Associations between Perinatal Sleepiness and Breastfeeding Intentions and Attitudes and Infant Feeding Behaviors and Beliefs

Breastfeeding rates fall short of public health goals, but barriers are poorly understood. We examined whether excessive sleepiness during pregnancy and the postpartum period was associated with breastfeeding intentions, attitudes, initiation, and continuation in a tobacco-exposed sample participating in a randomized controlled trial to reduce smoke exposure (n = 399). We used the Epworth Sleepiness Scale (ESS) to examine associations between excessive sleepiness in early (12-16 weeks gestation) and late (32 weeks gestation) pregnancy and at 6 months postpartum, with breastfeeding attitudes using the Mitra index, intentions, initiation, and continuation, as well as other infant feeding practices using the Infant Feeding Questionnaire. Logistic regression models adjusted for age, racial/ethnic identity, parity, marital status, and maternal education showed that excessive sleepiness in late pregnancy was associated with less favorable attitudes toward breastfeeding. In addition, in unadjusted models, excessive sleepiness at 6 months postpartum was associated with less of a tendency to use feeding to calm a fussy infant. Excessive sleepiness was not associated with intent, initiation, or continuation of breastfeeding. Assessing excessive sleepiness in late pregnancy may assist in identifying individuals with negative attitudes to breastfeeding and lead to novel approaches to promoting breastfeeding in populations with lower breastfeeding rates.

The paediatric cancer clinical research landscape in Spain: a 13-year multicentre experience of the new agents group of the Spanish Society of Paediatric Haematology and Oncology (SEHOP)

PURPOSE

Early phase trials are crucial in developing innovative effective agents for childhood malignancies. We report the activity in early phase paediatric oncology trials in Spain from its beginning to the present time and incorporate longitudinal data to evaluate the trends in trial characteristics and recruitment rates.

METHODS

Members of SEHOP were contacted to obtain information about the open trials at their institutions. The study period was split into two equal periods for analysis: 2007-2013 and 2014-2020.

RESULTS

Eighty-one trials and two molecular platforms have been initiated. The number of trials has increased over the time of the study for all tumour types, with a predominance of trials available for solid tumours (66%). The number of trials addressed to tumours harbouring specific molecular alterations has doubled during the second period. The proportion of industry-sponsored compared to academic trials has increased over the same years. A total of 565 children and adolescents were included, with an increasing trend over the study period. For international trials, the median time between the first country study approval and the Spanish competent authority approval was 2 months (IQR 0-6.5). Fourteen out of 81 trials were sponsored by Spanish academic institutions.

CONCLUSIONS

The number of available trials, and the number of participating patients, has increased in Spain from 2007. Studies focused on molecular-specific targets are now being implemented. Barriers to accessing new drugs for all ranges of age and cancer diseases remain. Additionally, opportunities to improve academic research are still required in Spain.

Deterministic Generation of Large Fock States

We present a protocol to deterministically prepare the electromagnetic field in a large photon number state. The field starts in a coherent state and, through resonant interaction with one or few two-level systems, it evolves into a coherently displaced Fock state without any postselection. We show the feasibility of the scheme under realistic parameters. The presented method opens a door to reach Fock states, with n∼100 and optimal fidelities above 70%, blurring the line between macroscopic and quantum states of the field.

Working With Severe Borderline Patients: A Clinical Study of Destructiveness and Its Communicative Potential

Destructive behavior is one of the most challenging aspects when treating severe borderline patients because both the therapist and the psychotherapeutic method are called into question. Drawing on three in-depth psychoanalytic sessions of a severe borderline patient, the authors present and discuss the communicative potential of destructive behavior in the transference relationship during treatment. A step-by-step analysis and the working through process of the therapist's countertransference led the authors to recognize several complex dynamics of the patient's pathological organization and to the containment and first representation of unsymbolized early anxieties generated during the original encounter with the object.

Predictors of relapse in high lethality suicide attempters: a six-month prospective study

BACKGROUND

This study is aimed to investigate the association between clinical, metabolic, inflammatory and environmental (photoperiod defined as daily sunlight exposure) parameters and suicide re-attempts after the index suicide attempt. Possible predictors of suicide re-attempts were also explored.

METHODS

Overall, 432 subjects with suicide attempts, of which 79 relapsed within the following six months were included in this prospective study. We adopted the Joiner's definition of suicide lethality, as "the acquired ability to enact lethal self-injury". The Cox regression was used to test the association between the mentioned variables and Kaplan-Meier plots showed the trend of suicide re-attempts.

RESULTS

Among participants, 30.8% committed a high-lethality suicide attempt. Cox regression confirmed the association between lifetime suicide attempts and number of suicide attempts in the study time-frame and suicide-reattempts. The longer photoperiod (Spring/Summer) was associated with suicide re-attempts, particularly patients with admission in June/July for the index event. Total cholesterol (TC), low-density lipo-protein cholesterol and c-reactive protein serum levels were significantly associated with suicide re-attempts but Cox regression confirmed only the association between lower TC serum levels and suicide re-attempt.

LIMITATIONS

Patients' seasonal environment, psychological factors, presence of acute life-events fostering the suicidal crisis and detailed medical history have been not investigated. Findings were derived from a single psychiatric unit.

CONCLUSIONS

Lifetime suicide attempts, higher number of previous suicide attempts, lower total cholesterol levels, and suicide attempt during longer photoperiod were significant predictors of suicide re-attempts. Further studies are needed in order to better characterize single- vs. multiple suicide attempter's profiles.

The role of seasonality and photoperiod on the lethality of suicide attempts: A case-control study

BACKGROUND

The risk factors related to suicidal behaviors are complex and not yet fully known. Several studies underline how suicide results from the combination of psycho-social, biological, cultural, and environmental factors. The aim of this study was to investigate the potential role of seasonality and photoperiod on high-lethality suicide attempts (HLSA) compared with low-lethality suicide attempts (LLSA) in a sample of psychiatric inpatients.

