The prevalence of depressive symptoms in a Trinidadian cardiac population / Prevalencia de síntomas depresivos en una población cardiaca de Trinidad

The current study investigated the prevalence of depressive symptoms in persons with self-reported cardiovascular disease and the interactions of depressive symptoms, reported cardiovascular disease and gender in a Trinidadian population. Between June 2009 and August 2009, 425 participants were recruited from the Eric Williams Medical Sciences Complex (EWMSC) Heart Clinic and all the participants completed the Center for Epidemiologic Studies Depression Scale. Clinical and demographic variables were obtained from the sociodemographic questionnaire. Forty-seven per cent of the self-reported cardiovascular disease participants were identified as having high depressive symptoms as compared to 32% of those who did not report having a cardiovascular illness. The odds ratio indicated that high depressive symptoms are more likely to occur in individuals with reported cardiovascular disease. The Mann-Whitney test revealed females had significantly higher levels of depressive symptoms than males. Previous studies suggest that depression is a risk factor for adverse prognosis in a cardiac population, therefore future research examining the link between depression and cardiovascular disease is warranted.

El presente estudio investigó la prevalencia de síntomas depresivos en personas con enfermedad cardiovascular autoreportadas y las interacciones de los síntomas depresivos, las enfermedades cardiovasculares reportadas y el género en una población de Trinidad y Tobago. Entre junio y agosto de 2009, 425 participantes fueron reclutados de la Clínica Cardiológica del Complejo de Ciencias Médicas Eric Williams (EWMSC), todos los participantes respondieron la Escala de Depresión del Centro de Estadios Epidemiológicos, y se obtuvieron las variables demográficas y clínicas del cuestionario sociodemográfico. Cuarenta y siete por ciento de los participantes con enfermedades cardiovasculares autoreportadas fueron identificados con síntomas depresivos altos en comparación con el 32% de aquellos que no reportaron tener enfermedad cardiovascular. El cociente de probabilidades (OR) indicó que los síntomas depresivos altos tienen mayor probabilidad de ocurrir en individuos con enfermedades cardiovasculares reportadas. La prueba de Mann-Whitney reveló que las hembras presentaban niveles significativamente mayores de síntomas depresivos que los varones. Los estudios previos sugieren que la depresión es un factor de riesgo para un pronóstico adverso en una población cardiaca. Por lo tanto, es un hecho que la investigación futura necesita examinar el vínculo entre depresión y enfermedad cardiovascular.

The prevalence of Type D personality in a Trinidadian cardiac population / Prevalencia de la personalidad de Tipo D en una población cardíaca Trinitense

OBJECTIVE: The current study investigated the prevalence of Type D personality in persons with selfreported cardiovascular disease and the interactions of Type D personality, reported cardiovascular disease and gender in a Trinidadian cardiac population. METHODS: Between June 2009 and August 2009, 425 participants were recruited from the Eric Williams Medical Sciences Complex (EWMSC) Heart Clinic and all the participants completed the Type D Scale. Clinical and demographic variables were obtained from the sociodemographic questionnaire. RESULTS: Forty-two per cent of participants with self-reported cardiovascular disease were identified as Type D as compared to 26% of participants who did not report having a cardiovascular illness. The odds ratio indicated individuals identified with Type D personality are 2.0 times more likely to report having cardiovascular disease and females with cardiac disease are 1.6 times more likely to be identified with Type D personality as compared to males. CONCLUSIONS: Previous studies suggest Type D personality is a risk factor for adverse prognosis in the cardiac population, therefore future research examining the link between Type D personality and cardiovascular disease is warranted.

