Is asthma treatment affordable in developing countries?

BACKGROUND: A study was undertaken to assess whether the therapeutic aspects of published international asthma management guidelines are practically applicable in developing countries. METHODS: Questionnaires were sent to expatriate doctors working in developing countries. RESULTS: Forty one replies were received from 24 countries in Africa and Asia. Oral salbutamol was prescribed "usually" or "often" by 35 of the 41 respondents, theophyllines by 30, inhaled bronchodilators by 12, inhaled steroids by two, and cromoglycate by two. Theophyllines were locally available in all 41 cases, oral salbutamol in 40, inhaled bronchodilators in 34, and inhaled steroids (usually beclomethasone 50 micrograms) in only 15. Where they were available, the median (range) coat of a beclomethasone 50 micrograms inhaler was 20% (6.8-100%) of average local monthly income, salbutamol inhaler 13% (3.3-250%), 90 salbutamol 4 mg tablets 3.8% (0.8-75%), and 90 aminophylline 100 mg tablets 4.5% (0.5-70%). If they were available locally at a cheaper price, 34 (83%) respondents would prescribe more inhaled steroids and 37 (90%) would prescribe more inhaled bronchodilators. CONCLUSIONS: Many asthma patients in developing countries are not receiving adequate treatment because the required drugs are not available in their area or are prohibitively expensive.     

Women's experiences of treatment of depression: Medicalization or empowerment?

An interview study was conducted in which women's experiences of diagnosis and treatment for depression were explored. Nine women (aged 19–66 yrs) who had been diagnosed by a physician participated in the study. Topics explored in the interview included how women came to be diagnosed as depressed, how treatment was experienced, how they understood the causes of their depression, and how being diagnosed had affected their view of themselves and their futures. Analysis involved a thematic approach guided by the topics addressed in the interview. The women's accounts also were analyzed with respect to the themes of medicalization and empowerment. All of the participants gave medicalized accounts of their depressive experiences, which were characterized by biomedical explanations and identification of anti-depressant drugs as beneficial in alleviating their distress. Based on this analysis of the women's accounts, it is concluded that a medicalized understanding and treatment of women's depressive experiences cannot readily co-exist with personal empowerment. Suggestions are made for developing strategies for treatment of women's depressive experiences that offer the benefits of medicalization without precluding the possibility of personal empowerment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

What place for endoscopic sphincterotomy in treatment of acute pancreatitis?

STUDY AIM: A prospective study was undertaken in order to evaluate the effects of endoscopic sphincterotomy on the evolution of biliary and idiopathic acute pancreatitis. PATIENTS AND METHODS: Among 320 patients with acute pancreatitis observed from 1986 to 1996, 118 were excluded from the study for etiological reasons and 137 were included for an endoscopic sphincterotomy within 72 hours from their admission. There were nine technical failures and 128 endoscopic sphincterotomies were performed. Sixty-five eligible patients were not included for logistic problems or patients' refusal; they can be considered as a "control group". RESULTS: The mortality rate of endoscopic sphincterotomy was 0 and the morbidity rate 2.1%. The mortality rate of acute pancreatitis was 3.1% in the sphincterotomy group vs 7.6% in the control group (P = 0.1) (NS) and the morbidity rate 25% versus 32% (P > or = 0.1) (NS). CONCLUSION: These results suggest that endoscopic sphincterotomy could be beneficial in acute biliary or idiopathic pancreatitis but they are not statistically significant. Endoscopic sphincterotomy does not increase the severity of acute pancreatitis and can be considered particularly in cases of gallstone pancreatitis but it should be performed less than 48 hours after the onset of acute pancreatitis.     

MMPI–2 typology of pregnant drug-dependent women in treatment.

