How lipids may affect risk for suicidal behavior.

Suicide and nonfatal suicidal behaviors are major causes of mortality and morbidity worldwide. Variability in rates of suicide and suicidal behaviors within and between countries has been attributed to population and individual risk factors, including economic status and cultural differences, both of which can have suicide risk effects mediated through a variety of factors, of which perhaps the least understood is the role of diet. We therefore review the scientific literature concerning two major dietary lipid classes, cholesterol and polyunsaturated fatty acids (PUFAs), that have been associated with higher risk of suicide attempts and suicide. We consider potential mechanistic intermediates including serotonin transporters and receptors, toll-like receptors (TLRs), nuclear factor kappa-light-chain-enhancer of activated B cells (NFκB), and peroxisome proliferator activated receptors (PPARs). Based on this review, we describe a theoretical model linking cholesterol and PUFA status to suicide risk, taking into account the effects of cholesterol-lowering interventions on PUFA balance, membrane lipid microdomains (rafts) as a nexus of interaction between cholesterol and omega-3 PUFAs, and downstream effects on serotonergic neurotransmission and specific inflammatory pathways.

Assessment of non-response bias in a probability household survey of male same-gender sexual behavior.

OBJECTIVE: To assess non-participation bias in a survey of male sexual behavior. MATERIAL AND METHODS: A household survey was carried out in 1992-1993 using a probability sampling frame in Mexico City. Demographic variables were available for all eligible men. The extent of non-participation bias was estimated using a version of the Heckman method, which utilizes two equations, one to predict participation and the other to predict reports of same-gender sexual behavior. RESULTS: A total of 8,068 of the 13,713 eligible men completed a face-to-face questionnaire (response rate 59%); 173 men (2.1%) reported bisexual behavior in their lifetime, and 37 (0.4%) reported only male partners. Survey participation was predicted using demographic variables: 67% of the observations were correctly predicted by a probit regression model: 82% of participants and 53% of non-participants (pseudo-r2 = 0.13). Same-gender sexual behavior was predicted by variables indicating attachment to gay/bisexual social networks, history of sexually transmitted diseases, positive attitudes towards gay and bisexual males, and lack of support from male relatives. Ninety-seven per cent of the cases was correctly predicted by the probit model (pseudo-r2 = 0.14). The correlation between these two equations was not statistically significant. CONCLUSIONS: These results indicate that prevalence estimates of same-gender sexual behavior among Mexico City men were not biased by selective survey participation. Careful selection and training of household interviewers may have assisted in minimizing potential bias.

Dental caries prevalence and treatment need in Chiriqui Province, Panama.

A pathfinder pilot survey was conducted in rural Chiriqui Province, Panama, using standard WHO methodology, in order to estimate dental caries prevalence and treatment need. Examinations for caries and treatment need were performed by six trained, experienced examiners. From a convenience sample of 2,597 subjects, a stratified cluster sample was constructed using index ages 12 and 15 years and age groups 35-44 and 65-74 years. The results showed a mean Decayed, Missing and Filled Teeth index (DMFT) of 4.08 for 12 year olds, 6.40 for 15 year olds, 13.20 for the 35-44 age group, and 18.88 for the 65-74 age group (P < 0.001). No statistically significant differences by gender were found. These findings rank rural Panama with Mexico and Haiti when compared to the results of other Central American community studies. The percentage of caries free 12 year olds was 6.8 per cent. Of the total sample, 74.7 per cent of individuals would require one or multiple surface restorations and 47.9 per cent would require at least one extraction. Restorative need was greatest in the 15 year olds. The severity of dental caries in this sample was moderately severe and the treatment need extraordinarily high.

Paralysis in AIDS vaccine development violates ethical principles and human rights.

AIDS: Although a preventive vaccine is essential for controlling the HIV/AIDS epidemic and AIDS vaccine candidates exist, field trials of AIDS vaccine candidates are still not underway. Reasons for field trials of HIV vaccines not being underway include: ethical issues regarding how such trials would be conducted, fear that trial failure would make successive trials impossible to conduct, and controversy among the scientific community that the current crop of vaccines will effectively protect against HIV infection. Explanations for why none of these arguments are realistic reasons for delays in testing are provided. The ethical and human rights issues underlying the failure to proceed with field trials are also explored.^ieng

Hopelessness in suicide attempters after acute treatment of major depression in late life.

