Nutrition supplementation plus standard of care versus standard of care alone or standard of care plus unconditional cash transfer in the prevention of chronic malnutrition in Southern Angola: study protocol for the MuCCUA study, a cluster randomized controlled trial

BACKGROUND

Chronic malnutrition is a condition associated with negative impacts on physical and cognitive development. It is multi-causal and can start very early in life, already in utero, thus it is especially challenging to find appropriate interventions to tackle it. The government of Angola is implementing a standard of care program with potential to prevent it, and the provision of cash transfers and the supplementation with small quantity lipid-based nutrients (SQ-LNS) are also promising interventions. We aimed to evaluate the impact of the standard of care program alone and of the standard of care plus a cash transfer intervention in the lineal growth of children less than 2 years old and compare it to the effectiveness of a nutrition supplementation plus standard of care program in Southern Angola.

METHODS/DESIGN

The three-arm parallel cluster randomised controlled trial is set in four communes of Huila and Cunene provinces. Clusters are villages or neighbourhoods with a population around 1075 people. A total of twelve clusters were selected per arm and forty pregnant women are expected to be recruited in each cluster. Pregnant women receive the standard of care alone, or the standard of care plus unconditional cash transfer or plus nutritional supplementation during the first 1000 days, from pregnancy to the child reaching 24 months. The primary outcome is the prevalence of stunting measured as height-for-age Z-score (HAZ) < -2 in children below 2 years. Impact will be assessed at 3, 6, 12, 18 and 24 months of children's age. Secondary outcomes include mortality, morbidity, caring, hygiene and nutrition behaviours and practices, and women and children's dietary diversity. Quantitative data are also collected on women's empowerment, household food security, expenditure and relevant clinical and social events at baseline, endline and intermediate time points.

DISCUSSION

The results will provide valuable information on the impact of the standard of care intervention alone as well as combined with an unconditional cash transfer intervention compared to a nutrition supplementation plus standard of care intervention, carried out during the first 1000 days, in the children´s growth up to 2 years and related outcomes in Southern Angola.

TRIAL REGISTRATION

Clinical Trials NCT05571280. Registered 7 October 2022.

From species descriptions to diversity patterns: the validation of taxonomic data as a keystone for ant diversity studies reproducibility and accuracy

Research findings in natural sciences need to be comparable and reproducible to effectively improve our understanding of ecological and behavioural patterns. In this sense, knowledge frontiers in biodiversity studies are directly tied to taxonomic research, especially in species-rich tropical regions. Here we analysed the taxonomic information available in 470 studies on Brazilian ant diversity published in the last 50 years. We aimed to quantify the proportion of studies that provide enough data to validate taxonomic identification, explore the frequency of studies that properly acknowledge their taxonomic background, and investigate the primary resources for ant identification in Brazil. We found that most studies on Brazilian ant diversity (73.6%) explicitly stated the methods used to identify their specimens. However, the proportion of papers that provide complete data for the repository institutions and vouchered specimens is vanishingly small (5.8%). Additionally, only 40.0% of the studies consistently presented taxon authorities and years of description, rarely referencing taxonomic publications correctly. In turn, the number of specialists and institutions consulted for ant identification in Brazil has increased in the last years, along with the number of studies that explicitly provide their taxonomic procedures for ant identification. Our findings highlight a shift between generations regarding the recognition of taxonomy as fundamental science, deepening our understanding of biodiversity.

Zooming in on Agoraphobic Behaviors: a Case Study

Introduction

The COVID-19 pandemic brought many new challenges that people had to overcome with ingenuity. However, many patients already suffering with psychiatric diseases saw their access to conventional health care limited, aggravating their statuses. E-Medicine is the branch of health care that provides access through the Internet, and it has been growing in the last few years. During the COVID-19 pandemic, many health care workers shifted towards E-Medicine, aiming to provide support to patients, especially with the social distance policies that were implemented worldwide.

