Distribution of hepatitis B virus genotypes in two different pediatric populations from Argentina

Differences in pathogenesis and the probability of becoming a chronic carrier depend on the age at which hepatitis B virus (HBV) infection is acquired, ranging from 82% in infants less than 6 months of age to 15 to 30% in older children. HBV genotypes from 22 pediatric patients from two areas that differ in prevalence have been determined. Phylogenetic analysis shows a clear difference between the genotype distribution in Buenos Aires, a low-prevalence area, and that found in Gualeguay, Entre Ríos, a high-prevalence area. While the analysis allocated the sequences in the Buenos Aires group to genotypes A (36%), D (9%), and F (55%), the Gualeguay group presented exclusively genotype A isolates with very low nucleotide divergence, which suggests a strong founder viral population. The high prevalence of genotype F in the Buenos Aires group and its high intragroup heterogeneity agree with the American origin of this genotype.

Production of emotional facial expressions in European American, Japanese, and Chinese infants

European American, Japanese, and Chinese 11-month-olds participated in emotion-inducing laboratory procedures. Facial responses were scored with BabyFACS, an anatomically based coding system. Overall, Chinese infants were less expressive than European American and Japanese infants. On measures of smiling and crying, Chinese infants scored lower than European American infants, whereas Japanese infants were similar to the European American infants or fell between the two other groups. Results suggest that differences in expressivity between European American and Chinese infants are more robust than those between European American and Japanese infants and that Chinese and Japanese infants can differ significantly. Cross-cultural differences were also found for some specific brow, cheek, and midface facial actions (e.g., brows lowered). These are discussed in terms of current controversies about infant affective facial expressions.

Three forms of somatization presenting in primary care settings in Spain

The objective of this paper is to study the prevalence and clinical characteristics of functional, hypochondriacal, and presenting somatization (FSTS, HSTS, and PSTS, respectively) defined by standardized criteria, as well as the validity of their distinction in primary care in Spain. A two-stage epidemiological study of a representative sample (N = 1559) of primary care patients was carried out. In the first phase, the validated Spanish versions of General Health Questionnaire, Mini-Mental State Examination, and CAGE were used. In the second phase, the Standardized Polyvalent Psychiatric Interview, an interview for the multiaxial assessment of medical patients, was employed. The prevalence of any form of somatization in Spain was 21.3% (FSTS: 16.2%, PSTS: 9.4%, HSTS: 6.7%). Overlap of any of the three clinical forms was very frequent (42.7%). FSTS patients tended to be more chronic and showed higher scores in fatigue but lower scores in both depression and anxiety. Chronicity was frequent among somatizers, particularly in those who fulfilled more than one kind of somatization. Differences in diagnostic distribution among the three groups were also observed. In conclusion, this is the first study giving support to the validity of the distinction among three types of somatization in Spain, but overlap was more frequent than reported in North American studies.

Production of emotional facial expressions in European American, Japanese, and Chinese infants

European American, Japanese, and Chinese 11-month-olds participated in emotion-inducing laboratory procedures. Facial responses were scored with BabyFACS, an anatomically based coding system. Overall, Chinese infants were less expressive than European American and Japanese infants. On measures of smiling and crying, Chinese infants scored lower than European American infants, whereas Japanese infants were similar to the European American infants or fell between the two other groups. Results suggest that differences in expressivity between European American and Chinese infants are more robust than those between European American and Japanese infants and that Chinese and Japanese infants can differ significantly. Cross-cultural differences were also found for some specific brow, cheek, and midface facial actions (e.g., brows lowered). These are discussed in terms of current controversies about infant affective facial expressions.

[Neuroendocrine carcinoma of the larynx. Review of literature in reference to one case report]

Neuroendocrin tumors are unusual neoplasies, even more within the ENT-sphere. Report of 1 case treated in our Service. Review of immunohistochemical criteria with the aim of achieving the diagnosis. Some bibliographical series are analyzed with the target to pick up the treatment of these uncommon growths.

