Modulatory effects of Duguetia furfuracea (A. St. Hil) Benth. and Hook. f. in Drosophila melanogaster somatic and germinative cells.

Mutagenic and antimutagenic activities of the medicinal plant Duguetia furfuracea were assessed using SMART/wing and ring-X-loss tests. For the ring-X-loss test, 2- to 3-day-old Drosophila melanogaster ring-X-lineage males and virgin ywsn³ females received D. furfuracea infusion at doses of 0.085, 0.042, or 0.014 g/mL for 24 h. We found that D. furfuracea did not produce any mutagenic effects in D. melanogaster germinative cells. The somatic cells of D. melanogaster were analyzed using the SMART/wing test involving three lineages - mwh, flr³, and ORR - and the same doses of D. furfuracea infusion employed in the ring-X-loss test, as well as 20 mM urethane. The results of both standard (ST) and high bioactivation (HB) crosses showed absence of mutagenic activity of D. furfuracea. In contrast, in both ST and HB crosses, we observed a modulatory effect of D. furfuracea against the genotoxic activity of urethane.

Mutagenic potential and modulatory effects of the medicinal plant Luehea divaricata (Malvaceae) in somatic cells of Drosophila melanogaster: SMART/wing.

Luehea divaricata is a native plant of the Brazilian Cerrado, known as "açoita-cavalo". It is used as a popular herbal medicine in the treatment of dysentery, bleeding, arthritis, tumors, ulcers, and gangrenous wounds. Considering that herbal medicines sometimes provoke tumors and/or may prevent mutational events, it is important to study the action of these natural drugs on DNA. Aqueous extract of the bark of L. divaricata was evaluated at three different concentrations (0.10, 0.30, 0.50 mg/mL), individually and in combination with the neoplastic drug doxorubicin (DXR), by the somatic mutation and recombination test (SMART/wing) in Drosophila melanogaster. Distilled water was included as a negative control. The mutation frequency in the treatments with L. divaricata extract alone was not significantly higher than in the negative control for standard (ST) and high bioactivation (HB) crosses. When L. divaricata extract was combined with DXR, there was a significant reduction in the frequency of spots when compared to DXR alone, in both crosses. Further studies with other experimental models would be useful to confirm that L. divaricata extract is not harmful and that it could be used in the prevention of cancer.

The reliability of the Brazilian version of the Composite International Diagnostic Interview (CIDI 2.1).

The objective of the present study was to determine the reliability of the Brazilian version of the Composite International Diagnostic Interview 2.1 (CIDI 2.1) in clinical psychiatry. The CIDI 2.1 was translated into Portuguese using WHO guidelines and reliability was studied using the inter-rater reliability method. The study sample consisted of 186 subjects from psychiatric hospitals and clinics, primary care centers and community services. The interviewers consisted of a group of 13 lay and three non-lay interviewers submitted to the CIDI training. The average interview time was 2 h and 30 min. General reliability ranged from kappa 0.50 to 1. For lifetime diagnoses the reliability ranged from kappa 0.77 (Bipolar Affective Disorder) to 1 (Substance-Related Disorder, Alcohol-Related Disorder, Eating Disorders). Previous year reliability ranged from kappa 0.66 (Obsessive-Compulsive Disorder) to 1 (Dissociative Disorders, Maniac Disorders, Eating Disorders). The poorest reliability rate was found for Mild Depressive Episode (kappa = 0.50) during the previous year. Training proved to be a fundamental factor for maintaining good reliability. Technical knowledge of the questionnaire compensated for the lack of psychiatric knowledge of the lay personnel. Inter-rater reliability was good to excellent for persons in psychiatric practice.

The reliability of the Brazilian version of the Composite International Diagnostic Interview (CIDI 2.1)

The objective of the present study was to determine the reliability of the Brazilian version of the Composite International Diagnostic Interview 2.1 (CIDI 2.1) in clinical psychiatry. The CIDI 2.1 was translated into Portuguese using WHO guidelines and reliability was studied using the inter-rater reliability method. The study sample consisted of 186 subjects from psychiatric hospitals and clinics, primary care centers and community services. The interviewers consisted of a group of 13 lay and three non-lay interviewers submitted to the CIDI training. The average interview time was 2 h and 30 min. General reliability ranged from kappa 0.50 to 1. For lifetime diagnoses the reliability ranged from kappa 0.77 (Bipolar Affective Disorder) to 1 (Substance-Related Disorder, Alcohol-Related Disorder, Eating Disorders). Previous year reliability ranged from kappa 0.66 (Obsessive-Compulsive Disorder) to 1 (Dissociative Disorders, Maniac Disorders, Eating Disorders). The poorest reliability rate was found for Mild Depressive Episode (kappa = 0.50) during the previous year. Training proved to be a fundamental factor for maintaining good reliability. Technical knowledge of the questionnaire compensated for the lack of psychiatric knowledge of the lay personnel. Inter-rater reliability was good to excellent for persons in psychiatric practice.

