Mental health utilization in women with symptoms of depression

This paper examines the help-seeking process of mental health services in women with high depressive symptoms. The data are based on an island wide probabilistic sample (n = 1,062) of 18- to 64-year-old women living in low socioeconomic areas in Puerto Rico. Symptoms of depression were measured by the Center for Epidemiological Studies Depression Scale (CES-D). Results show that one out of three women living in poor residential areas report high depressive symptoms. Of these women with high depressive symptoms, only 12% seek help from a mental health specialist and 14.5% from a general health care provider to deal with their emotional problems. Some factors related to the use of mental health services are: presence of an occupational disability, head of household status, having private insurance, and having a regular source of care. These data suggest that women underutilize mental health services and overutilize physical health services to deal with their emotional problems. The lack of recognition of emotional problems by these women may explain the low utilization of mental health services.

Teen perspectives on HIV and the relevance of Hawaii's health providers

Based on focus group interviews with adolescents from an urban Honolulu community, the present article describes how these adolescents view HIV, HIV-prevention and the role of health care providers in addressing HIV-related needs. Although medical providers are known to be knowledgeable experts in a variety of health care areas, other research points to an underutilization of this potential. While knowledgeable about HIV, many of the youth in this study continue to engage in risky behavior. Few perceive they have others they can meaningfully talk to about their HIV and other health concerns. Even when probed for, almost none of these teens saw health care providers as pertinent to HIV or their health beyond the traditional illness/prescription role. Suggestions for ways to get more involved in the prevention of HIV and, more generally, positive health development in teens are discussed.

[Paternity determination using the RFLP method in DNA probes]

By the discovery of restriction fragment length polymorphism and hypervariable minisatellite sequences paternity testings have become possible with almost one hundred percent probability. The procedure is based on the improvement of DNA probes which can recognize the different regions of minisatellites in the whole site of human genome. These sequences are found in noncoding regions of DNA, in the so-called intrones, in areas between genes. The sequence motives have a discriminating power and provide a possibility to distinguish individuals.

Dermatoglyphics in insulin-dependent diabetic patients with limited joint mobility

Hand and palm dermatoglyphics were studied in 158 insulin-dependent diabetic children and adolescents [85 with limited joint mobility (LJM) and 73 without]. The findings in this group were compared with those in 400 control subjects, with a similar racial distribution. The main dermatoglyphics alterations found in diabetic patients with LJM, as compared with non-LJM diabetic patients and controls, may be summarized as follows: (a) decrease in digital total ridges count (TRC); (b) higher frequency in the number of arches; (c) decrease in the sum of a line and cubital loops, particularly in the women; (d) increase in the number of t'-axial triradii. These alterations suggest a genetic aetiology of this complication. Further studies are recommended in order to provide more insight into the origin of this disorder.

Organizational response to adolescent HIV risk

Using semi-structured interviews, the present study examined organizational responses to adolescent HIV risk in an urban Honolulu community. All 23 health, social service, and educational organizations studied have been impacted by HIV. However, the overall organizational response has been compartmentalized and limited. Recommendations concerning improved organizational responses are provided.

HIV infection, risk behaviors, and depressive symptoms among Puerto Rican sex workers

This paper examines the association of depressive symptoms with human immunodeficiency virus (HIV) infection and risk behaviors among 127 sex workers. Data were obtained by a structured interview and blood specimens tested for HIV. Findings showed a high prevalence rate of depressive symptoms for all sex workers regardless of HIV infection status. Results of a logistic regression analysis indicated that the use of injected drugs and engaging in unprotected intercourse with clients were strongly associated with a high level of depressive symptoms.

Computed tomography imaging in children with head trauma: utilization and appropriateness from a quality improvement perspective

Computed tomography (CT) imaging plays an important role in the acute evaluation and management of children with head trauma. When routine quality improvement (QI) meetings with representatives from the Children's Hospital radiology and emergency departments revealed disagreement regarding the utilization and appropriateness of CT in children presenting with head trauma, an interdepartmental QI team was formed to address this issue. Because formal criteria for obtaining CTs for head trauma were unavailable, internal institutional criteria were developed by consensus after literature review. Contrary to perceptions of some staff members, the majority (95%) of children who received CT met at least one of the established criteria over a one-year study period. There was little relationship between the presence of criteria and abnormal CT results, but decisions whether to admit patients to the hospital or to send them home were influenced by CT results. Follow-up studies suggested that patients who were discharged home with a normal CT or no CT had uniformly good outcomes.