OBJETIVO: El presente estudio investigó la prevalencia de la personalidad tipo D en personas con enfermedades cardiovasculares autoreportadas, así como las interacciones de la personalidad de tipo D, las enfermedades cardiovasculares reportadas, y el género en una población cardíaca de Trinidad y Tobago. MÉTODOS: Entre junio y agosto de 2009, 425 participantes fueron reclutados de la Clínica Cardiológica del complejo de Ciencias Médicas Eric Williams (EWMSC), y todos los participantes llenaron el cuestionario de la Escala de Tipo D. Las variables demográficas y clínicas fueron obtenidas del cuestionario sociodemográfico. RESULTADOS: Cuarenta y dos por ciento de los participantes con enfermedad cardiovascular autoreportada, fueron identificados como tipo D, en comparación con el 26% de los participantes que no reportó tener una enfermedad cardiovascular. El cociente de probabilidades (odds-ratio) indicó que los individuos identificados con personalidad de tipo D son 2.0 veces más propensos a reportar su enfermedad cardiovascular, y las mujeres con enfermedad cardiaca presentan 1.6 veces más probabilidades de ser identificadas con personalidad tipo D en comparación con los varones. CONCLUSIONES: Estudios previos sugieren que la personalidad de tipo D es un factor de riesgo que apunta a una prognosis adversa en la población cardiaca. Por lo tanto, las investigaciones futuras que examinen el vínculo entre la personalidad de tipo D y las enfermedades cardiovasculares tienen un lugar asegurado.

Caribbean contributions to contemporary psychiatric psychopathology / Contribuciones caribeñas a la psicopatología psiquiátrica contemporánea

The intellectual exploration of phenomenological and psychiatric discovery that has flowered in the Caribbean in the period of political independence from British colonization is a reflection of the scholarship that has emerged from the academic nurturance by The University of the West Indies. Burgeoning migration of Caribbean people to England in the twentieth century has resulted in high reported rates of psychosis for this migrant population. Caribbean research into this condition has revealed that there exist hostile racial and environmental challenges in Britain that have had a profound pathological effect on the mental health of African Caribbean migrants. These findings have significantly shifted the pendulum of understanding of the aetiology of this condition from a genetic to a biopsychosocial position. Research has also revealed longstanding psychopathological effects of slavery and colonialism in the Caribbean that have had significantly negative long term effects on the mental health of many within the Caribbean population. Current research suggests that there is a need to nurture protective strategies to enhance resilience and social capital, which would ensure the wellness and continued survival of Caribbean people in spite of the many challenges they face.

La exploración intelectual del descubrimiento fenomenológico y psiquiátrico que ha florecido en el Caribe en el periodo de independencia política de la colonización británica, es un reflejo de la erudición surgida del cultivo académico de la Universidad de West Indies. La pujante migración de personas del Caribe a Inglaterra en el siglo 20, ha traído como consecuencia reportes de altas tasas de psicosis en relación con esta población de emigrantes. La investigación caribeña de esta condición ha revelado la existencia de retos producidos por la hostilidad racial y ambiental en Gran Bretaña, que han tenido un profundo efecto en la salud mental de los emigrantes afrocaribeños. Estos resultados han desplazado significativamente el péndulo de la comprensión de la etiología de esta condición, desde una posición genética a una posición biopsicosocial. La investigación también ha revelado la presencia de efectos psicopatológicos pertinaces provenientes de la esclavitud y el colonialismo en el Caribe. Se trata de efectos significativamente negativos y a largo plazo, sobre la salud mental de muchos dentro de la población caribeña. La investigación actual sugiere que hay una necesidad de fomentar estrategias de protección a fin de mejorar la resiliencia y el capital social, que asegurarían el bienestar y la continuación de la supervivencia de las personas del Caribe, a pesar de los muchos desafíos a que se enfrentan.

Increasing incidence of admissions to a General Hospital for deliberate self-harm in trinidad / Aumento de la incidencia de ingresos al Hospital General por auto-daño deliberado en trinidad

BACKGROUND: Deliberate self-harm and suicidal behaviour have become an increasingly common form of morbidity in the developing world. Suicidal behaviour is a major public health problem in Trinidad as the country has the second highest completed suicide rate in the English-speaking Caribbean. The objectives of this study were to determine the epidemiology of attempted suicide and self-harm at a specified site (the Port-of-Spain General Hospital) and compare it to previous studies done at the same site. SUBJECTS AND METHODS: This was investigated through a review of one years' admissions to the Port-of-Spain General Hospital for suicidal behaviour. Incidence was compared with a previous study completed at this site and reported in 1974. Comparison of the demographic characteristics of the sample with that of the previous study was also undertaken using chi-square analysis and significance testing through the use of t tests. RESULTS: A total of 368 referrals were made for attempted suicide or deliberate self-harm over the period indicating a fourfold increase in the incidence of this behaviour with a greater increase among males where the female to male ratio has declined from 4 to 1 to 2 to 1, p < 0.001; the mean age of males was 34 years compared to females 22 (p < 0.0001). The males were more likely to use violent means compared to females who were more likely to ingest tablets or bleach. Relationship difficulties were most commonly cited by both males and females as the reason for their attempt. There was a trend to greater propensity for this behaviour among Indo-Trinidadians as compared to Afro-Trinidadians in both females and males. CONCLUSIONS: Increasing numbers of men are engaging in self-harm behaviour and are using more violent and physically harmful methods suggesting a greater degree of suicidal risk while women mainly engage in acts of ingestion with a much lower risk of death. The older mean age of these men suggests that their problems are presenting in middle adulthood while women are engaging in this behaviour in young adulthood. Suicidal behaviour or deliberate self-harm is a major public health problem in Trinidad.

