High degree of Plasmodium vivax diversity in the Peruvian Amazon demonstrated by tandem repeat polymorphism analysis

Molecular tools to distinguish strains of Plasmodium vivax are important for studying the epidemiology of malaria transmission. Two sets of markers-tandem repeat (TR) polymorphisms and MSP3α-were used to study Plasmodium vivax in patients in the Peruvian Amazon region of Iquitos. Of 110 patients, 90 distinct haplotypes were distinguished using 9 TR markers. An MSP3α polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) using HhaI and AluI revealed 8 and 9 profiles, respectively, and 36 profiles when analyzed in combination. Combining TR and PCR-RFLP markers, 101 distinct molecular profiles were distinguished among these 110 patients. Nine TR markers arrayed along a 100 kB stretch of a P. vivax chromosome containing the gene for circumsporozoite protein showed non-linear linkage disequilibrium (I(SA) = 0.03, P = 0.001). These findings demonstrate the potential use of TR markers for molecular epidemiology studies.     

Implicit learning of emotional information under anesthesia

Surgical stress activates the amygdala and secretion of norepinephrine, both involved in memory and unconscious processing of emotionally negative information. This study examined surgically induced facilitation of implicit learning of emotionally negative information. Thirty patients undergoing laparoscopic cholecystectomy under general anesthesia were tested. Between 2 and 4 h after surgery, patients provided word-associates to cues previously presented (old) or not previously presented during anesthesia (new). Half the cues were emotionally negative and half neutral. Patients took less time to provide correct associates to old emotionally negative cues than to new emotionally negative cues (p < 0.05). Spectral edge frequency (SEF) of cerebral activity during surgery converged with this finding. Implicit learning during general anesthesia may be stronger for emotionally negative information and is detected by SE.     

Effects of guided written disclosure of stressful experiences on clinic visits and symptoms in frequent clinic attenders

BACKGROUND: Psychosocial variables such as major stressful life events/daily stressful events have been associated with health care utilization. OBJECTIVE: Our aim was to examine the effects of a guided disclosure protocol (GDP) of past traumas on symptoms and clinic visits among frequent clinic attenders. METHODS: Forty-one frequent clinic attenders (> or =2 visits/3 months) took part. Patients were randomly assigned individually to either a casual content writing control group (n = 19) or a trauma content writing experimental GDP group (n = 22). GDP patients wrote about an upsetting event chronologically (day 1), verbally described their thoughts and feelings and described the event's impact on life (day 2), and finally wrote about their current perspective on and future coping with the event (day 3). Three months later, patients were reassessed blindly for symptoms and clinic visits, and an average of 15 months later they were assessed blindly for clinic visits again. RESULTS: Compared with controls, GDP patients reported lower symptom levels at 3 months (2.3 versus 5.2), and made fewer clinic visits during the 3 (1.3 versus 3.0) and 15 month (5.1 versus 9.7) follow-ups. The percentage of GDP patients making > or =10 visits during the 15 month follow-up was smaller (10%) than among controls (33%). CONCLUSIONS: The findings extend previous findings to frequent clinic users, using a new form of written disclosure aimed at shifting trauma from implicit to explicit memory. The GDP may be an inexpensive additional intervention in primary care for reducing symptoms and clinic visits among frequent clinic users.     

Volunteer programs in mental health

A comparison of different types of volunteer programs in two mental health institutions is presented. The types of rewards available to volunteers and the method of structuring the volunteer program have an effect upon the types of volunteers attracted to and retained by the institutions. The institution that places a high value on the work of the volunteers, involves them in the professional treatment team, and provides work-related satisfactions for them attracts volunteers who differ in many respects from those attracted by institutions that use volunteers only in ancillary capacities.Dr. Gidron is the Director of the Joseph J. Schwartz Graduate Program for Training Community Center Directors and Senior Personnel at the Paul Baerwald School of Social Work, Hebrew University, Jerusalem. The research upon which this paper is based was carried out as part of Dr. Gidron's doctoral dissertation.     

Development and validation of a new measure of student attitudes and knowledge of international health and medicine

There is increasing awareness of the importance of international health and medicine (IHM) but there is a paucity of data regarding medical students' attitudes towards and knowledge of the subject. To the best of our knowledge there is currently no validated measure to assess this. The aim of the present study was to develop a validated measure of medical students' attitudes and knowledge of IHM and examine its correlates. A panel experienced in IHM formulated attitude and general knowledge items and clinical cases based on personal experience, literature review and texts. The survey was piloted and then administered to 82 students of the Ben Gurion University-Columbia University MD program in IHM, and 59 students from programs without specific IHM focus. Cronbach's a was 0.87. Test-retest reliability of attitudes was r=0.87. Correlation of openness to experience with attitudes was r=0.376, showing construct validity. Third-year IHM students scored higher than incoming students on IHM knowledge and clinical cases, demonstrating sensitivity. General IHM knowledge was positively correlated to clinical IHM knowledge r=0.36, but not attitude or openness to experience. Those with previous IHM work experience showed greater openness and positive attitude. Women showed more positive attitudes towards IHM than men. Attitude was negatively correlated with number of languages spoken r=-0.198. The survey may be a reliable and valid tool to assess and compare medical students' knowledge and attitude toward international health. This survey can be used to evaluate curricular innovations in the field.     

