Foreign-educated nurses: strangers in a strange land?
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Acculturation↗
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Sociodemographic and obstetric risk factors for postpartum depressive symptoms in Nigerian women.
OBJECTIVE: Studies from the Western culture have emphasized psychosocial risk factors for the development of postnatal depression (PND). In Africa, poor obstetrics practice and sociodemographic factors may contribute significantly to the risk of PND. The goal of this study was to examine sociodemographic and obstetric risk factors for postnatal depressive symptoms in a Nigerian community. METHODS: 876 women recruited at 6 weeks postpartum from the postnatal and infant immunization clinics of 5 participating health centers were screened with the Edinburgh Postnatal Depression Scale (EPDS). Sociodemographic and obstetric information were also obtained through a structured questionnaire. RESULTS: The mean EPDS score was 5.66 (SD = 4.20). Depression was diagnosed in 128 (14.6 %) of the postpartum women. The predictors of PND include hospital admissions during the pregnancy (OR 3.95, CI 2.57-6.07), female sex of the baby (OR 2.74, CI 1.87-4.03), preterm delivery (OR 4.21, CI 2.78-6.39), instrumental delivery (OR 3.32, CI 1.79-6.16), Cesarean section (OR 3.58, CI 1.72-7.48), and being single (OR 3.44, CI 2.15-5.53). CONCLUSION: Although the prevalence of PND symptoms seems to be the same across cultures, risk factors differ significantly. This study identified certain sociodemographic and obstetric risk factors for postnatal depressive symptoms in an underdeveloped community. These factors must be taken into consideration when planning intervention and preventive strategies for these women.
Adult↗
Treatment of acute psychosis without neuroleptics: two-year outcomes from the Soteria project.
The Soteria project (1971-1983) compared residential treatment in the community and minimal use of antipsychotic medication with "usual" hospital treatment for patients with early episode schizophrenia spectrum psychosis. Newly diagnosed DSM-II schizophrenia subjects were assigned consecutively (1971 to 1976, N = 79) or randomly (1976 to 1979, N = 100) to the hospital or Soteria and followed for 2 years. Admission diagnoses were subsequently converted to DSM-IV schizophrenia and schizophreniform disorder. Multivariate analyses evaluated hypotheses of equal or better outcomes in Soteria on eight individual outcome measures and a composite outcome scale in three ways: for endpoint subjects (N = 160), for completing subjects (N = 129), and for completing subjects corrected for differential attrition (N = 129). Endpoint subjects exhibited small to medium effect size trends favoring experimental treatment. Completing subjects had significantly better composite outcomes of a medium effect size at Soteria (+.47 SD, p =.03). Completing subjects with schizophrenia exhibited a large effect size benefit with Soteria treatment (+.81 SD, p =.02), particularly in domains of psychopathology, work, and social functioning. Soteria treatment resulted in better 2-year outcomes for patients with newly diagnosed schizophrenia spectrum psychoses, particularly for completing subjects and for those with schizophrenia. In addition, only 58% of Soteria subjects received antipsychotic medications during the follow-up period, and only 19% were continuously maintained on antipsychotic medications.
Adolescent↗
Ethnicity and treatment outcome variation in schizophrenia: a longitudinal study of community-based psychosocial rehabilitation interventions.
The purpose of this study was to investigate cross-ethnic variations in prospective treatment outcomes over a period of 12 months from community-based psychosocial rehabilitation interventions for people with schizophrenia. Data were pooled from two similar studies of psychosocial rehabilitation for clients with schizophrenia conducted in the same urban settings. The final sample consisted of 226 people diagnosed with a schizophrenia spectrum disorder, consisting of 108 (48%) white subjects, 81 (36%) African American subjects, and 37 (16%) Latino subjects. Main analyses were performed using hierarchical linear modeling. Analyses indicated that both study groups demonstrated statistically significant rehabilitative improvement over a period of 12 months. Although African American subjects had a significantly slower rate of improvement (compared with white subjects) in social functioning, analyses in several other outcome domains generally revealed that all three ethnic groups showed similar change trajectories over time, with no additional ethnic-related differences reaching statistical significance. With the exception of slower social improvement for African Americans, the findings from this study suggest that community-based psychosocial rehabilitation interventions did not result in significantly poorer outcomes for the ethnic minority groups examined. Several important implications are discussed.
