Challenging Health Problems Worldwide Research Articles

Hyperosmolar therapy for acute brain injury: study protocol for an umbrella review of meta-analyses and an evidence mapping

IntroductionAcute brain injury is a challenging public health problem worldwide. Elevated intracranial pressure is a common complication after acute brain injury. Hyperosmolar therapy is one of the main therapeutic strategies...

Prevalence of Clinical Artesunate Resistance among Cases of Complicated Malaria in Southern Odisha, India

Introduction: Drug resistant malaria represents the most challenging health problem worldwide. The major threat to malaria control is the increasing incidence of complicated and drug-resistant cases. Aim: To determine the prevalence of clinical artesunate resistance among complicated malaria cases by invivo method. Materials and Methods: The study included 241 patients with complicated malaria, which showed trophozoites of malarial parasite Plasmodium in the blood smear. They were administered with artesunate monotherapy. They were then followed-up for clinical response to therapy and quantification of parasitaemia levels on day 1, day 2, day 3, day 7, day 14 and day 28. Clinical examination included core body temperature recording, assessment of associated complications like vomiting, altered sensorium, anaemia, bleeding tendencies and investigation of renal parameters, liver function test and hypoglycaemia. Results: Out of 241 complicated malaria cases showing malarial parasite in peripheral blood smear, 204 cases were of Plasmodium falciparum, 32 cases were of Plasmodium vivaxand five were cases of mixed Plasmodium falciparum and Plasmodium vivax infection. Among the 241 malaria positive cases, the most commonly associated complication was severe anaemia in 87 (36.1%) cases. All the 32 cases of Plasmodium vivax malaria and the five cases of mixed infection responded and recovered after administration of artesunate monotherapy. But among the 204 cases of Plasmodium falciparum, clinical artesunate resistance was detected in 6 (2.94%) cases and the rest 198 (97.06%) cases were sensitive to artesunate monotherapy. Conclusion: Clinical artesunate resistance was noticed in 2.94% cases of Plasmodium falciparum malaria. Hence, continuous monitoring of antimalarial therapy is required, especially in complicated cases of Plasmodium falciparum malaria, to prevent the emergence of artesunate resistance.

Identification of Key Biomarkers and Potential Molecular Mechanisms in Oral Squamous Cell Carcinoma by Bioinformatics Analysis.

The aim of this study was to explore the key genes, microRNA (miRNA), and the pathogenesis of oral squamous cell carcinoma (OSCC) at the molecular level through the analysis of bioinformatics, which could provide a theoretical basis for the screening of drug targets. Data of OSCC were obtained from Gene Expression Omnibus (GEO) database. The differentially expressed genes (DEGs) were identified via GEO2R analysis. Next, protein-protein interaction (PPI) network of DEGs was constructed through Search Tool for the Retrieval of Interacting Gene and visualized via Cytoscape, whereas the hub genes were screened out with Cytoscape. Gene ontology (GO) analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis were performed by Database for Annotation, Visualization and Integrated Discovery. The miRNA, which might regulate hub genes, were screened out with TargetScan and GO and KEGG analysis of miRNA was performed by DNA Intelligent Analysis-miRPath. Survival analyses of DEGs were conducted via the Kaplan-Meier plotter. Finally, the relationships between gene products and tumors were analyzed by Comparative Toxicogenomics Database. A total of 121 differential genes were identified. One hundred thirty-five GO terms and 56 pathways were obtained, which were mainly related to PI3K-Akt signals pathway, FoxO signaling pathway, Wnt signaling pathway, cell cycle, p53 signaling pathway, cellular senescence, and other pathways; 10 genes were identified as hub genes through modules analyses in the PPI network. Finally, a survival analysis of 10 hub genes was conducted, which showed that the low expression of matrix metalloproteinase (MMP)1, MMP3, and C-X-C motif chemokine ligand (CXCL)1 and the high expression of CXCL9 and CXCL10 resulted in a significantly poor 5-year overall survival rate in patients with OSCC. In this study, the DEGs of OSCC was analyzed, which assists us in a systematic understanding of the pathogenicity underlying occurrence and development of OSCC. The MMP1, MMP3, CXCL1, CXCL9, and CXCL10 genes might be used as potential targets to improve diagnosis and as immunotherapy biomarkers for OSCC.