METHODS

After attempting suicide, subjects were admitted in the emergency/psychiatric ward of the IRCCS Ospedale Policlinico San Martino from 1st August 2013 to 31st July 2018. Socio-demographic and clinical characteristics were collected.

RESULTS

The sample consisted of four hundred thirty-two individuals admitted for suicide attempt. One hundred thirty-three subjects (30.8%) of the sample committed a HLSA. The HLSA group peaked in the months with a higher sunlight exposure (June and July). Bivariate correlation analyses between seasonality/photoperiod in the whole sample and HLSA were positively associated with summer and highest solar intensity period.

LIMITATIONS

Data were limited to a single hospital, patients' seasonal environment, meteorological variables and psychological factors. In addition, the presence of acute life-events fostering the suicidal crisis has not been investigated.

CONCLUSIONS

The current study provides a novel perspective on the questions surrounding the impact of seasonality and daylight exposure on lethality of suicide attempts. further studies are needed to provide deeper understandings on the delicate molecular network that links suicide behaviors, seasonality and daylight in order to develop more effective prevention and treatment strategies in the future.

The personal experience of severe suicidal behaviour leads to negative attitudes towards self- and other's suicidal thoughts and behaviours: A study of temperaments, coping strategies, and attitudes towards suicide among medical students

The attitudes individuals have towards suicidal behaviour, be it their own or others', and their capacity for developing specific coping strategies are influenced by affective temperaments that play a significant role in emotional regulation. However, few studies have investigated these specific patterns with a view to stratify them according to the severity of suicidal behaviours in medical students. The Pearson χ2 test for the comparison of categorical variables, the t-test for independent samples of continuous variables and logistic regression analysis were used to compare the association among temperaments, coping strategies, and attitudes towards suicide in a sample of medical students who attend the School of Medicine, Genoa. Severe suicidal thoughts and behaviours relative to those who were not at risk for suicide were also revealed. The severe suicidal thought and behaviour group had significantly more anxious and cyclothymic temperaments together with a higher use of dis-adaptive, lower emotional focus coping strategies, and higher self-reproaching, criticizing, and judgemental attitudes towards suicidality compared to the no severe suicidal thought and behaviour group. The identified pattern suggests the need for clinicians to carefully consider the complex interplay of clinical features which characterize severely at risk for suicide young adults in order to develop effective and comprehensive prevention strategies.

The Association Between Dyslipidemia and Lethality of Suicide Attempts: A Case-Control Study

Evidence supports the existence of an association between dyslipidemia, psychiatric disorders, and suicide risk due to the effects of altered lipid profiles on serotoninergic neuron membranes. The aim of this study was to investigate the differences in c-reactive protein (CRP), thyroid functioning, total cholesterol, high lipoprotein density cholesterol (HDL-c), low-lipoprotein density cholesterol (LDL-c), and triglycerides (TG) serum levels in low lethality (LLSA) vs. high lethality suicide attempters (HLSA) within 24 h from the suicide attempt and inpatients who never attempted suicide (NAS). After attempting suicide, subjects were admitted to the emergency ward of the IRCCS Ospedale Policlinico San Martino and later to the section of Psychiatry from 1st August 2013 to 31st July 2018. Socio-demographic and clinical characteristics, serum lipids profile, CRP, and thyroid functioning were collected. The sample consisted of 133 individuals with a HLSA, 299 subjects with LLSA, and 200 patients NAS. HLSA subjects were more likely to be males and diagnosed as having a bipolar disorder. Furthermore, HLSA subgroup showed significantly lower total cholesterol and LDL-c levels and higher CRP serum levels compared to LLSA and control group, respectively. LLSA subgroup showed higher HDL-c levels compared to HLSA subgroup (no differences between HLSA and control group were observed). Additionally, the control group reported higher triglycerides levels compared to patients admitted to psychiatric ward for a suicide attempt. Only male gender, having a diagnosis of bipolar disorder, lower total cholesterol, and higher CRP serum levels predicted HLSA. Investigating the relation between dyslipidemia and the severity of suicide attempts may contribute to reveal the complex determinants underlying at-risk behaviors such as suicide, thus playing a relevant role in the possible prevention of this disabling phenomenon.

Pliable Media as Transitional Space: From Psychotic Indifferentiation Toward The Construction of Meaning in Schizophrenia

Clinical material from the treatment of a highly destructive schizophrenic patient is used to demonstrate the role and function of therapeutic mediations in promoting transformation and symbolization. Use of the Squiggle Game as a therapeutic mediation is shown to sustain the therapeutic process and to facilitate working through of the obscure and complex dynamics commonly seen in the treatment of psychotic patients. The Squiggle Game presents a first transitional space entailing both the concreteness of psychosis and the potential for symbolization provided by psychoanalysis. The game becomes the first meeting ground for the progressive encounters of the therapeutic couple, primarily because in it the violent destructiveness of psychosis is partly deflected in a way that fosters development of the transference relationship. Step-by-step emotional transformations gained through the Squiggle Game are reported and discussed, together with the patient's need to rely on nonverbal communicative modes to bring early traumatic experiences that never reached verbalization into treatment. This working through process furthered development of the dyad's intense transference-countertransference dynamics, which stimulated construction of a link between here-and-now and there-and-then in sessions, leading to the patient's integration and a sense of the life-historical significance of her experience.

