Fine-needle aspiration cytology in lesions related to ornamental body procedures (skin tattooing,intraoral piercing) and recreational use of drugs (intranasal route)

Body adornment through tattooing and body piercing and the use of recreational drugs are on the increase, producing a variety of secondary lesions, the etiology of which often remains undetected, as the medical community is not yet aware of the extent of the morbidity of such procedures and practices. Three cases are presented, which underscore the problem and also the role that fine-needle aspiration (FNA) can play in clarifying the etiology of such lesions. Two of these cases were lymphadenopathies, one secondary to tattooing and the other to tongue piercing, while the third was a deep intranasal lesion, which in all probability had resulted from intranasal use of recreational drugs. Although the clinical diagnosis of these lesions was problematic, the FNA performed by a pathologist, by associating the cytologic findings with the corresponding clinical setting, was quite indicative of their relation to the aforementioned procedures or practices.     

Intravesical morphine analgesia is not effective after bladder surgery in children: results of a randomied double-blind study

PURPOSE: Intravesical morphine was recently recommended to reduce postoperative pain after reimplantation surgery for vesicoureteral reflux in children. The efficacy of such treatment, so far solely evaluated by open study, needed to be confirmed. MATERIALS AND METHODS: After parental informed consent was obtained, 80 children requiring Cohen cross-trigonal reimplantation were considered for inclusion in a double-blind study. On the day of surgery patients were randomly assigned to receive either 0.04 mg./kg. morphine per hour or placebo (normal saline) at a constant intravesical infusion rate of 0.08 ml./kg. per hour. Postoperative pain was assessed every 3 hours using a pain score adapted to patient age. If the score was above a predefined limit, patients received intravenous acetaminophen and nalbuphine alternately every 3 hours. Bladder infusion was discontinued after 48 hours. RESULTS: Mean and maximum pain scores as well as the number of scores above the limit were not statistically different when comparing the morphine and placebo groups. There was no difference in the number of doses of analgesics administered. Urine output, voiding frequency and the number of painful voiding episodes were not significantly different between the 2 groups. Plasma morphine concentrations were 3.0 +/- 2.7 and 1.9 +/- 1.9 ng./ml. at 24 and 48 hours in the morphine group and undetectable in the placebo group. CONCLUSIONS: Intravesical administration of morphine is not effective for relieving postoperative pain during the first 48 hours after intravesical ureteral reimplantation. This study emphasizes the importance of controlled studies in evaluating the effectiveness of a new drug or procedure before recommending its use for all patients.     

Beliefs and attitudes of caregivers toward compliance with childhood immunisations in Cameroon

This study analysed factors associated with caregiver compliance and childhood immunisation schedules using a framework based on the Health Belief Model and a cross-sectional questionnaire survey. Participants were caregivers who were enrolling their children (average age 5 y) into class one at randomly selected primary schools in Bamenda, Cameroon. Schools were selected using a stratified random sampling methodology. Seventy-two percent of the 550 participants responded that their children were up-to-date with their immunisations. Perceived susceptibility with an odds ratio (OR)=0.75, perceived severity (OR=0.74), and self-efficacy (OR=1.57) were found to be associated with caregiver compliance to childhood immunisations. Higher level of education and living in an urban location were also found to be associated with increased likelihood of caregivers being up-to-date with their children's immunisations. Results suggest that health service planning should include health education and health promotion programs targeting caregiver compliance with recommended immunisation schedules with resultant improvements in communicable disease control and child health in Cameroon.     

