Personality disorders and violence among female prison inmates

The current study seeks to expand our understanding of the increasingly well-documented relationship between mental disorder and violence, specifically by examining the relationship between Axis II disorders and community and institutional violence among a cohort of 261 incarcerated women. Drawing from an initial screening of 802 female inmates in maximum security, we sampled to identify 200 nonpsychotic women who met criteria for one of the four Cluster B personality disorders, and 50 nonpsychotic women who did not meet criteria for these disorders. Each inmate was interviewed with the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II). Information regarding instant offense and institutional behavior was obtained from prison files and a self-report inventory. The analyses indicated a high degree of comorbidity between the various Cluster B diagnoses and a significant association with various types of violent crime and nonviolent criminality. Significant relationships were found between Antisocial Personality Disorder and institutional violence, and Narcissistic Personality Disorder and incarceration for a violent crime. Cluster A diagnosis was unexpectedly found to be associated with both incarceration for a violent crime and incarceration for prostitution.     

Visceral Leishmaniasis in Rural Bihar, India

To identify factors associated with incidence of visceral leishmaniasis (VL), we surveyed 13,416 households in Bihar State, India. VL was associated with socioeconomic status, type of housing, and belonging to the Musahar caste. Annual coverage of indoor residual insecticide spraying was 12%. Increasing such spraying can greatly contribute to VL control.     

Determination of the differences in 2-h plasma glucose values after ingestion of carbohydrate foods and oral glucose in Caribbean non-diabetic subjects

It has been reported that mixed meals are used in clinics in developing and developed countries in screening and diagnosis of diabetes. Thus, we aimed to determine the differences in 2-h plasma glucose values after non-diabetic subjects ingested 75 g pure glucose and its equivalent content in frequently consumed carbohydrate foods in Caribbean subjects. Twenty-seven apparently healthy non-diabetic subjects (nine males, 18 females) consumed 75 g pure glucose and its carbohydrate equivalent in three ethnic test foods (bread, rice and roti) at 7 days apart. Plasma glucose and insulin levels were determined in blood samples collected before and after 60, 90, 120 and 150 min of ingestion of these foods. In comparison with each of the test foods, the postprandial 1-h and 2-h plasma glucose values and the 60, 90, 120 and 150 min incremental glucose concentrations after oral glucose load were significantly higher than the corresponding values for each of the test foods (all P<0.01). In spite of these higher postprandial glucose concentrations, the postprandial insulin responses following the oral glucose load and the test foods did not significantly differ at any time point (all P>0.05). However, the test food, roti, tended to stimulate higher absolute and incremental insulin secretions than pure glucose or any other test food (all P>0.05). Generally, the correlation between 2-h plasma glucose value after the ingestion of the pure glucose and each of the test foods was significant (all correlation coefficients were greater than 0.70, P<0.01). In conclusion, different ethnic mixed meals could serve as an alternative to glucose in routine screening and diagnosis of diabetes if its available carbohydrate content is known and quantified.     

Evaluation of the bioequivalence of two transdermal fentanyl systems following single and repeat applications

OBJECTIVE: Transdermal delivery of fentanyl has potential benefits over slow-release morphine, being largely preferred by patients owing to the combination of effective pain relief, a good safety profile and easy, pain-free dosing. The new drug-in-adhesive Durogesic D-TRANS fentanyl Matrix Delivery System (DDTDF) has improved pharmaceutical characteristics and patient acceptability compared to the original Durogesic transdermal reservoir system (fentanyl transdermal reservoir), whilst still providing reliable and consistent delivery of fentanyl. The bioequivalence of these two systems was evaluated in two studies. RESEARCH DESIGNS AND METHODS: Eighty healthy volunteers received single (72 h) or multiple (288 h) applications of DDTDF and the transdermal reservoir system (100 microg/h) in two separate randomised, crossover bioequivalence studies. Bioequivalence was assessed by calculating the ratio of least squares means based on log-transformed data following single system application and at steady-state during the fourth application. RESULTS: Both transdermal systems were bioequivalent with respect to all tested pharmacokinetic parameters. Inter-subject variability was comparable between the two systems and was greater than intra-subject variability. Transdermal delivery was well tolerated in both groups. CONCLUSIONS: The pharmacokinetic results demonstrate that DDTDF is bioequivalent to the original fentanyl transdermal reservoir system after single and multiple applications.     

