Ecological momentary assessment of contextual variables, satisfaction, and emotional and behavioral states of adolescents by level of victimization

The harmful effects of victimization on mental health have been demonstrated in several age groups, cultures, and populations, but there is wide variability in the resulting psychopathology. Ecological momentary assessment (EMA) allows the expression of an emotional state to be recorded at any given time and linked to a situation or context. This study aimed to analyze the contextual variables (where, with whom, and what), momentary satisfaction, and perception of momentary emotional and behavioral symptoms in a cohort of adolescents by the level of victimization, using EMA. We explored the everyday symptom profiles and the contexts in which events took place among 100 adolescents over a one-week period. Sociodemographic data were collected and assessment was done using the EMA (as a smartphone application) and the Juvenile Victimization Questionnaire (to assess childhood and adolescent victimization). In this study, regarding contextual variables, the group with the highest level of victimization (top 10%) showed a significant relationship with being away from home and being with friends other than classmates, and not being with parents or relatives. There was also an unexpectedly higher frequency of sporting engagement in this group. A relationship existed between emotional and behavioral problems and higher levels of victimization. In conclusion, the different groups of victimized subjects present a relatively high level of satisfaction in relation to the daily contexts and show low levels of emotional and behavioral symptomatology.

Factors predicting distress among parents/caregivers of children with neurological disease and home enteral nutrition

BACKGROUND & AIMS

Caregivers of children with chronic diseases included in a home enteral nutrition (HEN) programme are at risk of experiencing a feeling of burden, high level of anxiety and psychological distress. The aims of this study were: first, to examine the prevalence of symptoms of anxiety-depression in caregivers of children with neurological diseases requiring HEN by gastrostomy tube (GT); second, to compare the characteristics of caregivers with high or low risk of exhibiting symptoms of anxiety-depression; and third, to investigate possible associations to child disease severity and nutrition support mode.

METHODS

A cross-sectional observational study was performed in 58 caregivers of children (31 boys, aged 0.3-18 years) with neurological diseases and GT feeding. The characteristics of caregivers with high or low risk of presenting symptoms of anxiety-depression were compared regarding the following variables: socio-demographic characteristics, the primary caregiver's intrapsychic factors, anthropometric parameters of the child, length of HEN, type of nutrients delivered by GT and infusion regime.

RESULTS

All primary caregivers were mothers. Fifty-three per cent of them showed high risk of exhibiting symptoms of anxiety-depression. Mothers with high or low risk of presenting symptoms of anxiety-depression were comparable in age and family socio-economic status. They were also similar in terms of age, anthropometric conditions and length of HEN in their children.No differences were found between the two groups of mothers according to the level of the child's motor function impairment, type of nutrients delivered by GT and infusion regime. Higher levels of psychological distress and perception of burden overload were found in mothers with high risk of exhibiting symptoms of anxiety-depression.

CONCLUSIONS

This study found a high prevalence of symptoms of anxiety-depression, perception of burden overload and psychological distress in caregivers of children with HEN. Thus, greater practical and emotional support is required for these families.

Home enteral nutrition in children: a 10 year experience with 304 pediatric patients

BACKGROUND & AIMS

Home enteral nutrition is used increasingly in pediatric populations. Our objective was to describe the profile of pediatric patients requiring this treatment.

MATERIAL AND METHODS

All patients under 18 years old requiring treatment with home enteral nutrition between January 1995 and December 2004 were analyzed retrospectively.

RESULTS

304 patients were studied (157 boys). The mean age at the start of treatment was 4.02 ± 4.09 years, median of 2.5 years; 28% of all patients were under 1 year. The main indications were oncological disease in 91 patients (29.9%) and digestive diseases in 84 (27.6%). There were significant differences depending on the clinical diagnosis for the start age, type of access, infusion regime and formula prescribed. Nutrients were delivered by nasogastric tube in 218 patients (71.7%). Overnight enteral nutrition was the preferred infusion regime in 155 patients (51%). Adult or pediatric polymeric formulas were mostly prescribed in 190 patients (62.5%). The mean treatment duration was 306 ± 544 days.

CONCLUSION

In our series, enteral support usually begins at an early age. Its characteristics varied depending on patient pathology. Knowledge of the pediatric patient profile is important to design the most effective strategy for home enteral nutrition.

Psychometric properties of the structured Satisfaction Questionnaire with Gastrostomy Feeding (SAGA-8) for caregivers of children with gastrostomy tube nutritional support

BACKGROUND

To analyse the psychometric properties of the structured Satisfaction Questionnaire with Gastrostomy Feeding (SAGA-8) in parents/caregivers of children with home enteral nutrition (HEN) by gastrostomy tube (GT).