Adaptation, Psychological↗
Predicting medication-free treatment response in acute psychosis: cross-validation from the Finnish Need-Adapted Project.
This study tested predictors of 2-year antipsychotic-free response from the Soteria study (older, better social functioning, fewer cardinal symptoms) using data from the Finnish Acute Psychosis Integrated treatment study. The quasi-experimental study compared need-adapted family-oriented psychosocial intervention within a 3-week antipsychotic-free trial to psychosocial intervention plus antipsychotic medications. Forty-six percent of experimental completers (37% of intent-to-treat subjects) were successfully treated without antipsychotic medications for the entire 2-year study. The DSM-III-R diagnoses of schizophrenia and schizophreniform disorder and Soteria-suggested predictors were not related to antipsychotic-free response. Different variables within the same domains of good prognosis and fewer schizophrenia symptoms predicted antipsychotic-free response or nonresponse with 74% accuracy. The 6-month duration of symptom criterion distinguishing schizophrenia from schizophreniform disorder does not separate medication-free treatment responders from those requiring medications. Prognosis appears related to antipsychotic-free response and may be helpful in distinguishing schizophrenia from schizophreniform disorder in early episodes.
Acute Disease↗
Phylogenetic analysis of the precore/core gene of hepatitis B virus genotypes E and A in West Africa: new subtypes, mixed infections and recombinations.
One hundred and twenty-two new hepatitis B virus (HBV) preC/C sequences and three complete genomes from three major countries in West Africa were analysed. The majority of sequences were of genotype E and the only other genotype found was genotype A. Although for genotype E sequences, the genetic diversity of the preC/C gene was about two to three times higher than that of the preS/S gene, it was still considerably lower than that for genotype A sequences. The HBV/E preC/C gene was related most closely to subgenotype D1 and D2 sequences. Evidence of recombination was found in two strains that were of genotype A in the preS/S gene and of genotype E in the preC/C gene. The genotype A strains from Cameroon, Mali and Nigeria could be divided phylogenetically into three subtypes, A3 and two new subtypes, tentatively designated A4 and A5. Each subtype presented a genetic diversity of 2.19-3.85 % and intersubtype distances of 4.47-5.97 %. Interestingly, one sample from Nigeria showed evidence of a triple recombination of genotypes E/D and A, separated by a genotype G-specific insert of 36 bp. Of 110 patients, 19 (17.3 %) showed a coinfection of genotypes A and E, mostly in human immunodeficiency virus-positive children from Cameroon. Thus, in Cameroon, where both genotypes coexist, 37 % of all individuals tested had mixed infections. The low genetic variability in the preC/C gene of genotype E supports our previous speculation about a relatively short evolutionary history of this genotype, in contrast to the subtype-rich African genotype A strains.
Adult↗
New research and explorations into multiuser immersive display systems.
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Computer Graphics↗
Cyclosporin A and Trichinella spiralis: anthelminthic effects in immunosuppressed mice.
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Animals↗
Dynamics of porcine humoral responses to experimental infections by Spanish Trichinella isolates: comparison of three larval antigens in ELISA.
Five groups of six helminth-free pigs of the Iberian and Landrace x White breeds were each experimentally-infected randomly at a dose of 150 larvae per kg, body weight with one of the five Trichinella isolates, coded as Gm-1, Co-77, Laso, C-76 and Mad-83. These isolates were selected from the two Trichinella species (T. spiralis and T. britovi) so far identified in the Iberian Peninsula. Specific antibodies against the infections were measured on days -14, 0, 6, 16, 20, 27, 34, 49, 63 and 82 post-infection (p.i.), in a comparative indirect ELISA assay using three different antigens prepared from the muscle stage of the parasite. The antigens were a crude saline larval extract (CSLE), excretory-secretory (ES) and surface stripped cetyl-trimethyl ammonium bromide detergent (CTAB) products. Over all, the dynamics of antibody responses were very similar for infections with the five different isolates, although a significant delay in positive and maximum antibody titres was seen in the group infected with C-76, the isolate exhibiting a marked low infectivity to domestic mammals. ELISA with the crude antigen was more sensitive (positive antibody titres appeared between days 6 and 16 p.i.) than with the ES and CTAB preparations (positive titres appeared between days 16 and 20 p.i.). For infections with the C-76 isolate, positive titres appeared between days 16 and 20 p.i. with the CSLE antigen and, on day 27 p.i. with the ES and CTAB antigens. Little cross-reactivity with other common porcine helminth infections appeared only when ELISA was carried out with CSLE and CTAB antigens.
