A Community-Engaged Research Approach to Improve Mental Health Among Latina Immigrants: ALMA Photovoice

Recent Latina immigrants are at increased risk of poor mental health due to stressors associated with adapting to life in the United States. Existing social and health care policies often do not adequately address the mental health concerns of new Latino populations. Amigas Latinas Motivando el Alma, a community-partnered research project, seeks to improve immigrant Latinas' mental health outcomes. Using Photovoice methodology, promotoras (lay health advisors) reflected on community factors affecting mental health through photography and guided discussion. Discussions were audio-recorded, transcribed, and coded using content analysis to identify salient themes. Promotoras reviewed codes to develop themes that they presented in community forums to reach local policy makers and to increase community awareness. These forums included an exhibit of the promotoras' photographs and discussion of action steps to address community concerns. Themes included transitioning to life in the United States, parenting, education, and combating racism. Nearly 150 stakeholders attended the community forums and proposed responses to promotoras' photographic themes. Our findings suggest that Photovoice provides an opportunity for Latinas and the larger community to identify issues that they find most important and to explore avenues for action and change by creating sustainable partnerships between the community and forum attendees.

Public health surveillance and incidence of adulthood Guillain-Barré syndrome in Spain, 1998-1999: the view from a sentinel network of neurologists

Temporal variation in Guillain-Barré syndrome (GBS) warrants monitoring in certain situations. This study sought to describe a public-health-based GBS surveillance service in Spain and conduct pilot surveillance in the period 1998-1999. Neurologists from 11 hospitals countrywide, serving a population of 3.9 million, reported all patients, ages 20 years or over, admitted to hospital with suspected GBS. Cases that did not belong to the designated hospital catchment area or failed to fulfill diagnostic criteria after follow- up were excluded. Reported monthly incidence was compared against predicted incidence obtained from retrospective data (1985-1997) using a reported method based on 97.5% percentile values. Alarm thresholds for 2000 onwards were obtained by applying the same method to the updated 1985-1999 series. During the 2-year period, 98 GBS cases were reported, yielding an overall age-adjusted incidence of 1.26 per 100 000 population, with a breakdown by sex of 1.83 for males and 0.76 for females. Monthly incidence remained below or was similar to the corresponding threshold limit value. Seasonality with highest incidence in winter was more pronounced in the elderly. Preceding events, mainly respiratory infections, were identified in 71% of patients. Pilot two-year GBS surveillance in Spain resulted neither in alarm nor in preventive measures. Adult GBS incidence in Spain might be monitored by a surveillance system set up at short notice when a possible threat is perceived. A monthly incidence of over 3 per 100 000 person-years in the population aged 20 years or older would exceed threshold values.

Guillain-Barré syndrome in Spain, 1985-1997: epidemiological and public health views

Retrospective demographic information and hospital record data were collected for 337 patients resident in Spain who had validated Guillain-Barré syndrome (GBS) diagnoses and clinical onset during the period 1985-1997 and had been admitted to 11 centres, covering a population of 3.9 million. The European age-adjusted GBS incidence per 100,000 for 1985-1997 among the population aged 20 and over was 0.85, with a breakdown of 1.14 in men and 0.58 in women. Incidence increased with age and time, with occasional rises that mimicked outbreaks and occurred at irregular 2- to 4-year intervals, mainly in winter. Spatial variation was modest. Respiratory and gastrointestinal infections respectively constituted 49.3 and 19.3% of recorded preceding events. The 97.5% intercentile limit, obtained from the 1985-1997 monthly incidences using predictions from a Poisson model, was proposed as the threshold value for pilot epidemiological surveillance of GBS in 1998-1999.

Migrainous syndrome with CSF pleocytosis. SPECT findings

Brain single photon emission computed tomography (SPECT) findings are described in four adult patients with the transient syndrome of headache with neurological deficits and cerebrospinal fluid (CSF) pleocytosis. Focal deficits consisted of right-sided hemisensory changes with or without motor dysphasia or dysarthric speech (n = 4) and confusional episodes (n = 1). All patients had a CSF pleocytosis (with a mean of 309 cells/mm3 on the first spinal tap; range 75 to 590) and an elevated total protein (mean 130.5 mg/dL; range 70 to 193). The EEG showed excessive focal slowing (n = 2). A technetium Tc 99m hexamethyl propylenamine oxime (HMPAO) brain SPECT was performed during a symptom-free period, within 8 and 25 days after the onset of symptoms (n = 4). Three patients showed a decreased tracer uptake in the anterior left hemisphere, topographically consistent with the neurological deficits and EEG slowing. One patient showed no abnormalities. These findings indicate either focally impaired neuronal metabolism or hypoperfusion in regional cerebral blood flow, which could bear some relationship with the clinical features. The possibility that SPECT abnormalities may represent an epiphenomenon was also considered.

