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The diagnostic significance of video-EEG monitoring findings on pseudoseizure patients differs between neurologists and psychiatrists.

PURPOSE: The diagnosis of psychogenic pseudoseizures has improved with the availability of video-electroencephalography (EEG) monitoring; however, the outcome of this difficult disorder has remained poor. In an attempt to elucidate factors contributing to this poor outcome, we hypothesized that neurologists and psychiatrists differ in their views of the diagnosis and management of psychogenic pseudoseizure patients. METHODS: The hypothesis was tested by using a brief anonymous questionnaire administered to neurologists and psychiatrists at continuing medical education (CME) conferences. RESULTS: We found that neurologists and psychiatrists differ significantly in their opinion as to the accuracy of the video-EEG procedure; psychiatrists view video-EEG as often inaccurate in the diagnosis of psychogenic pseudoseizures compared with neurologists (p < 0.001). Neurologists, more frequently than psychiatrists, thought that patients' own psychopathology rather than "doctors dropping the ball" was a predominant factor in contributing to therapeutic failure, but this difference between specialties did not reach statistical significance. CONCLUSIONS: Resolving the differences between neurologists and psychiatrists would be helpful in caring for psychogenic pseudoseizure patients. These results support the need to encourage psychiatrists to have an integral involvement in epilepsy centers and to improve the understanding of psychogenic pseudoseizures in both disciplines.

Attitude of Health Personnel↗

[Public opinion on active euthanasia. The results of a pilot project].

BACKGROUND AND OBJECTIVE: Despite eager public interest there have been few significant studies about the views of the German population on active euthanasia. It was our purpose to investigate, before undertaking a representative enquiry about this controversial and ethically sensitive topic, to what extent public opinion and the underlying norms, values and preferences can be adequately obtained by standardized data collection. COHORT AND METHODS: An interdisciplinary project group established a standardized written form of enquiry for measuring public opinion about active euthanasia. The test was performed on an anonymized convenience [corrected] sample of 110 persons living in North Germany. The questionnaires consisted of ten hypothetical cases, 11 potentially relevant viewpoints on likely decisions and eight frequently expressed arguments used in the debate for and against euthanasia. RESULTS: The reply rate to the questionnaire was 89% (n = 98; 37 men and 59 women, average age 39.5 [21-81] years). Agreement with active euthanasia in the various case examples ranged, according to context, from 85 to 93%. Active euthanasia was accepted by a clear majority, if preconditions of a voluntary decision by a mentally sound person and incurable, terminal disease (cancer) are cumulatively fulfilled. Otherwise it was rejected by most respondents. To a clear majority, active euthanasia implied both the chance that suffering would be shortened, but also the danger of misuse. Among the persons questioned those with professional experience of euthanasia were clearly more sceptical about active euthanasia than those without such experience. CONCLUSIONS: The standardized written questionnaire made it possible to obtain a differentiated picture of public opinion on active euthanasia. However, these data represent only a moment in the dynamic process of a norm being established within a society and must on no account be used as legitimizing active euthanasia by plebiscite.

Adult↗

Epidemic of HIV coupled with hepatitis C virus among injecting drug users of Himalayan West Bengal, Eastern India, Bordering Nepal, Bhutan, and Bangladesh.

