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PubMed2004

Alcohol use and abuse by adolescents: the impact of living in a border community.

PURPOSE: To determine the rates of alcohol consumption and alcohol-related risk behaviors among a sample of high school students living on the U.S.-Mexico border, as well as to investigate factors associated with alcohol use among this population. METHODS: A self-administered anonymous questionnaire was administered to students in grades 9-12 during Fall and Spring semesters of 2001 (n = 1366; 639 males and 722 females) in 16 high schools in a community along the U.S.-Mexico border. The questionnaire addressed demographic factors, alcohol consumption, and alcohol-related behaviors. Surveys were completed by Chi-square tests for homogeneity of the odds ratio and logistic regression models were used to identify factors significantly associated with the outcome variables. RESULTS: Rates of binge drinking (45%), drinking and driving (19%), and riding with a driver who had been drinking (46%) were higher for our study population when compared with state and national rates. Students who consumed alcohol were more likely to report alcohol-related problems and lower academic grades. Drinking while in Mexico was significantly associated with binge drinking (OR = 6.44), drinking and driving (OR = 5.39), and riding with a driver who has been drinking (OR = 3.12). CONCLUSIONS: The high rates of alcohol risk behaviors among students living on the U.S.-Mexico border underscore the need to develop and implement culturally appropriate prevention programs that address alcohol consumption in Mexico, particularly in terms of students driving back home.

Adolescent↗
PubMed2001

Plasmodium falciparum: binding studies of peptide derived from the sporozoite surface protein 2 to Hep G2 cells.

Plasmodium falciparum sporozoite surface protein 2 (Pf SSP2), also called thrombospondin related anonymous protein (TRAP), is involved in the process of sporozoite invasion of hepatocytes. Pf SSP2/TRAP possesses two different adhesion domains sharing sequences and structural homology with von Willebrand factor A-domains and human repeat I thrombospondin (TSP). Pf SSP2/TRAP has also been implicated in sporozoite mobility and in mosquito salivary gland invasion processes. We tested 15-mer long synthetic peptides having five overlapping residues covering the complete protein Pf SSP2 sequence in binding assays to Hep G2 cells. In these 57 peptides, 21 high-activity binding peptides (HABPs) were identified; five were in the adhesion domains already described and 16 were in two regions toward the protein's carboxy and middle terminal part. Six HABPs showed conserved amino acid sequences: 3243 (21FLVNGRDVQNNIVDE35), 3279 (201FLVGCHPSDGKCNLY215), 3287 (241TASCGVWDEWSPCSV255), 3289 (251SPCSVTCGKGTRSRK265), 3327 (441ERKQSDPQSQDNNGNY455) and 3329 (451DNNGNRHVPNSEDREY465). The HABPs show saturable binding and dissociation constants between 140 and 900 nm with 40 000-855 000 binding sites per cell. The 3279 (201FLVGCHPSDGKCNLY215), 3323 (421NDKSDRYIPYSPLSP435) and 3331 (461SEDRETRPHGRNNENY475) HABPs have B epitopes in their sequences; these have previously been recognized by antibodies partially inhibiting hepatocyte invasion and development of the hepatic state. The 3287 (241TASCGVWDEWSPCSV255) and 3289 (251SPCSVTCGKGTRSRK265) HABPs share common sequences with the Pf SSP2/TRAP region II plus, which is present in a great number of adhesion proteins. Based on this information, six new peptides covering the high binding regions identified previously were synthesized and, using a competition assay, the amino acid involved in the binding were determined.

Amino Acid Sequence↗
PubMed2006

Consumption of sugar products and associated life- and school-satisfaction and self-esteem factors among schoolchildren in Kuwait.

