TB risk by time since U.S. entry among non-U.S.-born residents of Washington State, USA

BACKGROUND: Progress towards TB elimination in the United States will require improved detection and treatment of latent TB infection among non-U.S.-born residents who remain at disproportionate risk of TB disease. To inform targeted testing efforts, we evaluated risk of TB disease among non-U.S.-born residents of Washington State, USA, by region of origin and time from U.S. entry.METHODS: We conducted a retrospective cohort study among non-U.S.-born residents diagnosed with TB disease in Washington State from 2005 to 2014, for which country-specific population estimates were also available. The risk of TB disease among non-U.S.-born residents was estimated by time since U.S. entry, World Bank region of origin, and WHO TB incidence category.RESULTS: Risk of TB disease for non-U.S.-born residents was highest within the first year after U.S. entry. Among persons from countries with high TB incidence who had resided in the United States for more than 20 years, risk for TB remained elevated.CONCLUSION: Elevated risk of developing TB disease among individuals not born in the United States persisted long after U.S. entry, particularly among persons originating from certain regions and from high-burden countries. These findings contribute to evidence supporting a refinement of existing screening guidelines.

TLR9 gene region polymorphisms and susceptibility to tuberculosis in Vietnam

Humans exposed to Mycobacterium tuberculosis (Mtb) show variation in susceptibility to infection and differences in tuberculosis (TB) disease outcome. Toll-like receptor 9 (TLR9) is a pattern recognition receptor that mediates recognition of Mtb and modulates Mtb-specific T-cell responses. Using a case-population design, we evaluated whether single nucleotide polymorphisms (SNPs) in the TLR9 gene region are associated with susceptibility to pulmonary or meningeal TB as well as neurologic presentation and mortality in the meningeal TB group. In a discovery cohort (n = 352 cases, 382 controls), three SNPs were associated with TB (all forms, p < 0.05) while three additional SNPs neared significance (0.05 < p < 0.1). When these six SNPs were evaluated in a validation cohort (n = 339 cases, 367 controls), one was significant (rs352142) while another neared significance (rs352143). When the cohorts were combined, rs352142 was most strongly associated with meningeal tuberculosis (dominant model; p = 0.0002, OR 2.36, CI 1.43-3.87) while rs352143 was associated with pulmonary tuberculosis (recessive model; p = 0.006, OR 5.3, CI 1.26-31.13). None of the SNPs were associated with mortality. This is the first demonstration of an association between a TLR9 gene region SNP and tuberculous meningitis. In addition, this extends previous findings that support associations of TLR9 SNPs with pulmonary tuberculosis.

Experience with rifabutin replacing rifampin in the treatment of tuberculosis

SETTING

The use of a rifamycin in anti-tuberculosis treatment regimens is crucial for shortening treatment and achieving favorable outcomes. Rifampin (RMP) is the recommended rifamycin, although adverse effects (AEs) may require its discontinuation. The use of rifabutin (RFB), a rifamycin with activity against Mycobacterium tuberculosis, in patients with an RMP-related AE has not been well studied.

OBJECTIVE

To review our experience with RFB in tuberculosis (TB) treatment.

METHODS

We included TB patients who received RFB in their treatment regimens from 2003 to 2009. We evaluated the indications for RFB and, if applicable, the likelihood that RMP caused an AE. We identified RMPrelated AEs associated with RFB intolerance.

RESULTS

One hundred subjects were included. The indications for RFB use were RMP-related AE (57%), con- current antiretroviral therapy (21%), potential/actual interaction with other medications (14%), and as part of an alternative regimen in liver disease (8%). Nineteen patients experienced an AE while taking RFB. Among patients with a prior RMP-related AE, 80% of whom were successfully treated with RFB, only a dermatologic AE was associated with subsequent RFB intolerance.

CONCLUSIONS

Our study suggests that RFB is well tolerated by patients who develop RMP-related AEs. There may be an increased risk for RFB-related AE in patients who experienced RMP-related dermatologic events.

First record of preserved soft parts in a Palaeozoic podocopid (Metacopina) ostracod, Cytherellina submagna: phylogenetic implications

The metacopines represent one of the oldest and most important extinct groups of ostracods, with a fossil record from the Mid-Ordovician to the Early Jurassic. Herein, we report the discovery of a representative of the group with three-dimensionally preserved soft parts. The specimen--a male of Cytherellina submagna--was found in the Early Devonian (416 Ma) of Podolia, Ukraine. A branchial plate (Bp) of the cephalic maxillula (Mx), a pair of thoracic appendages (walking legs), a presumed furca (Fu) and a copulatory organ are preserved. The material also includes phosphatized steinkerns with exceptionally preserved marginal pore canals and muscle scars. The morphology of the preserved limbs and valves of C. submagna suggests its relationship with extant Podocopida, particularly with the superfamilies Darwinuloidea and Sigillioidea, which have many similar characteristic features, including a large Bp on the Mx, the morphology of walking legs, Fu with two terminal claws, internal stop-teeth in the left valve, adductor muscle scar pattern, and a very narrow fused zone along the anterior and posterior margins. More precise determination of affinities will depend on the soft-part morphology of the cephalic segment, which has not been revealed in the present material.