A study was conducted in June 2004 to find out the epidemiology of HIV infection among injecting drug users (IDUs) of Darjeeling District of West Bengal, eastern India. The district headquarter, Darjeeling town, also known as "Queen of Hills," is a beautiful spot situated in Himalayan West Bengal that attracts a large number of tourists each year from all over the world. Another unique feature of the district is that it has international boundaries with three countries, Nepal, Bhutan, and Bangladesh. Siliguri, the part of the district on plains, acts as a transit station for these countries as well as to the entire Himalayan region of West Bengal and neighboring state, Sikkim. It is also a transit point to all northeastern states of India: Assam, Arunachal Pradesh, Nagaland, Manipur, Mizoram, Meghalaya, and Tripura. Two hundred twenty-eight study subjects (IDUs) were included in this community-based cross-sectional study from all four subdivisions of the district. Informed consent was obtained, and then personal interviews, followed by blood testing were performed using unlinked anonymous procedure. The study revealed that overall HIV seroprevalence among IDUs was 11.8% (n = 27; 95% confidence interval, 7.9-16.7), whereas seroprevalence of hepatitis C was found to be 47.7% (n = 97). Prevalence of HIV was higher in subjects from hill districts (13.5%) compared with subjects from the plains (9.2%). It also revealed that most IDUs (75.3%) used "brown sugar," an impure form of heroin, as their major addictive substance followed by injection norphine. Sharing of injecting equipment was found to be as high as 67% among IDUs, and sharing of drugs from common ampules was found to be 35.5% of the studied subjects (n = 93). Most subjects (96%) were found to clean their injecting paraphernalia with plain water. Most IDUs (98%) were found to inject intravenously. About 52% of IDUs visited sex workers one or more times within the last 1 year, and 15% of the interviewed subjects (n = 93) reported to suffer from sexually transmitted diseases during the same period. All the IDUs knew about HIV/AIDS. About 69% of the subjects knew that apparently healthy looking person might have HIV infection. HIV was found to be associated significantly with age of the injectors and duration of injecting practices. The study revealed the epidemic of HIV and hepatitis C among IDU populations at this bordering district of West Bengal for the first time that requires urgent intervention at local, national, and international levels.

Adolescent↗

Predicting anonymous egg donor satisfaction: a preliminary study.

Our aim was to assess the psychologic characteristics and postdonation satisfaction of anonymous oocyte donors. Twenty-five consecutive anonymous oocyte donors completed psychologic tests before donation and satisfaction ratings following completion of the egg donation cycle. The average donor was 27 years old, married, and employed outside the home. All predonation scores on the psychologic measures were within the normal range. However, 24% of donors reported a history of sexual assault, and 40% described having had some type of reproductive loss. Although monetary compensation for donation was provided, altruism was reported as the most salient motivating factor. Following oocyte donation, 80% of women stated that they would be willing to donate again. Postdonation satisfaction was high. A significant negative correlation was found between predonation financial motivation and postdonation satisfaction (r = -.48, p < 0.01) and between predonation ambivalence and postdonation satisfaction (r = -.84, p < 0.0001). Donors with high levels of predonation financial motivation or ambivalence should be carefully screened and counseled before oocyte donation to ensure satisfactory psychologic outcome.

Adult↗

Risk perception and attitudes towards HIV in Serbian health care workers.

BACKGROUND: Health care workers (HCWs) are at risk of occupational exposure to human immunodeficiency virus (HIV). AIM: To investigate the perception of professional risk from, and the knowledge, attitudes and practice of HCWs to HIV and AIDS in Serbia. METHODS: Cross-sectional study of 1,559 Serbian HCWs using self-administered anonymous questionnaires. Chi-square testing and multiple logistic regression analysis were applied. RESULTS: Eighty-nine per cent of HCWs believed that they were at risk of acquiring HIV through occupational exposure. The perception of professional risk was higher among HCWs frequently exposed to patients' blood and body fluids (OR 7.9, 95% CI 4.4-14.5), who used additional personal protection if the HIV status of patient was known (OR 2.6, 95% CI 1.5-4.6), who had experienced sharp injuries within the last year (OR 1.9, 95% CI 1.0-3.8) or who had been tested for HIV (OR 2.1, 95% CI 1.2-3.5), and among HCWs who had treated HIV-positive patients (OR 1.7, 95% CI 1.1-2.8). The majority of respondents had deficient knowledge about modes of HIV transmission. Attitudes towards HIV-positive patients were significantly different by occupation. Seventy per cent of HCWs used appropriate protection during their daily work with patients. CONCLUSIONS: HCWs require specific educational programmes and training protocols to ensure that they are adequately protected when carrying out high quality care.

Adult↗

The Bali STD/AIDS Study: evaluation of an intervention for sex workers.