Objectives

Provide an example of how e-Medicine can be a tool in establishing a therapeutic alliance, and patient follow-up

Methods

Case report with a brief literature review on the subject

Results

RG is a 19-year-old female that contacts her family doctor through e-mail, expressing concerns over not being able to leave her house for over a year, also manifesting anxiety and depressed humor. This started in April 2020 and was slowly worsening throughout the year, culminating in a panic attack. RG started counselling and follow-up appointments via Internet and started treatment with vortioxetine. Three months later, improvements were stated, namely decreased anxiety, better sleep patterns, and leaving the house for small periods.

Conclusions

Without E-Medicine, RG wouldn’t be as able to reach out to her family doctor, and follow-up would be much more arduous since the patient avoided leaving her house, and telephone appointments lack the visual aspect of the clinical interview. E-Medicine is a valid alternative to conventional Medicine, providing a safe environment for patients concerned with public space.

Disclosure

No significant relationships.

Small for gestational age very preterm infants present a higher risk of developing bronchopulmonary dysplasia

INTRODUCTION

Several studies assessed the influence of a low birth weight on bronchopulmonary dysplasia (BPD), but not all could find a significant association. Our aim was to assess the association between low birth weight and BPD in preterm infants, prospectively recruited at 11 level III Portuguese neonatal centers.

METHODS

Obstetrical and neonatal data on mothers and preterm infants with gestational ages between 24 and 30 weeks, born during 2015 and 2016 after a surveilled pregnancy, were analyzed. Neonates were considered small for gestational age (SGA) when their birthweight was below the 10th centile of Fenton's growth chats and BPD was defined as the dependency for oxygen therapy until 36 weeks of corrected age. Statistical analysis was performed using IBM SPSS® statistics 23 and a p-value <0.05 was considered statistically significant.

RESULTS

Out of 614, a total of 494 preterm infants delivered from 410 women were enrolled in the study; 40 (8.0%) infants with SGA criteria. SGA were more often associated with a single pregnancy, had greater use of antenatal corticosteroids, increased prevalence of gestational hypertensive disorders, C-section, rupture of membranes below 18 hours, rate of intubation in the delivery room, use of surfactant treatment, oxygen therapy, mechanical ventilation need, BPD, cystic periventricular leukomalacia, nosocomial sepsis and pneumonia; had lower prevalence of chorioamnionitis, and lower Apgar scores. The multivariate analysis by logistic regression, adjusted for BPD risk factors revealed a significant association between SGA and BPD: OR = 5.2 [CI: 1.46-18.58]; p = 0.01.

CONCLUSION

The results of this study increase the scientific evidence that SGA is an independent risk factor for BPD.

ADHEAR in Conductive Hearing Loss: a case study

Introduction Bone conduction hearing systems can be applied through non-invasive devices, using soft bands that exert pressure on the skin, or they can be surgically implanted (Bone Anchored Hearing Aid - BAHA). However, these bone conduction devices are frequently not well accepted due to the pressure on the head. Therefore, a new non-surgical hearing system was developed not to exert pressure on the skin, the ADHEAR. The bone anchorage in ADHEAR is performed through an adhesive adapter and is indicated for patients with conductive hearing loss and normal inner ear function.

Objectives Evaluate the audiological performance with the adhesive bone conduction hearing device (ADHEAR) in a patient with conductive hearing loss.

Methodology The study was designed as a prospective single-subject repeated-measure study with the subject serving as his own control. A 29 year old female patient who had a primary surgery due to middle ear cholesteatoma, was adapted with unilateral non-invasive adhesive bone conduction system for the treatment of conductive hearing loss. Air and bone conduction thresholds, word recognition scores (WRS) and speech recognition thresholds (SRT) in quiet and noise were assessed to verify the inclusion criteria of the study. Aided and unaided pure tone audiometry at 0.5, 1, 2 and 4 kHz in free field and speech audiometry in quiet and noise were performed at baseline and after 4 weeks with the ADHEAR.

Results The functional gain with the ADHEAR averaged over 0.5, 1, 2, and 4 kHz after 4 weeks of usage of the adhesive hearing system, improved from 55 dB HL to 31dB HL. Speech perception in quiet and noise improved significantly in the aided situation, with SRT in quiet improving from 60 to 35 dB HL, when compared to the unaided condition. Similar results were found in noise. The patient evaluated the ADHEAR system as being useful, and without complaints of skin pressure. There was no adverse skin reaction.

