TRAIL mediated signaling in human mast cells: the influence of IgE-dependent activation.

BACKGROUND: Mast cells activation through FcepsilonRI cross-linking has a pivotal role in the initiation of allergic reactions. The influence of this activation on programmed cell death of human mast cells has not yet been clarified. This study evaluates the influence of IgE-dependent activation alone and in synergy with TRAIL on the expression of molecules involved in the apoptotic signal transduction. METHODS: Human cord blood derived mast cells (CBMC) were cultured with myeloma IgE followed by activation with anti-human IgE. The expression of proteins involved in apoptotic signal transduction was assessed by immunoblot analysis. To test the effect of activation on a pro-apoptotic stimulus, activated, IgE-treated and resting CBMC were incubated with TRAIL, or in a medium with suboptimal concentrations of stem cell factor (SCF). RESULTS: In accordance with a previous study of ours, it was found that IgE-dependent activation increased TRAIL-induced caspase-8 and caspase-3 cleavage. However, it did not have a significant influence on CBMC death induced by SCF withdrawal. IgE-dependent activation increased the expression of FLIP and myeloid cell leukemia 1 (MCL-1) anti-apoptotic molecules as well as the pro-apoptotic one, BIM. In addition, a decrease in BID expression was observed. TRAIL could reverse the increase in FLIP but did not influence the upregulation of MCL-1 and of BIM. CONCLUSIONS: These findings suggest that IgE-dependent activation of human mast cells induces an increase in both pro-survival and pro-apoptotic molecules. We therefore hypothesized that IgE-dependent activation may regulate human mast cell apoptosis by fine-tuning anti-apoptotic and pro-apoptotic factors.

The correlation of increased serum prolactin levels with decreased sexual desire and activity in elderly men.

Serum prolactin levels and sexual function were evaluated in 28 men from 60 to 64 years of age and in 44 men from 65 to 70 years of age. All subjects were married, physically healthy, and had no psychopathology or marital problem. About a third of the men aged 60 to 70 years suffered from impotence. No obvious correlation between elevated levels of serum prolactin and impotence was obtained. Subjects aged 65 to 70 who had decreased libido exhibited a significant elevation of serum prolactin levels, while subjects of the same age group who had reserved (normal) libido appeared to have low serum prolactin levels. Nine of ten men aged 60 to 70 years with serum prolactin levels above 40 ng/ml reported decreased libido. Potent men of both age groups (60-70 years) with high prolactin levels showed a tendency to have a decrease in frequency of sexual intercourse. Thus, it seems that mild hyperprolactinemia in aging men may be associated with decreased sexual desire and frequency of sexual activity.

Sulpiride-induced hyperprolactinemia and impotence in male psychiatric outpatients.

The relationship between erectile dysfunction and sulpiride stimulatory effect on prolactin secretion was studied in 13 married male psychiatric outpatients. The patients population was comprised of 2 groups: patients with anxiety disorders resistant to minor tranquilizers who were treated with sulpiride up to 200 mg/day, and schizophrenic patients treated with sulpiride 600 mg/day. All the patients were maintained on maximal dose for a period of 3 weeks. Sexual function and blood prolactin levels were monitored once weekly. The patients who developed impotence were maintained on higher doses of sulpiride and exhibited higher prolactin levels in comparison to the potent patients. Restoration of potency was observed after reduction or discontinuation of sulpiride treatment. It is concluded that sulpiride induced impotence is associated with hyperprolactinemia.

Prevalence of psychiatric disorders in three primary-care clinics in Beersheba, Israel. Concurrent assessment by the General Health Questionnaire, General Practitioners, and Research Diagnostic Criteria.

The General Health Questionnaire (GHQ) had identified fully 69% of 776 respondents who attended 12 primary-care clinics as "probable cases" of psychiatric disorders, whereas the general practitioners (GPs) involved had thought only 31% had psychological problems. To investigate more accurately the prevalence of psychiatric disorders we examined 112 of the original sample with the Schedule for Affective Disorders and Schizophrenia, Life-time version and found only 15% to have had a Research Diagnostic Criteria disorder at the time of the initial study. Raising the GHQ threshold to 15/16 improved specificity and positive predictive value, and improved GPs' case-finding modestly. These respondents either suffered from high rates of subclinical distress or readily report subjective distress in the clinic, or both.

