927 research outputs found
Direct evidence of extensive diversity of HIV-1 in Kinshasa by 1960
No full textHuman immunodeficiency virus type 1 (HIV-1) sequences that pre-date the recognition of AIDS are critical to defining the time of origin and the timescale of virus evolution. A viral sequence from 1959 (ZR59) is the oldest known HIV-1 infection. Other historically documented sequences, important calibration points to convert evolutionary distance into time, are lacking, however; ZR59 is the only one sampled before 1976. Here we report the amplification and characterization of viral sequences from a Bouin's-fixed paraffin-embedded lymph node biopsy specimen obtained in 1960 from an adult female in Léopoldville, Belgian Congo (now Kinshasa, Democratic Republic of the Congo (DRC)), and we use them to conduct the first comparative evolutionary genetic study of early pre-AIDS epidemic HIV-1 group M viruses. Phylogenetic analyses position this viral sequence (DRC60) closest to the ancestral node of subtype A (excluding A2). Relaxed molecular clock analyses incorporating DRC60 and ZR59 date the most recent common ancestor of the M group to near the beginning of the twentieth century. The sizeable genetic distance between DRC60 and ZR59 directly demonstrates that diversification of HIV-1 in west-central Africa occurred long before the recognized AIDS pandemic. The recovery of viral gene sequences from decades-old paraffin-embedded tissues opens the door to a detailed palaeovirological investigation of the evolutionary history of HIV-1 that is not accessible by other method
Hearing voices: coping, resilience and recovery
No full textIntroduction: The aim of this study was to explore the experience of people who hear voices and how the support offered to them affects coping, resilience and recovery.
Individual factors such as coping, resilience, belief systems and current service provisions are discussed within the developing context of the mental health system and
wider society.
Method: Seven people who hear voices were recruited from a local hearing voices group and interviewed using a semi-structured interview. Interpretative Phenomenological Analysis was used to analyse the transcripts.
Results: Six key themes emerged from the participants’ accounts. These included: Psychiatry: social control; Psychiatry: a clinical model; Trauma, trauma and re-trauma;
Voice awareness; Dancing with voices; and Relationships: lack of understanding.
Discussion: The participants highlighted the support provided by the Hearing Voices Group and help provided by family and friends. This was considered in contrast with
psychiatry which was viewed unfavourably. The primary difference in the experience of support, perceived as either helpful or unhelpful, was linked to the emphasis on specific factors that the interviewees considered to influence their process of recovery. These included being in a safe and non-judgemental environment, being offered hope and validation of their experiences, as well as having a means to socially connect and empower their position so that they can be more active in their own recovery. The
research suggests that more training in the conceptual frameworks and models of recovery, a greater focus on working with the family and wider support, enhanced
collaborative working, and more tailored outcome measures would help services to better meet these individuals’ needs during the recovery process
What are the experiences of those attending a self help hearing voices group: an interpretative phenomenological approach
No full textIntroduction: Self-help Hearing Voices Groups (HVG) have grown in popularity here in the UK, and internationally, since the 1980s. Despite research into the potential benefits of attending self-help groups for other mental health problems, little is known about their potential benefit for voice hearers. The present study was designed to explore the experiences of those attending one self-help Hearing Voices Group in the UK.
Methods: A homogenous convenience sample of seven adults aged between 28 and 48 years old was recruited and participants were interviewed using a semi-structured interview schedule. Interviews were transcribed and analysed using Interpretative Phenomenological Analysis. Analysis was conducted for individual participants in the first instance. Following this, a group analysis was conducted across participants to identify master and super-ordinate themes.
Results: Six master themes and eight super-ordinate themes emerged following the group analysis. Participants experienced the group as A Secure Base which offered the opportunity for Coming Together to Help Ourselves. As well as benefits of attending the group, participants also discussed challenging aspects to their experience; Threats to Engagement and Vicarious Experience. Participants experienced the group as A Catalyst for Change in terms of social and psychological recovery. Finally, participants talked about the sense of Belonging to a Special Tribe which offered mutual acceptance and social inclusion.
