Multiple informants in the assessment of psychological, behavioral, and academic correlates of bullying and victimization in middle school

The present study assessed agreement between student self-report and teacher ratings of bullying and victimization relative to psychological, behavioral, and academic correlates. Middle school students (N=1442) and teachers completed surveys evaluating peer relationships and psychosocial adjustment. Analyses of variance and logistic regressions were used to examine rater agreement on bullying/victimization and adjustment among groups (bullies, victims, bully/victims, and uninvolved) identified by rater (student self-report only, teacher-report only, concordant reports, and controversial reports). Concordant and controversial groups had among the greatest psychosocial and academic difficulties. Student learning difficulties and moodiness interacted with teacher reports of bullying and victimization, respectively, with agreement between teacher and student self reports of bullying greater at higher levels of learning problems and agreement for victimization lower at higher levels of moodiness. The results indicate biases in rater perspective of student behavior and continue to support the need for multiple raters of student functioning.     

Can an illness perception intervention reduce illness anxiety in spouses of myocardial infarction patients? A randomized controlled trial

Objective

To investigate whether a brief in-hospital illness perception intervention for myocardial infarction (MI) patients and their spouses could change spouses' illness perceptions and reduce spouses' anxiety about the illness.

Methods

Fifty-seven spouses participated in a randomized controlled trial of an illness perception intervention for MI patients. Spouses of patients randomized to the intervention attended one half-hour patient-and-spouse session with a psychologist in addition to standard care. Spouses completed measures of illness perceptions, expectations, and illness anxiety at admission and at 1 week following discharge, and spouses' illness worry was rated by the patients at 3 months. The main outcome for spouses was differences in anxiety between intervention and control groups.

Results

One week following discharge, spouses in the intervention group had higher illness understanding, lower concern, stronger causal attributions to hereditary factors, and fewer questions about their partner's heart condition compared to the control group. Intervention group spouses reported more positive expectations about the ability of the patient's heart to recover, and lower perceived likelihood of another MI. They had lower anxiety about the patient doing physical activity and about the patient's medications, and lower distress about the patient's symptoms. Spouses in the intervention group were rated as less worried about the illness at 3 months.

Conclusion

Spouses of patients represent a new target for illness perception interventions and these results demonstrate that a brief illness perception intervention can change illness perceptions and reduce anxiety about the illness in spouses of MI patients.     

Candidaemia with uncommon Candida species: predisposing factors, outcome, antifungal susceptibility, and implications for management

The risk factors for and clinical features of bloodstream infection with uncommon Candida spp. (species other than C. albicans, C. glabrata, C. parapsilosis, C. tropicals and C. krusei) are incompletely defined. To identify clinical variables associated with these species that might guide management, 57 cases of candidaemia resulting from uncommon Candida spp. were analysed in comparison with 517 episodes of Candida albicans candidaemia (2001–2004). Infection with uncommon Candida spp. (5.3% of candidaemia cases), as compared with C. albicans candidaemia, was significantly more likely to be outpatient-acquired than inpatient-acquired (15 of 57 vs. 65 of 517 episodes, p 0.01). Prior exposure to fluconazole was uncommon (n = 1). Candida dubliniensis was the commonest species (n = 22, 39%), followed by Candida guilliermondii (n = 11, 19%) and Candida lusitaniae (n = 7, 12%). C. dubliniensis candidaemia was independently associated with recent intravenous drug use (p 0.01) and chronic liver disease (p 0.03), and infection with species other than C. dubliniensis was independently associated with age <65 years (p 0.02), male sex (p 0.03) and human immunodeficiency virus infection (p 0.05). Presence of sepsis at diagnosis and crude 30-day mortality rates were similar for C. dubliniensis-related, non-C. dubliniensis-related and C. albicans-related candidaemia. Haematological malignancy was the commonest predisposing factor in C. guilliermondii (n = 3, 27%) and C. lusitaniae (n = 3, 43%) candidaemia. The 30-day mortality rate of C. lusitaniae candidaemia was higher than the overall death rate for all uncommon Candida spp. (42.9% vs. 25%, p not significant). All isolates were susceptible to amphotericin B, voriconazole, posaconazole, and caspofungin; five strains (9%) had fluconazole MIC values of 16–32 mg/L. Candidaemia due to uncommon Candida spp. is emerging among hospital outpatients; certain clinical variables may assist in recognition of this entity.     

