Need For Treatment Interventions Research Articles

Clients’ experiences with a Trauma-sensitive mindfulness and compassion group intervention: a first-person perspective on change and change mechanisms

Background: Trauma-related symptoms are common and there is a need for treatment interventions targeting underlying core vulnerabilities regardless of the client’s diagnosis. Mindfulness and Compassion interventions have shown promising results in trauma treatment. However, little is known of how clients experience such interventions. Objective: This study describes clients’ experiences of change after participating in a transdiagnostic group intervention, Trauma-sensitive Mindfulness and Compassion Group (TMC). Method: All 17 participants from two TMC groups were interviewed within one month of completing treatment. Transcripts were analysed using reflexive thematic analysis with a focus on how the participants experienced change and change mechanisms. Results: Three main themes of experienced change were developed: Becoming empowered; A new relationship to oneself and one’s body; and Gaining more freedom in relationships and life. Four main themes were developed to capture clients’ experiences of change mechanisms: New perspectives give understanding and hope; Accessing tools facilitates agency; Significant moments of awareness open up to new possibilities, and Circumstances in life that facilitate change. Conclusion: We discuss and reflect upon participants’ experiences of the effects of participating in a TMC group and the mental and emotional costs of doing the work and present a broader perspective on change processes overall.

Characteristics and Outcomes of Patient Transport to the Hospital by Emergency Medical Services (EMS); a Cross-sectional Study.

To enhance the efficiency, it is essential to understand the patterns of service users and develop policies that facilitate effective personnel and resource management. This study aimedto compare the characteristic and outcomes of patients who were transferred to emergency department (ED) by emergency medical services (EMS) and patients transported by other means. This retrospective cross-sectional study was conducted at Srinagarind Hospital, Thailand, over a 5-year period from 2017-2021. The baseline characteristics, treatment modalities, and outcomes of patients who were transported to ED using EMS and Non-EMS were gathered and compared using STATA software. The study included 15,501 patients with the median age of 51 (interquartile range (IQR): 23-71) years who were referred by EMS over the five-year period (51.72% male). EMS patients had significantly higher median age (51 (23 - 71) vs. 37 (21 - 60); p < 0.001) with male preference (p < 0.001). In the EMS group, the triage level 1 (need for resuscitation) was higher than the non-EMS group (p < 0.001), most of the patients referred following trauma (p < 0.001), and the frequency of cardiac arrest was considerably higher than non-EMS group (2.54% vs 0.05%; p < 0.001). Patients in the EMS group received a higher number of blood tests (p < 0.001), plain radiographic exams (p < 0.001), computerized tomography (CT) scans (p < 0.001), and complex procedures (p < 0.001) than the non-EMS group. The EMS group had a greater number of hospital admissions (p < 0.001) and intensive care unit (ICU) admissions (p < 0.001) compared to the non-EMS group. The EMS group exhibited a significantly higher mortality rate compared to the non-EMS group (p < 0.001). The population utilizing EMS services had higher median age, higher frequency of emergency cases and trauma related complaint, higher need for treatment interventions and imaging procedures, higher rate of hospital and ICU admissions, as well as higher rate of mortality compared to the non-EMS group.

Prostate-Specific Antigen Doubling Time Kinetics following Radical Prostatectomy to Guide Need for Treatment Intervention: Validation of Low-Risk Recurrences.

