Diversity, Co-Occurrence, and Nestedness Patterns of Sand Fly Species (Diptera: Psychodidae) in Two Rural Areas of Western Panamá.

Cutaneous Leishmaniasis transmission in the New World is observed in areas with rich sand fly species' faunas. The diversity and composition of sand fly species can change in response to seasonal weather and land use changes. Here, we present results from a two-year-long study where we collected, using Centers for Disease Control (CDC) light traps, sand flies from two rural areas, Las Pavas (LP) and Trinidad de las Minas (T) in western Panamá. Over 710 trap-nights, we collected 16,156 sand flies from 15 genera and 35 species. We identified 34 species in T, and the most abundant species collected was Nyssomyia trapidoi (Fairchild and Hertig, 1952) (n = 2278, 37%), followed by Psychodopygus panamensis (Shannon, 1926) (n = 1112, 18%), and Trichopygomyia triramula (Fairchild and Hertig, 1952) (n = 1063, 17%). In LP, we identified 26 species, and the most abundant species collected were Ty. triramula (n = 4729, 48%), and Ps. panamensis (n = 3444, 35%). We estimated a higher species' richness in T (Chao2 ± S.E.: 36.58 ± 3.84) than in LP (27.49 ± 2.28). In T, species' richness was significantly higher in the rainy season, but no seasonal differences were observed in LP. Species' assemblages were nested in the two areas. Phlebotomine sand fly species' abundance increased at the two sites during the rainy season. Our data suggest that seasonality is more important than land use as a factor driving sand fly species' diversity at the studied sites.

Teenagers, physicians, and the law in New England.

Physicians who treat teenagers are often unclear about the teenagers' legal rights and their own legal responsibility and liability. While laws may vary from state to state, certain doctrines are uniformly applicable: confidentiality, emergency treatment, and the right of the "mature minor" to consent to his or her own medical treatment. In this article, the laws pertaining to adolescent health care in the six New England states are reviewed. Guidelines for practitioners are given.

PIP: Physicians who treat teenagers are often unclear about the teenagers' legal rights and their own legal responsibilities and liabilities. While laws may vary from state to state within the US, certain doctrines are uniformly applicable: confidentiality, emergency treatment, and the right of the "mature minor" to consent to his or her own medical treatment. The emergency treatment rule holds that the existence of a life- or limb-threatening emergency where there is no time to obtain parental consent always obviates the need for parental consent. The authors believe that if a physician is willing to treat a minor without parental consent, then the normal physician-patient relationship of confidentiality should apply. Many states have statutes that provide for the treatment of emancipated minors. In this article, the laws pertaining to adolescent health care in the 6 New England states are reviewed, and guidelines for practitioners are given.

Migraine in children and adolescents.

Although migraine has been considered in the past to be uncommon in children and adolescents, there is mounting evidence that it is not, and that it produces significant childhood morbidity. However, the clinical picture varies from case to case, and often from attack to attack in the same patient. Stress plays a most important role in triggering attacks of this familial disease, and the physician must be aware of this if his treatment is to be successful. In adolescent girls, falling estradiol plasma levels are apprently important in triggering attacks of migraine associated with menstruation. In an attack, the initial vasoconstrictive phase, mainly intracranial gives way to a vasodilative phase, mainly extracranial, which results from withdrawal of the vasoconstrictive support from the extracranial arteries which is normally provided by serotonin. The plasma level of the latter drops sharply during an attack, and its excretion product, 5-hydroxy-indole acetic acid, appears in increased amounts in the urine. Laboratory investigations, after a most careful, detailed history, and physical examination, should include an EEG, skull films and possibly a brain scan. Management includes prophylactic measures, both environmental and pharmacologic, and treatment of the attack itself, where promptness is the watchword.