BACKGROUND: Prostitution has been an important factor in the spread of HIV infection in Asia. Interventions need to be developed to reduce the risk of transmission of sexually transmitted infections in this area. GOALS: To educate female sex workers about sexually transmitted infections and assess the impact of the educational intervention. STUDY DESIGN: Brothel areas in Denpasar, Bali, Indonesia, were divided into areas of high and low program (interventional) effort. The intervention included educational sessions for sex workers, treatment of sex workers for sexually transmitted disease (STD), condom distribution, and printed information for clients of the sex workers. A high-effort area was one in which a more intensive educational intervention occurred. A clinic was available for STD treatment in both areas. Behavioral surveys and STD testing were used to evaluate the programs. Six hundred female sex workers participated in behavioral surveys and STD examinations every 6 months for four rounds of data collection. Each round, about half of the women were new to the study. A total of 1586 women participated in at least one evaluation round. Changes were evaluated in AIDS knowledge, STD knowledge, and condom use, as well as in the prevalence of Neisseria gonorrhoeae, Chlamydia trachomatis, syphilis, and Trichomonas vaginalis. Testing for HIV was conducted anonymously. RESULTS: Improvements were noted in the knowledge of sex workers about AIDS and STDs and in the reduction of some bacterial STDs. Women who remained in the study area for more than one round had increased knowledge of HIV infection/STDs and condom use and had reduced levels of syphilis, gonorrhea, and trichomonas infection (P < 0.01). The additional education received by women in the high-effort program area was associated with a reduction in the prevalence of syphilis. Prevalence of HIV remained low throughout the study. The high level of turnover of female sex workers contributed to the maintenance of significant levels of STDs in this population. CONCLUSIONS: Developers of HIV/STD prevention programs for sex workers need to consider the mobility of the sex worker population. Interventions combining behavioral and medical approaches can contribute to prevention of these diseases.

Acquired Immunodeficiency Syndrome↗

The impostor phenomenon: self-perceptions, reflected appraisals, and interpersonal strategies.

Three studies tested theoretical assumptions regarding the impostor phenomenon. In Study 1, participants completed measures of impostorism, rated themselves, and indicated how they thought other people regarded them. Contrary to standard conceptualizations of impostorism, high impostors were characterized by a combination of low self-appraisals and low reflected appraisals. Study 2 was an experiment designed to determine whether the behaviors associated with the impostor phenomenon are interpersonal strategies. Participants were told that they were expected to perform either better or worse than they had previously predicted on an upcoming test, then expressed their reactions anonymously or publicly. High impostors expressed lower performance expectations than low impostors only when their responses were public. When expectations for performance were low, participants high in impostorism responded differently under public than private conditions. Study 3 examined the possibility that high scores on measures of impostorism may reflect two types of impostors--true impostors (who believe that others perceive them too positively) and strategic impostors (who only claim that they are not as good as other people think). The results did not support this distinction; however, evidence for the strategic nature of impostorism was again obtained. Although people may experience true feelings of impostorism, these studies suggest that the characteristics attributed to so-called impostors are partly interpersonal, self-presentational behaviors designed to minimize the implications of poor performance.

Adolescent↗

HIV mass screening of infants and mothers: historical, technical, and practical issues.

Screening groups of anonymous infants for HIV antibody, as an index of maternal infection rates, has been a widely used seroepidemiological method since being introduced in 1986 in Massachusetts (USA). One shortcoming has been the applicability only to parturient women, thus necessitating corrections for fertility rates in extrapolation to all women. A second disadvantage has been controversy and confusion about the distinction between anonymous seroprevalence studies and linked testing. However, there have been major advantages such as the "leading indicator" nature of the data obtained. Experience with screening nearly a half million Massachusetts newborns through December 1992 has shown seroprevalence rates stabilizing at 2.4 per 1000, and with consistent 10-fold differences between groups of birth hospitals serving different socio-economically defined populations. In addition to predicting the future of the AIDS epidemic in children, the information provides a reference point for comparing the completeness of targeted identifications of HIV infection in mothers and infants.

Female↗

Hepatitis C and young drug users: are they about to join the epidemic?

This study investigated what some high-risk youth in Perth knew about, believed about and did about hepatitis C, and the extent to which they had been exposed to the virus, by surveying 234 12-to-20-year-old users of injectable drugs. About half of the respondents (108) gave a blood sample for anonymous hepatitis C virus antibody testing. All respondents had used at least one illicit drug other than marijuana in the previous 12 months and most (75 per cent) reported injecting drugs at least once in the past 12 months. The study group was obtained through drug treatment agencies and interviewer networks. Although more than 80 per cent of the study group had heard of hepatitis C, only 50 per cent considered the infection to be a serious problem. Eighty per cent of respondents were at risk of infection from unsafe injecting practices, and their relevant knowledge of hepatitis C was at best, barely adequate. Of those tested, 5.5 per cent were seropositive. A pool of infection, albeit small, already exists among this group of users of illicit drugs. Given the low average duration of illicit drug use among this group (less than 2 years) and the fact that many of the users are part of a hidden population that will probably never be in treatment, that there is any infection present is of concern. Appropriate, well-aimed education and peer outreach programs are desperately needed if the transmission of hepatitis C among young users of injectable drugs is to be kept to a minimum.

