Geographic distribution of physicians in Portugal

The main goals of this paper are to (1) analyse the inequality in geographic distribution of physicians and its evolution, (2) estimate the determinants of physician density, and (3) assess the importance of competitive and agglomerative forces in location decisions. The analysis of the geographic distribution of physicians is based on the ratio of general practitioners (GPs) and specialists to 1,000 inhabitants. The inequality is measured using Gini indices, coefficients of variation, and physician-to-population ratios. The econometric models were estimated by ordinary least squares. The data used refer to 1996 and 2007. The impact of the growing number of physicians, and therefore potential increased competition, on geographic distribution during the period studied was small. Nonetheless, there is evidence of competitive forces acting on the dynamics of doctor localisation. Geographic disparities in physician density are still high, and appear to be due mainly to geographic income inequality.     

Lung carcinosarcoma

Lung carcinosarcoma is a neoplasm of high grade composed of epithelial and mesenchymal cells. It is exceptional; and usually affects men who are smokers, between the fifth and eighth decades of life. Medical treatment, chemotherapy and radiotherapy are not active in this kind of tumour, so surgery is the treatment of choice. Prognosis is poor with survival rates at 6 months around 27%. We describe the diagnostic process and the clinical outcome of a patient with lung carcinosarcoma with several paraneoplastic syndromes.     

Epilepsy following cortical injury: Cellular and molecular mechanisms as targets for potential prophylaxis

The sequelae of traumatic brain injury, including posttraumatic epilepsy, represent a major societal problem. Significant resources are required to develop a better understanding of the underlying pathophysiologic mechanisms as targets for potential prophylactic therapies. Posttraumatic epilepsy undoubtedly involves numerous pathogenic factors that develop more or less in parallel. We have highlighted two potential "prime movers": disinhibition and development of new functional excitatory connectivity, which occur in a number of animal models and some forms of epilepsy in humans. Previous experiments have shown that tetrodotoxin (TTX) applied to injured cortex during a critical period early after lesion placement can prevent epileptogenesis in the partial cortical ("undercut") model of posttraumatic epilepsy. Here we show that such treatment markedly attenuates histologic indices of axonal and terminal sprouting and presumably associated aberrant excitatory connectivity. A second finding in the undercut model is a decrease in spontaneous inhibitory events. Current experiments show that this is accompanied by regressive alterations in fast-spiking γ-aminobutyric acid (GABA)ergic interneurons, including shrinkage of dendrites, marked decreases in axonal length, structural changes in inhibitory boutons, and loss of inhibitory synapses on pyramidal cells. Other data support the hypothesis that these anatomic abnormalities may result from loss of trophic support normally provided to interneurons by brain-derived neurotrophic factor (BDNF).
Approaches that prevent these two pathophysiologic mechanisms may offer avenues for prophylaxis for posttraumatic epilepsy. However, major issues such as the role of these processes in functional recovery from injury and the timing of the critical period(s) for application of potential therapies in humans need to be resolved.     

Dysfunctional Attitudes,Dependency, and Self-Criticism as predictors of depressive mood states: A 12-month longitudinal study

The Dysfunctional Attitude Scale (DAS) and the Dependency and Self-Criticism scales from the Depressive Experiences Questionnaaire (DEQ) have been identified as possible markers for vulnerability to depressive mood states (Blatt, 1974; Weissman & Beck, 1978). Sixty-six undergraduate women were tested with the DAS, the DEQ, and the Beck Depression Inventory (BDI). Approximately 12 months later, 46 subjects were successfully contacted and retested with those scales. In addition, they rated the severity of their worst period of dysphoria during the 12-month interval using a retrospective version of the BDI and measures of anaclitic and introjective state depression. All three vulnerability measures displayed acceptable temporal stability. After controlling for initial levels of depression, the DAS predicted the BDI measure of worst period depression. Dependency predicted anaclitic state depression, and Self-Criticism predicted introjective state depression. The majority of both dependent and self-critical subjects' worst periods involved interpersonal events. The results added to the evidence that stable cognitive and personality variables confer vulnerability to depressive mood states.