Conclusion Hearing performance was significantly better with ADHEAR under all test conditions. Therefore, this transcutaneous hearing system seems to be an excellent alternative for patients who need a hearing solution for conductive hearing loss but for clinical reasons cannot undergo surgery or conventional hearing aids. Furthermore, it preserves skin over the mastoid and reduces the risk of infection. Otherwise it has benefits verified by absence of head pressure and improvement of patient’s quality of life.

Mexico ants: incidence and abundance along the Nearctic-Neotropical interface

Mexico is one of the most biodiverse countries in the world, with an important proportion of endemism mainly because of the convergence of the Nearctic and Neotropical biogeographic regions, which generate great diversity and species turnover at different spatial scales. However, most of our knowledge of the Mexican ant biota is limited to a few well-studied taxa, and we lack a comprehensive synthesis of ant biodiversity information. For instance, most of the knowledge available in the literature on Mexican ant fauna refers only to species lists by states, or is focused on only a few regions of the country, which prevents the study of several basic and applied aspects of ants, from diversity and distribution to conservation. Our aims in this data paper are therefore (1) to compile all the information available regarding ants across the Mexican territory, and (2) to identify major patterns in the gathered data set and geographic gaps in order to direct future sampling efforts. All records were obtained from raw data, including both unpublished and published information. After exhaustive filtering and updating information and synonyms, we compiled a total of 21,731 records for 887 ant species distributed throughout Mexico from 1894 to 2018. These records were concentrated mainly in the states of Chiapas (n = 6,902, 32.76%) and Veracruz de Ignacio de la Llave (n = 4,329, 19.92%), which together comprise half the records. The subfamily with the highest number of records was Myrmicinae (n = 10,458 records, 48.12%), followed by Formicinae (n = 3,284, 15.11%) and Ponerinae (n = 1,914, 8.8%). Most ant records were collected in the Neotropical region of the country (n = 12,646, 58.19%), followed by the Mexican transition zone (n = 5,237, 24.09%) and the Nearctic region (n = 3,848, 17.72%). Native species comprised 95.46% of the records (n = 20,745). To the best of our knowledge, this is the most complete data set available to date in the literature for the country. We hope that this compilation will encourage researchers to explore different aspects of the population and community research of ants at different spatial scales, and to aid in the establishment of conservation policies and actions. There are no copyright restrictions. Please cite this data paper when using its data for publications or teaching events.

Mycobacterium marinum lymphocutaneous infection

Mycobacterium marinum is a nontuberculous mycobacteria with worldwide distribution that lives in fresh or salt water and is responsible for infections in fish, and sometimes in humans. Human disease consists mainly of cutaneous nodules, but deep structure involvement may also occur. Diagnosis of M. marinum infection remains a challenge, with a considerable time delay between onset of symptoms and diagnosis. We present a 33-year-old man with no immunosuppressive history who was seen in our department with skin nodules over his hand and forearm, distributed in a sporotrichoid pattern. His hobbies included maintaining an aquarium of tropical fish. Histological examination of the patient's skin biopsy was compatible with the diagnosis of mycobacterial infection, and the Ziehl-Neelsen staining revealed acid-fast bacilli. Molecular techniques confirmed the suspicion of M. marinum infection. A necropsy was performed on one of the patient's fish, more specifically, a Poecilia reticulata, and resulted in identification of M. marinum from its gut. The patient was treated with clarithromycin, ethambutol, and rifampicin for 9 months, with clearance of infection.

Functioning and Disability in Leprosy

This study has been carried out to investigate the frequency of musculoskeletal symptoms in people affected by leprosy and correlate this to their functional capacity to perform daily living and working activities and to their degree of disability. This cross-sectional study was performed on 100 clients who answered a questionnaire on personal and clinical data, the Nordic Musculoskeletal (QNSO), and the shoulder, arm and hand dysfunction (DASH) questionnaires. The mean age was 53.63 years and there was a predominance of men (67%), low education (53%), and multibacillary disease (84%). Physical impairment affected 95% of respondents and 92% indicated pain and/or paresthesia in the arms that interfered in functional capacity.Respondents with musculoskeletal symptoms have more difficulty to perform daily living and working activities compared to those without musculoskeletal symptoms (p-value<0.05). The presence of physical disabilities was not associated with difficulties to perform daily living (p-value=0.29) and labor activities (p-value=0.87). The majority of patients experienced pain and/or paresthesia of the arms, and this was associated with difficulties to perform daily living and working activities. However, the presence of physical disability does not seem to cause major impediments or limitations to perform these activities.

