Dalhousie University

About: Dalhousie University is a education organization based out in Halifax, Nova Scotia, Canada. It is known for research contribution in the topics: Population & Health care. The organization has 25660 authors who have published 58465 publications receiving 2082403 citations. The organization is also known as: Dalhousie College & The Governors of Dalhousie College and University.

Clinical Assessment and Management of Toddlers With Suspected Autism Spectrum Disorder: Insights From Studies of High-Risk Infants

Abstract: With increased public awareness of the early signs and recent American Academy of Pediatrics recommendations that all 18- and 24-month-olds be screened for autism spectrum disorders, there is an increasing need for diagnostic assessment of very young children. However, unique challenges exist in applying current diagnostic guidelines for autism spectrum disorders to children under the age of 2 years. In this article, we address challenges related to early detection, diagnosis, and treatment of autism spectrum disorders in this age group. We provide a comprehensive review of findings from recent studies on the early development of children with autism spectrum disorders, summarizing current knowledge on early signs of autism spectrum disorders, the screening properties of early detection tools, and current best practice for diagnostic assessment of autism spectrum disorders before 2 years of age. We also outline principles of effective intervention for children under the age of 2 with suspected/confirmed autism spectrum disorders. It is hoped that ongoing studies will provide an even stronger foundation for evidence-based diagnostic and intervention approaches for this critically important age group.

Mental Health Literacy: Past, Present, and Future.

Abstract: Mental health literacy (MHL) is a construct that has arisen from the domain of health literacy (HL) and must be understood in that context. The development of HL was initially informed by observations that low functional literacy was associated with numerous poor health outcomes. In its early definition, HL was considered primarily within the health care environment, focusing on the ability of people to be able to understand and make effective use of medical information, particularly to better understand and better adhere to medication treatments. For example, the American Medical Association defined HL as the ‘‘ability to read and comprehend prescription bottles, appointment slips and other essential health-related materials required to successfully function as a patient.’’ In 1998, the World Health Organization (WHO) expanded the definition of HL to include ‘‘the cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand, and use information in ways which promote and maintain good health.’’ The Canadian Public Health Association has used these historical developments to inform their own and more expanded HL definition, noting that HL is ‘‘the ability to access, understand, evaluate and communicate information as a way to promote, maintain and improve health in a variety of settings across the life-course.’’ More recently, understanding of HL has evolved into a broader construct that is considered fundamental to improving a person’s health outcome, decreasing health inequities in populations, and enhancing the operation of health systems and the development of health policy. Thus it is now recognized as necessary to improve health outcomes at both the individual and population levels. For example, Kanj and Mitic proposed a tiered HL model comprising functional HL (generic skills applied by people within health care environments), conceptual HL (generic skills applied in social contexts), and HL as empowerment for people in social and political contexts. The Wagner Chronic Care Model, and other current approaches to chronic illnesses require the enhancement of HL as a core competency for people receiving health care to enhance the likelihood of provision and receipt of effective and collaborative health care. In this context, HL has evolved from a risk factor for poor health outcomes as a result of inadequate treatment adherence to an asset that can be enhanced through educational strategies. Recent research continues to demonstrate that poor HL is related to numerous negative health and social outcomes, including but not limited to: increased rates of chronic illness; decreased use of health services; increased health care costs; and early mortality. The WHO has identified that HL is perhaps the most important component of the social determinants of health, noting that it is ‘‘a stronger predictor of an individual’s health status than income, employment status, education and racial or ethnic group.’’ p 7 Currently, HL is understood to include the following components: the competencies needed by people to help obtain and maintain health and identify illness; understanding how and where to access and how to evaluate health information and health care; understanding how to properly apply prescribed treatments; and, obtaining and applying skills related to social capital, such as understanding rights related to health and health care and understanding how to advocate for health improvements. Further, HL is understood necessarily to be developmentally appropriate; contextually applied; involving multiple related stakeholders; and, available through existing institutional and

Differential responses to lithium in hyperexcitable neurons from patients with bipolar disorder