OBJECTIVE: The objective of this study was to assess how frequently schoolchildren report consuming sweets, soft drinks, and cakes, and whether life- and school-satisfaction and self-esteem factors are associated with the consumption of these sugar products. MATERIAL AND METHODS: A total of 2,312 schoolchildren between the ages of 11 and 13 years from the government schools in Kuwait completed an anonymous structured questionnaire during 2002 and 2003. A representative sample of children from all six governorates of the country was drawn into the study. The questionnaire of the Health Behaviour in School-Aged Children (HBSC) survey was translated from English to Arabic and was used after modification to suit Kuwaitis. The chi-square test and logistic regression model were used in the analysis. RESULTS: A large proportion of children reported consuming sweets (42%), soft drinks (43%), and cakes (31%) several times a day. Almost every fourth child reported consuming all these sugar products more than once a day. All life-satisfaction and self-esteem variables and almost all school-satisfaction variables seemed to associate with more-than-once-a-day consumption of sugar products. When all the associated variables were analyzed together using the logistic regression model, the life- and school-satisfaction and self-esteem factors seemed to have a stronger association with frequent sugar consumption than did gender, grade, or nationality. CONCLUSIONS: Consumption of sugar products was common among schoolchildren in Kuwait, and both positive and negative life-satisfaction and self-esteem factors were associated.

Adolescent↗
PubMed1997

Geographic structure of mitochondrial and nuclear gene polymorphisms in Australian green turtle populations and male-biased gene flow.

The genetic structure of green turtle (Chelonia mydas) rookeries located around the Australian coast was assessed by (1) comparing the structure found within and among geographic regions, (2) comparing microsatellite loci vs. restriction fragment length polymorphism analyses of anonymous single copy nuclear DNA (ascnDNA) loci, and (3) comparing the structure found at nuclear DNA markers to that of previously analyzed mitochondrial (mtDNA) control region sequences. Significant genetic structure was observed over all regions at both sets of nuclear markers, though the microsatellite data provided greater resolution in identifying significant genetic differences in pairwise tests between regions. Inferences about population structure and migration rates from the microsatellite data varied depending on whether statistics were based on the stepwise mutation or infinite allele model, with the latter being more congruent with geography. Estimated rates of gene flow were generally higher than expected for nuclear DNA (nDNA) in comparison to mtDNA, and this difference was most pronounced in comparisons between the northern and southern Great Barrier Reef (GBR). The genetic data combined with results from physical tagging studies indicate that the lack of nuclear gene divergence through the GBR is likely due to the migration of sGBR turtles through the courtship area of the nGBR population, rather than male-biased dispersal. This example highlights the value of combining comparative studies of molecular variation with ecological data to infer population processes.

Alleles↗
PubMed2002

A new approach to assessing skill needs of senior managers.

Management of health care organizations must improve to meet the well-documented challenges of quality improvement and cost control. Other industries have developed the tools--entry education, mentoring, planned mid-career formal education and experience, and special programs for senior management. The purpose of this paper is to pilot test an alternative method to identify competencies and performance of health care executives. We propose using formal lists of technical, interpersonal, and strategic competencies and specific real events chosen by the respondent to identify and prioritize competencies. Results of a trial with 30 large health care system CEOs and 15 early careerists demonstrate that the method reveals useful depth and detail about managers' educational needs. The results suggest that current thinking about managerial education and learning patterns may be seriously inadequate in several respects. The continued improvement of U.S. health care is a pressing national concern. Quality of care is highly variable and substantially deficient in many institutions (Chassin and Galvin 1998; Committee on Quality of Health Care in America 2001). "Quality improvement should be the essential business strategy for healthcare in the 21st century (Kizer 2001)." Productivity improvements will be essential to balance cost pressures from an aging population and growing technology (Heffler, et al. 2002). Skillful management is necessary to improve quality and productivity. Teams of dozens of caregivers are often required to improve a patient's health. The organizations that provide care have grown larger in response to the greater cost, complexity of operation and finance, and evidence of the success of scale in other industries. While many small professional practices, hospitals, and nursing homes remain, consolidation has created a few dozen provider and intermediary organizations exceeding a billion dollars a year in expenditures. These large health care organizations are, or should be, modern corporate organizations at least as effective as their counterparts in manufacturing, retailing, or finance. To achieve that goal, they will require managers with comparable ability, motivation, and preparation. The National Summit on The Future Of Health Management and Policy Education emphasized the development of "evidence-based management education" by identifying, prioritizing, and measuring mastery of specific skills, knowledge, and abilities (Griffith 2001). Faculty of Association of University Programs in Health Administration (AUPHA) are working with practitioners to identify and prioritize specific learning competencies at the graduate degree level. Their effort focuses on skills teachable in the classroom, and it is expected to lead to measured performance of graduate school cohorts (Griffith 2001). The purpose of this paper is to pilot test an alternative method to identify competencies and performance of health care executives. Although it deliberately draws competency elements from academic sources, it supplements the teachable skills approach with a questionnaire that asks practitioner respondents to identify the skills and knowledge necessary to manage a specific management event and to evaluate the performance of an anonymous colleague against these skills and knowledge.

