Cooperation in mental health: an Italian project in Nicaragua

The experience acquired over the last four years in developing a program of cooperation in mental health in Nicaragua is reported. The concept of 'transfer' underlying the intervention and the general framework of Nicaragua's mental health system is discussed together with the results of the cooperative work. This included organizing training for mental health workers in six teaching and supervision modules, drawing up a mental health manual for primary health care workers, and survey of patterns of care in the 15 existing psychiatric services. Besides the key aspects of general reform of the psychiatric system after the revolution, the paper focuses on differences between organization and patterns of care in urban and rural areas.     

SINGLE-BLIND RANDOMIZED CONTROLLED TRIAL OF AN EDUCATIONAL BOOKLET FOR PATIENTS WITH CHRONIC ARTHRITIS

Consecutive new attendees at a rheumatology clinic were randomlyallocated to one of three groups. All groups received routinecare, but one received no other intervention, one an educationalbooklet on arthritis and one the booklet plus instruction froma health professional. Prior to intervention, all groups hadsimilar knowledge, Nottingham Health Profile (NHP) and HealthAssessment Questionnaire (HAQ) score. After 6 weeks, the knowledgescore was significantly increased in both groups given the booklet,but not in the control group. The group instructed by a healthprofessional showed no greater increase than the group giventhe booklet alone. Increased knowledge was not associated withimproved clinical status and no group showed a significant'change in NHP or HAQ scores. Nearly all patients said they foundthe booklet useful. KEY WORDS: Randomized controlled trial, Evaluation, Patient education, Booklet, Knowledge, Arthritis     

Melatonin rhythms and pineal structure in a tropical bat, Anoura geoffroyi, that does not use photoperiod to regulate seasonal reproduction

Abstract: It has been hypothesized that pineal structure and function might differ between temperate zone and tropical species of mammals because of lower amplitudes of seasonal change in photoperiod and, in some areas, less seasonal climatic variation. Anoura geoffroyi produce a single offspring in November or December of each year on the Caribbean island of Trinidad, at 10°N latitude in the deep tropics. Previous work has shown that this population lacks reproductive responses to photoperiod, and must be enforcing seasonal breeding using a non-photoperiodic cue. Anoura geoffroyi have a minute, thin, and rod-like pineal gland. Throughout much of its length, the pineal courses irregularly within the ventrolateral wall of the great cerebral vein. This intimate relationship may have functional implications. Despite having a very small pineal gland, this species produced a nocturnal rise in serum melatonin. Serum melatonin levels in most individuals were below or near undetectable levels during the light period and rose to a peak averaging 100 pg/ml in the last third of the dark period. Our results indicate that, although the pineal gland of A. geoffroyi is extremely small, serum melatonin levels are comparable to those of other mammals.     

Gestörte immunologische Regulationsmechanismen im Rahmen endokriner und infektiöser Erkrankungen bei HIV-infizierten Frauen

Ohne Zusammenfassung     

Muscle growth and myosin isoform transitions during development of a small teleost fish, Poecilia reticulata (Peters) (Atheriniformes, Poeciliidae): a histochemical, immunohistochemical, ultrastructural and morphometric study

The myosin composition of lateral muscle in Poecilia reticulata from birth to adult was studied by ATPase histochemistry and immunostaining with myosin isoform-specific antibodies. At birth the muscle consists of two layers containing developmental isoforms of myosin. In deep layer fibres the developmental myosin is replaced by the adult fast-white isoform soon after birth. In the epaxial and hypaxial monolayer fibres the myosin composition present at birth (J1) is replaced within 3 days by another (J2). In some fibres, this J2 composition is retained in the adult, but in others it is slowly replaced by the adult slow-red muscle isoform. Close to the lateral line, all monolayer fibres are already in transition between the J2 myosin and the adult slow-red form at birth, and rapidly complete the transition to slow-red form. These fibres, together with others generated de novo in an underlying hyperplastic zone, form the red muscle layer of the adult. The pink muscle develops during the first month after birth, and by 31 days it consists of an outer, middle and inner layer. A few middle layer fibres are already present at birth, while the outer layer fibres first appear 3 days after birth. The thin inner layer is probably a transitional form between the middle pink and adult white types, and appears at about 31 days. A morphometric analysis showed that growth of the white muscle occurs principally by hypertrophy. Even at the magnification level of the electron microscope, no satellite cells or myoblasts which could give rise to new fibres were found in the white muscle, except in the far epaxial and hypaxial regions and only in the first 10 days. A zone of hyperplastic growth was also found lying just under the superficial monolayer close to the lateral line, and this presumably contributes fibres to the red and pink muscle layers.     

Drinking and driving among rural youth

Data concerning rural youth drinking and driving practices werecollected from 622 junior and senior high school students innorthwest Ohio, utilizing an ex post facto cross-sectional survey-researchdesign. The results suggested that 69% of the sample had usedalcohol at least once. With regard to quantity of alcohol use,about 27% reported drinking four or more drinks at a sitting.Approximately 19% of the sample had driven under the influenceof alcohol and 35% had ridden in a car with an intoxicated school-agedriver; 35% had refused a ride from a friend who was intoxicated,while 43% had tried to stop a drunk friend from driving. Nosignificant differences were found between males and femalesregarding drinking and driving but grade level was a significantmoderating factor. As grade level increased, the frequency ofeach alcohol-related behavior increased substantially (P <0.01). This paper presents prevalence data concerning drinkingand driving among rural youth as well as recommendations forcommunity health education program development.     

Endothelial function and aqueous humor flow rate in patients with Fuchs' dystrophy

Using a two-dimensional scanning fluorophotometer, we studied 50 subjects with symmetric ocular involvement of Fuchs' dystrophy without epithelial edema. Twenty-six subjects with confluent or nearly confluent cornea gutata with increased corneal thickness and 24 subjects with mild to moderate cornea guttata with normal corneal thickness were compared to normal control subjects. There were no statistically significant differences in endothelial permeability between the three groups. Corneal thickness was significantly increased in the subjects with confluent to nearly confluent guttae, however. These results suggest that endothelial pump function may be affected in subjects with advanced cornea guttata with stromal edema.