ANTECEDENTES: El auto-daño deliberado y el comportamiento suicida se han convertido cada vez más en una forma común de morbosidad en el mundo en vías de desarrollo. El comportamiento suicida es un serio problema de salud pública en Trinidad, como país que tiene la tasa más alta de suicidios efectuados en el Caribe anglófono. Los objetivos de este estudio fueron determinar la epidemiología del suicidio efectuado y el auto-daño en un lugar específico (el Hospital General de Puerto España) y compararla con estudios previos realizados en el mismo lugar. SUJETOS Y MÉTODOS: Esto fue investigado mediante una revisión de los ingresados de un año al Hospital General de Puerto España por comportamiento suicida. La incidencia fue comparada con un estudio previo terminado en este sitio y reportado en 1974. La comparación de las características demográficas de la muestra con la del estudio previo se llevó a cabo usando un análisis de chi-cuadrado y pruebas de significatividad mediante el uso de tests t. RESULTADOS: Se produjeron un total de 368 casos referidos por intento de suicidio o auto-daño deliberado en el período en cuestión, lo cual indica que la incidencia de esta conducta aumentó en cuatro veces, con un mayor incremento entre los varones, y una disminución de la proporción hembras-varones de 4:1 a 2:1; p < 0.001); la edad promedio de los varones fue 34 años en comparación con la de las hembras, 22 (p < 0.0001). Los varones mostraron una tendencia mayor a usar medios violentos en comparación con las hembras, entre las que había una mayor probabilidad de ingerir tabletas o lejía. Las dificultades en las relaciones constituyeron la explicación más comúnmente dada como causa del intento, tanto por los varones como por las hembras. Hubo tendencia a una mayor propensión a este comportamiento entre los indo-trinitenses en comparación con los afro-trinitenses, tanto en hembras como varones. CONCLUSIONES: Un número cada vez mayor de hombres se involucran en conductas auto-agresivas y están usando métodos más violentos y físicamente dañinos, lo que sugiere un grado mayor de riesgo de suicidio, mientras que las mujeres se entregan principalmente a actos de ingestión con riesgo mucho menor de muerte. La edad promedio mayor de estos hombres sugiere que sus problemas se presentan en medio de su adultez, mientras que las mujeres se entregan a estas conductas como adultos jóvenes. La conducta suicida y el auto-daño deliberado constituyen un problema principal de salud pública en Trinidad.

Early exposure to cannabis and risk for psychosis in young adolescents in Trinidad.

OBJECTIVE: Cannabis use increases the risk for psychosis, but psychotogenic effects of cannabis may be restricted to exposure during early adolescence. METHOD: Four hundred and seventy-two participants (aged 12-23 years), randomly selected from the general population in Trinidad, completed questionnaires on past and current cannabis use and psychotic symptoms (using the Community Assessment of Psychic Experiences). RESULTS: Cannabis use increased the risk of experiencing psychotic symptoms and this effect was conditional on early exposure, defined around the mean age of onset of cannabis use. Thus, exposure before but not after the age of 14 years predicted psychotic symptoms (respectively beta: 0.71, 95% CI 0.22; 1.19, P = 0.004 and beta: -0.11, 95% CI -0.57; 0.36, P = 0.66). The developmental effect of cannabis use was independent of use of other drugs or current use of cannabis. CONCLUSION: Early adolescence may be a critical period with regard to the psychotogenic effect of cannabis across geographical settings and ethnic groups.

The prevalence, organ distribution and fertility of cystic echinoccosis in feral pigs in tropical North Queensland, Australia.