Identification of Key Biomarkers and Potential Molecular Mechanisms in Renal Cell Carcinoma by Bioinformatics Analysis.

Renal cell carcinoma (RCC) is the most common form of kidney cancer, caused by renal epithelial cells. RCC remains to be a challenging public health problem worldwide. Metastases that are resistant to radiotherapy and chemotherapy are the major cause of death from cancer. However, the underlying molecular mechanism regulating the metastasis of RCC is poorly known. Publicly available databases of RCC were obtained from Gene Expression Omnibus (GEO) database. The differentially expressed genes (DEGs) were identified using GEO2R analysis, whereas the Gene Ontology (GO) analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis were performed by Gene Set Enrichment Analysis (GSEA) and Metascape. Protein-protein interaction (PPI) network of DEGs was analyzed by STRING online database, and Cytoscape software was used for visualizing PPI network. Survival analysis of hub genes was conducted using GEPIA online database. The expression levels of hub genes were investigated from The Human Protein Atlas online database and GEPIA online database. Finally, the comparative toxicogenomics database (CTD; http://ctdbase.org) was used to identify hub genes associated with tumor or metastasis. We identified 229 DEGs comprising 135 downregulated genes and 94 upregulated genes. Functional analysis revealed that these DEGs were associates with cell recognition, regulation of immune, negative regulation of adaptive immune response, and other functions. And these DEGs mainly related to P53 signaling pathway, cytokine-cytokine receptor interaction, Natural killer cell mediated cytotoxicity, and other pathways are involved. Ten genes were identified as hub genes through module analyses in the PPI network. Finally, survival analysis of 10 hub genes was conducted, which showed that the MMP2 (matrix metallo peptidase 2), DCN, COL4A1, CASR (calcium sensing receptor), GPR4 (G protein-coupled receptor 4), UTS2 (urotensin 2), and LDLR (low density lipoprotein receptor) genes were significant for survival. In this study, the DEGs between RCC and metastatic RCC were analyzed, which assist us in systematically understanding the pathogeny underlying metastasis of RCC. The MMP2, DCN, COL4A1, CASR, GPR4, UTS2, and LDLR genes might be used as potential targets to improve diagnosis and immunotherapy biomarkers for RCC.

Soluble Egg Antigen Activates M2 Macrophages via the STAT6 and PI3K Pathways, and Schistosoma Japonicum Alternatively Activates Macrophage Polarization to Improve the Survival Rate of Septic Mice.

Sepsis is one of the most challenging health problems worldwide. Our previous study showed that chronic schistosoma japonica (SJ) infection might increase serum anti-inflammatory factors to play a protective role, thus improving the survival rate of septic mice. Further research revealed that SJ infection promoted J774A.1 macrophage differentiation into M2 macrophages; suppressed LPS-induced activation of M1 macrophages; up-regulated CD163, IL-10, and TGF-β1 expression; inhibited TNF-α and iNOS expression; and blocked the effect of LPS-promoted TNF-α and iNOS expression. Furthermore, adoptive transfer of ex vivo programed M2 macrophages significantly increased the survival rate of septic mice. In vitro studies suggested that soluble egg antigen (SEA) from SJ played the same role as worm infection but had no impact on M1 macrophages. SEA reduced LPS-induced TNF-α and iNOS expression, decreased the inhibitory effect of LPS on IL-10 and TGF-β1 expression, increased STAT6 phosphorylation, and up-regulated PI3K and Akt expression but inhibited SOCS1 expression. When PI3K inhibitors were added, SEA-induced expression of CD163, IL-10, and arg1 might be reduced. Therefore, worm infection has a protective effect in septic mice in which SEA may play a key role via the STAT6 and PI3K pathways. This finding may provide a favorable solution for the treatment of sepsis, especially early cases. J. Cell. Biochem. 118: 4230-4239, 2017. © 2017 Wiley Periodicals, Inc.

