Measuring disorganized speech in schizophrenia: automated analysis explains variance in cognitive deficits beyond clinician-rated scales.

BACKGROUND: Conveying information cohesively is an essential element of communication that is disrupted in schizophrenia. These disruptions are typically expressed through disorganized symptoms, which have been linked to neurocognitive, social cognitive, and metacognitive deficits. Automated analysis can objectively assess disorganization within sentences, between sentences, and across paragraphs by comparing explicit communication to a large text corpus. METHOD: Little work in schizophrenia has tested: (1) links between disorganized symptoms measured via automated analysis and neurocognition, social cognition, or metacognition; and (2) if automated analysis explains incremental variance in cognitive processes beyond clinician-rated scales. Disorganization was measured in schizophrenia (n = 81) with Coh-Metrix 3.0, an automated program that calculates basic and complex language indices. Trained staff also assessed neurocognition, social cognition, metacognition, and clinician-rated disorganization. RESULTS: Findings showed that all three cognitive processes were significantly associated with at least one automated index of disorganization. When automated analysis was compared with a clinician-rated scale, it accounted for significant variance in neurocognition and metacognition beyond the clinician-rated measure. When combined, these two methods explained 28-31% of the variance in neurocognition, social cognition, and metacognition. CONCLUSIONS: This study illustrated how automated analysis can highlight the specific role of disorganization in neurocognition, social cognition, and metacognition. Generally, those with poor cognition also displayed more disorganization in their speech-making it difficult for listeners to process essential information needed to tie the speaker's ideas together. Our findings showcase how implementing a mixed-methods approach in schizophrenia can explain substantial variance in cognitive processes.

Canine NAPEPLD-associated models of human myelin disorders.

Canine leukoencephalomyelopathy (LEMP) is a juvenile-onset neurodegenerative disorder of the CNS white matter currently described in Rottweiler and Leonberger dogs. Genome-wide association study (GWAS) allowed us to map LEMP in a Leonberger cohort to dog chromosome 18. Subsequent whole genome re-sequencing of a Leonberger case enabled the identification of a single private homozygous non-synonymous missense variant located in the highly conserved metallo-beta-lactamase domain of the N-acyl phosphatidylethanolamine phospholipase D (NAPEPLD) gene, encoding an enzyme of the endocannabinoid system. We then sequenced this gene in LEMP-affected Rottweilers and identified a different frameshift variant, which is predicted to replace the C-terminal metallo-beta-lactamase domain of the wild type protein. Haplotype analysis of SNP array genotypes revealed that the frameshift variant was present in diverse haplotypes in Rottweilers, and also in Great Danes, indicating an old origin of this second NAPEPLD variant. The identification of different NAPEPLD variants in dog breeds affected by leukoencephalopathies with heterogeneous pathological features, implicates the NAPEPLD enzyme as important in myelin homeostasis, and suggests a novel candidate gene for myelination disorders in people.

Prevalence of the AMHR2 mutation in Miniature Schnauzers and genetic investigation of a Belgian Malinois with persistent Müllerian duct syndrome.

Persistent Müllerian duct syndrome (PMDS) is a sex-limited disorder in which males develop portions of the female reproductive tract. Important consequences of PMDS are cryptorchidism and its sequelae of infertility and increased risk of testicular cancer. Anti-Müllerian hormone (AMH) and its receptor (AMHR2) induce the regression of the Müllerian ducts in male embryos. In Miniature Schnauzer dogs, the genetic basis has been identified as an autosomal recessive nonsense mutation in AMHR2, but the allele frequency of the mutation is unknown. Thus, the primary objective of this study was to estimate the prevalence of the AMHR2 mutation in North American Miniature Schnauzers, in order to ascertain the value of genetic testing in this breed. An additional objective was to determine whether mutations in AMH or AMHR2 were responsible for PMDS in a Belgian Malinois; this would aid development of a genetic test for the Belgian Malinois breed. Genomic DNA from 216 Miniature Schnauzers (including one known PMDS case) was genotyped for the AMHR2 mutation, and DNA from a single PMDS-affected Belgian Malinois was sequenced for all coding exons of AMH and AMHR2. The Miniature Schnauzer cohort had an AMHR2 mutation allele frequency of 0.16 and a carrier genotypic frequency of 0.27. The genetic basis for PMDS in the Belgian Malinois was not determined, as no coding or splicing mutations were identified in either AMH or AMHR2. These findings support a benefit to AMHR2 mutation testing Miniature Schnauzers used for breeding or with cryptorchidism.

