Rurality, gender, and mental health treatment

Mental health problems are common and costly, yet many individuals with these problems either do not receive care or receive care that is inadequate. Gender and place of residence contribute to disparities in the use of mental health services. The objective of this study was to identify the influence of gender and rurality on mental health services utilization by using more sensitive indices of rurality. Pooled data from 4 panels of the Medical Expenditure Panel Survey (1996-2000) yielded a sample of 32,219 respondents aged 18 through 64. Variables were stratified by residence using rural-urban continuum codes. We used logistic and linear regression to model effects of gender and rurality on treatment rates. We found that rural women are less likely to receive mental health treatment either through the general healthcare system or through specialty mental health systems when compared to women in metropolitan statistical areas (MSA) or urbanized non-MSA areas. Rural men receive less mental health treatment than do rural women and less specialty mental health treatment than do men in MSAs or least rural non-MSA areas. Reported mental health deteriorates as the level of rurality increases. There is a considerable unmet need for mental health services in most rural areas. The general health sector does not seem to contribute remarkably to mental health services for women in these areas.     

Adrenoleukodystrophy: genetics, phenotypes, pathogenesis, and treatment

Adrenoleukodystrophy is a genetically determined disorder inherited as an X-linked recessive trait due to the defective peroxisomal oxydation of very long chain fatty acids (VLCFA). It is hallmarked by demyelination of the central nervous system and adrenal insufficiency. Even though the studies concerning the molecular basis of the disease are in progress, the role of VLCFA in the demyelination is still unclear. In this paper we report the most recent knowledges about genetics, pathogenesis and treatment of this disorder. 117 cases have been recognized in Italy in the period 1985-1997, but many cases could be missing due to the heterogeneus clinical manifestations that vary from mild to very severe forms. To control the devastating course of this disease two therapeutic approaches are under evaluation: bone marrow transplantation and dietary treatment based on a mixture of glyceroyl trioleate and glyceroyl trierucate. Nevertheless this dietary treatment provides normalization of plasma VLCFA, no significant modification of the natural course of the disease has been demonstrated. For what concerns bone marrow transplantation, in recent years a more accurate selection of patients and donors has been giving favourable results, but some strict criteria should be respected.     

Malaria: control strategies, chemoprophylaxis, diagnosis, and treatment

Malaria caused by Plasmodium falciparum continues to be the principal medical threat to travelers in tropical zones. Eighty percent of malaria cases occur in sub-Saharan Africa. Prevention capacity nears 100%. In the event of infection, early diagnosis and bitherapy (treatment that includes two different active molecules) provide a nonfatal outcome. The greatest risk occurs in the weeks after returning home. The history of malaria has shown that it is important to anticipate the evolving nature of the disease and to be able to respond to it in a timely fashion. The efficiency of preventive treatments should lead toward the goal of zero malaria cases when dealing with travelers; however, virtually all empiric experience indicates that this goal rarely is reached.     

Adolescent depression: diagnosis, treatment, and educational attainment

In this paper, I use nationally representative longitudinal data to examine adolescent depression and educational attainment. First, I examine the individual, family, and community-level determinants of adolescent depression, diagnosis, and treatment. I find that male and minority adolescents who score high on depression scales are less likely to be diagnosed as depressed or receive treatment than female and non-Hispanic white adolescents. Additionally, I find several community-level variables to be important determinants of depression, diagnosis, and treatment. Second, I examine the importance of adolescent depression for educational attainment. Although it is uncontroversial to expect a negative relationship, most previous research uses cross-sectional data, making it difficult to adequately determine the magnitude of the effect. I find that depressive symptoms are related to educational attainment along multiple margins: dropping out of high school, college enrollment, and college type. These relationships are only found for adolescent females, and there are several interesting results across income groups. Overall, these findings suggest that further attempts to diagnose and treat adolescents with depressive symptoms are needed and that additional treatment options may be required to combat the important relationship between adolescent depression and human capital accumulation for females.     

Hypersomnia: diagnosis, classification and treatment

Hypersomnia or excessive daytime sleepiness is common in neurological practice and may have different etiologies. Hypersomnia may be defined as sleepiness at an inappropriate time or in an inappropriate situation. It is important to consider that hypersomnia is at times referred to as tiredness or fatigue. A detailed clinical history is essential to reach an accurate diagnosis. A correct diagnosis is necessary to initiate the appropriate treatment considering the negative social and occupational consequences of hypersomnia. Excessive daytime sleepiness syndromes include primary sleep disorders like narcolepsy and hypersomnia secondary to several neurological and psychiatric disorders and also as an adverse effect of numerous drugs.