The Evolving Patterns of Uremia: Unmet Clinical Needs in Dialysis.

End-stage renal disease (ESRD) has become a challenging health problem worldwide. Currently, ESRD patients treated with hemodialysis mainly undergo low-flux hemodialysis, high-flux hemodialysis (HF-HD), or hemodiafiltration (HDF). The clearance of middle and large molecules is, however, quite insufficient as regards HF-HD, HDF, and on-line HDF. An unsatisfactory prognosis has led to improved dialysis technology and materials; both protein-leaking membranes and high cut-off membranes increase the clearance of uremic toxin, but in clinical application they may induce albumin loss. Novel membranes with similar clearance efficiency but little impact on albumin leakage are yet to be developed. To enhance the removal of uremic toxins and increase membrane permeability, a high retention onset (HRO) membrane with larger pore size and HRO, once defined as medium cut-off, has been developed in the past few years. Such a membrane enables leakage of larger size molecules including albumin. The dialysis using HRO membranes has recently been proposed as expanded hemodialysis (HDx). Theoretically, HDx could promote the removal of more toxin solutes retained in the blood of ESRD patients, and improve the outcomes of dialysis. However, randomized controlled trials are required to evaluate the long-term efficacy, safety, and side effects of HDx in the future.

The impact of pharmacist-managed clinic on medication adherence and health-related quality of life in patients with COPD: a randomized controlled study.

IntroductionCOPD is rapidly becoming one of the most challenging health problems worldwide, which is characterized by not fully reversible airflow limitation. Although a lot of treatment medications have been delivered, the treatment goals of COPD are often not achieved. Furthermore, few well-designed randomized controlled trials in the People’s Republic of China have been reported to evaluate the impact of pharmacist-managed clinic (PMC) on medication adherence and health-related quality of life in patients with COPD.MethodsA prospective randomized controlled study (on a PMC group and a control group) was conducted between January 2015 and December 2015. A structured education about COPD was provided by a clinical pharmacist to the PMC group. Primary outcomes were medication adherence (assessed by medication refill adherence scores) and health-related quality of life (assessed by St George’s Respiratory Questionnaire). Secondary outcomes were exacerbation rate, hospitalization rate, and smoking behavior.ResultsA total of 244 patients were enrolled for our study. The PMC group showed a significantly greater improvement in medication adherence compared with the baseline (93.1±14.2 vs 78.8±12.3, P<0.01). When compared with the control group, there were more patients whose medication refill adherence score was ≥80 in the PMC group (83.3% vs 51.3%, P<0.01). The total St George’s Respiratory Questionnaire scores was found to be improved significantly in the PMC group (42.7±3.2 vs 52.4±5.2, P<0.05). There was a lower hospitalization rate in the PMC group, and more patients in the PMC group quit smoking (71.0% vs 52.2%, P<0.05).ConclusionThe PMC may result in improvement of medication adherence and the health-related quality of life in patients with COPD. In the PMC group, a significant reduction in exacerbation rate, hospitalization rate, and smoking behavior was observed; therefore, our study provides support for a greater involvement of PMC in the care of patients with COPD.

Research progress on hypoglycemic active components in natural products

Diabetes is one of the most challenging health problems worldwide. Commonly used anti-diabetic drugs include insulin, Pramlintide, GLP-1 receptor agonists and oral hypoglycemic. Due to the limitation of these anti-diabetic drugs related to potency, stability and cell toxicity, new drugs isolated from natural materials have been served for alternative and safe anti-diabetic medications in the most recent decade. In this manuscript, pharmacological reaction and molecular mechanism of hypoglycemic active components in natural products were discussed in detail.

Bacterial contamination of inanimate surfaces and equipment in the intensive care unit.