[Neuroblastoma in childhood. Review of clinical aspects and of 2 forms of treatment]

The optimum time for a surgical resection of the primary lesion in the advanced neuroblastoma has not been defined properly. Recently the therapeutic results of the advanced neuroblastoma have improved through the use of preoperative chemotherapy. We check on our patients who were affected by this disease in the last 15 years. From 185 malignant tumours diagnosed in our department, 52 belonged to neuroblastomas with more than 12 months of evolution. Most of them were diagnosed during the year after their birth and it was not observed a difference of sexes. The location was the habitual one, except 2 cases of thoracoabdominal tumour and 1 of stesioneuroblastoma the most common manifestation was the metastatic disease. Catecholamines in 24 hours urine were positive in 74% of our patients, and enolase in 100% of the same ones. The longest percentage of patients is distributed in the advanced stages of Evans.

A receiver operating characteristic (ROC) curve analysis of a model of mental health services use by Puerto Rican poor

In this study, the contribution of four distinct domains of the Help Seeking-Decision Making model to predicting the use of mental health services is examined. Using a proposed methodology the authors assess the relevance of this model and its domains to mental services planning. The methodology combines logistic regression analysis and receiver operating characteristic (ROC) curves. Logistic regression analysis allows us to examine the individual variables of the model and generate predictions about use. ROC curves allow us to compare and interpret the relative contribution of a predisposing domain, a physical and mental health domain, an enabling-restrictive domain, and an organizational domain in correctly classifying users and nonusers of mental health services. The physical and mental health domain yielded a Somer's D-statistic of 0.7, which corresponds to an 85% correct classification of randomly selected pairs of users and nonusers. The study findings suggest that comparing ROC curves helps to describe and interpret the domains of the model that are relevant for making predictions about who will or will not use mental health services during a 1-year period.

Depressive symptoms among Puerto Ricans: island poor compared with residents of the New York City area

This paper compares the distribution and sociodemographic patterns of depressive symptoms among two groups of Puerto Ricans. The data employed for the analysis are from a probability sample of two communities of adults. Puerto Ricans living in poor residential areas on the Island (n = 1,658) and those living in the New York City area (n = 1,267). The first group was interviewed during 1989, and the second during 1984. Symptoms of depression were measured with the Center for Epidemiologic Studies Depression Scale. Results show that Puerto Ricans residing in the New York City area and the Island poor have similar levels of high depressive symptomatology, 28.1% and 28.6%, respectively. Results of the logistic regression analysis indicated that female sex, low educational level, low household income, and unemployment are predictors of high depressive symptoms for both samples. These results are similar to findings for other ethnic groups. For Puerto Ricans living in New York, the effect of interviewing in Spanish on high depressive symptoms diminishes after sex, education, and income variables are controlled.

Patterns of mental health utilization among island Puerto Rican poor

BACKGROUND

This paper describes utilization of mental health services by poor Puerto Ricans living on the island. It examines the utilization rates, within health sectors, and settings for the provision of mental health services.

METHODS

Data are based on an islandwide probability sample of 18- to 64-year-old respondents living in low socioeconomic areas. We assessed need with the Psychiatric Symptom and Dysfunction Scales.

RESULTS

Approximately one-third of our study population (31.5%) met criteria for need. Of these, only 32% had received any mental health care in the past year. Need was significantly associated with use of physical or mental health services for mental health problems. We found those who needed services to be five times more likely than those who did not need services to have used one or both sectors of care at least once in the past year. Among the first group 21.8% used the physical health sector to deal with mental health problems in contrast with 17.9% who sought care in the mental health sector. In the physical health sector, subjects used the public and private settings equally. In the mental health sector, 70% of subjects used the public setting.