SMAD2 and the relationship of colorectal cancer to inflammatory bowel disease.

Inflammatory bowel diseases (IBDs) affecting the colon [Crohn's disease (CD) and ulcerative colitis (UC)] are associated with an increased risk of colorectal cancer (CRC). Our previous work using oligonucleotide array data indicated that SMAD2 was significantly underexpressed in UC dysplastic tissue compared to benign UC. The aim of this current study was to determine whether single nucleotide polymorphisms (SNPs) within the SMAD2 gene are associated with IBD dysplasia/cancer. We performed an SNP haplotype-based case-control association study. Leukocyte DNA was obtained from 489 unrelated Caucasians (158 UC, 175 CD, 71 CRC, 85 controls). Eleven SNPs were genotyped. All 11 SNPs were in Hardy-Weinberg equilibrium in the control population. Strong linkage disequilibrium was observed among nearly all SMAD2 SNPs. There were no significant associations between SMAD2 allele or haplotype frequencies. Power calculations indicated good power for single-marker analysis (>0.8) and reasonably good power against effects of 0.1-0.15 for haplotype analysis. SMAD2 SNPs were not associated with the development of IBD dysplasia/cancer. This incongruity between our previous microarray data and the findings from this genotype study may be attributed to mechanisms such as alternative splicing of pre-mRNA SMAD2 and/or cross talk with other cellular pathways.

Gender, victimization, and psychiatric outcomes.

BACKGROUND: Although gender differences in rates of internalizing disorders, particularly depression, are well documented, the causes of these differences are not well understood. One influential hypothesis [Cutler & Nolen-Hoeksema, Sex Roles (1991), 24, 425-438] proposes that higher rates of depression in females compared to males may be partially attributable to gender differences in the effects of childhood sexual abuse. The present study has evaluated this possibility by reviewing evidence for gender moderating the effects of childhood victimization on psychiatric outcomes. METHOD: Literature search using PsycINFO and Medline, applying the following inclusion criteria: publication from 1996 to 2006, community-based sampling, adequate male-to-female sample ratio, use of clearly defined psychiatric outcomes, and a statistical test of gender differences in the effects of childhood victimization on psychiatric outcomes. RESULTS: Thirty studies met inclusion criteria. Overall, the results were mixed. Nearly half of all studies find no gender differences. In studies that do observe gender differences, victimization tends to be associated with higher psychiatric risk in females in studies with adult samples, whereas in samples of youth, victimization tends to be associated with higher psychiatric risk in males. With respect to outcome, when gender differences were observed, outcomes were distributed across both internalizing and externalizing categories for both genders. CONCLUSIONS: The gender differences in prevalence rates of internalizing disorders, such as depression, do not appear to be attributable to differential effects of childhood victimization.

Meta-analysis: antibiotic prophylaxis to prevent peristomal infection following percutaneous endoscopic gastrostomy.

BACKGROUND: Despite numerous guidelines recommending prophylactic antibiotics prior to percutaneous endoscopic gastrostomy, their use remains controversial. AIM: To conduct a systematic literature review and performed meta-analyses to determine the benefit of antibiotic prophylaxis for percutaneous endoscopic gastrostomy placement. METHODS: We performed a systematic literature review by searching healthcare databases and grey literature for randomized-controlled trials of antibiotic prophylaxis against wound infection after percutaneous endoscopic gastrostomy. Relative risks were calculated for individual trials and data pooled using fixed-effects model. Relative risk reduction, absolute risk reduction and number needed to treat were calculated and are reported with 95% confidence intervals. RESULTS: Ten randomized-controlled trials met the inclusion criteria and 1059 cases were pooled. Overall findings indicated that antibiotic prophylaxis resulted in a relative risk reduction of 64% and an absolute risk reduction of 15%. Number needed to treat to prevent one wound infection was 8. Cephalosporin prophylaxis was associated with a relative risk reduction of 64%, absolute risk reduction of 10% and number needed to treat of 10, whereas penicillin-based prophylaxis was associated with a relative risk reduction of 62%, absolute risk reduction of 13% and number needed to treat of 8. CONCLUSIONS: Antibiotic prophylaxis prior to percutaneous endoscopic gastrostomy is effective in reducing the incidence of percutaneous endoscopic gastrostomy site wound infection. Based on sensitivity analyses, penicillin-based prophylaxis should be the prophylaxis of choice.

Systematic reviews and meta-analysis for the surgeon scientist.