Repeated cocaine administration differentially affects NMDA receptor subunit (NR1, NR2A-C) mRNAs in rat brain

We investigated the effects of intermittent intraperitoneal (i.p.) injections of cocaine (20 mg/kg) on subunit mRNAs of N-methyl-D-aspartate (NMDA) receptors (NR1/NR2A-2C) in the rat brain by in situ hybridization using phosphor screen analysis. The level of NR1 subunit mRNA significantly increased in hippocampal complexes 1 h after a single i.p. injection of cocaine. After repeated cocaine injection, the mean scores of stereotyped behavior were increased with the number of injections. The level of NR1 subunit mRNA was obviously decreased in the striatum and cortices 24 h (early withdrawal) after a final injection following 14 days of subchronic administration. During the early withdrawal period, the amount of the NR1 subunit decreased in the nucleus accumbens, globus pallidus, and subiculum. In the dentate gyrus, the NR1 mRNA level significantly increased during early withdrawal in rats subchronically treated with cocaine. Levels of NR2B subunit mRNA were reduced in the cortices and striatum. During late withdrawal from cocaine, the level of NR2C subunit mRNA in the cerebellum was also reduced. These findings suggest that the disruption of NR1, NR2B, and NR2C subunits in the discrete brain regions occurs under the cocaine-related behavioral abnormalities and would be closely implicated in the initiation and expression of behavioral sensitization induced by repeated cocaine administration. Further studies on the changes in non-NMDA receptors are required to elucidate the biological significance of glutamate receptors for the mechanisms underlying the development of behavioral sensitization.     

Widespread but regionally specific effects of experimenter- versus self-administered morphine on dendritic spines in the nucleus accumbens,hippocampus, and neocortex of adult rats

We studied the effects of self-administered (SA) vs. experimenter-administered (EA) morphine on dendritic spines in the hippocampal formation (CA1 and dentate), nucleus accumbens shell (NAcc-s), sensory cortex (Par1 and Oc1), medial frontal cortex (Cg3), and orbital frontal cortex (AID) of rats. Animals in the SA group self-administered morphine in 2-h sessions (0.5 mg/kg/infusion, i.v.) for an average of 22 sessions and animals in the EA group were given daily i.v. injections of doses that approximated the total session dose for matched rats in Group SA (average cumulative dose/session of 7.7 mg/kg). Control rats were given daily i.v. infusions of saline. One month after the last treatment the brains were processed for Golgi-Cox staining. In most brain regions (Cg3, Oc1, NAcc-s) morphine decreased the density of dendritic spines, regardless of mode of administration (although to a significantly greater extent in Group SA). However, only SA morphine decreased spine density in the hippocampal formation and only EA morphine decreased spine density in Par1. Interestingly, in the orbital frontal cortex morphine significantly increased spine density in both Groups SA and EA, although to a much greater extent in Group SA. We conclude: 1) Morphine has persistent (at least 1 month) effects on the density of dendritic spines in many brain regions, and on many different types of cells (medium spiny neurons, pyramidal cells, and granule cells); 2) The effect of morphine on spine density (and presumably synaptic organization) varies as a function of both brain region and mode of drug administration; and 3) The ability of morphine to remodel synaptic inputs in a regionally specific manner may account for the many different long-term sequelae associated with opioid use.     

Current issues in continuing education for contemporary behavioral health practice

The evolving health care system poses a number of challenges for the continuing development of the professional workforce. An overview of continuing education is provided, including typical objectives, format, content, and sponsors. Data are presented on continuing education requirements by discipline and by state. The forces of change that have driven the need for revised approaches to continued professional development are described, including research findings on the apparent lack of effectiveness of didactic learning activities. Current issues in continuing education are discussed, with a focus on educational content, financing, and the use of emerging technologies as a medium for these activities. The authors conclude with five recommendations for improving the process and content of continuing education for the professional behavioral health workforce.     

