Viral anti-inflammatory serpin reduces immuno-coagulopathic pathology in SARS-CoV-2 mouse models of infection

SARS-CoV-2 acute respiratory distress syndrome (ARDS) induces uncontrolled lung inflammation and coagulopathy with high mortality. Anti-viral drugs and monoclonal antibodies reduce early COVID-19 severity, but treatments for late-stage immuno-thrombotic syndromes and long COVID are limited. Serine protease inhibitors (SERPINS) regulate activated proteases. The myxoma virus-derived Serp-1 protein is a secreted immunomodulatory serpin that targets activated thrombotic, thrombolytic, and complement proteases as a self-defense strategy to combat clearance. Serp-1 is effective in multiple animal models of inflammatory lung disease and vasculitis. Here, we describe systemic treatment with purified PEGylated Serp-1 as a therapy for immuno-coagulopathic complications during ARDS. Treatment with PEGSerp-1 in two mouse-adapted SARS-CoV-2 models in C57Bl/6 and BALB/c mice reduced lung and heart inflammation, with improved outcomes. PEGSerp-1 significantly reduced M1 macrophages in the lung and heart by modifying urokinase-type plasminogen activator receptor (uPAR), thrombotic proteases, and complement membrane attack complex (MAC). Sequential changes in gene expression for uPAR and serpins (complement and plasminogen inhibitors) were observed. PEGSerp-1 is a highly effective immune-modulator with therapeutic potential for severe viral ARDS, immuno-coagulopathic responses, and Long COVID.

P2547Statin and glucose-lowering treatment in individuals with and without schizophrenia

Background

We have recently shown that Cardiovascular (CV) mortality is surprisingly high in patients with schizophrenia in Sweden. Diabetes is 2–3 times more common in patients with schizophrenia. Treatment with Metformin have consistently shown effective to lower CV mortality in patients with diabetes. In addition, recent studies have shown that treatment with Metformin reduces weight and improves lipids even in patients with schizophrenia without diabetes. One reason for the high CV mortality in Swedish patients with schizophrenia may be lack of risk factor treatment, such as glucose-lowering treatment and/or lipid lowering treatment with statins.

Objective

To determine the prevalence of treatment with glucose-lowering treatment and statins in patients with and without schizophrenia in Stockholm, Sweden.

Material and methods

Cross-sectional study based on individual-level patient data from the Stockholm regional health-care data warehouse. 6 347 patients with a diagnosis of schizophrenia (International Classification of Diseases, Tenth Revision code F 20.X) were compared with 2 062 112 without schizophrenia from Stockholm County. The prescription of Metformin and insulin were compared in 5-year age groups from 30 to 85 years of age. In addition, the prescription of statins (any statin) were also compared in the same population.

Results

The prescription of metformin in age groups under 60 years were approximately 2 to 8 times more common in patients with schizophrenia, in patients over 60 the corresponding figures were 0.7 to 3 times. The prescription of statin in age groups under 60 were approximately 0.8–3 times more common in patients with schizophrenia. In contrast, in patients over 60 years statins were less often prescribed in patients with schizophrenia compared to controls.

Figure 1

Conclusions

Our results indicate that lack of treatment with metformin may not be a reason for the increase cardiovascular mortality in patients with schizophrenia. However, the surprisingly low prescription of statins in older (>60 years) patients with schizophrenia might explain the high CV mortality in this patient group.

Providing culturally appropriate mental health services for minorities

Research on the use of outpatient mental health services has shown lower rates of utilization by minorities. Barriers include economic considerations, access difficulties, and cultural factors. Promoting the use of outpatient mental health services by minorities can have a positive effect on the overall cost of health and mental health care, as well as increasing access to care and quality of care for minority populations. Advantages and disadvantages of various approaches to providing culturally appropriate programming in mental health services are discussed.