Evaluation of the PAHO/WHO training program on the detection and treatment of depression for primary care nurses in Panama.

OBJECTIVE: This study evaluated the efficacy of a training program developed by Pan American Health Organization/World Health Organization (PAHO/WHO) for primary care nurses aimed at improving their capacity to detect and manage depression. METHOD: Changes in knowledge and clinical practice were assessed in a group of primary care nurses in Panama who underwent the program. They were compared with a group of controls. RESULTS: Nurses who underwent the training program showed a statistically significant improvement in knowledge and detection of depressive disorders. In addition, they increased their notification of patients with depression to the primary care physician. No change was noted in the control group. CONCLUSION: The results point to the benefit of the PAHO/WHO training program for primary care nurses in the care of major depression. Further studies are required to confirm these results.

[Reliability of diagnostic instruments: investigating the psychiatric DSM-III checklist applied to community samples]. / Confiabilidade de instrumentos diagnósticos: estudo do inventário de sintomas psiquiátricos do DSM-III aplicado em amostra populacional.

This study focused on the reliability of the DSM-III inventory of psychiatric symptoms in representative general population samples in three Brazilian cities. Reliability was assessed through two different designs: inter-rater reliability and internal consistency. Diagnosis of lifetime (k = 0.46) and same-year generalized anxiety (k = 1.00), lifetime depression (k = 0.77), and lifetime alcohol abuse and dependence (k = 1.00) was consistently reliable in the two methods. Lifetime diagnosis of agoraphobia (k = 1.00), simple phobia (k = 0.77), non-schizophrenic psychosis (k = 1.00), and psychological factors affecting physical health (1.00) showed excellent reliability as measured by the kappa coefficient. The main reliability problem in general population studies is the low prevalence of certain diagnoses, resulting in small variability in positive answers and hindering kappa estimation. Therefore it was only possible to examine 11 of 39 diagnoses in the inventory. We recommend test and re-test methods and a short time interval between interviews to decrease the errors due to such variations.

Day care centres as an institution for health promotion among needy children: an analytical study in São Paulo, Brazil.

OBJECTIVE: To evaluate the role of day care centres in the nutritional state of children belonging to a low-income population, comparing the nutritional state of the children in the day care centres with children in the same population who were given other types of day care. DESIGN: Analytical cross-sectional study. SETTING: Public day care centres/primary health care. PARTICIPANTS: Children aged 0-6 yr attending in 4 public day care centres (n=446) and sample of population obtained during vaccination campaign (n=1626). MEASUREMENT: Nutritional evaluation was conducted through weight and height measurements, using as a standard the NCHS (USA) table and Gomez and Waterlow methodology. The type of daily care received by the children was assessed through a questionnaire answered by the responsible persons during the vaccination campaign. RESULTS: The nutritional status of children attended in the day care centers was better than children of the same community receiving other types of daily care (OR=0.48; CI 95%=0.36-0.65;P>0.0001). The improvement was related to more than 1 year of enrollment in the day care (OR=0.74; CI 95%=0.57-0.96;P=0.02).

Impact of the application of neurolinguistic programming to mothers of children enrolled in a day care center of a shantytown.

CONTEXT: Of the members of a family, the mother is without doubt the most important one, which provides justification for including an evaluation of her mental health as one of the variables to be considered as determining factors in each child's level of development. OBJECTIVE: To assess the impact of the application of Neurolinguistic Programming (NLP) on child development, home environment and maternal mental health. DESIGN: Randomised controlled trial. SETTING: The study included children enrolled in the municipal day care center of a shantytown in the City of São Paulo. PARTICIPANTS: 45 pairs of mothers and respective children between 18 and 36 months of age. MAIN MEASUREMENTS: Children's development (Bayley scales); home environment variation (HOME); and maternal mental health (SRQ). Comparison between before and after the intervention was made in terms of children's psychomotor development, home environment and maternal mental health. INTERVENTION: Application of the NLP technique to the experimental group and comparison with a control group. 1--Experimental (EG), consisting of 23 children submitted to intervention by NLP; and 2--Control (CG), with 22 children with no intervention. Length of intervention: 15 sessions of NLP. RESULTS: 37 children remained in the study (EG = 10, CG = 27). Variations in mental development (OR 1.21, IC 95% 0.0 to 23.08) in their home environment (Wilcoxon): p = 0.96 (before) and p = 0.09 (after); in maternal mental health: p = 0.26, 2 df. CONCLUSIONS: There was a trend that indicated positive effects on the home environment from the intervention.