Simple SummaryBiochemical recurrence following radical prostatectomy is concerning but does not accurately predict cancer progression or death. In our patients with a biochemical recurrence, we explore whether PSA doubling time kinetics can safely guide avoidance of treatment, preventing unwanted side effects and costs. In our study, initial PSADT and subsequent DT patterns were the only predictors of no need for treatment. Gleason grade group, pathological stage, preoperative PSA, and age were not significant predictors of treatment. Approximately one-third of BCRs observed in this cohort following RP were determined to be low-risk and able to be safely followed without treatment using PSADT kinetics, with a 100% cancer-specific survival after 7.6 years of follow-up.Biochemical recurrence (BCR) following radical prostatectomy (RP) has a limited ability to predict prostate cancer (PC) progression, leading to overtreatment, decreased quality of life, and additional expenses. Previously, we established that one-third of men with BCR in our group experienced low-risk recurrences that were safely observed without treatment. Our retrospective cohort analysis of 407 BCR patients post RP validates the use of PSA doubling time (DT) kinetics to direct active observation (AO) versus treatment following RP. The primary outcome was no need for treatment according to the predictive value of models of ROC analysis. The secondary outcome was PC-specific mortality (PCSM) according to Kaplan–Meier analysis. A total of 1864 men underwent RP (June 2002–September 2019); 407 experienced BCR (PSA > 0.2 ng/dL, ×2), with a median follow-up of 7.6 years. In adjusted regression analysis, initial PSADT > 12 months and increasing DT were significant predictors for AO (p < 0.001). This model (initial PSADT and DT change) was an excellent predictor of AO in ROC analysis (AUC = 0.83). No patients with initial PSADT > 12 months and increasing DT experienced PCSM. In conclusion, the combination of PSADT > 12 months and increasing DT was an excellent predictor of AO. This is the first demonstration that one-third of BCRs are at low risk of PCSM and can be managed without treatment via DT kinetics.

MP57-19 VALIDATION OF PROSTATE SPECIFIC ANTIGEN DOUBLING TIME KINETICS FOLLOWING RADICAL PROSTATECTOMY TO GUIDE ACTIVE OBSERVATION AND INTERVENTION

You have accessJournal of UrologyCME1 May 2022MP57-19 VALIDATION OF PROSTATE SPECIFIC ANTIGEN DOUBLING TIME KINETICS FOLLOWING RADICAL PROSTATECTOMY TO GUIDE ACTIVE OBSERVATION AND INTERVENTION Erica Huang, Linda My Huynh, Adam Gordon, Ryan Chandhoke, Blanca Morales, Douglas Skarecky, Joshua Tran, and Thomas Ahlering Erica HuangErica Huang More articles by this author , Linda My HuynhLinda My Huynh More articles by this author , Adam GordonAdam Gordon More articles by this author , Ryan ChandhokeRyan Chandhoke More articles by this author , Blanca MoralesBlanca Morales More articles by this author , Douglas SkareckyDouglas Skarecky More articles by this author , Joshua TranJoshua Tran More articles by this author , and Thomas AhleringThomas Ahlering More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002640.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Biochemical recurrence (BCR) following radical prostatectomy (RP) has limited ability to predict metastatic progression or prostate cancer specific mortality (PCSM). In our experience, a significant number of men with BCR have non-lethal BCR that can be safely observed based on PSA doubling time (DT) and subsequent DT change without radiation (RT) and/or androgen deprivation therapy (ADT). The present study seeks to validate the use of DT kinetics to direct active observation (AO) and intervention. METHODS: A retrospective cohort analysis of 1864 men who underwent RP between June 2002 and September 2019 was conducted. Patients were assessed for treatment intervention (RT and/or ADT) versus AO with DT kinetics. Our main outcome was the predictive value of multivariate regression models for no treatment via ROC analysis. Secondary outcomes were PCSM via Kaplan-Meier analysis. RESULTS: 407/1864 (21.8%) men experienced BCR (PSA >0.2 ng/dl, x2), with median follow-up of 7.6 years (IQR 3.3-11.9) (Table 1). In multivariable analysis, DT >12 months (OR: 8.93, 95%CI: 4.53, 17.6) and increasing DT (OR: 5.49, 95%CI: 2.81, 10.71) were significant predictors for continued observation without treatment (p <0.001), while pGGG, p-stage, age, and preoperative PSA were not. This model was an excellent predictor for continued no treatment (AUC=0.83). No patients with DT >12 months, increasing DT experienced PCSM (Figure 1). CONCLUSIONS: In our experience, one third of patients with BCR were observed without RT and/or ADT, with 0% PCSM at mean 7.6 years follow-up. DT >12 months and increasing DT were excellent predictors of no need for treatment. We introduce PSA kinetics as a means for guiding need and/or no need for treatment intervention. Source of Funding: N/A © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e989 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Erica Huang More articles by this author Linda My Huynh More articles by this author Adam Gordon More articles by this author Ryan Chandhoke More articles by this author Blanca Morales More articles by this author Douglas Skarecky More articles by this author Joshua Tran More articles by this author Thomas Ahlering More articles by this author Expand All Advertisement PDF DownloadLoading ...