An investigation was carried out to study the prevalence of Echinococcus granulosus hydatidosis in feral pigs (Sus domesticus) in the Charters Towers region of tropical North Queensland. Data were collected from a total of 238 carcasses, which were hunted and shot in the Burdekin River catchment area. Organs of the abdominal, thoracic, and pelvic cavities were examined for the presence of hydatid cysts. In the laboratory, cysts and hydatid cyst fluids were examined under a stereoscopic binocular microscope and a compound microscope. An overall prevalence of E. granulosus hydatid cysts in feral pigs was found to be 31.1%. There was no significant difference in either sex or age between infected and non-infected feral pigs. The predilection sites of cysts were livers (23%) and lungs (62%), with more cysts in lungs (252) than livers (48). The ratio of livers to lungs infected with fertile cysts was 1:4 compared to 1:8 sterile cysts. The overall fertility of cysts was 70.1%. The percentage of fertile cysts in liver and lung was 79.2% and 68.7%, respectively. The diameter of fertile cysts ranged from 15 to over 60 mm. There was no significant difference in size between fertile and non-fertile cysts in lungs. The high prevalence rate and fertility of cysts in feral pigs confirm that feral pigs can take part in the sylvatic cycle of the parasite in the region. The public health significance of this observation is potentially very important.

Prevalence and risk factors for HIV infection in pregnant women in north Trinidad / Prevalencia y Factores de Riesgo por Infección de VIH Entre las Gestantes del Norte de Trinidad

BACKGROUND: The prevalence of Human Immunodeficiency Virus (HIV) infection in the Caribbean is reported to be second only to sub Saharan Africa. HIV in pregnancy has become an increasingly important focus of attention in HIV research because of its role in contributing to spread of the infection. This study sought to establish the prevalence and risk factors associated with HIV infection among antenatal women in the northwest region of Trinidad. SUBJECTS AND METHODS: Using a cross-sectional survey design, interviews were conducted with each new pregnant attendee to the antenatal clinics in the county of St George West over a six-month period after informed consent was obtained. These women were all offered routine HIV testing in their antenatal assessment. Their HIV results were confirmed through the island's HIV monitoring facility. The interviews included questions on demographics, known risk factors for HIV infection, mental health history and related information on their partners. Women who had refused testing were also asked to give reasons for this. RESULTS: There was a total of 541 women attending the clinic for the first time during the six-month period Seven of them refused testing. Of the remaining 534 women, 37 were HIV positive (6.8%). Fourteen of the HIV positive women (37.8%) admitted to knowing of their status prior to becoming pregnant. Risk factors significantly associated with positive HIV status were early age of first sexual intercourse, a history of sexually transmitted disease, mental health problems and homelessness. Regression analysis established a history of sexually transmitted disease as the only independent predictor of HIV infection in this sample. CONCLUSION: These findings reveal a high rate of HIV infection among pregnant women in northwest Trinidad and suggest that having a history of sexually transmitted disease is a key determinant of this. Prevention efforts must therefore be targeted at identifying the factors which influ...

Antecedentes: Se reporta que la prevalencia de infección por VIH en el Caribe, ocupa el segundo lugar detrás del África subsaharana. Debido al papel que juega en diseminar la infección, el VIH en los embarazos se ha convertido cada vez más en foco de atención de las investigaciones de VIH. Por tal motivo, nos dimos a la tarea de establecer la prevalencia y los factores de riesgo asociados con la infección por VIH entre las mujeres que reciben cuidados antenatales en la región noroccidental de Trinidad y Tobago. Sujetos y métodos: Usando un diseño de encuesta transversal, se llevaron a cabo entrevistas con cada nueva embarazada atendida en las clínicas antenatales en el condado de Saint George West, por un período de seis meses, tras de obtener consentimiento informado. A estas mujeres se les aplicó pruebas de VIH de rutina en su valoración antenatal. Los resultados de sus pruebas de VIH fueron confirmados en la instalación de monitoreo de VIH de la isla. Las entrevistas incluyeron preguntas sobre datos demográficos, factores de riesgo conocidos en las infecciones por VIH, historia de salud mental, así como información relacionada con sus parejas. A las mujeres que rehusaron hacerse las pruebas, se les preguntó también sus motivos para el rechazo. Resultados: Hubo un total de 541 mujeres que asistieron a la clínica por primera vez durante el período de seis meses. Siete de ella rechazaron las pruebas. De las restantes 534 mujeres, 37 resultaron VIH positivas (6.8%). Catorce de las mujeres positivas al VIH (37.8%), admitieron conocer su condición antes de salir embarazadas. Los factores de riesgo...