Attitude of Health Personnel↗
PubMed2006

AIDS health beliefs and intention for sexual abstinence among male adolescent students in Kathmandu, Nepal: a test of perceived severity and susceptibility.

OBJECTIVES: In Nepal, male adolescent students are at high risk for infection with human immunodeficiency virus (HIV) because of their risky sexual behaviours. This study examined whether two subscales of the Health Belief Model (HBM), perceived severity and perceived susceptibility, are associated with abstinence intention among Nepalese male adolescent students for HIV/acquired immunodeficiency syndrome (AIDS) prevention. STUDY DESIGN AND METHODS: A school-based study was conducted at a single school located in central Kathmandu from July to August 2002. Participants included 183 male students in Grades 9-12 aged 14-19 years. Anonymous self-reported questionnaires were used, and Zagumny's AIDS Health Belief Scale was adopted as a measure of perceived severity and perceived susceptibility. RESULTS: Over half of the students (53%) strongly agreed with abstinence intention. Students with higher levels of perceived severity strongly agreed with abstinence intention [crude odds ratio 1.86, 95% confidence interval (CI) 1.02-3.38; adjusted odds ratio 1.94, 95% CI 1.05-3.58], but those with higher levels of perceived susceptibility did not. Moreover, age-stratified analysis showed that a high level of perceived susceptibility tended to decrease strong abstinence intention among students aged 16-19 years. CONCLUSIONS: Perceived severity enhanced abstinence intention. The interpretations of perceived susceptibility need further examination through a longitudinal study among students aged 16-19 years. Furthermore, future research is needed to assess the effect of HIV/AIDS education on HIV/AIDS prevention strategies using perceived severity as a motivational tool to help persuade Nepalese male students to abstain from sexual intercourse.

Acquired Immunodeficiency Syndrome↗
PubMed2006

DLL3 as a candidate gene for vertebral malformations.

Investigations have not identified a major locus for congenital vertebral malformations. Based on observations in mice, we hypothesized that mutations in DLL3, a member of the notch-signaling pathway, might contribute to human vertebral malformations. We sequenced the DLL3 gene in 50 patients with congenital vertebral malformations. A Caucasian male patient with VACTERL manifestations including a T5-T6 block vertebrae was heterozygous for a "G" to "A" missense mutation changing glycine to arginine at codon 269. This residue is conserved in mammals, including chimpanzee, mouse, dog, and rat. Additional testing in the patient did not show evidence of chromosome abnormalities. The patient's asymptomatic mother was also heterozygous for the missense mutation. Since this mutation was not observed in a control population and leads to an amino acid change, it may be clinically significant. The mutation was not found in a control population of 87 anonymous individuals. Several established mechanisms could explain the mutation in both the patient and his asymptomatic mother (susceptibility allele requiring additional environmental factors, somatic mosaicism, multigenic inheritance). Documenting the absence of the mutation in a larger control population or the presence of the mutation in additional affected patients, or documenting a functional difference in DLL3 would provide further evidence supporting its causal role.