Clinical Profile of Post-vaccination COVID-19-Positive Patients

Background: Government of India launched the National COVID Vaccination Program with two vaccines, BBV152 (Covaxin) and AZD1222-ChAdOx1-S (Covishield). Both these vaccines have shown an efficacy of 78% and 63.1%, respectively, in clinical trials. It is evident that there still will be post-vaccination COVID-19-positive patients. However, there are no data regarding the severity and clinical profile of these vaccines in real world scenario. Hence, through this study, we aimed to assess clinical profile of patients of COVID-19 post-vaccination and evaluate the severity of the disease. Materials and Methods: This hospital-based cross-sectional study was done in a dedicated COVID Hospital with 1800 beds including 350 ICU beds after an Institutional Ethics Committee (IEC) approval. Confirmed COVID-19 RT–PCR-positive patients admitted to the DCH from March 10, 2021 to May 10, 2021 were asked history of vaccination and subjected to a predesigned standardized study proforma. Blood investigations were done at regular intervals. Regular standard of care was given to all patients. All cases post AZD1222 (Covishield) vaccine were categorized into two groups depending on the number of doses received and the data were statistically analyzed. Conclusion: As demonstrated by biochemical and radiological evaluation, two doses of the vaccine significantly reduced the severity of COVID-19 disease compared with a single dose, reducing the need for treatment interventions and also reducing the duration of hospitalization.

The unheard parental cry of a stillbirth: fathers and mothers.

Our objective was to compare the prevalence of depression, anxiety, stress, and domestic violence among parents after a stillbirth vs. livebirths and assessing of the need for psychological and pharmacological interventions for the affected individuals. This was a prospective cohort study conducted in a tertiary care public sector hospital Northern India. 150 consecutive couples with a recent stillbirth (group 1) and 150 couples with a recent live birth (group 2) were enrolled. They were screened for depression (EPDS scale), anxiety (GAD-7), stress (PSS). Apriori sample size was calculated. Screen positive mothers and fathers were compared for the presence of depression, anxiety and stress, domestic violence, and need for treatment interventions. Depression was higher in group 1 mothers (39.3 vs 14.0%, p < 0.001) as well as fathers (18.1 vs 6.7%, p value = 0.022). Anxiety and moderate to severe stress were also significantly higher in stillborn than liveborn groups respectively. Characteristics associated with higher risk are analyzed. Domestic violence was found in 6.7% in group 1 and 2.7% in group 2 mothers (p value 0.169). Pharmacotherapy and counselling were required by 11.3 and 18.0% in stillbirth versus 3.3 and 18.7% in livebirth group, respectively. Couples suffering stillbirths are at higher risk of depression, anxiety, and stress. We highlight this obstetrical public health issue, especially for the low middle income countries (LMIC) and advocate development of health policies for mental health screening of couples suffering stillbirths.

Association of the Triglyceride/High-Density Lipoprotein Cholesterol Index with Insulin Resistance in a Pediatric Population in Northeast Mexico.

