Detection and management of depressive disorders in primary care in Spain

OBJECTIVE: Many patients with depression who attend primary care are not detected and are unaware of the benefits of therapeutic intervention. Our aim is to evaluate the recognition and management of depressed patients presenting in primary care in Spain. METHODS: This was a two-phase cross-sectional study in primary care centers in Tarragona (Spain). In the first phase, we screened 906 consecutive patients using the Zung's Self-Rating Depression Scale. In the second phase, all 209 patients whose results were positive and 97 patients whose results were negative (1/7 at random) were given the Structured Clinical Interview for DSM-IV Disorders, a series of questionnaires, and the judgment of the physician about the presence of depression was determined. In the 120 patients with major depression and/or dysthymia, predictors of detection and treatment of depression were determined. RESULTS: Seventy-two percent of depressed patients were detected. The detection was associated with educational level, severity of the depression, level of impairment, and the complaint of explicit psychological symptoms. Thirty-four percent were receiving treatment with antidepressants. Antidepressant treatment was associated with marital status, severity of and impairment from the depression, frequency of visits to the family physician, and the patients' complaint of psychological symptoms. CONCLUSION: Many depressed patients are not detected, but these are often the patients who present with the mildest forms of depression and for whom the benefits of detection are far from clear. Although treatment was associated with the severity of depression, most depressed patients, at any level of seriousness, do not receive appropriate treatment.     

Implementation of rapid HIV and HCV testing within harm reduction programmes for people who inject drugs: a pilot study

Including HCV and HIV rapid tests in harm reduction programmes (HRP) for people who inject drugs (PWID) can increase detection of these infections in high-risk populations who do not seek conventional health care. Aims: To assess acceptability and feasibility of rapid HIV and HCV tests in HRP; to identify HIV and HCV prevalence rates in HRP; to identify the percentage of PWID with a reactive test that attend hospital for confirmation and follow-up. Rapid oral tests for HCV and HIV were offered to users of 13 HRP from both mobile units and facility-based centres. A total of 172 HCV and 198 HIV tests were performed, with a refusal rate of 1.7% and 10.4%, respectively. Injectors made up 64.9% of all drug users and 35.1% did not inject drugs. Overall, 20.3% of HCV tests and 2.5% of HIV test were reactive. Only 24 of the 35 reactive HCV could be confirmed (68.6%) and one was false-negative. Of the five HIV reactive cases, only two could be confirmed (40%) with 1 false-positive case. Acceptability of rapid HIV and HCV tests among HRP users was high. The usefulness of oral rapid tests in HRP has been demonstrated, especially in mobile HRP.     

Insight into the bioreductive mode of action of antitrypanosomal 5-nitrofuryl containing thiosemicarbazones

In order to get insight into the trypanocidal mechanism of action of a series of 5-nitrofuryl containing thiosemicarbazones some studies related to their bioreduction were performed. Electron spin resonance spectra of radicals generated in T. cruzi by compounds' bioreduction were analyzed. Three different patterns of ESR signals were observed for the different assayed compounds. These results were in agreement with the changes in the T. cruzi-oxygen uptake promoted by these compounds. On the other hand, free-radical scavenger properties, measured as oxygen radical absorbance capacity (ORAC), did not seem to correlate with the trypanocidal activity.     

Age-related capacity of neuroendocrine factors to differentiate T cells in vitro.

The present report shows the capacity of hypothalamic extract (HE) to differentiate bone marrow cells to Thy-1+ cells in vitro. A two-step short-term culture was used. In the first step thymus and pituitary were co-cultured in the presence of HE. Supernatant was then transferred to a bone marrow cell suspension and following a period of culture, the percentage of Thy-1+ cells was determined by a microcytotoxicity assay. Results indicated that: (a) HE from young mice show a very efficient differentiating capacity; (b) HE from young mice is equally efficient when old pituitary, thymus and marrow are used; (c) HE from old donors has no capacity to differentiate T cells; (d) there is a progressive age-related decline of this capacity; and (e) there is a feed-back mechanism involved in this process. It is concluded that hypothalamic factors can regulate the differentiation of T cells and that this effect operates through a mechanism involving pituitary and thymus.     

Autoimmune thyroiditis in young and old mice: differential effect of high doses of PHA.

Experimental autoimmune thyroiditis (EAT) was used to study the effect of age and PHA in the autoimmune response. EAT was induced in mice by two injections 7 days apart of soluble syngeneic mouse thyroglobulin (MTg) and lipopolysaccharide (LPS) as adjuvant. Thereafter the antibody titre to MTg was determined in the serum and the degree of cellular infiltration estimated in thyroid sections. The results show that in old mice the humoral response is low and no cellular infiltration is found in the thyroid; young mice showed both types of immune response. Phytohaemagglutinin (PHA) was shown to inhibit antibody production when given before the first and second antigen injection, and to suppress completely the cellular immunity against thyroid tissue. When given to old mice a reduction in anti-MTg titre is also seen, but no effect on infiltration is found. However when PHA is only given before the second dose of antigen a stimulation of cellular immunity is seen in contrast to young mice where there is no effect.