Depression in multiple sclerosis: effect of brain derived neurotrophic factor Val66Met polymorphism and disease perception.

BACKGROUND AND PURPOSE: Depression is common amongst subjects with multiple sclerosis (MS), and several investigations have explored different determinants of this condition, including physical disability, psychological and psychosocial factors. The brain derived neurotrophic factor (BDNF) Val66Met polymorphism has been associated with depression. The aim of this study was to analyze the influence of disease-related factors, BDNF Val66Met polymorphism and perception of disease on the severity of depression in MS. METHOD: In total, 136 MS patients (88 women) were recruited and genotyped for BDNF rs6265 polymorphism at nucleotide 196 (G/A) using 'high resolution melting'. Depressive symptoms were assessed by the Multiple Sclerosis Depression Rating Scale. Perception of health status was assessed using the SF-36 questionnaire. RESULTS: A multivariable linear regression model showed that the best predictors of depression were the SF-36 General health (ß = -0.209; P = 0.013), Mental health (ß = -0.410; P < 0.001) and Social activity (ß = -0.195; P = 0.035) scores; physical disability (assessed by the Extended Disability Status Scale score) was directly correlated to depression severity on univariate analysis, but it was not a relevant predictor of depression on multivariate analysis; other variables directly related to the disease (treatment, annual relapsing rate) and the BDNF Val66Met polymorphism were not significantly associated with depression. CONCLUSION: Perception of the health status is the principal predictor of depressive symptoms in our sample. This result supports the hypothesis that the subjective interpretation of the disease's consequences is one of the main factors in determining depression in MS.

[In the heart of the district. 50 interviews with the health professionals of the Lazio Region districts, Italy]. / Nel cuore del distretto. 50 interviste con gli operatori dei distretti sanitari della Regione Lazio.

This article aims to explore some key issues relating to the health districts of the Lazio Region, in particular the major critical aspects as well as some strengths highlighted by the operators. In the Lazio Region there are 12 Local Health Units, divided into 55 health districts. In recent years, the majority of the authors analized theoretical models proposed by regional standards, while the strengths and weaknesses of the district, as well as the organizational difficulties and problems experienced daily by the operators have not been investigated. It was decided to use qualitative methods of research, through open interviews with 50 operators in 15 health districts of the Region. Interviews were analysed utilizing software Nvivo. Some codes were identified to guide interviews. We can summarize the emergency issues at least in three major areas: 1) the organization of the district, 2) the management of personnel and resources, 3) the care pathways. It is hoped that, during next years, the research directed at health district analysis will grow, with particular reference to quantitative and qualitative investigations, in order to build a body of knowledge from practical experience of health professionals.

[Continuing education pathways. The training experience of the agency for public health Laziosanità]. / Percorsi di educazione continua in medicina. L'esperienza formativa di Laziosanità - ASP.

In recent decades, the continuing medical education has experienced deep changes in terms of theoretical and pedagogical methods as well as expectations regarding the potential results. There is a growing need to initiate more effective programs, producing changes in professional practice and not only in acquiring new knowledge. In the national context, the Health Agency of Lazio Region has developed some formative experiences that have adopted these principles and have shown significant results. In the present article will be presented the principles as well the methods adopted in one of these programmes, a clinical pathway for the hospital management of hip fractures in patients over 65 years of age.

Cultural meanings of tuberculosis in Aceh Province, Sumatra.

This paper shows how disease transmission and particularly what biomedicine calls tuberculosis are interpreted in the non-Western context of Aceh Province, Sumatra, Indonesia. It tries also to focus on factors influencing perceptions and health-seeking behaviors. Results show that what biomedicine calls TB is represented by a semantic network of illnesses. Parts of this network are clearly identified as transmissible while others are related to specific phenomena affecting the individual, such as terbuk (poisoning) or trouk (fatigue produced by hard work), and are not considered contagious. Forms of transmission are interpreted mostly through empirical and analogic categories. TB is attributed to four different aspects: (a) biomedical categories such as germ theory; (b) socio-economic conditions; (c) transgression of social rules; and (d) poisoning and the influences of supernatural powers. Health-seeking behaviors are related to the perceived causes of the disease, economic factors, and the accessibility of health services.

[The patient-physician relationship: towards humanization of medical practice]. / A Relação paciente-médico: para uma humanizaçáo da prática médica.

Based on a literature review, this article discusses the physician-patient relationship by presenting anthropological and communicational approaches, physicians' experiences as patients, key concepts showing the need for humanization of the patient-physician relationship, and some theoretical-philosophical reflections relating primarily to hermeneutics. Based on this framework, one can already identify a series of possibilities for implementing humanizing proposals. The challenge now is to classify, publish, and evaluate these proposals.