Adult↗
PubMed2006

The resident view of professionalism behavior frequency in outstanding and "not outstanding" faculty.

BACKGROUND: Professionalism assessment has become necessary for all postgraduate training programs because it is now required for accreditation. To validate the novel items we generated to assess professionalism, we tested whether residents' ratings of faculty they judged as outstanding in professionalism would be distinguishable from those they judged as not outstanding. METHODS: Educators from core clinical disciplines generated 20 items assessing professionalism behaviors on a 7-point frequency scale anchored by "always" and "never." Thirty-five surgical and pediatric residents completed the form twice, anonymously rating 1 faculty member they judged as outstanding and another they judged as not outstanding. RESULTS: The residents produced 69 faculty ratings with means that differed significantly on all items between the outstanding and not-outstanding faculty. The form was highly unidimensional, with the primary factor's eigenvalue being 11.5 and Cronbach's alpha being 0.97. Groups differed most on items, ie, "listens well," "inspires trust," "answers questions directly," and "demonstrates respect for all." CONCLUSION: The behaviors that best distinguished clinical faculty judged by residents as outstanding professionals were listening, trustworthiness, answering directly, and respect.

Clinical Competence↗
PubMed2001

Gender differences in syringe exchange program use in Oslo, Norway.

AIMS: To examine gender differences in syringe exchange program (SEP) use, particularly frequent SEP use, within and across survey years. DESIGN: Three consecutive, anonymous cross-sectional surveys. SETTING: The SEP in Oslo, Norway. PARTICIPANTS: Two hundred and eighty-eight, 449 and 523 SEP participants interviewed during comparable 1-week periods in 1992, 1994 and 1997, respectively. MEASUREMENTS: Brief structured questionnaires assessed SEP use, HIV risk behaviors and self-reported HIV status. Chi square statistics, t-tests and analysis of variance were used to identify gender differences; logistic regression was used to identify independent correlates of frequent SEP use. FINDINGS: Women reported injecting more frequently than men, but neither reported more frequent SEP use nor acquiring more syringes during an exchange. Although syringe sharing decreased significantly over time, in 1997, 51% of SEP participants continued to share. HIV prevalence remained low (3-5%) over time. After controlling for gender, age and HIV risk factors, frequent SEP use was significantly correlated with frequent injection for both women (OR = 1.4) and men (OR = 1.5). A lack of income or benefits independently increased the likelihood of being a frequent SEP user (OR = 3.0), while having shared a syringe at last injection independently decreased this likelihood (OR = 0.5). CONCLUSIONS: Gender was not associated with frequent SEP use; rather, the single most important correlate of frequent SEP use was injection frequency. Women's need for sterile syringes may not be fully addressed, despite the existence of a well-established and well-utilized SEP.

Adolescent↗
PubMed1998

Systematic analysis of hMSH2 and hMLH1 in young colon cancer patients and controls.

Germ-line mutations in DNA mismatch-repair genes impart a markedly elevated cancer risk, often presenting as autosomal dominant hereditary nonpolyposis colorectal cancer (HNPCC). However, there are no pathognomonic features of HNPCC, not all gene carriers have a family history of the disease, and families fulfilling the Amsterdam criteria are relatively uncommon. Genetic testing of probands with early-onset colorectal cancer, irrespective of family history, is one approach that would allow predictive genetic testing of at-risk relatives. We cloned and sequenced hMSH2 and hMLH1 introns, to optimize genomic sequencing. We then systematically analyzed the entire hMSH2 and hMLH1 genes, by genomic sequencing and in vitro synthesized-protein-truncation assay (IVSP), in 50 colorectal cancer patients <30 years of age at diagnosis. To determine polymorphic variants, 26 anonymous donors also were sequenced. All subjects analyzed had at least 1 of 37 different polymorphic or pathogenic variants. IVSP complemented genomic sequencing, by detection of mutations not identified by genomic analysis. Fourteen cancer patients (28%) had pathogenic mutations, and a number of other variants also may have had a pathogenic significance that remains to be elucidated. Tumor replication-error status was useful in targeting sequencing efforts for this cohort of young patients: sensitivity was 86%, specificity 73%, and positive and negative predictive values 63% and 90%, respectively. These data indicate that an appreciable proportion of young colon cancer probands carry a germ-line mutation in a DNA mismatch-repair gene.

