"Healthometer"--an instrument for self-distributed health screening and prevention in the population

In the ongoing expansion of medical systems toward prevention and health promotion, primary care is increasingly recognized as a key vehicle and agent. In order to establish a comprehensive health dialogue in the population, there is a need for innovative instruments corresponding to the information and linked media revolution that this shift is a part of. Based upon the experiences of the Department of Preventive Medicine in Malm?, Sweden, a self-mediated, interactive health testing and promotion instrument called "healthometer" has been developed and tested for feasibility. The instrument uses a special variety of a quintile-distributed visual analog scale with the thermometer as reference and allows: (a) easy summation and averaging of single or different aggregates of the test items as a "wellness" profile and score with emphasis upon the positive aspects of health, and (b) recognition against this on the whole favorable background of the weak points motivating further action. The instrument, which can be distributed on paper or electronic medium, supports participation and insight in the initial stages of a directed individual health program for the continuation of which the utilization of professional counsel is stimulated.     

Comment on "Suggestions for a Radical Change".

Comments on "Suggestions for a Radical Change", by Mitchell Berkun (1954). Berkun's intriguing ideas seem both exciting and practical. The biggest problem would be the complexity of carrying out the system recommended, but once in function for a year, certain problems could perhaps be ironed out as a result of this initial experience. Factors improved by Berkun's system of binding articles separately are summarized. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Measurement properties of the Center for Epidemiologic studies—Depression Scale in a homeless population.

The measurement properties of the Center for Epidemiologic Studies—Depression Scale (CES-D; L. S. Radloff, 1977) were evaluated in a probability sample of homeless adults residing in a large and demographically diverse community. The findings from this investigation suggest that the CES-D is a reliable measure of depressive symptoms among homeless adults and that the factor structure of the scale replicates the factor structure found in the general population. Change in the CES-D scores was associated with change in residential status, with participants who had made a transition from homelessness to regular domicile, reporting significantly lower levels of depressive symptomatology. This result indicates the scale's sensitivity to current depressive mood, as affected by significant life events encountered by homeless persons. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of childhood abuse on relapse in a recently homeless substance-dependent veteran population.

The impact of childhood abuse, both childhood sexual abuse (CSA) and childhood physical abuse (CPA), is well documented. Both CSA and CPA have been associated with a number of mental health difficulties, including substance dependence. Though the association between abuse and mental health problems is well documented, what has received little attention is the impact that abuse histories may have on the ability to complete treatment for these problems. This study evaluates the association between abuse and failure to complete treatment due to substance relapse in 70 substance-dependent homeless men served by a Veterans Affairs Domiciliary Residential Rehabilitation and Treatment Program. Demographic and mental health variables were compared with incident rates of sexual and physical abuse as well as with rates of relapse prior to program completion. Contrary to predictions, results found that physical abuse, not sexual abuse, was associated with higher relapse rates. Limitations, implications, and future directions are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

ALATOP-RIA in the screening of atopy in a non Caucasian population

ALATOP is an "in vitro" radioimmunoassay screening test for atopy, previously validated in a caucasian population. The aim of the study was to assess the usefulness of a screening test of atopy in a non caucasian population. We select a non caucasian population (n = 208), from hospital immunoallergy consultations, Cape Verde Republic (Africa). It was determined the sensitivity, specificity and predictive values comparing with skin prick tests (SPT) results for the 208 patients, and with clinical data (Clin) in 115 patients. It was also determined the levels of total IgE, done by IRMA. RESULTS: Using different corrections factors, 0.85 gives the best results: ALATOP/SPT-Sensitivity-88.5% +/- 4.34; Specificity-73.8% +/- 8.41; Positive predictive value-66.9%; Negative predictive value-91.4%; Efficiency of the test-79.3%. ALATOP/CLIN-Sensitivity-95.2% +/- 3.89; Specificity-71.2% +/- 12.07; Positive predictive value-65.6%; Negative predictive value-96.2%; Efficiency of the test-80.0%. The mean values of total IgE were-406 IU/ml. CONCLUSIONS: The mean value of total IgE was significantly increased even in the ALATOP-/SPT-not saw in caucasian populations. The use of a different correction factor (0.85) for ALATOP, optimize the test, showing a good negative predictive value, but raises the question of adapted compositions of screening tests for different populations.     

Reactions to Albee's "Psychology in the sixties".