Electro-oculogram in multiple system and late onset cerebellar atrophies

The present investigation uses electrooculogram to evaluate multiple system atrophy (MSA) and late onset cerebellar atrophies (LOCAs), both idiopathic (ILOCA) and late onset autosomal dominant cerebellar ataxia (ADCA). Forty cases were clinically examined using scales for cerebellar, pyramidal, parkinsonian, mental status and neuroimaging quantitative evaluations. The patients were classified into three groups: olivopontocerebellar atrophy (OPCA), striatonigral degeneration (SND), Shy-Drager syndrome (SDS), and LOCA. We have used direct current electro-oculography in order to establish their validity in making the diagnosis. Cerebellar signs were significantly correlated with impaired VOR-fix gain and OKN, abnormalities of saccades, and reduced smooth pursuit gain (p < 0.05). Pons atrophy was significantly correlated with impaired VOR-fix gain (p < 0.01), abnormalities of saccades (p < 0.01), and reduced smooth pursuit gain (p < 0.05). Cerebellar hemisphere atrophy was significantly correlated only with impaired VOR-fix gain (p < 0.05), and medulla oblongata atrophy only with abnormalities of saccades (p < 0.05). Gaze-evoked nystagmus was found in 42.8% of patients with OPCA, and only in 14.2% with SND, but was not found in LOCA patients (t test, p < 0.05). In patients with OPCA, the combination of gaze-evoked nystagmus, abnormalities of sinusoidal VOR and reduced OKN gain measurements was very frequent, while infrequent in both LOCA (Fisher's exact test, p < 0.05) and SND subjects (p < 0.01). SDS also showed abnormalities of the oculomotor system.

Transcranial magnetic stimulation in multiple system and late onset cerebellar atrophies

Central motor conduction time (CMCT) after transcranial magnetic stimulation (TMS) of the cortex, electromyography and nerve conduction velocity were performed in 24 patients with multiple system (MSA) and late onset cerebellar atrophy (LOCA) (often olivopontocerebellar atrophy--OPCA -). CMCT was abnormal in 7 patients with OPCA and one with LOCA. CMCT abnormalities (43% of cases) and increased threshold (68%) were more often found within OPCA group than in another multisystem atrophy and LOCA. Reduction in amplitude of the response after TMS was significantly correlated with cerebral hemispheres's atrophy. Increased threshold was correlated with upper vermal hemisphere atrophy and enlargement of the fourth ventricle. Electrophysiologic signs of mixed peripheral neuropathy were found in 8 patients. TMS abnormalities were not related to peripheral nerve involvement. Marked variation in CMCT suggests heterogeneity in these diseases. However, the percentage of CMCT abnormalities in OPCA group suggests that TMS seems to play a role in the neurophysiological diagnosis of these heterogeneous disorders.

Multimodal evoked potentials in multiple system and late onset cerebellar atrophies

Forty subjects were clinically examined using scales for cerebellar, pyramidal, parkinsonian, and mental status and by quantitative evaluation of neuroimages. The patients were classified into two groups: cerebellar-plus and "pure" cerebellar syndromes. Patients with "pure" cerebellar syndrome were diagnosed as autosomal dominant cerebellar ataxia III (ADCA III) or "pure idiopathic" late-onset cerebellar ataxia (ILOCA) in this series. Patients with cerebellar-plus syndrome were diagnosed as multiple system atrophy (MSA), subclassified as either ILOCA-plus, ADCA I, ADCA II or autosomal recessive LOCA. We have used visual (VEP), brainstem auditory (BAEP) and somatosensory (SEP) evoked potentials in order to establish their diagnostic validity. Cerebellar-plus syndrome and "pure" cerebellar syndrome showed overlapping VEP, BAEP and SEP abnormalities. VEP P100 latency, however, shows a certain ability to differentiate between the two groups (p = 0.08) and appears useful in distinguishing between sporadic cerebellar-plus syndromes (MSA or ILOCA-plus) and "pure" cerebellar syndromes (p < 0.02). The incidence of prolonged N9-N13 latency was significantly higher in the latter subgroup (p < 0.04) as well. Within cerebellar-plus syndromes, VEP, BAEP and SEP abnormalities were more frequent in inherited cases (ADCA I and II, along with autosomal recessive LOCA) than in sporadic ones. The most apparent differences were a higher incidence of abnormal BAEPs at brainstem level (p < 0.002), and of both peripheral and possible central SEP impairment in hereditary cerebellar-plus syndrome than in sporadic cerebellar-plus syndrome (p < 0.03). EP investigation is useful to a certain extent in differentiating between some variants of LOCA.

