Feasibility study of a smoking cessation intervention in Directly Observed Therapy Short-Course tuberculosis treatment clinics in Rio de Janeiro, Brazil

A pilot feasibility study was conducted to determine whether Directly Observed Therapy Short-Course (DOTS) workers could be trained to deliver smoking cessation counseling and referral interventions, identify potential barriers to a full-scale randomized controlled trial on the effectiveness of integrated smoking cessation in DOTS, and determine whether tuberculosis (TB) patients who smoke would agree to participate in such a program. DOTS providers in two Rio de Janeiro primary health clinics received 1-day training in cessation counseling. They completed pre- and post-training surveys and participated in post-program focus groups. Patients were surveyed 3 months after program completion, and semiquantitative urine assays for cotinine were used to confirm cessation. Providers' mean self-efficacy scores for cessation counseling improved significantly (advise to quit, assess readiness, assist with quitting, and arrange follow-up) from scores (on a scale of 1-5) of 2-3 pre-training to 3-4 post-training (P < 0.05), with only ability to change motivation not significant. Providers' knowledge about cessation (withdrawal, nicotine replacement therapy, precontemplation) was low before training and did not improve after training (P > 0.1 for all comparisons). Implementation of a smoking cessation intervention by DOTS providers in TB clinics in Brazil is feasible. Randomized controlled trials to test intervention effectiveness in reducing TB-related morbidity must include cross-training for tobacco control and TB providers. Smoking cessation in DOTS programs may be important in reducing the global burden of TB, improving the health of TB patients, and reducing TB transmission in households.

Automatic orienting of visuospatial attention in Parkinson's disease

The basal ganglia are involved in not only motor behavior, but also other more cognitive processes, such as attention. We tested Parkinson's disease (PD) patients in a task that measures reflexive orienting of spatial attention. Seven patients with idiopathic PD and eight control subjects performed a covert orienting task where spatial attention was directed by means of exogenous cues (luminance increments) with no predictive validity for target position. The subjects' task was to make a speeded saccade to a visual target, which appeared a variable time after onset of the cue either in the cued or an uncued spatial position. There was no overall difference between PD patients and control subjects in terms of the initial facilitation following reflexive cues, and later inhibition of return (IOR). However, PD patients differed from control subjects in two important respects. First, they were significantly faster than were control subjects on this reflexive visual-orienting task. Second, disease severity correlated with attentional performance; more advanced patients showed less initial facilitation but greater IOR. Thus PD patients show better performance on a reflexive saccade task and, for more advanced patients, greater IOR than control subjects. These findings are consistent with the possibility that reflexive attentional processes in PD patients may be more active.

Inhibition of return in manual and saccadic response systems

When nonpredictive exogenous visual cues are used to reflexively orient covert visual spatial attention, the initial early facilitation for detecting stimuli at cued versus uncued spatial locations develops into inhibition by 300 msec following the cue, a pattern referred to as inhibition of return (IOR). Experiments were carried out comparing the magnitude and time course for development of IOR effects when manual versus saccadic responses were required. The results showed that both manual and saccadic responses result in equivalent amounts of facilitation following initial exposure to a spatial cue. However, IOR developed more quickly for saccadic responses, such that, at certain cue-target SOAs, saccadic responses to targets were inhibited, whereas manual responses were still facilitated. The findings are interpreted in terms of a premotor theory of visual attention.