Psychological factors correlate meaningfully with percent-monocytes among acute coronary syndrome patients

Recent research demonstrates the importance of inflammatory parameters in the etiology and prognosis of the acute coronary syndrome (ACS). This study explored relations between psychological factors and immunological parameters routinely measured among ACS patients. Forty-two ACS patients completed questionnaires assessing perceived-control, emotional support, hostility, and life-events 2-4 days after hospitalization. Data on total leukocytes and percentages (%) of monocytes, %neutrophils, and %lymphocytes upon admission to hospital were collected from computerized medical charts as well as various biomedical information and risk-factors (e.g., diagnosis, left-ventricle-LV functioning, smoking, and hypertension). Of all significant biomedical variables, LV-function and arrival-time correlated uniquely with total leukocytes. Controlling for LV-function and arrival-time, hostility and life-events positively correlated with %monocytes, and perceived-control and emotional-support inversely correlated with %monocytes. Emotional-support was positively correlated and life-events were negatively correlated with %neutrophils. Macrophages play a pivotal role in plaque instability, the trigger of an ACS. This initiating role, and our finding of a relationship between recruitment of monocytes and a poor psychosocial profile, predictive of ACS, are consistent with a PNI component in the pathophysiology of ACS.     

Effect of myocardial infarction on components of fibrinolytic system.

A systematic investigation of the fibrinolytic system during the period after acute myocardial infarction in 42 patients showed a progressive reduction of fibrinolytic activity, with the longest lysis times on days 4 to 5 after the event. There is a concomitant rise in the levels of fibrinogen, plasminogen, and antiplasmin; only the latter parallels the delay in lysis. After 12 to 15 months, normal lysis times and fibrinogen levels were found in 24 patients re-examined. It is concluded that the reduced fibrinolytic activity in these patients was a transient phenomenon after myocardial infarction.     

Stress and coping patterns of participants and non-participants in self-help groups for parents of the mentally ill

The authors examined differences in stress and coping patterns as well as in situationally-related variables between participants and non-participants in self-help groups for parents of the mentally ill in Israel. Participants, who were higher on socio-economic status indicators, reported coping patterns that tended to be both more active and interactive. They also reported greater concerns around psycho-social issues than non-participants. The authors discuss the possible interrelationships among these findings.     

Selective effects of upper respiratory tract infection on cognition, mood and emotion processing: a prospective study

Observational and experimentally induced infection studies show that upper respiratory tract infections (URTI) affect mood and cognition. This study tested the effects of naturally occurring URTI on cognition, mood and emotional processing, using a prospective design, with a broader array of tests than previous research, and with well matched control participants. Eighty participants (42 younger, M age 20.3 years; 38 older, M age 64.3 years) underwent neuropsychological assessment at baseline. Once a participant had URTI symptoms, s/he and a healthy, matched participant were retested. The Cognitive Drug Research computerised assessment battery was used to assess Power and Continuity of Attention, Quality of Episodic and Working Memory, Speed of Memory, and mood. Additionally, emotional processing was measured on matching of emotionally-negative faces with faces and faces with labels. Forty-two of 80 participants were matched (21 well, 21 ill). Well participants improved in Speed of Memory and face-label reaction time. Despite a lack of fever, ill participants demonstrated significantly smaller improvements. Older participants reported feeling less alert if ill, and less stressed if well, than at baseline. All ill participants reported less contentment than at baseline than well participants. Severity of URTI symptoms correlated with changes in Speed of Memory and mood. Even without fever, infectious disease produces large disturbances in speed of cognitive processing, particularly that reflecting retrieval from memory, and these effects are more marked in older participants. URTIs also affect mood. Future studies need to examine the role of inflammatory molecules and the brain regions implicated in mediating these findings.     

Blunted HPA axis response to stress influences susceptibility to posttraumatic stress response in rats.

BACKGROUND: Posttraumatic stress disorder (PTSD) is associated with low levels of circulating cortisol, and recent studies suggest that cortisol administration may reduce PTSD symptoms. This study investigated the role of cortisol in the manifestation of anxiety- and fear-like symptoms in an animal model of PTSD. METHOD: Magnitude of changes in prevalence of anxiety-like behaviors on the elevated plus-maze and nonhabituated exaggerated startle reaction were compared in three strains of rats exposed to predator stress, with and without prior corticosterone treatment. Extreme behavioral changes in both paradigms implied an extreme behavioral response (EBR), representing PTSD-like symptoms. RESULTS: Lewis rats exhibited greater baseline anxiety-like behaviors and greater stress-induced increases in anxiety-like behaviors than Fischer F344 or Sprague-Dawley rats, with only minor corticosterone increases following stress. Prevalence of EBR was 50% among Lewis rats compared with 10% of Fischer F344 and 25% of Sprague-Dawley rats. Administering corticosterone 1 hour before stress exposure reduced the prevalence of EBR from 50% to 8% in the Lewis rats. CONCLUSIONS: These results suggest that a blunted HPA response to stress may play a causal role in this model of PTSD and that this susceptibility may be prevented by administration of cortisol before stress exposure.