The Correlation Between Postpartum Depression and Health Status

To investigate a purported correlation between postpartum depression and self-rated maternal general health status in a sample of mothers in Southern Brazil. As part of this process, the Personal Health Scale (PHS), a self-rated health status measure, was tested for the first time among postpartum women. Research volunteers completed the Structured Clinical Interview for DSM-IV Disorders (SCID), the 12-item General Health Questionnaire (GHQ), the PHS, the Postpartum Depression Screening Scale (PDSS), and the Edinburgh Postnatal Depression Scale (EPDS). Correlation coefficients were computed among the scores of the health status questionnaires and the postnatal depression scales. Bivariate linear regression analyses were conducted to evaluate the prediction of scores of postnatal depression scales having the scores of health status questionnaires as predictors. Significant correlations among both health status questionnaires and both postnatal screening tools attest to a significant interconnection between the expression of depressive symptoms and maternal health status in the postpartum period. The health status measures predicted the scores of postpartum depression scales. This study demonstrates that both general health questionnaires and postpartum depressive rating scales are useful tools for detecting depressive phenomena in postpartum women. The association between self-rated health measures and postpartum depression may be even more significant in the context of socioeconomic deprivation.     

The RNA-binding protein Musashi-1 regulates neural development through the translational repression of p21WAF-1

RNA-binding proteins regulate cell fate decisions during nervous system development. The Msi family of RNA-binding proteins is expressed in multipotential neural progenitors, and is required for maintaining cells in a proliferative state. We demonstrate that Msi-1's ability to regulate progenitor maintenance is through the translational inhibition of the cyclin-dependent kinase inhibitor p21WAF-1. Msi-1 ectopic expression increases the proliferation rate and the capacity to regulate p21WAF-1 protein expression, independent of p53. The 3' untranslated region (UTR) of the native p21(WAF-1) mRNA contains a Msi-1 consensus-binding site that permits Msi-1 to directly repress the translation of p21WAF-1 protein. Reduction of Msi-1 through antisense leads to aberrant p21WAF-1 expression, which significantly impairs neural differentiation. A double knockdown for p21WAF-1 and Msi-1 rescues the production of mature MAP+ neurons. Our results further elucidate the symbiotic relationship between cell cycle withdrawal and the onset of differentiation in the developing nervous system, as well as increasing the understanding of the influence that RNA-binding proteins serve in regulating these processes.     

Differences in the therapeutic functioning of paraprofessionals with varying lengths of experience

Measured differences in the ability of paraprofessionals to discriminate and communicate facilitative conditions in psychotherapy as a function of length of experience. Hypotheses tested were that discrimination and communication abilities would be greater in Ss with longer experience and that these abilities would be correlated positively within individuals. Thirty-six mental health workers were categorized into three levels of experience and initial competency. Ss were administered the Carkhuff Discrimination Rating Scale; the level of conditions communicated to patients was assessed through replies to taped patient interviews. Results failed to support the hypothesized relationships between functioning and experience. However several interactions were found. Initially more competent Ss tended to improve over time and less competent Ss declined. A positive correlation between abilities within individuals was found. Results were compared with studies that measured the functioning of professional psychology trainees over time, are relevant to issues of therapist selection, and support the use of experiential training programs.     

Age-related alterations of the CD19 complex and memory B cells in children with Down syndrome

Children with Down syndrome (DS) have a high incidence of recurrent respiratory tract infections, leukaemia and autoimmune disorders, suggesting immune dysfunction. The present study evaluated the role of the CD19 complex and memory B cells in the pathogenesis of immunodeficiency in children with DS. The expression levels (median fluorescein intensity—MFI) of CD19, CD21 and CD81 molecules on the surface of B cells and memory B cell subsets were studied in 37 patients and 39 healthy controls. Twenty-nine of the DS group had congenital cardiac disease. The B cell count was significantly low in children with DS compared with healthy age-matched controls for all three age groups (under 2 years; 2–6 years and older than 6 years). The MFI of CD19 was reduced in all the age groups, whereas that of CD21 was increased in those older than 2 years with DS. The expression level of CD81 was significantly increased in those older than 6 years. Age-related changes were also detected in memory B cell subsets. The frequency of CD27⁺IgD⁺IgM⁺ natural effector B cells was reduced in children with DS who had needed hospitalisation admission due to infections. The observed intrinsic defects in B cells may be responsible for the increased susceptibility of children with DS to severe respiratory tract infections.     