METHODS

Eighty-six caregivers (mothers) of paediatric patients with HEN by GT were recruited. Patients suffered from neurological disease (61.6%) and other chronic diseases. The SAGA-8 scale, a structured questionnaire to explore satisfaction with HEN by GT, and the Caregiver Burden Inventory (Zarit) were completed. The discriminating power of each of the SAGA-8 items, internal consistency and external validity were evaluated. An exploratory factor analysis and Kaiser-Meyer-Olkin (KMO) was performed as well.

RESULTS

Eighty-four percent of the families expressed high satisfaction with GT feeding. All eight items of SAGA-8 gave additional information. The exploratory factor analysis revealed that a significant part of the items' variability could be explained by two independent factors: Factor 1 (direct benefit), which compiled the variables related to the perception of children's overall improvement by GT feeding; Factor 2 (indirect benefit), which grouped the variables related to a decrease in respiratory infections, feeding time and institutional support. Results from KMO (0.628) indicated the high adequacy of the items assessed in the factorial analysis. Moreover, the questionnaire presented high internal consistency (0.76), and the external validation analysis confirmed the correlation between SAGA-8 and Zarit, thereby emphasising the approptiate use of the SAGA-8 to detect carers' satisfaction.

CONCLUSIONS

The SAGA-8 questionnaire has a high discriminatory power to assess the degree of satisfaction experienced by parents/caregivers of children with HEN by GT and, subsequently, the patients' wellbeing.

Epigenetic regulation of PRAME in acute myeloid leukemia is different compared to CD34+ cells from healthy donors: effect of 5-AZA treatment

PRAME is a tumor associated antigen (TAA) of particular interest since it is widely expressed by lymphoid and myeloid malignancies. Several studies have associated high PRAME RNA levels with good prognosis in acute myeloid leukemia (AML). PRAME expression is regulated at the epigenetic level. For this reason inhibitors of DNA methylation, such as 5-azacytidine, can modulate the expression of this TAAs. In the current study we analyzed the effect of 5-azaC on the expression of PRAME in blasts versus CD34+ cells from healthy donors in an attempt to increase its expression, thus inducing a potential target for therapeutic strategies.

[Implication of the anxiety and depression in eating disorders of young obese]

OBJECTIVES

the goals of the present study were: 1) to compare the levels of anxiety, depression, and eating disorders in young patients assisted at a children's hospital for obesity; 2) to determine whether anxiety and depression explain the symptoms of the eating disorders; and 3) to know which of these symptoms better discriminate the young people with different degrees of obesity.

MATERIALS AND METHOD

Descriptive, cross-sectional study with a sample comprised by 281 youngsters (56% girls) aged 11-17 years. The BMI percentiles were calculated by using the WHO growth tables. Two study groups were created: severe obesity and overweight/light-moderate obesity. The following questionnaires were used: Eating Disorders Inventory-2 (EDI-2), depression questionnaire (DQ), and Status-Trait Anxiety Questionnaire (STAI).

RESULTS

The youngsters with obesity showed more psychological problems than youngsters with overweight/light-moderate obesity, 12% had anxiety, and 11% depression. In both groups, the behaviours related with eating disorders were partially explained by the presence of symptoms of anxiety and depression. Dissatisfaction with the body and high anxiety trait increased the risk for perpetuating the obesity and were the two symptoms that better discriminated the patients with or without severe obesity.

CONCLUSION

Obesity prevention programmes should include body dissatisfaction and the anxiety trait into the assessment and management protocols, and prevent anxiety getting fixed as a personality trait.

Health impact assessment of an urban regeneration project: opportunities and challenges in the context of a southern European city

BACKGROUND

Social values and the political context have an influence on the use and spread of health impact assessment (HIA). In Spain, there is little experience in HIA but some regional governments are already introducing it. The aim of this article is to describe the health impacts of a local regeneration project to improve accessibility in a neighbourhood of Bilbao (Spain), and discuss the main difficulties, opportunities and challenges of the process, considering the specificities of the social and political context.

METHODS

A concurrent and prospective assessment, based on a broad model of health, was carried out following the Merseyside guidelines. A literature review, community profiling and qualitative data collection were undertaken. Profound involvement of members of the community and key informants was judged as essential in the HIA process.

RESULTS

The overall expected effect of the new lifts, roads, park and the rainwater collection system was positive. Uncertain or negative impacts were identified in some of those areas, and also concerning the burying of four high-voltage power lines. Historical and current characteristics of the community were highly influential on the way local people perceived the project and its impacts. Likewise, the way in which processes of planning and implementation were developing also played an important role.

