Legionellosis: clinical and epidemiological data

Legionellosis is a contagious disease occurring either sporadically or more frequently in outbreaks, the infections being caused by members of the family Legionellaceae. The disease may show two clinical forms, i.e.: 1) the pneumonic form characterized by fever, pulmonary, neurologic and often hepatic and renal affections, severe evolution and high mortality rate; and 2) non-pneumonic form similar to influenza infection. Occurrence of the disease was mentioned almost all over the world its incidence in Europe reaching 1-3%. The infection sources are: warm water supply systems of hospitals, hotels etc.; water cooling towers, humidifier of air-conditioning systems, disperses for therapeutically applied aerosols, water sprinkling equipment, etc. Incubation period of the disease is 2-10 days. The factors favoring infection have to be looked for with all the conditions generating a decrease in activity of immunization system. Disease control steps through eliminating infection sources: water hyperchlorination, increase of water temperature in water supply systems at 60 degrees C for short periods, detachment of non-functional water pipes from the main trunk line. Occurrence of legionellosis is monitored by both active and passive means applied within the country and on an international level through the Reference Centres for Legionellosis.     

Relationship among hormonal treatments, suppression of spermatogenesis, and testicular protection from chemotherapy-induced damage

To further elucidate the mechanism by which hormonal pretreatment protects the rat testis from damage by procarbazine, we investigated the relationship between the suppression of hormone levels and spermatogenesis and the recovery of spermatogenesis from stem spermatogonia. LBNF1 rats were implanted with capsules containing testosterone or testosterone plus estradiol. After hormone treatment, rats were injected with procarbazine, and recovery of spermatogenesis was assessed. Testosterone (2 cm) plus estradiol (0.5-cm) reduced serum LH levels causing intratesticular testosterone (ITT) to fall to 3% of control levels within 2 weeks, but testis weights and sperm head counts were not appreciably suppressed until 4 weeks. Two weeks' hormone pretreatment, only slightly enhanced spermatogenesis recovery, but 4 weeks markedly increased it. Testosterone (2 cm) alone produced slower suppression of spermatogenesis and less protection from procarbazine than did testosterone plus estradiol implants, despite equivalent suppression of LH and ITT. Long testosterone implants (24-cm) partially maintained ITT at 14% of control despite undetectable LH levels, prevented any decline in sperm counts, and nearly completely abrogated the protective effect of the hormone treatment. Protection appeared to be best correlated with the testis weight reduction by hormone treatment. Thus, recovery of spermatogenesis after chemotherapy is dependent on the degree of suppression of spermatogenesis caused by the reduction of ITT levels at the time of chemotherapy and likely involves cells, such as the Sertoli cells, that are both androgen-responsive and affected by the numbers of germ cells present.     

Exploring the structure of strength-related attitude features: The relation between attitude importance and attitude accessibility.

One of the most significant current controversies in the attitude literature involves the latent structure of attitude attributes related to their strength. Four studies were conducted to explore whether 2 strength-related attributes (importance and accessibility) are affected identically by various manipulations (which would suggest that they reflect a single latent construct) and whether the attributes cause one another (which would suggest they are distinct constructs). Three laboratory experiments and 1 survey study show that (a) repeated expression and personal relevance manipulations have different effects on importance and accessibility and (b) increased importance can cause heightened accessibility. Thus, these 2 attitude attributes appear to constitute related but independent constructs. These studies therefore help to illuminate the nature of attitude strength and the interplay of its sources. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The attitude polarization phenomenon: Role of response measure, attitude extremity, and behavioral consequences of reported attitude change.

Four studies examined the generality of attitude polarization (C. G. Lord et al, 1979). Biased assimilation of essays on 2 controversial issues was substantial and correlated with reported attitude change. Polarization was observed for reported attitude change on capital punishment and generally stronger in Ss with extreme than moderate attitudes. Polarization was not indicated in a pre–post measurement design. For affirmative action, reported polarization was not observed. The hypothesis that Ss reporting polarization would subsequently write particularly strong essays was not supported, although those reporting depolarization wrote relatively weak essays. The results suggest the relevance of individual differences in reported attitude change but do not confirm the powerful inferences frequently drawn regarding the pervasive, undesirable consequences of self-reported attitude polarization. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Efficacy and specific effects data on new treatments: A case study strategy with mixed anxiety-depression.