Adaptor Proteins, Signal Transducing↗
PubMed2001

Clinical governance: learning and changing practice.

CONTEXT: This paper describes a very simple, non-threatening method for improving communication and sharing learning points. OBJECTIVE: To test whether sharing anonymised reporting of problems and helpful hints is acceptable and useful to staff. DESIGN: A pink slip (pinkie) was designed and made available in every clinic venue. All staff were asked to write about any episodes where practice was less than optimum or to share good clinical experiences. The forms could be completed anonymously if preferred. A senior nurse collated the reports monthly and fed them back to all staff as a report. In May 2000 all staff were surveyed for their opinion of the scheme. RESULT: Over 22 months, 139 'pinkies' were returned. Fifty-six of the 100 'less than optimum' events were classified as 'system failures'. The response to the staff survey was very positive, with 62% of staff replying. Fifty-four of the 55 staff found the scheme helpful. A third of those who responded had contributed and all but two individuals felt able to contribute if the situation arose again. CONCLUSION: This simple system of self completed pink slips has allowed examples of less than optimum practice and helpful suggestions to be shared across a large service that has a predominantly part time work force providing services from over 15 venues. The system is seen as non-threatening and was acceptable to over 95% of the staff who responded to the survey. Fifty percent of doctors and nurses had made a submission. Changes in practice have resulted since its introduction.

Ambulatory Care Facilities↗
PubMed1999

[Anonymous serological screening for HIV infection in umbilical cord blood by the pooled-batch system].

OBJECTIVE: The aim of this study was to estimate the sero-prevalence of HIV infections in pregnant women of the health area of Zamora, Spain by unlinked anonymous screening and to estimate the percentage of non-diagnosed cases by non-systematic screening. PATIENTS AND METHODS: Umbilical cord blood samples of 2,695 newborns at "Virgen de la Concha" hospital of Zamora collected between January 1994 and December 1996 were stored with a code number and with no personal identification. HIV antibody testing in the serum from the umbilical cord blood was performed with an enzyme-immunoassay using pooled sera and verified with Western blot. All children born to HIV-infected women during the same period were registered. RESULTS: Four of 2,695 samples were seropositive. HIV prevalence was 0.15% (CI 95%, 0.04-0.37). During the same period only 3 children born to HIV infected women were recognized. We estimate that at least 25% of seropositive women were undetected. CONCLUSIONS: We conclude that routine HIV screening should be offered to all pregnant women.

Adult↗
PubMed1990

Prevalence of marijuana use during pregnancy. A pilot study.

We examined the prevalence of marijuana use in a group of pregnant women using a qualitative, rapid urine screen to detect marijuana metabolites. Between July 1, 1987, and Aug 15, 1987, 322 consecutive patients underwent an anonymous urine toxicology screen at the time of admission to the labor-and-delivery unit. Patients were identified only by a consecutive number and by their age, race, marital status, gravidity, parity and obstetric service (clinic vs. private). The prevalence of positive urine toxicologic screens for marijuana was 19.9% among the study population (64 positive tests among 322 women screened). The prevalence was greater among the clinic patients than the private patients (52 of 161, or 32.3%, vs. 12 of 161, or 7.5%, respectively). The distribution of race and marital status among the marijuana-positive and -negative groups were also significantly different. Specifically, the proportions of black and single women were higher among the marijuana-positive group. Our findings suggest that marijuana use is common in our obstetric patients. The possible association between marijuana use during pregnancy and perinatal morbidity, as well as the unreliable nature of patient drug histories, may support the use of rapid, inexpensive screening techniques, especially if general screening is considered.