Effect of the glandular composition on digital breast tomosynthesis image quality and dose optimisation

In the image quality assessment for digital breast tomosynthesis (DBT), a breast phantom with an average percentage of 50 % glandular tissue is seldom used, which may not be representative of the breast tissue composition of the women undergoing such examination. This work aims at studying the effect of the glandular composition of the breast on the image quality taking into consideration different sizes of lesions. Monte Carlo simulations were performed using the state-of-the-art computer program PENELOPE to validate the image acquisition system of the DBT equipment as well as to calculate the mean glandular dose for each projection image and for different breast compositions. The integrated PENELOPE imaging tool (PenEasy) was used to calculate, in mammography, for each clinical detection task the X-ray energy that maximises the figure of merit. All the 2D cranial-caudal projections for DBT were simulated and then underwent the reconstruction process applying the Simultaneous Algebraic Reconstruction Technique. Finally, through signal-to-noise ratio analysis, the image quality in DBT was assessed.

Personalization algorithms applied to cardiovascular disease risk assessment

Cardiovascular disease (CVD) is the major cause of death in the world. Clinical guidelines recommend the use of risk assessment tools (scores) to identify the CVD risk of each patient as the correct stratification of patients may significantly contribute to the optimization of the health care strategies. This work further explores the personalization of CVD risk assessment, supported on the evidence that a specific CVD risk assessment tool may have good performance within a given group of patients and might perform poorly within other groups. Two main personalization methods based on the proper creation of groups of patients are presented: i) clustering patients approach; ii) similarity measures approach. These two methodologies were validated in a Portuguese population (460 Acute Coronary Syndrome with non-ST segment elevation (ACS-NSTEMI) patients). The similarity measures approach had the best performance, achieving maximum values of sensitivity, specificity and geometric mean of, respectively, 77.7%, 63.2%, 69.7%. These values represent an enhancement in relation to the best performance obtained with current CVD risk assessment tools applied in clinical practice (78.5%, 53.2%, 64.4%).

A large community outbreak of Legionnaires’ disease in Vila Franca de Xira, Portugal, October to November 2014

Binary file ES_Abstracts_Final_ECDC.txt matches

A large community outbreak of Legionnaires disease in Vila Franca de Xira, Portugal, October to November 2014

An outbreak of Legionnaires’ disease with 334 confirmed cases was identified on 7 November 2014 in Vila Franca de Xira, Portugal and declared controlled by 21 November. Epidemiological, environmental and microbiological analysis identified industrial wet cooling systems to be the probable source of infection. Preliminary results from sequence-based typing of clinical specimens and environmental isolates confirmed this link. A series of meteorological phenomena are likely to have contributed to the scale of this outbreak.

Genetic diversity and evolutionary relationships among Legionella pneumophila clinical isolates, Portugal, 1987 to 2012

The genetic diversity of 89 clinical Legionella isolates, collected between 1987 and 2012, in 22 hospitals from the five regions of Portugal, was analysed in this study using monoclonal antibodies (MAbs) of the Dresden panel and the sequence-based typing (SBT) protocol. The eBURST algorithm was used to infer levels of relatedness between isolates. All isolates collected were Legionella pneumophila, which were further characterised into four subgroups by MAbs, and 30 sequence types (STs) by SBT. Twelve of the STs were unique to Portugal; one of them (ST100) was represented by 32 epidemiologically related isolates. The ST44 was the profile with the highest number of epidemiologically unrelated isolates. The eBURST analyses indicate that, within the group formed by the 30 STs identified in this study, 17 STs were genetically close to at least another ST in the group. The comparison between the eBURST diagrams obtained with the STs from this study and the entire SBT database of the European Working Group for Legionella, showed that 24 (seven of them unique to Portugal) of our 30 STs were related with STs identified in others countries. These results suggest that the population of L. pneumophila clinical strains in Portugal includes both worldwide and local strains.