CONCLUSION

The spread of HIA in southern European countries will depend on the progressive introduction of values underlying HIA, as well as on the promotion of intersectoral work, a better knowledge of the social model of health and community's participation in policy making.

Endovascular surgery by means of a Talent endoprosthesis implant in adult patients with thoracic aorta coarctation

AIM

The aim of this study was to show the initial experience of a therapeutic alternative in the surgical treatment of thoracic aorta coarctation in adult patients by means of a Talent endoprosthesis implant and angioplasty, maintaining the advantages of minimally invasive surgery, avoiding recurrence, offering safety and protection against dissections, tearing, or even aortic ruptures and, hence, minimizing risks and complications from a thoracic aorta surgery through thoracotomy.

METHODS

The authors present a series of 12 cases of thoracic aorta coarctation in adult patients, treated with endovascular surgery by means of a Talent endoprosthesis implant using a transfemoral or iliac access. Age, gender, gradient release, perioperative mortality and morbidity, presence of palpable pulses in the limbs, claudication, and follow-up time.

RESULTS

Eight men and four women, average age of 23.6 years (18 to 38). The average diameter of the normal aorta was 21.65 mm (13.5-24.5 mm) and the smallest diameter at the coarctation site was 3.4 mm (0 to 8 mm). No complications occurred and no patient required blood transfusion. The time spent in the intensive care unit for postoperative monitoring averaged 15 h (12 to 18 h) and hospital stay averaged 2.33 days (1 to 4 days). All patients presented palpable pulses of normal characteristics during the postoperative period. No residual pressure gradient was present requiring treatment. In this series, neither trans nor postoperative complications occurred, and the follow-up time averaged 52 months (6 to 93 months).

CONCLUSION

Endovascular treatment of thoracic aorta coarctation with protected dilatation is a safe and effective procedure.

Pulmonary, microbiological and hematological changes in Crotalus durissus terrificus (Serpentes, Viperidae) parasitized by nematodes of the genus Rhabdias (Nematoda, Rhabdiasidae)

This study reported the pulmonary, microbiological, and hematological alterations in Crotalus durissus terrificus parasitized by nematodes of the genus Rhabdias. Histological, microbiological, and hematological analysis were performed on parasitized (n=6) and non-parasitized (n=6) snakes. Granulocytic and mononuclear cell infiltrates in the pulmonary parenchyma and epithelium were also observed during the histological analysis of parasitized snakes. Microbiological analysis of parasitized animals revealed the following Gram-negative bacteria: Citrobacter divergens, Burkholderia cepacia, Stenotrophomonas maltophilia, Proteus vulgaris, Enterobacter sakazakii, Enterobacter ammnigenus, Pseudomonas aeruginosa, Pantoea sp. and Providencia rettgeri. In non-parasitized snakes, the following species were identified: B. cepacia, Pseudomonas fluorescens, and Acinetobacter baumanii. Increased levels of plasmatic protein, decreased lymphocyte counts, and normal red blood cell values were observed in parasitized animals.

Effect of different fermentation conditions on the kinetic parameters and production of volatile compounds during the elaboration of a prickly pear distilled beverage

An experimental design considering thermal treatment of must, yeast strain, prickly pear variety and degree of ripeness was chosen to evaluate the fermentation behavior and generation of volatile compounds, during the elaboration of a distilled beverage from prickly pear. Four Mexican prickly pear varieties were characterized physically and two of them were selected for fermentation studies. The thermal treatment of the must showed the highest statistical influence on fermentation behavior and production of volatile compounds, followed by prickly pear variety, then yeast strain and finally the degree of ripeness was the least statistically significant factor. The growth rate increased when the thermal treatment was applied whereas the ethanol production rate and alcoholic efficiency were unaffected. The results also suggested that thermal treatment was effective for inhibition of microbial contamination. As regards volatile compounds production, acetic acid and methanol decreased while other volatiles increased when the thermal treatment was applied. Despite the influence of thermal treatment, prickly pear variety strongly influences the volatile profile of fermented musts.

Hemangiossarcoma cardíaco em cão. Relato de dois casos

O artigo não apresenta resumo.

[Estimating the supply of medical specialists in Colombia by using the capture-recapture method]

OBJECTIVE

Given that it is not known how many medical doctors there are in Colombia and that, without that datum, studies of demand are simply theoretical exercises, we proposed to estimate the supply of 12 medical specialties in Colombia, using the capture-recapture technique, which was developed by zoologists to estimate wild-animal populations.

METHODS

Three lists, or "captures," were used: 1) university degrees obtained abroad and graduates of postgraduate programs in Colombia, 2) members of medical societies, and 3) specialists in the principal health care enterprises. To estimate the total population we used the CAPTURE software program.