Psychiatric disorders in sexually abused children

OBJECTIVE

This study was designed to compare the prevalence of psychiatric disorders in a clinical sample of sexually abused children referred for outpatient evaluation. Two a priori hypotheses were tested: (1) the sexually abused group would have more post-traumatic stress disorder than the non-sexually abused group and (2) non-sexually abused children referred for evaluation would have more diagnoses than the sexually abused group.

METHODS

Twenty-six sexually abused children and 23 non-sexually abused children referred for psychiatric outpatient evaluation at a medical school center were matched by age, sex, race, and socioeconomic status and compared to determine differences in prevalence of Axis I, DSM-III-R disorders. The Schedule for Affective Disorders and Schizophrenia for School-Age Children-Epidemiologic Version was used for systematic diagnosis.

RESULTS

Groups did not differ significantly in the number of diagnoses and, in both groups, attention-deficit hyperactivity disorder was the most frequent diagnosis. However, the prevalence of post-traumatic stress disorder among sexually abused children was significantly greater (p < .02), with 42.3% of sexually abused children and 8.7% of non-sexually abused children meeting full criteria. There were no significant differences between groups in other diagnostic categories.

CONCLUSIONS

This study, using structured interviews and comparison groups, confirmed earlier findings suggesting that sexually abused children are at heightened risk for the development of post-traumatic stress disorder.

A comparison of male and female clients in substance abuse treatment

To assess the extent to which women appear to have special treatment needs, this paper compares male and female patients receiving inpatient substance abuse treatment. The author analyzed completed intake interview forms from the files of all clients entering two private, nonprofit inpatient substance abuse treatment facilities during an 8-month period in 1989 (a total of 181 men and 48 women). The women were similar to the men with respect to sociodemographic characteristics, family history, alcohol/drug history, and treatment completion. However, they were more likely to report a sexual abuse history and indicated more emotional distress than the men. Implications for treatment are discussed.

Alcoholism treatment in general hospitals

This article examines recent developments in the role of general hospitals in providing treatment for alcoholism. It employs data on 5,000 U.S. short-term general hospitals and on all patients discharged from a subsample of 400 of these hospitals in the years 1980 through 1985. The article describes the growth in alcoholism treatment resources in short-term hospitals (1980-85) and examines linked hospital and patient data for the 400 hospitals in the subsample to describe patient diagnoses and resource use (1980 and 1985). Patients are classified by the stage of their alcohol problem, and hospital use is examined for patients in different stages.

Spontaneously transformed NRK cells lose their mitogenic response to epidermal growth factor

To understand the relationship between growth factor-induced mitogenesis and spontaneous cell transformation, a clonal isolate of epidermal growth factor (EGF)-responsive NRK cells was passed in vitro until morphologically transformed variants arose. Subclones of EGF responsive (Cl-3) and EGF nonresponsive (Cl-10) NRK cells were isolated. Cl-3 cells grew as flat, contact-inhibited monolayers, while Cl-10 cells grew as rounded or spindle-shaped cells that formed dense foci. Cl-10 cells formed colonies in soft agar more efficiently (p less than 0.01) and formed larger tumors in nude mice (p less than 0.05) than Cl-3 cells. Cl-3 cells exhibited a sixfold increase in DNA synthesis in response to 1.0 nM EGF. Cl-10 cells did not increase DNA synthesis on exposure to 100 nM EGF. These different responses to EGF occurred despite similar numbers of receptors and similar receptor.binding affinities for EGF (Cl-3: 7000 receptors, Kd = 0.67 nM; Cl-10: 8000 receptors, Kd = 0.72 nM). No evidence of transforming growth factor-alpha was detected in either of these cell lines using Northern blots, Western blots, or biologic assays. We conclude that NRK cells which undergo spontaneous morphologic transformation and exhibit enhanced anchorage-independent growth lose their mitogenic response to EGF.