Cat scratch disease and lymph node tuberculosis in a colon patient with cancer

A 71-year-old man operated for a sigmoid tumour remained in the surveillance after adjuvant chemotherapy. After 3 years, a left axillary lymph node was visible on CT scan. The biopsy revealed a necrotising and abscessed granulomatous lymphadenitis, suggestive of cat scratch disease. The patient confirmed having been scratched by a cat and the serology for Bartonella henselae was IgM+/IgG-. Direct and culture examinations for tuberculosis were negative. The patient was treated for cat scratch disease. One year later, the CT scan showed increased left axillary lymph nodes and a left pleural effusion. Direct and cultural examinations to exclude tuberculosis were again negative. Interferon-γ release assay testing for tuberculosis was undetermined and then positive. Lymph node and pleural tuberculosis were diagnosed and treated with a good radiological response. This article has provides evidence of the importance of continued search for the right diagnosis and that two diagnoses can happen in the same patient.

MO-F-BRB-06: Gold Nanoparticle Modify Density of Ionizations inside Cells Submitted to Radiation Therapy: Microscopic Track Analysis of Secondary Electrons Using Monte Carlo

PURPOSE

Study density of ionization in cells containing gold nanoparticles (AuNP) submitted to Radiation Therapy.

METHODS

Spherical gold nanoparticles with diameters ranging 0-100nm were considered evenly distributed inside a 20mgr;m cubic cell, maintaining the gold concentration of 0.01%, with constant number of gold atoms inside the cell. Monte Carlo simulations were performed using PENELOPE code considering event-by-event transport of secondary electrons with minimum energy of 1keV. Simulated clinical energy spectrum of 250kV and 6MV x-rays;Co-60 and Ir-192 γ-ray sources obtained at each corresponding build-up depths were considered. Density of ionization inside the cell was evaluated counting delta electrons created either in AuNP or cell, excluding electrons attenuated inside the nanoparticles. The dose enhancement resultant from interaction of electrons with few micrometers range was quantified by the factor μDEF as the ratio of doses inside the cell with and without AuNP.

RESULTS

Maps of ionization density were obtained at the central plane of the cell illustrating ionizations around and between AuNP. The density of ionization increases in cell medium as the AuNP diameter enlarges, being higher to larger nanoparticles for all energies studied. The total dose deposited in the cell is affected by the fraction of electrons consumed in the nanoparticles, resulting in size-dependence for μDEF. The μDEFs for 250kV are 1.68 to 20nm, 1.83 to 60nm and 1.72 to 100nm; μDEFs for 6MV are 1.14 to 20nm, 1.38 to 60nm and 1.20 to 100nm, therefore presenting an optimum nanoparticle size for clinical applications in Radiation Therapy.

CONCLUSIONS

The μDEF describes dose enhancements founded on the effective density of ionizations inside cell medium containing AuNP, considering real electron tracks close to metallic interfaces. The profile of ionizations describes electron spectra of electrons with intracellular range considering dynamics of creation and consumption, hence being directly proportional to potential applicability of AuNP in Radiation Therapy. This work was funding supported by CAPES - Nanobiomed Network.

Influence of dental restorative materials on ESR biodosimetry in tooth enamel

Using an experimental model and PENELOPE Monte Carlo simulations, the effects of resin and amalgam on the absorbed doses in tooth enamel were studied to evaluate the feasibility of using restored teeth in electron spin resonance (ESR) dose reconstruction. The model consisted of a phantom containing a plate of these restorative materials placed between powered enamel layers exposed to X rays and a ⁶⁰Co beam. The experimental results and simulations agreed, showing that the attenuation produced by amalgam and resin with a thickness of 1, 2, and 4 mm is similar to that produced by the enamel itself in the case of the radiation sources employed. For X rays and ⁶⁰Co γ radiation the attenuation reached almost 100% and 40%, respectively. These results show that for ESR dose reconstruction, the use of all available enamel of a tooth leads to errors in the estimated dose due to attenuation effects in both healthy and restored teeth. Thus the importance of an enamel selection from different sides of the tooth surface to apply ESR dose reconstruction in the case of a practical situation is shown.

