Detecting Depression in People Living with HIV in South Africa: The Factor Structure and Convergent Validity of the South African Depression Scale (SADS).

Screening measures for depression developed in high-income countries have not always demonstrated strong psychometric properties in South Africa and with people living with HIV (PLWH). The present study explored the psychometric properties of the 16-item South African Depression Scale (SADS) comprised of idioms of distress specific to isiXhosa culture in PLWH. The SADS was administered to 137 Xhosa-speaking PLWH who met diagnostic criteria for major depressive disorder (MDD) together with the Hamilton Depression Scale (HAM-D) and the Center for Epidemiological Studies Depression Scale (CES-D). We conducted exploratory factor analysis, correlation, and reliability statistics. Four factors of the SADS emerged: Sadness, lethargy/burdened, anhedonia/withdrawal, and cognitive/somatic. All factors correlated significantly with the HAM-D and CES-D. Internal consistency of the overall measure was high (α = .89). The SADS promises to be a robust measure of depression in isiXhosa-speaking PLWH in South Africa likely due to the inclusion of local idioms of distress.

'I went back to being myself': acceptability of a culturally adapted task-shifted cognitive-behavioural therapy (CBT) treatment for depression (Ziphamandla) for South African HIV care settings.

There is a need for a culturally adapted, evidence-based, psychotherapy treatment that is effective, acceptable, and feasible for integration into primary care in South Africa. This qualitative study used exit interviews to examine participants' experiences of an adapted cognitive-behavioural therapy treatment for adherence and depression, task-shifted and delivered by nurses in two peri-urban HIV clinics near Cape Town. Nine semi-structured exit interviews were conducted with isiXhosa-speaking females and analysed using thematic analysis. Overall, participants responded positively to the treatment, viewing it as acceptable and beneficial and as a catalyst to returning to normalcy. Results indicated that participants viewed the treatment as being effective in ameliorating their depressive symptoms and improving their adherence to ART . Additional benefits described included improvements in subjective wellbeing and social and occupational functioning. Several began or resumed employment, an important behavioural indicator of the treatment's capacity to facilitate positive change and cost saving. Recommendations to improve the treatment included using video material and educating others about depression. These findings have positive implications regarding the acceptability and cultural applicability of the treatment for use in South Africa.

Probing the potential of mucus permeability to signify preterm birth risk.

Preterm birth is the leading cause of neonatal mortality, and is frequently associated with intra-amniotic infection hypothesized to arise from bacterial ascension across a dysfunctional cervical mucus plug. To study this dysfunction, we assessed the permeability of cervical mucus from non-pregnant ovulating (n = 20) and high- (n = 9) and low-risk (n = 16) pregnant women to probes of varying sizes and surface chemistries. We found that the motion of negatively charged, carboxylated microspheres in mucus from pregnant patients was significantly restricted compared to ovulating patients, but not significantly different between high- and low-risk pregnant women. In contrast, charged peptide probes small enough to avoid steric interactions, but sensitive to the biochemical modifications of mucus components exhibited significantly different transport profiles through mucus from high- and low-risk patients. Thus, although both microstructural rearrangements of the components of mucus as well as biochemical modifications to their adhesiveness may alter the overall permeability of the cervical mucus plug, our findings suggest that the latter mechanism plays a dominant role in the impairment of the function of this barrier during preterm birth. We expect that these probes may be readily adapted to study the mechanisms underlying disease progression on all mucosal epithelia, including those in the mouth, lungs, and gut.

A Comparison of Five Brief Screening Tools for HIV-Associated Neurocognitive Disorders in the USA and South Africa.

Screening for HIV-associated neurocognitive disorders (HAND) is important to improve clinical outcomes. We compared the diagnostic sensitivity and specificity of the mini-mental state examination, International HIV dementia scale (IHDS), Montreal cognitive assessment, Simioni symptom questionnaire and cognitive assessment tool-rapid version (CAT-rapid) to a gold standard neuropsychological battery. Antiretroviral-experienced participants from Cape Town, South Africa, and Baltimore, USA, were recruited. The sensitivity and specificity of the five tools, as well as those of the combined IHDS and CAT-rapid, were established using 2 × 2 contingency tables and ROC analysis. More than a third (65165) had symptomatic HAND. In detecting HIV-D, the CAT-Rapid had good sensitivity (94 %) and weak specificity (52 %) (cut-point ≤10), while the IHDS showed fair sensitivity (68 %) and good specificity (86 %) (cut-point ≤10). The combined IHDS and CAT-rapid showed excellent sensitivity and specificity for HIV-D at a cut-off score of ≤16 (out of 20; 89 and 82 %). No tool was adequate in screening for any HAND. The combination IHDS and CAT-rapid tool appears to be a good screener for HIV-D but is only fairly sensitive and poorly specific in screening for any HAND. Screening for milder forms of HAND continues to be a clinical challenge.