Intensive care unit (ICU)-acquired infections are a challenging health problem worldwide, especially when caused by multidrug-resistant (MDR) pathogens. In ICUs, inanimate surfaces and equipment (e.g., bedrails, stethoscopes, medical charts, ultrasound machine) may be contaminated by bacteria, including MDR isolates. Cross-transmission of microorganisms from inanimate surfaces may have a significant role for ICU-acquired colonization and infections. Contamination may result from healthcare workers’ hands or by direct patient shedding of bacteria which are able to survive up to several months on dry surfaces. A higher environmental contamination has been reported around infected patients than around patients who are only colonized and, in this last group, a correlation has been observed between frequency of environmental contamination and culture-positive body sites. Healthcare workers not only contaminate their hands after direct patient contact but also after touching inanimate surfaces and equipment in the patient zone (the patient and his/her immediate surroundings). Inadequate hand hygiene before and after entering a patient zone may result in cross-transmission of pathogens and patient colonization or infection. A number of equipment items and commonly used objects in ICU carry bacteria which, in most cases, show the same antibiotic susceptibility profiles of those isolated from patients. The aim of this review is to provide an updated evidence about contamination of inanimate surfaces and equipment in ICU in light of the concept of patient zone and the possible implications for bacterial pathogen cross-transmission to critically ill patients.

Luteolin as an anti-inflammatory and neuroprotective agent: A brief review.

According to the World Health Organization, two billion people will be aged 60 years or older by 2050. Aging is a major risk factor for a number of neurodegenerative disorders. These age-related disorders currently represent one of the most important and challenging health problems worldwide. Therefore, much attention has been directed towards the design and development of neuroprotective agents derived from natural sources. These phytochemicals have demonstrated high efficacy and low adverse effects in multiple in vitro and in vivo studies. Among these phytochemicals, dietary flavonoids are an important and common chemical class of bioactive products, found in several fruits and vegetables. Luteolin is an important flavone, which is found in several plant products, including broccoli, pepper, thyme, and celery. Numerous studies have shown that luteolin possesses beneficial neuroprotective effects both in vitro and in vivo. Despite this, an overview of the neuroprotective effects of luteolin has not yet been accomplished. Therefore, the aim of this paper is to provide a review of the available literature regarding the neuroprotective effects of luteolin and its molecular mechanisms of action. Herein, we also review the available literature regarding the chemistry of luteolin, its herbal sources, and bioavailability as a pharmacological agent for the treatment and management of age-related neurodegenerative disorders.

Preventing the Future Pandemic of Diabetes Mellitus in Oman.

Preventing the Future Pandemic of Diabetes Mellitus in Oman.

Pharmacogenetics: an Emerging Therapeutic option for Bangladesh

From socioeconomic point of view adverse drug reactions (ADRs) present a challenging and expensive public health problem worldwide. Most important factors involved in this life threatening events are false diagnosis, failure of treatment, lack of proper patient counseling, lack of knowledge regarding medication use and polypharmacy. Pharmacogenetic research explores genetic variability between patients to explain observed differences in effectiveness of a drug therapy as well as adverse event profile. Thus, pharmacogenetic testings could help to prevent treatment failure and adverse drug reaction in patients. It also allows the detection and prediction of ADRs and is a tool that can reduce the risks associated with ADRs. In this particular review we will discuss how genetic variation can influence drug response and how personalized medicine can be achieved as well as some recent pharmacogenetic works carried out in Bangladesh. The aim of this review is to increase awareness of the physicians and other health care practitioners and professionals about the variation of drug response due to genetic variation. This review can help the physicians to identify genetic factors associated with ADRs with all drugs and effectively incorporate pharmacogenetics into the practice of pharmacovigilance. DOI: http://dx.doi.org/10.3329/dujps.v13i2.21902 Dhaka Univ. J. Pharm. Sci. 13(2): 207-214, 2014 (December)

Skewed Epigenetics: An Alternative Therapeutic Option for Diabetes Complications.