Abnormal cortisol awakening response predicts worse cognitive function in patients with first-episode psychosis

BACKGROUND

Cognitive impairment, particularly in memory and executive function, is a core feature of psychosis. Moreover, psychosis is characterized by a more prominent history of stress exposure, and by dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis. In turn, stress exposure and abnormal levels of the main HPA axis hormone cortisol are associated with cognitive impairments in a variety of clinical and experimental samples; however, this association has never been examined in first-episode psychosis (FEP).

METHOD

In this study, 30 FEP patients and 26 controls completed assessment of the HPA axis (cortisol awakening response and cortisol levels during the day), perceived stress, recent life events, history of childhood trauma, and cognitive function. The neuropsychological battery comprised general cognitive function, verbal and non-verbal memory, executive function, perception, visuospatial abilities, processing speed, and general knowledge.

RESULTS

Patients performed significantly worse on all cognitive domains compared to controls. In patients only, a more blunted cortisol awakening response (that is, more abnormal) was associated with a more severe deficit in verbal memory and processing speed. In controls only, higher levels of perceived stress and more recent life events were associated with a worse performance in executive function and perception and visuospatial abilities.

CONCLUSIONS

These data support a role for the HPA axis, as measured by cortisol awakening response, in modulating cognitive function in patients with psychosis; however, this association does not seem to be related to the increased exposure to psychosocial stressors described in these patients.

Sequence-based and monoclonal antibody typing of Legionella pneumophila isolated from patients in Portugal during 1987-2008

The monoclonal antibodies and the sequence-based typing (SBT) are two methodologies widely used to characterise Legionella pneumophila strains serogroup 1 (sg1). In this study, we analysed the clinical strains received in two Portuguese laboratories since 1987, including the strains isolated in Portugal during the four years of the surveillance scheme for Legionnaires' disease implemented in 2004. In total, 63 clinical isolates of L. pneumophila sg1 were differentiated by SBT into 19 different sequence types. Ten of them were new in the SBT database of the European Working Group for Legionella Infections (EWGLI). As a result of the combination of the two methodologies, these strains were discriminated into 25 different profiles. This study enabled, for the first time in Portugal, not only to characterise the L. pneumophila sg1 clinical isolates, but also to create a database of Portuguese profiles for use in epidemiological surveillance efforts.

Skunk and psychosis in South East London

Background:

Epidemiological studies have reported that the increased risk of developing psychosis in cannabis users is dose related. In addition, experimental research has shown that the active constituent of cannabis responsible for its psychotogenic effect is Delta-9-Tetrahydrocannabinol (THC) (Murray et al, 2007). Recent evidence has suggested an increased in potency (% TCH) in the cannabis seized in the UK (Potter et al, 2007).

Hypothesis:

We predicted that first episode psychosis patients are more likely to use higher potency cannabis and more frequently than controls.

Methods:

We collected information concerning socio-demographic, clinical characteristics and cannabis use (age at first use, frequency, length of use, type of cannabis used) from a sample of 191 first-episode psychosis patients and 120 matched healthy volunteers. All were recruited as part of the Genetic and Psychosis (GAP) study which studied all patients who presented to the South London and Maudsley Trust.

Results:

There was no significant difference in the life-time prevalence of cannabis use or age at first use between cases and controls. However, cases were more likely to be regular users (p=0.05), to be current users (p=0.04) and to have smoked cannabis for longer (p=0.01). Among cannabis users, 86.8% of 1st Episode Psychosis Patients preferentially used Skunk/Sinsemilla compared to 27.7% of Controls. Only 13.2 % of 1st Episode psychosis Patients chose to use Resin/Hash compared to 76.3% of controls. The concentration of TCH in these in South East London, ranges between 8.5 and 14 % (Potter et al, 2007). Controls (47%) were more likely to use Hash (Resin) whose average TCH concentration is 3.4% (Potter et al, 2007).

Conclusions:

Patients with first episode psychosis have smoked higher potency cannabis, for longer and with greater frequency, than healthy controls.