RESULTS

A total of 24,910 records were obtained: 8,397 from the university records, 6,561 from the scientific societies, and 9,952 from the health care businesses. More than half of the physicians have entered the labor market during the last decade. The estimated number of physicians (with the 95% confidence interval) for each specialty was: anesthesiology, 1,753 (1,727 to 1,789); cardiology, 607 (598 to 624); dermatology, 517 (514 to 525); obstetrics and gynecology, 2,338 (2,290 to 2,400); pulmonary disease, 304 (297 to 320); neurosurgery, 324 (319 to 334); neurology, 321 (296 to 369); ophthalmology, 1,049 (1,042 to 1,061); orthopedics, 1,217 (1,212 to 1,227); otolaryngology, 634 (628 to 645); psychiatry, 855 (838 to 879); and urology, 452 (452 to 458).

CONCLUSIONS

The capture-recapture technique is useful in the study of human resources. In Colombia the number of specialists doubled in less than a decade. There are specialties that are already oversupplied, such as neurosurgery. All the other specialties show growth rates that indicate a future over-supply for the health care system.

[Qualitative approach to the attitudes and expectations of doctors during the process of computerising primary care]

OBJECTIVE

To find the attitudes and expectations of doctors during the process of computerising primary care (PC).

DESIGN

Qualitative investigation through discussion groups.

PARTICIPANTS

Thirty-one doctors from the two PC regions of Gipuzkoa.

METHOD

Intentional stratified sampling by regions and by experience in using a computer in the consulting-room. Five discussion groups with recording and transcription of the contents with prior authorisation and guarantee of confidentiality. Qualitative analysis of the notes and transcriptions with the help of computer back-up. Validation through sending of results to participants and discussion between the authors.

RESULTS

Introducing computers into PC consulting-rooms had repercussions both on the ordering and contents of the information recorded. The effort <> was not accompanied by subsequent evaluation. Notable deficiencies in management of the computerising process were perceived. Computer use created additional symbolic effects for both patients and doctors.

CONCLUSIONS

Computerising PC is a process whose repercussions on medical care are far from neutral and so require rigorous discussion and evaluation. Defining step-by-step and measurable objectives, transparency in management and the promotion of evaluative research would all favour the effective development of projects to computerise PC.

[Meloxican-induced cholestasis]

The cholestasis by meloxicam has not been often described. However, we present here the clinic, laboratory, histologic and follow up of a patient with cholestatic hepatitis produced by this drug.

[Application of advanced oxidant systems in the treatment of residual waters in the petroleum industry (Fenton system)]

Typical contaminants from the oil industry were treated with the Fenton system (H2O2/Fe2+) under normal conditions of pressure and temperature. The treated contaminants, in harzadous concentrations, were the following: m-cresol, 2-chlorophenol, and methyl-tertbutyl -ether (MTBE). Additionally, waters contaminated with reformulated gasoline were also treated and the degradation of MTBE and volatile aromatics (benzene, toluene, ethylbenzene and xylene) was followed. The system efficiency, in the contaminated water treatment of two different samples were also tested. One of the samples came from oil production operations and the other from a petrochemical plants complex. In all cases an advanced mineralization of the contaminants was observed in relatively short periods of time. The rate constants, at room temperature, for degradation of m-cresol, 2-chlorophenol and MTBE were measured.

[Guidelines of the Spanish Society of Cardiology for clinical practice in exercise testing]

Most exercise testing is performed in adults with known or suspected ischemic heart disease. In the last few years cardiac imaging techniques have been applied in this field, improving the information obtained with the procedure. However, the exceptions to this rule are emerging rapidly not only in healthy people (asymptomatic individuals, athletes, handicapped people) but also in cardiac patients (advanced congestive heart failure, hypertension, rhythm disorders, congenital heart disease, etc.). All the-se issues justify the need for a multidisciplinary consensus document in Spain. This paper reviews and updates the methodological aspects of the stress test, including those related to oxygen consumption measurements. The main aim of this review was to determine the role of exercise testing in the evaluation of ischemic heart disease as well as the applications of imaging stress testing. The usefulness of this test in other non-ischemic cardiac disorders and in selected subsets of healthy people is also reviewed.

[Carcinoma hepatocellular. Description of verified clinical characteristics in a region of Southern Chile]

BACKGROUND

Hepatocellular carcinoma is the most frequent primary tumor of the liver. It is associated to chronic liver diseases and has a high prevalence in some regions of Africa and Asia.

AIM

To describe the clinical characteristics of patients with hepatocellular carcinoma, admitted to two hospitals of the IX region of southern Chile.