Grey matter correlates of minor physical anomalies in the AeSOP first-episode psychosis study.

BACKGROUND: Minor physical anomalies are more prevalent among people with psychosis. This supports a neurodevelopmental aetiology for psychotic disorders, since these anomalies and the brain are both ectodermally derived. However, little is understood about the brain regions implicated in this association. AIMS: To examine the relationship between minor physical anomalies and grey matter structure in a sample of patients with first-episode psychosis. METHOD: Sixty patients underwent assessment of minor physical anomalies with the Lane scale. High-resolution magnetic resonance images and voxel-based methods of image analysis were used to investigate brain structure in these patients. RESULTS: The total anomalies score was associated with a grey matter reduction in the prefrontal cortex and precuneus and with a grey matter excess in the basal ganglia, thalamus and lingual gyrus. CONCLUSIONS: Minor physical anomalies in a sample of patients with first-episode psychosis are associated with regional grey matter changes. These regional changes may be important in the pathogenesis of psychotic disorder.

Variation of homicidal and suicidal behaviour within Trinidad and Tobago and the associated ecological risk factors / Variación del Comportamiento Homicida y Suicida en Trinidad-Tobago, y Factores Ecológicos de Riesgo Asociados

Self destructive behaviour may not occur consistently across a population. Identification of variations in homicidal and suicidal behaviour within a country can enable specific prevention and public health strategies to be adopted. This is significant because morbidity and mortality associated with these behaviour patterns is preventable and the affected population is increasingly young adults with potentially productive lives. The author sought to identify some of the associated risk factors with the behaviours in Trinidad and Tobago, a developing island-state in the English-speaking Caribbean, by disaggregating the homicide and suicide data available from Police records for distinct geographical regions. Spearman rank correlation was used to determine whether any of the variations observed could be attributed to social or demographic factors. Homicide and suicide were inversely related in many areas of the country. They were both low in Tobago. Homicide was positively associatedwith high population density, low marriage rates, African ethnicity and showed a trend toward association with school drop-out rates. For suicide, low population density, low income, East Indian ethnicity and alcohol consumption were significantly correlated. These findings underline the benefit of disaggregating national data and suggest specific interventions to diminish the occurrence of these harmful behaviour patterns in Trinidad and Tobago with possible extension to other similar developing countries.

Puede que los comportamientos auto-destructivos no ocurran de forma sistemáticamente en una población La identificación de variaciones en el comportamiento homicida y suicida dentro de un país puede hacer posible la adopción de estrategias específicas tanto con respecto a la prevención como en relación con la salud pública. Esto es significativo porque la morbosidad y la mortalidad asociadas con estos patrones de conducta son prevenibles y la población afectada consiste cada vez más de adultos jóvenes con vidas potencialmente productivas. Desagregando los datos sobre suicidios y homicidios a su disposición en los archivos de la policía en diferentes regiones geográficas, el autor se dio a la tarea de identificar algunos de los factores de riesgo asociados con los comportamientos en Trinidad-Tobago ­ una Isla-Estado en vías de desarrollo en el Caribe anglófono. A fin de determinar si alguna de las variables observadas podía atribuirse a factores sociales o demográficos, se recurrió al coeficiente de correlación por rangos de Spearman. El homicidio y el suicidio se hallaban en relación de proporcionalidad inversa en muchas áreas del país. En Tobago, ambos resultaron ser bajos. El homicidio estuvo positivamente asociado con una alta densidad de población, tasas de matrimonio, etnicidad africana y mostró una tendencia hacia la asociación con las tasas de deserción escolar. Por su parte, el suicidio presentó una correlación significativa con una baja densidad de población, ingresos bajos, etnicidad indo-oriental, y consumo de alcohol. Estos hallazgos destacan el beneficio de desagregar los datos nacionales, y sugieren intervenciones específicas con el fin de disminuir la manifestación de estos patrones de conducta negativos en Trinidad-Tobago, con la extensión posible en otros países similares en vías de desarrollo.