Twin frequency and industrial pollution in different regions of Hesse, Germany.

AIMS: To investigate whether twinning occurs more frequently in residents in the vicinity of a toxic waste incinerator (TWI). METHODS: Within a longitudinal environmental study that addressed child health second grade school children and their parents were recruited. The proportion of twinning in the TWI region was compared with two comparison areas. In a second confirmatory investigation, birth records for the years 1994-97 from the Hessian Perinatal Survey (HEPS) were accessed to determine whether the incidence of twinning was higher in regions around the TWI compared to adjacent reference areas. RESULTS: In the environmental study, 61.5% of the children and 95% of their mothers participated. In mothers, twinning was 5.3% in the TWI region compared to 1.6% and 2.3% in the comparison regions. The proportion of mothers with fertility assessment/treatment was 5.7%, 8.3%, and 0% respectively. The prevalence of twinning was not significantly higher (4.5%) in mothers with treatment compared to mothers without (3.7%). From the HEPS, data of 20 603 births was analysed. The incidence of twins was significantly higher in areas which surround the TWI and other industries (1.4-1.6 per 100 births) compared to births in reference areas (0.8 per 100). CONCLUSIONS: Twinning rates may be associated with exposure to industrial pollution. Future environmental health studies that consider multiple births as an outcome are warranted. These should also investigate whether the incidence of monozygotic or dizygotic twinning may be associated with industrial pollution.

Early childhood determinants of organochlorine concentrations in school-aged children.

We investigated whether early childhood factors such as breast-feeding, parity, and smoking contribute to the variation of organochlorine compounds (OC: dichlorodiphenyldichloroethene, hexachlorobenzene, beta-hexachlorocyclohexane, and the sum of polychlorinated biphenyls including the congeners 101, 118, 138, 153, 170, 180, 183, and 187) at approximately 7 y of age. OC were measured in whole blood of 350 children. Pregnancy characteristics and the child's living conditions were gathered by questionnaires administered to the parents and interviews with the mother. Height and weight were determined during the medical examination. Exclusion of incomplete data and nonbiologic children of the mothers yielded a sample of 337 children. We applied regression analysis with indicator variables, controlling for confounders. No systematic association was detected for birth order or maternal smoking during pregnancy. The OC concentrations are diluted in children with a higher body mass index (>18 kg/m(2)). We found a strong, dose-dependent relationship between the duration of breast-feeding (none, 1-4 wk, 5-8 wk, 9-12 wk, >12 wk) and the concentration of all five OCs. Of the potential determinants analyzed, more of the variance of the OC concentration is accounted for by breast-feeding than by any other variable. Exclusive breast-feeding beyond 12 wk was associated with a doubling of OC whole blood concentration compared with bottle-fed children (dichlorodiphenyldichloroethene, 0.28 microg/L versus 0.55 microg/L; beta-hexachlorocyclohexane, 0.05 microg/L versus 0.14 microg/L; hexachlorobenzene, 0.14 microg/L versus 0.25 microg/L; sum of polychlorinated biphenyls, 0.25 microg/L versus 0.55 microg/L). These findings indicate that breast-feeding can lead to an extended duration of increased OC exposure in childhood.

Insurance policies may cover costs of False Claims Act litigation.

Expenses associated with the defense of a False Claims Act investigation or lawsuit may be covered by insurance. Such coverage may be available through a general liability policy, or in the case of not-for-profit organizations, through a provision added to the organization's directors and officers policy. In either instance, the extent of coverage is determined by the language used in the policy and state law governing interpretation of the insurance policy.

Exposure to polychlorinated biphenyls and levels of thyroid hormones in children.

