'I went back to being myself': acceptability of a culturally adapted task-shifted cognitive-behavioural therapy (CBT) treatment for depression (Ziphamandla) for South African HIV care settings

There is a need for a culturally adapted, evidence-based, psychotherapy treatment that is effective, acceptable, and feasible for integration into primary care in South Africa. This qualitative study used exit interviews to examine participants' experiences of an adapted cognitive-behavioural therapy treatment for adherence and depression, task-shifted and delivered by nurses in two peri-urban HIV clinics near Cape Town. Nine semi-structured exit interviews were conducted with isiXhosa-speaking females and analysed using thematic analysis. Overall, participants responded positively to the treatment, viewing it as acceptable and beneficial and as a catalyst to returning to normalcy. Results indicated that participants viewed the treatment as being effective in ameliorating their depressive symptoms and improving their adherence to ART . Additional benefits described included improvements in subjective wellbeing and social and occupational functioning. Several began or resumed employment, an important behavioural indicator of the treatment's capacity to facilitate positive change and cost saving. Recommendations to improve the treatment included using video material and educating others about depression. These findings have positive implications regarding the acceptability and cultural applicability of the treatment for use in South Africa.

A Comparison of Five Brief Screening Tools for HIV-Associated Neurocognitive Disorders in the USA and South Africa

Screening for HIV-associated neurocognitive disorders (HAND) is important to improve clinical outcomes. We compared the diagnostic sensitivity and specificity of the mini-mental state examination, International HIV dementia scale (IHDS), Montreal cognitive assessment, Simioni symptom questionnaire and cognitive assessment tool-rapid version (CAT-rapid) to a gold standard neuropsychological battery. Antiretroviral-experienced participants from Cape Town, South Africa, and Baltimore, USA, were recruited. The sensitivity and specificity of the five tools, as well as those of the combined IHDS and CAT-rapid, were established using 2 × 2 contingency tables and ROC analysis. More than a third (65165) had symptomatic HAND. In detecting HIV-D, the CAT-Rapid had good sensitivity (94 %) and weak specificity (52 %) (cut-point ≤10), while the IHDS showed fair sensitivity (68 %) and good specificity (86 %) (cut-point ≤10). The combined IHDS and CAT-rapid showed excellent sensitivity and specificity for HIV-D at a cut-off score of ≤16 (out of 20; 89 and 82 %). No tool was adequate in screening for any HAND. The combination IHDS and CAT-rapid tool appears to be a good screener for HIV-D but is only fairly sensitive and poorly specific in screening for any HAND. Screening for milder forms of HAND continues to be a clinical challenge.

Twin frequency and industrial pollution in different regions of Hesse, Germany

AIMS

To investigate whether twinning occurs more frequently in residents in the vicinity of a toxic waste incinerator (TWI).

METHODS

Within a longitudinal environmental study that addressed child health second grade school children and their parents were recruited. The proportion of twinning in the TWI region was compared with two comparison areas. In a second confirmatory investigation, birth records for the years 1994-97 from the Hessian Perinatal Survey (HEPS) were accessed to determine whether the incidence of twinning was higher in regions around the TWI compared to adjacent reference areas.

RESULTS

In the environmental study, 61.5% of the children and 95% of their mothers participated. In mothers, twinning was 5.3% in the TWI region compared to 1.6% and 2.3% in the comparison regions. The proportion of mothers with fertility assessment/treatment was 5.7%, 8.3%, and 0% respectively. The prevalence of twinning was not significantly higher (4.5%) in mothers with treatment compared to mothers without (3.7%). From the HEPS, data of 20 603 births was analysed. The incidence of twins was significantly higher in areas which surround the TWI and other industries (1.4-1.6 per 100 births) compared to births in reference areas (0.8 per 100).

CONCLUSIONS

Twinning rates may be associated with exposure to industrial pollution. Future environmental health studies that consider multiple births as an outcome are warranted. These should also investigate whether the incidence of monozygotic or dizygotic twinning may be associated with industrial pollution.

Early childhood determinants of organochlorine concentrations in school-aged children

We investigated whether early childhood factors such as breast-feeding, parity, and smoking contribute to the variation of organochlorine compounds (OC: dichlorodiphenyldichloroethene, hexachlorobenzene, beta-hexachlorocyclohexane, and the sum of polychlorinated biphenyls including the congeners 101, 118, 138, 153, 170, 180, 183, and 187) at approximately 7 y of age. OC were measured in whole blood of 350 children. Pregnancy characteristics and the child's living conditions were gathered by questionnaires administered to the parents and interviews with the mother. Height and weight were determined during the medical examination. Exclusion of incomplete data and nonbiologic children of the mothers yielded a sample of 337 children. We applied regression analysis with indicator variables, controlling for confounders. No systematic association was detected for birth order or maternal smoking during pregnancy. The OC concentrations are diluted in children with a higher body mass index (>18 kg/m(2)). We found a strong, dose-dependent relationship between the duration of breast-feeding (none, 1-4 wk, 5-8 wk, 9-12 wk, >12 wk) and the concentration of all five OCs. Of the potential determinants analyzed, more of the variance of the OC concentration is accounted for by breast-feeding than by any other variable. Exclusive breast-feeding beyond 12 wk was associated with a doubling of OC whole blood concentration compared with bottle-fed children (dichlorodiphenyldichloroethene, 0.28 microg/L versus 0.55 microg/L; beta-hexachlorocyclohexane, 0.05 microg/L versus 0.14 microg/L; hexachlorobenzene, 0.14 microg/L versus 0.25 microg/L; sum of polychlorinated biphenyls, 0.25 microg/L versus 0.55 microg/L). These findings indicate that breast-feeding can lead to an extended duration of increased OC exposure in childhood.