Discussion: The main findings of the research project are discussed in relation to existing psychological theories of groups and research into the effectiveness of self-help groups in other clinical contexts. The research adds to the existing knowledge base in terms of exploring how participants developed attachments to the group and its members. Implications for the potential benefits of attending self-help Hearing Voices Groups are discussed. Finally, the clinical implications for Clinical Psychologists working with voices and with self-help Hearing Voices Groups are discussed. The research concludes with recommendations for areas of further research
Alcoholism recovery and treatment needs of women
No full textPlan BAmong American women, alcohol is the single leading drug of abuse, yet research in addiction has concentrated on male subjects. Most models of treatment were developed to meet the needs of male patients. Contemporary research indicates that clear differences in substance abuse effects exist between men and women. This study identified specific issues or themes that could help augment recovery for women who are in treatment for alcoholism. Structured interviews were conducted with seven adult women, 21 years or older who are in recovery from alcohol dependence and who regularly attend AA meetings. The study addressed several issues pertaining to women’s alcoholism that formed themes relating to factors that could help women obtain treatment earlier and elements of treatment programs that could be more responsive to female clients and improve their aftercare services. The respondents were asked ten open-ended questions concerning issues that were important in their recovery from alcoholism but were not adequately addressed while in treatment and aftercare. It was found that the two youngest women sought treatment earlier than most of the older women, and that other women often were the impetus for many of the participants seeking treatment. The participants’ answers indicated that if women’s emotional concerns were addressed more in treatment, they likely would have benefited more from treatment. Relationship health was an important topic for women in this study. It was also found that, in general, the women in this study were not satisfied with their counselors in treatment or in aftercare. Information gathered through this study may be helpful to identify the specific recovery and treatment needs of women with alcoholism
The Efficacy of Dexamethasone in the Prevention of Postoperative Shivering: A Double-blind Placebo-Controlled Clinical Trial
No full textBackground: Post-operative shivering is very common and followed by many problems such as increasing oxygen consumption, blood pressure, intracranial and intraocular pressure, and post-operation pain. Therefore, prevention of shivering is important especially in elderly and ischemic heart disease patients. The goal of this study was comparing the effect of Pethidine (Meperidine), Dexamethasone and Placebo on prevention of shivering.
Material and Methods: This double blind clinical trial study was carried out on 120 patients who were candidates for surgery under general anesthesia.The patients were randomly divided into three groups including those who received placebo (a) Dexamethasone (b) and Pethidine (c). Induction and maintenance of anesthesia for all patients were similar. Central and peripheral temperature of patients was measured every 5 minute interval. After induction saline normal, Dexamethasone and Pethidine were injected to groups a, b and c respectively. In recovery all patients were controlled for visible shivering: All data were statistically analyzed by SPSS software and ANOVA and chi square tests.
Results: There were no significant differences among three mentioned groups regarding of gender, age , duration of surgery and recovery time. Nineteen cases (47.5%) in group a had post-operative shivering. Whereas, in group b only 4 cases (10%) had shivering and the difference between 2 groups was significant (P value = 0.001). Also in group c, 15 cases (37.5%) had shivering that the difference with placebo group was significant (P value = 0.08).
Conclusion: The present study showed that pethidine and dexamethasone are effective drugs for preventing of post-operative shivering in elective surgery. And the effect of dexamethasone in preventing the post – operative shivering is better than Pethidine. Dexamethasone can be administered after induction of anesthesia as an alternative to administration of Pethidine (as a common method of prevention and treatment of postoperative shivering) particularly in patients with hemodynamic instability
Mental Health Service Provision for the People of Cambridge: Are services facilitating recovery?
No full textThe purpose of the present research was to investigate consumer perspectives of mental health service provision in Cambridge and whether services were helpful in facilitating recovery. Cambridge is a small township in the Waikato region, approximately twenty-five kilometers south-east of Hamilton. The study aimed to: gain an understanding of consumers’ interpretations of recovery; identify consumer perspectives of service delivery in Cambridge; assess whether services in Cambridge are working from a recovery ethos; and determine how consumers’ think service delivery could be improved. Interviews with 14 consumers of mental health services were completed. The key findings of this study suggest that the mental health needs of Cambridge consumer’s were not being met. More specifically, consumers’ who had severe or mild mental illness were reasonably happy with service delivery. However, consumers whose mental illness impacted their life considerably, yet their symptoms were not deemed severe enough to access public services, identified significant discrepancies between service provision and recovery facilitation
Risk and predictive factors of prolonged viral RNA shedding in upper respiratory specimens in a large cohort of COVID-19 patients admitted to an Italian reference hospital
No full textBackground: Limited data are available about the predictors and outcomes associated with prolonged SARS-CoV-2 RNA shedding (VS).