Human psychopharmacology of hoasca, a plant hallucinogen used in ritual context in Brazil.

A multinational, collaborative, biomedical investigation of the effects of hoasca (ayahuasca), a potent concoction of plant hallucinogens, was conducted in the Brazilian Amazon during the summer of 1993. This report describes the psychological assessment of 15 long-term members of a syncretic church that utilizes hoasca as a legal, psychoactive sacrament as well as 15 matched controls with no prior history of hoasca ingestion. Measures administered to both groups included structured psychiatric diagnostic interviews, personality testing, and neuropsychological evaluation. Phenomenological assessment of the altered state experience as well as semistructured and open-ended life story interviews were conducted with the long-term use hoasca group, but not the hoasca-naive control group. Salient findings included the remission of psychopathology following the initiation of hoasca use along with no evidence of personality or cognitive deterioration. Overall assessment revealed high functional status. Implications of this unusual phenomenon and need for further investigation are discussed.

Mental health of the mothers of malnourished children.

BACKGROUND: The objective of this study is to measure the association between protein-energy malnutrition (PEM) in children and their mothers' mental health, in a low income area in the city of Embú, São Paulo, Brazil. METHODS: A case-control study was performed. Cases were 60 moderately and severely malnourished children (Gomez criteria) selected from two primary health care units. Controls consisted of 45 eutrophic children attending the same units. The main outcome measure was for the mothers to present a mental health score > 6 according with the 'Adult Psychiatric Morbidity Questionnaire' (QMPA), a psychiatric screening instrument. RESULTS: Of mothers of children with PEM, 63% and 38% of mothers in the control group were QMPA positive: odds ratio (OR) = 2.8 (95% confidence interval [CI]: 1.2-6.9). Of PEM children, 27% had low birthweight (LBW = < 2500 g) and 6% of the control group had LBW. Interactions were found between: mothers' mental health and number of children (with > or = 4 children: OR = 20.0 [95% CI: 2.1-274.2], with < or = 3 children: OR = 1.6 [95% CI: 0.6-4.5), as well as mothers' mental health and maternal age (in women > 30: OR = 12.5 [95% CI: 2.0-93.4], in women < or = 30: OR = 1.5 [95% CI: 0.5-4.4]. CONCLUSIONS: Mothers of children with PEM showed a higher rate of mental disturbances than mothers of eutrophic children. Unlike LBW, maternal age and number of children interact with mothers' mental health, increasing the association. Management of poor mental health may lead to mothers being better caretakers of their children and this may have a positive impact on PEM.

Farmacologia humana da hoasca, planta alucinogena usada em contexto ritual no Brasil: I. Efeito psicologico

Uma investigacao biomedica em cooperacao multinacional dos efeitos da hoasca (ayahuasca), uma potente decoccao de plantas alucinogenas, foi conduzida na Amazonia brasileira durante o verao de 1993. Esta comunicacao descreve os achados psicologicos de membros filiados ha 15 anos de uma religiao sincretica que utiliza a hoasca legalmente como sacramento, assim como de 15 individuos-controle sem historia anterior de ingestao da hoasca. Avaliacoes administradas a ambos os grupos incluiram entrevistas para diagnostico psiquiatrico estruturado, teste de personalidade e avaliacao neuropsicologica. Achados fenomenologicos dos estados alterados de consciencia, bem como entrevistas semi-estruturadas e abertas de historias de vida foram conduzidas com o primeiro grupo, mas nao com o grupo controle. Os achados incluiram a presenca de psicopatologias em grau significativo no passado do grupo usuario, anterior a primeira experiencia com a hoasca, que pareceu haver remitido na sequencia. Diferencas significativas foram tambem encontradas nos testes neuropsicologicos e de personalidade entre os dois grupos, entretanto, nao houve evidencia de deterioracao cognitiva ou de personalidade nos usuarios da hoasca. De fato a avaliacao global revelou status funcional elevado, atribuido pelos individuos ao uso ritual do seu sacramento psicoativo, hoasca. Embora as interpretacoes destes resultados sejam na por ora preliminares devido a limitacoes metodologicas, investigacao futura quanto ao risco de sequelas adversas, assim como ao potencial para efeito solutar deste fenomeno nao usual, e indicada.