Health services research on mental health in primary care

OBJECTIVE

The article seeks to provide an international perspective on the facilitating role of health services research in the treatment of psychiatric disorders in primary care. It builds on Goldberg and Huxley's model describing pathways to mental care for the psychiatrically ill in the community.

METHOD

Seventy studies were selected for review by Medline search, sixteen studies by contacting prominent researchers in the field. All studies are discussed more or less extensively.

RESULTS

Case identification strategies including screening tools and diagnostic modules have been developed. Other strategies include educational training programs and psychiatric consultation services designed to facilitate psychopharmacological and other types of treatment of psychiatric disorders in primary care. Several models for the linkage of primary care and specialty mental health providers are discussed, and a primary care psychiatry programme is examined.

CONCLUSION

Better psychiatric training of general practitioners (GPs), on-site consultation, and better communication between mental health professionals and GPs can improve the recognition, management, and referral of psychiatrically ill primary care patients. The further development of guidelines focusing on anxiety disorders, somatization, subthreshold disorders, and effectiveness in primary care is recommended.

Atherosclerotic lesions, myocardial damage and lipidograms: a multiarterial study applying an atherometric system and canonical correlation

472 autopsy subjects were examined with the following aims: to study the association pattern of atherosclerotic lesions between different arterial sectors, the impact of serum lipid disorders (total cholesterol, HDL-c, LDL-c, VLDL-c, and triglycerides were analyzed) and the association pattern between the atherosclerotic lesions in different arterial sectors and the degree of heart damage. For morphometric analysis of the vessels (aorta, circle of Willis, coronary, renal, iliac, and femoral arteris) the atherometric system was used. The most relevant results were as follows: the lipid disorders show their greatest impact in the heart, coronary and femoral arteries and abdominal aorta, whereas the strongest correlations between the atherosclerotic lesions in different arterial sectors were found in those with anatomical continuity.

Autologous peripheral blood stem cell transplantation (PBSCT) mobilized with G-CSF in AML in first complete remission. Role of intensification therapy in outcome

In order to determine if peripheral blood stem cells (PBSC) collected after priming with G-CSF in AML in first complete remission (CR) can be used for autologous transplantation and to evaluate the efficacy of early intensification therapy as in vivo purging, we studied 35 consecutive patients with AML in first CR. After standard induction and consolidation chemotherapy, 24 of them were treated with one (10 patients) or two (14 patients) cycles of high-dose cytarabine plus etoposide prior to PBSC collection. G-CSF was used as the priming agent. Of the 35 patients scheduled for peripheral blood stem cell transplantation (PBSCT), three relapsed before transplantation, and the 32 remaining underwent PBSCT. High-dose therapy consisted of either total body irradiation plus cyclophosphamide or busulphan plus cyclophosphamide. The median number of CD34+ cells infused was 3.24 x 10(6)/kg (range 0.15-14). The median times to reach a PMN count of 0.5 x 10(9)/l and a platelet count of 50 x 10(9)/l were 12 (8-28) and 30 (11-345) days, respectively. There was no transplant-related mortality. Twelve patients relapsed between 2 and 21 months post-PBSCT. With a median follow-up of 28 months, actuarial disease-free survival (DFS) is 52.41 +/- 9% in the intent-to-treat group and 57.4 +/- 9.8% in patients who underwent PBSCT. The probability of DFS is significantly higher for patients who receive early intensification therapy prior to both PBSC collection and PBSCT as compared with patients that do not: 68.8 +/- 10.27% vs 35.5 +/- 12.6%, P = 0.0418. These results indicate the feasibility of PBSCT in AML using G-CSF-mobilized PBSC. The use of intensification treatment as 'purging in vivo' prior both to collection of PBSC and PBSCT significantly reduces the risk of relapse in this group of patients.

[Immune response against modified low-density lipoproteins in patients with non-insulin-dependent diabetes mellitus]

BACKGROUND

Diabetes mellitus is a risk factor for atherosclerosis. Low density lipoproteins are considered a key factor in the formation of atheroma and the immune system has an important contribution to this process.

AIM

To quantify the immune response against modified low density lipoproteins in patients with non insulin dependent diabetes mellitus.