MATERIAL AND METHODS

Prospective study of 29 consecutive patients admitted to two hospitals in Temuco, Chile. Clinical features, laboratory values and viral markers were analyzed.

RESULTS

Eighteen patients were male and ages ranged from 29 to 75 years old. The most frequent presenting symptom was abdominal pain in 21 patients. Seven subjects had a history of alcoholism. Serum bilirubin values ranged from 0.1 to 15.8 mg/dl, alkaline phosphatases ranged from 171 to 3476 U/l, ASAT from 24 to 5400 U/l and alpha feto protein from 1.4 to 350 ng/ml. Two patients had a positive hepatitis B surface antigen and all had negative hepatitis C virus antibodies. Mean tumoral diameter was 9.6 cm and the most common presentation was nodular. Mean survival after the diagnosis was 6.3 months.

CONCLUSIONS

These patients with hepatocellular carcinoma have a low frequency of positive viral markers and tumors of large sizes on presentation.

Semiquantitative culture of subcutaneous segment for conservative diagnosis of intravascular catheter-related infection

BACKGROUND

Sensitivity and negative predictive values of combined surface cultures (skin and hub) are high in the presumptive diagnosis of catheter-related infection, but specificity and PPVs are poor. The purpose of the study was to evaluate the yield of the semiquantitative culture of the subcutaneous segment in the diagnosis of colonization of the catheter tip without removal of the catheter.

METHODS

A prospective study was performed in 124 nontunneled central venous catheters that were removed because of suspected infection or the end of therapy. Catheter colonization was considered if >15 colony-forming units (CFU) in the roll procedure or > 1,000 CFU in the quantitative Cleri procedure were recovered from the tip cultures ("gold standard"). Before removing the catheter, a semiquantitative culture of skin surrounding the point of insertion, a semiquantitative culture of the subcutaneous segment (after removing the catheter only 2 cm), a semiquantitative cultures of the hub, and a pareated quantitative blood culture were performed. Receiver operating characteristic curves were calculated to estimate the cutoff points, and a culture was considered positive when CFUs were > or =15, > or =15, and > or =5 for skin, hub, and subcutaneous segment cultures, respectively.

RESULTS

Catheter colonization was detected in 51 catheters. The mean duration of catheterization was 14 +/- 8 days, and the rates of incidence of tip colonization and bacteremia were 2.9 per 100 catheter days and 1.2 per 100 catheter days, respectively. Sensitivity of skin, subcutaneous, and hub cultures analyzed individually were < or =61%; however, specificity and positive predictive values (PPVs) of subcutaneous segment cultures were significantly higher than skin cultures (94% and 88.5% vs 71.6% (p = .001) and 62% (p = .014), respectively). Sensitivity of the combined skin and hub cultures and of the combined subcutaneous segment and hub cultures were similar: 86.2% and 84.3%, respectively; however, specificity and PPVs of this latter combination were significantly higher than former: 82% and 78.1% vs 59.7% (p = .008) and 61.9% (p = .07), respectively. The likelihood ratio of a positive test for the combined subcutaneous segment and hub culture was 4.68, and only 2.13 for the combined skin and hub culture.

CONCLUSIONS

These results indicate that the combined subcutaneous segment and hub culture constitutes an easy, effective procedure for the conservative diagnosis of catheter colonization.

[Neurology and the reform of the health care system in Colombia]

INTRODUCTION AND OBJECTIVES

Despite the magnitude of the Colombian health system reform, introduced in 1993, changes in specialized medical practice have not been evaluated. This paper is the follow-up of a similar study on the practice of neurology done by the authors before the reform.

MATERIAL AND METHODS

Of the 62 members of the Colombian Association of Neurology living in Bogotá, 47 (76%) of them responded an anonymous survey inquiring on the characteristics of their medical practice and registering all the medical encounters during one week in October 1998.

RESULTS

Two thirds of the total working time is devoted by neurologists to clinical work. Half of the neurologists in the sample have invested in diagnostic equipment. There was no significant change in the total number of patients attended during the week, as compared with the 1993 study, and the diagnostic profile was similar. The proportion of private patients was significantly lower, while patients from prepaid medical schemes increased. Patients belonging to the Obligatory Health Plan, designed to cover lowest income population, and to prepaid medicine are not distributed homogeneously throughout all ages. The first year of life is particularly uncovered by the Obligatory Health Plan, while prepaid schemes do not address the problems of individuals age 60 or more.

CONCLUSIONS

There has been a significant reduction in private practice compensated by an increase in prepaid medicine. There is no evidence of increased coverage for neurological disorders.