The present study examined the validity of Minnesota Multiphasic Personality Inventory–2 (MMPI–2) typology for pregnant drug-dependent women. A 3-cluster solution based on 7 MMPI–2 clinical scales emerged as the best model and was replicated across split-half samples and different primary substance-use diagnoses and treatment modalities. The 3 subtypes identified included Type I (n?=?40, 24%) with no clinical elevation, Type II (n?=?72, 42%) with elevated psychopathic deviate scale, and Type III (n?=?58, 34%) with elevations on all 7 scales. Analyses with interview and self-report measures showed good concurrent validity. Type II had higher retention than Type I and Type III across methadone and medication-free treatments, showing some predictive validity. An a priori method for classifying new cases on the basis of the proposed typology was developed and validated. Study findings support MMPI–2's use with pregnant drug-dependent women for assessment and possibly treatment planning. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Banding phenomena in AlFe alloys subjected to laser surface treatment

Using beam rates of between 0.005 and 18.0 m/s, laser-melted tracks were produced on AlFe alloy samples containing between 0.25 and 8.0 wt% Fe. The local solidification rates were measured by taking a longitudinal section through the centre of the laser trace, and the corresponding microstructures were studied quantitatively using transmission electron microscopy. Two different banded structures were observed: one at slow scanning rates (low-velocity bands) and another at high growth rates (high-velocity bands). The low-velocity bands were shown to depend essentially upon conditions prevailing at the surface, and were attributed to convection (Marangoni) effects. For all of the alloys there was a critical growth rate, at which the cellular-dendritic structure was replaced by a high-velocity banded structure which consisted of a succession of light and dark bands which lay approximately parallel to the solid-liquid interface. The structure of the dark bands was similar to that of the cellular-dendritic structure prior to the onset of the banded structure. Diffraction patterns from the light bands exhibited spots only of the f.c.c. α-Al solid solution and microanalyses showed that, within a light band, the concentration was uniform and equal to the nominal concentration of the alloy. With increasing growth rate, the widths of the dark bands decreased continuously and, since the overall spacing of the bands remained constant, this finally led to the disappearance of the dark bands. A completely precipitation-free was then observed at very high growth rates in the more dilute alloys. A phenomenological model, based upon periodic instabilities of the growth rate, was proposed in order to explain the origin of the high-velocity banded structure.     

Is androgen deprivation therapy effective in the treatment of sex offenders?

We review the effects of androgen deprivation on the sexual behavior of human males. Although eunuchs have existed in many cultures over the last 4,000 years, there is scant detailed and specific information in the historical record about castration status and sexual behavior. From the literature on modern-day eunuchs who are not sex offenders, we conclude that androgen deprivation reduces sexual desire and behavior, including sexual intercourse. Most men, especially those who did not volunteer for the treatment, experience the side effects as extremely bothersome. Androgen deprivation therapy (ADT) receives endorsements from some clinicians who treat sex offenders, and it probably reduces sexual recidivism among men who freely request the procedure, but good evidence is sorely lacking. Men who freely request and persist with ADT are probably an especially low-risk group. Little is known about the effects of sexual or violent recidivism among sex offenders who do not freely request it. Little is known about the long term effects of ADT on sexual behavior in general, and sexual recidivism in particular, or about long-term health effects. Clearly, much more research is needed before ADT has a sufficient scientific basis to be relied upon as a principal component of sex offender treatment. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Research on the heat treatment of tool steel 5Cr15MoV

Tempered tool steel 5Cr15MoV was normalized at different temperatures followed by air-cooling.It is found that the hardness increases with the increment of a normalizing temperature from 950℃ to 1 150℃,and it then decreases with the temperature getting higher.The Thermo-calc calculation reveales that the mole fraction of carbides decreases when the normalizing temperature increases,which indicates that more carbon dissolved in the matrix enhances the hardness of the steel.However,the existence of retained austenite causes hardness reduction when the normalizing temperature is over 1 150℃.The salt spray test shows that the steel possesses poor corrosion resistance when it is normalized at a temperature above 1 100℃.The precipitation of the carbides in the cooling process creates a number of chromium-depleted zones,making the steel vulnerable to corrosives.In the present work,an appropriate normalizing temperature is suggested.     