Synthetic- and bio-polymer use for runoff water quality management in irrigated agriculture

Low concentrations of synthetic- or bio-polymers in irrigation water can nearly eliminate sediment, N, ortho- and total-P, DOM, pesticides, micro-organisms, and weed seed from runoff. These environmentally safe polymers are employed in various sensitive uses including food processing, animal feeds, and potable water purification. The most common synthetic polymer is anionic, high purity polyacrylamide (PAM), which typically provides 70-90% contaminant elimination. Excellent results are achieved adding only 10 ppm PAM to irrigation water, applying 1-2 kg ha(-1) per irrigation, costing 4 dollars - 12 dollars kg(-1). Biopolymers are less effective. Using twice or higher concentrations, existing biopolymers are approximately 60% effective as PAM, at 2-3 times the cost. A half million ha of US irrigated land use PAM for erosion control and runoff protection. The practice is spreading rapidly in the US and worldwide. Interest in development of biopolymer surrogates for PAM is high. If the supply of cheap natural gas (raw material for PAM synthesis) diminishes, industries may seek alternative polymers. Also "green" perceptions and preferences favor biopolymers for certain applications.

Biomass production and nutrient cycling in Eucalyptus short rotation energy forests in New Zealand. I: Biomass and nutrient accumulation

Accumulation of biomass and nutrients (N, P, K, Ca, Mg and Mn) was measured during the first 3-year rotation of three Eucalyptus short rotation forest species (E. botryoides, E. globulus and E. ovata) irrigated with meatworks effluent compared with no irrigation. E. globulus had the highest biomass and nutrient accumulation either irrigated with effluent or without irrigation. After 3-year growth, E. globulus stands irrigated with effluent accumulated 72 oven dry t/ha of above-ground total biomass with a total of 651 kg N, 55 kg P, 393 kg K, 251 kg Ca, 35 kg Mg and 67 kg Mn. Effluent irrigation increased the accumulation of biomass, N, P, K and Mn, but tended to reduce the leaf area index and leaf biomass, and decreased the accumulation of Ca and Mg.

Development of a pain attitudes questionnaire to assess stoicism and cautiousness for possible age differences

This study aimed to develop a pain attitudes questionnaire (PAQ) and examine its reliability and validity for use in assessing the constructs of stoicism and cautiousness relevant to pain perception. The questionnaire was administered to 373 healthy community-dwelling individuals who were subsequently divided into four age groups to test for differences in stoicism and cautiousness, two attitudes that have previously been claimed to influence pain perception and report among older adults. Factor analysis revealed that two dimensions of stoicism and two dimensions of cautiousness are measured by the scale, with reticence and superiority characterizing the first construct and self-doubt and reluctance characterizing the second. There was support for the scale's reliability and validity. Age-related increase in degree of reticence to pain, self-doubt, and reluctance to label a sensation as painful was found, emphasizing the need for careful consideration of pain attitudes in older patients who may underreport their pain symptoms.

Pain language of bone marrow transplantation patients

Previous studies have shown that hypnosis may be effective in reducing intensity of pain among bone marrow transplantation patients whereas cognitive behavioral intervention without imagery was not effective for this group of patients. Since hypnosis alters patients' perception of pain and cognitive behavioral intervention changes patients' beliefs and improves their coping with pain, we hypothesized that sensory pain is more important than affective pain in understanding the pain experience of patients undergoing bone marrow transplantation. To test this hypothesis we administered the McGill Pain Questionnaire longitudinally to 50 consecutive eligible recipients of bone marrow transplantation during hospitalization to assess the different dimensions of pain they experienced. Consistent with our hypothesis, sensory pain fluctuated with treatment stages, and the pattern was consistent with previous findings. Patients reported significantly higher sensory pain than affective pain at all assessment points. In contrast, affective pain remained low and stable throughout the treatment. Our results contribute to the understanding of the nature of pain in bone marrow transplantation and suggest pain management strategies that focus on sensory pain as in hypnosis are more useful for such patients.