ON BECOMING ABLE TO PLAY: INDIVIDUAL CHILD PSYCHOANALYTIC PSYCHODRAMA AND THE DEVELOPMENT OF SYMBOLIZATION

In this paper, the authors analyze the relevance and transformative potential of individual psychoanalytic psychodrama in the treatment of children with severe impairments in symbolization. Central features of this modality, including promoting the representation of early traumatic experiences, are presented and discussed. Specific features include double-envelope containment of the co-therapists' group and play leader, consequent diffraction of the transference-determining portrayal, gradual integration, and initial figuration of coexisting split-off fragments. Drawing on in-depth clinical material, the authors show how psychodrama tempers the potentially traumatic effects of the encounter with the object, allowing these patients to access the transitional area of play.

The use of “Pliable Media” in Promoting Symbolization in the Psychoanalytical Psychotherapy of Psychosis

Introduction

In psychosis, the capacity of symbolization is lost to different extents and patients live in a concrete world of objects. Moreover, the lack of boundaries between self/other, inside/outside severely impairs the capacity of these patients to understand and recognize reality from the delusional dimension.

Objectives

Working through psychotic concreteness and accessing a first subjectivation of this experience, that leads to the development of a first symbolization.

Aims

Achieving the possibility to access a first symbolization and begin a delicate process of appropriation of the emotional experience with the establishment of the boundaries between inside/outside.

Methods

The use of “pliable media”, such as drawing, as therapeutic mediation allows a partial defraction of the violent transferential dynamics from the therapist and let unsymbolized material to emerge less destructively in the treatment fostering a first figurability.

Results

The Squiggle game as “pliable medium” facilitates a first encounter in the therapeutic relationship and represents a primal transitional area that allows a gradual working through process to take place where the establishment of the boundaries between inside/outside could begin.

Conclusions

We suggest that the use of “pliable media” in the early stages of the psychotherapy of psychotics can significantly favor a first encounter between patient and therapist and, at the same time, provides the first experience of a transitional space where a working through process leading to first representations can take place.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

A Google-based approach for monitoring suicide risk

People seeking information and news regarding suicide are likely to use the Internet. However, evidence of the relationship between suicide-related search volumes and national suicide-rates in different countries can be strikingly different. We aimed to investigate the relationship between suicide-rates and Google suicide-related search volumes in the Italian population (2008-2012) using the Italian mortality database that provided monthly national data concerning suicides (2008-2012). Moreover, this study aimed to identify future trends of national suicide rates on the basis of the results we obtained concerning the period 2013-14. Google Trends provided data of online monthly search-volumes of the term "suicide", "commit suicide" and "how to commit suicide" in Google Search and Google News (2008-2014). Google Search volumes for the term "suicide" lags suicide by three months (ρ=0.482, p-value<0.001), whereas no correlation was found between search volumes for "commit suicide" and "how to commit suicide" and national suicide rates. Google News search volumes for the three terms resulted in white noise. Apparently, online searches for suicide-related terms in Italy are more likely to be linked to factors other than suicidiality such as personal interest and suicide bereavement.

Variations in attack behaviours between Glossina palpalis gambiensis and G. tachinoides in a gallery forest suggest host specificity

Tsetse flies Glossina palpalis gambiensis and G. tachinoides are among the major vectors of sleeping sickness (Human African Trypanosomiasis-HAT) and nagana (African Animal Trypanosomiasis - AAT) in West Africa. Both riparian species occur sympatrically in gallery forests of south west Burkina Faso, but little is known of their interspecies relationships although different authors think there may be some competition between them. The aim of this study was to check if sympatric species have different strategies when approaching a host. A man placed in a sticky cube (1 m × 1 m × 1 m) and a sticky black-blue-black target (1 m × 1 m) were used to capture tsetse along the Comoe river banks in a Latin Square design. The number and the height at which tsetse were caught by each capture method were recorded according to species and sex. Glossina p. gambiensis was more attracted to human bait than to the target, but both species were captured at a significantly higher height on the target compared with the human bait (P < 0.05). No significant difference in heights was found between G. tachinoides and G. p. gambiensis captured on targets (33 and 35 cm, respectively, P > 0.05). However, catches on human bait showed a significant difference in height between G. tachinoides and G. p. gambiensis (22.5 and 30.6 cm, respectively, P < 0.001). This study showed that these sympatric species had different attack behaviours to humans, which is not the case with the target. The implications of these findings are discussed.

[Ecology of Glossina palpalis VANDERPLANK, 1949 (Diptera: Glossinidae) in mangrove area of Guinea: influence of tides on tsetse densities]

The mangrove area on the Guinea littoral constitutes a favourable habitat for transmission of Trypanosoma brucei gambiens, the parasite causing sleeping sickness also called Human African Trypanosmosis (HAT), due the simultaneous presence of the vector (tsetse flies) and the human hosts. In order to assess the influence of the sea tides on the densities of Glossina palpalis gambiensis (Gpg), major vector of HAT in the mangrove, entomological surveys were performed using two transects, according to tides coefficient (great and small) and tide daily fluctuations (high and low). On each transect, 12 biconical traps were deployed through the mangrove to the continent. In total, up to 612 Gpg were caught, giving a density of 2.13 flies/trap/day (f/t/d). Highest captures were recorded during small tides and more tsetse were caught during the dry season than in the wet season. There were significant differences between captures when considering the different biotopes, and highest tsetse densities were recorded at the junction of the river and the channel of the mangrove (6.17±5.24); and in the channels of mangrove (3.50±3.76), during high tides of small coefficients. The results of this study may be used to improve vector control methods.

On Interpretative Experiences: Unconcious-to-Unconcious Communication Through Reverie, Language, and the Setting

Interpretation has been looked upon for decades as the analyst's central tool to promote transformation, and it was intended as a synonym for making the unconscious conscious. Nowadays, work with patients with unrepresented mental areas has become more common and the classical conceptualizations require broadening. Reflecting and retrieving the original acceptations of Freud's word Deutung, we suggest the existence of "unconscious-to-unconscious" communications that we shall call "interpretative experiences," which can promote transformation through nonverbal communicative modes, thus getting in touch with more primitive mental functioning. Drawing on case material, we discuss the transformative function of reverie, language, and the setting within the framework of the post-Kleinian and French psychoanalytic model.