Background: The present study aimed to determine the association of the triglyceride/high-density lipoprotein cholesterol (TG/HDL-C) index with IR in pediatric patients with overweight (OW) and OB, to assess the ability of the TG/HDL-C index to predict IR, and to estimate the prevalence of IR and metabolic syndrome (MetS). Methods: A cross-sectional study comprised 628 Mexican children (2-16 years old) from the OB clinic. IR was estimated using the HOMA-IR index (‡2.5). The modified Adult Treatment Panel III criteria were used to define MetS. Correlation analyses and a receiver operating characteristic (ROC) curve were used to assess the association of the TG/HDL-C index with IR and to establish the best cutoff for the TG/HDL-C index. Results: About 79.3% of the children presented IR and 55.4% MetS. Common findings in patients with IR were acanthosis nigricans (94.8%) and a TG/HDL-C index ‡2.27 (70.5%). Considering all the patients with a high TG/HDL-C index, 78.4% presented MetS, and 88.0% IR. The area under the curve-ROC for the ability of the TG/HDL-C index to predict IR was 0.72 (P < 0.001), with a sensitivity of 70.5% and specificity of 63.1%. Conclusions: TG/HDL-C index is a feasible alternative to the HOMA-IR index to predict IR in Mexican children with OW or OB. It might be used to identify children with the greatest need for treatment interventions.

Does Self-Change Occur Among Severely Dependent Substance Users?

ABSTRACT The aims of the current study were to examine differences between self-changers (SC) and treatment-changers (TC) in sociodemographic, personal characteristics, severity of substance use disorders (SUDs), and psychiatric problems, and to predict the severity of SUDs, psychiatric problems, and belonging to the SC group. The sample included 229 Israeli respondents (134 SC and 95 TC). Significant differences between the two groups were found. The SC were younger, had a higher sense of coherence, and reported more cannabis use. The TC were involved more in crime and had experienced more child abuse and severe psychiatric problems compared with the SC. No significant group differences were found in the severity of substance dependence. The findings suggested that severity of SUDs did not differentiate between the groups, but the severity of psychiatric problems and history of child abuse did. This indicates a need for treatment interventions targeting all three issues of childhood trauma, SUDs, and psychiatric problems.

Electrocardiographic variables in children with syndromic craniosynostosis and primary snoring to mild obstructive sleep apnea: significance of identifying respiratory arrhythmia during sleep

BackgroundIn the spectrum of children with symptomatic sleep disordered breathing (SDB), some individuals – such as those with upper airway resistance syndrome (UARS) – do not have abnormalities on polysomnography (PSG). In this study we have assessed whether assessment of respiratory arrhythmia (RA) and heart rate variability (HRV) analysis helps in management of children with syndromic craniosynostosis and none-to-mild obstructive sleep apnea (OSA). MethodsProspective cohort study in children aged 1–18 years old with syndromic craniosynostosis. Children were selected for HRV analysis from the ECG if their obstructive apnea–hypopnea index (oAHI) was between zero and five per hour (ie, oAHI ≤5/hour). Subjects were divided into groups based on the presence or absence of respiratory arrhythmia (with or without RA respectively) using the electrocardiogram (ECG). The main analysis included studying the relationship between RA and HRV, symptoms, interventions, and sleep architecture. ResultsWe identified 42 patients with, at worst, mild OSA. We found higher parasympathetic control and higher total power in children with RA during the non-rapid eye movement (non-REM) sleep. Children with RA also have a relatively higher percentage of paradoxical breathing during non-REM sleep (P = 0.042). Intracranial hypertension was distributed equally between groups. Last, RA patients showed increased parasympathetic activity that further increased in non-REM sleep. ConclusionIn syndromic craniosynostosis cases with SDB and PSG showing oAHI ≤5/hour, the presence of RA may indicate subsequent need for treatment interventions, and a trend toward higher occurrence of clinical symptoms. ECG analyses of HRV variables in subjects with RA demonstrate increased parasympathetic activity and total power. Such findings may add to the diagnosis of apparently asymptomatic children.

The influence of military sexual trauma on returning OEF/OIF male veterans.