Care of children with psychiatric disorders at community hospitals

Short-term general hospitals account for most psychiatric hospitalizations of children, but relatively little research has examined the psychiatric care of children at these facilities. This study compared the characteristics of and use of hospital services by children and adults who received a primary psychiatric diagnosis at 380 short-term general hospitals in 1977. Of the 100,000 patients studied, 7,000, or 7 percent, were children, most between the ages of 12 and 17. Children 12 and older were hospitalized the longest, a mean of 15.6 days, followed by adults (12.7 days), children between six and 11 (10.7 days), and children five and younger (5.6 days). The great majority of children under age 12 and roughly one-third of children between ages 12 and 17 were not seen by a psychiatrist during their hospital stay. Very few were seen by child psychiatrists. The authors believe that child psychiatrists should be concerned about the effect their relative absence from general hospitals has on quality of care.

Screening for alcoholism: techniques and issues

Alcoholism is an often overlooked health problem because alcoholics usually do not seek treatment for their drinking problems. They do, however, seek general medical care for other health reasons, and a number of screening techniques have proven useful for identifying alcoholics. The advantages and disadvantages of self-report, as well as biochemical techniques that have been found effective in screening for alcoholism, are discussed. We recommend that future research be aimed at developing quick, accurate, and inexpensive screening devices that also can evaluate the severity of the alcohol problem. Ideally, screening procedures would discourage feigned responses, differentiate between drinking and consequences of drinking, and permit the identification of subtypes of alcoholics. Better understanding of the types of errors made by common screening instruments would enable researchers to construct an optimal sequencing strategy for screening for alcoholism.

Alcoholism treatment service systems: a health services research perspective

This article examines the role of health services research in alcoholism treatment. Alcoholism services research has only recently emerged as a self-defined discipline. Alcoholism services research can be grouped into five classifications: a) descriptive studies of resources for alcoholism treatment and of the use or cost of these services, b) estimates of the need or demand for alcohol services in the population or in particular subpopulations, c) studies of the costs or cost-effectiveness of alcoholism treatment or of alternative treatments, d) studies of the possible "cost-offsets" of treating alcoholism, and e) studies that examine strategies for financing and reimbursement for alcoholism treatment. Research is needed to determine how alcoholism treatment services are now delivered, who uses these services, how treatment setting and organization affect service delivery, who pays for alcoholism treatment, and how reimbursement policies affect the delivery of alcoholism services. Research on large-scale social issues is also needed, such as the effects of warning labels appearing on alcoholic beverage containers or estimates of the overall cost to society of alcohol abuse.

Factors associated with the use of psychiatric consultations in short-term general hospitals

A significant number of patients in general hospitals suffer from psychiatric distress or illness, but not all receive psychiatric consultation. This study examined several potential predictors of such consultation. These included patient characteristics (age, sex, race, insurance, disease stage, and number of medical diagnoses), characteristics of hospital stay (number of procedures, other consultations, length of stay, discharge destination), hospital characteristics (size, percent occupancy, teaching status, presence of a psychiatric unit, type of control), and community characteristics (region, urban/rural setting). Data were derived from a national sample of 327 hospitals. Parallel analyses using stepwise logistic regression were carried out across four samples: patients determined at discharge to have been hospitalized for diabetes, hip fracture, chronic obstructive pulmonary disease, and coronary artery bypass surgery. Results show a wide variation in the use of psychiatric consultations across different subgroups. Longer lengths of stay, urban setting. Northeast region, younger patient age, and other consultations were the most consistent predictors of the probability of psychiatric consultation. These variations may reflect differences in the need for consultation, differential recognition of these needs by providers, or differential availability of psychiatric consultation services. Moreover, they may have implications for equity and/or quality of hospital care.

