Cheilognathopalatoschisis: its embryology, epidemiology, etiology, clinical picture and therapy. The experience of a division of pediatrics]

The local lymph node assay is an alternative method for the prospective identification of chemicals that have the potential to cause skin sensitization. Activity in the assay is measured as a function of proliferative responses by draining lymph node cells induced by topical exposure of mice to the test chemical. Positive responses are defined as those where a test chemical, at one or more application concentrations, is able to induce a stimulation index of 3 or greater compared with concurrent vehicle-treated control values. Although the method has been evaluated extensively, the stability over time of responses induced in the local lymph node assay has not previously been addressed formally. It was the purpose of the investigations described here to consider this issue and, to this end, responses provoked in the local lymph node assay by hexyl cinnamic aldehyde (HCA)--a skin sensitizing chemical of moderate potency--were assessed in five separate experiments conducted in a single laboratory over a 10-month period. In each case, HCA elicited a positive response. Although some significant inter-experimental variation was recorded, this was attributable entirely to the stimulation by HCA of slightly more vigorous responses in one of the five experiments. When the results of this experiment were excluded from the data set, significant variations were lost. Finally, for each experiment an EC3 value was derived, this being the estimated concentration of test chemical required to induce a stimulation index of 3. Similar EC3 values were derived in each experiment. These data demonstrate the relative stability over time of activity in the local lymph node assay.     

Vascular dementia: a contemporary review of epidemiology, diagnosis, prevention, and treatment

The past decade has seen a renewed interest in vascular dementia. Key epidemiologic studies have examined the prevalence, incidence, course and risk factors of vascular dementia. New classification systems have been developed to improve the reliability of the diagnosis, and there have been advances in diagnostic methodology, such as neuroimaging and neuropsychological assessment. New treatments for vascular dementia are being developed to protect the brain from cerebral ischemia and to limit progression of cognitive impairment. Diagnostic criteria for vascular dementia remain to be validated by carefully designed, systematic, clinicopathologic study. Once such criteria are validated, meaningful study of subgroups of vascular dementia can be explored. Until the relationship between vascular dementia and Alzheimer's disease is better defined, the nosology for vascular dementia may be defined best as dementia associated with stroke.     

Hospital-acquired pneumonia: epidemiology, etiology, and treatment

Despite improvements in diagnosis, treatment, and prevention, hospital-acquired pneumonia (HAP) remains the number one cause of nosocomial mortality. This article reviews the current knowledge regarding the incidence, epidemiology, and causes of HAP, with the appreciation that the available information is incomplete and that controversies are common, and thus the authors provide a rational approach to the initial management of HAP in immunocompetent adults. A discussion of therapy and what to do with patients who do not respond to the empiric therapy are included. The American Thoracic Society (ATS) statement on HAP has served as a foundation for this review but has been supplemented by newer literature that was not available when the ATS statement was developed.     

Ovarian cancer: epidemiology, diagnosis, and management

Ovarian cancer is a common malignancy for which no widely effective prevention or early detection strategies are known. It is one of the most responsive of adult solid tumors, however, and patients can be cured by appropriately applied regimens of surgery, radiation, and chemotherapy. Expertise is required to select and coordinate the appropriate combinations. Therapeutic trials are underway at various centers, including the Medicine Branch of the NCI, to develop new treatment strategies and refine existing modalities.     

Insult, aggression, and the southern culture of honor: An "experimental ethnography."

Three experiments examined how norms characteristic of a "culture of honor" manifest themselves in the cognitions, emotions, behaviors, and physiological reactions of southern White males. Participants were University of Michigan students who grew up in the North or South. In 3 experiments, they were insulted by a confederate who bumped into the participant and called him an "asshole." Compared with northerners (who were relatively unaffected by the insult) southerners were more likely to think their masculine reputation was threatened, more upset (as shown by a rise in cortisol levels), more physiologically primed for aggression (as shown by a rise in testosterone levels), more cognitively primed for aggression, and more likely to engage in aggressive and dominant behavior. Findings highlight the insult–aggression cycle in cultures of honor, in which insults diminish a man's reputation and he tries to restore his status by aggressive or violent behavior. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Facing chronic illness: the family support model and its benefits

With the aging of the population and the evolving health care system, it is more important than ever before that individuals be actively involved in selfcare activities and that individuals and families receive education and support to help them cope with chronic illness. This article describes a model family support program which operates within a hospital setting to provide information, education, support, and respite services. This model is based on an extensive research base which underscores the value of this model both for the individuals and families involved and for the health care system.     

Orthostatic hypotension: epidemiology, pathophysiology and management

Orthostatic hypotension is characterized by low upright blood pressure levels and symptoms of cerebral hypoperfusion. Whereas orthostatic hypotension is heterogeneous, correct pathophysiologic diagnosis is important because of therapeutic and prognostic considerations. Although therapy is not usually curative, it can be extraordinarily beneficial if it is individually tailored. Management of the Shy-Drager syndrome (multiple-system atrophy) remains a formidable challenge.     

Overview of somatization: diagnosis, epidemiology, and management

This article outlines critical issues in the psychiatric assessment of patients presenting with medically unexplained physical symptoms that form the core of the somatoform disorders in current nosologies. The prevalence of these disorders in communities and clinical settings emphasizes that a majority of these patients are primary care service users rather than mental health clients. A brief review of previous studies on the pharmacological management of these syndromes with antidepressants highlights unique features of these disorders that are relevant to the design of double-blind studies. The promising results emerging from some of these studies bring new excitement to the field that may help counter the prevailing therapeutic nihilism, thus attracting new investigators to this area. Finally, several caveats are provided on issues of research design and interpretation for the benefit of those entering this field of research.     

