Assessment of risk behaviors for HIV infection among psychiatric inpatients.

A 13-item questionnaire was constructed to assess risk factors for HIV infection among 476 patients newly admitted over a one-year period to a state psychiatric hospital in New York City. Because psychopathology can affect patients' self-reports, the validity of the instrument was established by HIV antibody tests in a subset of 352 patients. Results of the questionnaire indicated that the 352 patients were almost equally divided between the high-risk and low-risk categories. HIV seroprevalence was .6 percent among the low-risk patients, but 14.4 percent among the high-risk patients. The findings suggest that a screening program to detect HIV-positive patients should be undertaken in this population, that it should be focused on the high-risk subgroup, and that the questionnaire can be used to define that subgroup. However, results of the study may not generalize to other geographic areas.     

Clinical characterization and mutation spectrum in Hispanic families with adenomatous polyposis syndromes

Several genetically defined hereditary colorectal cancer (CRC) syndromes are associated with colonic polyposis including familial adenomatous polyposis (FAP) and MUTYH adenomatous polyposis (MAP). Limited data exists on the clinical characterization and genotypic spectrum of polyposis syndromes among Hispanics. To describe the phenotype and genotype of Puerto Rican Hispanic patients with FAP and MUTYH and compare with other ethnic and racial groups. Probands were identified from the Puerto Rico Familial Colorectal Cancer Registry (PURIFICAR). Recruited individuals completed risk factors, medical, and family history questionnaires and underwent genetic testing for genotype analysis. Frequency analysis, Chi square, Fisher’s exact and Wilcoxon rank-sum tests were used for statistical analysis methods. A total of 31 FAP (from 19 families) and 13 MAP (from 13 families) Hispanic patients recruited from the PURIFICAR were evaluated. Among the FAP cases, mean age at diagnosis was 27.6 (range 9–71 years); 67.7 % cases had more than 100 polyps and 41.9 % had upper gastrointestinal polyps. Among the 19 FAP families, there were 77 affected FAP individuals and 26 colorectal cancer cases. Genetic mutations were available for 42.2 % of FAP families; all mutations identified were unique. Surgeries were reported in 31 cases; 14 (45.2 %) prophylactic surgeries and 6 (19.4 %) therapeutic surgeries for management of CRC. Among MAP cases, mean age at diagnosis was 53 (range 34–76 years). Genetic analysis revealed homozygous biallelic mutations (G382D) in 53.8 %, compound heterozygous mutations (G382/Y165C) in 23 %, and non-G382/Y165C monoallelic mutations in 23 %. Familial cancer registries should be promoted as vehicles for detection, education and follow up of families at-risk of acquiring familial cancers. PURIFICAR is the first and only familial cancer registry in Puerto Rico providing these services to families affected with familial cancer syndromes promoting education, testing and surveillance of at-risk family members, and focusing on cancer prevention efforts. The fact that only 40 % of FAP patients had access to genetic testing stresses the need to promote the establishment of policies supporting genetic testing coverage by medical insurance companies in order to provide patients with the highest standard of care to prevent cancer. Furthermore, our results suggest that Hispanics may have uncommon mutations in adenomatous polyposis related genes, which emphasize the need for full gene sequencing to establish genetic diagnosis.     

The neurosteroid 3alphaDIOL modulates place preference when infused in the basolateral amygdala according to sex

Three different behavioral tasks were used to study the role of the neurosteroid 5alpha -androstane-3alpha, 17beta-diol (3alphaDIOL) in affective components of behavior when infused into the basolateral amygdala (BLA) of both sexes. Female rats were ovariectomized; half received implants containing estradiol benzoate (OVX-EB), whereas the other half received empty implants (OVX). Male rats were gonadally intact. No differences were noted in male behavior according to the conditioned place preference (CPP) test, the modified Vogel conflict test (VCT), or the elevated plus maze (EPM) upon infusion of 3alphaDIOL. In contrast, 3alphaDIOL modulated CPP and VCT performance among female rats. Therefore, the authors propose that 3alphaDIOL modulates affect through the BLA via a sex-specific mechanism.     

Non-Targeted Dried Blood Spot-Based Metabolomics Analysis Showed Rice Bran Supplementation Effects Multiple Metabolic Pathways during Infant Weaning and Growth in Mali

Rice bran contains essential nutrients, antioxidants, and bioactives with anti-inflammatory and diarrheal protective properties important for infants. This 6-month randomized controlled trial investigated the effects of heat-stabilized rice bran supplementation during Malian infant weaning. Fifty healthy 6-month-old infants were randomized to a rice bran intervention (N = 25) or non-intervention control group (N = 25). Intervention infants received dose-escalating rice bran supplementation for 6 months (1–5 g/day). Monthly infant dried blood spot and anthropometric measurements were collected. Dried blood spot metabolite abundances were compared monthly according to diet for six months. Supplementation resulted in favorable weight-for-age and weight-for-length z-score changes. Non-targeted dried blood spot-based metabolomics identified 796 metabolites, of which 33% had significant fold differences between groups (7–12 months). Lipids and amino acids represented 70.6% of the metabolites identified. Rice bran supplementation during infant weaning significantly modulated the metabolites involved in antioxidant defenses and with neuroactive properties including reduced glutathione, glycine, glutamate, cysteinylglycine, tryptophan betaine, and choline. These findings support rice bran as a weaning ingredient to meet infant nutritional requirements and with the potential to reduce oxidative stress and improve cognitive outcomes. This study provides evidence for dried blood spots as a cost-effective tool to detect infant biomarkers of nutritional and metabolic status.     

