Can sharing experiences in groups reduce the burden of living with diabetes, regardless of glycaemic control?

AIMS

To test whether patients with Type 1 diabetes would join support groups and benefit by improving psychosocial functioning, regardless of their HbA1c levels.

METHODS

A pre-post test with follow-up after 6 and 12 months was conducted as a concurrent mixed-method study. The convenience sample included patients with Type 1 diabetes aged ≥21 years, having been diagnosed ≥1 year earlier. Primary outcome was diabetes-related distress (using the Problem Areas in Diabetes scale). Secondary outcomes were psychological distress and depressive symptoms (Symptom Check List -90-R/Global Severity Index and depression subscale), well-being (World Health Organization 5) and HbA1c .

RESULTS

Equal numbers of patients with HbA1c above and below 64 mmol/mol (8%) joined the support groups (n = 54). Focus group interviews revealed that major benefits were feeling less alone and being intuitively understood among peers. The patients perceived the support groups as a safe environment for sharing experiences. Problem Areas in Diabetes, Global Severity Index and depression subscale scores were significantly reduced post-intervention and maintained at 1-year follow-up. Well-being increased insignificantly. HbA1c was unchanged.

CONCLUSIONS

Support groups are able to reduce diabetes-related and psychological distress 1 year after the intervention for patients with both good and poor glycaemic control displaying high levels of distress. Although patients with severely high levels of diabetes-related distress might need more extensive therapeutic interventions to further reduce their level of distress. Further, interventions that target specific self-management problems are needed for patients with poor glycaemic control to help them accomplish lower levels of HbA1c. Moreover, healthcare providers must be aware that patients with good glycaemic control might have an unacknowledged psychosocial burden of living with the illness.

A new HLA-C allele, C*08:43, identified during a UCLA Immunogenetics Centre cell exchange

HLA-C*08:43 differs from HLA-C*08:02:01 by one nucleotide (A>G) at position 584 resulting in an amino acid change of 171 tyrosine to 171 cysteine.

No-shows, drop-outs and completers in psychotherapeutic treatment: demographic and clinical predictors in a large sample of non-psychotic patients

BACKGROUND

A primary challenge in mental health services is a high rate of non-attendance (i.e. no-show and drop-out) for patients referred to treatment for psychiatric disorders.

AIM

The aim of the present study was to assess the influence of demographic and clinical variables on mental health treatment attendance and to investigate differences in predictors for no-shows and drop-outs.

METHODS

A naturalistic study of 2473 non-psychotic consecutive patients offered psychotherapeutic treatment at a community mental health centre in Denmark. Fifteen demographic and clinical variables were recorded at assessment. Bivariate and multiple logistic regression analyses were conducted to investigate the associations between these variables and no-show and drop-out.

RESULTS

Of the 2473 participants, 668 (27.0%) did not show up for treatment, whereas 290 (11.7%) dropped out of treatment. Regression analysis showed that the significant predictors of treatment no-show were: age below 25, no more than the compulsory 9 years of school education, no sick leave, a diagnosis of personality disorder, a Global Assessment of Functioning score (GAF) below 40 or above 70, no previous psychiatric/psychological treatment, no use of antidepressants and substance abuse. The significant predictors of treatment drop-out were: age below 45, no more than the compulsory 9 years of school education or up to 11 years of school education, no vocational/university education, unemployment and substance abuse.

CONCLUSION

No-show was predicted by both demographic and clinical factors, whereas drop-out was predicted by demographic factors and substance abuse as the only clinical factor. Results and strategies to reduce non-attendance are discussed.

Sexual revictimization in a clinical sample of women reporting childhood sexual abuse

BACKGROUND

Child and adolescent sexual abuse (CSA) increases the risk for adult sexual assault (ASA), and psychological vulnerability as well as aspects of CSA and upbringing might influence the risk.

AIMS

The aims of this study were to investigate whether women who reported both CSA and ASA: 1) have been exposed to more severe CSA and 2) have greater psychological distress and vulnerability than women who were not revictimized.