Abstract: Bipolar disorder is a complex neuropsychiatric disorder that is characterized by intermittent episodes of mania and depression; without treatment, 15% of patients commit suicide. Hence, it has been ranked by the World Health Organization as a top disorder of morbidity and lost productivity. Previous neuropathological studies have revealed a series of alterations in the brains of patients with bipolar disorder or animal models, such as reduced glial cell number in the prefrontal cortex of patients, upregulated activities of the protein kinase A and C pathways and changes in neurotransmission. However, the roles and causation of these changes in bipolar disorder have been too complex to exactly determine the pathology of the disease. Furthermore, although some patients show remarkable improvement with lithium treatment for yet unknown reasons, others are refractory to lithium treatment. Therefore, developing an accurate and powerful biological model for bipolar disorder has been a challenge. The introduction of induced pluripotent stem-cell (iPSC) technology has provided a new approach. Here we have developed an iPSC model for human bipolar disorder and investigated the cellular phenotypes of hippocampal dentate gyrus-like neurons derived from iPSCs of patients with bipolar disorder. Guided by RNA sequencing expression profiling, we have detected mitochondrial abnormalities in young neurons from patients with bipolar disorder by using mitochondrial assays; in addition, using both patch-clamp recording and somatic Ca(2+) imaging, we have observed hyperactive action-potential firing. This hyperexcitability phenotype of young neurons in bipolar disorder was selectively reversed by lithium treatment only in neurons derived from patients who also responded to lithium treatment. Therefore, hyperexcitability is one early endophenotype of bipolar disorder, and our model of iPSCs in this disease might be useful in developing new therapies and drugs aimed at its clinical treatment.

Allogeneic peripheral blood stem-cell compared with bone marrow transplantation in the management of hematologic malignancies: an individual patient data meta-analysis of nine randomized trials

Abstract: PURPOSE: Considerable uncertainty exists regarding relative effects of allogeneic peripheral blood stem cells transplantation (PBSCT) versus bone marrow transplantation (BMT) on outcomes of patients with hematologic malignancies. PATIENTS AND METHODS: To provide the totality of research evidence related to the effects of PBSCT versus BMT, we conducted an individual-patient data meta-analysis using data from nine randomized trials enrolling 1,111 adult patients. RESULTS: Compared with BMT, PBSCT led to faster neutrophil (odds ratio [OR] = 0.31; 95% CI, 0.25 to 0.38; P < .00001) and platelet engraftment (OR = 0.52; 95% CI, 0.44 to 0.61; P < .00001). PBSCT was associated with a significant increase in the development of grade 3-4 acute graft-versus-host disease (GVHD; OR = 1.39; 95% CI, 1.03 to 1.88) and extensive (47% v 31% at 3 years; OR = 1.89; 95% CI, 1.47 to 2.42; P < .000001) and overall chronic GVHD (68% v 52% at 3 years; OR = 1.92; 95% CI, 1.47 to 2.49; P < .000001), but not grade 2-4 acute GVHD (54% v 53%; P = .49). PBSCT was associated with a decrease in relapse (21% v 27% at 3 years; OR = 0.71; 95% CI, 0.54 to 0.93; P = .01) in both late-stage-(33% v 51% at 3 years; OR = 0.59; 95% CI, 0.38 to 0.93; P = .02) and early-stage-disease patients (16% v 20% at 3 years; OR = 0.69; 95% CI, 0.49 to 0.98; P = .04). Nonrelapse mortality was not different between groups. Overall and disease-free survival were only statistically significantly improved in patients with late-stage disease (overall survival: 46% v 31% at 3 years; OR = 0.64; 95% CI, 0.46 to 0.90; P = .01; disease-free survival: 41% v 27% at 3 years; OR = 0.63 95% CI, 0.45 to 0.87; P = .01). CONCLUSION: PBSCT is associated with a decreased relapse rate in hematologic malignancies and improvement in overall and disease-free survival in patients with late-stage disease. PBSCT is also associated with a significant risk of extensive chronic GVHD.