Understanding mental health issues faced by young homeless persons is instrumental to the development of successful targeted interventions. No systematic review of recent published literature on psychopathology in this group has been completed. We conducted a systematic review of published research examining the prevalence of psychiatric problems among young homeless people. We examined the temporal relationship between homelessness and psychopathology. We collated 46 articles according to the PRISMA Statement. All studies that used a full psychiatric assessment consistently reported a prevalence of any psychiatric disorder from 48% to 98%. Although there was a lack of longitudinal studies of the temporal relationship between psychiatric disorders and homelessness, findings suggested a reciprocal link. Supporting young people at risk for homelessness could reduce homelessness incidence and improve mental health.
The combination of immune checkpoint blockade with chemotherapy is currently under investigation as a promising strategy for the treatment of triple negative breast cancer (TNBC). Tumor-associated macrophages (TAMs) are the most prominent component of the breast cancer microenvironment because they influence tumor progression and the response to therapies. Here we show that macrophages acquire an immunosuppressive phenotype and increase the expression of programmed death ligand-1 (PD-L1) when treated with reactive oxygen species (ROS) inducers such as the glutathione synthesis inhibitor, buthionine sulphoximine (BSO), and paclitaxel. Mechanistically, these agents cause accumulation of ROS that in turn activate NF-κB signaling to promote PD-L1 transcription and the release of immunosuppressive chemokines. Systemic in vivo administration of paclitaxel promotes PD-L1 accumulation on the surface of TAMS in a mouse model of TNBC, consistent with in vitro results. Combinatorial treatment with paclitaxel and an anti-mouse PD-L1 blocking antibody significantly improved the therapeutic efficacy of paclitaxel by reducing tumor burden and increasing the number of tumor-associated cytotoxic T cells. Our results provide a strong rationale for the use of anti–PD-L1 blockade in the treatment of TNBC patients. Furthermore, interrogation of chemotherapy-induced PD-L1 expression in TAMs is warranted to define appropriate patient selection in the use of PD-L1 blockade.
Over two thirds of Americans live with pets and consider them important members of the family. Pets benefit human health (zooeyia) in 4 ways: as builders of social capital, as agents of harm reduction, as motivators for healthy behavior change, and as potential participants in treatment plans. Conversely, pets can present risks to their owners. They are potential sources of zoonotic disease and injury. Pets can also challenge a family's prioritization of financial and social resources. To activate the benefits of zooeyia and appropriately calibrate and mitigate zoonotic risk, physicians first need to know about the pets in their patients' families. Asking about pets is a simple and feasible approach to assess patients' environmental history and social capital. Asking about pets is a nonthreatening way to build rapport and demonstrates an interest in the whole family, which can improve the physician-patient therapeutic alliance. Physicians can use an interprofessional, collaborative approach with veterinarians to address zoonotic health risks and leverage zooeyia. (J Am Board Fam Med 2015;28:526 -534.)
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