Adolescent↗

Who declines to give a name at a sexual health service?

OBJECTIVE: To characterise patients who decline to provide their surname at a public sexual health centre. METHODS: A case-control study of all patients first attending the Sydney Sexual Health Centre from 1998 to 2004, using proforma-collected electronic data to compare patients who did not provide their surname with those who did. In addition, the frequencies of the 10 most common surnames in the Sydney telephone directory were compared with the frequency of those names in the patient database. RESULTS: Of 27 241 patients, 1350 (5%) declined to provide their surname. The most common surnames were also over-represented, suggesting that aliases remained pervasive among the centre's patients. Sex workers, married people and people requesting HIV, hepatitis or sexually transmissible infection (STI) screening were all more likely to decline to provide a surname. By contrast, patients with symptoms, patients who were referred with a prior STI diagnosis and patients with a new bacterial or non-HIV viral STI or were a known contact with STI were all significantly more likely to provide a surname. Among patients who declined to provide a surname, 20 tested HIV positive. CONCLUSION: The anonymous option did not seem to eliminate the use of aliases. Although limited, there seems to be a market for anonymous sexual health screening, particularly for the asymptomatic.

Adult↗

High prevalence of sexually transmitted and blood-borne infections amongst the inmates of a district jail in Northern India.

Two hundred and forty male and 9 female jail inmates confined for various crimes in a district jail near Delhi were screened for sexually transmitted and blood-borne diseases including HIV, syphilis and hepatitis B and C viral infections, skin diseases etc. The inmates were aged 15-50 years with a mean of 24.8+/-0.11. Their alleged criminal background, period of stay in the jail, drug addiction, education, birth place, marital status, sexual activity, and clinical complaints were recorded by an anonymous questionnaire. Serum samples were tested for antibodies against HIV (1+2), hepatitis C (HCV), Treponema pallidum and for hepatitis B surface antigen (HBsAg). Sputum examination was done for acid-fast bacilli. Out of the 240 men, 115 were married and 125 unmarried. One hundred and eighty-four (76.6%) men gave history of penetrative sex. Of the 184, 53 (28.8%) were homosexuals or bisexuals and 131 (71.2%) had sex with women only. Sixty of the 131 (45.8%) were faithful to their partners while 124 gave a history of having multiple sexual partners and 100 of them (80.6%) had unprotected sex. Eighty-three of these 100 also had had sex with commercial sex workers (CSWs). One hundred and twenty-six were addicted for alcohol, 44 for smack/charas and 8 had a history of intravenous drug abuse. One hundred and seventy-four were not aware of AIDS. On examination 28 of the 240 (11.6%) had active hepatitis with or without a history of jaundice in the last 2 years, 25 (10.4%) active pulmonary tuberculosis (TB) and 11 (4.6%) had syphilitic ulcers on the penis. Four-fifths of the teenagers confined to a particular barrack had moderate to severe scabies. Three males (1.3%) were found to be Western blot confirmed HIV-1 positive while 28 (11.1%) men and 2 (22.2%) women were positive for HBsAg. Twelve (5.0%) men but no women, were found to be positive for anti-HCV antibodies. Out of the 3 HIV-positive persons, one was an intravenous drug user (IVDU), second was a drug addict and frequent CSW visitor while the third was a homosexual. This pilot study gives an indication that sexually transmitted and blood-borne infections are highly prevalent in jail premises and pose a threat of rapid spread of these infections through IVDU and homosexuality.

Acquired Immunodeficiency Syndrome↗

[Behavioral characteristics of the only child vs first-born and children with siblings].