The effect of N-acetylcysteine supplementation upon viral load, CD4, CD8, total lymphocyte count and hematocrit in individuals undergoing antiretroviral treatment.

Individuals infected with the human immunodeficiency virus (HIV-1) present with decreased CD4, a progressive increase in viral load, compromised cell immune defense, and hematologic alterations. The aim of this study was to assess the serum viral load, CD4, CD8, lymphocyte count and hematocrit at the beginning of antiretroviral therapy in individuals who were supplemented with N-acetylcysteine (NAC). Twenty volunteers participated in this double-blind, placebo-controlled 180-day study. Ten participants received 600 mg of NAC per day (NAC group) and the other ten serving as a control group received placebo. The above mentioned parameters were determined before treatment, and after 60, 120 and 180 days. In NAC-treated patients hematocrit remained stable and an increase in CD4 cell count took place earlier than that in the control group.     

Identification of neonatal deaths in a large managed care organisation

Summary. The neonatal (< 28 days) mortality rate (NMR) is one of the most commonly employed maternal and child health epidemiological measures. It is also being employed in quality measures (‘report cards’) used to assess the performance of health care organisations. The objectives were to (1) develop methods for the rapid quantification of the neonatal mortality rate in a multi-hospital system, the Kaiser Permanente Medical Care Program's Northern California Region (KPMCP NCR), (2) develop methods for generating facility-specific rates and case lists, and (3) ascertain the capture rates of the information sources available to us. Potential neonatal deaths were identified in the KPMCP NCR for the 1990 and 1991 calendar years from 3 sources: (1) clerical searches of local facility records, (2) electronic searches of the KPMCP NCR hospitalisation database, and (3) linking KPMCP electronic birth records to death certificate tapes. The medical records of all infants identified through these methods were reviewed. The neonatal mortality rate was calculated in three ways: (1) including all livebirths, (2) excluding births weighing <500g, and (3) adjusting for prematurity by increasing the follow-up period in preterm babies (these babies were included as neonatal deaths if they died up to 40 weeks corrected age + 27.9 days). A total of 352 records out of 64469 birth records in the KPMCP NCR were reviewed. If one includes babies <500g, the neonatal mortality rate was 3.72/1000 live-births; if these babies are excluded, the rate was 3.05/1000. Adjusting for prematurity increased these rates to 3.91/1000 and 3.24/1000, respectively. Accurate quantification of the neonatal mortality rate in a multi-hospital system requires the use of multiple information sources. Use of a single source can lead to varying rates of over- or under-estimation. It is possible to employ our methodology for both research and operational purposes.     

Familial male breast carcinoma

Breast cancer in men is a rare disease, accounting for approximately 1% of all breast cancers. In a recent review of the literature, only 12 reports of breast cancer in related men have been recorded. A case of familial breast cancer is reported involving two men and two women. The role of hereditary factors and associated etiologic factors in male breast cancer are reviewed. The overall prognosis of male patients with breast cancer is poor compared with female patients with breast cancer, possibly related to a delay in diagnosis and difference in regional spread of the tumor. Increased surveillance of families with a history of male breast cancer and the presence of associated etiologic factors appears advisable.     

Determinants of Operative Survival Following Combined Mitral Valve Replacement and Coronary Revascularization

To determine the operative survival rate following combined mitral valve replacement (MVR) and coronary artery bypass graft (CABG) operation, we evaluated 100 patients, who were seen consecutively at the Peter Bent Brigham and Brigham and Women's Hospital from 1972 to 1981. There were 63 men and 37 women; the mean age was 62 years. Thirty-six patients were in New York Heart Association (NYHA) Functional Class III, and 64 were in Functional Class IV. Mitral regurgitation was predominant in 76 patients; mitral stenosis, in 24. Emergency operations were performed in 15 patients, and elective or semielective operations were performed in 85.There were 18 operative deaths (18%): 9 in patients having elective operations (10.5%) and 9 in those having emergency operations (60%; p < 0.01). Significant preoperative factors related to operative death were NYHA functional class, increased pulmonary vascular resistance, lower cardiac index, and lower ejection fraction in the nonsurvivors. The rate of survival did not differ according to sex, age, or degree of coronary artery disease. In addition, myocardial protection with potassium cardioplegia and complete coronary revascularization significantly reduced operative mortality in the elective group of patients but did not alter the mortality in the emergency group.