Exposure to polychlorinated biphenyls and levels of thyroid hormones in children

As part of an epidemiologic study on exposure to a toxic waste incineration plant we investigated whether blood concentrations of polychlorinated biphenyls (PCBs), lead, and cadmium, as well as concentration of mercury in 24-hr urine samples were associated with thyroid hormone status. As an indication of status, we determined levels of thyroid-stimulating hormone (TSH), free thyroxine (FT(4)), and free triiodothyronine (FT(3)) in children living in households where [less than/equal to] 10 cigarettes were smoked per day. Eight PCB congeners (PCBs 101, 118, 138, 153, 170, 180, 183, and 187) were measured in whole blood samples. Of these, seven congeners (PCB 101 was not detected in any sample) and the sum of all PCB congeners were analyzed as predictors for thyroid hormone status in separate linear regression models adjusted for potential confounders. In addition, the possible effects of cadmium, lead, and mercury on levels of thyroid hormones were examined. Blood concentrations and information on questionnaire data were available for 320 children 7-10 years of age. We found a statistically significant positive association between the mono-ortho congener PCB 118 and TSH as well as statistically significant negative relationships of PCBs 138, 153, 180, 183, and 187 to FT(3). There was no association for the PCB congeners and FT(4). Blood cadmium concentration was associated with increasing TSH and diminishing FT(4). Blood lead and urine concentration of mercury were of no importance to thyroid hormone levels. The results stress the need for future studies on the possible influences of PCB and cadmium exposure on thyroid hormones, particularly in children. These studies should also take neurologic development into account.

Characterization of two myotrophic neuropeptides in the FMRFamide family from the segmental ganglia of the moth Manduca sexta: candidate neurohormones and neuromodulators

We have characterized two new members of the FMRFamide family of neuropeptides from the segmental ganglia of the tobacco hornworm Manduca sexta. Levels of peptides in ganglia used for purification were enhanced by manipulating their exposure to the steroid molting hormones. Explants of ganglia were cultured in the low-level ecdysteroid environment of diapausing pupae shown previously to evoke accumulation of FMRFamide-like immunoreactivity (FLI). Sufficient material for sequencing was obtained from 180 explanted ganglia. Extracts of ganglia were fractionated using two reverse-phase liquid chromatography procedures, and the immunoreactive fractions were subjected to sequence analysis using electrospray mass spectrometry. The sequences of the two peptides were determined to be GNSFLRFamide and DPSFLRFamide. These peptides have been named MasFLRFamide II and MasFLRFamide III, respectively; the previously characterized M. sexta FLRFamide (pEDVVHSFLRFamide) has been renamed MasFLRFamide I. The three peptides show distinctive tissue and developmental distributions as determined from fractionated extracts of larval and adult central nervous system structures and neurohemal organs. In the retrocerebral corpora cardiaca/corpora allata, MasFLRFamide I was the predominant form, while in the segmental ganglia MasFLRFamides II and III predominated. Higher levels of MasFLRFamide I and II were found in the adult, whereas there was little apparent change in the level of MasFLRFamide III upon metamorphosis. Determinations of peptide levels in fractionated hemolymph of newly emerged moths revealed that levels of MasFLRFamide I and III could exceed 10 nmol l-1. The actions of the three peptides were tested on the moth ileum. MasFLRFamides II and III were found to be stimulatory. At 1 nmol l-1, these peptides induced robust increases in the rate of rhythmic longitudinal and peristaltic waves of contractions. In contrast, MasFLRFamide I was ineffective even at 20 nmol l-1. Thus, while all three peptides have the characteristics of neurohormones in M. sexta, the physiological findings show that the heptapeptide FLRFamides have properties distinct from those of the decapeptide.

Neurobehavioral and neurophysiological outcome of chronic low-level tetrachloroethene exposure measured in neighborhoods of dry cleaning shops

The effects of chronic low-level tetrachloroethene (TCE) exposure on functions of the central nervous system (CNS) were measured in subjects living in the neighborhood of dry cleaning shops with a mean residential time of 10.6 years. Neurobehavioral tests were performed using a German version of the NES battery. Additionally, a pattern reversal visual-evoked potentials (VEPs) were recorded. the mean blood TCE concentration in the subjects was 17.8 micrograms/liter and the median indoor TCE air concentration measured in the residences was 1.36 mg/m3. The outcome of the NES subtests for vigilance, simple reaction time, as well as visual memory differed statistically significantly between the exposed subjects and the controls, whereas for VEP latencies the differences were statistically not significant. It is concluded that despite the low exposure levels, CNS functions might be affected by TCE in subjects living close to a dry cleaning facility if the exposure lasts for several years.