The healing significance of the Negev's Bedouin Dervish.

Among the Bedouins of the Negev desert, Israel, there are Dervish healers specializing in what are now called psychiatric disorders. Five Dervish (three male, two female) were interviewed and observed with reference to concepts of etiology, symptom classification, diagnosis, stages of treatment, and aftercare. The conclusion examines reasons why Bedouins might want to seek treatment from a Dervish, rather than a modern health care practitioner.

Life events, sense of coherence and health: gender differences on the kibbutz.

The effects of recently experienced life events (RLE) and of a personal coping resource--the sense of coherence (SOC)--on the health of men and women were investigated among members of two small and cohesive communities--two kibbutzim in Israel (n = 230). Results of analyses lend support to previous findings about the negative effects of life events on health, and to Antonovsky's theory about the positive influence of SOC on health. Separate analyses for men and women, however, show that while RLEs negatively affect women's health, SOC has no significant counterbalancing effect on their health. Among men, an opposite pattern is found; their health is not affected by RLE, but is significantly affected by their SOC. Our findings lead to the conclusion that men and women are differentially affected by stressors and make different use of their coping resources. These findings should be taken into consideration in further research on stress, coping and health.

Changes in psychological well-being during postmenopause as a result of estrogen therapy.

A study of the effects of a conjugated estrogen (Femipren) upon various climacteric symptoms, depression and anxiety scores and psycho-social factors in 120 women around the menopause, was carried out in a Menopause Clinic. In order to participate in this study, the women had to meet very strict criteria. A climacteric symptom list, the MMPI and a psycho-social questionnaire were used for assessment, and were employed before, during and at the end of 1 yr of hormone replacement therapy. Typical vasomotor and psychic symptoms changed significantly as did such factors as self-image, optimism, perception of the future and satisfaction with personal appearance, in those patients who received hormonal replacement therapy for 1 yr. As the psychological factors changed only in those patients who received long-term estrogen therapy, a tentative hypothesis of direct psychotropic effect of estrogen was formulated.

The effects of oestrogen therapy on the sex life of post-menopausal women.

The literature concerning sexual behaviour around the time of the menopause is reviewed. Mentioned is a decline in sexual activity and satisfaction in women which is attributed to the changes in the women themselves, and not merely a reaction to the decline in the sexual capacity of their husbands. Forty women were treated during 1 yr with oestrogens. The eventual effect of this treatment on sexual activity and satisfaction was investigated and compared with a group who had undergone partial treatment only. The results show that in the completely treated Group A, symptoms such as hot flushes and depression diminished, and the pain of sexual relations was relieved. As a consequence of this improvement, coital activity and satisfaction were more gratifying. The partially treated Group B showed a clear decline in sexual activity and in sexual satisfaction.

Relationship between biological changes and symptoms and health behaviour during the climacteric.

The object of this investigation was to assess the impact of biological (hormonal) changes during the climacteric on self-reported health status and health behaviour in a group of middle-aged women. The central research question was whether or not the menopausal phase (pre, peri, post) affects the number and frequency of the symptoms a women reports, the frequency of her visits to the primary-care clinic and her perception of her general state of health. The subjects comprised a random sample of 47 women aged 48-53 yr who were judged by their family doctors to be healthy or to be suffering from a chronic disease which was inactive at the time the study was carried out. The women were chosen from among a population of married couples under investigation in a larger study. The sample was homogeneous both ethnically (all subjects born in North Africa) and in terms of social class (lower to lower-middle class). No relationships were found between menopausal phase and any of the health criteria considered. The number and frequency of symptoms was low for all the women. Only a small number of women (2-10%) reported a frequent occurrence even of symptoms that are considered to be direct consequences of hormonal changes. These findings conflict with those deriving from studies of women attending gynaecological clinics, but confirm those of other community (non-clinic) studies. The results of this study bear out the general theoretical conclusion that climacteric symptoms are 'psychological and cultural artifacts' rather than consequences of biological changes.