The case study research strategy presented here can be used to develop new psychotherapeutic treatments, test theorized mechanisms of action, and obtain initial outcome data of the type needed to support treatment outcome grant applications. The strategy is illustrated by 2 case studies of a new psychotherapeutic intervention for patients with coexisting generalized anxiety disorder and major depression as described in the Diagnostic and Statistical Manual of Mental Disorders-III-Revised (DSM-III-R). The treatment is a modification and integration of existing treatments for panic disorder (D. H. Barlow & M. G. Craske, 1989) and for major depression (G. L. Klerman et al, 1984). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sporadic Creutzfeldt-Jakob disease in the United Kingdom: analysis of epidemiological surveillance data for 1970-96

OBJECTIVE: To identify changes in the occurrence of Creutzfeldt-Jakob disease that might be related to the epidemic of bovine spongiform encephalopathy. DESIGN: Epidemiological surveillance of the United Kingdom population for Creutzfeldt-Jakob disease based on (a) referral of suspected cases by neurologists, neuropathologists, and neurophysiologists and (b) death certificates. SETTING: England and Wales during 1970-84, and whole of the United Kingdom during 1985-96. SUBJECTS: All 662 patients identified as sporadic cases of Creutzfeldt-Jakob disease. MAIN OUTCOME MEASURES: Age distribution of patients, age specific time trends of disease, occupational exposure to cattle, potential exposure to causative agent of bovine spongiform encephalopathy. RESULTS: During 1970-96 there was an increase in the number of sporadic cases of Creutzfeldt-Jakob disease recorded yearly in England and Wales. The greatest increase was among people aged over 70. There was a statistically significant excess of cases among dairy farm workers and their spouses and among people at increased risk of contact with live cattle infected with bovine spongiform encephalopathy. During 1994-6 there were six deaths from sporadic Creutzfeldt-Jakob disease in the United Kingdom in patients aged under 30. CONCLUSIONS: The increase in the incidence of sporadic Creutzfeldt-Jakob disease and the high incidence in dairy farmers in the United Kingdom may be unrelated to bovine spongiform encephalopathy. The most striking change in the pattern of Creutzfeldt-Jakob disease in the United Kingdom after the epidemic of bovine spongiform encephalopathy is provided by the incidence in a group of exceptionally young patients with a consistent and unusual neuropathological profile. The outcome of mouse transmission studies and the future incidence of the disease in the United Kingdom and elsewhere, will be important in judging whether the agent causing bovine spongiform encephalopathy has infected humans.     

Using epidemiological data to guide clinical practice: review of studies on cardiovascular disease and use of combined oral contraceptives

OBJECTIVE: To explore the usefulness of epidemiological data to guide clinical practice by seeking an answer to the question "What is the risk of cardiovascular disease among users of currently available, low dose, combined oral contraceptives who are aged less than 35 years, do not smoke, and do not have a medical condition known to increase the risk of vascular disease?" DESIGN: Review of all relevant published studies identified from the library of references held by Royal College of General Practitioners' Manchester Research Unit, checking of reference lists of identified studies, and Medline search. MAIN OUTCOME MEASURES: Identification of methodologically sound studies able to address the specific clinical question. RESULTS: Our literature search identified 74 papers about the relation between current use of combined oral contraceptives and cardiovascular disease: 23 papers reporting risk of venous thromboembolism, 22 on ischaemic stroke, 13 on haemorrhagic stroke or subarachnoid haemorrhage, 13 on all stroke, and 33 on myocardial infarction. Only five papers provided information that directly addressed our clinical question; all related to the risk of venous thromboembolism. Fourteen of the discarded papers probably had the potential to answer our clinical question. CONCLUSIONS: Much of the epidemiological data about the risk of cardiovascular disease in users of combined oral contraceptives is not useful to clinicians. Some of the discarded data could be made more useful to clinicians by reanalysis. This situation is unlikely to be unique to use of contraceptives.     

Organization of collecting and analysis of the data on nutrition in epidemiological study of cardiovascular diseases

The principles of collecting and analysis of information on nutrition in epidemiological study of cardiovascular diseases by means of electronic computers are described. A special program computes the consumption of 11 nutrients, the calorific value of the diet, and the calorie percentage of different nutrients with the exception of cholesterol. Certain coefficients are estimated, such as the ratio between the poly-unsaturated and the saturated fatty acids in the diet, and the ratio between the amount of starch and the total amount of refined and unrefined sugar, Well-trained technical personnel may be entrusted with the collection of the information, its coding, perforation, and feeding into the computer and with the obtainment of the data, which reduces the cost of the study considerably.     

Letter: Risks and benefits of hormonal agents in pregnancy

Concern over the possible teratogenic effects of the hormone 17alpha -hydroxyprogesterone caproate (17alpha OHP-C) when given intrapartum to the mother and the possible effects on the cervix and vagina in later life, was voiced in response to a published report, and advocacy of use of this hormone for the prevention of early abortion questioned. In response, the authors share their concern over possible long-term carcinogenic effects as well as possible effects on the hypothalamic-pituitary-gonadal axis, the mammary apparatus, the male genitalia, and psychosexual behavior.     