As part of an epidemiologic study on exposure to a toxic waste incineration plant we investigated whether blood concentrations of polychlorinated biphenyls (PCBs), lead, and cadmium, as well as concentration of mercury in 24-hr urine samples were associated with thyroid hormone status. As an indication of status, we determined levels of thyroid-stimulating hormone (TSH), free thyroxine (FT(4)), and free triiodothyronine (FT(3)) in children living in households where [less than/equal to] 10 cigarettes were smoked per day. Eight PCB congeners (PCBs 101, 118, 138, 153, 170, 180, 183, and 187) were measured in whole blood samples. Of these, seven congeners (PCB 101 was not detected in any sample) and the sum of all PCB congeners were analyzed as predictors for thyroid hormone status in separate linear regression models adjusted for potential confounders. In addition, the possible effects of cadmium, lead, and mercury on levels of thyroid hormones were examined. Blood concentrations and information on questionnaire data were available for 320 children 7-10 years of age. We found a statistically significant positive association between the mono-ortho congener PCB 118 and TSH as well as statistically significant negative relationships of PCBs 138, 153, 180, 183, and 187 to FT(3). There was no association for the PCB congeners and FT(4). Blood cadmium concentration was associated with increasing TSH and diminishing FT(4). Blood lead and urine concentration of mercury were of no importance to thyroid hormone levels. The results stress the need for future studies on the possible influences of PCB and cadmium exposure on thyroid hormones, particularly in children. These studies should also take neurologic development into account.

Developmental and regional-specific expression of FLRFamide peptides in the tobacco hornworm, Manduca sexta, suggests functions at ecdysis.

The developmental profile of a family of three FLRFamide (Phe-Leu-Arg-Phe-NH2) peptides in the tobacco hornworm, Manduca sexta, revealed regional-specific expression patterns within the segmental ganglia. Levels of the three peptides-F7G (GNSFLRF-amide), F7D (DPSFLRFamide), and F10 (pEDVVHS-FLRFamide)-were always higher in the thoracic than abdominal ganglia. The predominant peptide also differed regionally, with F7G being highest in the thoracic ganglia and F7G and F100 being equivalent in the abdominal ganglia. Furthermore, we found regional-specific transient declines in ganglion peptide levels temporally correlated to ecdysis. Thoracic ganglion peptide levels declined at each molt, while abdominal ganglion levels declined over a period of 2 days after ecdysis. The decline in central levels was accompanied by an increase in levels in peripheral neurohemal sites, the transverse nerves (TNs). These observations suggest peptides were released from neurosecretory cells (NSCs) at ecdysis. Distinct sets of thoracic and abdominal NSCs and their processes in peripheral neurohemal sites were immunoreactive, supporting the biochemical data. These results also suggest the regional differences may arise from cellular-specific expression patterns for this family of peptides. In addition, fine immunoreactive processes were observed traveling between TNs and skeletal muscles, suggestive of myotropic actions. We propose that the release of different M. sexta FLRFamides from regionally distinct NSCs leads to a coordinated modulation of skeletal and visceral muscles that facilitate ecdysis.

Distribution of GABA-like immunoreactive neurons in insects suggests lineage homology.

Gamma-aminobutyric acid (GABA) is an important inhibitory neurotransmitter in vertebrates and invertebrates (Sattelle [1990] Adv. Insect Physiol. 22:1-113). The GABA phenotype is lineally determined in postembryonic neurons in the tobacco hawkmoth, Manduca sexta (Witten and Truman, [1991] J. Neurosci. 11:1980-1989) and is restricted to six identifiable postembryonic lineages in the moth's thoracic hemiganglia. We used a comparative approach to determine whether this distinct clustering of GABAergic neurons is conserved in Insecta. In the nine orders of insects surveyed (Thysanura, Odonata, Orthoptera, Isoptera, Hemiptera, Coleoptera, Diptera, Lepidoptera, and Hymenoptera), GABA-like immunoreactive neurons within a thoracic hemiganglion were clustered into six distinct groups that occupied positions similar to the six postembryonic lineages in Manduca. On the basis of cell body position and axon trajectories, we suggest that these are indeed homologous lineage groups and that the lineal origins of the GABAergic cells have been very conservative through insect evolution. The distinctive clustering of GABA-positive cells is shared with crustaceans (Mulloney and Hall [1990] J. Comp. Neurol. 291:383-394; Homberg et al. [1993] Cell Tissue Res. 271:279-288) but is not found in the centipede Lithobius forficulatus. There is a two- to threefold increase in numbers of thoracic neurons between the flightless Thysanura and the most advanced orders of insects. Using the GABA clusters as indicators of specific lineages, we find that only selected lineages have significantly contributed to this increase in neuronal numbers.