The prevalence of spondylolysis in the Spanish elite athlete

The diagnosis of spondylolysis is a major cause of concern for patients and their families, especially when the patients are young athletes with promising futures in their sports. In this study, 3152 case histories of high-level athletes were evaluated to determine which sports had a higher prevalence of spondylolysis. The overall percentage of spondylolysis among athletes in this study (8.02%) was not very much higher than that among the general population, which varies between 3% and 7%. However, when each sport was considered separately we found much higher values for some sports, with the highest percentages occurring in throwing sports (26.67%), artistic gymnastics (16.96%), and rowing (16.88%). The analysis of the biomechanical movements involved in the sports with greater prevalence of spondylolysis has led us to include the element of torsion against resistance as another possible causative factor for spondylolysis that should be added to the already known causative mechanisms, lumbar hyperextension and rotation. We have divided the sports into three risk groups according to the prevalence of spondylolysis shown and the characteristics of the sample, and we recommend systematic radiological examination of the lumbar spine in athletes considered to be at greater risk of developing spondylolysis.

Neurological impairment in alpha-mannosidosis: a longitudinal clinical and MRI study of a brother and sister

Neurological development over a period of 25 years and MRI findings are reported in two members of the same family affected by mannosidosis type II. Progressive axial and appendicular cerebellar syndrome, moderate hearing loss and deterioration of gait were present in both patients. Neuropsychological deficiency was severe, but progression over the years was not observed except in the woman's speech capacity. Neither of the patients showed clinical improvement. A progressive corticosubcortical atrophy stands out in the brain neuroimaging studies, especially at the vermian cerebellar level. The osseous cranial deformities are very characteristic and include brachycephaly, thickening of the calvaria at the expense of the diploe, and poor pneumatization of the sphenoid. Neither of our cases showed an empty sella turcica.

Respiratory disturbances during sleep in syringomyelia and syringobulbia

OBJECTIVE

To determine the frequency and types of abnormalities of respiratory control during sleep in syringomyelia and syringobulbia and to provide a basis to predict patients at risk of sudden death.

METHODS

Thirty patients (15 male and 15 female; mean age 39.0 +/- 12.6 years) with communicating syringomyelia were divided into two groups: those with evidence of syringobulbia (17 patients) and those without compromise of the medulla or syringomyelia (13 patients). Patients were studied with pulmonary function studies and polysomnography. Respiratory center sensitivity to CO2 (rebreathing technique) was measured in 9 patients.

RESULTS

Severely affected patients had mild-to-moderate restriction and individual patients had bilateral diaphragmatic or vocal cord palsy, abnormal respiratory rhythm, prolonged inspiratory time, or an abnormal respiratory response to CO2. Very prolonged central, obstructive, and mixed sleep apneas with low O2 saturation values and a fixed heart rate were recorded in most patients with syringobulbia. Five patients developed severe respiratory complications and died during a follow-up period of 10 years. Respiratory abnormalities failed to correlate with syrinx size.

CONCLUSIONS

Severe abnormalities in respiratory rhythm generation during sleep occur in patients with syringobulbia. The respiratory disturbances are not due to muscle weakness and they are not correlated with the size of the cavity. The combination of dysphagia and dysphonia in patients with longstanding syringomyelia and syringobulbia predicted likelihood of respiratory disturbances during sleep.

[Homeopathic and primary care doctors: how they see each other and how they see their patients: results of a qualitative investigation]

OBJECTIVE

To explore the views of Primary Care and homeopathic doctors in the same geographical and population catchment area towards Homeopathy as a discipline and the motives that bring patients to use its services.

DESIGN

A qualitative study, using in-depth interviews and a focus group.

SETTING

A community of 18,000 inhabitants with a Health Centre and four homeopathic physicians.

PARTICIPANTS

The four homeopathic physicians and nine of the ten doctors from the Health Centre.

METHOD

After face-to-face and later telephone interviews, each of the four homeopathic physicians was interviewed in depth and the author led a focus group with the 9 Health Centre doctors.

MAIN RESULTS

a) From the homeopaths: they emphasised an integrated patient-centred approach. They insisted on their status as doctors and that their treatment was not iatrogenic, etc. b) From PC doctors: They were ignorant of Homeopathy. They identified it with a type of remedy of which they knew nothing, but for which they demanded scientific evidence, etc.

CONCLUSIONS

PC doctors' ignorance of Homeopathy put them at risk of not understanding patients' expectations. It seems that the patient-centred, as against disease-centred, care model is, in practice, outside the scope of PC health delivery.