Military sexual trauma (MST) encompasses experiences of sexual harassment and/or assault that occur during active duty military service. MST is associated with postdeployment mental health, interpersonal, and physical difficulties and appears to be more influential in the development of posttraumatic stress disorder (PTSD) than other active duty experiences, including combat, among women veterans. Although some literature suggests that men who experience MST also evidence significant postdeployment difficulties, research in this area is lacking. The current study evaluated a large sample of returning male veterans (N = 961) who served in Iraq and/or Afghanistan. Veterans were referred for treatment in a trauma and anxiety specialty clinic at a large VA hospital. Of this sample, 18% (n = 173) reported MST perpetrated by a member of their unit. Results indicated veterans who reported MST were younger (p = .001), less likely to be currently married (p < .001), more likely to be diagnosed with a mood disorder (p = .040), and more likely to have experienced non-MST sexual abuse either as children or adults (p < .001). Analyses revealed that MST was negatively associated with postdeployment social support (p < .001 and positively associated with postdeployment perceived emotional mistreatment (p = .004), but was not associated with postdeployment loss of romantic relationship (p = .264), job loss (p = .351), or unemployment (p = .741) after statistically controlling for other trauma exposures and current social support. Results reflect the detrimental associations of MST on male veterans and the need for more research in this area. These findings also highlight the need for treatment interventions that address social and interpersonal functioning in addition to symptoms of depressive disorders.

Intranasal therapies for acute seizures.

Most seizure emergencies occur outside of the hospital, and there is a need for treatment interventions that can be administered quickly and safely by nonclinical caregivers. Intranasal benzodiazepine administration does not require intravenous access and offers rapid seizure cessation. Intranasal midazolam is faster at aborting seizure activity than rectal diazepam and quicker to administer than intravenous diazepam. Although time to seizure cessation varies from study to study, intranasal midazolam is efficacious when administered not only by emergency department personnel but also by paramedics and caregivers in out-of-hospital and home settings. Absorption of midazolam intranasal formulations appears to be relatively rapid compared to diazepam formulations. Its shorter elimination half-life may also be beneficial in that patients may more quickly return to normal function because of rapid offset of effect. On the other hand, the faster rate of elimination of midazolam may expose patients to a higher rate of seizure recurrence compared with diazepam. Two diazepam formulations and one midazolam formulation are being currently developed for intranasal use. This article is part of a Special Issue entitled "Status Epilepticus".

Incidence and Management of Hematological Toxicities Associated with Treatment of Hepatitis C Virus Infection in Cancer Patients