HIV mania as a marker for clinical deterioration in AIDS.

HIV infection continues to be a significant health problem in the Caribbean region. With the availability of antiretroviral drug treatment, it is becoming increasingly important to identify clinical markers for deterioration from infection to disease. Psychiatric symptoms are well recognized as a complication of HIV infection. Three cases are presented to suggest that the occurrence of HIV related mania may herald the transition from HIV infection to AIDS. This is relevant in assessing the course of the disorder and could indicate that the psychiatric manifestation of neurotropic infection represents a distinguishing marker for the diagnosis of AIDS perhaps before other clinical signs are evident.

HIV mania as a marker for clinical deterioration in AIDS / La Manía en la Infección por el VIH como Marcador de Deterioro Clínico en el SIDA

HIV infection continues to be a significant health problem in the Caribbean region. With the availability of antiretroviral drug treatment, it is becoming increasingly important to identify clinical markers for deterioration from infection to disease. Psychiatric symptoms are well recognized as a complication of HIV infection. Three cases are presented to suggest that the occurrence of HIV related mania may herald the transition from HIV infection to AIDS. This is relevant in assessing the course of the disorder and could indicate that the psychiatric manifestation of neurotropic infection represents a distinguishing marker for the diagnosis of AIDS perhaps before other clinical signs are evident

La infección del VIH continúa siendo un importante problema de salud en la región del Caribe. Con la disponibilidad de tratamiento de droga de antiretroviral, está poniéndose en aumento importante para identificar los marcadores clínicos para el deterioración de la infección enfermar. Se reconocen bien los síntomas psiquiátricos como una complicación de infección por VIH. Sin embargo, se presentan tres casos para sugerir que específicamente la manifestación de manía relacionada con el VIH puede tener importancia clínica en anunciar la transición de la infección por VIH a SIDA. Esto tiene relevancia en cuanto a evaluar el curso del trastorno y podría indicar que la manifestación psiquiátrica de infección neurotrópica representa un marcador distintivo para el diagnóstico del SIDA, quizás antes de que cualquier otra señal clínica se haga evidente.

Gender and ethnicity in first admissions to a psychiatric unit in Trinidad

It has been recognized that there are gender disparities in the admission rates to psychiatric units. While the community prevalence of the major non-organic psychotic mental disorders are thought to have no gender bias, non-psychotic disorders such as depression are more commonly diagnosed in women. Gender differences in admission may indicate differences in severity or in presentation to psychiatric services and would have important implications for the targeting of preventative strategies. The case notes of all admissions to the psychiatric unit at the San Fernando General Hospital were obtained for the calendar year 1999. The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) diagnoses and gender were analysed to determine the distribution of diagnostic categories by gender. A total of 119 patients were admitted to the unit for the first time in the period under review, 72 were male (60.5) and 47 were female (39.5). There were no significant differences in age by gender. Substance use related admissions and psychotic illnesses (schizophrenia spectrum and affective psychoses) were significantly more common in men (p = 0.006; p = 0.03 respectively). These differences were especially marked for those of East Indian descent. Non-psychotic illnesses were more commonly diagnosed among women (p = 0.0008). These findings suggest that a larger proportion of males are admitted to the general hospital psychiatric unit among first time admissions. This is also true for re-admissions. Men are more likely to be diagnosed with substance use and psychotic disorders, while for women, major depression and non-psychotic illnesses are the main diagnoses. Community surveys are needed to determine whether this demographic pattern of admission reflects the population prevalence of these disorders. Reduction of admission rates will require interventions that are sensitive to gender differences in diagnosis among those admitted to psychiatric units

Making a diagnosis of adult attention deficit hyperactivity disorder

This paper describes the diagnosis of adult attention deficit hyperactivity disorder (ADHD) in a 26-year-old female. Adult ADHD is being increasingly acknowledged as a cause of psychiatric morbidity particularly since the diagnosis is frequently missed in childhood. Greater recognition of this disorder is important because it can be a cause of low productivity and employment disruption as well as a risk factor for other psychiatric problems such as substance abuse and mood disorders.

Evaluation of the chemotherapy patient monitor: an interactive tool for facilitating communication between patients and oncologists during the cancer consultation.