Analysis of the relationships between environmental factors (aeroallergens, air pollution, and weather) and asthma emergency admissions to a hospital in Mexico City

There have been several studies of the relationships between environmental factors, particularly air pollution, and attacks of asthma. Most of these studies have ignored the potential confounding effects of aeroallergens such as pollens and fungal spores. We report a statistical analysis of the relationships between emergency admissions for asthma to a hospital in Mexico City and daily average airborne concentrations of pollen, fungal spores, air pollutants (O3, NO2, SO2, and particulates) and weather factors. Asthma admissions had a seasonal pattern with more during the wet season (May-October) than the dry season (November-April). There were few statistical associations between asthma admissions and air pollutants for the three age groups studied (children under 15 years, adults, and seniors [adults over 59 years]) in either season. Grass pollen was associated with child and adult admissions for both the wet and dry seasons, and fungal spores were associated with child admissions during both the wet and dry seasons. The analysis was done with environmental data averaged over the day of admission and the 2 previous days. Our results suggest that aeroallergens may be statistically associated more strongly with asthma hospital admissions than air pollutants and may act as confounding factors in epidemiologic studies.

Soft salt-mannitol agar-cloxacillin test: a highly specific bedside screening test for detection of colonization with methicillin-resistant Staphylococcus aureus

The early detection of colonization with methicillin-resistant Staphylococcus aureus (MRSA) of patients in intensive-care units is an essential step in the strategy for preventing MRSA epidemics. In this study, tubes containing soft salt-mannitol agar with cloxacillin (6 microg/ml) (SSMAC) were prepared for inoculation of clinical samples at patients' bedsides by personnel of an intensive-care unit. A total of 1,914 swabs from different sample sites of 81 patients were dipped into SSMAC tubes, and after 24 h of incubation (in an incubator located near the intensive-care unit), an evident color change was considered by the intensive-care-unit personnel to be an MRSA alarm. Sixty-three (3.3%) SSMAC tubes were considered positive for MRSA, 1,827 (95.4%) were considered negative, and 24 (1.2%) were considered intermediate. Compared with values for parallel conventional surveillance cultures for MRSA, excluding tubes with intermediate results, the SSMAC test had a sensitivity of 72.7%, a specificity of 99.2%, a positive predictive value of 76.2%, and a negative predictive value of 99.0%. When intermediate tubes were considered positive, the corresponding values were 75.3, 98.2, 63.2, and 99.0%, respectively. The sensitivity and specificity values of the test to identify MRSA-colonized patients were 89.4 and 100%, respectively. Oropharyngeal and naris specimens were the most reliable samples for MRSA detection. False-negative results were frequent in bronchial aspirates with low (< 10(3) to 10(6) CFU/ml) MRSA counts. False-positive results were mainly due to methicillin-resistant Staphylococcus haemolyticus. The SSMAC tube is a useful, rapid, and inexpensive tool for the early identification of MRSA-colonized patients and, consequently, for the implementation of measures to prevent the spread of MRSA.

[Considerations concerning the 1st outbreak of poliomyelitis in the city of Orizaba, Veracruz]

The objective is to present some deliberations on the paralytic poliomyelitis outbreak in the city of Orizaba, Veracruz. Fifty years after its occurrence, the original report of the first paralytic poliomyelitis epidemic in Mexico is presented herein. The detailed description of this outbreak by the authors reflects the devoted task of public health workers and clinicians who promptly identified an abnormal pattern of disease considered exotic in Mexico at that time. Unfortunately, this outbreak was the beginning of what proved to be an endemic disease with over 9,000 cases being reported in the ensuing ten years; some studies place the incidence figures three-to-fivefold higher. Fifty years after this outbreak, wild polio virus has been eradicated in Mexico and with it, the virtual eradication of paralytic poliomyelitis.

Usefulness of phage typing and "two-way ribotyping" to differentiate Salmonella enteritidis strains

The capacity to differentiate Salmonella enteritidis strains by phage typing and "two-way ribotyping" performed with PstI and SphI was evaluated. The typeability was 96.8% in phage typing and 100% in ribotyping. The series was differentiated into 13 phage types, 19 combined ribotypes, and 39 subtypes or clonal lines by combining results from both methods (of which 11, 13, and 35, respectively, were represented by natural strains). Ribotyping differentiated strains ascribed to PTs 1, 4, 6a, 7, 8, RDNC and UPT. Conversely, some strains of PTs 1, 4, 5a, 6, 6a, 7, 34, RDNC and UPT fall into the most frequent combined ribotype. A dendrogram of genetic similarity generated from the combined ribotypes was traced, and, at a 0.82 similarity level, it showed a major cluster (including 17 combined ribotypes, 88.4% strains ascribed to all PTs tested except PT11), a minor cluster, and four additional lines more loosely related.