Adult↗
PubMed1989

A fine-structure deletion map of human chromosome 11p: analysis of J1 series hybrids.

Deletion analysis offers a powerful alternative to linkage and karyotypic approaches for human chromosome mapping. A panel of deletion hybrids has been derived by mutagenizing J1, a hamster cell line that stably retains chromosome 11 as its only human DNA, and selecting for loss of MIC1, a surface antigen encoded by a gene in band 11p13. A unique, self-consistent map was constructed by analyzing the pattern of marker segregation in 22 derivative cells lines; these carry overlapping deletions of 11p13, but selectively retain a segment near the 11p telomere. The map orders 35 breakpoints and 36 genetic markers, including 3 antigens, 2 isozymes, 12 cloned genes, and 19 anonymous DNA probes. The deletions span the entire short arm, dividing it into more than 20 segments and define a set of reagents that can be used to rapidly locate any newly identified marker on 11p, with greatest resolution in the region surrounding MIC1. The approach we demonstrate can be applied to map any mammalian chromosome. To test the gene order, we examined somatic cell hybrids from five patients, whose reciprocal translocations bisect band 11p13; these include two translocations associated with familial aniridia and two with acute T-cell leukemia. In each patient, the markers segregate in telomeric and centromeric groups as predicted by the deletion map. These data locate the aniridia gene (AN2) and a recurrent T-cell leukemia breakpoint (TCL2) in the marker sequence, on opposite sides of MIC1. To provide additional support, we have characterized the dosage of DNA markers in a patient with Beckwith-Wiedemann syndrome and an 11p15-11pter duplication. Our findings suggest the following gene order: TEL - (HRAS1, MER2, CTSD, TH/INS/IGF2, H19, D11S32) - (RRM1, D11S1, D11S25, D11S26) - D11S12 - (HBBC, D11S30) - D11S20 - (PTH, CALC) - (LDHA, SAA, TRPH, D11S18, D11S21) - D11S31 - D11S17 - HBVS1 - (FSHB, D11S16) - AN2 - MIC1 - TCL2 - delta J - CAT - MIC4 - D11S9 - D11S14 - ACP2 - (D11S33, 14L) - CEN. We have used the deletion map to show the distribution on 11p of two centromeric repetitive elements and the low-order interspersed repeat A36Fc. Finally, we provide evidence for an allelic segregation event in the hamster genome that underlies the stability of chromosome 11 in J1. The deletion map provides a basis to position hereditary disease loci on 11p, to distinguish the pattern of recessive mutations in different forms of cancer and, since many of these genes have been mapped in other mammalian species, to study the evolution of a conserved syntenic group.

Animals↗
PubMed1990

Genetic heterogeneity in tuberous sclerosis.

Tuberous sclerosis (TSC) is an autosomal dominant disorder characterized by widespread hamartosis. Preliminary evidence of linkage between the TSC locus and markers on chromosome 9q34 was established, but subsequently disputed. More recently, a putative TSC locus on chromosome 11 has been suggested and genetic heterogeneity seems likely. Here we describe an approach combining multipoint linkage analysis and heterogeneity tests that has enabled us to obtain significant evidence for locus heterogeneity after studying a relatively small number of families. Our results support a model with two different loci independently causing the disease. One locus (TSC1) maps in the vicinity of the Abelson oncogene at 9q34 and a second locus (TSC2) maps in the region of the anonymous DNA marker Lam L7 and the dopamine D2 receptor gene at 11q23.

Chromosome Mapping↗
PubMed1996

Seroepidemiology of HTLV-I in relation to that of HIV-1 in the Gauteng region, South Africa, using dried blood spots on filter papers.