Effective communication between oncologists and patients with cancer is of paramount importance. The Chemotherapy Patient Monitor (CPM) is a novel tool designed to assist doctor-patient communication regarding patient concerns and side-effects. Initially, the CPM was assessed in a primary evaluation study of its use during consultations with 26 patients with advanced colorectal cancer (one consultation without, followed by two with, the CPM per patient). This led to a further dissemination/audit of 34 patients attending oncology centres in the UK, who had completed the survey prior to three consultations. The CPM contains a checklist of common side-effects of chemotherapy regimens used in advanced colorectal cancer, and other common concerns of patients with advanced colorectal cancer. The CPM records the presence of side-effects/concerns, the distress caused, whether patients wish to discuss them further, and actions taken as a result. Questionnaires explored the views of patients and oncologists in the UK and Spain regarding the effectiveness of consultations during a baseline visit conducted without the CPM, and then with the CPM in subsequent visits. These data were then complemented by the dissemination/audit study of the CPM across nine centres in the UK. All patients understood the CPM. The CPM was rated as useful by oncologists in 83% of consultations, and did not lengthen 82% of visits. Patients felt it had improved the visit in 95% of cases. Responses from patients (100%) and oncologists (84%) indicated willingness to use the CPM for at least some consultations in the future. The results of the dissemination/audit study supported these conclusions. We conclude that the CPM appears to be a useful new tool for improving patient-doctor communication during cancer consultations.

Inhibition of growth of cultured Babesia microti by serum and macrophages in the presence or absence of T cells.

Serum and macrophages from the acute-phase (days 12-14 p.i.) and recovery-phase (days 23-25 p.i.) of infection of mice with Babesia microti were analyzed for their ability to inhibit the in vitro growth of B. microti in the presence or absence of T cells. Recovery-phase serum was inhibitory to the growth of B. microti, whereas, acute-phase serum had no inhibitory effects. Both acute- and recovery-phase macrophages inhibited B. microti growth. The co-culture of acute- but not recovery-phase T cells with macrophages from uninfected control mice was inhibitory to the growth of B. microti. Growth of B. microti was also inhibited in cultures containing macrophages from uninfected control mice plus culture supernatant fluid from acute-phase but not recovery-phase T cells. The supernatant fluid from B. microti cultures with acute-phase T cells contained IFN-gamma detected by a sandwich ELISA, whereas cultures with control T cells or recovery phase T cells did not. Results of the present study suggest the likelihood of a protective role against B. microti in mice for antibody which appeared in recovery-phase serum and for macrophages activated by IFN-gamma from acute-phase T cells.

HIV infection rates and associated factors in high risk patients admitted to a psychiatric hospital in Trinidad and Tobago

We investigated the rate of HIV infection in patients at the St Ann's psychiatric hospital in Trinidad and Tobago, and identified the demographic and clinical variables associated with infection. Patients admitted to the hospital were tested for HIV when details of their sexual history suggested that they might be at high risk of infection. We examined hospital records for the 1991-1995 period. During that time a total of 1,227 patients were tested, of whom 84 (6.9) were confirmed positive for HIV. Since there was a total of 11,203 admissions over the period, the minimum infection rate for all patients was 0.75. Among the high-risk group tested, being positive for HIV was associated with age (p = 0.01) and ethnicity (p = 0.003). The highest rates of infection were in the 15-44-year age group while the rates in patients of African and mixed ethnicity were higher than in East Indians. When the underlying diagnoses were examined, the highest rates were found in patients with substance abuse problems, especially those who abused cocaine (p < 0.001). Patients who were VDRL reactive were also more likely to be HIV positive than other patients (p < 0.001). These findings indicate that psychiatric patients are at greater than average risk for HIV infection. Mental health specialists may need to be trained in sexual health counselling to facilitate preventive intervention for this high-risk group.

Perceptions about mental illness among pre-clinical medical students in Trinidad & Tobago

Perceptions about mental illness among medical practitioners are likely to determine their capacity to recognise, treat appropriately and refer patients who have mental health problems. It is therefore important that training of medical students in psychiatry is undertaken with knowledge of their attitudes to mental health disorders. We determined the perceptions of 108 pre-clinical medical students (69 males, 39 females; mean age 22 years) toward mental illness in Trinidad & Tobago by analysing their responses to a questionnaire based on a case vignette of a young man with a paranoid psychotic illness. 88felt that medical treatment in hospital was the best means of treating the illness and 86suggested that discharge should be conditional on regular visits to a doctor. 89however opposed the patient's marrying into their families and 85to his teaching their children. This was associated significantly with having a personal relationship with someone having a mental illness (p < 0.03). Surprisingly, 25believed that mental illness could be caused by supernatural forces, particularly females who were almost twice as likely as males to express this belief.