BACKGROUND: Understanding of data-reporting methods is imperative for correct interpretation of the medical literature as well as for proper performance of future clinical research. Recent developments in biostatistics have greatly changed the types of statistical analyses used and the minimum quality standards that must be maintained. METHOD: Different types of review are described, including systematic review with and without meta-analysis. Minimum reporting standards, sources of bias, both quantitative and qualitative, and references are discussed. RESULTS AND CONCLUSION: Meta-analysis has become a clearly defined technique, with reporting standards for both randomized controlled trials and observational studies. It is assuming a wider role in the surgical literature. Although many sources of bias exist, there are clear reporting standards and readers should be aware of these when studying the literature.

Seasonal affective disorder in an Arctic community.

OBJECTIVE: To determine the rate of seasonal-pattern depression in an Inuit community above 70 degrees N. METHOD: One-hundred and eleven people from randomly selected households were surveyed for depression and anxiety and the effect of the seasons on their mood. Eighty-eight people provided replies on the influence of the seasons. RESULTS: One in five (22.6%) of the community sample was found to be depressed. Of these, seven (6.3%) had seasonal affective disorder (SAD), with fall onset occurring in six of these (5.4%). Subsyndromal SAD (SSAD) occurred in 11.7%, while any effect of the seasons (seasonality) occurred in 39.6%. Persons with SSAD and seasonality were significantly older than those unaffected by the seasonal effect. No other significant correlation of SAD, SSAD, or seasonality occurred with gender, age, and language preference. CONCLUSION: Seasonal mood changes in this Inuit group living in the Canadian Arctic are elevated above the rates found in other studies using similar survey methods.

Spatial working memory: absence of gender differences in schizophrenia patients and healthy control subjects.

BACKGROUND: Spatial working memory dysfunction has been suggested to be a cardinal feature of schizophrenia. But schizophrenia is heterogeneous in its clinical profile, course, and outcome. One fundamental contributor to this heterogeneity may be gender. No report has yet addressed gender differences in spatial working memory, as measured by the delayed-response task (DRT). METHODS: We aggregated data from three previously published studies of spatial working memory in schizophrenia and also collected DRT data from a new sample of subjects in order to examine potential gender differences in DRT performance. RESULTS: As previously reported, schizophrenia patients (n = 71) showed deficits in spatial working memory relative to normal control subjects (n = 213), however, no within-group or between-group gender differences were present. CONCLUSIONS: These findings provide evidence for the absence of gender differences in spatial working memory function.

A behaviour risk factor survey in Jamaica.

A population based probability sample of 958 persons (454 males and 504 females) aged 15 to 49 years was surveyed in Jamaica in late 1993 for lifestyle and behaviour risk factors. Demographic characteristics of the sample were comparable to the general population, 60% of persons visited a private doctor the last time that they were ill. Based on self-reporting, 18% of the women and 8% of the men were hypertensive and 4.8% of the women and 3.3% of the men were diabetic. 26% of the men and 8% of the women had never had their blood pressure taken. 40% of the women had never had a Papanicolaou smear, 29% had never had a breast examination and 33% said that they were overweight compared with 18% of men. Smoking cigarettes and marijuana was more common among men (36%) than women (11%), as were drinking alcohol (79% of men, 41% of women) and heavy alcohol use (30% of men, 9% of women). Injuries requiring medical attention in the previous five years were reported by 40% of the men and 15% of the women. 34% of the men and 12% of the women regularly carried a weapon and 18% of the sample had participated in or witnessed at least one violent act in the previous month. Most of the people interviewed used a contraceptive method; 10% were not sexually active. Significantly more men than women had two or more sexual partners in the previous year (54% vs 17%, p < 0.001) or reported ever having a sexually transmitted disease (29% vs 9%, p < 0.001). Younger persons were more sexually active and more likely to use condoms during their most recent sexual intercourse. Higher socio-economic status and educational level generally had a more positive effect on health behaviour. This survey provides vital information relevant to planning health promotion campaigns and assessing their success.