Schizotypal traits, attention and eye movements

1. Subjects demonstrating high, average, or low schizotypal traits participated in saccade tasks of eye movements and attention including: a simple saccade task, an antisaccade task, and/or a cued saccade task measuring both facilitatory effects of cuing and inhibition of return (IOR). 2. Subjects were recruited based on their scores on the Rust Inventory of Schizotypal Cognitions (RISC) and then were given Raine's Schizotypal Personality Questionnaire (SPQ) (1991). 3. Subjects scoring high in schizotypy demonstrated increased errors on the voluntary eye movement task (antisaccade task) (p<0.05). Performance on the reflexive saccade task was not impaired in high compared to low schizotypals, but may have been enhanced as demonstrated by a negative correlation between scores on the SPQ and performance on this task. For the cued saccade task, there were no overall differences in cueing effects between schizotypal groups, however there was a laterality difference between low versus high scoring schizotypal subjects. 4. These results indicate distinct differences in tasks of overt orienting (saccade and antisaccade tasks) and covert orienting tasks (cued saccade task). The patterns of performance by our schizotypy subjects, including impaired voluntary saccade, enhanced reflexive saccade, and lateralized performance on the cued saccade task, are consistent with the performance of schizophrenic patient populations. Thus, our study supports the previous findings of a physiological relationship between schizotypal personality and schizophrenia.

Control of voluntary and reflexive saccades in Parkinson's disease

Eight patients with idiopathic Parkinson's disease (PD) were compared with a group of age-matched controls on both reflexive saccade and antisaccade tasks. While reflexive, visually guided saccades led to equivalent performance in both groups, PD patients were slower, made more errors, and showed reduced gain on antisaccades (AS). This is consistent with previous results showing that PD patients have no difficulty with reflexive saccades but show deficiencies in a number of voluntary saccade paradigms. Moreover, visual information in the form of landmarks improves AS performance more for PD patients than controls, a finding analogous to results seen with other motor acts such as target-directed pointing. Results are discussed in terms of a two-process model of attention and eye movements.

Shape selectivity in primate lateral intraparietal cortex

The extrastriate visual cortex can be divided into functionally distinct temporal and parietal regions, which have been implicated in feature-related ('what') and spatial ('where') vision, respectively. Neuropsychological studies of patients with damage to either the temporal or the parietal regions provide support for this functional distinction. Given the prevailing modular theoretical framework and the fact that prefrontal cortex receives inputs from both temporal and parietal streams, recent studies have focused on the role of prefrontal cortex in understanding where and how information about object identity is integrated with (or remains segregated from) information about object location. Here we show that many neurons in primate posterior parietal cortex (the 'where' pathway) show sensory shape selectivities to simple, two-dimensional geometric shapes while the animal performs a simple fixation task. In a delayed match-to-sample paradigm, many neuronal units also show significant differences in delay-period activity, and these differences depend on the shape of the sample. These results indicate that units in posterior parietal cortex contribute to attending to and remembering shape features in a way that is independent of eye movements, reaching, or object manipulation. These units show shape selectivity equivalent to any shown in the ventral pathway.

Spatial selective attention in schizophrenic, affective disorder, and normal subjects

Schizophrenic, affective disorder, and normal subjects performed tasks involving exogenous (automatic) and endogenous (voluntary) attention. In the exogenous attention task, schizophrenic subjects demonstrated a greater benefit in response time than did normal subjects. In the endogenous attention task, however, schizophrenic subjects showed a smaller benefit in response time than did normal subjects. These results are consistent with a model of schizophrenia that predicts a deficit in voluntary (endogenous) control, and a disinhibition and therefore enhancement of the automatic (exogenous) processes of spatial selective attention. Affective disorder subjects did not demonstrate a greater benefit in response time than normal subjects in the exogenous attention task, but did show a smaller benefit in response time than normal subjects in the endogenous attention task. The somewhat similar pattern of behavior of schizophrenic and affective disorder subjects suggests that abnormal spatial selective attentional processes may not be specific to schizophrenia.

Antisaccades and smooth pursuit eye movements in schizophrenia

Saccadic and smooth pursuit eye movements were recorded in schizophrenic patients, nonschizophrenic psychiatric patients, and normal controls. Both schizophrenic subjects and psychiatric controls demonstrated greater increases in error rates and greater delays in generating antisaccades than did normal controls. Schizophrenic patients with impaired smooth pursuit tracking showed greater increases in error rates in the antisaccade task than did schizophrenic patients with normal pursuit. Among psychiatric controls, increased errors on the antisaccade task were unrelated to pursuit performance. The small size of this group, however, reduces the power to detect a relation between smooth pursuit tracking and performance on the antisaccade task. Although most patients were receiving one or more medications, some of which can affect eye movements, medication state in this study did not account for differences we report in dependent variables.