[in vitro activity of carbapenems against Enterobacteriaceae and Pseudomonas aeruginosa hyperproducers of group 1 chromosomal beta-lactamases]

Resistance to imipenem and meropenem, reported sporadically in Enterobacteriaceae and more frequently in Pseudomonas aeruginosa, can be caused, among other mechanisms, by the combination of changes in permeability and hyperproduction of inducible chromosomal beta-lactamases. In this study, the in vitro activity of imipenem and meropenem was analysed by the agar dilution method against cefotaxime, ceftazidime, and aztreonam resistant clinical strains of Enterobacteriaceae (n = 202) and P. aeruginosa (n = 90). This phenotype is consistent with the hyperproduction of group 1 chromosomal beta-lactamases and was previously determined in stably derepressed mutants in the same species, obtained from strains with inducible beta-lactamase expression by selection with cefotaxime and ceftazidime. Likewise, the activity of imipenem and meropenem against the same number of clinical isolates susceptible to cefotaxime, ceftazidime, and aztreonam was evaluated. In general, imipenem and meropenem showed an excellent activity, which was intrinsically greater for meropenem against Enterobacteriaceae and P. aeruginosa organisms. Nevertheless, imipenem and meropenem activity was slightly affected on cefotaxime, ceftazidime, and aztreonam resistant isolates of E. cloacae (MIC90, 1 and 0.2 microgram/ml, respectively), E. aerogenes (1 and 0.2 microgram/ml), C. freundii (1 and 0.1 microgram/ml), M. morganii (1 and 0.5 microgram/ml), and S. marcescens (4 and 0.5 micrograms/ml). On the other hand, the activity of imipenem and meropenem against ceftazidime and aztreonam resistant isolates of P. aeruginosa was more significantly affected, with MIC90 values of 64 and 16 micrograms/ml, respectively.

[Specialized care of neurological diseases in Colombia]

This study sought to reveal the patterns of medical care given to patients with neurologic diseases in Colombia. To that end, it tracked the daily activities of 30 neurologists chosen from a representative sample of 119 neurologists registered in Colombia in 1993. The information was requested by means of a previously standardized questionnaire and was complemented by demographic and epidemiologic data. The results showed that demand for specialized neurologic care depended more on cultural perceptions than on objective measures of prevalence. Moreover, it was found that education in neurology should place greater emphasis on ambulatory treatment as an alternative to hospital treatment. The survey also offered preliminary information on the prevalence and incidence of the primary neurologic diseases in the country. The prevalence of these diseases far exceeds the supply of specialized neurologic care. Finally, the results point out the advantages and deficiencies of this type of care, findings that might guide future efforts in this field in other countries and under different circumstances.

Resistance of Veillonella to Hydrosoluble Pristinamycins: A Possible Outer Membrane Barrier Effect

An in vitro study on 25 Veillonella strains showed a consistent clindamycin susceptibility with resistance to erythromycin and to the hydrosoluble pristinamycins, quinupristin and dalfopristin and its 30:70 combination, the synergistin RP59500. Double erythromycin-clindamycin disk tests did not show any inducible resistance pattern. The addition of 10 or 50 mug/mL of polymyxin B nonapeptide, an outer membrane permeabilizing agent, consistently reduced quinupristin and dalfopristin MICs in most strains. This result suggests that the Veillonella outer membrane may act as a permeability barrier to these antibiotics, as in the case of other Gram-negative bacteria.

Decreased macrophage-mediated cytotoxicity in mammary-tumor-bearing mice is related to alteration of nitric-oxide production and/or release

Peritoneal-exudate macrophages (PEM) from mammary-tumor-bearing mice have impaired cytotoxic activity against syngeneic and allogeneic tumor targets. The ability of PEM from normal and tumor-bearing mice to bind tumor targets was found to be similar in the presence or the absence of surrogate receptors, which enhanced the binding but not the killing of tumor targets by PEM from tumor-bearing mice, suggesting that other mechanisms are involved in their impaired cytolytic activity. Soluble and membrane-bound TNF-alpha, as well as H2O2, were found in higher amounts in PEM from tumor bearers upon stimulation with LPS, as compared with PEM from normal mice. However, tumor-bearers' macrophages displayed decreased capacity to produce and/or release nitric oxide, which could be reversed by the addition of increasing levels of IFN-gamma. These results indicate that the lack of macrophage cytotoxicity in mammary-tumor-bearing mice is related to impaired production and/or release of NO by these effector cells, possibly aggravated by the insufficient IFN-gamma production previously reported in these animals. Moreover, mammary-tumor progression results in dis-regulation of synthesis of macrophage-mediators, with over-production of molecules to which mammary-tumor cells are insensitive and deficient production of NO, the crucial molecule to which these cells appear to be highly sensitive.