Sexual satisfaction among middle-aged couples: correlation with frequency of intercourse and health status.

The central hypothesis of this investigation is that the greater the sexual satisfaction that a couple reports from their sexual relationship, the better will be their adjustment to the changes that occur during middle age, as reflected in their reported health status and health behaviour. Forty-seven married couples, of North African Jewish origin, were investigated, the women being in the age range 48-53 yr. The findings regarding reported frequency of sexual intercourse and sexual satisfaction of women and men separately showed that a great majority of both men (87%) and women (74%) reported a decrease in sexual activity over the 5 yr preceding the study. Most of the men (56%) said the change was due to the aging process, whereas the women's responses were more varied and included aging, worries and decrease in sexual interest or desire. Eighty percent of the men reported satisfaction in their sexual relationship with their wives, but only 43% of the women stated that they were satisfied. A significant correlation was found, for women only, between the degree of satisfaction and the change in frequency of intercourse. Among the women there was also a positive correlation between general life satisfaction and sexual satisfaction. The hypothesis in regard to mutual (couple) sexual satisfaction was not confirmed in the men. It was validated in the women in regard to only two of the four criteria used - their perception of their health status and of their well-being. The women perceived the sexual satisfaction of their husbands much more accurately than the husbands perceived that of their wives.

The effect of outside work on the menopausal woman.

1,148 women between the ages of 45 and 54 from five different ethnic groups in Israel, representing a traditional-modern continuum were investigated with regard to the relationship of their menopausal symptomatology with their work situations now and what they were when the women were aged 40. A relatively low symptomatology was found among European Jews, North African Jews and Arabs in the peri- or postmenopause where their work load was unchanged or somewhat more than before. On the other hand, the Persian Jews showed a remarkable contrast, namely: those who had never worked at all outside the home suffered less than all the others in all the stages of menopause. These results cannot be explained only by the socioeconomic differences between the five groups, as the North Africans and Persians both belong to the lower urban socioeconomic class and the Arabs to the low rural socioeconomic class, with the Europeans belonging to the middle urban class. Nor can the results be explained merely by the difference in modernity and traditionalism. The matter is more complicated, and additional factors such as physical health, marital relationships and general stability are almost certainly involved. The advice to "go out and work" which is so often given by medical practitioners to menopausal women is thus not always correct, and should not be given automatically.

Coping with recent life events: the interplay of personal and collective resources.

The importance of personal and collective resources in coping with recent life events was studied among 230 kibbutz members. The sense of coherence, a global life orientation that detects the ability to avoid stressors and to choose appropriate coping strategies and resources, represented personal resources. Collective resources, embedded in the social system to which one belongs, were measured by membership in a religious kibbutz, the kibbutz being viewed as a powerful, collective-coping resource by itself. Physical well-being, psychological distress, and functional limitations were used as outcome measures. Both types of resources have a salutogenic effect, but sense of coherence appears to be a better resource for avoiding the effect of recent life events and for moderating psychological distress and functional limitation after experiencing such events. The two types of resources have no additive effect, nor do they compensate for each other. Only one significant interaction was found, suggesting that the combination of the two resources is useful in avoiding functional limitation. It is also suggested that collective resources have a slight positive effect on personal resources, which, in turn, take over and become most valuable in coping with recent life events. When stress affects social functioning, these same personal resources facilitate the mobilization of whatever collective resources are available.

Creativity and self-actualization in the aging personality.

Twenty-five residents (sixty-nine to ninety-three years old) of two Israeli homes for the elderly were investigated in order to see if there was a correlation between the creative attitude (self-actualizing personality) and the way of coping with the process of aging and attitude toward death. The results showed that the more creative-actualizing a personality, the better the coping with aging phenomena and the less denial of death.

Physicians' detection of psychological distress in primary-care clinics.