OBJECTIVE: To assess the impact of being an only child on characteristics of parental and peer relationships, school achievement, social and sexual behavior. METHODS: In the total, 360 adolescents identified at third year of high school were sampled from a private school from Porto Alegre in 2000 and 2001. Fifteen to nineteen years old male and female were selected in a cross-sectional study. Assessment of demographic data, education of the parents, birth order (only child, first born and non-first born children), cigarette smoking, alcoholic beverages consumption, illicit drug use, school achievement, social and sexual behavior were gathered with a pre-tested self-administered questionnaire, anonymously fulfilled at the classroom. RESULTS: This study encompassed 8% of only children, 35% first-born, and 57% non-first born adolescents of a socioeconomic homogeneous sample. Social behavior, parents and peer relationships, sports participation, smoking and illicit drug were not associated with birth order. Only children were less likely to report an episode of alcohol intoxication (39%) than first-born (68.9%; p=0.03) and adolescents with siblings (72.3%; p<0.001). Only children had high school achievement than adolescents with siblings (p=0.03). Sexual behavior distinguished only children due to younger age at first sexual intercourse and lower rate of heterosexual self-identification, which persisted even after adjustment for confounding variables in comparison with non first-born adolescents (p=0.038). CONCLUSIONS: Our findings suggest that the status of being only child is not associated with a poor outcome in several areas of the development. The impact of the presence of siblings in the development of sexual identification should be further explored.

Adolescent↗

[Intravesical morphine analgesia in pediatric urology].

OBJECTIVE: Evaluation of the technique and value of intravesical morphine instillation after ureterovesical reimplantation in children. MATERIAL AND METHODS: From July 1997 to June 1998, the Duckett protocol (Philadelphia, USA), comprising slow intravesical infusion of morphine for the first three prosoperative days, was applied in 25 children aged five months to twelve years after ureterovesical reimplantation surgery, without bladder catheterization. Postoperative pain was evaluated by CHEOPS and VAS scales and by all nursing staff by an anonymous questionnaire. RESULTS: Analgesic assessment tests confirmed a significant improvement of postoperative comfort, despite the absence of a bladder catheter. No adverse effects or complications related to intravesical morphine instillation were observed. CONCLUSION: Intravesical morphine instillation is an easy, effective postoperative analgesia technique, allowing good tolerance of the absence of postoperative bladder catheterization.

Administration, Intravesical↗

[Family practitioners' knowledge and attitudes towards various fields of non-conventional medicine].

BACKGROUND: The common feature of the different varieties of non-conventional medicine (NCM) is the lack of recognition, complete or partial, given to them by the institutions of conventional medicine. Treating all varieties in the same way can cause confusion. AIM: To investigate the knowledge and attitudes of family practitioners (FP) in the methods of NCM that are most commonly practiced in Israel. METHODS: Anonymous questionnaires were used that tested knowledge and probed attitudes about FP about acupuncture, homeopathy, shiatsu and reflexology. RESULTS: 130 FP participated in the study (response rate 91%). In-depth training of any one of the NCM methods was rare (3-7%). Overall, a very minimal level of knowledge of all four methods was found--58% did not manage to answer even one knowledge question correctly, and the best result was five correct answers out of eight. Most of the doctors recognized NCM as legitimate, and thought that conventional and non-conventional medicine should co-exist side by side. Over 30% saw the possibility of integrating all four NCM methods within the institutions of conventional medicine. No significant difference was found in the doctors' attitudes towards the different methods. Better knowledge was associated with more positive attitudes towards NCM (p < 0.05), and a greater likelihood of referring patients (p < 0.1). CONCLUSION: Since attitudes towards NCM seem to be shaped by knowledge to a certain extent, educators should consider teaching more about these treatments both in medical schools and as part of CME.

Acupressure↗

Epidemiology of HIV infection among brothel-based sex workers in Kolkata, India.

A cross-sectional study was carried out during January-June 2004 to assess the status of HIV infection among brothel-based sex workers in Kolkata city, India. Six hundred and twenty-two sex workers, selected from six brothels, were included in the study to assess their HIV status, and 362 sex workers, a subset of the above population, were interviewed to study their risk behaviour and practices. Blood samples were collected from each sex worker for testing HIV by an unlinked anonymous method. The prevalence of HIV infection was 9.6%, but was much higher among younger sex workers aged 20 years or less (27.7%) compared to the older age group (8.4%). This difference was statistically significant, indicating an association of younger ages with HIV infection [p = 0.006 and odds ratio (OR) = 4.18; (95% confidence interval (CI) 1.2-13.8)]. HIV was not associated with duration of sex work, average number of clients entertained per day, condom use, practice of sex during menstruation, pre-coital examination of penis for visible ulcer/discharge, suffering from sexually transmitted infections, and entertaining clients outside the brothel. There was a big gap between the reported and the evaluated condom use by sex workers. The results suggest that there is a need to develop suitable HIV intervention strategies, considering the socioeconomic and cultural aspects of city sex workers, with a provision for continuous monitoring and evaluation.