The seroprevalence of human T-lymphotropic virus type I (HTLV-I), in relation to that of human immunodeficiency virus type I (HIV-1), was determined in a comparative unlinked anonymous antenatal and neonatal (for indirect measurement of maternal antibodies) serosurvey in the Gauteng region of South Africa, using dried blood spots (DBS) and modified particle agglutination assays. Samples were confirmed to be antibody positive by western blot. A total of 2582 DBS collected during 1993 and 1994 from subjects of African, European and coloured origin were tested. Ten were confirmed as positive for HTLV-I and 128 for HIV-1. No antibodies to HTLV-I or HIV-1 were demonstrated in the 221 women of European and coloured origin who were screened. The HTLV-I seroprevalence rate in subjects of African origin appeared to increase from 0% in 1993 to 0.49% in 1994, while HIV-1 seroprevalence rates of 5.2% and 5.4% were recorded for 1993 and 1994 respectively. No significant differences in HTLV-I and HIV-1 seroprevalence rates were noted for the two areas investigated. These results indicate that HTLV-I should be included in infection control programs, and provide baseline data for monitoring the possible spread of HTLV-I in the heterosexual population in this region.

Black People↗
PubMed2006

A folate-dependent metabolite in amniotic fluid from pregnancies with normal or trisomy 21 chromosomes.

INTRODUCTION: Previous studies have given conflicting results as to whether or not folate metabolism is altered in Down syndrome. Folate is necessary to facilitate metabolism of one-carbon units. Folate accepts one-carbon units from one-carbon unit donors, including formiminoglutamate (FIGLU). Folate deficiency leads to accumulation of FIGLU and impairment of one-carbon unit metabolism. FIGLU is a functional measure of folate deficiency. MATERIALS AND METHODS: Archived anonymized amniotic fluid specimens were obtained from normal pregnancies and those with Down syndrome. Gas liquid chromatography/mass spectrometry was used to quantitate FIGLU, which is elevated in folate deficiency. A tetra-deuterated FIGLU was used as a standard, and single-ion monitoring was performed. Nonparametric statistical analysis was performed with the Mann-Whitney U test. RESULTS: FIGLU was significantly lower in pregnancies with Down syndrome. The median FIGLU level was 0.9 micromol/l in amniotic fluid from fetuses with Down syndrome. The median FIGLU level was 1.3 in amniotic fluid from control fetuses. This difference was statistically significant (p = 0.009). No statistically significant differences were found with histidine or glutamate. DISCUSSION: There was no evidence of folate deficiency. FIGLU was decreased, not increased. Decreased FIGLU might result from accelerated activity of one or more genes on chromosome 21, by a gene dosage effect. Genes which might explain the reduced FIGLU include one which degrades FIGLU (glutamate formiminotransferase-cyclodeaminase), one which participates in purine synthesis, and one which degrades homocysteine (cystathionine-beta-synthase).

Amniocentesis↗
PubMed1998

Anonymity, neutrality, and confidentiality in the actual methods of Sigmund Freud: a review of 43 cases, 1907-1939.

OBJECTIVE: The aim of this historical study was to examine the methods actually used by Sigmund Freud in his practice of psychoanalysis in his mature years (1907-1939) and to assess the relationship between these methods and Freud's published recommendations concerning anonymity, neutrality, and confidentiality. METHOD: The authors used both published and unpublished sources, including reports or autobiographies by analysands, letters by analysands, interviews of analysands, letters by Freud, published works by Freud, and clinical records of subsequent treatment. RESULTS: Information concerning Freud's actual methods was found in 43 cases, including 10 clinical psychoanalyses, 19 didactic analyses, and 14 with combined clinical and didactic purposes. These 43 cases probably encompassed a majority of Freud's psychoanalytic hours during these years. Deviations from Freud's recommendations were found to the following extent: for anonymity, 43 cases (100%); for neutrality, 37 cases (86%); for confidentiality, 23 cases (53%). In addition, there were significant extra-analytic relations between Freud and 31 of these analysands (72%). CONCLUSIONS: These results show a substantial disparity between Freud's recommendations and his actual methods. Freud's prescribed method, as defined by his recommendations, was not tested or used in his practice. Freud's actual method was never explicitly described in his writings and cannot be replicated.

Austria↗