This study investigated the amount of psychological distress reported by 182 soldiers in the Israeli military and compared soldiers' self-ratings of distress with ratings by military physicians of observed distress. Comparisons indicated a low detection rate by physicians with only 13% of self-reported cases of emotional distress identified. This and several related findings were taken to indicate shortcomings in medical care. Possible remedies include additional psychiatric training for military physicians, less frequent rotation of physicians to allow for more stable care, and the initiation of mental health education among soldiers.

Psychiatry and primary medicine.

Psychiatry and primary medicine are related to one another for theoretical and practical reasons. The development of this relationship in Israel in recent years is described. Many patients with mental problems are seen by the primary physician only. The most serious cases are usually detected and referred. The main problem is that people with modest mental disturbances are often neither detected nor referred and treated. The development of various forms of communication between psychiatry and primary medicine, such as consultation-liaison programs, Balint groups and other methods of training, are described and discussed.

Modelling the process of encounter between general practitioner and patient as a method for the detection of psychosocial problems.

In the Netherlands all patient on the list of a GP can present with all health problems in all their stages of development at any time, and more than 80% of all complaints presented to a GP are resolved by him or her. Many of these problems have psychosocial aspects. GPs need a structured consultation model for the doctor-patient encounter and, at the same time, need an open consultation style. The model must be seen as an aid in the doctor-patient communication and in medical education. In this article such a model, based on the SOAP system, a system for medical recording is described. Furthermore, a broader protocol of the SOAP, called the BATHE, is introduced. In addition, a description is given of how students at the medical school of Maastricht University are trained to use this model, especially in the clerkship in general practice.

Psychosomatic medicine and primary care in Germany.

The development and training in psychosomatic medicine in Germany are presented. This branch of medicine emphasizes the biopsychosocial understanding of disorders, and psychological, particularly psychoanalytic, methods are used. The outcome of treatment studies are awaited to clarify their role in the medical services of Germany.

Application of models of working at the interface between primary care and mental health services in Israel.

Psychiatric morbidity is common in primary care, a large proportion being treated without specialist referral. A significant proportion may be undetected or inadequately treated. This article describes current models of mental health services (MHS) working at the interface between primary care and MHS with review of data regarding these models and discussion of the application of these models to the Israeli health system. The shifted out-patient model, primarily provided by psychiatrists independent of the Primary and Secondary Care Teams, would seem to increase access to psychiatric services, increase treated prevalence of the disorders and attract a similar population to hospital out-patient services. The psychiatric community liaison model aims to improve primary care practitioner detection and management skills, might reduce referrals to psychiatrists with similar patient outcome and enables treatment of patients unwilling to see a mental health professional (MHP). The attached MHP Model would allow access to a greater range of psychosocial interventions provided by a primary care team member. The community mental health team, currently a model not in practise in Israel, provides a single point of referral for multidisciplinary care but has shown varying patterns of integration and responsiveness to primary care. Other interfaces of collaboration such as Balint groups and education are also discussed.

Respiratory and other symptoms in panic disorder versus other anxiety disorders.

Respiratory abnormalities have been proposed as a central feature of panic disorder, but the literature is not unanimous. Symptoms of anxiety were quantitatively recorded with the Hamilton Rating Scale for Anxiety (HAM-A) in 72 psychiatric out-patients in two anxiety disorders clinics in Israel; 44 patients had panic disorder with or without agoraphobia and 28 patients had other anxiety disorders. Panic patients had more cardiovascular symptoms, but not more respiratory symptoms, than other patients. The relative importance of respiratory symptoms in panic disorder is not yet settled.

Measuring psychological stress in primary care military medical clinics.

In this study, the amount of psychological distress reported by soldiers is investigated and measured over time. The soldiers--enlisted and career--were randomly chosen while visiting five different military primary care clinics (for ostensible somatic problems) and administered the General Health Questionnaire (Goldberg and Huxley, 1980). A third of the subjects were given the GHQ a year later. Fifty-two percent showed psychological stress: combat soldiers showed considerably less distress than technical/maintenance and administrative soldiers, and the psychological stress findings remained relatively stable over time. Possible explanations for these findings are discussed.