Extreme sensory processing patterns and their relation with clinical conditions among individuals with major affective disorders

Previous studies highlighted the involvement of sensory perception in emotional processes. However, the role of extreme sensory processing patterns expressed in hyper- or hyposensitivity was not thoroughly considered. The present study, in real life conditions, examined the unique sensory processing patterns of individuals with major affective disorders and their relationship with psychiatric symptomatology. The sample consisted of 105 participants with major affective conditions ranging in age from 20 to 84 years (mean=56.7±14.6). All participants completed the Temperament Evaluation of Memphis, Pisa, Paris and San Diego (TEMPS-A), the second version of the Beck Depression Inventory (BDI-II), and Adolescent/Adult Sensory Profile (AASP). Sensory sensitivity/avoiding hypersensitivity patterns and low registration (a hyposensitivity pattern) were prevalent among our sample as compared to normative data. About seventy percent of the sample showed lower seeking tendency. Stepwise regression analyses revealed that depression and anxious/cyclothymic affective temperaments were predicted by sensory sensory/avoiding. Anxious and irritable affective temperaments were predicted by low registration. Hyperthymic affective temperament and lower severity of depression were predicted by sensation seeking. Hyposensitivity or hypersensitivity may be "trait" markers of individuals with major affective disorders. Interventions should refer to the individual unique sensory profiles and their behavioral and functional impact in the context of real life.

Tsetse diversity and abundance in Southern Burkina Faso in relation with the vegetation

The increase of human population, combined with climatic changes, contributed to the modification of spatial distribution of tsetse flies, main vector of trypanosomiasis. In order to establish and compare tsetse presence and their relationship with vegetation, entomological survey was performed using biconical traps deployed in transects, simultaneously with phyto-sociological study, on the Comoe river at its source in the village of Moussodougou, and in the semi-protected area of Folonzo, both localities in Southern Burkina Faso. In Folonzo, the survey revealed a diversity of tsetse with 4 species occurring with apparent densities as follows: Glossina tachinoides (8.9 tsetse/trap/day); G. morsitans submorsitans (1.8 tsetse/trap/day); G. palpalis gambiensis (0.6/trap/day) and G. medicorum (0.15 tsetse/trap/day). In Moussodougou, a highly anthropized area, mainly G. p. gambiensis was caught (2.06 tsetse/trap/day), and rarely G. tachinoides. The phyto-sociological study allowed discrimination of 6 types of vegetation in both localities, with 3 concordances that are riparian forest, shrubby and woody savannah. In Moussodougou, all tsetse were caught in the riparian forest. That was also the case in Folonzo where a great proportion (95 to 99 % following the season) of G. p. gambiensis and G. tachinoides were caught in the gallery, while G. m. submorsitans was occurring as well in the gallery as in the savannah, and G. medicorum in the forest gallery. This study showed that although G. tachinoides and G.p. gambiensis are both riparian, they do not have the same preference in terms of biotope.

On "free associative activities"

Free association has been at the heart of the analytic process for decades, though nowadays the work with borderline and psychotic mental functioning has become more common. We discuss and compare contributions from the Kleinian and the French psychoanalytic models regarding the role of free association and the analyst when working with these disorders. Drawing on case material, we suggest a broader conceptualization of free association--free associative activities--which encompasses communications that cannot be expressed through verbal modes because of their primitiveness. Their working through in the analytic couple could allow a first representation of unsymbolized early psychic traumas.

Outline-based morphometrics, an overlooked method in arthropod studies?

Modern methods allow a geometric representation of forms, separating size and shape. In entomology, as well as in many other fields involving arthropod studies, shape variation has proved useful for species identification and population characterization. In medical entomology, it has been applied to very specific questions such as population structure, reinfestation of insecticide-treated areas and cryptic species recognition. For shape comparisons, great importance is given to the quality of landmarks in terms of comparability. Two conceptually and statistically separate approaches are: (i) landmark-based morphometrics, based on the relative position of a few anatomical "true" or "traditional" landmarks, and (ii) outline-based morphometrics, which captures the contour of forms through a sequence of close "pseudo-landmarks". Most of the studies on insects of medical, veterinary or economic importance make use of the landmark approach. The present survey makes a case for the outline method, here based on elliptic Fourier analysis. The collection of pseudo-landmarks may require the manual digitization of many points and, for this reason, might appear less attractive. It, however, has the ability to compare homologous organs or structures having no landmarks at all. This strength offers the possibility to study a wider range of anatomical structures and thus, a larger range of arthropods. We present a few examples highlighting its interest for separating close or cryptic species, or characterizing conspecific geographic populations, in a series of different vector organisms. In this simple application, i.e. the recognition of close or cryptic forms, the outline approach provided similar scores as those obtained by the landmark-based approach.

Eating disorders as autisticlike defenses: unmentalizable experiences in primitive mental states

Autisticlike symptoms have been acknowledged in several fields; thus it cannot be claimed that they encompass a delineated pathological organization. The authors argue that in primitive mental functioning, eating symptoms-both bulimic and anorexic-can be used as autisticlike defenses in which the altered body becomes an objectified protective shell providing shelter from intolerable anxieties that derive from unmentalized and unmentalizable experiences. The role of the psychoanalytic third, rising from the analyst's reverie, as a possible meeting ground between the concrete and the symbolic is discussed. Drawing on case material from the analysis of two patients with eating symptoms used as autisticlike defenses clarifies some of the theoretical aspects of eating disorders.