Adolescent↗

Serosurvey of human immunodeficiency virus, hepatitis B virus, and hepatitis C virus infection among hospital-based surgeons. Serosurvey Study Group.

BACKGROUND: Because occupational blood contact places health-care workers at risk for infection with bloodborne pathogens, we wanted to estimate the prevalence of infection with human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) among hospital-based surgeons and correlate the results with occupational and nonoccupational risk factors. STUDY DESIGN: All surgeons in training or in practice in general surgery, obstetrics and gynecology, or orthopedics at 21 hospitals in moderate to high AIDS incidence areas were eligible to participate in a voluntary, anonymous serosurvey. Serum samples were tested for HIV antibody, for HCV antibody, and for markers of HBV infection: hepatitis B surface antigen, total antibody to hepatitis B core antigen, and antibody to hepatitis B surface antigen. RESULTS: Of 2,887 eligible surgeons, 770 (27 percent) participated in the study. One of 740 surgeons not reporting nonoccupational risk factors was HIV seropositive (0.14 percent, upper limit 95 percent confidence interval [CI] equals 0.64 percent). None of 20 participants reporting nonoccupational HIV risk factors and none of ten not responding to the question on nonoccupational risk factors were HIV positive. Of 129 (17 percent) participants with past or current HBV infection, three (0.4 percent) had chronic HBV infection; all were negative for hepatitis B e antigen. Risk factors for HBV infection included not receiving hepatitis B vaccine (odds ratio [OR] 14.7, 95 percent CI 8.3 to 26.0) and practicing surgery at least ten years (OR 2.2, 95 percent CI 1.3 to 3.8). Seven (0.9 percent) participants had anti-HCV. CONCLUSIONS: Although not necessarily generalizable to all surgeons in moderate to high AIDS incidence areas, these results do not indicate a high rate of previously undetected HIV infection among surgeons who trained or practiced in these areas, or both. Hepatitis B virus posed the highest risk of infection with a bloodborne pathogen, followed by HCV and HIV.

General Surgery↗

Top performer survey: computerized psychological assessment in aircrew.

There were 29 (80%) subjects from a squadron of 36 F-16 pilots who voluntarily participated in a newly developed anonymous, self-administered, computerized testing protocol. The test battery consisted of two 2.5-h blocks that gathered demographic information and measured personality (MMPI-2), cognitive capacity (MAB), crew coordination skills (PCI), and history of psychiatric diagnoses (C-DIS). The test battery also included a peer rating survey that collected information about the squadron's top performers and their personal qualities. Results indicated that aviators can agree who are top performers and what personal qualities are important in top performers. This pilot project demonstrated the success of the battery to gather aircrew information in a field location. Test data are presented.

Adult↗

Molecular genetics of dilated cardiomyopathy.

The recent advances in molecular biology and genetic engineering are producing relevant results in cardiology, in particular in the field of cardiomyopathies. Molecular genetics has been used for the detection of viral genomes persisting in myocardial tissue of patients with idiopathic dilated cardiomyopathy (IDC). Very recent data, based on highly sensitive and specific technologies, suggest, however, that enterovirus persistence is not a major cause of the disease. Another application of molecular genetics is the study of the familial form of IDC, using linkage analysis as a tool for the identification of the disease gene. According to this method, the X-linked form of familial IDC has been mapped within the dystrophin gene in a series of families, and preliminary reports suggest that the mutation (or mutations) concerns the muscle-promoter region. Linkage studies on the autosomal dominant form of IDC are in progress. A possible approach is the identification of linkage between the disease and an array of "candidate genes". Preliminary data have ruled out the involvement of a series of relevant candidates genes, among which the cardiac beta-myosin heavy chain gene. An alternative approach for linkage studies is to perform a random screening of the genome, in which a large number of anonymous markers are selected and tested. In conclusion, molecular genetics is starting to provide fundamental data about the pathogenetic mechanisms of IDC. The relevance of these findings is also crucial for clinical and therapeutic implications.

Cardiomyopathy, Dilated↗