METHODS

The study was a cross-sectional study of 161 adult women with a reported history of intrafamilial CSA. Thirty-six per cent of the women stated they had been exposed to ASA. The severity of CSA, psychological distress (Symptoms Checklist-90-R) and Cognitive Distortion were assessed. Five factors of Cognitive Distortion (fearful, scared, shy, mistrust and vulnerable) were identified by factor analysis of Symptoms Checklist-90-R sub-scale.

RESULTS

The CSA was significantly more severe (penetration: 77%/60%; multiple offenders: 67%/25%) in women exposed to ASA compared with their counterparts, as was the rate of suicide attempts (47%/30%). Also, the psychological distress and the factors: fearful, scared, shy and mistrust were significant higher.

CONCLUSION

The results showed an increased psychological vulnerability among women with ASA, but whether the results are cause or effect of sexual revictimization or can be generalized to other clinical samples are not clear. Interventions targeting the increased risk of ASA should be developed, implemented and tested in prevention as well treatment programmes.

Phase I study of lapatinib, a dual-tyrosine kinase inhibitor, and pemetrexed in the second-line treatment of advanced or metastatic non-small cell lung cancer

e19027

Background: Lapatinib is an oral, reversible small-molecule inhibitor of epidermal growth factor receptor (EGFR) and human epidermal growth factor receptor 2 (HER2). EGFR overexpression is very common in non-small-cell lung cancer (NSCLC), ranging from 30% to 83%, whereas HER2 overexpression occurs in about 20%. Pemetrexed is currently given as second-line therapy and achieves a 9% response rate. The rationale for EGFR/HER2 inhibition in combination with pemetrexed is to demonstrate clinical synergy as previously shown with gemcitabine, another fluoropyrimidine pathway inhibitor. Methods: Eligible patients included those with stage IIIB or IV NSCLC and European Cooperative Oncology Group performance status of 0–2 following 1 previous chemotherapy treatment. Patients were treated in 3 escalating dose levels (DLs) of pemetrexed (given intravenously every 21 days) and daily lapatinib (DL 0: 400 mg/1,250 mg; DL 1: 500 mg/1,250 mg; DL 2: 500 mg/1,500 mg, respectively). A standard phase 1, 3+3 trial design was used. The primary objective was to determine the optimal treatment regimen. Results: Eighteen patients were treated (DL 0: n=4, DL 1: n=8; DL 2: n=6). The most common adverse events (any grade) were diarrhea (61%), rash (44%), fatigue (28%), nausea (28%), anemia (28%), anorexia (22%), vomiting (22%), dyspnea (17%), and neutropenia (17%). Grade 3/4 adverse events were lymphocytopenia (n=5) and neutropenia (n=5). Other related grade 3 events were diarrhea (n=2), nausea (n=1), decreased ejection fraction (n=1), and increased alkaline phosphatase (n=1). The optimal treatment regimen was determined as lapatinib 1250 mg given with 500 mg pemetrexed after occurrence of 3 dose-limiting toxicities during the first cycle in DL 2 (grade 3 diarrhea, grade 4 lymphocytopenia, and grade 3 mucositis). No further dose-limiting toxicities were observed in DL 0 or DL 1. Preliminary evidence of clinical activity was encouraging, with 3 patients showing partial response. Conclusions: The combination of lapatinib with pemetrexed is well tolerated; encouraging activity has been demonstrated in pretreated NSCLC patients and warrants further studies.

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Synthesis and characterization of TiOx nanowires using a novel silicon oxide support layer

Titanium oxide (TiO(x)) nanowires of various compositions were synthesized using a vapour-liquid-solid growth process without the need of a titanium-based support layer. The process utilized liquid gold droplets, evaporated titanium vapours, and an argon-5% oxygen gas mixture at 1100 degrees C. A thin layer of thermally grown silicon oxide was used as the support layer. The resulting nanowires were 80-100 nm in diameter with lengths varying from 0.5 to 10 microm. Nanowires of TiO, as opposed to TiO(2), were formed in low pressures of argon-oxygen. Environmental pressure was found to greatly affect nanowire quality. Surface abrasion did not contribute to or inhibit the overall growth process. X-ray photon spectroscopy and Auger electron spectroscopy confirmed the presence of titanium. X-ray diffraction and transmission electron microscopy electron diffraction analysis confirmed the presence of rutile and face centred cubic crystal structures in both materials.