Dementia: a serious and enduring mental illness

At the 1997 RCN Congress, the RCN Mental Health and Older People Forum put forward a matter for debate--how the definition of 'serious and enduring mental illness' affects services to people with dementia. Subsequently, the RCN agreed both a position paper, which includes dementia in the definition, and an action plan for dissemination and support of the RCN position. Alison Soliman describes the background to the position paper.     

From ethnography to intervention: developing a breast cancer control program for Latinas

Latinas are less likely than Anglo women to have appropriate breast cancer screening for reasons that may include culturally based beliefs as well as socioeconomic factors. This study employed ethnographic methods to explore breast cancer-related knowledge, attitudes, and behaviors among Latinas, Anglo women, and physicians, tested the generalizability of the findings in a telephone survey of randomly selected women, and used the results to design a culturally sensitive breast cancer control intervention in Orange County, Calif. Respondents for the ethnographic interviews included 28 Salvadoran immigrants, 39 Mexican immigrants, 27 Chicanas (U.S.-born Latinas of Mexican heritage), 27 Anglo women, and 30 physicians selected through organization-based network sampling. Latinas had very different beliefs about risk factors for breast cancer and held more fatalistic attitudes about the disease. For example, they believed that trauma to the breast was among the most important risk factors. Results of a telephone survey of 1225 randomly selected women (269 U.S.-born Latinas, 425 Mexican immigrants, 109 other Latina immigrants, and 422 Anglo women) generally confirmed the dissimilar beliefs among Latinas and Anglo women. The findings influenced our decision to design and pilot-test a breast cancer control intervention based on Bandura's self-efficacy theory and Freire's empowerment pedagogy. The methodology and findings of this study have important implications for future cancer control research and interventions.     

Hantavirus pulmonary syndrome: epidemiology, prevention, and case presentation of a new viral strain

Hantavirus pulmonary syndrome (HPS) is a viral infection from a new strain of Hantavirus. The Hantavirus was first discovered in North America in 1993 after an outbreak of fatal illness on a Navajo Indian reservation in New Mexico. Since then, 122 cases of HPS (with a high mortality rate of more than 50%) have been reported in 23 states, with the highest prevalence in the Four Corners area. The reservoir for Hantavirus is small rodents, mostly field mice, vole, and chipmunks. It is transmitted through inhalation of airborne virus from dry rodent excreta and saliva. A North American strain of Hantavirus, named ain nombre virus (SNV), primarily affects the lungs, causing rapid accumulation of fluids and leading to noncardiogenic pulmonary edema, pleural effusion, and acute respiratory distress syndrome (ARDS). In the prodromal stage, HPS presents with flu-like symptoms, nausea, vomiting, and gastrointestinal pain and is often mistaken on the first visit for other infectious diseases or gastroenteritis. In the second acute stage, rapid respiratory deterioration begins: HPS is often misdiagnosed for pneumonia, idiopathic ARDS, and pulmonary edema. HPS treatment with an experimental antiviral intravenous drug, ribavirin, is under investigation. Practitioners must possess through clinical knowledge on the diagnoses, pathology, treatment, and course of the disease to reduce the mortality and morbidity rate of this rare but serious infection. A case report based on a recent HPS death in New York State on Long island in April 1995 is presented.     

Ethics, epidemiology and the thrifty gene: biological determinism as a health hazard

This paper briefly describes the rise of the thrifty genotype hypothesis as an explanation for the late twentieth century epidemic of diabetes, particularly in post-colonial indigenous societies. It looks at some of the ethical consequences of the biological deterministic paradigm, particularly the popular confusion of "genes" with "race" and how this paradigm served to exclude consideration of social determinants of disease in epidemiological thinking. Some alternative hypotheses to the thrifty gene theory are explored, together with the consequences of acceptance of these other theories in terms of public health action. Finally, there is a need for epidemiology to be continually conscious, critical and transparent with respect to the general disease (and wellness) theory under which it operates if it is to be truly a science rather than a collection of methodologies.     

Personality in its natural habitat: Manifestations and implicit folk theories of personality in daily life.

To examine the expression of personality in its natural habitat, the authors tracked 96 participants over 2 days using the Electronically Activated Recorder (EAR), which samples snippets of ambient sounds in participants' immediate environments. Participants' Big Five scores were correlated with EAR-derived information on their daily social interactions, locations, activities, moods, and language use; these quotidian manifestations were generally consistent with the trait definitions and (except for Openness) often gender specific. To identify implicit folk theories about daily manifestations of personality, the authors correlated the EAR-derived information with impressions of participants based on their EAR sounds; judges' implicit folk theories were generally accurate (especially for Extraversion) and also partially gender specific. The findings point to the importance of naturalistic observation studies on how personality is expressed and perceived in the natural stream of everyday behavior. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Families, culture, and mental illness: constructing new realities

In Modern Western cultures, conceptual models of mental illness are interwoven with value systems of individualism, agency, internal locus of control, and fear of dependency. These values have translated into psychological theory and practice, affected families' relationships with the professional, legal, and consumer communities and have often exacerbated family burden. Culturally patterned attributions of individual accountability also affect family-patient interactions and may have an effect on relapse and prognosis. The family and consumer movements are discussed in terms of their orientations, services, social impact, and influence on epistemology, particularly with reference to the different effects of protective paternalism and individualistic autonomy. Questions are raised regarding cultural values and differential prognoses in modern and developing countries and whether the process of recovery may be shaped by different cultural introjects. It is suggested that the era of family and consumer empowerment may be heuristic in discovering parameters of mental illness and potential for recovery, and ideas are offered for future cross-cultural research.