Accident cognitions and subsequent psychological trauma

This study used a sample of 72 consecutive attendees to hospital following motor vehicle accidents. It aimed to assess the relationship between demographic variables, details of the accident and cognitions about the accident recorded soon afterward, and degree of psychological trauma 3 and 6 months later. Psychological trauma was assessed using the General Health Questionnaire, Impact of Event Scale, and Posttraumatic Stress Disorder Interview. A structured interview was used to gain information about demographic, accident, and accident cognition variables. Results showed that initial cognitions such as perceived threat to life, rather than demographic or accident variables, had the strongest relationships to subsequent trauma.

The development of a practical and reliable assessment measure for atopic dermatitis (ADAM)

Previous measures of Atopic Dermatitis (AD) have not been adequate for research purposes. This paper describes a study conducted in dermatology clinics of the Royal Children's Hospital, Melbourne, Australia, to develop a reliable, valid and practical measure. A pool of items to describe both site and morphology of AD was generated from a literature survey and expert opinion. Selected items were incorporated into a measure with each item rated on a four point scale. The measure was piloted and revised to a simpler format and called the Atopic Dermatitis Assessment Measure (ADAM). Unidimensionality was established. Reliability was determined by comparing two doctors blind ratings on 51 patients (mean age = 70 months). Agreement varied depending upon site and morphology with more agreement on "mild" AD than on "severe" AD. These results imply that operational definitions of the scales need to be defined more clearly. The measure satisfies the assumptions for a partial credit analysis.

Psychological symptoms in rural road trauma victims

There is limited research into the psychological aftermath for people who have experienced road accidents, especially outside major cities. This study by postal survey used the General Health Questionnaire-28, the Impact of Events Scale, the Post-Traumatic Stress Disorder Interview, and the Late Effects of Accidental Injury Questionnaire to assess the psychological effects on a sample of 80 people who had attended a hospital in a regional Australian centre following road accidents. Results showed that there were marked effects on many people and that these had not always been diagnosed or treated.

Childhood depression, stressors and parental depression

The relationship between depression and stressors and the relationship between depression in children and depression in their parents were investigated. Depressed children aged 7-11 years (n = 20) were compared with clinical non-depressed children (n = 88) and normal children (n = 55). Children, mothers and fathers in the three groups were tested. Measures included the Children's Depression Inventory, Recent Life Events Scale, Stressor Scale and Beck Depression Inventory. The findings showed that children and mothers in the depressed group reported more stressors than other children and other mothers while fathers of children in the depressed group did not report more stressors. The findings also showed that mothers of depressed children were more depressed than mothers of normal children while there were no differences between the scores of fathers in the three groups.

Preparing patients for invasive medical and surgical procedures. 1: Adding behavioral and cognitive interventions

The authors of three related articles look at various aspects of preparing adult and child patients psychologically for invasive surgical procedures. The first article is a review of the literature in the field, primarily from the last 30 years. Researchers have examined anxiety and coping mechanisms, patient-practitioner relationships, medical phobias, and the effectiveness of different types of psychological intervention. In the second article, the authors offer practical suggestions for implementing preparatory psychological interventions, describing effective communication techniques such as active listening, role plays, imaging, modeling, and progressive relaxation. In the final article in the series, the author considers policy, practice, and educational implications of the use of behavioral and cognitive interventions for patients, medical practitioners, and healthcare planners.

Psychological profile of the atopic eczema patient

A survey of 40 patients with long-standing atopic eczema was carried out to test for the presence of certain psychological traits which had been reported in studies in earlier decades. A series of standardised personality tests was administered to these patients and the results compared with the findings for a normal group for each test. It was demonstrated that atopic eczema patients do have significantly high levels of anxiety and problems in dealing with anger and hostility. Whether such findings make any contribution to understanding the aetiology of this disorder is debatable, but they do have implications for treatment and management, and some of these are discussed.

A preliminary study of psychological therapy in the management of atopic eczema

This paper presents a pilot study of the treatment of atopic eczema using a cognitive-behavioural approach involving self-monitoring of eczema severity, recording both internal (cognitive) and environmental antecedent trigger stimuli to flare-ups, and relaxation using imagery and habit reversal. Three patients are presented suffering from chronic atopic eczema. Although each differed in personality, complexity and severity of atopic eczema, all three showed a post-treatment reduction in symptom severity, an increase in their ability to control the disorder and a decrease in their reliance on medication. It is argued that although the cognitive-behavioural approach used did provide a useful conceptual framework for implementing the treatments described, certain aspects of these cases could also usefully be understood in more psychodynamic terms. A controlled trial is necessary to evaluate the relative importance of the different components of treatment reported in this pilot study.