Methods: A retrospective study including COVID-19 patients admitted to an Italian hospital between March 1 and July 1, 2020. Predictors of viral clearance (VC) and prolonged VS from the upper respiratory tract were assessed by Poisson regression and logistic regression analyses. The causal relation between VS and clinical outcomes was evaluated through an inverse probability weighted Cox model.
Results: The study included 536 subjects. The median duration of VS from symptoms onset was 18 days. The estimated 30-day probability of VC was 70.2%. Patients with comorbidities, lymphopenia at hospital admission, or moderate/severe respiratory disease had a lower chance of VC. The development of moderate/severe respiratory failure, delayed hospital admission after symptoms onset, baseline comorbidities, or D-dimer >1000ng/mL at admission independently predicted prolonged VS. The achievement of VC doubled the chance of clinical recovery and reduced the probability of death/mechanical ventilation.
Conclusions: Respiratory disease severity, comorbidities, delayed hospital admission and inflammatory markers negatively predicted VC, which resulted to be associated with better clinical outcomes. These findings highlight the importance of prompt hospitalization of symptomatic patients, especially where signs of severity or comorbidities are present
Determinants of recovery from post-COVID-19 dyspnoea: analysis of UK prospective cohorts of hospitalised COVID-19 patients and community-based controls
No full textData sharing statement:
PHOSP-COVID: The protocol, consent form, definition and derivation of clinical characteristics and outcomes, training materials, regulatory documents, requests for data access and other relevant study materials are available online at https://www.phosp.org.
COVIDENCE UK: De-identified participant data will be made available upon reasonable request to the corresponding author.Supplementary data is available online at: https://www.sciencedirect.com/science/article/pii/S2666776223000546?via%3Dihub#appsec1 .Copyright © 2023 The Author(s). Background: The risk factors for recovery from COVID-19 dyspnoea are poorly understood. We investigated determinants of recovery from dyspnoea in adults with COVID-19 and compared these to determinants of recovery from non-COVID-19 dyspnoea. Methods: We used data from two prospective cohort studies: PHOSP-COVID (patients hospitalised between March 2020 and April 2021 with COVID-19) and COVIDENCE UK (community cohort studied over the same time period). PHOSP-COVID data were collected during hospitalisation and at 5-month and 1-year follow-up visits. COVIDENCE UK data were obtained through baseline and monthly online questionnaires. Dyspnoea was measured in both cohorts with the Medical Research Council Dyspnoea Scale. We used multivariable logistic regression to identify determinants associated with a reduction in dyspnoea between 5-month and 1-year follow-up. Findings: We included 990 PHOSP-COVID and 3309 COVIDENCE UK participants. We observed higher odds of improvement between 5-month and 1-year follow-up among PHOSP-COVID participants who were younger (odds ratio 1.02 per year, 95% CI 1.01–1.03), male (1.54, 1.16–2.04), neither obese nor severely obese (1.82, 1.06–3.13 and 4.19, 2.14–8.19, respectively), had no pre-existing anxiety or depression (1.56, 1.09–2.22) or cardiovascular disease (1.33, 1.00–1.79), and shorter hospital admission (1.01 per day, 1.00–1.02). Similar associations were found in those recovering from non-COVID-19 dyspnoea, excluding age (and length of hospital admission). Interpretation: Factors associated with dyspnoea recovery at 1-year post-discharge among patients hospitalised with COVID-19 were similar to those among community controls without COVID-19. Funding: PHOSP-COVID is supported by a grant from the MRC-UK Research and Innovation and the Department of Health and Social Care through the National Institute for Health Research (NIHR) rapid response panel to tackle COVID-19. The views expressed in the publication are those of the author(s) and not necessarily those of the National Health Service (NHS), the NIHR or the Department of Health and Social Care. COVIDENCE UK is supported by the UK Research and Innovation, the National Institute for Health Research, and Barts Charity. The views expressed are those of the authors and not necessarily those of the funders.PHOSP-COVID: This study would not be possible without all the participants who have given their time and support. We thank all the participants and their families. We thank the many research administrators, health-care and social-care professionals who contributed to setting up and delivering the study at all of the 65 NHS trusts/Health boards and 25 research institutions across the UK, as well as all the supporting staff at the NIHR Clinical Research Network, Health Research Authority, Research Ethics Committee, Department of Health and Social Care, Public Health Scotland, and Public Health England, and support from the ISARIC Coronavirus Clinical Characterisation Consortium. We thank Kate Holmes at the NIHR Office for Clinical Research Infrastructure (NOCRI) for her support in coordinating the charities group. The PHOSP-COVID industry framework was formed to provide advice and support in commercial discussions, and we thank the Association of the British Pharmaceutical Industry as well NOCRI for coordinating this. We are very grateful to all the charities that have provided insight to the study: Action Pulmonary Fibrosis, Alzheimer's Research UK, Asthma + Lung UK, British Heart Foundation, Diabetes UK, Cystic Fibrosis Trust, Kidney Research UK, MQ Mental Health, Muscular Dystrophy UK, Stroke Association Blood Cancer UK, McPin Foundations, and Versus Arthritis. We thank the NIHR Leicester Biomedical Research Centre patient and public involvement group and Long Covid Support.