Medically unexplained somatic symptoms in different cultures. A preliminary report from phase I of the World Health Organization International Study of Somatoform Disorders.

The World Health Organization has recently launched an international study of somatoform disorders in different cultures. Five centres representing distinct cultures participated in phase I of the project, the main objective of which was to test the cross-cultural applicability and reliability of instruments for the assessment of somatoform disorders. The analysis of the assessed somatic symptoms showed that various aches and pains in different parts of the body represented cross-culturally the most frequent symptoms for which there was no medical explanation. Such symptoms may indicate the presence of an underlying mental disorder but can also represent a means for culture-specific expression of psychosocial distress. This bears particular significance for health professionals in primary and general medical care, who are most likely to encounter patients presenting with multiple, persistent and medically unexplained somatic symptoms.

The epidemiology of psychotropic use in the city of São Paulo.

This is a cross-sectional community study conducted to assess the one-year prevalence of psychotropic use in the city of São Paulo. A representative stratified sample of the city was drawn from three sub-districts selected on the basis of their health indicators (Ramos & Goihman, 1989). The probability of a psychiatric disorder was estimated by means of the Adult Psychiatric Morbidity Questionnaire (QMPA) developed by Santana (1982). The total sample comprised 1742 subjects: 11.7% of males and 24.6% of females were probable cases in the QMPA, at the cut-off point 7/8. The overall psychotropic consumption was 101.6 persons/1000 inhabitants. The rate of psychotropic use was higher for females (142.3 persons/1000 inhabitants) than males (50.0 persons/1000), a difference statistically significant (chi(2) = 18.0, 1 df, P < 0.001). The highest rate of consumption was for tranquillizers (80.4/1000 inhabitants) and the general physician was found to be the leading prescriber (46.9%), being followed by cardiologists (15.3%). A log-linear model was constructed to study the combined effect of sociodemographic factors on the probability of being a tranquillizer user. Women were found to take more tranquillizers than men, consumption increased with age, and the positives in the QMPA were more likely to be users than were the negatives. The higher the family income per capita the higher the risk of being a tranquillizer user. These findings applied regardless of the sub-district, marital status, and migration status of the subjects. These results are discussed in the light of the alternative possible interventions by general practitioners.

Caracterizacao de uma instituicao nao-escolar e avaliacao de sua possivel interferencia no desenvolvimento da personalidade de parte de sua clientela (segunda parte). / Profiles of an extra-school institution and evaluation of its possible interference on the personality development of part of its clients (2d part)

Na etapa inicial desta pesquisa, os autores compararam a analise de uma instituicao nao-escolar para criancas de seis a catorze anos com os resultados de duas aplicacoes da prova de Rorschach com intervalo de um ano. Neste intervalo detectaram a evasao de quarenta das setenta criancas da amostragem inicial. Na presente etapa, propoem a pesquisa dos fatores que ponderam esse fenomeno. Apresentam os dados obtidos junto as familias da populacao evadida (que se mostram possiveis de explicar o fenomeno) bem como discutem aplicacao da prova de Rorschach junto as criancas desta segunda populacao

Caracterizacao de uma instituicao nao-escolar e avaliacao de sua possivel interferencia no desenvolvimento da personalidade de parte de sua clientela. / Characterization of a non-schoolar institution and evaluation of its possible interference on the personality development of part of its clientele

Os autores descrevem a etapa inicial de uma experiencia em que compararam os resultados da analise de uma instituicao nao-escolar para criancas de 6 a 14 anos, com os resultados de duas aplicacoes de prova de Rorschach (com intervalo de um ano) em uma parcela de sua clientela. Levam em consideracao o estudo das familias dos probandos. Concluem nessa etapa que a interacao entre a instituicao e sua clientela apresenta resultantes positivas reciprocas, e que a aplicacao de dois metodos distintos (estudo da Instituicao e prova de Rorschach) foi eficaz para avaliacao dessas resultantes

Doenca mental e processos migratorios. / Mental disease and migratory process

Estudo preliminar realizado por uma equipe multidisciplinar do Setor de Psiquiatria Social da Escola Paulista de Medicina, com base na observacao participante de um grupo de familias migrantes nordestinas com ocorrencia de quadros psiquiatricos. Atraves de analise de alguns casos foi possivel supor que certas condutas, alem de "desviantes", seriam tambem respostas adequadas a situacoes concretas.Levanta-se a hipotese de que e preciso analisar as perturbacoes psiquicas desta populacao no contexto das correntes migratorias internas brasileiras, vinculando o que, na maioria das vezes, e visto exclusivamente do ponto de vista do individuo com processos sociais e culturais mais amplos