The relation between hopelessness and suicide attempts in the elderly was examined by studying the course of hopelessness in depressed patients. Sixty-three elderly patients with recurrent major depression were treated with nortriptyline and interpersonal psychotherapy and underwent serial ratings of hopelessness and depression during the acute and continuation phases of treatment. Patients who had made a suicide attempt in the past had significantly higher hopelessness scores than nonattempters during both phases of treatment. They were also more likely to drop out of treatment. A high degree of hopelessness persisting after remission of depression in elderly patients appears to be associated with a history of suicidal behavior. It may also increase the likelihood of premature discontinuation of treatment and lead to future suicide attempts or suicide.

Abnormal behavioral responses to fenfluramine in patients with affective and personality disorders. Correlation with increased serotonergic responsivity.

Serotonergic responsivity was assessed in 20 psychiatric patients by the prolactin response to a fenfluramine challenge test. During the fenfluramine challenge 6 of 20 patients (30%) spontaneously reported psychopathologic reactions that included: increased anxiety/agitation, psychotic symptoms, illusions, mood elevation, and anergia. The time of peak behavioral symptoms (2.5 +/- 0.8 hrs) corresponded closely to the time of peak increase in prolactin levels (3.0 +/- 1.1 hr). Abnormal behavioral responders had statistically significant greater increases in prolactin 1 to 4 hr after fenfluramine when compared to normal responders. Patients who developed an abnormal psychopathologic response to fenfluramine were characterized by higher levels of anxiety and agitation at the time of admission to the hospital but otherwise were not distinguishable on the basis of severity of other psychiatric symptoms. This study suggests that increased serotonergic transmission may trigger anxiety, psychosis, and mood elevation in specific vulnerable individuals, whereas other patients with similar psychiatric illnesses are not affected.

Similar effects of glycine, zinc and an oxidizing agent on [3H]dizocilpine binding to the N-methyl-D-aspartate receptor in neocortical tissue from suicide victims and controls.

This study used [3H]dizocilpine (MK-801) binding to the N-methyl-D-aspartate (NMDA) receptor to examine glycine, redox and zinc modulatory sites in membranes derived from the frontal and parietal cortex of control subjects (n = 8) and suicide victims (n = 6). [3H]dizocilpine binding in the presence of glutamate and glutamate plus glycine was similar in control and suicide subjects. The sulphydryl redox site was assessed using the oxidizing agent 5,5'-dithio-bis (2-nitrobenzoic acid), which inhibited binding in a dose-dependent fashion. Both redox and zinc sites were unaffected in the frontal and parietal cortex of suicide victims. These data indicate that the NMDA receptor and its glycine, redox and zinc subsites are preserved in the neocortex of suicide victims.

Antidepressant medications and the relative risk of suicide attempt and suicide.

OBJECTIVE: Suicide by drug overdose is a major public health problem, and antidepressant medications are the most common agent involved. European studies suggest differences in the rates of suicide by overdose among antidepressants, but no reports have been published for the United States. We estimated the comparative risks of suicide attempts and suicides, and the relative risk of fatality in the event of an overdose for the major antidepressants currently marketed in the United States. DATA SOURCES: Information regarding suicide attempts and suicides by antidepressant overdose was obtained from the published reports of the Drug Abuse and Warning Network and the annual report of the American Association of Poison Control Centers, and corrected for differences in total annual prescriptions using data from the National Prescription Audit. RESULTS: The risk of a suicide attempt did not appear to differ among antidepressants. The tricyclic antidepressants were associated with a higher rate of death in the event of an overdose than the newer nontricyclic antidepressants in both the annual report of the American Association of Poison Control Centers and the Drug Abuse and Warning Network data. The chance of death after an overdose was greater for desipramine hydrochloride than for other tricyclics. CONCLUSION: The higher risk of suicide with tricyclics vs nontricyclics may be explained by a higher rate of death from overdose rather than more suicide attempts. Tricyclics carry the risk of greater cardiotoxicity. The basis for the even higher rate of death/overdose of desipramine is not known and requires further research. If these findings are replicated in a case-control study design, they have important implications for the choice of an antidepressant for the depressed patient at risk for suicidal behavior.

Role of the dopaminergic system in depression.

A hypothesis implicating dopamine in depression was proposed over 15 years ago (Randrup et al 1975). The identification of multiple new subtypes of dopamine receptors and evolving views regarding the function of the dopamine systems in the brain require a reexamination of this hypothesis. Results from studies in depression, Parkinson's disease, and animal models of depression suggest a deficiency of dopamine in depression. Dopamine precursors, dopamine agonists, and dopamine reuptake inhibitors show therapeutic efficacy in depression. Electroconvulsive therapy (ECT) and standard pharmacological antidepressants enhance dopamine function. Studies using receptor-specific drugs in clinical trials and neuroimaging studies are needed to further clarify the role of dopamine in depression.

