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Mass psychogenic illness attributed to toxic exposure at a high school.

BACKGROUND AND METHODS: Mass psychogenic illness may be difficult to differentiate from illness caused by bioterrorism, rapidly spreading infection, or toxic substances. We investigated symptoms attributed to exposure to toxic gas at a high school in Tennessee. In November 1998, a teacher noticed a 'gasoline-like' smell in her classroom, and soon thereafter she had a headache, nausea, shortness of breath, and dizziness. The school was evacuated, and 80 students and 19 staff members went to the emergency room at the local hospital; 38 persons were hospitalized overnight. Five days later, after the school had reopened, another 71 persons went to the emergency room. An extensive investigation was performed by several government agencies. RESULTS: We were unable to find a medical or environmental explanation for the reported illnesses. The persons who reported symptoms on the first day came from 36 classrooms scattered throughout the school. The most frequent symptoms (in this group and the group of people who reported symptoms five days later) were headache, dizziness, nausea, and drowsiness. Blood and urine specimens showed no evidence of carbon monoxide, volatile organic compounds, pesticides, polychlorinated biphenyls, paraquat, or mercury. There was no evidence of toxic compounds in the environment. A questionnaire administered a month later showed that the reported symptoms were significantly associated with female sex, seeing another ill person, knowing that a classmate was ill, and reporting an unusual odor at the school. CONCLUSIONS: The illness attributed to toxic exposure had features of mass psychogenic illness - notably, widespread subjective symptoms thought to be associated with environmental exposure to a toxic substance in the absence of objective evidence of an environmental cause. Alleviation of the anxiety surrounding an episode of mass psychogenic illness requires prompt recognition and a detailed investigation.

Disease Outbreaks↗

Regulation of behavioral maturation by a primer pheromone produced by adult worker honey bees.

Previous research showed that the presence of older workers causes a delayed onset of foraging in younger individuals in honey bee colonies, but a specific worker inhibitory factor had not yet been identified. Here, we report on the identification of a substance produced by adult forager honey bees, ethyl oleate, that acts as a chemical inhibitory factor to delay age at onset of foraging. Ethyl oleate is synthesized de novo and is present in highest concentrations in the bee's crop. These results suggest that worker behavioral maturation is modulated via trophallaxis, a form of food exchange that also serves as a prominent communication channel in insect societies. Our findings provide critical validation for a model of self-organization explaining how bees are able to respond to fragmentary information with actions that are appropriate to the state of the whole colony.

Aging↗

Biotransformation of pantoprazole by the fungus Cunninghamella blakesleeana.

To investigate the biotransformation of pantoprazole, a proton-pump inhibitor, by filamentous fungus and further to compare the similarities between microbial transformation and mammalian metabolism of pantoprazole, four strains of Cunninghamella (C. blakesleeana AS 3.153, C. echinulata AS 3.2004, C. elegans AS 3.156, and AS 3.2028) were screened for the ability to catalyze the biotransformation of pantoprazole. Pantoprazole was partially metabolized by four strains of Cunninghamella, and C. blakesleeana AS 3.153 was selected for further investigation. Three metabolites produced by C. blakesleeana AS 3.153 were isolated using semi-preparative HPLC, and their structures were identified by a combination analysis of LC/MS(n) and NMR spectra. Two further metabolites were confirmed with the aid of synthetic reference compounds. The structure of a glucoside was tentatively assigned by its chromatographic behavior and mass spectroscopic data. These six metabolites were separated and quantitatively assayed by liquid chromatography-ion trap mass spectrometry. After 96h of incubation with C. blakesleeana AS 3.153, approximately 92.5% of pantoprazole was metabolized to six metabolites: pantoprazole sulfone (M1, 1.7%), pantoprazole thioether (M2, 12.4%), 6-hydroxy-pantoprazole thioether (M3, 1.3%), 4'-O-demethyl-pantoprazole thioether (M4, 48.1%), pantoprazole thioether-1-N-beta-glucoside (M5, 20.6%), and a glucoside conjugate of pantoprazole thioether (M6, 8.4%). Among them, M5 and M6 are novel metabolites. Four phase I metabolites of pantoprazole produced by C. blakesleeana were essentially similar to those obtained in mammals. C. blakesleeana could be a useful tool for generating the mammalian phase I metabolites of pantoprazole.

2-Pyridinylmethylsulfinylbenzimidazoles↗

Review of some studies of group behaviour relevant to global security.

Since the publication of Lionel Penrose's On the Objective Study of Crowd Behaviour, significant advances have been made in the understanding of intragroup and intergroup behaviour relevant to world security and peace. Some of these are reviewed in this article. Rational decisions in the complex and dangerous modern world may require understanding of the constraints and influence of both the cultural and biological backgrounds of human social existence.

Animals↗

Association of heat index and patient volume at a mass gathering event.

UNLABELLED: In 1999, a department of emergency medicine was asked to provide medical care at a football stadium with a capacity of 61,625. Over four seasons, the department's experience has been that the number of patients seen during a game correlates closely with game-time heat and humidity (heat index). OBJECTIVE: To determine how closely the heat index is associated with the number of patients who will require care at a mass gathering event. METHODS: This was a retrospective review of all patient care from 1999 to 2003 at a Division I college football stadium located in the southeastern United States. All patrons seen in two emergency care centers (ECCs) were included. To control for stadium attendance, the Pearson product-moment correlation (PPMC) was calculated for each game. This statistical tool determines whether there is a positive correlation between heat index and ratio of number of patients cared for per 10,000 patrons. RESULTS: A total of 20 games occurred, and the heat index ranged from 33 to 92. Number of patients varied from 15 to 74, and stadium attendance ranged from 53,371 to 61,625. The PPMC was calculated as 0.607, which indicates a strong positive correlation between heat index and patient volume (p < 0.005). Linear modeling predicts that for every 10-degree increase in the heat index, three more patients per 10,000 patrons will require care. CONCLUSIONS: In this retrospective study, the heat index was strongly associated with the volume of patients who would be seen at a mass gathering event.