Expressed emotion versus relationship quality variables in the prediction of recurrence in bipolar patients

BACKGROUND: The expressed emotion (EE) construct has predicted clinical outcomes in schizophrenia and depression, but few studies have been conducted with bipolar patients. Moreover, there is a particular dearth of information regarding the prediction of depressive versus manic episodes in bipolar patients. Questions also remain about the utility of EE compared to other variables (perceived criticism, relationship negativity, and chronic strain in close relationships) that more directly evaluate interpersonal stress and about specific predictions of mania or depression. METHODS: Forty-seven outpatients with bipolar I disorder participated in a 1-year longitudinal study. A close collateral of the patient completed the Five Minute Speech Sample (FMSS) to assess EE, and participants completed perceived criticism and negativity ratings of collaterals. Clinical outcomes and chronic interpersonal stress were assessed by interview at 3-month intervals. RESULTS: High EE predicted depressive, but not manic recurrence. Other variables of close interpersonal relationships were not significant predictors of recurrence. LIMITATIONS: Participants nominated collaterals, and those who did not have such a confidant were excluded. CONCLUSIONS: The FMSS was sensitive to even mild negativity by the collateral that predicted later depressive episodes. This is the first study to demonstrate polarity-specific effects of EE on the prediction of recurrence in bipolar disorder.     

Experience with ethynodiol diacetate and mestranol as an oral contraceptive

A study was made in Bombay, India of oral contraception using 2 combinations of ethynodiol diacetate and mestranol in 521 women over a period of 3 years with a total of 5196 menstrual cycles. The women were divided into 2 groups: 1 using 1 mg of ethynodiol diacetate plus .1 mg of mestranol and the other using .5 mg of ethynodiol diacetate and .1 mg of mestranol. 70% of the women studied were aged 21-30 years. Women over 35 and those with more than 3 children were urged to undergo operative procedures. Most had used no contraceptive method previously, 56.6% desired planned families, and 43.4% wanted no more children. There was a monthly interview when a new supply of tablets was distributed. No pregnancies followed in either group when tablets were taken regularly, but 2 did occur otherwise. Side effects were most severe during the first cycle. 55 women (10.5%) discontinued medication at the end of 3 years because of side effects. 267 discontinued the program because pills were not available near their homes. Of these, 71 became pregnant over the 3-year period, only 10 of whom desired pregnancy. None showed evidence of thromboembolic phenomena. Liver function tests showed no change. The cycle length of most women taking the preparations became more regular at 27-28 days. There was little difference in side effects of the 2 preparations.     

Osteopenia in hypoestrogenic young women with anorexia nervosa

Replacement estrogen therapy for premenopausal women with secondary hypogonadism (exercise/weight loss amenorrheas) remains controversial. In a group of 14 women with anorexia nervosa, amenorrhea, and no evidence of other endocrinopathy or protein-calorie malnutrition, significant osteopenia was demonstrated as assessed by cortical thickness of carpal bones. The degree of bone thinning was related to the duration and age at onset of amenorrhea as well as abnormalities of pubertal milestone progression. In the young women with "constitutionally delayed" menarche, or with secondary amenorrhea and hypogonadism, significant osteopenia may also be present. For those women with (1) hypoestrogenism and amenorrhea of over 36 months' duration, (2) pubertal delay, and (3) early onset of secondary amenorrhea, evaluation of osteopenia radiographically, and serious consideration for estrogen replacement, is important.