[AIDS in the world: revolution, paradigm and solidarity]. / El SIDA en el mundo: revolucion, paradigma y solidaridad.

PIP: AIDS in a single decade has affected life and assumptions on the societal and individual level more than any other illness or epidemic in history. The most important aspect of the HIV pandemic is that it is still in an early stage of development. The pandemic will continue to be volatile and dynamic; its greatest impact has not yet been felt. There is still great potential to influence its future course. HIV infection is spreading rapidly in some already affected populations in Africa, Latin America, and the Caribbean, and is penetrating deeply into new areas such as Eastern Europe, the Middle East, and Southeast Asia. Thailand and India are symbols of its rapid spread. The more than 100 million new cases of sexually transmitted diseases diagnosed in the world each year demonstrate the potential for sexual transmission of HIV. On the global level, the foundations have been laid for preventing the spread of HIV infection. But in many countries information is still inadequate or incorrect, needed social and health services are nonexistent, and punitive and discriminatory attitudes persist toward the infected. The gap between rich and poor within and between countries is widening. 2/3 of AIDS cases and 3/4 of seropositive individuals are in developing countries. The cost of drugs and treatment implies that "early intervention" is a meaningless concept for developing countries. The developed world contributes $200 million or less to combat AIDS in developing countries. Some of the revolutionary ideas prompted by the advent of AIDS included the immediate attention given to behavior as a preventive measure, the eradication of complacency about the condition of health and social services, the insistence of AIDS patients and the HIV infected on being included in the total process of prevention, treatment, and research, and the unexpected flowering of a dialogue on dignity, human rights, and social justice. AIDS is now leading to a new vision of health promotion in which individual and collective behavior is recognized as the greatest challenge for future health. Solidarity is a central aspect of the emerging perspective on health prompted by AIDS. The disease has revealed the inherent limitations of 2 alternatives to solidarity: coercion and discrimination.^ieng

Septicemic plague in New Mexico.

Eighteen of the 71 cases of plague reported in New Mexico from 1980 to 1984 were septicemic. We reviewed these cases to better describe the clinical presentation of this disorder and to identify risk factors for developing septicemic plague. The symptoms (fever, chills, malaise, headache, and gastrointestinal symptoms) and signs (tachycardia, tachypnea, and hypotension) of septicemic plague are similar to those of other forms of gram-negative septicemia. Abdominal pain was reported in nearly half of the cases, and differential white blood cell counts revealed a marked shift to the left. The risk of developing septicemic plague was higher for persons greater than 40 years of age. Because of empirical antibiotic treatment of older persons, deaths from septicemic plague occurred primarily among persons less than 30 years old. Deaths from septicemic plague could be reduced by aggressive antibiotic therapy for patients with a clinical presentation suggesting gram-negative septicemia, especially patients less than 30 years old.

Suppression of plasma aldosterone during stimulation of cardiopulmonary mechanoreceptors in man

Con el objeto de analizar la participación de los mecanorreceptores cardiopulmonares en la secreción de la aldosterona, se estudiaron 10 voluntarios varones mediante la utilización de un traje que, al ser llenado con agua y estando el sujeto en inclinación de 45§, ejerce una presión positiva sobre los miembros inferiores con traspaso de volumen sanguíneo de éstos al compartimiento cardiopulmonar. En estas condiciones se comprobó una caída significativa de la aldosterona plasmática a los 60 minutos, de 223ñ23pg/ml a 190ñ26pg/ml (p<0,01), coincidiendo con un descenso de la actividad renínica plasmática a los 30 minutos de 3,51ñ1,48mg/ml/h a 1,8ñ0,89mg/ml/h (p<0,05) y un incremento de la radioactividad de fin de diástole de ventrículo derecho de 9500ñ1150cpm a 11685ñ2600cpm (p<0,01) y de la radioactividad de fin de sístole ventricular derecha de 5865ñ946cpm a 7758ñ1050cpm (p<0,05), medida con un ventriculograma radioisotópico. Al suspender la presión sobre los miembros inferiores, la aldosterona y la actividad renínica plasmática retornaron inmediatamente a los niveles basales, luego de registrarse un descenso de la radioactividad de fin de diástole y fin de sístole del ventrículo derecho. Se concluye que los mecanorreceptores cardiopulmonares participan en la regulación de la aldosterona y el sistema renina-angiotensina