PIP: A population-based probability sample of 958 people (454 men and 504 women) aged 15-49 in Jamaica was surveyed during 1993 to monitor health-related behaviors and risk factors. A pre-tested, pre-coded questionnaire was administered by experienced public health workers to obtain information about sociodemographic characteristics, self-reported prevalence of the main chronic disease, and risk behavior associated with the diseases and quality of life. Results revealed that 60% of the studied population visited a private physician the last time they were ill. Based on the prevalence rates of hypertension and diabetes, 18% of the women and 8% of the men were hypertensive, while 4.8% of the women and 3.3% of the men were diabetic. Furthermore, 26% of the men and 8% of the women had never had their blood pressure taken. About 40% of the women had never had a Papanicolaou smear, and 29% had never had a breast examination. The men were much more likely than the women to smoke cigarettes or marijuana or drink alcohol. Of particular concern was that 30% of the men and 9% of the women had drunk an excessive amount of alcohol on at least one occasion. Injuries and violence were common, and many persons carried a weapon. This survey also found that the men had multiple sexual partners and that condom use was highest among the young adults. Higher socioeconomic status and educational status generally had a positive effect on health behavior.

A behaviour risk factor survey in Jamaica

A population based probability sample of 958 persons (454 males and 504 females) aged 15 to 49 years was surveyed in Jamaica in late 1993 for lifestyle and behaviour risk factors. Demographic characteristics of the sample were comparable to the general population. 60 percent of persons visited a private doctor the last time that they were ill. Based on self-reporting, 18 percent of the women and 8 percent of the men had never their blood pressure taken. 40 percent of the women had never had a Papanicolaou smear, 29 percent had never had a breast examination and 33 percent said that they were overweight compared with 18 percent of men. Smoking cigarettes and marijuana was more common among men (36 percent) than women (11 percent) as were drinking alcohol (79 percent of men, 41 percent of women) and heavy alcohol use (30 percent of men, 9 percent of women). Injuries requiring medical attention in the previous five years were reported by 40 percent of the men and 15 percent of the women. 34 percent of the men and 12 percent of the women regularly carried a weapon and 18 percent of the sample had participated in or witnessed at least one violent act in the previous month. Most of the people interviewed used a contraceptive method; 10 percent were not sexually active. Significantly more men than women had two or more sexual partners in the previous year (54 percent vs 17 percent, p<0.001) or reported ever having a sexually transmitted disease (29 percent vs 9 percent, p<0.001). Younger persons were more sexually active and more likely to use condoms during the most recent sexual intercourse. Higher socio-economic status and educational level generally had a more positive effect on health behaviour. This survey provides vital information relevant to planning health promotion campaigns and assessing their success.(AU)

A behaviour risk factor survey in Jamaica

A population based probability sample of 958 persons (454 males and 504 females) aged 15 to 49 years was surveyed in Jamaica in late 1993 for lifestyle and behaviour risk factors. Demographic characteristics of the sample were comparable to the general population, 60of persons visited a private doctor the last time that they were ill. Based on self-reporting, 18of the women and 8of the men were hypertensive and 4.8of the women and 3.3of the men were diabetic. 26of the men and 8of the women had never had their blood pressure taken. 40of the women had never had a Papanicolaou smear, 29had never had a breast examination and 33said that they were overweight compared with 18of men. Smoking cigarettes and marijuana was more common among men (36) than women (11), as were drinking alcohol (79of men, 41of women) and heavy alcohol use (30of men, 9of women). Injuries requiring medical attention in the previous five years were reported by 40of the men and 15of the women. 34of the men and 12of the women regularly carried a weapon and 18of the sample had participated in or witnessed at least one violent act in the previous month. Most of the people interviewed used a contraceptive method; 10were not sexually active. Significantly more men than women had two or more sexual partners in the previous year (54vs 17, p < 0.001) or reported ever having a sexually transmitted disease (29vs 9, p < 0.001). Younger persons were more sexually active and more likely to use condoms during their most recent sexual intercourse. Higher socio-economic status and educational level generally had a more positive effect on health behaviour. This survey provides vital information relevant to planning health promotion campaigns and assessing their success.

Cysteamine blocks amphetamine-induced deficits in sensorimotor gating.

Somatostatin is a neuropeptide that has been shown to interact with dopamine. Low concentrations of cysteamine selectively depletes somatostatin and has been used to investigate the role of endogenous somatostatin in lieu of an available selective receptor antagonist. We examined the effects of various doses of subcutaneous cysteamine on baseline and amphetamine-disrupted sensorimotor gating as measured by prepulse inhibition of the acoustic startle reflex. Cysteamine in doses ranging from 50-300 mg/kg reversed decreases in PPI induced by systemic injections of amphetamine (2 mg/kg). Cysteamine had no effect on the amplitude of the acoustic startle reflex itself. The results lend further support to a somatostatin-dopamine interaction within the brain in which endogenous somatostatin facilitates dopaminergic activity. These findings also suggest that endogenous somatostatin might play a significant role in regulation of sensorimotor gating deficits. This has clinical implications as deficient prepulse inhibition is recorded in humans suffering from neuropsychiatric conditions such as schizophrenia.