The anatomy of the heart

The normal heart is the size of the patient’s closed fist. The venae cavae drain into the right atrium, which bears the fossa ovalis and receives the coronary sinus and the anterior cardiac vein. The atrium empties into the right ventricle through the tricuspid valve. Both ventricles have trabeculated walls (trabeculae carneae), and from some project the papillary muscles, bearing the chordae tendinae attached to the free borders of the tricuspid valve. The same arrangement is seen on the left side. The right ventricle leads to the pulmonary trunk, guarded by its three valve cusps. Oxygenated blood returns to the left atrium via the four pulmonary veins and passes to the left ventricle via the mitral valve. Exit is through the tricuspid aortic valve. The right and left coronary arteries arise above the valves, their orifices lying in the sinuses of Valsava. The right coronary artery lies in the right part of the atrioventricular groove and gives off the posterior interventricular artery. The left coronary arteries divide into the anterior (descending) interventricular branch and the circumflex branch. Major veins accompany the arteries, except for the anterior cardiac vein, which drains directly into the right atrium.     

Cliniconeuropathologic correlates of human immunodeficiency virus in the era of antiretroviral therapy

The objective of this study was to examine the spectrum of human immunodeficiency virus (HIV) brain pathology and its clinical correlates in the antiretroviral era. We carried out a cross-sectional survey, analyzing prospective clinical and neuropathological data collected by the National NeuroAIDS Tissue Consortium (NNTC), comprising 589 brain samples from individuals with advanced HIV disease collected from 1999 onwards. We assessed gender, ethnicity/race, mode of transmission, age, year of death, nadir CD4, plasma viral load, last antiretroviral regimen, presence of parenchymal HIV brain pathology, HIV-associated neurocognitive disorder, and major depressive disorder. We compared cohort demographic variables with Centers for Disease Control and Prevention US HIV/AIDS statistics and examined associations of parenchymal HIV brain pathology with demographic, clinical, and HIV disease factors. With regard to Centers for Disease Control and Prevention US data, the NNTC was similar in age distribution, but had fewer females and African Americans and more Hispanics and men who have sex with men. Only 22% of the brains examined were neuropathologically normal. Opportunistic infections occurred in 1% to 5% of the cohort. Parenchymal HIV brain pathology was observed in 17.5% of the cohort and was associated with nadir CD4 and plasma viral load. Brains without parenchymal HIV brain pathology often had other noninfectious findings or minimal nondiagnostic abnormalities that were associated with HIV-associated neurocognitive disorder. Clinically, 60% of the cohort reported a lifetime episode of major depressive disorder and 88% had a HIV-associated neurocognitive disorder. No pathological finding correlated with major depressive disorder. Both antiretroviral treatment regimen and elevated plasma HIV viral load were associated with presence of parenchymal HIV brain pathology; however, multivariate analyses suggest a stronger association with plasma viral load. The frequency of HIV brain pathology was lower than previous pre-antiretroviral reports, and was predicted by lower nadir CD4 and higher plasma viral load. Noninfectious pathologies and minimal changes correlated with HIV-associated neurocognitive disorder, suggesting a shift in pathogenesis from florid HIV replication to other, diverse mechanisms.     

Myocarditis: basic and clinical aspects

Myocarditis represents a heterogeneous final common pathway for myocardial inflammation of diverse etiologies and accounts for up to one-third of cases of dilated cardiomyopathy. The pathophysiology of viral myocarditis can be disaggregated into the effects of direct viral mediated injury, triggered acute and chronic autoimmune responses, and subsequent adverse remodeling. Recent research highlights the pathogenic role of persistent viral genome expression, Fas-ligand, tumor necrosis factor-alpha receptor 1, and antimyosin autoantibodies in the evolution of chronic systolic and diastolic heart failure. Recent refinements in endomyocardial biopsy evaluation, cardiac magnetic resonance imaging, and cytokine assays augment existing diagnostic modalities. Novel specific immunosuppressive targets aimed at interrupting myocyte injury and apoptosis, including interferon-beta seem promising to date in small clinical studies performed on selected patients.