Cultural interpretations of contagion.

Anthropological research in recent years has examined how single diseases such as Aids, tuberculosis, measles, malaria and leprosy are conceptualized by laypersons in non-Western societies. But how is disease transmission itself interpreted in other cultures? Data from ethnographical studies in Côte d'Ivoire and the Afro-Brazilian culture in Bahia, Brazil show that the interpretations of contagion and preventive practices cut across society involving five main relationships: empirical and analogical thinking, symbolic factors and social organization, the concept of person and body elements, natural and supernatural powers and individual and contextual factors. There is not a general theory, such as Pasteur's theory of germs. Instead, contagion presents itself as a transversal, multidimensional concept crossing and interconnecting society and culture. Public health programmes aimed at controlling infectious diseases need first to understand how contagion is conceptualized by laypersons, the extent to which diseases are considered infectious and the relation between perceptions and preventive practices. This would help in implementing infectious disease control programmes within local contexts based on meaningful community participation.

[Community perception on the quality of public health services delivery in the Norte and Ichilo districts of Bolivia]. / Percepción de la comunidad acerca de la calidad de los servicos de salud públicos en los distritos Norte e Ichilo, Bolivia.

The current study identifies the people perception on the quality of public health services in Norte and Ichilo health districts (Bolivia), with a particular emphasis on the relationship between heath workers and patients. Both qualitative and quantitative methods were utilised such as: survey, focus groups, participatory observation, unstructured interviews to Key informants and open discussions with the community. Results show that the public health services reputation is affected by elements as discriminatory attitude towards people belonging to a low socio-economic strata, lack of communication between health workers and patients, perceived insufficient technical skills and recognition of a low therapeutic efficacy. The people who are coming from highlands (collas) appear as the most disappointed by the health service provision structured on the western predominant pattern with a top-bottom approach ignoring its potential users' expectations and needs. A low capability of the public health services to accept and recognise the inter-cultural features of the region, makes that the challenge to be undertaken by the district health personnel should focus on the establishment of intercultural bridges between the public health service providers and the potential patients, as well as among the different co-existing medical systems.

The perception of AIDS in the Bété and Baoulé of the Ivory Coast.

The purpose of this study was to gain a better understanding of the socio-cultural aspects of transmissible diseases, in particular AIDS perceptions, among the two major Ivorian ethnic groups, the Bété and Baoulé, in order to implement more suitable educational programmes. The methods used consist of structured interviews to obtain quantitative findings on knowledge and practices, and 'focus groups' and semi-structured interviews with key-informants for the collection of qualitative data. Interpretations according to traditional ways of thinking are widespread among both the Bété and Baoulé. Urinating where an AIDS patient has urinated and sorcery attacks are considered possible ways of transmitting AIDS according to traditional categories of pure-impure and supernatural powers intervention. Educational level is the factor which most influences a person's knowledge of AIDS and prevention methods through western categories. Education as well as a better knowledge of the disease appear to be associated with an attitude that favours isolating the patient. The content of health education messages on AIDS, in the rural environment, cannot be separated from the Bétés or Baoulés conceptions of transmissible diseases.

Sociocultural aspects of AIDS in an urban peripheral area of Abidjan (Côte d'Ivoire).

This study aimed to gain a better understanding of the social dynamics--migration, urbanization, the status of women, education--related to AIDS in an urban peripheral area of Abidjan. Structured interviews were administered to 420 people, selected through cluster random sampling. Focus groups and semi-structured interviews were performed with key-informants. The results show that 26.9% of the interviewees are foreigners and 40% of all people interviewed participate in ethnic associations. Knowledge of AIDS is associated with age, gender, educational level and purchasing power. Those who are generally better informed about AIDS are: younger people; people with a higher education; and wealthier people. Men respond correctly to questions more frequently than women. French, the chosen language of the education campaigns, is not understood by 18% of the immigrants, and when considering only immigrant women, the figure increases to 38%. Particular attention should be paid to the design of health education messages and strategies for specific groups, such as non-educated people, women and immigrants. Care must also be taken to match the language used to the target population. Ethnic associations constitute an important starting point, particularly in relation to their use by immigrants, and these should be involved in educational programmes.

Time-resolved M(2) of nanosecond pulses from a Q-switched variable-reflectivity-mirror Nd:YAG laser.

Time-resolved M(2) numerical computation and experimental measurements of nanosecond pulses from a Q-switched variable-reflectivity-mirror Nd:YAG laser are presented for the first time to our knowledge. The beam quality parameter is seen to vary approximately from 1 at the beginning to 2 at the end of a high-energy pulse, with a value of 1.35 at the peak of the pulse, which also corresponds to the M(2) obtained from the time-averaged detection of the pulse profile.