Steviol glycosides (SGs), such as stevioside and rebaudioside A, are natural, non-caloric sweet-tasting organic molecules, present in extracts of the scrub plant Stevia rebaudiana, which are widely ...used as sweeteners in consumer foods and beverages. TRPM5 is a Ca
-activated cation channel expressed in type II taste receptor cells and pancreatic β-cells. Here we show that stevioside, rebaudioside A and their aglycon steviol potentiate the activity of TRPM5. We find that SGs potentiate perception of bitter, sweet and umami taste, and enhance glucose-induced insulin secretion in a Trpm5-dependent manner. Daily consumption of stevioside prevents development of high-fat-diet-induced diabetic hyperglycaemia in wild-type mice, but not in Trpm5
mice. These results elucidate a molecular mechanism of action of SGs and identify TRPM5 as a potential target to prevent and treat type 2 diabetes.
Autistic adults often experience health problems and a range of healthcare barriers. Therefore, the aim of this study was to evaluate barriers and explore how primary care providers and autistic ...adults want to improve their primary healthcare. Semi-structured interviews with three autistic adults, two parents of autistic children and six care providers, were performed to evaluate barriers in Dutch healthcare. Next, in a three-round Delphi-study, 21 autistic adults and 20 primary care providers rated barriers in primary healthcare and assessed recommendations based on usefulness and feasibility. In the thematically analysed interviews, 20 barriers in Dutch healthcare for autistic people were identified. In the Delphi-study, the primary care providers rated the negative impact of most barriers lower than the autistic adults. The Delphi-study resulted in 22 recommendations to improve primary healthcare for autistic adults, focused on: primary care providers (i.e. education in collaboration with autistic people), autistic adults (i.e. improvement of preparation for general practitioner-appointments) and organization of general practice (i.e. enhancement of continuity in care). In conclusion, primary care providers seem to assess healthcare barriers as less impactful than autistic adults. With the use of the Delphi-method, useful and feasible recommendations to improve primary healthcare for autistic adults were identified, based on the needs of autistic adults and primary care providers.
Lay abstract
Autistic adults often encounter different types of healthcare barriers. Because autistic adults also have an increased risk for health problems, the aim of this study was to evaluate barriers and to explore how primary care providers and autistic adults want to improve their primary healthcare. In this co-created study, semi-structured interviews with three autistic adults, two parents of autistic children and six care providers were performed to evaluate barriers in Dutch healthcare. Next, in the survey-study (using the Delphi-method including controlled feedback in three consecutive questionnaires), 21 autistic adults and 20 primary care providers rated the impact of barriers and the usefulness and feasibility of recommendations to improve primary healthcare. In the interviews, 20 barriers in Dutch healthcare for autistic people were found. In the survey-study, the primary care providers rated the negative impact of most barriers lower than the autistic adults. This survey-study resulted in 22 recommendations to improve primary healthcare focused on: primary care providers (including education in collaboration with autistic people), autistic adults (including improvement of preparation for general practitioner-appointments) and organization of general practice (including improvement of continuity in care). In conclusion, primary care providers seem to view healthcare barriers as less impactful than autistic adults. In this co-created study, recommendations to improve primary healthcare for autistic adults were identified, based on the needs of autistic adults and primary care providers. These recommendations provide a basis for primary care providers, autistic adults and their support network to start conversations about, for example, strategies to improve primary care providers’ knowledge, autistic adults’ preparation for a general practitioner-appointment and organization of primary care.
Objective
Although a significant number of professionals who provide eating disorder (ED) treatment have lived experience with an ED in the past, there is no consensus on whether these professionals ...should use these experiences in treatment. This review aims to evaluate current literature on recovered professionals with an ED past treating ED patients, unravelling advantages and disadvantages in treatment, the impact on professionals and their surroundings, and implications for practice.
Method
A systematic literature search was conducted which included 10 articles. We analysed qualitative data through a systematic synthesis. Strength of evidence was calculated for each subtheme.
Results
Three themes and 14 subthemes were divided into categories. The category ‘treatment (patient‐professional interaction)’ was divided into: advantages, disadvantages and other implications for treatment. Additionally, the category ‘professionals themselves’ included subthemes that directly impact or relate to ED professionals: recovery as a non‐linear process, the significant role of self‐care and adverse feelings of professionals. Finally, the category ‘work settings’ included: company culture and training, supervision and professional development.
Discussion
Recovered ED professionals are a promising addition to ED treatment due to the enhanced expertise of the professional. However, attention should be paid to the risk of distorted boundaries between patient and professional.