Vascular complications are major causes of morbidity and mortality in type 2 diabetes patients. Mitochondrial reactive oxygen species (ROS) generation and a lack of efficient antioxidant machinery, a result of hyperglycaemia, mainly contribute to this problem. Although advances in therapy have significantly reduced both morbidity and mortality in diabetic individuals, diabetes-associated vascular complications are still one of the most challenging health problems worldwide. New healing options are urgently needed as current therapeutics are failing to improve long-term outcomes. Particular effort has recently been devoted to understanding the functional relationship between chromatin structure regulation and the persistent change in gene expression which is driven by hyperglycaemia and which accounts for long-lasting diabetic complications. A detailed investigation into epigenetic chromatin modifications in type 2 diabetes is underway. This will be particularly useful in the design of mechanism-based therapeutics which interfere with long-lasting activating epigenetics and improve patient outcomes. We herein provide an overview of the most relevant mechanisms that account for hyperglycaemia-induced changes in chromatin structure; the most relevant mechanism is called “metabolic memory.”

Sequence and Functional Analysis of the Envelope Glycoproteins of Hepatitis C Virus Variants Selectively Transmitted to a New Host

Hepatitis C virus (HCV) remains a challenging public health problem worldwide. The identification of viral variants establishing de novo infections and definition of the phenotypic requirements for transmission would facilitate the design of preventive strategies. We explored the transmission of HCV variants in three cases of acute hepatitis following needlestick accidents. We used single-genome amplification of glycoprotein E1E2 gene sequences to map the genetic bottleneck upon transmission accurately. We found that infection was likely established by a single variant in two cases and six variants in the third case. Studies of donor samples showed that the transmitted variant E1E2 amino acid sequences were identical or closely related to those of variants from the donor virus populations. The transmitted variants harbored a common signature site at position 394, within hypervariable region 1 of E2, together with additional signature amino acids specific to each transmission pair. Surprisingly, these E1E2 variants conferred no greater capacity for entry than the E1E2 derived from nontransmitted variants in lentiviral pseudoparticle assays. Mutants escaping the antibodies of donor sera did not predominate among the transmitted variants either. The fitness parameters affecting the selective outgrowth of HCV variants after transmission in an immunocompetent host may thus be more complex than those suggested by mouse models. Human antibodies directed against HCV envelope effectively cross-neutralized the lentiviral particles bearing E1E2 derived from transmitted variants. These findings provide insight into the molecular mechanisms underlying HCV transmission and suggest that viral entry is a potential target for the prevention of HCV infection.

Recent developments in the epidemiology and management of tuberculosis &amp;ndash; new solutions to old problems?

Tuberculosis is an ancient human disease that is still a major cause of death and one of the most challenging public health problems worldwide. After decades of stagnancy, new public–private partnerships to fight the disease and the increasing awareness of a vicious circle between the tuberculosis epidemic and the obstruction of economic development have fuelled recent progress in our understanding of the disease. As a result, new strategies to improve management and treatment of tuberculosis have been initiated. At the same time, however, the devastating effect of human immunodeficiency virus on tuberculosis susceptibility and the rapid expansion of multidrug-resistant (MDR) tuberculosis threaten to undermine the advances made by tuberculosis management programs. With an estimated 9 million new cases annually, tuberculosis affects a higher number of individuals worldwide than ever before. Here, recent developments in the epidemiology and management of tuberculosis are summarized and an overview is provided of emerging strategies to combat this ancient scourge.

The helminth product ES-62 protects against septic shock via Toll-like receptor 4–dependent autophagosomal degradation of the adaptor MyD88

Sepsis is one of the most challenging health problems worldwide. Here we found that phagocytes from patients with sepsis had considerable upregulation of Toll-like receptor 4 (TLR4) and TLR2; however, shock-inducing inflammatory responses mediated by these TLRs were inhibited by ES-62, an immunomodulator secreted by the filarial nematode Acanthocheilonema viteae. ES-62 subverted TLR4 signaling to block TLR2- and TLR4-driven inflammatory responses via autophagosome-mediated downregulation of the TLR adaptor-transducer MyD88. In vivo, ES-62 protected mice against endotoxic and polymicrobial septic shock by TLR4-mediated induction of autophagy and was protective even when administered after the induction of sepsis. Given that the treatments for septic shock at present are inadequate, the autophagy-dependent mechanism of action by ES-62 might form the basis for urgently needed therapeutic intervention against this life-threatening condition.

