An evaluation of the hemiplegic subject based on the Bobath approach. Part II: The evaluation protocol

A protocol of evaluation of the hemiplegic patient based on the Bobath approach to treatment is presented. Six parameters are evaluated: sensorium, muscle tone, reflex activity, active movement, postural reactions and pain. The first and last of these are included because of their possible effects on the motor recovery process of the hemiplegic patient. The other four are directly borrowed from the Bobath modality of treatment. For each of these parameters, the procedures are given for its evaluation along with its respective rating scales. These scales are of an ordinal nature ranging from 0 to 3. It is suggested that this new evaluation protocol is fully compatible with the therapeutic modality developed by Bobath and as well is adequate to quantify patient progress in the principle aspects treated by this well used rehabilitation approach.     

Follistatin and activin A production by the male reproductive tract

Follistatin is a binding protein for the activin and inhibin family of hormones, regulating their biological activity. In the male reproductive tract, the interaction of these factors is likely to be involved in the regulation of the proliferation of several cell types. We have investigated the presence of follistatin and activin A in seminal plasma using specific immunoassays and have localized follistatin and activin/inhibin subunits in the adult human testis, prostate and seminal vesicle to establish their likely sources. High concentrations of immunoreactive follistatin were present in seminal plasma in normal men (mean 97.9 ng/ml; 1.43 ng/ml in peripheral plasma) and were similar in men with oligo/azoospermia and following vasectomy. Follistatin immunoreactivity was localized to both Leydig and Sertoli cells of the testis, and to epithelial cells of the prostate gland and seminal vesicle, which are likely to be the predominant sources of the hormone in seminal plasma. Activin A was also present in seminal plasma in normal men but was undetectable following vasectomy, thus deriving from the testis. Consistent with this finding, the betaA-subunit was immunolocalized in Sertoli and Leydig cells but was not present in seminal vesicle or prostate gland. The functional significance of the high concentrations of follistatin secreted into seminal plasma by the prostate gland and/or seminal vesicle is uncertain, but they may regulate the biological activity of testis-derived activin A and inhibin B.      

Some Guidelines for the Use of Stimulus Modifications in Teaching Response Topography to People with Developmental Disabilities

The use of stimulus modifications in teaching involves altering the materials of a task in order to simplify its execution. Though their use in teaching stimulus discriminations to people with developmental disabilities has been extensively investigated, less attention has been given to their utilization in teaching response topography. This paper offers some general guidelines about their use for this purpose. In relation to their design, it is suggested that the aim should be to reduce the demands made by task components, to eliminate components, and/or to increase the attentional value of the discriminating features of the response topography. In relation to their application, guidelines are suggested about when they should be employed in conjunction with response prompts; when they should be used, either alone or in conjunction with response prompts, in preference to response prompts alone; whether one or a series of modifications is required; and at what point during teaching should probe trials on the unmodified task be introduced.     

Measurement of dissociation

Dissociation, a failure to integrate thoughts, feelings, and actions into consciousness, has been hypothesized to be the mechanism by which classical "hysterical" phenomena (e.g., trance states, conversion symptoms, multiple personality) are produced. With the exception of a recent article by Bernstein and Putnam (J Nerv Ment Dis 174:727-735, 1986), no standardized techniques are available to study or quantify this construct. A scale, the Questionnaire of Experiences of Dissociation, has been developed and extensively tested in the general population. The QED demonstrates good reliability and validity and is offered as an alternate assessment technique for the study of dissociation.     

The psychiatric management of the globus syndrome

Controversy surrounding the term "globus hystericus" points up the historical dichotomy between organic disease and conversion disorder that has hampered the understanding of this syndrome. Regardless of its sometimes incapacitating nature, there is little information in the literature regarding the treatment of globus when an organic cause cannot be established. Regarding the syndrome as psychosomatic in nature, rather than merely hysterical, we suggest the need for an integrated treatment approach. A case study is utilized to illustrate a model for psychiatric management of the globus syndrome. In this model, pharmacologic and psychotherapeutic interventions are integrated into a comprehensive, biopsychosocial treatment plan. Each aspect of the model is reviewed and discussed.     

Rapid quantitative determination of fenitrothion on balsam fir foliage: Development of a colorimetric technique and its use in determining insecticide lifetimes on foliage

A method is described for the colorimetric determination of fenitrothion spray deposit on conifer foliage. The technique is suitable for rapid deposit determination in the field using a portable mini-spectrophotometer. The detection limit is approximately 0.5 g fenitrothion/g foliage, although this could be improved. The technique is used in conjunction with gas chromatography to examine the evaporation and absorption dynamics of fenitrothion deposits on balsam fir foliage.     

Periodontal health in 200 HIV-positive patients

Two hundred HIV-positive subjects were surveyed to determine their periodontal health status. Particular attention was given to the occurrence of a severe and rapidly progressing form of periodontal disease designated "HIV-associated periodontitis", which has been reported as being unique to AIDS patients. Among the subjects comprising the cohort, 85 subjects had good gingival health, 59 subjects exhibited gingivitis, 49 cases of adult periodontitis were observed, 5 subjects presented with advance adult periodontitis, and 2 cases of necrotizing ulcerative periodontitis (NUP) were found within the group. The periodontitis of the patients in this survey did not have unique or pathognomonic characteristics which could set their periodontal disease apart from the periodontal disease seen in HIV negative population.     

Satisfaction with medical care among elderly people in fee-for-service care and an HMO

This study investigates satisfaction with care among elderly Medicare beneficiaries enrolled in a health maintenance organization (HMO) and beneficiaries in fee-for-service (FFS) care in the same geographic area. Satisfaction with two dimensions of care, access/quality and costs, are examined, to investigate differences in enrollee/FFS evaluation of these dimensions of care as well as predictors of satisfaction with care. In addition, satisfaction among healthy and chronically ill elderly people in these two care settings is explored. Results indicate higher satisfaction with access/quality of care among those in FFS and higher satisfaction with costs among HMO enrollees. These relationships hold controlling for other variables and among the chronically ill elderly. Sources of variation in satisfaction are somewhat different among the HMO and FFS elderly. Satisfaction with paperwork and ease of getting to care, however, influences satisfaction with other aspects of care in both populations.     

Multiclonal Leishmania braziliensis population structure and its clinical implication in a region of endemicity for American tegumentary leishmaniasis

In Corte de Pedra (CP), northeastern Brazil, Leishmania braziliensis causes three distinct forms of American tegumentary leishmaniasis (ATL). To test the hypothesis that strain polymorphism may be involved in this disease spectrum and accurately characterize the parasite population structure in CP, we compared one L. major, two non-CP L. braziliensis, one CP L. amazonensis, and 45 CP L. braziliensis isolates, obtained over a 10-year period from localized cutaneous, mucosal, and disseminated leishmaniasis patients, with randomly amplified polymorphic DNA (RAPD). Electrophoretic profiles were mostly unique across species. All typing protocols revealed polymorphism among the 45 CP L. braziliensis isolates, which displayed eight different RAPD patterns and greater than 80% overall fingerprint identity, attesting to the adequacy of the tools to assess strain variability in CP's geographically limited population of parasites. The dendrogram based on the sum of RAPD profiles of each isolate unveiled nine discrete typing units clustered into five clades. Global positioning showed extensive overlap of these clades in CP, precluding geographic sequestration as the mechanism of the observed structuralization. Finally, all forms of ATL presented a statistically significant difference in their frequencies among the clades, suggesting that L. braziliensis genotypes may be accompanied by specific disease manifestation after infection.