Treatment of malignant tumors in the parotid glands

This study is a review of 105 patients with histologically confirmed salivary gland carcinoma in the parotid glands. The patients were consecutively registered at the Radium Centre of Copenhagen from 1971 to 1980. The different treatment modalities of these patients are examined concerning recurrence and survival. Sixty-two patients obtained local tumor control, 36 of them were in the group of patients treated with a combination of surgery and irradiation therapy. Twenty-five patients developed distant metastasis, and six patients had disseminated disease at the time of diagnosis. The overall 5-year crude survival in this report is 46%. Tumors of the parotid salivary glands must not be neglected, as early diagnosis and treatment are vital in order to achieve better results.

Results in treatment of carcinoma of the external auditory canal and middle ear

Of 31 patients treated for carcinoma of the external auditory canal and/or middle ear, 19 patients (61%) presented with a long-term history of otitis. Thirteen patients (42%) had cranial nerve involvement. The patients were treated by surgery, radiotherapy, or a combined treatment of surgery and radiotherapy. The overall 5-year crude survival rate was 29%. Irrespective of the final outcome, 19 patients (61%) obtained pain relief after initial treatment. Three of the patients with facial nerve involvement survived 5 years after the initial treatment. Postmortem examinations of ten patients revealed distant metastases in four patients.

An enzyme linked immunosorbent assay (ELISA) for measurement of human serum thyroglobulin. Evaluation of the influence of thyroglobulin auto-antibodies

The aim of the study was to develop an enzyme linked immunosorbent assay (ELISA) for measuring thyroglobulin (Tg) in human serum and to evaluate the influence of serum thyroglobulin auto-antibodies (TgAb) on the ELISA. The sensitivity of the ELISA was 2.1 micrograms/l. Serum Tg levels in healthy controls were from less than 2.1 to 55.5 micrograms/l (n = 46) (95% reference range). With serum Tg concentrations between 19.6 to 90 micrograms/l the within-assay coefficient of variation (CV) was from 4.5 to 6.6% (n = 12) and the between-assay CV from 8.5 to 10.5% (n = 6). The recovery from 20 to 89 micrograms Tg/l serum was from 93 to 101%. There was significant correlation between serum Tg concentrations measured by the ELISA and a RIA method in healthy controls (r = 0.85, n = 46, p less than 0.001) and in patients with differentiated thyroid carcinoma (r = 0.97, n = 28, p less than 0.001). The TgAb interfered with the serum Tg determination both in the ELISA and in the RIA method. The assay is simple and easy to perform, and the equipment is inexpensive and useful for large-scale serum Tg measurements as an alternative to RIA.

Model peptidergic systems at the insect neuromuscular junction

The emergence of neuropeptides as a prominent neurotransmitter class raises fundamental new questions about modes of chemical signaling in the nervous system. These relate to the large number of peptides, their co-localization in neurons and to novel actions at innervated targets. Synaptic preparations in insects offer excellent experimental models for studies of multiple transmitters and their joint actions at uniquely identified nerve-muscle junctions. Peptidergic systems in insects are reviewed with particular reference to two identified neuromuscular preparations which demonstrate cotransmitter actions of peptides and "classical" neurotransmitter substances.

Isolation and characterization of two myoactive neuropeptides: further evidence of an invertebrate peptide family

The neuropeptide proctolin acts as a neuromuscular co-transmitter in insect skeletal muscle. As a prelude to determining whether other peptides may function in a similar way, we are attempting to isolate and characterize the chemical nature of new myoactive neuropeptides in insects. We examined the corpus cardiacum, a major insect neurosecretory structure of the American cockroach (Periplaneta americana), using a skeletal muscle bioassay and high pressure liquid chromatography fractionation and identified two myoactive factors, MI and MII. They are synthesized in the corpus cardiacum and released from it into the blood by a calcium-dependent mechanism. Amino acid and fast atom bombardment-mass spectroscopy analysis show that MI and MII are structurally related octapeptides representing the major secreted products of the cockroach corpus cardiacum. Both MI and MII are also present in the CNS and in the gut, indicating transmitter as well as hormonal functions in the cockroach. A survey in other species indicates MI may be present in invertebrates other than insects, but neither was found in the rat. The MI and MII peptides have clear chemical affinities to two previously described invertebrate peptides, locust adipokinetic hormone and crustacean red pigment concentrating hormone, as well as sharing biological activity with these peptides. Our results provide further evidence for the existence of a large family of structurally related peptides with divergent functions in a variety of invertebrate types.