The effects of intra-accumbens neurotensin on sensorimotor gating.

Neurotensin is a neuropeptide which coexists with mesolimbic dopamine. Previous studies have shown that centrally administered neurotensin can modulate the activity of mesolimbic dopamine with a profile similar to neuroleptics. For example, infusions of neurotensin into the nucleus accumbens inhibit amphetamine-induced hyperlocomotion. Prepulse inhibition (PPI) occurs when a weak prestimulus ('prepulse') inhibits the amplitude of the startle response to an intense stimulus ('pulse'). PPI is an operational measure of sensorimotor gating which is strongly regulated by mesolimbic dopamine. This study examined the effects of various doses of neurotensin infused into the nucleus accumbens of rats on the prepulse inhibition (PPI) of their acoustic startle reflex. Neurotensin (0.25-5.0 microg) was infused into the nucleus accumbens of rats. Animals then received subcutaneous injections of amphetamine (2 mg/kg) or saline and were placed in startle chambers where measures of startle amplitude and PPI were obtained. Neurotensin increased baseline PPI and blocked amphetamine-induced disruption of PPI in a dose-dependent fashion. The lowest dose of neurotensin tested (0.25 microg) significantly increased baseline PPI and both 0.25 and 1.0 microg neurotensin blocked amphetamine-induced decreases in PPI. The 5.0 microg dose of neurotensin had no significant effect on prepulse inhibition. Neurotensin had no effect on the amplitude of the acoustic startle reflex in amphetamine- or saline-treated rats. The results suggest that intra-accumbens neurotensin has a significant, dose-dependent effect on sensorimotor gating in which lower doses (0.25-1.0 microg) exhibit a neuroleptic-like action.

Luminal and basolateral mechanisms involved in the renal tubular uptake of inorganic mercury.

The principle aim of the present study was to provide evidence for the existence of both a luminal and a basolateral mechanism involved in the renal tubular uptake of inorganic mercury. To accomplish this aim, we examined individually and collectively the effects of a "stop-flow" technique designed to reduce glomerular filtration to negligible levels and pretreatment with the organic anion p-aminohippurate (PAH) on the renal uptake and disposition of administered inorganic mercury. More specifically, we compared the disposition of inorganic mercury in groups of surgical control rats, rats that underwent a unilateral ureteral ligation, and rats that underwent a bilateral ureteral ligation that were pretreated with either normal saline or a 7.5 mmol/kg intravenous dose of PAH 5 min prior to receiving a nontoxic 0.5-mumol/kg intravenous dose of mercuric chloride. The disposition of mercury was evaluated at both 1 h and 24 h after the dose of inorganic mercury had been administered. In brief, the "stop-flow" conditions induced by either unilateral or bilateral ureteral ligation caused a significant reduction in the uptake and content of mercury in the kidneys (whose ureter was ligated) both at 1 h and 24 h after the intravenous injection of the nontoxic dose of mercuric chloride. This decreased renal uptake of mercury was due specifically to decreased uptake of mercury in the renal cortex and outer stripe of the outer medulla. Assuming that glomerular filtration was reduced to negligible levels, the amount of mercury not taken up during ureteral ligation represents the portion of mercury that is presumably taken up by a luminal mechanism. Pretreatment with PAH also caused a significant reduction in the renal uptake of mercury, specifically in the cortex and outer stripe of the outer medulla. The effects were most prominent 1 h after the injection of inorganic mercury. When either unilateral or bilateral ureteral ligation was combined with PAH pretreatment, an additive inhibitory effect occurred with respect to the renal uptake of mercury. In fact, the renal uptake of mercury was reduced by approximately 85% at 1 h after the injection of mercuric chloride. Since the luminal uptake of mercury was blocked by ureteral ligation, the effect of PAH on the renal uptake of mercury must have occurred at the basolateral membrane. Thus, the findings from the present study indicate that there are two distinct mechanisms involved in the uptake of mercury, with one mechanism located on the luminal membrane and another located on the basolateral membrane (presumably on proximal tubular epithelial cells).