Leprosy and tuberculosis: the epidemiological consequences of cross-immunity

OBJECTIVES: This study tested the hypothesis, first proposed by Chaussinand, that individual-level immunity acquired from exposure to tuberculosis may have contributed to the disappearance of leprosy from western Europe. METHODS: The epidemiological consequences of cross-immunity were assessed by the formulation of a mathematical model of the transmission dynamics of tuberculosis and leprosy. RESULTS: The conditions under which Mycobacterium tuberculosis could have eradicated Mycobacterium leprae were derived in terms of the basic reproductive rates of the two infections and the degree of cross-immunity. CONCLUSIONS: If the degree of cross-immunity between two diseases within an individual is known, then the epidemiological consequences of this cross-immunity can be assessed with transmission modeling. The results of this analysis, in combination with previous estimates of the basic reproductive rate of tuberculosis and degree of cross-immunity, imply that tuberculosis could have contributed to the decline of leprosy if the basic reproductive rate of leprosy was low.     

Sixty adrenal masses of large dimensions: hormonal and morphologic evaluation

OBJECTIVES: To evaluate the nature and function of adrenal masses of large dimensions (macrotumors). METHODS: Sixty consecutive patients (31 women, 29 men, age range 15 to 84 years) with adrenal masses 4.0 cm in diameter or larger (range 4.0 to 15.0 cm) underwent morphologic study by computed tomography (CT); the majority also underwent 131-I-6beta-norcholesterol (131I-NC) or 131I-MIBG scintigraphy. Basal evaluation of glucocorticoids, mineralcorticoids, and catecholamines was performed in all patients, and in 38 cases determination of androgens was also made. In addition, on the basis of various clinical suspicions, a dynamic hormonal study was performed. RESULTS: Macrotumors were benign in 78.3% of cases and included pheochromocytomas (n = 17), nonfunctioning cortical adenomas (n = 12), and cortisol-secreting tumors (n = 7, Cushing's syndrome). Malignant forms were 21.7% of the total, including pheochromocytomas (n = 3), cortical carcinomas (n = 6), and metastases (n = 4). On CT, malignant masses were larger (8.4+/-0.9 cm) than benign ones (5.7+/-0.3 cm) (P < 0.0001) and the mass size was strictly related to malignancy (P < 0.03). CT did not offer other diagnostic criteria for malignancy, except irregular margins and regional lymph node enlargement, which were more frequently (P < 0.0001) found in malignant forms. 131I-MIBG scintigraphy showed tracer uptake in all pheochromocytomas, both benign and malignant. By contrast, on 131I-NC scintigraphy, cortical malignancies never accumulated the radiotracer, whereas uptake was observed in all cases of solid cortical benign adenomas. Patients with cortical carcinomas showed plasma sex steroids above the normal range, pheochromocytomas were asymptomatic in 15% of cases, and almost half of the patients with Cushing's syndrome did not show clinical features of the disease (pre-Cushing's syndrome). CONCLUSIONS: Adrenal macrotumors frequently show endocrine activity and the medulla seems to be involved more than the cortex. Pheochromocytomas and cortisol-secreting adenomas are sometimes asymptomatic. Malignancy is often found in macromasses and, at least for the cortical forms, size of the tumor on CT, 131I-NC uptake on scintigraphy, and determination of levels of sex steroids seem to be useful criteria for predicting the nature of the mass.     

Ultrasonographic patterns of polycystic ovaries: color Doppler and hormonal correlations

Ultrasound has been used in the identification of two different morphological patterns of polycystic ovaries, namely a peripheral cystic pattern and a general cystic pattern. The aim of this study was to evaluate whether patients with the peripheral form of polycystic ovaries showed different ovarian and uterine blood flow from those with the general form, and to investigate whether there was a correlation between the forms and different hormonal parameters. Eighteen patients with the general form and 16 patients with the peripheral form of polycystic ovary underwent clinical, biochemical, gray-scale and color Doppler ultrasonographic evaluation. The parameters analyzed confirmed polycystic ovarian syndrome (PCOS) in all patients. Individual levels of plasma luteinizing hormone (LH), follicle stimulating hormone (FSH), testosterone, androstenedione and estradiol did not differ between the groups. However, there was a significantly higher LH/FSH ratio and a greater stromal echodensity in the peripheral cystic group than in the general cystic group. Doppler ultrasonography demonstrated significantly lower pulsatility index values in the intraovarian arteries of the peripheral cystic group and a higher rate of visualization of these arteries than in the general cystic group. These findings suggest that, apart from the LH/FSH ratio, the different morphological types of polycystic ovary do not reflect differences in endocrine profile. The differences in blood flow demonstrated by Doppler assessment in each case, however, showed that PCOS does not predetermine a single intraovarian blood flow pattern.     