Psychiatric consultations in short-term general hospitals

We investigated the use of psychiatric consultations in short-term general hospitals using a national sample of 327 hospitals and examining the hospital experience of approximately 263,000 patients discharged from these hospitals. We found that the demographic characteristics of patients receiving psychiatric consultations in the national sample were roughly similar to those reported for patients receiving consultations in earlier, single-hospital studies. Rates of consultation were considerably lower, however: 0.9%, compared with a median rate of 3.3% reported in the literature. We also found that patients receiving psychiatric consultations used more hospital resources than other patients.

Male-female differences in mental health visits under cost-sharing

This article, which was prepared as part of a larger study of the impact of the copayment requirement on United Mine Workers of America (UMWA) beneficiaries carried out at the National Center for Health Services Research (NCHSR), compares male to female changes in ambulatory care visits for mental disorders and discusses the implications of these changes for the use of other services and for the quality of care. Figures were derived from aggregate claims data provided by the UMWA for the time periods immediately preceding the introduction of copayment (full coverage for all health care) and the first year following the introduction of copayment. Our findings suggest that, at least as far as visits for mental disorders are concerned, copayment may reduce necessary visits. The men in our population, who sought care for mental disorders more sparingly than women and for more severe complaints, were most affected by copayment.

Employer-based health insurance

Employer-based health insurance (insurance that is purchased by employers for their employees and financed through employer or joint employer-employee contributions) is currently subsidized in part by the federal government through tax exclusions for employer contributions to employee health insurance plans. This subsidization costs the federal government close to 10 billion dollars a year in lost revenues. Many proposed national health insurance plans assign a key role to employer-based health insurance as a vehicle for financing health care. Federal subsidization of employer-based health insurance and plans that assign employers a key role in the administration of a national health insurance plan both assume that private industry acts to realize federal health policy goals-- particularly cost containment--in administering health insurance plans. Little is known, however, about how employers go about selecting the plans they offer their employees or about the incentives and disincentives regarding cost of care than are created by employer-based health insurance. Existing evidence suggests that rather than helping to contain health care costs, employer-based health insurance may be partly responsible for their present escalation. In addition, employer-based health insurance may not be the most equitable way to implement a national health insurance plan.

Physician stereotypes about female health and illness: a study of patient's sex and the informative process during medical interviews

Three hundred and thirty-six tape recorded interactions between a stratified random sample of physicians and a sample of their patients are analyzed in order to compare male and female information-seeking behavior in the medical interview and to contrast the response of doctors to male and female requests for information. Some of the underlying attitudes on the part of the physicians that may affect the information-exchange process are discussed.

Homes or hospitals? Contradictions of the urban crisis

Medical expansion is threatening to eliminate many urban residential areas, despite criticisim that argues for comprehensive planning, reduced costs, less concentrated power in the health sector, and a reversal of "medicalization." Our research on expansion, which grew partly from personal participation in a local struggle against expanding institutions in Boston, revealed certain tensions in combining sociomedical research with concrete political practice. From events in Boston and from an exploratory review of periodicals, we recognized that medical expansion and community conflict occur frequently in cities throughtout the United States. Based on general theoretical perspectives from organizational analysis and political economy, we made several hypotheses that we tested through a questionnaire sent to all hospitals in the 20 largest cities of the United States and through other data available on the same hospitals. In large part, this empirical study confirmed our theoretical expectations that (a) larger medical centers show a greater tendency toward territorial growth than smaller hospitals; (b) bureaucratic and administrative dynamics lead to facilities that do not necessarily enhance patient care; (c) despite short-term cycles of expansion and contraction in public hospital growth, expansion projects are widespread and generate considerable political conflict; (d) because of the state's contradictory roles in regulation and social capital expenditures, opposition to medical expansion comes more from community organizations than from governmental monitoring or planning bodies; and (e) the needs of capital determine that medical expansion has a more detrimental impact on housing than on commercial or industrial facilities. Future expansion of private medical facilities is more likely than that of public facilities, although much private expansion may receive public subsidization. As ideologic patterns are demystified, the contradictions between medical expansion and housing needs can provide a focus for successful community organizing.