A behaviour risk factor survey in Jamaica - abstract

A population-based probability sample of 958 persons (454 males and 504 females) aged 15 - 49 years were surveyed in Jamaica in late 1993 for lifestyle and behaviour risk factors. Demographic characteristics of the total sample were comparable to those of the general population. The majority (60 percent) of persons visited a private doctor the last time that they were sick. Eighteen per cent of the women and 8 percent of the men were hypertensive while 4.8 percent of the women and 3.3 percent of the men were diabetic. Twenty-six per cent of the men and 8 percent of the women had never had their blood pressure taken. Among women, 40 percent had never had a Pap smear, 29 percent had never had a breast examination and 33 percent were over weight compared with 18 percent of men. Smoking cigarettes and marijuana was more common among men (36 percent) than women (11 percent) as was drinking alcohol and heavy alcohol use (30 percent of men, 9 percent of women). Injuries requiring medical attention in the past 5 years were reported by 40 percent of the men and 15 percent of the women. The majority of persons used a contraceptive method while 10 percent of adults were no sexually active. Significantly more men than women had had two or more sexual partners in the past (54 percent vs 17 percent) or reported ever having STD (29 percent vs 9 percent). Younger persons were more sexually active and more likely to have used a condom on the last occasion. Higher socioeconomic status and educational level generally had a more positive effect on health behaviour. This survey provides vital information relevant to planning health promotion compaigns and assessing their success (AU)

Sertraline, a selective inhibitor of serotonin uptake, induces subsensitivity of beta-adrenoceptor system of rat brain.

Subacute administration (b.i.d. for 4 days) of sertraline, a potent and selective inhibitor of serotonin uptake, was found to reduce cyclic AMP generation by the norepinephrine receptor-coupled adenylate cyclase in rat limbic forebrain slices and decrease the number of beta-adrenoceptors in rat cerebral cortex without affecting the affinity of [3H]dihydroalprenolol binding. Co-administration of sertraline and the serotonin agonist, quipazine, at doses at which neither agent had an effect, resulted in desensitization of norepinephrine receptor-coupled adenylate cyclase and down-regulation of beta-adrenoceptors. These findings suggest that increased serotonergic activity may be involved in the induction of subsensitivity of the beta-adrenoceptor system of rat brain by sertraline.

First World standards versus Third World settings.

PIP: The 3rd world population programs supported by international agencies are being heatedly debated, and the conclusions reached are frequently confusing, extreme, and biased. The international agencies at the center of the debate must make numerous decisions, many of which have ethical implications. Such a wide range of opinions exist that it is becoming more and more difficult for agencies to maintain a balance. Consequently a maze of rules and regulations had proliferated in recent years. It is not clear whether these are meant to protect the user or the provider. Measures intended to safeguard family planning users in developing countries frequently do more harm than good. Complicated Western requirements for informed consent, meant to educate users and protect providers from malpractice suits, may be unrealistic in developing nations. It is mandatory to ensure that an individual is not treated against his/her will, but the informed consent forms for all contraceptive methods are becoming longer and more complicated. The most salient facts are completely lost or undermined in the profusion of information. Where the population is illiterate and unaccustomed to signing forms, this practice raises suspicion and creates mistrust. Comparing the relative risks and benefits of the many fertility control methods is both complicated and controversial, even among highly educated populations. It is most important to ensure that persons are not coerced into accepting family planning and that they have a clear understanding of the major consequences of the particular contraceptive they choose. This information needs to be communicated in a manner acceptable to the local culture. The use of modern equipment and gadgetry is tempting to both donors and recipients, but it is essential to evaluate carefully local conditions and capabilities before deciding whether these or simpler family planning methods are more appropriate. Another factor for consideration is the reluctance of physicians to revert to simple techniques once they have become accustomed to sophisticated methods. Reporting is a reasonable requirement for any agency to impose, but detailed and elaborate documentation requirements serve primarily to impose an additional burden on the program staff. Donor agencies that are sincerely concerned about the welfare of people in developing countries must make their assistance more meaningful. As the benefit of all foreign aid to the developing countries is constantly being negated by staggering population increases, it is essential that assistance for family planning programs be well managed.^ieng

Development and evaluation of a training program for volunteers working in day treatment.

When staff members of a community mental health center's day treatment program for adults with emotional problems found there was not enough time for planning and meeting program goals, they considered using volunteers to help in the treatment process. The center staff worked with the local mental health association to plan the training and use of volunteers. Twenty-five volunteers were initially selected and trained. They evaluated the training through questionnaires immediately after training and after three and six months of service. Respondents felt the training prepared them to perform their duties and understand their roles as volunteers. Volunteers have worked in the program for two and a half years; currently 28 volunteers each work approximately three hours a week.