▪BackgroundHematologic toxicity is a common treatment complication of chronic hepatitis C virus (HCV) infection, especially when interferon (IFN) and ribavirin are used. The side effects of treatment are often augmented in cancer patients due to baseline cytopenias. These adverse events often lead to dose reduction or discontinuation of antivirals. Hematopoietic growth factors (GF) and blood transfusions are used to counteract toxicities allowing patients to complete treatment. We aimed to evaluate the incidence and management of hematological toxicity associated with different types of HCV treatment in cancer patients.MethodsMedical records of cancer patients treated for HCV infection at MD Anderson Cancer Center between 2009 and 2014 were reviewed. Those seen from 8/2009 to 10/2012 were analyzed retrospectively, whereas those seen from 11/2012 to 7/2014 were prospectively studied. Patients who received combination treatment with peg-IFN and ribavirin (PR), telaprevir or boceprevir plus PR (TBPR), sofosbuvir plus PR (SPR), sofosbuvir with simeprevir (SS) and sofosbuvir with ribavirin (SR) were included in the study. Data regarding treatment interventions (dose reductions and/or discontinuation of antivirals), use of GFs or blood transfusions in the management hematological side effects were analyzed. Categorical variables were analyzed using the χ2 or Fischer’s exact test.ResultsSixty-five patients were identified (Table). The need for treatment interventions, GFs or blood transfusions was comparable between patients with hematologic malignancies and solid tumors. Seventeen (81%) of the PR group, 13 (93%) of the TBPR group, 6 (67%) of the SPR group, 9 (64%) of the SR group and 0 of the SS group required treatment interventions (p <0.001) (Figure). Twelve (57%) of the PR group, 9 (64%) of the TBPR group, 3 (33%) of the SPR group, 2 (14%) of the SR group and 0 of SS group required the use of GFs (p <0.01). Six (29%) patients of the PR group, 9 (64%) from the TBPR group, 1 (11%) from the SPR group, 1 (7%) from the SR group and 0 from the SS group received blood transfusions (p <0.01). From patients who received GFs (N=26), 2 received epoetin alfa, 11 darbepoetin alfa, 2 filgrastim, 17 pegfilgrastim, 4 eltrombopag and 1 romiplostim. Ten of them (39%) required multiple GFs, with darbepoetin alfa and pegfilgrastim being the most common combination. Combined use of GFs was only needed in those receiving TBPR (56%), PR (33%) or SPR (33%). Overall, 82% of the patients who received treatment interventions, 77% of those who received GFs and 47% of those who received blood transfusions were able to complete HCV treatment. Thirteen patients (62%) from the PR group, 12 (86%) from the TBPR group, 3 (33%) from the SPR group, 2 (14%) from the SR group and 0 from the SS group developed grade 3 or 4 hematologic toxicities (p <0.001). One (25%) of 4 patients receiving eltrombopag developed portal vein thrombosis. No other patients developed side effects attributed to GF support.ConclusionsHematologic toxicity during HCV treatment in cancer patients is common. The use of GFs helps manage such toxicity, allowing completion of antiviral therapy. The newer HCV direct-acting antiviral agents are associated with less hematological toxicity, requiring fewer interventions, GFs and blood transfusions. No hematologic side effects were seen with the IFN-free, ribavirin-free combination of SS.Abstract 4126. TableCharacteristics of HCV-infected cancer patients treated with different antiviral regimensPR (N=21)%TBPR (N=14)%SPR (N=9)%SR (N=14)%SS (N=7)%Age, median (range)54.3 (45-68)59.7 (49-69)54.7 (35-75)62.7 (33-82)60.9 (46-64)Male gender13 (62)6 (43)4 (44)8 (57)4 (57)Type of cancer Solid Hematologic16 (76)5 (24)10 (71)4 (29)4 (44)5 (56)6 (43)8 (57)4 (57)3 (43)Cirrhosis5 (24)7 (50)2 (22)3 (21)6 (86)Baseline labs, median (range) Hemoglobin (g/dL) Platelets (x1,000 K/uL) Absolute Neutrophil count (K/uL)12.8 (10-15.9)165 (83-408)1385 (940-6120)13.5 (9.6-16.3)112 (52-397)2360 (800-4900)13.8 (8.8-14.2)183 (121-268)2680 (1650-5810)13.1 (9.8-15.5)179 (57-390)2490 (1040-4040)13.8 (12.3-16.1)141 (59-239)3000 (1390-5030)FDA-recommended duration of antiviral treatment, weeks24-4824-481212-2412Duration of antiviral treatment, median (range)24 (2-48)19 (3-52)12 (1-12)*12 (3-24)*6 (3-12)**Patients may still be on treatment. [Display omitted] DisclosuresTorres:Genentech,: Consultancy; Vertex Pharmaceuticals: Consultancy, Research Funding; Merck & Co., Inc. : Consultancy, Research Funding; Gilead Sciences: Consultancy.

Cognitive Behavioral Treatment for Recurrent Binge Eating in Adolescent Girls: A Pilot Trial

There is a need for treatment interventions to address the high prevalence of disordered eating throughout adolescence and early adulthood. We developed an adolescent-specific manualized CBT protocol to treat female adolescents with recurrent binge eating and tested its efficacy in a small, pilot randomized controlled trial. We present lessons learned in recruiting adolescents, a description of our treatment approach, acceptability of the treatment for teens and parents, as well as results from the pilot trial. Participants in the CBT group had significantly fewer posttreatment eating binges than those in a treatment as usual/delayed treatment (TAU-DT) control group; 100% of CBT participants were abstinent at follow-up. Our results provide preliminary support for the efficacy of this adolescent adaptation of evidence-based CBT for recurrent binge eating. The large, robust effect size estimate observed for the main outcome (NNT=2) places this among the larger effects observed for any mental health intervention.