Molecular typing of Cryptococcus neoformans: taxonomic and epidemiological aspects

Pulsed-field gel electrophoresis (PFGE), randomly amplified polymorphic DNA (RAPD) analysis, serotype, and killer toxin sensitivity patterns of a wide range of saprobic, clinical, and veterinary isolates of both varieties of Cryptococcus neoformans were examined. C. neoformans var. neoformans and C. neoformans var. gattii differed in chromosomal makeup, RAPD patterns, and killer sensitivity patterns. These results suggest that there are two separate species rather than two varieties. No clear genetic or phenotypic differences were observed among the clinical, saprobic, and veterinary isolates within each taxon. The serotypes differed substantially in their RAPD characteristics. Geographical clustering was observed among the isolates of C. neoformans var. gattii, but not among the isolates of C. neoformans var. neoformans. The isolates of each taxon that originated from restricted geographical areas often had identical or similar karyotypes and RAPD patterns, suggesting that clonal reproduction had occurred. The combination of PFGE and RAPD analysis allowed us to distinguish almost all isolates. This combination of techniques is recommended for further research on epidemiological, ecological, and population issues.     

Employing people with disabilities: Impact of attitude and situation.

Examined the impact of attitude and hypothetical situational encounters on affective, behavioral and cognitive responses of nondisabled employees toward coworkers with disabilities. 176 Ss completed the Attitudes Toward Disabled Persons Scale, and responded to 1 of 9 situations of varying levels of intimacy in which they imagined themselves and a person with an immediately obvious disability. Their affective, behavioral and cognitive reactions were assessed by 3 different measures. Both more negative attitudes and situations with higher discomfort levels resulted in the most negative responses. Attitude and situation independently influenced responses. Findings provide a basis for interventions by rehabilitation professionals who work with individuals with disabilities and for employers seeking to implement the Americans with Disabilities Act. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Ability and attitude correlates of academic achievement: Family-group differences.

In this study, I examined the proposition that for children from different family groups, there are variations in relations among their ability, attitudes toward school, and academic achievement. Data were collected from 928 11-year-old Australian children and their parents. In the analysis, the children were classified into four family groups that were defined conjointly by family social status and parents' getting-ahead or getting-by orientation. Within each family group, regression surfaces were constructed from models that included terms to account for possible linear, interaction, and curvilinear associations among the variables. The results indicated that (a) there are moderate family-group differences in children's word performance and more modest variations in their ability, attitudes toward school, and mathematics achievement and (b) ability and school attitudes had differential linear and curvilinear relations to academic achievement for boys and girls from different family groups. In general, the study indicated that the family may act as a critical substratum variable that influences the relations between children's attitudinal and cognitive attributes and their academic performance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Coca chewing for exercise: hormonal and metabolic responses of nonhabitual chewers

To determine the effects of acute coca use on the hormonal and metabolic responses to exercise, 12 healthy nonhabitual coca users were submitted twice to steady-state exercise (approximately 75% maximal O2 uptake). On one occasion, they were asked to chew 15 g of coca leaves 1 h before exercise, whereas on the other occasion, exercise was performed after 1 h of chewing a sugar-free chewing gum. Plasma epinephrine, norepinephrine, insulin, glucagon, and metabolites (glucose, lactate, glycerol, and free fatty acids) were determined at rest before and after coca chewing and during the 5th, 15th, 30th, and 60th min of exercise. Simultaneously to these determinations, cardiorespiratory variables (heart rate, mean arterial blood pressure, oxygen uptake, and respiratory gas exchange ratio) were also measured. At rest, coca chewing had no effect on plasma hormonal and metabolic levels except for a significantly reduced insulin concentration. During exercise, the oxygen uptake, heart rate, and respiratory gas exchange ratio were significantly increased in the coca-chewing trial compared with the control (gum-chewing) test. The exercise-induced drop in plasma glucose and insulin was prevented by prior coca chewing. These results contrast with previous data obtained in chronic coca users who display during prolonged submaximal exercise an exaggerated plasma sympathetic response, an enhanced availability and utilization of fat (R. Favier, E. Caceres, H. Koubi, B. Sempore, M. Sauvain, and H. Spielvogel. J. Appl. Physiol. 80: 650-655, 1996). We conclude that, whereas coca chewing might affect glucose homeostasis during exercise, none of the physiological data provided by this study would suggest that acute coca chewing in nonhabitual users could enhance tolerance to exercise.     

The prevalence, structure and clinical problems of multiple sclerosis in the Transcarpathian area based on epidemiological study data

As many as 230 patients with disseminated sclerosis were examined in the Transcarpathian region. Sick male- and female populations were found out to be almost similar. There were more sick persons in the medium-range areas of the Carpathian Mountains, with a mean age being 35 +/- 5 years. It has been established that intake of spirulina makes for lengthening of remission in those patients with disseminated sclerosis.