Highlights
This review aims to evaluate current literature about recovered professionals with an eating disorder past treating eating disorder patients.
Advantages we found were patients feeling recognised and understood with improved perspectives, and enhanced expertise of professionals.
Disadvantages were distorted boundaries, the vulnerability and risk of relapse of professionals.
To work as an eating disorder professional, it is important to focus on self‐care, stimulate a safe work setting and organising supervision among colleagues.
To provide integrated Youth Care responsive to the needs of families with multiple problems across life domains, it is essential to incorporate parental perspectives into clinical practice. The aim ...of this study is to advance our understanding of key components of integrated Youth Care from a parental perspective.
Semi-structured interviews were administered to 21 parents of children receiving Youth Care from integrated care teams in the Netherlands. Qualitative content analysis was conducted by means of a grounded theory approach following qualitative reporting guidelines.
Parental perspectives were clustered into six key components: a holistic, family-centred approach; addressing a broad range of needs in a timely manner; shared decision making; interprofessional collaboration; referral; and privacy. Parents emphasized the importance of a tailored, family-centred approach, addressing needs across several life domains, and active participation in their own care process. However, they simultaneously had somewhat opposing expectations regarding these key components, for example, concerning the changing roles of professionals and parents in shared decision making and the value of involving family members in a care process. Professionals should be aware of these opposing expectations by explicitly discussing mutual expectations and changing roles in decision making during a care process. To enable parents to make their own decisions, professionals should transparently propose different options for support guided by an up-to-date care plan.
Background: At present, professionals experience difficulties applying known facilitators and barriers of integrated care in practice 1. This is particularly intricate when working with youth at-risk ...and their families. These families have a diversity of problems in different life-areas, that often do not seek or accept care, and with a continuing risk of crisis situations occurring. To improve integrated care for youth at-risk, we aimed at deepening insights into how to enable facilitators or overcome barriers when implementing integrated care for youth at risk.
Targeted population and stakeholders: The overall study design comprises practice-based action research. The primary focus of this study is on the perspective of Youth Care professionals, policymakers and youth at-risk in the Dutch Youth Care system. This study is designed and monitored in co-creation with professionals, policymakers and youth representatives. By organizing learning sessions based on the results of the study, professionals and other stakeholders are stimulated to learn and improve the quality of care for youth at-risk.
Method: For the aim of this study, we conducted 31 semi-structured interviews, observations with different stakeholders and one learning session with a youth and parent representative, professionals, and policymakers within a network of an integrated care initiative for youth at-risk. To analyse the transcripts, learning session and observation reports, we conducted a thematic analysis both deductively and inductively.
Results: The implementation of integrated care for youth at risk seemed to be influenced by three underlying mechanisms: mandate, care coordination, and professional autonomy. Neither mandate, nor care coordination, nor professional autonomy was reported as lying with one person or organization and shifted between them depending on the specific case. When there was a lack of, or insufficient agreement on professional autonomy, mandate, or care coordination, it became extremely difficult for the professionals involved to provide integrated care in practice. Specifically in crisis situations, when clarity on mandate, care coordination, and professional autonomy was urgent but often lacking in practice. This led to indecisiveness and inappropriate support or no care provision at all. At the same time when these mechanisms were present: integrated care for youth at-risk was more easily realized.
Conclusions: Providing integrated care for youth at-risk is a joint effort. The different organizations need to specify with every new case who is involved and what their role and responsibility is, in order to offer youth at-risk the care they need. Therefore, professionals and organizations need to realize, understand and act on the underlying mechanisms mandate, care coordination and professional autonomy when providing integrated care for youth at-risk. Future studies are needed to establish whether and if so, what, other underlying mechanisms are crucial when providing integrated care for youth at risk in practice and how these mechanisms are successfully implemented.
Reference: 1.Nooteboom LA, Mulder EA, Kuiper CH, Colins OF, Vermeiren RRJM. Towards integrated youth care: A systematic review of facilitators and barriers for professionals. Administration and Policy in Mental Health and Mental Health Services Research. 2020;48(1):88–105.