Pan-European study on culture-proven Legionnaires' disease: distribution of Legionella pneumophila serogroups and monoclonal subgroups

This pan-European study included unrelated strains of Legionella pneumophila obtained from 1335 cases of Legionnaires' disease. The isolates were serotyped into the serogroups 1 to 15 by monoclonal antibodies (MAb) and/or rabbit antisera. Additionally, MAb subgrouping was undertaken for isolates belonging to serogroups 1, 4, and 5. Monoclonal types of serogroup 1 were subdivided as having, or not having, the virulence-associated epitope recognized by the MAb 3/1 (Dresden Panel). This epitope is not present on strains belonging to any other serogroups. Taking all Legionella incidents together, MAb 3/1-positive cases were most frequent (66.8%); 11.7% of the isolates belonged to MAb 3/1-negative serogroup 1 subgroups and 21.5% to other serogroups, with serogroups 3 and 6 predominating. Among all serotypes discriminated in this study, monoclonal subtype Philadelphia was the most frequent. If categories of infection were considered, the proportion of MAb 3/1-negative strains differed significantly ( P<0.0005) between community-acquired cases (139/510; 27.3%) and travel-associated (42/295; 14.2%) or hospital-acquired infections (176/329; 53.5%). Moreover, taking distribution in different European areas into account, the proportion of MAb 3/1-negative strains was significantly higher in the Scandinavian region than in the Mediterranean countries or the UK for both community-acquired (48.7% vs. 18.6% or 12.0%; P<0.0005) and nosocomial cases (87.7% vs. 32.6% or 52.6%; P</=0.0007).

The application of dental methods of identification to human burn victims in a mass disaster

This paper deals with the usefulness of dental identification in the case of 28 human burn victims of a bus accident in Spain. Postmortem forensic procedures for identification were used including general external examination, routine photographs and radiographs and complementary biological methods. Dental identification was also used and a description of the method is presented. Dental identification was established in 57% of the cases. When victims were less than 20 years of age, the success rate of identification by dental methods was higher (76% of victims in this age group). The assessment of dental age allowed the establishment of identity of four victims. We recommend that dental procedures be used in human identification after mass disasters. Odontological and radiographic procedures are powerful methods when dealing with burn victims.

Methods for identification of 28 burn victims following a 1996 bus accident in Spain

A car collided head-on with a bus containing 56 passengers plus the driver. A few seconds after the crash, the bus caught fire and 28 persons (15 male and 13 female) lost their lives. All the deceased were almost completely incinerated. To establish the identity of the victims, the judge in charge of the case designated a multidisciplinary Identification Commission. Postmortem procedures included a general external examination, routine photographs, dental examination, dental (intraoral and extraoral) and general radiographs (chest, ankle, etc.), and complementary biological methods for identification (e.g., DNA analysis). The antemortem information, including dental and medical records available, were transcribed onto the INTERPOL disaster victim identification forms. The detailed ante- and postmortem information were compared manually. In this disaster dental identity could be established in 57% of the victims, whereas dental evidence did not allow by itself the identification of 12 burned victims. Odontological examination and complementary radiographic procedures were found to be accurate, economic and rapid methods of identifying badly burned victims in this bus accident.

Group psychoeducation for bulimia nervosa with and without additional psychotherapy process sessions

OBJECTIVE

The present study examined whether additional sessions of group psychotherapy process (PP) would incrementally benefit bulimia nervosa (BN) subjects over and above that which is achieved through a course of brief group psychoeducation (PE).

METHOD

Utilizing a quasi-experimental design, the first cohort of 40 BN subjects completed five-session PE-alone groups that were highly didactic and explicitly devoid of group process work. The second cohort of 41 BN subjects completed 12-session PE + PP groups that integrated PE with more conventional cognitive-behavioral group process interventions.

RESULTS

Both treatments were associated with comparable levels of change on measures of specific and nonspecific psychopathology. Furthermore, the two treatments did not differ in rates of premature termination, in rates of remission in eating symptoms, in rates of normalization of scores on psychometric measures, or in consumer evaluation of the treatments.

DISCUSSION

While subjects value the opportunity to engage in psychotherapy process with other group members, the addition of seven such sessions offers no enhanced therapeutic benefit over five sessions of group PE.