Study on phosphating treatment of aluminum alloy： role of yttrium oxide

Zinc phosphate coatings formed on 6061-Al alloy, after dipping in phosphating solutions containing different amounts of Y2O3(yttrium oxide), were studied by scanning electron microscopy (SEM), X-ray diffraction (XRD) and electrochemical measurements. Significant variations in the morphology and corrosion resistance afforded by zinc phosphate coating were especially observed as Y2O3 in phosphating solution varied from 0 to 40 mg/L. The addition of Y2O3 changed the initial potential of the interface between aluminum alloy substrate and phosphating solution and increased the number of nucleation sites. The phosphate coating thereby was less porous structure and covered the surface of aluminum alloy completely within short phosphating time. Phosphate coating was mainly composed of Zn3(PO4)2-4H2O (hopeite) and AIPO4(aluminum phosphate). Y2O3, as an additive of phosphatization, accelerated precipitation and refined the gain size of phosphate coating. The corrosion resistance of zinc phosphate coating in 3% NaCl solution was improved as shown by po-larization measurement. In the present research, the optimal amount of Y2O3 was 10-20 mg/L, and the optimal phosphating time was 600 s.     

Does stress exacerbate parental differential treatment of siblings? A pattern-analytic approach.

To develop a typology based on family members' perspectives on parental differential treatment of siblings, data from mothers, fathers, firstborn adolescent siblings (M?=?15 years), and second-born adolescent siblings (M?=?12.5 years) from 187 families were submitted to cluster analysis. A 4-cluster solution based on the convergence or divergence of reports and the levels of parental differential treatment was identified and replicated: convergent/all below average (n?=?94), convergent/all above average (n?=?48), divergent/all below average except older sibling (n?=?20), and divergent/all above average except mother (n?=?25). Analyses revealed cluster differences in family structure (e.g., sex of siblings, age spacing) and in parents' perceived levels of stress across several domains (e.g., work, marriage, and individual mental health). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The coupled zone of rapidly solidified AlSi alloys in laser treatment

Laser-melted tracks were produced on AlSi samples containing between 15.5 and 26 wt% Si with the resultant solidification rates being measured by taking a longitudinal section through the centre of the laser trace. The Al-rich boundary of the coupled zone, i.e.the growth rate-concentration limit at which the transition from fibrous AlSi eutectic to α-Al dendrites plus interdendritic eutectic takes place, has been experimentally determined for concentrations of Si varying from 15.5 to 20 wt%. Supposing that the growing structure, for a given growth rate, is the one having the higher growth temperature, good agreement is found with the more recent microstructural growth models when kinetic effects are taken into account. For concentrations of Si higher than 20 wt%, primary Si crystals imbedded in equiaxed eutectic grains are observed which replace columnar eutectic and dendritic growth.     

Structure of electroexplosive TiC–Ni composite coatings on steel after electron-beam treatment

The phase and elemental compositions of the surface layer in Hardox 450 steel after electroexplosive spraying of a TiC–Ni composite coating and subsequent irradiation by a submillisecond high-energy electron beam are studied by the methods of modern physical metallurgy. The electron-beam treatment conditions that result in the formation of dense surface layers having high luster and a submicrocrystalline structure based on titanium carbide and nickel are found. It is shown that electron-beam treatment of an electroexplosive coating performed under melting conditions leads to the formation of a homogeneous (in structure and concentration) surface layer.     

The microstructure of rapidly solidified AlFe alloys subjected to laser surface treatment

Using traverse rates of between 0.1 and 6.0 m/s, laser-melted tracks were produced on AlFe alloy samples containing between 0.25 and 8.0 wt% Fe. The local solidification rates were measured by taking a longitudinal section through the centre of the laser trace and the corresponding microstructures were studied quantitatively using transmission electron microscopy. Three types of microstructures were observed. At low growth rates, cellular/dendritic structures were obtained. At high growth rates, a banded structure was formed which consisted of a succession of light and dark bands which lay approximately parallel to the solid-liquid interface. At the lower concentrations, precipitate-free structures were obtained at very high solidification rates. A recent model, for dendritic growth under rapid solidification conditions, was compared with the experimental results and a good correlation was found. It was shown that, at rates close to the limit of absolute stability, steady-state planar-front growth was not the preferred growth morphology; but rather a banded structure. It was only at much higher rates that a fully precipitation-free structure, probably involving plane-front growth, developed.     

“Gender aware therapy” for professional men in a day treatment center.