Widely available and easily accessible testing for COVID-19 is a cornerstone of pandemic containment strategies. Nasopharyngeal swabs (NPS) are the currently accepted standard for sample collection ...but are limited by their need for collection devices and sampling by trained healthcare professionals. The aim of this study was to compare the performance of saliva to NPS in an outpatient setting. This was a prospective study conducted at three centers, which compared the performance of saliva and NPS samples collected at the time of assessment center visit. Samples were tested by real-time reverse transcription polymerase chain reaction and sensitivity and overall agreement determined between saliva and NPS. Clinical data was abstracted by chart review for select study participants. Of the 432 paired samples, 46 were positive for SARS-CoV-2, with seven discordant observed between the two sample types (four individuals testing positive only by NPS and three by saliva only). The observed agreement was 98.4% (kappa coefficient 0.91) and a composite reference standard demonstrated sensitivity of 0.91 and 0.93 for saliva and NPS samples, respectively. On average, the Ct values obtained from saliva as compared to NPS were higher by 2.76. This study demonstrates that saliva performs comparably to NPS for the detection of SARS-CoV-2. Saliva was simple to collect, did not require transport media, and could be tested with equipment readily available at most laboratories. The use of saliva as an acceptable alternative to NPS could support the use of widespread surveillance testing for SARS-CoV-2.
This cross‐sectional study examined the relationships (using structural equation modeling) between exposure to early‐onset interpersonal trauma, symptoms of posttraumatic stress disorder (PTSD), ...symptoms of complex PTSD, and other mental health problems. The participants were 92 girls recruited from 3 residential treatment facilities. Exposure to early‐onset interpersonal trauma was directly related to mental health problems and symptoms of PTSD mediated the relationship between exposure to early‐onset interpersonal trauma and mental health problems. Symptoms of complex PTSD did not significantly mediate this relationship. These findings have direct implications for rehabilitation efforts in girls in compulsory residential care.
Traditional and Simplified Chinese s by AsianSTSS
標題 : 在強制性住宿的女孩中，人際創傷、創傷後壓力症症狀和其他精神問題的相互關係。
撮要:本橫斷面研究檢視(利用結構方程式模型)早期人際創傷、創傷後壓力症(PTSD)症狀/複雜PTSD症狀、和其他精神問題之間的關係。參與人士是92名住在3間住宿治療中心的女孩。早期人際創傷經歷直接與精神問題相連，而PTSD症狀則居中調節，複雜PTSD症狀則未能有效居中調節。上述結果直接啟示復康計劃在強制性住宿的女孩中如何執行。
标题 : 在强制性住宿的女孩中，人际创伤、创伤后压力症症状和其他精神问题的相互关系。
撮要:本横断面研究检视(利用结构方程式模型)早期人际创伤、创伤后压力症(PTSD)症状/复杂PTSD症状、和其他精神问题之间的关系。参与人士是92名住在3间住宿治疗中心的女孩。早期人际创伤经历直接与精神问题相连，而PTSD症状则居中调节，复杂PTSD症状则未能有效居中调节。上述结果直接启示复康计划在强制性住宿的女孩中如何执行。
To examine the relationship between a history of childhood abuse and mental health problems in juveniles who sexually offended (JSOs) over and above general offending behavior.
A sample of 44 JSOs ...incarcerated in two juvenile detention centers in the Netherlands between May 2008 and March 2014 were examined for childhood abuse history (Childhood Trauma Questionnaire-Short Form) and mental health problems (Massachusetts Youth Screening Instrument-Version 2). Furthermore, the connection between childhood abuse and mental health problems in JSOs was compared to a sample of 44 propensity score matched juveniles who offended non-sexually (non-JSOs).
In JSOs, sexual abuse was related to anger problems, suicidal ideation, and thought disturbance. These associations were significantly stronger in JSOs than in non-JSOs.
Our results suggest that the relationship between childhood abuse and both internalizing and externalizing mental health problems is of more salience for understanding sexual offending than non-sexual offending, and should, therefore, be an important focus in the assessment and treatment of JSOs.
Isolating and characterizing emerging SARS-CoV-2 variants is key to understanding virus pathogenesis. In this study, we isolated samples of the SARS-CoV-2 R.1 lineage, categorized as a variant under ...monitoring by the World Health Organization, and evaluated their sensitivity to neutralizing antibodies and type I interferons. We used convalescent serum samples from persons in Canada infected either with ancestral virus (wave 1) or the B.1.1.7 (Alpha) variant of concern (wave 3) for testing neutralization sensitivity. The R.1 isolates were potently neutralized by both the wave 1 and wave 3 convalescent serum samples, unlike the B.1.351 (Beta) variant of concern. Of note, the R.1 variant was significantly more resistant to type I interferons (IFN-α/β) than was the ancestral isolate. Our study demonstrates that the R.1 variant retained sensitivity to neutralizing antibodies but evolved resistance to type I interferons. This critical driving force will influence the trajectory of the pandemic.
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