[Idiopathic granulomatous angiitis of the central nervous system]

We diagnosed idiopathic granulomatous angiitis of the central nervous system in a 51-year-old man by leptomeningeal and cortical biopsy. The patient's disease was prolonged, with symptoms recurring over a period of 15 years. Treatment with prednisone and cyclophosphamide produced total remission after a follow-up of 22 months. Computerized tomography was less sensitive and revealed fewer lesions than did magnetic resonance imaging. Angiography was not sensitive and leptomeningeal and cortical biopsy were essential for diagnosis in this patient.

[Clinical and investigative approaches in mitochondrial diseases. A review of 15 cases]

The results of laboratory investigations in concerning 15 patients suspected of mitochondrial disease (MD) are presented. Our purpose is to provide an outline of the investigative modalities that support the clinical suspicion and have been found to be useful in the diagnosis. Five clinical groups were studied including 5 exercise intolerances (2 with inflammatory myopathy), 3 with myopathies (1 with dilated cardiomyopathy), 2 with progressive external oftalmoplegia (1 associated with cerebellar ataxia+epilepsy+hypertrophic cardiomyopathy+pes cavus), 4 with encephalopathies (3 with myoclonic encephalopathies with ataxia and dementia and 1 with epilepsy and tremor), and 1 with metabolic acidosis and cardiomyopathy. We used the following categories of investigative procedures: clinical phenotype analysis including pedigree study, neurophysiological tests, bicycle ergometric evaluation, neuroimaging, microscopic study of skeletal muscle biopsy, post-mortem examination, biochemical assays and molecular genetic studies. EMG showed myopathic changes in 5 cases, features of neuropathy in 2, mixed myopathic and neuropathic pattern in 1 and nonspecific changes in 3. EMG was normal in 3 patients. The most common skeletal muscle abnormalities were variation in fiber size (60%), lipid inclusions (33.3%), oxidative subsarcolemmal aggregates (26.7%) and ragged-red fibers (26.7%). Electron microscopy revealed mitochondrial abnormalities in 8 out of 14 patients' muscle biopsies, and in myocardiac and hepatic tissues of another. Site of biochemical defect was located in 12 patients. Complex I defect in 6, complexes I+IV deficiencies in 3, complex II defect in 1, complex IV deficiency in 1, complexes II+IV deficiencies in 1, and complex III defect in 1. In 2 patients the biochemical defect was not located. Mitochondrial DNA alterations were not found in 7 investigated patients. The clinical spectrum of MD has become increasingly wider. After the clinica suspicion, the diagnosis depends up on the appropriate use of skeletal muscle biopsy, biochemical investigations and molecular genetic techniques. Conventional EMG and automatic measurement of the electromyogram are particularly helpful in confirming the clinical suspicion in patients with predominantly central nervous system disease or in cases in which clinical signs are few.

Benign mitochondrial myopathy with decreased succinate cytochrome C reductase activity

In most of the cases previously described, the defect on complex II was suggested by low activity of succinate cytochrome C reductase (SCCR). The clinical pattern of the previous 10 cases is heterogeneous and may be limited to one particular tissue or be of a more general nature. We report a 22-year-old-woman, daughter of consanguineous parents, with generalized muscle weakness, easy fatigability and benign course, who showed a decrease of SCCR activity in mitochondria of muscle fibers. Free carnitine (FC) concentration was decreased in muscle as well. The muscle biopsy showed a mild variation in fiber size, with fiber type I predominance, subsarcolemmal oxidative DPNH accumulations, excess of neutral lipids and abnormally large mitochondria with paracrystalline inclusions. A possible inheritance pattern is discussed. Coenzyme Q10 therapy in this patient induced a significant increase of global MRC index score and a decrease of the turns-mean amplitude ratio in the automatic analysis of the EMG.