Animals↗
Measurement of phosphocreatine to ATP ratio in normal and diseased human heart by 31P magnetic resonance spectroscopy using the rotating frame-depth selection technique.
31P magnetic resonance spectroscopy, using surface coils placed on perfused or surgically exposed animal hearts, shows that unequivocal changes in phosphocreatine (PCr) and adenosine triphosphate (ATP) occur during interventions, such as ischemia. Similar measurements seem warranted in man. We have used a modification of the rotating-frame imaging technique to measure PCr-to-ATP ratio non-invasively in human heart. The subject lay prone on a double-surface coil probe with the apex and the anterior surface of the heart covered by the coil in a 1.9 T magnet. 31P spectra were obtained from slices of tissue approximately 6 cm in diameter and 2 cm in thickness. Though skeletal and cardiac muscle contain similar phosphorus metabolites, animal studies show that the ratio in the two are different. We argued that the ratio should start high (skeletal muscle) and plateau at a low value representing cardiac muscle. Using this criterion, which makes no assumption on what the ratio is in heart muscle, the PCr:ATP in six normal subjects was 1.55 +/- 0.2. This protocol has been used in a preliminary study in patients with cardiomyopathies.
Adenosine Triphosphate↗
Vicious circle behaviour under two shock intensities.
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Humans↗
Differential Alloreactivity: Lessons Learned From a Singular HLA Locus.
Alloreactivity entails the recognition of cells and tissues from one individual as foreign by T cells and other immune effectors from another individual. Alloreactive immune responses play an important role in various clinical contexts, in particular in transplantation. Major drivers of these responses are the highly immunogenic, non-self HLA molecules. However, the immunogenicity of these allogeneic HLA molecules has been observed to vary according to certain immunobiological and immunogenetic parameters, leading to the concept of differential alloreactivity. Recent progress in unveiling the underpinnings of this phenomenon has been made for the frequently mismatched HLA-DP allotypes, whose singular genomic, structural and population genetics characteristics offer an ideal scenario for these investigations. Studies in the HLA-DP context have highlighted the immunopeptidome overlap between self and non-self HLA allotypes, as well as its editing by non-classical class II chaperones HLA-DM and HLA-DO, as a main determinant of their immunogenicity likely via indirect effects of thymic education. Recent evidence suggests that these observations could also be extended to alloresponses directed against HLA molecules encoded by other loci. How these functional characteristics of HLA molecules shape allorecognition by T-cell subsets, and how they translate into different clinical consequences in the context of transplantation will be the subject of the present review.
Humans↗
Real-time reverse transcription-PCR quantification of cytokine mRNA expression in golden Syrian hamster infected with Leishmania infantum and treated with a new amphotericin B formulation.
A real-time quantitative reverse transcription-PCR assay was developed for the quantification of cytokine mRNA expression in the golden Syrian hamster Mesocricetus auratus infected with Leishmania infantum and treated with amphotericin B (AMB) formulated in microspheres made of human serum albumin (HSA). Treatment was administered intravenously on days 69, 71, and 73 postinfection (p.i.) with 10(7) metacyclic promastigotes, at doses of 2 and 40 mg/kg of AMB. High infection levels were recorded for untreated animals by day 76 p.i., with parasite loads always about 2 log10 per gram higher in the liver than in the spleen. Treatment was highly effective with both doses, but at 40 mg/kg, almost complete parasite elimination was achieved. mRNA expression of gamma interferon (IFN-gamma) and, to a lesser extent, tumor necrosis factor alpha (TNF-alpha) and transforming growth factor beta (TGF-beta) in spleen cells was up-regulated in most animals of the untreated group. The mRNA expression of interleukin-4 was strongly down-regulated in untreated as well as treated infected animals. Treatment with the lower dose of AMB-HSA down-regulated the mRNA expression of IFN-gamma and TNF-alpha, with no effect on the deactivating cytokine TGF-beta. In contrast, treatment with the higher dose (40 mg/kg) of the formulation caused moderate up-regulation of IFN-gamma and TNF-alpha and strong suppression of TGF-beta. Treatment of noninfected animals did not alter the cytokine expression pattern with regard to untreated controls. Our results suggest that treatment of L. infantum-infected Syrian hamsters with highly effective nontoxic doses of AMB-HSA causes deactivation of the anti-inflammatory cytokine TGF-beta, which in turn results in up-regulation of the Th1 cytokines IFN-gamma and TNF-alpha.