Treatment of Perinatal Mood and Anxiety Disorders: A Review

To review the nonpharmacologic and pharmacologic treatment modalities for perinatal mood and anxiety disorders and to discuss the importance of weighing the risks and the benefits of exposing the fetus or baby to maternal mental illness as opposed to exposure to antidepressant medications. We conducted a literature search of the PubMed and MEDLINE databases. Key words included the following: perinatal, pregnancy, postpartum, depression, anxiety, pharmacologic, nonpharmacologic, psychotherapy, and treatment. Recent literature reflects that both pharmacologic and nonpharmacologic treatments for perinatal women are associated with positive and negative outcomes. No treatment decision was found to be risk-free. The detrimental effects of untreated mental illness on the mother, as well as on the baby, highlight the need for treatment intervention. The long-term effects of exposure to either medications or maternal mental illness are unknown, as yet. Women with perinatal depression and anxiety disorders require timely and efficient management with a goal of providing symptom relief for the suffering mother while simultaneously ensuring the baby's safety. Although knowledge in the area of appropriate intervention is constantly evolving, rigorous and scientifically sound research in the future is critical.

HIV and liver disease forum: Conference proceedings

Liver disease has emerged as one of the major causes of morbidity and mortality among patients infected with the human immunodeficiency virus (HIV), particularly in regions where highly active antiretroviral therapy (ART) is widely available. This dramatic change in disease epidemiology is attributable to a complex interaction between etiologic factors that appear to increase the rate of hepatic fibrosis and accelerate progression to end-stage liver disease. Key factors include ART related hepatoxicity, frequent coinfection with hepatitis B and C, and possibly the direct interaction of HIV virus or soluble protein viral products that interact with hepatocytes and other liver resident cell types. Additionally, there is some evidence that gut permeability is altered during active HIV replication, which affects the complex mix of toxins and growth factors present in the portal circulation. It is critical that hepatologists maintain a strong knowledge base to provide the best possible guidance to HIV-infected patients and their healthcare providers. To this end, the second international forum on HIV and Liver Disease was convened in Jackson Hole, WY in September 2008. The first forum, held two years earlier was previously summarized in Hepatology, and has been widely cited by experts in the field.1 However, the fast moving nature of this critical health issue led to development of a second meeting, supported by grants from three institutes of the National Institutes of Health (NIAID, NIDDK, NIAAA) and by unrestricted grants provided by the pharmaceutical industry. As before, the meeting sought to bring together basic and clinical researchers representing multiple disciplines including hepatology, infectious diseases, epidemiology, virology, and drug development as well as governmental experts in health policy, research and research funding. This document provides a summary of key presentations and highlights the current state of knowledge and future directions this field will take.

Regret after Sex Reassignment Surgery in a Male-to-Female Transsexual: A Long-Term Follow-Up

This case report describes a four-decade presentation of a non-homosexual gender dysphoric male patient. The case material was collected from two main sources. One of the authors had weekly therapy sessions with the patient over a period of 2 years almost 15 years after sex reassignment surgery. Information was also gained from the patient's medical records covering the period from the early 1960s to the early 1990s. Over the years, the patient fulfilled the criteria for different diagnoses: overanxious reaction of childhood, fetishism and transvestism during adolescence, and transsexualism during adolescence and early adulthood. The purpose of this report was to shed light on aspects of regret, its manifestation in a male-to-female transsexual with psychiatric co-morbidity, and to show the complexity of the process of adjustment when regret is involved. The present case is an argument for a strict interpretation of the Standards of Care provided by the Harry Benjamin International Gender Dysphoria Association in terms of evaluating patients' mental health, apart from the evaluation of the gender identity disorder, and the patients' subsequent need for treatment interventions.