Developmental plasticity of neuropeptide expression in motoneurons of the moth, Manduca sexta: steroid hormone regulation.

Developmental changes in the expression of a FMRFamide-like (Phe-Met-Arg-Phe-NH2) peptide or peptides in motoneurons of the tobacco hornworm, Manduca sexta, were demonstrated using immunohistochemical techniques. The onset of FMRFamide-like immunoreactivity (FLI) was gradual during larval growth but by the final larval stage, immunoreactivity was present in the majority of motoneurons. FLI then declined during metamorphosis and was absent in all identified adult motoneurons. We used a novel in vivo culture system to demonstrate that the steroid hormone, 20-hydroxyecdysone, regulates the loss of FLI in motoneurons during metamorphosis. The small commitment peak of ecdysteroid appears to shut off the program of neuropeptide accumulation that is characteristic of the larval state of the motoneurons. The prepupal peak of steroid then causes the rapid loss of stored FLI. This steroid-induced change in the neuropeptide content of motoneurons may reflect major changes in neuromuscular functions between the larval and adult stages.

Characterization of two myotrophic neuropeptides in the FMRFamide family from the segmental ganglia of the moth Manduca sexta: candidate neurohormones and neuromodulators

We have characterized two new members of the FMRFamide family of neuropeptides from the segmental ganglia of the tobacco hornworm Manduca sexta. Levels of peptides in ganglia used for purification were enhanced by manipulating their exposure to the steroid molting hormones. Explants of ganglia were cultured in the low-level ecdysteroid environment of diapausing pupae shown previously to evoke accumulation of FMRFamide-like immunoreactivity (FLI). Sufficient material for sequencing was obtained from 180 explanted ganglia. Extracts of ganglia were fractionated using two reverse-phase liquid chromatography procedures, and the immunoreactive fractions were subjected to sequence analysis using electrospray mass spectrometry. The sequences of the two peptides were determined to be GNSFLRFamide and DPSFLRFamide. These peptides have been named MasFLRFamide II and MasFLRFamide III, respectively; the previously characterized M. sexta FLRFamide (pEDVVHSFLRFamide) has been renamed MasFLRFamide I. The three peptides show distinctive tissue and developmental distributions as determined from fractionated extracts of larval and adult central nervous system structures and neurohemal organs. In the retrocerebral corpora cardiaca/corpora allata, MasFLRFamide I was the predominant form, while in the segmental ganglia MasFLRFamides II and III predominated. Higher levels of MasFLRFamide I and II were found in the adult, whereas there was little apparent change in the level of MasFLRFamide III upon metamorphosis. Determinations of peptide levels in fractionated hemolymph of newly emerged moths revealed that levels of MasFLRFamide I and III could exceed 10 nmol l-1. The actions of the three peptides were tested on the moth ileum. MasFLRFamides II and III were found to be stimulatory. At 1 nmol l-1, these peptides induced robust increases in the rate of rhythmic longitudinal and peristaltic waves of contractions. In contrast, MasFLRFamide I was ineffective even at 20 nmol l-1. Thus, while all three peptides have the characteristics of neurohormones in M. sexta, the physiological findings show that the heptapeptide FLRFamides have properties distinct from those of the decapeptide.

Neurobehavioral and neurophysiological outcome of chronic low-level tetrachloroethene exposure measured in neighborhoods of dry cleaning shops.

The effects of chronic low-level tetrachloroethene (TCE) exposure on functions of the central nervous system (CNS) were measured in subjects living in the neighborhood of dry cleaning shops with a mean residential time of 10.6 years. Neurobehavioral tests were performed using a German version of the NES battery. Additionally, a pattern reversal visual-evoked potentials (VEPs) were recorded. the mean blood TCE concentration in the subjects was 17.8 micrograms/liter and the median indoor TCE air concentration measured in the residences was 1.36 mg/m3. The outcome of the NES subtests for vigilance, simple reaction time, as well as visual memory differed statistically significantly between the exposed subjects and the controls, whereas for VEP latencies the differences were statistically not significant. It is concluded that despite the low exposure levels, CNS functions might be affected by TCE in subjects living close to a dry cleaning facility if the exposure lasts for several years.