The effect of three commercially available dentifrices containing triclosan on supragingival plaque formation and gingivitis: a six month clinical study

In order to compare the antiplaque and antigingivitis activity of three commercially-available triclosan containing dentifrices with that of a placebo dentifrice without triclosan, a double-blind clinical study was conducted on 194 subjects over six months. Following baseline supragingival plaque and gingivitis examinations and a complete oral prophylaxis, subjects were stratified by their whole mouth baseline plaque (modified Quigley-Hein) and gingivitis (modified Löe-Silness) scores and then randomly assigned to one of four dentifrice using groups. Plaque and gingivitis examinations were then performed after six weeks, three months and six months use of the dentifrices. Subjects brushed twice daily in their customary manner. The triclosan/soluble pyrophosphate and the triclosan/zinc citrate commercially available dentifrices did not provide statistically significant reductions in either supragingival plaque accumulation or gingivitis at any of the examination intervals, as compared to the placebo dentifrice. The subjects using the commercially available triclosan/copolymer dentifrice had, after six months, statistically significant reductions in supragingival plaque (11.3 per cent), plaque severity (18.8 per cent), gingivitis (19.9 per cent) and gingivitis severity (27.8 per cent), as compared to the placebo dentifrice.

Occupational meralgia paraesthetica

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[Erection while walking and stenosis of the lumbar canal]

Lumbar channel stenosis is frequently manifested by a Cauda Equina intermittent claudication. Only exceptionally erections during walking have been described. We have observed two patients with severe lumbar channel stenosis and a Cauda Equina syndrome with intermittent erections during walking. One patient was laminectomized presenting a clinical improvement. There does not exist a satisfactory explanation for this strange affectation.

The effect of a dentifrice containing triclosan and a copolymer on plaque formation and gingivitis: a 14-week clinical study

One hundred eighteen male and female adult subjects were entered into a 14-week, double-blind clinical study to compare the effect of a dentifrice containing 0.3% triclosan and 2% of a copolymer of methoxyethylene and maleic acid on plaque formation and gingivitis. The subjects were stratified into two balanced groups according to baseline plaque scores. They then received an oral prophylaxis and were assigned to the use of either a placebo dentifrice or the triclosan/copolymer dentifrice for the next 14 weeks. After 6 weeks' use, the triclosan/copolymer dentifrice provided a 21.34% statistically significant (99% level of confidence) reduction in supragingival plaque deposits, as compared to the placebo dentifrice. The triclosan/copolymer dentifrice also provided a 5.49% reduction gingivitis after 6 weeks' use, as compared to the placebo dentifrice. This reduction was not statistically significant. After 14 weeks' use, the triclosan/copolymer dentifrice provided a 38.80% statistically significant (99% level of confidence) reduction in supragingival plaque deposits, as compared to the placebo dentifrice. The dentifrice containing triclosan and copolymer also provided 50.72% statistically significant (99% level of confidence) reduction in gingivitis, as compared to the placebo dentifrice. When tooth surfaces with the highest degree of plaque formation (i.e. Quigley-Hein score greater than or equal to 3) were examined at 6 weeks, the triclosan/copolymer dentifrice provided a 42.92% statistically significant (99% level of confidence) reduction in supragingival plaque deposits, as compared to the placebo dentifrice.(ABSTRACT TRUNCATED AT 250 WORDS)

Purification of several proteins involved in glycogen metabolism

Several well-established procedures for the isolation of enzymes involved in glycogen metabolism have been modified such that all the enzymes can now be isolated from the same muscle preparation. The purified proteins are the catalytic subunit of cyclic AMP-dependent protein kinase, its thermostable inhibitor, glycogen phosphorylases a and b, and phosphorylase kinase. Phosphorylase kinase is separated by acid precipitation of the muscle extract. The other proteins are purified from the acid supernatant by chromatography on DEAE-cellulose. Further purification of each protein to homogeneity is then achieved using previously described methods. The proposed protocol saves sample tissue, and considerably reduces the work involved in obtaining muscle samples.

Rationale and methods for crown lengthening

Surgical crown lengthening should not be attempted when tooth fractures extend into the middle third of the root. Excessive bone reduction on the fractured tooth and necessary blending of osseous contours over adjacent teeth may result in mobility or furcation involvement. In addition, the necessary osseous surgery may create precipitous changes in the bony architecture that will be bridged by soft tissues. This results in increased pocket depth and an unhealthy situation. If the tooth in question has a hopeless prognosis or the osseous surgical procedure would create a poor crown-root ratio, furcation involvement, mobility, or esthetic problems, crown lengthening should be avoided. In cases such as these, extraction may be indicated.