Marijuana use and the risk of Major Depressive Episode. Epidemiological evidence from the United States National Comorbidity Survey

Background This is an epidemiological study of a possible causal role of marijuana use in the development of Major Depressive Episode (MDE). Male-female differences in the suspected causal association have also been studied. Method Data are from 6,792 National Comorbidity Survey participants aged 15–45 years, assessed via the University of Michigan modified version of the Composite International Diagnostic Interview (UM-CIDI). Survival analysis methods were used to estimate cumulative risk of MDE by levels of marijuana use and to estimate suspected causal associations after adjustment for other influences. Results The risk of first MDE was moderately associated with the number of occasions of marijuana use and with more advanced stages of marijuana use. Relative to never users, non-dependent marijuana users had 1.6 times greater risk of MDE (95 % Confidence Interval: 1.1, 2.2), even with statistical adjustment for sex, birth cohorts, alcohol dependence, and history of daily tobacco smoking. Conclusions There was male-female variation in the degree of association between stage of marijuana involvement and MDE, but the strength of the association is modest at best. Accepted: 15 January 2002     

I've come for his throat': roles and identities in doctor-parent-child communication

Previous studies on doctor-parent-child communication at the general practitioner's surgery showed that the GP and the parent differ fundamentally in the way they enable or constrain child participation. The question how to explain these differences is at the core of the present study. The aim is to describe how the three participants display their orientation to their institutional roles and identities; how they collaboratively co-construct the course of action; and how these discursive constructions structure the ongoing interaction. A qualitative analysis of 106 videos shows that although GP and parent initially show incongruent orientations toward child participation, in the further course of the encounter all three participants jointly establish a situation in which child participation appears to be rather an exception. It is concluded that parental speaking for the child is, in a way, institutionally co-constructed; parents take their responsibility, which is hardly ever questioned by children, and GPs ratify this behaviour by refraining from meta-communicative comments and by aligning with the parent in the course of the interaction. The results are discussed in terms of enabling child participation and implications for medical practice.     

Reduced DAT- and DBH-immunostaining in the limbic system of Sardinian alcohol-preferring rats

We have recently shown that tyrosine-hydroxylase immunostaining (TH-IM) is selectively decreased in the cingulate cortex and in the shell of the nucleus accumbens (nAcc) of Sardinian alcohol-preferring rats (sP) when compared with Sardinian alcohol-non preferring (sNP) and Wistar (W) rats. Since these regions contain both dopamine and noradrenaline (NA) fibers, clarification of the dopaminergic and noradrenergic contribution to the decreased TH-immunoreactivity was needed. To this aim, we carried out the present immunohistochemistry study using two antibodies raised against dopamine beta-hydroxylase (DBH), the enzyme responsible for the conversion of dopamine into noradrenaline, and against the dopamine transporter (DAT), as markers for noradrenergic and dopaminergic fibers, respectively. The results show that DBH-immunostaining (DBH-IM) and DAT-immunostaining (DAT-IM) were both lower in the cingulate cortex of the sP rats with respect to sNP and W rats. In the shell of the nAcc a reduced DAT-IM in sP rats was found, while the DBH-IM did not differ between the three lines of rats. The analysis of the cell-body area of noradrenergic neurons in the locus coeruleus, revealed no differences between sP, sNP and W rats. These results indicate a selective reduction of the terminal innervation in the mesocorticolimbic dopamine and NA systems in sP rats. This genetically-determined difference may be involved in the opposite alcohol preference and consumption of sP and sNP rats.     

The effects of alcohol on mood induced by an emotional film: a study among women

OBJECTIVE: The present study was designed to investigate the effects of alcohol on women's reactions to a negative mood-inducing stimulus. It is hypothesized that, like in men, alcohol also reduces tension or induces positive mood in women. In addition, we explored whether different mood states were affected differentially by alcohol intake. METHODS: Participants were 132 female students who were randomly divided into four groups: (1) control, (2) placebo, (3) low-dose alcohol and (4) high-dose alcohol. A dramatic film was used to induce negative affect and mood was assessed at baseline, before and after the movie. RESULTS: Alcohol consumption decreased the negative impact of the emotional film on mood. Some mood states varied with pharmacological changes, while others varied with expectancy of drinking alcohol. Relaxation, fear and sadness were not differentially affected by alcohol intake or expectancy. CONCLUSION: Drinking when exposed to emotional situations may be reinforced by the short-term positive effects on well-being among moderate female drinkers. The findings further suggest that the effects of alcohol on certain specific emotional states (including sadness and fear) are minimal at best.