Fate of abdominal ventral unpaired median cells during metamorphosis of the hawkmoth, Manduca sexta.

Each of the unfused abdominal ganglia in the larval, pupal, and adult stages of the hawkmoth, Manduca sexta, has two large ventral median neurons with axons that bifurcate to innervate targets on both sides of the abdomen. Although the dendritic structures of the two neurons are similar, their axons branch to innervate distinct sets of target muscles. During metamorphosis both neurons undergo dendritic regression, followed by growth of new arborizations during adult development. The neurons must innervate different targets in the larva and adult, since many larval muscles degenerate and are replaced during metamorphosis. Both neurons were reactive with an antibody to the neuromodulatory compound, octopamine, in the larval and adult stages. Pairwise intracellular recordings in isolated nerve cords revealed spontaneous excitatory synaptic potentials that occurred in the ventral median neurons of each ganglion in an anterior-to-posterior sequence. The synaptic potentials were eliminated when the interganglionic connective was interrupted posterior to the subesophageal ganglion. The ventral median neurons were also excited by tactile stimulation of the body surface in larvae, pupae and adults.

The regulation of transmitter expression in postembryonic lineages in the moth Manduca sexta. I. Transmitter identification and developmental acquisition of expression.

The majority of the neurons in the adult nervous system of Manduca sexta are born postembryonically, during larval life. Stereotypic arrays of identifiable neuroblasts generate their clonal families or lineages commencing at the end of the second larval instar through pupal day 2, when the neuroblasts die (Booker and Truman, 1987a). We have used immunohistochemical techniques to follow the neurochemical differentiation of GABA and a peptide similar to molluscan small cardioactive peptide B (SCPB) in identified lineages. We report here the distribution and developmental acquisition of the expression of these putative transmitters. There are 24 postembryonic lineages in the second thoracic ganglion of the larvae (Booker and Truman, 1987a). Immunoreactivity against GABA and SCPB is seen only in a subset of these 24 clonal families. GABA immunoreactivity is confined to the progeny of the E, K, M, N, T, and X neuroblasts and is expressed by most or all of the neurons in these lineages. The SCPB-like immunoreactivity is found in a subset of the neurons in only two clonal groups, the K and M groups, and is colocalized with GABA. These results show that, though heterogeneity in transmitter type exists (GABA, GABA/SCPB), members of a given lineage share at least some features (GABA) in common. The onset of transmitter expression was followed in detail for the K- and M-lineage neurons. During the larval stages, the postembryonic lineage cells are developmentally arrested in a partially differentiated state (Booker and Truman, 1987a) and do not express transmitter immunoreactivity at this time. Their maturation resumes with the onset of metamorphosis.(ABSTRACT TRUNCATED AT 250 WORDS)

The regulation of transmitter expression in postembryonic lineages in the moth Manduca sexta. II. Role of cell lineage and birth order.

The expression of GABA is restricted to the progeny of only six of the 24 identified postembryonic lineages in the thoracic ganglia of the tobacco hornworm, Manduca sexta (Witten and Truman, 1991). It is colocalized with a peptide similar to molluscan small cardioactive peptide B (SCPB) in some of the neurons in two of the six lineages. By combining chemical ablation of the neuroblasts at specific larval stages with birth dating of the progeny, we tested whether the expression of GABA and the SCPB-like peptide was determined strictly by cell lineage or involved cellular interactions among the members of individual clonal groups. Chemical ablation of the six specific neuroblasts that produced the GABA-positive neurons (E, K, M, N, T, and X) or of the two that produced the GABA + SCPB-like-immunoreactive neurons (K, M) prior to the generation of their lineages resulted in the loss of these immunoreactivities. These results suggest that regulation between lineages did not occur. Ablation of the K and M neuroblasts after they had produced a small portion of their lineages had no effect on the expression of GABA, but did affect the pattern of the SCPB-like immunoreactivity. Combining birth-dating techniques with transmitter immunocytochemistry revealed that it was the position in the birth order and not interactions among the clonally related neurons that influenced the peptidergic phenotype. These results suggest that cell lineage is involved in establishing the GABAergic phenotype and that both cell lineage and birth order influence the determination of the peptidergic phenotype.(ABSTRACT TRUNCATED AT 250 WORDS)

Treatment of malignant tumors in the parotid glands.