Substance Use Disorders in Gay/Bisexual Men With HIV and AIDS

The authors conducted a longitudinal study of psychological adaptation to AIDS in subjects with and without lifetime and current substance use disorders (SUD), in a cohort of HIV+ gay/bisexual subjects. A sample of HIV+ gay/bisexual men (n = 183) and an HIV- comparison group (n = 84) were assessed for SUD, depression, and anxiety disorders. Among HIV+ men, combined lifetime (42%) but not current (11.5%) SUDs were more prevalent than in HIV- men (27% and 10%, respectively). HIV+ men with current SUD reported more depression, distress and diminished quality of life than HIV+ men with no SUD, but HIV-illness severity did not differ. HIV+ men in recovery did not differ from men with no lifetime history. Most HIV+ gay/bisexual men with SUD discontinue or reduce substance use before or subsequent to knowledge of their HIV infection, probably in an attempt to adopt a healthier lifestyle. However, for some HIV+ men, persistent substance abuse/dependence is accompanied by higher levels of distress and diminished quality of life, underscoring their need for treatment intervention.

Family survivors of homicide victims: Theoretical perspectives and an exploratory study

AbstractLittle empirical information is available on the impact of homicide on surviving family members. Existing descriptions fall into a dichotomy of grief theory and those reporting symptoms of Post‐traumatic Stress Disorder. This pilot study offers a multidimensional formulation which combines symptoms reported across previous studies. Participants were 19 survivors recruited through a victim witness program and a victim rights organization. A learning model, Mowrer's Two Factor Theory, was applied to explain the acquisition and maintenance of post‐traumatic symptoms. Consistent with this model, survivors reported recurrent homicide‐related intrusions and avoidance behaviors on the Horowitz Impact of Event Scale (IES). Comparison of survivors' IES scores with those of victims of rape, loss of a family member, and other trauma revealed a high frequency of symptoms. Mean length of time since homicide was 2.5 years. The Derogatis Symptom Check List 90‐Revised (SCL9O‐R) revealed a high level of general psychiatric distress, with 66% of survivors meeting “caseness” criteria, indicating a need for treatment intervention. A 7‐point Likert scale measure of satisfaction with the criminal justice system was highly correlated with SCL9O‐R subscales of depression (r = − 0.82) and anxiety (r = − 0.82). This link between distress and perceptions of the justice system provided preliminary support for an equity theory perspective on survivor attributions. Conceptual, research, and clinical implications were discussed.

Family survivors of homicide victims: Theoretical perspectives and an exploratory study

Little empirical information is available on the impact of homicide on surviving family members. Existing descriptions fall into a dichotomy of grief theory and those reporting symptoms of Post-traumatic Stress Disorder. This pilot study offers a multidimensional formulation which combines symptoms reported across previous studies. Participants were 19 survivors recruited through a victim witness program and a victim rights organization. A learning model, Mowrer's Two Factor Theory, was applied to explain the acquisition and maintenance of post-traumatic symptoms. Consistent with this model, survivors reported recurrent homicide-related intrusions and avoidance behaviors on the Horowitz Impact of Event Scale (IES). Comparison of survivors' IES scores with those of victims of rape, loss of a family member, and other trauma revealed a high frequency of symptoms. Mean length of time since homicide was 2.5 years. The Derogatis Symptom Check List 90-Revised (SCL9O-R) revealed a high level of general psychiatric distress, with 66% of survivors meeting “caseness” criteria, indicating a need for treatment intervention. A 7-point Likert scale measure of satisfaction with the criminal justice system was highly correlated with SCL9O-R subscales of depression (r = − 0.82) and anxiety (r = − 0.82). This link between distress and perceptions of the justice system provided preliminary support for an equity theory perspective on survivor attributions. Conceptual, research, and clinical implications were discussed.