Innate Immunity and Sepsis: MyD88 as a Target for Therapeutics

Sepsis is one of the most challenging health problems worldwide. In the USA alone, around three-quarters of a million cases occur every year, and the fatality rate remains between 30% and 50% [1]. A recent report indicates that between 1999 and 2005, sepsis contributed to 6% of all deaths in the United States [2]. Treating sepsis remains problematic, as no effective anti-sepsis drug is currently available.

Adolescent Substance Abuse: Psychiatric Comorbidity and High Risk Behaviors

Back to table of contents Previous article Next article Book ReviewFull AccessAdolescent Substance Abuse: Psychiatric Comorbidity and High Risk BehaviorsLisa R. Fortuna M.D., M.P.H.Lisa R. Fortuna M.D., M.P.H.Search for more papers by this authorPublished Online:13 Jan 2015https://doi.org/10.1176/ps.2009.60.1.128AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail The book Adolescent Substance Abuse by Yifrah Kaminer and Oscar G. Bukstein is a must-have for anyone interested in the most up-to-date knowledge in adolescent substance abuse. Both authors of this text have their main interest and expertise in clinical research, particularly in the assessment and treatment of adolescents with comorbid substance use disorders and psychiatric disorders and other high-risk behaviors. Based on their many years of experience in treatment research on adolescent substance use problems, they have written this highly informative book. This is likely one of the most comprehensive texts to cover the knowledge base on adolescent dual diagnosis. This book has brought all the critical pieces together, providing an overall picture of the most important comorbid diagnoses associated with adolescent substance abuse. The book is organized into several sections and starts with etiology, course, assessment, and treatment interventions. The middle section addresses the specific comorbid psychiatric disorders (depression, bipolar disorder, attention-deficit hyperactivity disorder, obsessive-compulsive disorder, schizophrenia, posttraumatic stress disorder, anxiety, and eating disorders) as well as other high-risk behaviors (gambling and suicidal or nonsuicidal self-harm behaviors). Finally, the last section talks about the integration of services for adolescent substance use disorders and mental health problems, as well as ethical, legal, and policy issues in the treatment of dual diagnoses among adolescents.Adolescence is the developmental period during which experimental use of substances is considered normative in today's society. However, substance use puts millions of adolescents at risk, and for some it results in impairment in daily functioning while interfering with the achievement of developmental tasks. This book gives the reader A-to-Z information, from statistics to interventions. Several chapters include tables, graphs, figures, and flowcharts that clearly display the data and enable the reader to understand the material easily and clearly. The language used in this book is understandable without any extensive knowledge of technical terminology. This book can therefore be read by a diverse readership with clinical, research, and public health interests.This book will also interest the person who has just stepped into the amazing field of adolescent clinical research. It has a rich bibliography and extensive references to published studies. Ninety percent of the studies referenced are from within the past seven years. It also introduces the reader to current ongoing research projects in the field. At the end of every chapter there is a section called "Future Directions for Research" that stimulates ideas for new research protocols.Accurate assessment directs physicians toward the best treatment planning and intervention. This book provides an in-depth review of the latest screening measures and treatment interventions. The treatment interventions discussed include both pharmacological and psychological approaches, and those with strong evidence or promise are identified. One more thing that sets this book apart from others of its genre is its insightful coverage of integrated treatment models and how to deal with the complex ethical, legal, and policy issues that arise in the treatment of co-occurring substance use and mental health problems among adolescents.In summary, adolescent substance use disorders continue to present a challenging public health problem worldwide. The main objective of this book is to address theory and practice pertaining to understanding and improving treatment of psychiatric comorbidity among adolescents with substance use disorders. That objective is 100% achieved.Dr. Fortuna is professor of psychiatry, University of Massachusetts Medical School, Worcester. FiguresReferencesCited byDetailsCited ByNone Volume 60Issue 1 January, 2009Pages 128-128PSYCHIATRIC SERVICES January 2009 Volume 60 Number 1 Metrics PDF download History Published online 13 January 2015 Published in print 1 January 2009