High accountability men in the medical, legal, corporate, and mental health professions sometimes engage in behavior that violates their fiduciary responsibilities. These highly skilled men may engage in disruptive or explosive behavior, cross sexual boundaries with clients or patients, abuse substances, or have other psychiatric problems that compromise their workplace performance. When this occurs, licensing boards, professional societies, or supervising executives often require the dysregulated man to seek assistance. This article reports on ways the Professional Renewal Center incorporates recommendations from “Gender Aware Therapy” in developing a male-friendly approach to conducting comprehensive multidisciplinary psychological assessments, and to providing intensive, multimodal, weeks-long treatment services. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Is radiotherapy still the first choice treatment in spinal metastases from breast cancer?

The skeletal system is a frequent site of metastatic involvement from breast cancer, whose pattern of spread is such that cure becomes practically impossible. The best palliation with the minimum discomfort for the patient must therefore be the major objective. With an increasing number of reports about major surgical procedures for spinal metastases, we reviewed our series of patients submitted to radiotherapy. Of 2,189 breast cancer patients, we selected 28 who might have been potential candidates for surgical resection (with lesions only in the spine, only one or no more than three contiguous bodies involved and no other metastases). All these patients had been treated with 20 or 30 Gy plus systemic (chemo, hormone, or both) therapy. Follow-up revealed that all of them had developed new metastases outside the treated field within one year. Local control was achieved in 68% of patients and 75% of them had stable or better performance status at 3 months. Median survival was 36 months. From our analysis, even patients with a so called "solitary lesion" seem not to have a better prognosis than others. We conclude that radiotherapy is still the method of choice to treat vertebral metastases from breast cancer. The role of surgery should be limited to patients with neurologic compression or severe mechanical instability.     

Should third-generation cephalosporins be the empirical treatment of choice for severe community-acquired pneumonia in adults?

The choice of empirical treatment for community-acquired pneumonia (CAP) is highly controversial. Our survey of 42 Australian emergency department doctors showed that monotherapy with a third-generation cephalosporin was the preferred regimen for severe CAP (14/42; 33%). We argue that cheaper regimens with a narrower spectrum are likely to be just as effective as third-generation cephalosporins and will have fewer adverse effects on the microbial ecology of hospitals. We suggest penicillin or ampicillin (to cover pneumococci--even if penicillin "resistant"--and Haemophilus influenzae), plus a macrolide (e.g., azithromycin or erythromycin; to cover Legionella and other "atypical" pathogens), plus a single large dose of an aminoglycoside (e.g., gentamicin; to cover gram-negative bacilli such as Klebsiella pneumoniae) as empirical therapy for severe CAP.     

Women with bulimic eating disorders: When do they receive treatment for an eating problem?

Variables associated with the use of health services were examined in a prospective, community-based study of women with bulimic-type eating disorders who did (n = 33) or did not (n = 58) receive treatment for an eating problem during a 12-month follow-up period. Participants who received treatment for an eating problem differed from those who did not in several respects, including higher body weight, higher levels of eating disorder psychopathology, general psychological distress, and impairment in role functioning, deficits in specific aspects of coping style, greater awareness of an eating problem, and greater likelihood of prior treatment for a problem with weight. However, the variables most strongly associated with treatment seeking were greater perceived impairment in role functioning specifically associated with an eating problem and greater perceived inability to suppress emotional difficulties. These were the only variables that were significantly associated with treatment seeking in multivariable analysis. The findings suggest that individuals’ recognition of the adverse effects of eating-disordered behavior on quality of life may need to be addressed in prevention and early intervention programs for eating disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive–behavioral treatment of anxiety disorders in children: Long-term (6-year) follow-up.

Authors evaluated the long-term effectiveness of cognitive–behavioral therapy (CBT) for childhood anxiety disorders. Fifty-two clients (aged 14 to 21 years) who had completed treatment an average of 6.17 years earlier were reassessed using diagnostic interviews, clinician ratings, and self- and parent-report measures. Results indicated that 85.7% no longer fulfilled the diagnostic criteria for any anxiety disorder. On a majority of other measures, gains made at 12-month follow-up were maintained. Furthermore, CBT and CBT plus family management were equally effective at long-term follow-up. These findings support the long-term clinical utility of CBT in treating children and adolescents suffering from anxiety disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)