This study is a review of 105 patients with histologically confirmed salivary gland carcinoma in the parotid glands. The patients were consecutively registered at the Radium Centre of Copenhagen from 1971 to 1980. The different treatment modalities of these patients are examined concerning recurrence and survival. Sixty-two patients obtained local tumor control, 36 of them were in the group of patients treated with a combination of surgery and irradiation therapy. Twenty-five patients developed distant metastasis, and six patients had disseminated disease at the time of diagnosis. The overall 5-year crude survival in this report is 46%. Tumors of the parotid salivary glands must not be neglected, as early diagnosis and treatment are vital in order to achieve better results.

Results in treatment of carcinoma of the external auditory canal and middle ear.

Of 31 patients treated for carcinoma of the external auditory canal and/or middle ear, 19 patients (61%) presented with a long-term history of otitis. Thirteen patients (42%) had cranial nerve involvement. The patients were treated by surgery, radiotherapy, or a combined treatment of surgery and radiotherapy. The overall 5-year crude survival rate was 29%. Irrespective of the final outcome, 19 patients (61%) obtained pain relief after initial treatment. Three of the patients with facial nerve involvement survived 5 years after the initial treatment. Postmortem examinations of ten patients revealed distant metastases in four patients.

Peptidergic innervation of insect skeletal muscle: immunochemical observations.

Proctolin (Arg-Tyr-Leu-Pro-Thr) is a pentapeptide present in the hindgut or proctodeum of the cockroach Periplaneta americana where it may be a transmitter. Its widespread distribution among peripherally projecting neurons in the CNS (Bishop and O'Shea, '82) suggested that proctolin's motor function is not restricted to the hindgut, but has a variety of peripheral targets. This idea was further supported when proctolin was localized to an identified skeletal motoneuron, the slow coxal depressor, where it acts as a cotransmitter (O'Shea and Bishop, '82; Adams and O'Shea, '83). Our objective was to investigate the proctolinergic innervation of a variety of skeletal muscles of the cockroach Periplaneta americana. We used immunohistochemical and radioimmunochemical methods to map the distribution of proctolin immunoreactivity. This survey revealed that a subpopulation of skeletal muscles are innervated by proctolinergic motoneurons. The anatomical features of the peptidergic innervation and the levels of proctolinlike immunoreactivity of one muscle group, the coxal depressor system, are here described in detail. The source of the proctolin innervation to the metathoracic coxal depressor group is identified as the slow coxal depressor motoneuron. The results of a survey of fast and slow skeletal muscles revealed that proctolin is associated with slow motor function. The functional implications of the association of a peptide with motoneurons are discussed in relationship to the organization of the insect motor pool.

An enzyme linked immunosorbent assay (ELISA) for measurement of human serum thyroglobulin. Evaluation of the influence of thyroglobulin auto-antibodies.

The aim of the study was to develop an enzyme linked immunosorbent assay (ELISA) for measuring thyroglobulin (Tg) in human serum and to evaluate the influence of serum thyroglobulin auto-antibodies (TgAb) on the ELISA. The sensitivity of the ELISA was 2.1 micrograms/l. Serum Tg levels in healthy controls were from less than 2.1 to 55.5 micrograms/l (n = 46) (95% reference range). With serum Tg concentrations between 19.6 to 90 micrograms/l the within-assay coefficient of variation (CV) was from 4.5 to 6.6% (n = 12) and the between-assay CV from 8.5 to 10.5% (n = 6). The recovery from 20 to 89 micrograms Tg/l serum was from 93 to 101%. There was significant correlation between serum Tg concentrations measured by the ELISA and a RIA method in healthy controls (r = 0.85, n = 46, p less than 0.001) and in patients with differentiated thyroid carcinoma (r = 0.97, n = 28, p less than 0.001). The TgAb interfered with the serum Tg determination both in the ELISA and in the RIA method. The assay is simple and easy to perform, and the equipment is inexpensive and useful for large-scale serum Tg measurements as an alternative to RIA.