Adolescent Substance Abuse: Psychiatric Comorbidity and High Risk Behaviors

Back to table of contents Previous article Next article Book ReviewFull AccessAdolescent Substance Abuse: Psychiatric Comorbidity and High Risk BehaviorsLisa R. Fortuna M.D., M.P.H.Lisa R. Fortuna M.D., M.P.H.Search for more papers by this authorPublished Online:13 Jan 2015https://doi.org/10.1176/ps.2009.60.1.128AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail The book Adolescent Substance Abuse by Yifrah Kaminer and Oscar G. Bukstein is a must-have for anyone interested in the most up-to-date knowledge in adolescent substance abuse. Both authors of this text have their main interest and expertise in clinical research, particularly in the assessment and treatment of adolescents with comorbid substance use disorders and psychiatric disorders and other high-risk behaviors. Based on their many years of experience in treatment research on adolescent substance use problems, they have written this highly informative book. This is likely one of the most comprehensive texts to cover the knowledge base on adolescent dual diagnosis. This book has brought all the critical pieces together, providing an overall picture of the most important comorbid diagnoses associated with adolescent substance abuse. The book is organized into several sections and starts with etiology, course, assessment, and treatment interventions. The middle section addresses the specific comorbid psychiatric disorders (depression, bipolar disorder, attention-deficit hyperactivity disorder, obsessive-compulsive disorder, schizophrenia, posttraumatic stress disorder, anxiety, and eating disorders) as well as other high-risk behaviors (gambling and suicidal or nonsuicidal self-harm behaviors). Finally, the last section talks about the integration of services for adolescent substance use disorders and mental health problems, as well as ethical, legal, and policy issues in the treatment of dual diagnoses among adolescents.Adolescence is the developmental period during which experimental use of substances is considered normative in today's society. However, substance use puts millions of adolescents at risk, and for some it results in impairment in daily functioning while interfering with the achievement of developmental tasks. This book gives the reader A-to-Z information, from statistics to interventions. Several chapters include tables, graphs, figures, and flowcharts that clearly display the data and enable the reader to understand the material easily and clearly. The language used in this book is understandable without any extensive knowledge of technical terminology. This book can therefore be read by a diverse readership with clinical, research, and public health interests.This book will also interest the person who has just stepped into the amazing field of adolescent clinical research. It has a rich bibliography and extensive references to published studies. Ninety percent of the studies referenced are from within the past seven years. It also introduces the reader to current ongoing research projects in the field. At the end of every chapter there is a section called "Future Directions for Research" that stimulates ideas for new research protocols.Accurate assessment directs physicians toward the best treatment planning and intervention. This book provides an in-depth review of the latest screening measures and treatment interventions. The treatment interventions discussed include both pharmacological and psychological approaches, and those with strong evidence or promise are identified. One more thing that sets this book apart from others of its genre is its insightful coverage of integrated treatment models and how to deal with the complex ethical, legal, and policy issues that arise in the treatment of co-occurring substance use and mental health problems among adolescents.In summary, adolescent substance use disorders continue to present a challenging public health problem worldwide. The main objective of this book is to address theory and practice pertaining to understanding and improving treatment of psychiatric comorbidity among adolescents with substance use disorders. That objective is 100% achieved.Dr. Fortuna is professor of psychiatry, University of Massachusetts Medical School, Worcester. FiguresReferencesCited byDetailsCited ByNone Volume 60Issue 1 January, 2009Pages 128-128PSYCHIATRIC SERVICES January 2009 Volume 60 Number 1 Metrics PDF download History Published online 13 January 2015 Published in print 1 January 2009