[Human African trypanosomiasis in Côte d'Ivoire and Burkina Faso: optimization of epidemiologic surveillance strategies]

L’objectif de cet article est de décrire les récentes données de surveillance médicale de la Trypanosomose Humaine Africaine (THA) au Burkina Faso et en Côte d’Ivoire afin (i) de dresser un bilan de la situation actuelle de la maladie dans ces deux pays qui entretiennent depuis plus d’un siècle des liens migratoires, économiques et épidémiologiques intimes et (ii) de définir les stratégies à mettre en place dans l’objectif d’une élimination durable. Les résultats de la surveillance active et passive ont montré que les trypanosomés dépistés au Burkina-Faso ces dernières années sont tous des cas importés provenant de Côte d’Ivoire. Cependant, la réintroduction du parasite est effective et le risque d’une reprise de la transmission existe. En Côte d’Ivoire, plusieurs foyers “historiques” toujours endémiques font craindre des phénomènes de réémergence et de propagation. Dans l’objectif d’une élimination durable de la THA dans ces deux pays, les acteurs de la lutte doivent adapter leur système de surveillance en fonction des différents contextes épidémiologiques. Les prévalences actuelles ne justifient plus, excepté des cas particuliers, l’usage systématique et très onéreux du dépistage actif par prospections médicales exhaustives. Elles tendent plutôt à privilégier des systèmes intégrés aux systèmes de santé nationaux et utiliser des méthodes permettant de cibler les zones prioritaires d’intervention à partir notamment d’un échange d’informations épidémiologiques entre les deux pays. Pour accompagner le processus d’élimination durable, les acteurs de la recherche doivent étudier le rôle respectif des réservoirs humain et animal dans le maintien de la transmission, participer au suivi sur le long terme des cas traités et des suspects sérologiques, et évaluer en termes de coût/efficacité les stratégies mises en place par les Programmes Nationaux afin de les optimiser.

[History of an epidemiological route between Ivory Coast and Burkina Faso: the case of the Koudougou sleeping sickness foci]

Dans la première moitié du XXème siècle, alors que la Haute-Volta (actuel Burkina Faso) subissait une terrible épidémie de maladie du sommeil, l’administration coloniale française a orchestré des déplacements massifs de populations de la Haute-Volta vers la Côte d’Ivoire, pour exploiter le territoire. Cela a conduit à la mise en place de villages de colonisation Mossi en zone forestière ivoirienne, comme ceux de Koudougou, issus de l’une des régions les plus peuplées de Haute-Volta, mais aussi l’une des plus touchées par la maladie du sommeil. Depuis 2000, au Burkina Faso, c’est dans le district sanitaire de Koudougou que sont dépistés passivement le plus grand nombre de trypanosomés en provenance de Côte d’Ivoire. Qui sont-ils ? Où habitent-ils au Burkina Faso ? D’où viennent-ils de Côte d’Ivoire ? Après avoir retracé l’histoire épidémiologique des villages de Koudougou au Burkina Faso et en Côte d’Ivoire, nous avons recherché les trypanosomés dépistés passivement depuis 2000 dans le district sanitaire de Koudougou au Burkina Faso. Au total, dix trypanosomés ont été enquêtés. Le processus de propagation de la maladie du sommeil dans l’espace ivoiro-burkinabé a été mis en évidence et des zones à risque de la maladie identifiées dans ce même espace.

Genetic comparison of Glossina tachinoides populations in three river basins of the Upper West Region of Ghana and implications for tsetse control

Tsetse flies are the cyclical vectors of African animal trypanosomosis (AAT) and human African trypanosomosis (HAT). In March 2010, the Government of Ghana initiated a large scale integrated tsetse eradication campaign in the Upper West Region (UWR) (≈18,000 km(2)) under the umbrella of the Pan-African Tsetse and Trypanosomosis Eradication Campaign (PATTEC). We investigated the structuring of Glossina tachinoides populations within and between the three main river basins of the target area in the UWR. Out of a total sample of 884 flies, a sub-sample of 266 was genotyped at nine microsatellite loci. The significance of the different hierarchical levels was tested using Yang's parameters estimated with Weir and Cockerham's method. A significant effect of traps within groups (pooling traps no more than 3 km distant from each other), of groups within river basins and of river basins within the whole target area was observed. Isolation by distance between traps was highly significant. A local density of 0.48-0.61 flies/m(2) was estimated and a dispersal distance that approximated 11 m per generation [CI 9, 17]. No significant sex-biased dispersal was detected. Dispersal distances of G. tachinoides in the UWR were relatively low, possibly as a result of the fragmentation of the habitat and the seasonality of the Kulpawn and Sissili rivers. Moreover, very high fly population densities were observed in the sample sites, which potentially reduces dispersal at constant habitat saturation, because the probability that migrants can established is reduced (density dependent dispersal). However, the observed spatial dispersal was deemed sufficient for a G. tachinoides-cleared area to be reinvaded from neighboring populations in adjacent river basins. These data corroborate results from other population genetics studies in West Africa, which indicate that G. tachinoides populations from different river basins cannot be considered isolated.

Characterization ofTrypanosoma bruceis.l. infecting asymptomatic sleeping-sickness patients in Côte d'Ivoire: a new genetic group?

Six villagers in the Sinfra focus of sleeping sickness in Côte d'Ivoire who in 1995 were asymptomatic and refusing treatment, despite then being serologically and parasitologically positive for trypanosomes, were followed-up, while still refusing treatment, until 2002. In 2002, five of the six cases remained serologically positive but no trypanosomes could be found in any of them by use of the classical parasitological methods. A PCR-based assay, however, revealed that all six had the DNA of Trypanosoma brucei s.l. in their blood, so confirming the low sensitivity of the classical parasitological tests. The analysis of satellite, minisatellite and microsatellite markers indicated that, in 2002, all six cases were infected with a 'new' distinct genetic group of T. brucei s.l. and four were co-infected with T. b. gambiense group 1. The epidemiological consequences of such co-infections are discussed. The 'new' group of T. brucei had a molecular pattern that differed from those of the classical T. b. gambiense group 1 and the 'bouaflé' group.