Amphotericin B↗
Global and depth resolved phosphorus magnetic resonance spectroscopy to predict outcome after birth asphyxia.
Twelve normal and 32 asphyxiated neonates were studied using global and depth resolved phosphorus magnetic resonance spectroscopy (31PMRS). Eight of the asphyxiated group died or survived with major neurodevelopmental abnormalities. A global phosphocreatinine/inorganic phosphate (PCr/Pi) ratio below the range of values from normal infants predicted adverse outcome after asphyxia with a positive predictive value of 64%, sensitivity 88%, and specificity 83%. Corresponding values for global inorganic orthophosphate/adenosine triphosphate (Pi/ATP) ratios were positive predictive value 88%, sensitivity 96%, and specificity 88%. Spatially localised MRS data, obtained using phase modulated rotating frame imaging, showed cerebral energy metabolism to be more abnormal in deep than superficial regions after birth asphyxia. However, in this population of full term infants none of the regional metabolite concentrations were superior to global data for prediction of outcome.
Adenosine Triphosphate↗
Radiological diagnosis of scaphoid fractures: are two views enough?
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Carpal Bones↗
The role of menthol in skin penetration from topical formulations of ibuprofen 5% in vivo.
In vivo plasma profiles from formulations containing 5% ibuprofen were compared after a single topical application in a randomised, double-blind, cross-over trial. Ibuleve gel (Dermal Laboratories, UK) contained only ibuprofen whilst Deep Relief gel (Mentholatum, UK) also contained 3% menthol. In contrast to results obtained when these products were compared under in vitro conditions, there was no statistically significant difference in vivo between delivery of ibuprofen. Estimated relative bioavailability fraction (Deep Relief gel/Ibuleve gel) from log-transformed AUC((0-24h)) was 0.99 (95% CI: 0.94-1.04), estimated C(max )ratio was 0.96 (95% CI: 0.91-1.00) and estimated t(max) ratio was 1.01 (95% CI: 0.81-1.20). Menthol produces local vasodilation, which reduces skin barrier function, and these data demonstrate that it is inappropriate to extrapolate from in vitro data where formulation components produce biologically-mediated enhancement of permeation which cannot be modelled ex vivo. In clinical use, these products deliver comparable amounts of ibuprofen, but only Deep Reliefgel provides the secondary immediate benefit of the direct analgesic action of menthol.
Administration, Cutaneous↗
Metabolic changes during experimental cerebral ischemia in hyperglycemic rats, observed by 31P and 1H magnetic resonance spectroscopy.
Progressive cerebral ischemia was induced in seven anesthetized hyperglycemic rats by carotid artery ligation and hemorrhagic hypotension. Phosphorus metabolites, intracellular pH, and lactate in the brain were monitored by 31P and 1H magnetic resonance spectroscopy. Under conditions in which blood flow was low, phosphocreatine (PCr) concentration and intracellular pH decreased and the concentration of lactate increased. The decrease in ATP was approximately one-third that of PCr until only 25% PCr remained, after which ATP was lost more rapidly than PCr. These changes were interpreted in terms of three regions observed by the magnetic resonance coil, one of complete ischemia, one of partial ischemia, and one of perfusion sufficient to maintain normal metabolite levels. The extent of the three regions was estimated quantitatively. Broadening and splitting of the inorganic phosphorus (Pi) peak into two components provided further evidence of distinct populations of cells, one very acidic and another less so. Apparent intracellular buffering capacity was calculated as 23.6 +/- 1.3 mumol lactate/g wet wt/pH.
Acidosis, Lactic↗
Prevalence and correlates of major depressive disorder in Nigerian outpatients with heart failure.
This study aims to estimate the prevalence and correlates of major depressive disorder (MDD) in Nigerian outpatients with heart failure. Authors assessed patients with heart failure (N = 102) for DSM-IV diagnosis of MDD and obtained sociodemographic and clinical data. MDD was found in 28 (27.5%) of the patients. The significant correlates predicting MDD included unemployment and disability due to the illness, more severe illness (NYHA class), age younger than 60 years, and not being married. These factors should be considered in planning further studies and in screening and intervention programs for patients with heart failure.
Aged↗