MATERIAL AND METHODS

LDLs obtained from blood of healthy subjects, were glycated or altered with malondialdehyde and used as antigens. Serum autoantibodies against these LDLs were measured by ELISA in 22 patients with non insulin dependent diabetes mellitus aged 46 to 67 years old and 13 healthy controls aged 41 to 65 years old. Basal and LDL stimulated tumor necrosis factor a production in vitro, by peripheral leukocytes of diabetics and controls was also measured.

RESULTS

The ratio of glycated LDL/native LDL antibodies was higher in diabetics than in controls (9.37 +/- 2.72 and 0.41 +/- 0.11 respectively p < 0.05) and the ratio of MDA modified LDL/native LDL antibodies was not significantly different (8.64 +/- 3.83 and 2.14 +/- 1.26 respectively, NS). Tumor necrosis or production by leukocytes was higher in diabetics than in controls in basal conditions (53.3 +/- 15.3 and 26.9 +/- 14.7 arbitrary units (a.u.) respectively), when stimulated with native LDL (46.5 +/- 5 and 24.3 +/- 9.4 a.u. respectively), when stimulated with malondialdehyde modified LDL (50 +/- 16.2 and 24.4 +/- 7.7 a.u. respectively) or when stimulated with glycated LDL (38.3 +/- 8.8 and 14.4 +/- 7.5 a.u. respectively).

CONCLUSIONS

Diabetic patients have an enhanced immune response against low density lipoproteins, factor that could contribute to the accelerated atherogenesis of this disease.

Characteristic in vitro evolution pattern of foot and mouth disease virus A81/Castellanos/Arg/87

The in vitro evolution of Foot and mouth disease virus (FMDV) A/81/Castellanos/Arg/87 (A/Castellanos/87) was studied by partial biological and biochemical characterization of viral populations selected after 25 passages on secondary fetal bovine kidney cell monolayers. These passages were performed in the presence or absence of immune pressure exerted in the form of antiviral polyclonal serum. While the viral populations passaged in the absence of immune pressure acquired characteristics such as antigenic heterogeneity, VP1 amino acid modification and plaque size reduction, the populations selected after immune pressure also presented both neutralizing resistance and attenuation for suckling mice. The comparison with other previously studied FMDV strains suggests that FMDV A/Castellanos/87 adopts a differential response to immunological pressure and other selective forces. In addition, the sequencing analysis of viral selected populations shows a restriction in the number and type of amino acid replacements tolerated by FMDV capsid proteins.

Attribution in somatizers: stability and relationship to outcome at 1-year follow-up. Grupo Morbilidad Psiquica y Psicosomática de Zaragoza (GMPPZ)

The aim of this study was to determine whether attributional style is a stable pattern in somatizers, to analyse the sociodemographic and psychopathological characteristics that can modify it, and to study the relationship between attributional pattern and outcome. A total of 147 somatizers and 46 psychologizers from a representative sample (n = 1559) of primary care patients in Zaragoza, Spain were followed up for 1 year. Attribution of somatic symptoms was a stable construct in somatizers. Patients who modified attribution were younger (by 15 years on average), tended to be without a partner, and had a shorter illness duration (by 20 months on average) than those who maintained it. Attribution showed no correlation with outcome at the 1-year follow-up.

The contribution of epidemiology to psychosomatic medicine

OBJECTIVE

To discuss the contribution of epidemiology and epidemiological methods to psychosomatic medicine.

METHOD

Critical review of the literature, including both philosophical concepts and empirical data.

RESULTS

The adjective "psychosomatic" has been used in two different ways: in the so called "psychosomatic" or holistic approach to medicine; and in a narrower approach, referring to particular disorders in which psychological factors were considered to have a fundamental aetiological role. While the ideal of the holistic, "humanistic" or "anthropological" approach should probably be never abandoned, the practical limitations of encompassing models, including Engel's bio-psycho-social model are also obvious: they may be heuristically sterile. On the other side, in relation to the narrow psychosomatic approach, psychogenetic views in the so called "psychosomatic illnesses" have been strongly criticized on empirical grounds. The potential of epidemiological methods to study these illnesses, but also "somatopsychic" disorders is shown in a number of papers in the empirical literature. We have grouped such contributions, including our own experience, in the five categories suggested by M. Shephered for epidemiological methods in general: 1) the completion of the spectrum of disease; 2) the establishment of outcome; 3) the actuarial assessment of morbid risk; 4) the evaluation of the efficacy of treatment; and 5) the conceptual construction of diagnosis and classification.