Simultaneous rotation, orientation and displacement control of birefringent microparticles in holographic optical tweezers

We report the experimental implementation of a new method for generating multiple dynamical optical tweezers, where each one of them is generated with an independent linear polarization state with arbitrary orientation. This also allows an independent simultaneous polarization-rotation control. The laser beam, both for generating multiple traps and polarization control, has been modulated using a single reflective nematic liquid crystal with parallel alignment. We present experimental results of controlled displacement, orientation and rotation of birefringent particles. In addition, a simple method for estimating and canceling out the primary astigmatism present in the system is presented.

Three-dimensional clustered speckle fields: theory, simulations and experimental verification

Clustered speckle patterns are a particular type of speckles that appear when a coherently illuminated diffuser is imaged through a multiple aperture pupil mask attached to a lens. The cluster formation is the result of the complex speckle modulations of the multiple interferences produced by the apertures. In this paper, a three-dimensional analytical approach to simulate cluster speckles everywhere after the lens is presented. This approach has the possibility of including multiple aperture masks at the lens and at the diffuser, in contrast to previous works which were also limited to the description of the patterns only at the image plane. This model contributes to the development of tailor made speckle patterns that can be used in diverse optical applications, including those lying in the focus region. The approach is validated under different conditions by comparing experimental results with simulations on a statistical basis. Some aspects of possible uses of these clusters are briefly revised, such as optical trapping, manipulation and metrology.

Employment status, inflation and suicidal behaviour: an analysis of a stratified sample in Italy

BACKGROUND

There is abundant empirical evidence of a surplus risk of suicide among the unemployed, although few studies have investigated the influence of economic downturns on suicidal behaviours in an employment status-stratified sample.

AIMS

We investigated how economic inflation affected suicidal behaviours according to employment status in Italy from 2001 to 2008.

METHODS

Data concerning economically active people were provided by the Italian Institute for Statistical Analysis and by the International Monetary Fund. The association between inflation and completed versus attempted suicide with respect to employment status was investigated in every year and quarter-year of the study time frame. We considered three occupational categories: employed, unemployed who were previously employed and unemployed who had never worked.

RESULTS

The unemployed are at higher suicide risk than the employed. Among the PE, a significant association between inflation and suicide attempt was found, whereas no association was reported concerning completed suicides. No association was found between completed and attempted suicides among the employed, the NE and inflation. Completed suicide in females is significantly associated with unemployment in every quarter-year.

CONCLUSION

The reported vulnerability to suicidal behaviours among the PE as inflation rises underlines the need of effective support strategies for both genders in times of economic downturns.

[Behavioral interactions and rhythms of activity of Glossina palpalis gambiensis and G. tachinoides (Diptera: Glossinidae) in a forest gallery in Burkina Faso]

Glossina palpalis gambiensis et G. tachinoides sont des vecteurs majeurs des trypanosomoses humaines et animales en Afrique de l’Ouest. Sur une partie de leur aire de répartition, elles sont présentes en sympatrie, mais très peu d’informations sont disponibles sur leurs interactions. Nous avons capturé ces deux espèces en utilisant un système attractif composé d’écrans de tissu noir/bleu/ noir muni de film adhésif, afin de retenir toutes les glossines posées et de pouvoir mesurer la hauteur à laquelle elles se sont posées, ainsi que leur rythme d’activité en fonction de l’heure de la journée. L’étude a eu lieu dans deux zones du sud du Burkina Faso : Kartasso en amont du fleuve Mouhoun, où seule G. p. gambiensis est présente, et Folonzo sur le fleuve Comoé, où les deux espèces cohabitent. Les résultats, sur 3 800 glossines capturées, montrent une forte prédominance des captures de G. tachinoides par rapport à G. p. gambiensis à Folonzo (84 % contre 16 % des captures respectivement). À Kartasso, où elle est seule, G. p. gambiensis est capturée en moyenne à 46 cm du sol. À Folonzo, G. p. gambiensis est en moyenne attrapée à une hauteur de 65 cm, et G. tachinoides à 55 cm, ces différences de hauteurs étant significatives. Les femelles sont capturées en général plus haut que les mâles. Les deux espèces montrent un rythme d’activité similaire en fonction de l’heure de capture, mais seule G. p. gambiensis réduit sa hauteur de vol aux heures les plus chaudes. Plusieurs hypothèses, non exclusives, sont évoquées pour expliquer ces hauteurs de capture différentes : la nature de la galerie forestière, un comportement d’approche qui différerait entre espèces, mais aussi la possibilité de phénomènes de compétition interspécifique en relation avec l’utilisation de ressources énergétiques limitées (métabolisme lié à la proline). Sont également discutées les conséquences possibles de ces différences de comportement sur les méthodes de lutte, par exemple lors de l’utilisation d’attractifs olfactifs qui pourraient avoir des efficacités distinctes en fonction de la hauteur de vol.

Experimental evaluation of xenodiagnosis to detect trypanosomes at low parasitaemia levels in infected hosts

In Human African Trypanosomosis (HAT) endemic areas, there are a number of subjects that are positive to serological tests but in whom trypanosomes are difficult to detect with the available parasitological tests. In most cases and particularly in West Africa, these subjects remain untreated, thus posing a fundamental problem both at the individual level (because of a possible lethal evolution of the disease) and at the epidemiological level (since they are potential reservoirs of trypanosomes). Xenodiagnosis may constitute an alternative for this type of cases. The objective of this study was to update the use of xenodiagnosis to detect trypanosomes in infected host characterized by low parasitaemia levels. This was carried out experimentally by infecting cattle and pigs with Trypanosoma congolense and T. brucei gambiense respectively, and by feeding tsetse flies (Glossina morsitans submorsitans and G. palpalis gambiensis, from the CIRDES colonies) on these animals at a time when the observed blood parasitaemia were low or undetectable by the classical microscopic parasitological tests used for the monitoring of infected animals. Our results showed that: i) the G. p. gambiensis colony at CIRDES could not be infected with the T. b. gambiense stocks used; ii) midgut infections of G. m. submorsitans were observed with both T. congolense and T. b. gambiense; iii) xenodiagnosis remains positive even at very low blood parasitaemia for both T. congolense and T. b. gambiense; and iv) to implement T. b. gambiense xenodiagnosis, batches of 20 G. m. submorsitans should be dissected two days after the infective meal. These results constitute a first step toward a possible implementation of xenodiagnosis to better characterize the parasitological status of seropositive individuals and the modalities of parasite transmission in HAT foci.