Effectiveness and cost of olanzapine and haloperidol in the treatment of schizophrenia: a randomized controlled trial

Context  Although olanzapine has been widely adopted as a treatment of choice for schizophrenia, its long-term effectiveness and costs have not been evaluated in a controlled trial in comparison with a standard antipsychotic drug. Objective  To evaluate the effectiveness and cost impact of olanzapine compared with haloperidol in the treatment of schizophrenia. Design and Setting  Double-blind, randomized controlled trial with randomization conducted between June 1998 and June 2000 at 17 US Department of Veterans Affairs medical centers. Participants  Three hundred nine patients with a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnosis of schizophrenia or schizoaffective disorder, serious symptoms, and serious dysfunction for the previous 2 years. Fifty-nine percent fully completed and 36% partially completed follow-up assessments. Interventions  Patients were randomly assigned to receive flexibly dosed olanzapine, 5 to 20 mg/d, with prophylactic benztropine, 1 to 4 mg/d (n = 159); or haloperidol, 5 to 20 mg/d (n = 150), for 12 months. Main Outcome Measures  Standardized measures of symptoms, quality of life, neurocognitive status, and adverse effects of medication. Veterans Affairs administrative data and interviews concerning non-VA service use were used to estimate costs from the perspective of the VA health care system and society as a whole (ie, consumption of all resources on behalf of these patients). Results  There were no significant differences between groups in study retention; positive, negative, or total symptoms of schizophrenia; quality of life; or extrapyramidal symptoms. Olanzapine was associated with reduced akathisia in the intention-to-treat analysis (P<.001) and with lower symptoms of tardive dyskinesia in a secondary analysis including only observations during blinded treatment with study drug. Small but significant advantages were also observed on measures of memory and motor function. Olanzapine was also associated with more frequent reports of weight gain and significantly greater VA costs, ranging from $3000 to $9000 annually. Differences in societal costs were somewhat smaller and were not significant. Conclusion  Olanzapine does not demonstrate advantages compared with haloperidol (in combination with prophylactic benztropine) in compliance, symptoms, extrapyramidal symptoms, or overall quality of life, and its benefits in reducing akathisia and improving cognition must be balanced with the problems of weight gain and higher cost.      

HIV seroprevalence and risk behaviors in psychiatric inpatients.

The seroprevalence of the human immunodeficiency virus (HIV) in 515 patients consecutively admitted to a state psychiatric hospital in New York City was 8.9%. There were 365 patients whose results were individually traceable; the remaining 150 patients were tested anonymously. Risk factors including parenteral drug abuse, male homosexual behaviors, and other sexual behaviors were studied in the traceable patients. Logistic regressions indicated that parenteral drug abuse was the main risk factor in both males and females. In females, two additional factors were significant: sex with parenteral drug users or with partners who have the acquired immunodeficiency syndrome (AIDS), and sex with bisexual men. Females with bipolar disorders were particularly likely to report sex with parenteral drug users or with partners who have AIDS.     

A novel flow cytometric phagocytosis assay of malaria-infected erythrocytes

Monocytes play a crucial role in controlling malaria infection. To facilitate our research into the development of antibody-mediated immunity against pregnancy-associated malaria we have established several novel malaria-specific flow cytometric phagocytosis assays based on ethidium bromide staining of DNA present in blood stage trophozoites. The first assay quantifies the ability of sera to opsonise trophozoites and promotes phagocytosis by the monocytic cell line THP1. This measures the levels of functional antibodies to the chosen strain of parasite. The second assay is a whole blood phagocytosis assay which measures the phagocytic ability of patient monocytes ex vivo. The third assay employs simultaneous labelling of trophozoites with ethidium bromide and erythrocytes with fluorescein isothiocyanate to compare phagocytosis of both non-infected and parasitised erythrocytes to assess possible bystander effects on uninfected erythrocytes. These assays have the advantage over other malaria phagocytosis assays in that they are rapid, simple and specific to malaria-infected cells and avoid potential bias associated with manual counting.     

Neuroleptic augmentation with alprazolam: clinical effects and pharmacokinetic correlates

Alprazolam added to stable doses of neuroleptics in nine schizophrenic patients was associated with a 20%-30% mean reduction in positive and negative symptoms, although clinical response was variable and in some patients particularly brisk. The authors examined the possibilities of a pharmacokinetic effect of alprazolam on neuroleptic plasma levels and of a clinical effect of alprazolam. The modest increase in mean neuroleptic plasma levels did not correlate with clinical change, but those patients with the highest alprazolam plasma levels tended to show more robust clinical responses.     

Response to trauma in Haitian youth at risk

In order to characterize undesirable behavior (drug use, fighting, criminal activity) among Haitian youth at risk and determine the relationship between traumatic experience and that kind of behavior, investigators recruited 292 Haitian youths via networks of informal social relations in two zones of Miami/Dade County strongly identified with Haitian ethnicity. Each recruit responded to an interview schedule eliciting sociodemographic information and self-reported activities, including involvement in youth-dominated groups. They also reported traumatic experience. Clinicians administered CAPS to a subset of those respondents who self reported traumatic experience. Staff ethnographers selected respondents for in-depth interviews and family studies to provide contextual depth for findings of the interview schedule and the CAPS assessments. Although traumatic experience may still play a role in mental health outcomes among children, childhood victimization among Haitian children does not appear to be related to the drug use and undesirable behaviors associated with unsupervised youth, including formation of gangs.