CONCLUSIONS

The contribution of epidemiological data to areas of interest in psychosomatic medicine has been relevant in recent years. The potential of epidemiological methods in this area is very important both to increase knowledge and to improve the quality of clinical practice.

Screening of somatization disorder: validation of the Spanish version of the Othmer and DeSouza test

The objective of this study was to validate the Spanish version of the Othmer and DeSouza Screening Test for Somatization Disorder. We have designed a validity study using the Standardized Polyvalent Psychiatric Interview, an instrument specifically designed to diagnose psychiatric morbidity in medical settings as the 'golden rule'. The control group displayed 'functional' and 'presenting' somatization. The Othmer and DeSouza Screening Test, with a threshold of three symptoms, shows 88% sensitivity, 78% specificity and a misclassification rate of 17%. It is concluded that Othmer and DeSouza's screening test, with a threshold of three symptoms, is a useful tool for the diagnosis of somatization disorder in medical and primary care settings in Spain. Discrepancies with US findings are discussed on a cross-cultural basis.

Somatisation in primary care in Spain: I. Estimates of prevalence and clinical characteristics. Working Group for the Study of the Psychiatric and Psychosomatic Morbidity in Zaragoza

BACKGROUND

This is the first attempt to study the prevalence and clinical characteristics of somatisation (ST) in a representative primary care sample in Spain.

METHOD

The sample consisted of 1559 consecutive patients attending eight randomly selected health centres in Zaragoza, Spain, examined by two-phase screening. First phase (lay interviewers): Spanish versions of GHQ-28, CAGE questionnaire, substance abuse, Mini-Mental State Examination. Second phase (research clinicians and psychiatrists): Standardised Polyvalent Psychiatric Interview, which permits the reliable coding of Bridges & Goldberg's ST criteria.

RESULTS

The prevalence of somatisers was 9.4% (34.5% of the cases) and most patients (68.7%) were diagnosed in the depression or anxiety DSM-IV categories. The severity was moderate in 401% and 66.6% were chronic (six or more months). No significant demographic differences were found with non-cases. Backache was the most frequent somatic presentation (71.4+%).

CONCLUSIONS

ST in primary care is a much broader phenomenon than categories such as somatoform disorders reflect. It may be less influenced by sociodemographic factors, but more chronic than previously reported.

Somatisation in primary care in Spain: II. Differences between somatisers and psychologisers. Working Group for the Study of the Psychiatric and Psychosomatic Morbidity in Zaragoza

BACKGROUND

This study is the first attempt to document the differences between somatisers (STs) and psychologisers (PGs) in Spanish primary care patients.

METHOD

A sample of 1559 consecutive patients attending eight randomly selected health centres in Zaragoza, were examined in a two-phase screening using Spanish versions of GH-28, CAGE questionnaire, substance abuse, MMSE and SPPI. STs and PGs were diagnosed according to operationalised Bridges & Goldberg's criteria.

RESULTS

ST was found to be three times more prevalent than PG, but the ratio ST: PG was highest (10.5) in the DSM-IV category dysthymia. Generalised anxiety disorder was the most frequent diagnosis in STs and major depressive episode the most frequent in PGs. No significant differences between the two groups have been found in demographic characteristics. Total GHQ scores were significantly higher in PGs, but global SPPI scores were not. Most psychopathological scores were higher in PGs, but both somatic symptoms and suspiciousness were higher in STs. The psychopathological findings are consistent with hypotheses related to blame avoidance and defensiveness in STs.

CONCLUSIONS

ST is three times more prevalent than PG, but the ratio ST: PG depends heavily on diagnostic categories. While most psychopathological scores are higher in PGs, both patient groups are similarly disturbed. Previously assumed socio-demographic differences between STs and PGs have not been found in this study.

