was correlated with food assistance usage, education, household size and income, and perception of diet. B-TL(1) and B-TL(2) were on average overweight (BMI> or =25<30), US men were obese (mean BMI=32.4+/-7.4), and women were overweight (mean BMI=29.1+/-6.8). Themes identified were cultural values impact eating and lifestyle behaviors, food insecurity history influences post-migration behavior, acculturation impacts BMI through diet and exercise, and health status is influenced by changed environments. Environmental changes and increased acculturation have negatively impacted the weight and health of Hmong adults.

Physiological and biochemical responses of resistant and susceptible wheat to injury by Russian wheat aphid.

We examined the physiological and biochemical responses of resistant ('Halt' and 'Prairie Red') and susceptible ('TAM 107') wheat, Triticum aestivum L., to injury by the Russian wheat aphid, Diuraphis noxia (Mordvilko). Photosynthetic capacity was evaluated by measuring assimilation/internal CO2 (A/Ci) curves, chlorophyll fluorescence, chlorophyll, and nonstructural carbohydrate content. Total protein and peroxidase specific activity also were determined. No significant differences were detected in chlorophyll concentration between aphid-infested and control TAM 107 plants. The aphid-infested resistant cultivars had similar or significantly higher chlorophyll concentrations compared with their respective control plants. Measurements over time showed that infested Halt plants had delays in photosynthetic senescence, Prairie Red plants had photosynthetic rate changes that were similar to control plants, and TAM 107 plants displayed accelerated photosynthetic senescence patterns. The photochemical and nonphotochemical quenching coefficients were significantly higher in infested Halt plants compared with their respective control plants on day 3. Infested TAM 107 plants had significantly higher photochemical quenching compared with control plants at all times evaluated, and they had significantly higher nonphotochemical quenching on day 3. Throughout the experiment, infested Prairie Red plants exhibited photochemical and nonphotochemical quenching coefficient values that were not significantly different from control plants. Total protein content was not significantly different between aphid-infested and control plants for all cultivars. Differences between physiological responses of infested susceptible and resistant cultivars, particularly temporal changes in photosynthetic activity, imply that resistant Halt and Prairie Red wheat tolerate some impacts of aphid injury on photosynthetic integrity.

Physiological responses of resistant and susceptible buffalograsses to Blissus occiduus (Hemiptera: Blissidae) feeding.

The impact of Blissus occiduus Barber feeding on resistant ('Prestige') and susceptible ('378') buffalograsses, Buchloë dactyloides (Nuttall) Engelmann, was evaluated through measurement of carbon exchange rate, light and carbon assimilation (A-C(i)) curves, chlorophyll a fluorescence, and nonstructural carbohydrates. No significant differences in carbon exchange rates were observed between infested and control plants for 378 at 5 and 10 d after infestation; however, at 20 d after chinch bug introduction, significant differences in carbon exchange rates between infested and control 378 plants were detected. Carbon exchange rates were similar between infested and control Prestige plants at 5,10, and 20 d after infestation, suggesting that resistant plants can allocate energy for recovery from chinch bug injury. Significant differences in the photochemical efficiency of photosystem II (PSII) and the apparent photosynthetic electron transport ratio were observed between infested and control 378 plants, whereas, no significant differences in the photochemical efficiency of PSII and the electron transport ratio were detected between control and infested Prestige plants. Blissus occiduus-infested 378 and Prestige plants consistently had similar or higher levels of nonstructural carbohydrates compared with their respective control plants. These data suggest that both resistant and susceptible buffalograsses increase levels of nonstructural carbohydrates in response to B. occiduus feeding. This research also suggests compensatory photosynthesis takes place in Prestige but not in 378.