Evaluation of a new method for the analysis of free catecholamines in plasma using automated sample trace enrichment with dialysis and HPLC.

BACKGROUND: Analysis of urinary free catecholamines was automated recently, but analysis of plasma samples posed special difficulties. The present study was undertaken to evaluate a new method for the automated analysis of plasma catecholamines. METHODS: The procedure is based on an improved sample handling system that includes dialysis and sample clean-up on a strong cation trace-enrichment cartridge. The catecholamines norepinephrine, epinephrine, and dopamine are then separated by reversed-phase ion-pair chromatography and quantified by electrochemical detection. RESULTS: Use of a 740- microL sample is required to give the catecholamine detection limit of 0.05 nmol/L and analytical imprecision (CV) between 1.1% and 9.3%. The assay can be run unattended, although >12 h of analysis time is not recommended without cooling of the autosampler rack. Comparison (n = 68) of the automated cation-exchange clean-up with the well-established manual alumina procedure gave excellent agreement (mean, 3.78 +/- 2.76 and 3.8 +/- 2.89 nmol/L for norepinephrine and 0.99 +/- 1.72 and 1.08 +/- 1.78 nmol/L for epinephrine). Hemodialysis had no clear effect on plasma norepinephrine. Epinephrine concentrations were similar (0.05 < P < 0.1) in chronic renal failure patients (0.24 +/- 0.3 nmol/L; n = 15) and healthy controls (0.5 +/- 0.24 nmol/L; n = 31). Dopamine was not quantified, being usually <0.2 nmol/L. CONCLUSION: The availability of such a fully automated procedure should encourage the more widespread use of plasma catecholamine estimation, e.g., after dialysis, exercise, or trauma/surgery and in the investigation of catecholamine-secreting tumors, particularly in the anuric patient.

Interaction of metargidin (ADAM-15) with alphavbeta3 and alpha5beta1 integrins on different haemopoietic cells.

Metargidin (ADAM-15) is a type I transmembrane glycoprotein belonging to the ADAM (A Disintegrin and Metalloprotease Domain) family of proteins and is widely expressed in different tissues and cell types. Members of this family contain an amino-terminal metalloprotease domain followed by a disintegrin domain, a cysteine-rich region and a membrane proximal EGF-like domain. The disintegrin domain of metargidin contains an RGD tripeptide sequence, suggesting that it may potentially interact with the integrin family of proteins. Here we identify integrin ligands for metargidin on haemopoietic cells, by using a chimeric protein containing the extracellular domain of metargidin fused to the Fc portion of human IgG. Binding activity to a panel of human cell lines was analysed by solid-phase cell-adhesion assays. Metargidin bound to a monocytic cell line, U937, and a T cell line, MOLT-4, in a specific manner. Adhesion was divalent cation- and temperature- dependent and strongly enhanced by Mn2+, all features of integrin-mediated binding. Using a panel of anti-integrin antibodies we show that alphavbeta3 is a ligand for metargidin on U937 cells. In contrast, for MOLT-4 cells, the integrin alpha5beta1 contributes to cell binding. Adhesion was mediated by the disintegrin domain of metargidin as RGD-based peptides inhibited cell binding to both cell lines. The specificity of the interaction between both alphavbeta3 and alpha5beta1 and metargidin was further confirmed by solid-phase adhesion assays using purified recombinant integrins. These results together indicate that metargidin can function as a cell adhesion molecule via interactions with alphavbeta3 and alpha5beta1 integrins.

Psychiatric symptoms and an anterior cranial fossa meningioma.

We present a case of a patient admitted to a psychiatric hospital with psychotic symptoms and cognitive impairment but who was subsequently found to have an anterior interhemispheric falx meningioma. There must be a high index of suspicion for organic brain disease in patients over age 45 years presenting with psychotic symptoms and seizures for the first time.