CONCLUSIONS

This suggests the nonpsychiatric physician as a main provider for mental health treatment.

Partial intercalation with DNA of peptides containing two aromatic amino acids

The interactions with DNA of tetrapeptide amides containing lysine at the N-terminal position and aromatic amino acids at the second and fourth positions (Ala at position three), 1-6, have been investigated by nmr, CD, and viscometric methods. Tetrapeptides with N-terminal lysine and a single aromatic amino acid, 7-10, were investigated as controls. Significant decreases in DNA viscosity occurred on addition of 7, with the aromatic group at the second position, but not with any of the other single aromatic amino acid peptides. All of the tetrapeptides with two aromatic groups caused DNA viscosity decreases which were two to three times larger than with 7. Peptides with p-nitrophenylalanine (p-NO2Phe) as the aromatic group were synthesized for nmr studies because of its simpler aromatic nmr spectrum relative to Phe. Large upfield shifts of the aromatic proton signals were obtained when the amino acid in the second position was L-p-NO2Phe, and the fourth position contained either p-NO2Phe or Phe. Such peptides also caused the largest DNA viscosity decreases on complex formation. Smaller upfield shifts of the aromatic signals were obtained when the amino acid in the second position was L-Phe or a D isomer of Phe or p-NO2Phe. With all peptides, larger upfield nmr shifts were obtained with heat-denatured, recooled DNA than with native DNA under the same conditions. As with nmr, CD results are quite different for the peptides with L and D amino acids at the second position. All of the results can be interpreted in terms of a model in which lysine interacts stereospecifically with the backbone in a DNA double helix and the aromatic group at the second position stacks strongly with the base pairs when the amino acid is an L isomer. The aromatic group at the fourth position can also interact with the base pairs, but primarily through a sideways stacking of the aromatic group with base pairs for either L or D isomers. Because of covalent constraints on the separation distance for the two aromatic groups in the tetrapeptides, they must stack on opposite sides of the same base pair in violation of the neighbor exclusion principle observed with classical intercalators. This stacking at the same base pair no doubt accounts for the larger viscosity decreases in DNA with the peptides containing two aromatic groups relative to those with a single aromatic group.(ABSTRACT TRUNCATED AT 400 WORDS)

A study of the respiratory function in insulin-dependent diabetic patients with and without limited joint mobility (LJM)

The respiratory function of 51 insulin-dependent diabetic patients (31 with and 20 without LJM) was studied. The variables age, diabetes duration, height, and metabolic control were similar for both groups. Vital capacity (VC), forced expiratory volume (FEV), mean maximum expiratory flow (MMEF), and FEV/VC ratio were determined before and after the administration of a bronchodilator. VC, FEV, and MMEF showed significantly lower values (p less than 0.02) in patients without LJM as compared to those with LJM. It is suggested that these alterations may be due to abnormalities of collagen fibers and elasticity in the lung and are not related to reversible bronchial obstruction. We believe that LJM is an extrinsic manifestation of a systemic process, aggravating the prognosis of diabetes mellitus.

Sociodemographic, cultural and interpersonal risk factors as indicators of mental health needs

The goal of this paper is to examine an integrated model of mental health needs which takes into consideration psychiatric symptoms and dysfunctions, behavioral dimensions, as well as socioeconomic and cultural factors. This model presupposes that specific life situations and positions of the respondent in different dimensions of the social structure are basic factors for the identification of mental health needs. The method of data collection was a personal interview with a sample of two hundred community members, 18 to 64 years, selected using a stratified random sampling based on the criteria of sex and age. Statistically significant differences were identified between age, sex, education, social role performance, subjective perceptions, and levels of mental health need. This evidence suggests that social roles and specific risk factors are basic elements in determining mental health needs.