Crowding↗

Use of treat-and-release medical directives for paramedics at a mass gathering.

INTRODUCTION: Paramedics provide a substantial proportion of care at mass gatherings but do not typically release patients without physician assessment. OBJECTIVE: To evaluate treat-and-release medical directives implemented at a large single-day summer rock concert. METHODS: Medical directives allowed paramedics to administer acetaminophen, dimenhydrinate, diphenhydramine, or polymyxin B ointment for common complaints without evidence of serious illness on history or examination. After treatment, patients were released or transferred to a medical facility according to predefined criteria. Patient demographics, chief complaint, treatment, and disposition were obtained from paramedic records. To determine whether any patients released by paramedic subsequently required ambulance transport, all ambulance records were searched for a period of eight hours before to 24 hours after the event. RESULTS: More than 450,000 people attended the concert, with 1,870 presenting for medical attention. Four hundred seven patients received medications under the directives. No disposition was recorded in 13 cases. Two hundred ninety-nine patients were treated with acetaminophen, of whom 269 (90.0%) were released and 23 (7.7%) required additional care. Sixty-two patients received dimenhydrinate, 44 (71%) were released, and 14 (23%) required transport. Thirty-six patients received diphenhydramine, and 34 (94%) were released. Ten patients received polymyxin B and were released. No patient released by paramedics was found to have later required ambulance transport. CONCLUSIONS: Treat-and-release medical directives for paramedics at mass gatherings may help divert patients from requiring care at a medical facility. Future research is needed to determine the safety (morbidity and mortality) of these directives.

Adolescent↗

The case of Serbia/Yugoslavia: an analysis through spiral dynamics.

Yugoslavia and later Serbia have puzzled the world since the early 1990s. This article presents a study based on the principles of spiral dynamics that were used to analyze the transformation of South Africa. According to spiral dynamics, Yugoslavia under the joint influence of nationalists and retro-socialists regressed to the egocentric and exploitative level of psychosocial existence and, in spite of recent political changes, has maintained the same centre of gravity. Although its political structure has changed, nationalist and retro-socialist values remain dominant in the cultural domain and in the domain of self. Yugoslavia/Serbia desperately needs the new dynamic process of development. Priorities are the establishment of a hierarchy of authority, self-confrontation and development of widely based enthusiasm. These could lead Serbia to become responsible and mature.

Culture↗

Age, hormones, and cognitive functioning among middle-aged and elderly men: cross-sectional evidence from the Massachusetts Male Aging Study.

BACKGROUND: This study examines interrelationships among age, hormones, and cognition for middle-aged and elderly men, and tests whether hormones predict lower cognitive functioning and mediate the age-cognition relationship. METHODS: We analyzed Time 2 data from the Massachusetts Male Aging Study, a population-based cohort study. Selection criteria included complete information on cognition and hormones (n = 981). Cognitive measures included working memory (Backward Digit Span test), speed/attention (Digit Symbol Substitution test), and spatial ability (Figural Relations test). Hormones included free testosterone, total testosterone, dehydroepiandrosterone (DHEA), dehydroepiandrosterone sulfate (DHEAS), androstanediol glucuronide (3 alpha-A-diol-gluc), luteinizing hormone (LH), follicle-stimulating hormone (FSH), sex hormone-binding globulin (alternatively known as a "binding protein") (SHBG), prolactin (PRL), estrone (E1), and cortisol (CRT). Age was measured in years. Adjusted analyses added educational attainment, health conditions and behaviors, body mass index, and depression. RESULTS: Older age was associated with lower cognitive functioning. In unadjusted models, logged free and total testosterone, DHEA, and DHEAS related to higher functioning in at least one cognitive domain; logged FSH, SHBG, and LH related to lower functioning in at least one cognitive domain; and logged E1, CRT, and PRL were not significant. In adjusted models, logged hormones did not relate to cognitive function except for logged E1 and CRT, which had negative effects. Logged hormones did not mediate the age-cognition relationship. CONCLUSIONS: The direct effects of hormones on cognition are not significant when salient factors are considered. Further, hormones do not mediate the age-cognition relationship; it is necessary to look to other explanatory pathways.

Age Factors↗

Preventive social work in perceived environmental disasters.

A modified social support network intervention model is presented that can prevent extreme or inappropriate public response to exposure to perceived environmental toxins and other perceived technological disasters. Social workers in public health and environmental health settings may find this model useful as a basis for preexposure community intervention.

Community Psychiatry↗

Epidemiological enquiries into a school outbreak of an unusual illness.

A total of 65 students and one female teacher were afflicted with an unusual illness following alleged inhalation of a 'gas' in the school. The main symptoms were dizziness, chills, nausea, headache, difficulty in breathing and faintness. Initial investigations revealed elevated carboxyhaemoglobin levels (greater than 5%) of 16 hospitalized students. However, no sources of carbon monoxide emission could be detected despite extensive environmental investigations. The outbreak was characterized by the following features: most victims were adolescent girls; there was a high proportion of recurrences; the illness was self-limiting with inconsistent clinical and epidemiological findings; its mode of transmission was associated with antecedent visual observation or verbal information, and it died down immediately after confidence had been restored. A diagnosis of mass psychogenic illness was made. The high-risk students were Malay girls who were from the normal class (for slow learners), engaged in part-time employment and easily influenced by what they had heard or seen.

Adolescent↗