Comments on the G. W. Albee article (see record 1964-01626-001), which discusses statistics on PhDs granted in psychology, clinical psychologists in private practice, and application vs basic research in the 1960s. The present author feels that the Albee article was interesting, enlightening, and offered a welcome overview of the current status of our profession, but argues that Albee overlooks one important aspect of the training and personnel problem, as does the Joint Commission on Mental Illness and Health. Albee assumes an opposition or antagonism between research and practice which is theoretically unsound and does not correspond to the facts. It is concluded that what is needed is an integration of research and practice, a breakdown of the barriers between those who work in the clinic or office and those in the laboratory. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Large-scale screening for factor V Leiden mutation in a north-eastern German population

A 37-year-old man was referred with thoracic pain after a deceleration trauma. He also had a cerebral contusion and a wrist fracture. There were no sings of hypovolemic shock. Computerized tomography (CT) of the chest and transoesophageal echocardiography (TEE) demonstrated a type B aortic dissection originating just distal to the left subclavian artery. There was a patent false lumen without rupture or distal ischaemia. Conservative treatment was given. A paralytic ileus developed and abdominal complaints persisted for several months. Angiography showed normal patency of mesenteric vessels. On follow-up, 3 years after the accident a slight aortic dilation was found on CT thorax without development of a post-dissection aneurysm. Blunt thoracic injury to the aorta usually gives rise to aortic rupture in the region of the isthmus, which can be complete or partial. In the latter case a false aneurysm may develop. An intimal tear after blunt trauma leading to type B aortic dissection rarely occurs. General principles regarding treatment of type B dissection also apply to this particular condition.     

"Medical Ethics Patient Forum". Results of a model project

BACKGROUND: The patients' forum Medical Ethics is an innovative model project, which aims at intensifying the dialogue between health care professionals and patients as well as their relatives. METHODS AND RESULTS: Practical experiences and data from a complementing evaluative study are reported. By means of a sophisticated instrument of moral psychology, the Moralisches-Urteil-Test (M-U-T), differences are revealed between the participating groups--doctors, health care professionals, patients, medical students etc.--referring to more cognitive or emotional orientations in moral judgment, respectively. These differences contradict common assumptions. CONCLUSION: On the ground of the data presented as well as by subjective estimations of participants it is shown that the ethics discussion with patients is not only successful, but that it is also valuable for teaching by fostering new insights and experiences.     

Fasting plasma glucose in screening for diabetes in the Taiwanese population

OBJECTIVE: To reveal the relationship between fasting and 2-h postload plasma glucose and to examine the appropriate fasting glucose cutoff as the primary screening test for diabetes. RESEARCH DESIGN AND METHODS: We recruited 5,303 subjects from preventive services of the National Cheng Kung University Hospital. Exclusion criteria were age <20 years, pregnancy, known diabetes, and a history of recent surgery, trauma, or illness. All subjects received the 75-g oral glucose tolerance test. The relationship between fasting and 2-h glucose was examined. Sensitivities, specificities, efficiency, and predictive values were assessed at different cutoffs of fasting glucose for prediction of diabetes. RESULTS: The best fit model for the relationship between fasting and 2-h glucose was fasting glucose = 4.914-0.060 x (2-h glucose) + 0.0144 x (2-h glucose)2. From this model, the fasting glucose was 6.0 mmol/l when 2-h glucose was 11.1 mmol/l. A fasting glucose with 6.25 mmol/l gave the same diabetes prevalence as the World Health Organization 2-h glucose criterion. When 7.8 mmol/l was the fasting glucose cutoff, the sensitivity was 28.5%. Lowering the cutoff from 7.8 to 7.0 mmol/l increased the sensitivity by 11.2% and slightly reduced the specificity and positive predictive value. If the cutoffs were 6.25 and 6.0 mmol/l, the sensitivity increased and the specificity and the positive predictive value decreased accordingly. CONCLUSIONS: Our results suggest that fasting glucose as a screening criterion for diabetes could be revised downward to 7.0 mmol/l, because the slight reduction of positive predictive value was more than balanced by an apparent increase of sensitivity and insignificant change of specificity.     