Clinical applications of visual analogue scales: a critical review

Visual Analogue Scales (VAS) provide a simple technique for measuring subjective experience. They have been established as valid and reliable in a range of clinical and research applications, although there is also evidence of increased error and decreased sensitivity when used with some subject groups. Decisions concerned with the choice of scoring interval, experimental design, and statistical analysis for VAS have in some instances been based on convention, assumption and convenience, highlighting the need for more comprehensive assessment of individual scales if this versatile and sensitive measurement technique is to be used to full advantage.

Psychological treatment of phobic anxiety associated with adjuvant chemotherapy

A 50-year-old patient with breast cancer was about to withdraw from her adjuvant chemotherapy regimen because of a long-standing phobia about being injected, which had been compounded by anxieties that were associated with the severe side-effects of adjuvant chemotherapy. She experienced a conditioned nausea response to hospital and medical situations. A psychological programme that incorporated relaxation training, systematic desensitization by way of the patient's visual imagination and videotape modelling, allowed her to complete the course of chemotherapy and to feel less anxious in hospital and medical settings.

Treatment effectiveness of hypnosis and behaviour therapy in smoking cessation: a methodological refinement

Studies in smoking cessation have generally failed to adequately control for active treatment effects and have assumed that measures of smoking behaviour (i.e., estimated smoking rate, self-monitoring and chemical analysis) are equally reliable measures. Sixty smokers were randomly assigned to one of four different smoking cessation treatment groups: hypnosis, focussed smoking, attention placebo and a waiting list control. Subjects were asked to estimate and monitor their own smoking behaviour. Blood samples were also taken for thiocyanate analysis before treatment. Smoking rates were similarly measured directly, at 3 months and 6 months after treatment. The results indicate that the three measures of smoking behaviour were all highly correlated. No significant differences were found between treatments, directly after treatment or at the 3- and 6-month follow-ups. These results suggest that active treatment effects may not be responsible for behavioural change in a smoking cessation program. The implications of these findings are discussed.

Cerebral lupus erythematosus responding to plasmaphaeresis

A 44-year-old nurse with a 12-year history of systemic lupus erythematosus developed a schizophrenia-like psychosis due to cerebral lupus. Prednisolone in doses up to 200 mg daily was ineffective. Levels of immune complexes by the Raji cell assay were greatly increased in serum and cerebrospinal fluid. Plasma exchange was performed on 4 occasions over 4 days. Three days later, there was a marked and sustained improvement in the mental state, the psychosis resolved and tests of psychological function and electroencephalographic abnormalities improved. There was a corresponding decrease in levels of immune complexes and in titres of anti-neuronal antibody. Five months later, several serological indices had risen to pre-plasmaphaeresis levels except for the level of immune complexes. The patient remained in clinical remission. This case provides further evidence that high levels of circulating immune complexes may be a determinant of cerebral lupus and that plasmaphaeresis may be of lasting benefit in this disease.

The premenstrual syndrome. A psychological evaluation

The aim of the present study was to verify the presence of certain psychological factors in women complaining of the premenstrual syndrome which would differentiate these women from others. Of 42 women initially interviewed, 25 were finally selected for study, on the basis of clear premenstrual/menstrual symptoms. Twenty-three women who did not suffer premenstrual symptoms acted as controls. Women suffering from the premenstrual syndrome had significantly higher levels of 'trait' anxiety (STAI), 'neuroticism' (EPI-B), and more negative attitudes towards their bodies, genitals, sex and masturbation, as measured by a 'Role Acceptance Scale'. Both premenstrual syndrome sufferers and controls held negative attitudes toward menarche and menses.

Sensorimotor control in Parkinsonism

Performance on two sensorimotor tasks was compared between 28 patients with Parkinsonism and 28 age and sex matched controls. One task involved complex motor activity (the Bead and Tapper test) and the other simple motor activity with a verbal component (the Letter Cancellation test). Both tests had three levels of complexity. Under conditions of increasing complexity in the performance required, the scores for the Parkinsonism subjects decreased disproportionately compared with the controls. This finding was more clearly established for the Bead and Tapper test than for the Letter Cancellation test. These results confirmed previous studies, and the nature of a possible central programming deficit was discussed. Laterality of brain involvement in the Parkinsonism subjects had no significant effect.

Huntington's chorea and tryptophan

Daily use of 7 g l-tryptophan and 70 mg pyridoxine for 14 days led to no deterioration of objectively measured manual motor skills in a small group of patients with Huntington's chorea.

Drug treatment of adolescent tiqueurs. A double-blind trial of Diazepam and Haloperidol

Various forms of treatment have been recommended for multiple tics, including psychotherapy (Zausmer, 1954), behaviour therapy (Yates, 1958) and phenothiazines and other tranquillizers (Lucas, 1964; Kelman, 1965), but there have been no reports of an adequate controlled trial of any particular therapy.