Trapping tsetse flies on water

Riverine tsetse flies such as Glossina palpalis gambiensis and G. tachinoides are the vectors of human and animal trypanosomoses in West Africa. Despite intimate links between tsetse and water, to our knowledge there has never been any attempt to design trapping devices that would catch tsetse on water. In mangrove (Guinea) one challenging issue is the tide, because height above the ground for a trap is a key factor affecting tsetse catches. The trap was mounted on the remains of an old wooden dugout, and attached with rope to nearby branches, thereby allowing it to rise and fall with the tide. Catches showed a very high density of 93.9 flies/"water-trap"/day, which was significantly higher (p < 0.05) than all the catches from other habitats where the classical trap had been used. In savannah, on the Comoe river of South Burkina Faso, the biconical trap was mounted on a small wooden raft anchored to a stone, and catches were compared with the classical biconical trap put on the shores. G. p. gambiensis and G. tachinoides densities were not significantly different from those from the classical biconical one. The adaptations described here have allowed to efficiently catch tsetse on the water, which to our knowledge is reported here for the first time. This represents a great progress and opens new opportunities to undertake studies on the vectors of trypanosomoses in mangrove areas of Guinea, which are currently the areas showing the highest prevalences of sleeping sickness in West Africa. It also has huge potential for tsetse control using insecticide impregnated traps in savannah areas where traps become less efficient in rainy season. The Guinean National control programme has already expressed its willingness to use such modified traps in its control campaigns in Guinea, as has the national PATTEC programme in Burkina Faso during rainy season.

Is the time for suicide a random choice among young adults? An Italian study

Introduction

Every year between 100’000 and 200’000 young people die by suicide and possibly 40 times as many attempt it [1]. Several studies analyze the seasonality of suicide in the general population, but few of them investigate it among young adults.

Objectives

We look for a seasonal pattern in suicidal behaviors performed by young adults and evaluate the lethality of their behaviors.

Aims

We test the hypothesis that(a)

Methods

Analyses are based on data for 3614 cases of suicidal behaviours performed by individuals aged between 18 to 24 occurring between 2001 and 2008, provided by the Italian Institute for Statistical Analysis (ISTAT). Variables included in the analysis were gender, lethality of the act and season.

Results

ANOVA shows a significant association between months and number of suicides with a significant difference between the first and the second semester. Peaks were found in January, March and May. Males have a significantly greater regularity of the peaks than females (Mann-Whitney U- Test p < 0,001). Females have a rapport between completed and attempted suicides of 0.14, while among males it is of 0.72.

Conclusions

Clinical implications of these findings should be considered with the aim of developing more effective preventative strategies targeted to this age group.

[Ivory Coast uprising and returning Burkinabe immigrants: evaluation of the risk for reemergence of sleeping sickness in Burkina Faso]

Following the sociopolitical unrest that occurred in Ivory Coast in 2002, 360,000 Burkinabe immigrants returned to Burkina Faso that was the epicenter of sleeping sickness last century and is now thought to be free of autochthonous transmission. The purpose of this study was to determine if the massive return of immigrants from human African trypanosomiasis (HAT) endemic areas of Ivory Coast to areas in Burkina Faso where the vector (tsetse fly) is currently present could lead to re-emergence of the disease. Risk areas for re-emergence were identified taking into account the number of returning immigrants, history of the disease, and presence of tsetse flies. Based on these criteria, study was focused on two villages, i.e., Folonzo and Gbalara, located in southern Burkina Faso near the Ivory Coast border. Study in these two villages consisted of characterization of the population (repatriates or not, origin, ...) and medical surveys to assess the presence/absence of the disease. Departure of some returning immigrants from areas including sleeping sickness foci in Ivory Coast (e.g. center west) confirmed the potential risk of re-emergence of the disease. Although no case of sleeping sickness was diagnosed, several serologically positive people were identified and will be followed up. This study failed to demonstrate a clear-cut correlation between massive population movements due to war and reemergence of sleeping sickness. However, this study may have been timed too soon after the return of immigrants to detect reemergence of HAT that could require several years.

A geographical approach to identify sleeping sickness risk factors in a mangrove ecosystem

OBJECTIVES

To provide a better understanding of sleeping sickness transmission and spread in mangrove areas to optimize its control.

METHODS

In the Forecariah mangrove area, Guinea, 19 sleeping sickness cases and 19 matched controls were followed up in their living areas (at home, in fields and at water points). All occupational sites and pathways were mapped and then placed in their environmental context.

RESULTS

The sleeping sickness cases displayed a significantly broader and more diverse spatial occupation than the controls. They covered double the daily walking distances of controls and had on average two more occupational sites, most of which were located in mangrove forests. Activities with a higher transmission risk (rice culture, attendance of pirogue jetties) were identified as well as high-risk areas and pathways.

CONCLUSIONS

An entomological control strategy targeting transmission risk areas is proposed. Its implementation in a control programme would reduce by 86% the efforts needed for a classical vector control programme throughout the area. Medical surveys set up at specific locations, such as pirogue jetties and high-risk paths, should also enable better targeting of the population at highest risk.