Anxiety, depression and management of medically unexplained symptoms in medical clinics

This study assessed the prevalence of medically unexplained symptoms in cardiology, gastroenterology and neurology outpatient clinics at a large teaching hospital and investigated the current clinical management of these patients. Data were collected retrospectively from the casenotes of all new referrals to these clinics over a two month period. The total number of new patients seen was 343, of whom 120 (35%) had a final diagnosis of 'functional' disorder, 204 (59.5%) a final diagnosis of organic disorder and 19 (5.5%) remained undiagnosed. The number of investigations was similar in patients whether the eventual diagnosis was 'functional' or organic (median 2, range 0-9 in each case). However, the cost of investigation was significantly higher for the organic group (median 89 pounds compared with 41 pounds, p > or = 0.01). Anxiety and depression were documented in 33% of patients with unexplained symptoms. In 73 (61%) of patients with an eventual 'functional' diagnosis, the information that organic disease had been excluded was communicated to the GP, but there was no advice about further management. Four percent were referred to psychiatrists and 2% started on antidepressants. The paucity of recommended management strategies for patients with a 'functional' diagnosis suggests that physicians see their role with this group of patients as primarily one of exclusion of organic disease. It is suggested that more positive management strategies, including treatment of anxiety and depression, might lead to greater patient satisfaction and play a role in reducing the development of chronic somatisation.

[Somatization disorders in primary care: differential clinical aspects. Study Group of Psychic and Psychosomatic Morbidity of Zaragoza, Primary Care Section]

BACKGROUND

To identify specific sociodemographic and psychopathological features of somatization disorder (SD) patients in relation to other patients with psychiatric and organic morbidity in primary care (PC) setting.

METHODS

A group of SD patients from PC was compared with other two control groups: the first one made of patients with psychiatric morbidity (with or without organic disease) and the second group of patients with only organic disease without psychiatric morbidity. Polivalent standardized psychiatric interview (PSPI), a specific psychiatric interview for PC settings, was used as diagnostic instrument.

RESULTS

1) there is a female predominance in SD statistically significant compared with organic patients and with a trend to significance in relation to psychiatric patients. Age, marital status and educational level show no significant differences among the groups; 2) in relation to psychopathology, SD patients show, in relation with organic patients, statistically higher levels in all items measured by PSPI. On the contrary, SD overwhelmed psychiatric patients in just four items: somatic symptoms, fatigue, reported anxiety and hystrionism as well as sexual problems and lack of social support, and 3) high psychiatric morbidity (85%) in SD, most of them affective and anxiety diagnosis, make it difficult to differentiate from the other patients suffering from psychiatric morbidity in PC.

CONCLUSION

Patients with SD show a very different profile compared with those with organic disease in relation to psychiatric symptoms and social problems. On the other hand, when compared with patients with psychiatric disorders, differences are rather scarce. In addition, affective and anxiety comorbidity associated make it difficult the diagnosis. For this reason, the use of screening instruments for SD seems mandatory.

HIV-related knowledge and risk behaviors of street youth in Belo Horizonte, Brazil. The Street Youth Study Group

Individual interviews were conducted with 379 youth who work and/or live on the streets of a large Brazilian city to assess HIV-related knowledge, sources of information, risk behaviors, and prevention beliefs and strategies. Respondents demonstrated high levels of factual knowledge about HIV transmission (84% correct) coupled with high levels of misconceptions about casual transmission (53% correct) and intermediate levels of knowledge about prevention (64% correct). Only 54% of the respondents had heard about AIDS recently, and 37.5% said they talked to someone about AIDS. The most common sources of information about HIV/AIDS were the mass-media and friends. Over half the sample reported taking precautions to reduce their risk of HIV infection; however, the proportion of youth taking effective precautions was low. Among the 247 youth (65% of the sample) who had initiated sexual activity, lifetime condom use was reported by 18%, and condom use at last intercourse by 10%. Youth with higher levels of knowledge were more likely to report behavior changes to avoid HIV infection. These findings underscore the urgent need for prevention programs tailored to street youth in developing countries.