Selective screening for Chlamydia trachomatis infection in a primary care population of women

The potency of food chemicals to induce cell aging was evaluated in human diploid fibroblast cells HAIN-55 having a finite replicative potential by using in vitro aging markers, i.e., decreases of maximum proliferative potential (lifespan) of cells, saturation density in monolayer culture (SD), plating efficiency (PE) and mitotic index (MI), and an increase of cells with polyploid karyotypes. By treatment twice with low concentration of genotoxic chemicals aflatoxin B1, allylisothiocyanate or trans-cinnamaldehyde (severe clastogenic flavoring agent; Kasamaki et al., 1982), lifespan (expressed by the number of cumulative cell population doubling (CPD)) of the treated cells was reduced by 8-12 CPDs accompanied by change of the other aging markers. By successive treatment (29 or 25 times) with non-genotoxic chemical aspartame (N-L-aspartyl-L-phenylalanine) or L-canavanine (structural analogue of L-arginine), lifespan of the treated cells was also slightly shortened (by 2-6 CPDs) compared with the untreated control cells. In the process of cell aging, Mitochondrial activity (MTT activity) decreased almost in parallel with the decrease of SD and MI. On the basis of these results, a variety of genotoxic and non-genotoxic chemicals were examined by using MTT activity as the aging marker for their effects on the aging of HAIN-55 cells and bovine artery endothelial cells which also had a finite replicative potential. The results showed that seven genotoxic and nine non-genotoxic chemicals promoted cell aging.     

Chlamydia trachomatis screening in the adolescent population

1. The reproducibility of measurements of the arterial wall thickness in both the carotid and femoral artery was investigated by means of high-resolution B-mode ultrasonography. For this purpose, subjects with normal and increased intima-media thickness were selected. Images were stored on an optical disk and were analysed with a semi-automatic software program by two readers. Individuals were scanned twice by two independent observers. 2. Measurements were performed of the far and near wall of the common carotid artery and bulbous in 30 healthy subjects and 19 patients known to have an increased intima-media thickness. Far-wall measurements were made of the internal carotid artery on both sides and common femoral artery on the right side only. 3. In healthy subjects the mean within-observer coefficient of variation was 1.8% and 3.0% for the far wall in the common carotid artery on the right side and left side, respectively. For the near wall the mean coefficient of variation of the common carotid artery was 2.8% on the right and 3.4% on the left side. The mean coefficient of variation was less than 4% for both far and near wall in the bulbous and far wall in the internal carotid artery. Even in patients with increased intima-media thickness the mean coefficient of variation of each segment was less than 4.5%. In the control subjects the between-observer coefficient of variation of the common carotid artery was 2.8% and 5.1% for the far wall on the right and left side, respectively, and 3.4% and 4.2% for the near wall on the right and left side. In healthy subjects a mean difference of 0.002 mm within observers was found in the right far-wall common carotid artery, with limits of agreement of -0.048 to 0.052 mm. The coefficient of repeatability was 0.050 mm. For patients with increased intima-media thickness the mean difference in this segment was -0.006 mm (-0.094 to 0.082) with a coefficient of repeatability of 0.088 mm. For the near wall in the common carotid artery and far and near wall in the bulbous and internal carotid artery the mean differences were larger, but were all below 0.1 mm. The differences and limits of agreements increased between observers. In patients the between-observer mean difference of the far wall of the common carotid artery was -0.055 mm (-0.255 to 0.145). For the common femoral artery of normal control subjects the within- and between-observer mean differences were 0.005 mm (-0.119 to 0.129) and 0.015 mm (-0.081 to 0.111), respectively. 4. In conclusion, the reproducibility of intima-media thickness measurements in the common carotid artery is reliable, even in patients with increased artery wall thickness. Also in other segments prone to atherosclerosis, such as the bulbous, internal carotid artery and common femoral artery, a good reproducibility was found. To obtain good reproducibility it is highly recommended to use the same ultrasonographer to scan patients in follow-up studies.     

Discriminative effectiveness for two psychiatric screening instruments for a gerontological population.

Evaluated the ability of 2 screening instruments for geriatric psychiatric patients: one by A. Simon et al and the other by R. D. Savage and P. G. Britton. The overall correctness in discriminating was 66% for the Simon et al scale and 74% for the Savage and Britton scale, although the former misidentified normals as impaired, and the latter misidentified impaired Ss as normal. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

"I non-exist". Paradoxes of death in adolescence

This text presents, from the case study of the analytical treatment of a young girl after a very serious suicide attempt, a theoretical reflection on the question of death during adolescence and its place and function in the psyche. The hypothesis suggested is that resorting to the "idea of death" constitutes an attempt to neutralise the excitement created by the excess of representational activities. A parallel is suggested between the way death and pain are used as a protective shield.