COVIDENCE UK: We thank all participants of COVIDENCE UK, and the following organisations who supported study recruitment: Asthma UK/British Lung Foundation, the British Heart Foundation, the British Obesity Society, Cancer Research UK, Diabetes UK, Future Publishing, Kidney Care UK, Kidney Wales, Mumsnet, the National Kidney Federation, the National Rheumatoid Arthritis Society, the North West London Health Research Register (DISCOVER), Primary Immunodeficiency UK, the Race Equality Foundation, SWM Health, the Terence Higgins Trust, and Vasculitis UK
Recovery in Borderline Personality Disorder (BPD): A Qualitative Study of Service Users' Perspectives
No full textPMCID: PMC3355153This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited
Colchicine in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial
No full textBackgroundColchicine has been proposed as a treatment for COVID-19 based on its anti-inflammatory actions. We aimed to evaluate the efficacy and safety of colchicine in patients admitted to hospital with COVID-19.MethodsIn this streamlined, randomised, controlled, open-label trial, underway at 177 hospitals in the UK, two hospitals in Indonesia, and two hospitals in Nepal, several possible treatments were compared with usual care in patients hospitalised with COVID-19. Patients were eligible for inclusion in the study if they were admitted to hospital with clinically suspected or laboratory confirmed SARS-CoV-2 infection and had no medical history that might, in the opinion of the attending clinician, put the patient at significant risk if they were to participate in the trial. Eligible and consenting adults were randomly assigned (1:1) to receive either usual standard of care alone (usual care group) or usual standard of care plus colchicine (colchicine group) using web-based simple (unstratified) randomisation with allocation concealment. Participants received colchicine 1 mg after randomisation followed by 500 μg 12 h later and then 500 μg twice a day by mouth or nasogastric tube for 10 days in total or until discharge. Dose frequency was halved for patients receiving a moderate CYP3A4 inhibitor (eg, diltiazem), patients with an estimated glomerular filtration rate of less than 30 mL/min per 1·73m2, and those with an estimated bodyweight of less than 70 kg. The primary outcome was 28-day mortality, secondary endpoints included time to discharge, the proportion of patients discharged from hospital within 28 days, and, in patients not on invasive mechanical ventilation at randomisation, a composite endpoint of invasive mechanical ventilation or death. All analyses were by intention-to-treat. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936.FindingsBetween Nov 27, 2020, and March 4, 2021, 11 340 (58%) of 19 423 patients enrolled into the RECOVERY trial were eligible to receive colchicine; 5610 (49%) patients were randomly assigned to the colchicine group and 5730 (51%) to the usual care group. Overall, 1173 (21%) patients in the colchicine group and 1190 (21%) patients in the usual care group died within 28 days (rate ratio 1·01 [95% CI 0·93 to 1·10]; p=0·77). Consistent results were seen in all prespecified subgroups of patients. Median time to discharge alive (10 days [IQR 5 to >28]) was the same in both groups, and there was no significant difference in the proportion of patients discharged from hospital alive within 28 days (3901 [70%] patients in the colchicine group and 4032 [70%] usual care group; rate ratio 0·98 [95% CI 0·94 to 1·03]; p=0·44). In those not on invasive mechanical ventilation at baseline, there was no significant difference in the proportion meeting the composite endpoint of invasive mechanical ventilation or death (1344 [25%] in the colchicine group vs 1343 [25%] patients in the usual care group; risk ratio 1·02 [95% CI 0·96 to 1·09]; p=0·47).InterpretationIn adults hospitalised with COVID-19, colchicine was not associated with reductions in 28-day mortality, duration of hospital stay, or risk of progressing to invasive mechanical ventilation or death.FundingUK Research and Innovation (Medical Research Council), National Institute of Health Research, and Wellcome Trust
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