The role of somatic complaints in the diagnosis of depression in children and adolescents

The question of whether somatic complaints are a significant feature of depression independent of anxiety was explored. Structured interview (Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children) and Child Behavior Checklist data from depressed and nondepressed psychiatric controls were analyzed to explore the interaction of somatic complaints, anxiety, and depression. Seventy percent of the children who met criteria for depression also had significant somatic complaints in contrast to 34% of the controls. Findings revealed that frequency of somatic complaints increased with severity of depression regardless of coexisting anxiety.     

Acute Cellular Rejection with CD20-Positive Lymphoid Clusters in Kidney Transplant Patients Following Lymphocyte Depletion

Lymphoid clusters (LC) containing CD20-positive B cells in kidney allografts undergoing acute cellular rejection (ACR) have been identified in small studies as a prognostic factor for glucocorticoid resistance and graft loss. Allograft biopsies obtained during the first episode of ACR in 120 recipients were evaluated for LC, immunostained with CD20 antibody, and correlated with conventional histopathologic criteria, response to treatment and outcome. LC were found in 71 (59%) of the 120 biopsies. All contained CD20 positive B cells that accounted for 5-90% of the LC leukocyte content. The incidence of LC was highest in the patients who had no lymphoid depletion or had been treated with Thymoglobulin preconditioning (79% vs. 75%, respectively) compared to 37% in patients pretreated with Campath (p = 0.0001). Banff 1a/1b ACR were more frequent in the LC-positive than the LC-negative group (96% vs. 80%, respectively; p = 0.0051). With a posttransplant follow-up of 953 +/- 430 days, no significant differences were detected between LC-postitive and LC-negative groups in time to ACR, steroid resistance, serum creatinine and graft loss. CD20+LC did not portend glucocorticoid resistance or worse short to medium term outcomes. CD20+LC may represent a heterogenous collection in which there may be a small still to be fully defined unfavorable subgroup.     

Occupational and environmental health in the 21st century: the new frontier in genetics and disease prevention.

Society is currently on the threshold of a new revolution in understanding the interaction of genes and the environment. This research has profound implications for understanding occupational disease and will present ethical challenges to occupational health practice. The public must be educated about the potential promise, as well as the threats, posed by emerging genetic technologies.     

ISCHAEMIA-REPERFUSION INJURY TO THE INTESTINE

Ischaemia-reperfusion injury (IRI) is of obvious relevance in situations where there is an interruption of blood supply to the gut, as in vascular surgery, or in the construction of free intestinal grafts. It is now appreciated that IRI also underlies the gut dysfunction that occurs in early shock, sepsis, and trauma. The events that occur during IRI are complex. However, recent advances in cellular biology have started to unravel these underlying processes. The aim of this review is to provide an outline of current knowledge on the mechanisms and consequences of IRI. Initially, IRI appears to be mediated by reactive oxygen metabolites and, at a later stage, by the priming and activation of polymorphonuclear neutrophils (PMN). Ischaemia-reperfusion injury can diminish the barrier function of the gut, and can promote an increase in the leakage of molecules (intestinal permeability) or the passage of microbes across the wall of the bowel (bacterial trans-location). Ischaemia-reperfusion injury to the gut can result in the generation of molecules that may also harm distant tissues.     

Normal and abnormal glenoid labrum: assessment with multiplanar gradient-echo MR imaging.

A retrospective study of magnetic resonance (MR) imaging of the glenoid labrum performed with multiplanar gradient-echo (MPGR) sequences was done to ascertain the different appearances of the normal labrum and the findings in patients with tears. MPGR images were obtained with a 1.5-T magnet in 37 shoulders of 16 healthy subjects and 19 patients with subsequent surgical evaluation. Increased intralabral signal intensity was seen in 12 of 26 normal shoulders (46%), and atypical morphology was seen in six shoulders (23%). Atypical morphology was present in eight of nine patients with labral tears. Deformity (n = 2 [22%]) and clefts (n = 2 [22%]) were seen in patients with tears. Deformity (n = 3 [12%]) and clefts (n = 1 [4%]) were occasionally seen in healthy subjects. Absence of the labrum and separation of the labrum from the glenoid cavity was present only in patients with tears; therefore, the labrum should be presumed torn in the presence of these findings. Increased intralabral signal intensity on MPGR images did not help predict labral integrity; morphologic findings were more predictive of labral tear.     

Immigrant workers in the United States: recent trends, vulnerable populations, and challenges for occupational health.

Immigrant workers are a rapidly growing segment of the U.S. work force, and these increasing numbers have resulted in a different ethnic mix in the work force than in previous decades. Immigrant workers are not a homogenous group, but are over-represented in low-paying occupations. Their diversity and vulnerability present distinct challenges for occupational health nurses. High-risk occupations in which a large proportion of immigrant workers are hired include agriculture, sweatshops, day laborers, and construction. Initiatives needed to improve the working conditions of this vulnerable population include improved surveillance and research, culturally competent care providers, improved health care access, advocacy, and changes in immigration and health policy.