Psychiatric symptomatology and health care utilization

This paper examines the relationship between psychiatric symptoms and dysfunctions and utilization of general and mental health services. A sample of two hundred community members, 18 to 64 years old, was selected using a stratified random sampling based on the criteria of sex and age. Respondents were categorized according to their aggregated scores on the validated Psychiatric Symptom and Dysfunction Scales. Patterns of utilization were ascertained according to identified levels of psychiatric symptoms. Results indicated that as the level of psychiatric symptoms increased so did the proportion of users of mental health services. Subjects scoring high in psychiatric symptomatology were also found to make more use of general health services and prescribed drugs than those with low levels of psychiatric symptoms and dysfunctions. Worth mentioning is the fact that 61.12% of the respondents, who were identified as in need of mental health services, reported that they had not received such services. This result suggests that other factors, in addition to psychiatric symptomatology, also influence the use of general and mental health services.

Health care services and sterilization among Puerto Rican women

This paper considers the variables related to the type of health care utilization for sterilization and family planning among Puerto Rican women. The study is based on a representative sample of 1,375 women between the ages of 15-49 years. The data shows that the majority of women used the private sector of health care for their sterilization. Younger women, women with a low level of education, unemployed, living in consensual marriages and those who had their children as adolescents, made more use of the public services for their sterilization. It is a well proven fact that women with the above mentioned characteristics are more socioeconomically deprived than the educated, married and working women. Thus, it is to be expected that this group of women does not have the economic resources needed to utilize the private health care system.

Histological and histochemical skin changes in insulin-dependent diabetic patients with and without limited joint mobility

We studied 24 skin biopsies of the hand in 24 IDDM patients followed at the National Institute of Endocrinology (NIE). Biopsies of 7 healthy individuals were used as controls. The diabetics were divided into two groups, with limited joint mobility (LJM) and without LJM. We compared the different structural components of the skin, and their changes; we used quantitative, semi-quantitative and qualitative methods. We found that patients with LJM had a greater levelling, less rete pegs and dermal papillae (p less than 0.05), increased alteration of the mucopolysaccharides distribution (p less than 0.005), higher frequency of alterations of the elastic fibers (p less than 0.05) and collagen (p less than 0.005), vessel enlargement (p less than 0.025) acquiring cord shape, and reduction of the vessel lumen (p less than 0.005) in comparison with patients without LJM and controls. This could be a consequence of the chronic hyperglycemia from childhood that affects the structure, architecture and function of collagen fibers. Genetic and immunologic studies could help to elucidate the mechanisms of this alteration.

[Various immunologic indices of children and adolescents with type I diabetes mellitus]

An experimental study was performed in patients with Type I diabetes mellitus of various duration in order to determine the levels of total T-lymphocytes (TTC) and T-lymphocytes forming an active rosette (TLAR) and to find possible correlation between the level of the above cells and titers of anticytoplasmatic antibodies (ACA) versus islet cells. The TLAR level in patients with disease of less than 2 mos. duration was significantly lowered (P less than 0.001) as compared to the control one. In ACA determination there was a decrease in positive cases with a growing period of disease (P less than 0.01). Correlation between the TLAR level and ACA titers was absent.

Contraceptive use and the need for family planning in Puerto Rico

In 1982, 69 percent of Puerto Rican women in union were practicing contraception. Forty-five percent relied on contraceptive sterilization (40 percent, female, and five percent, male), eight percent were using the pill, four percent each, the IUD and the condom, five percent relied on rhythm, and three percent were using other methods. Thus, sterilization is the dominant form of fertility regulation in Puerto Rico, and there is relatively little use of reversible methods for childspacing. Reliance on female sterilization peaks among women in union in the age-group 35-44 (54 percent), whereas pill use is highest among those aged 15-24 (approximately 23 percent). Overall, eight percent of all women aged 15-49 are at risk of unintended pregnancy because they are fecund, sexually active, not pregnant or seeking pregnancy and not using any kind of contraceptive method. However, among women in union, this risk ranges from nine percent among those aged 30-39 to 22 percent among women aged 15-19. Reliance on sterilization rather than reversible methods of contraception is strongly influenced by socio-demographic variables. Women with less than a high school education, the wives of blue-collar workers, women living outside of the major cities and those born in Puerto Rico depend upon sterilization more than do women with a college education, the wives of white-collar employees, women living in cities and those born outside of the country. These findings point to the need for improved availability of reversible family planning services, especially for young women, and those whose childbearing is incomplete.