A simplified surveillance case definition of AIDS derived from empirical clinical data. The Clinical AIDS Study Group, and the Working Group on AIDS case definition

A clinical AIDS case definition is needed for surveillance in countries where the CDC case definition is not practical. To derive such a definition, we compared 110 HIV-seropositive and 135 randomly selected HIV-seronegative adult medical-ward inpatients in Brazil. Multivariate analysis of clinical signs and symptoms and simple diagnoses resulted in a discriminant function with sensitivity of 89% and specificity of 96% in predicting for AIDS. These data were the empirical basis for a clinical definition of AIDS in adults drafted in a Caracas, Venezuela, workshop sponsored by the Pan American Health Organization. The revised "Caracas" definition presented here requires a positive HIV serology, the absence of cancer or other cause of immunosuppression, plus > or = 10 cumulative points, as follows: Kaposi's sarcoma (10 points); extrapulmonary/noncavitary pulmonary tuberculosis (10); oral candidiasis or hairy leukoplakia (5); cavitary pulmonary/unspecified tuberculosis (5); herpes zoster < 60 years of age (5); CNS dysfunction (5); diarrhea > or = 1 month (2); fever > or = 1 month (2); cachexia or > 10% weight loss (2); asthenia > or = 1 month (2); persistent dermatitis (2); anemia, lymphopenia, or thrombocytopenia (2); persistent cough or any pneumonia except TB (2); and lymphadenopathy > or = 1 cm at > or = 2 noninguinal sites for > or = 1 month (2). This definition has a sensitivity of 95% and a specificity of 100% (91% without HIV serology) when applied to the Brazilian patients in this study. The Caracas definition has been adopted by Brazil, Honduras, and Surinam, and is in validation elsewhere. The use of a reasonably sensitive and specific case definition commensurate with available diagnostic resources should facilitate AIDS surveillance in developing countries.

Identification of mixed HIV-1/HIV-2 infections in Brazil by polymerase chain reaction

Analysis of sera from hospitalized Brazilian patients by whole-virus lysate-based enzyme immunoassay and Western blot indicated that 0.4% were reactive to HIV-2 alone while 4% were reactive to both HIV-1 and HIV-2. When these sera were tested for HIV antibody by type-specific peptide enzyme immunoassays, dual seropositivity was confirmed in only 0.4% of patients. To define genetically the HIV strains within the population, we analyzed peripheral blood mononuclear cells from selected seropositive patients for the presence of HIV-1 and HIV-2 proviral DNA using the polymerase chain reaction (PCR). Independent primers/probes sets were used for the amplification and detection of viral sequences from the long terminal repeat (LTR), gag, and protease (prt) gene regions. Our findings confirmed the serologic evidence of HIV-2 in Brazil and determined the extent of mixed HIV-1 and HIV-2 infections. Detailed evaluation of the amplified viral protease sequences by endonuclease restriction analysis and DNA sequencing independently confirmed mixed HIV-1 and HIV-2 infections in the two patients seropositive for HIV-1 and HIV-2. The data further indicated that these isolates are distinct from the HIV laboratory standards. We interpret the combination of culture and PCR findings to demonstrate the presence of both HIV-1 and HIV-2 in Brazil.

Discrimination within and between hemifields: a new constraint on theories of attention

Subjects were presented with two groups of characters and were to decide whether they were the same or different. The stimulus groups differed either by a single feature ("preattentive" trials) or by a conjunction of features ("attentive" trials). The two stimulus groups appeared at the corners of an imaginary square centered about the fixation point, falling either in the same or different hemifields. In two experiments, subjects evaluated both types of stimuli faster when they were presented in different hemifields than in the same hemifield. Subjects also compared pairs of single characters faster when they appeared in different hemifields. Finally, this different-hemifield advantage was eliminated when the characters appeared sequentially. These results indicated that two stimuli that appear simultaneously in the same hemifield engender either a competition for common processing structures or intrahemispheric inhibition.