Epidemiological study of canine trypanosomosis in an urban area of Ivory Coast

Following confirmed cases of trypanosomosis in military working dogs, a cross-sectional study was undertaken to evaluate the source of infection and determine the prevalence of canine infection with Trypanosoma congolense in the urban focus of Abidjan, Ivory Coast. Blood from 123 dogs were collected and subjected to PCR using specific primers for Trypanosoma congolense "forest type". In addition, an entomological study was conducted in an urban area near the forest surronding the military camp. The observed prevalence was 30.1% and PCR positivity to Trypanosoma congolense was not significantly associated with sex or age of animals. This study demonstrates the high contamination rate of dogs in enzootic zones, the potential risk of introduction of the disease in free animal populations and the ability of Glossina palpalis to adapt to urban areas and to transmit trypanosomosis in such areas. The factors leading to a possible emergence of canine trypanosomiasis in enzootic zones need further investigations.

[Eco-distribution and Trypanosoma infection of Glossina palpalis palpalis in the Banco forest of and its relics, Abidjan (Côte d'Ivoire)]

In order to implement an anti-vector programme in the suburb of Abidjan (Côte d'Ivoire), investigations were conducted to assess the tsetse fly densities as well as infection with trypanosomes. Catches were carried out during the rainy season and dry season with Vavoua traps laid during four consecutive days in different sites (Banco forest, Abidjan zoological park, area of the University of Abobo-Adjamé). One species of tsetse fly (Glossina polpalis palpalis) and two species of trypanosomes (Trypanosoma congolense, T. vivax) have been revealed. The apparent density per trap per day (DAP) is very high in the zoological park, 54.8 tsetse fly/trap/day during the dry season and 28.1 during the rainy season. At the University of Abobo-Adjamé, the DAP is respectively 13.5 and 8.1 tsetse fly/trap/day during the rainy season, and in the dry season it is only 0.9 and 0.8 in the Banco Forest. The physiological age on all sites is as follows: 57.5 % of old parous, 39% of young parous and 3.6 % of nulliparous in the rainy season. These proportions vary to 51.9% of young porous, 47.1% of old parous and 1% of nulliparous in the dry season. The overall infection rate is estimated at 20.7% in the rainy season and 20% in the dry season. Statistical analysis have showed a significant difference in the distribution of infection rates.

Population sizes and dispersal pattern of tsetse flies: rolling on the river?

The West African trypanosomoses are mostly transmitted by riverine species of tsetse fly. In this study, we estimate the dispersal and population size of tsetse populations located along the Mouhoun river in Burkina Faso where tsetse habitats are experiencing increasing fragmentation caused by human encroachment. Dispersal estimated through direct (mark and recapture) and indirect (genetic isolation by distance) methods appeared consistent with one another. In these fragmented landscapes, tsetse flies displayed localized, small subpopulations with relatively short effective dispersal. We discuss how such information is crucial for designing optimal strategies for eliminating this threat. To estimate ecological parameters of wild animal populations, the genetic measures are both a cost- and time-effective alternative to mark-release-recapture. They can be applied to other vector-borne diseases of medical and/or economic importance.

Obsessive-compulsive disorder and related disorders: a comprehensive survey

Our aim was to present a comprehensive, updated survey on obsessive-compulsive disorder (OCD) and obsessive-compulsive related disorders (OCRDs) and their clinical management via literature review, critical analysis and synthesis. Information on OCD and OCRD current nosography, clinical phenomenology and etiology, may lead to a better comprehension of their management. Clinicians should become familiar with the broad spectrum of OCD disorders, since it is a pivotal issue in current clinical psychiatry.

[Impact of the dynamics of human settlement on tsetse and trypanosomosis distribution in the Mouhoun river basin (Burkina Faso)]

In Burkina Faso, the Mouhoun river basin (formerly "Black Volta") constitutes a historical focus of Human (HAT) and Animal (AAT) African Trypanosomoses, both transmitted by tsetse flies. Nowadays, HAT seems to have disappeared from this area, while AAT still causes severe economic losses. In order to explain these different epidemiological situations, we undertook a geographical study based on the analysis of aerial pictures between 1952 and 2007, and field surveys to collect medical, entomological, and veterinary data on trypanosomoses. Our results suggest that in this area, landscapes have been dramatically modified as a consequence of population growth, and in turn have had an impact on the number and distribution of tsetse flies. Combined with the historical medical action on HAT which probably led to the disappearance of T. b. gambiense, this environmental degradation and the development of hydrological structures provide explanations for the local disappearance of HAT, and for the maintenance of AAT. It appears necessary to extrapolate these studies to other areas in order to identify the factors explaining the presence/absence of trypanosomoses in the context of human population growth and climatic changes, in order to help to target priority areas for the control of these diseases.

[Population growth and global warming: impacts on tsetse and trypanosomoses in West Africa]

Demographic evolution, climatic change and economical development that happened in West Africa during the XXth century had a lot of consequences on human settlement and landscape. These changes have in turn an impact on the pathogenic system of human and animal trypanosomoses. Since last century, the northern tsetse distribution limit has shifted towards the south, probably due to a decrease in rainfall combined to the impact of human pressure. Sleeping sickness (SS) foci have also shifted from the savannah areas (where there is no more SS) to the forest and mangrove areas of West Africa, but animal trypanosomoses are still present in savannah. We show a decrease of tsetse of the morsitans group as a result of an increase of human densities. On the opposite, tsetse species like Glossina palpalis adapt to high human densities and are found in the biggest urban centres of West Africa. There is a need to promote multidisciplinary studies on this demographic-climatic-vector borne disease topic, especially in Africa to be able to define future areas of presence/absence of these diseases in order to help continental plans of control that have recently begun.