The life cycle of Gregarina cuneata in the midgut of Tribolium castaneum and the effects of parasitism on the development of insects.

Tribolium castaneum Herbst 1797 (Coleoptera: Tenebrionidae), an important pest of stored grains and byproducts, is naturally infected by Gregarina cuneata Stein 1848 (Apicomplexa: Gregarinidae). Changes in the life cycle of insects caused by the parasite development in the midgut were studied. Trophozoites, gamonts (solitary and associated), and gametocysts were present in the midgut of the insects. In young trophozoites, the apical region differentiated into an epimerite that firmly attached the parasite to the host epithelial cells. With maturation, trophozoites developed in gamonts that were associated with the initiation of sexual reproduction in the cell cycle, culminating in the formation of the spherical gametocyst. Morpho-functional analyses indicated that gregarines absorb nutrients from infected cells and can occlude the midgut as they develop. Consequently, nutritional depletion may interfere with the host's physiology, causing decreased growth, delayed development, and high mortality rates of the parasitized insects. These results suggest G. cuneata could be an important biological agent for controlling T. castaneum in integrated pest management programs.

Spherites in the midgut epithelial cells of the sugarcane borer parasitized by Cotesia flavipes

Diatraea saccharalis, the main pest of sugarcane, has been controlled by Cotesia flavipes. Very little is known about the effect of parasitism on the host organs, including the midgut. The Lepidoptera midgut epithelium is composed of columnar, goblet, regenerative, and endocrine cells. Spherites have been described in columnar and regenerative cells of several Lepidoptera species, and presented a lot of functional meaning. We identified spherites in the midgut epithelial cells of non-parasitized D. saccharalis larvae analyzed the effect of parasitism on spherite morphology and distribution along the length of the midgut. Midgut fragments of both non-parasitized and parasitized larvae were processed for transmission electron microscopy. All the midgut epithelial cells showed spherites, but they were not preferentially located in a particular part of the cells. Parasitized larvae had more spherites, mainly in the columnar cells, than non-parasitized larvae. This observation was associated with an ionic imbalance within the insect host. Spherites were more abundant in the anterior midgut region than in other regions, which suggests that this region is involved in ion transport by intracellular and/or paracellular route.The morphological variability of spherites in the cells of parasitized larvae was related to the developmental stages of these structures.(AU)

Spherites in the midgut epithelial cells of the sugarcane borer parasitized by Cotesia flavipes

Diatraea saccharalis, the main pest of sugarcane, has been controlled by Cotesia flavipes. Very little is known about the effect of parasitism on the host organs, including the midgut. The Lepidoptera midgut epithelium is composed of columnar, goblet, regenerative, and endocrine cells. Spherites have been described in columnar and regenerative cells of several Lepidoptera species, and presented a lot of functional meaning. We identified spherites in the midgut epithelial cells of non-parasitized D. saccharalis larvae analyzed the effect of parasitism on spherite morphology and distribution along the length of the midgut. Midgut fragments of both non-parasitized and parasitized larvae were processed for transmission electron microscopy. All the midgut epithelial cells showed spherites, but they were not preferentially located in a particular part of the cells. Parasitized larvae had more spherites, mainly in the columnar cells, than non-parasitized larvae. This observation was associated with an ionic imbalance within the insect host. Spherites were more abundant in the anterior midgut region than in other regions, which suggests that this region is involved in ion transport by intracellular and/or paracellular route.The morphological variability of spherites in the cells of parasitized larvae was related to the developmental stages of these structures.

A prognostic rule for elderly patients admitted with community-acquired pneumonia.

PURPOSE: We sought to identify admission characteristics predicting mortality in elderly patients hospitalized with community-acquired pneumonia and to develop a prognostic staging system and discriminant rule. PATIENTS AND METHODS: We retrospectively analyzed data from 2,356 patients aged > or = 65 years admitted with community-acquired pneumonia. Multivariable analyses of a derivation cohort (n = 1,000) identified characteristics associated with hospital mortality. A staging system and discriminant rule based on these characteristics were tested in a validation cohort (n = 1,356). Our discriminant rule was compared with a rule formulated from a heterogeneous adult population with community-acquired pneumonia. RESULTS: Hospital mortality rates were 9% (derivation cohort) and 12% (validation cohort). We identified five independent predictors of mortality: age > or = 85 years [odds ratio 1.8 (95% confidence interval 1.1-3.1)], comorbid disease [odds ratio 4.1 (2.1-8.1)], impaired motor response [odds ratio 2.3 (1.4-3.7)], vital sign abnormality [odds ratio 3.4 (2.1-5.4)], and creatinine level > or = 1.5 mg/dL [odds ratio 2.5 (1.5-4.2)]. These variables stratified patients into four distinct stages with increasing mortality in the derivation cohort (Stage 1, 2%; Stage 2, 7%; Stage 3, 22%; Stage 4, 45%; P = 0.001) as well as in the validation cohort (Stage 1, 4%; Stage 2, 11%; Stage 3, 23%; Stage 4, 41%; P = 0.001). The discriminant rule developed from the derivation cohort had greater overall accuracy (77.1%) in the validation cohort than a rule formulated from a heterogeneous adult population (68.0%, P = 0.001). CONCLUSION: Elderly patients with community-acquired pneumonia have characteristics at admission that can predict mortality. Our staging system and discriminant rule improve prognostic stratification of these patients.

Gender differences in recalled parental childrearing behaviors and adult self-esteem.

A retrospective questionnaire study investigated gender differences in the relations between the self-reported self-esteem of 155 psychiatric adult outpatients and their recalled experience of their parents' behavior toward them as children. There were no significant sex differences in degree of self-esteem. However, it had a higher correlation to parenting variables for the men than for the women, with maternal predictor variables accounting for 36% and paternal predictors accounting for 32% of the variance in the men's self-esteem. Neither combined maternal nor combined paternal variables were significant predictors for women. For men, parental acceptance/ autonomy was significantly and positively related and inconsistency negatively related to self-esteem. Paternal rejection but not maternal rejection was significantly associated with low self-esteem only for the women. The greater amount of variance explained by childrearing variables in the men's self-esteem scores was attributed to the earlier ego development and consequent increased individuation in women.

The psychological mindedness scale : factor structure and relationship to outcome of psychotherapy.

Two studies are reported. The first examined the factor structure of the Psychological Mindedness (PM) Scale, and the second reassessed the scale's predictive validity. A principal components analysis (varimax rotation) of the data of 256 psychiatric outpatients produced five factors that accounted for 38% of the variance. A tentative definition of PM based on these factors is proposed. For a subsample of 116 patients who attended at least four psychotherapy sessions, PM was unrelated to levels of functioning and psychosocial symptoms at admission and was positively associated with number of sessions attended, consistent with findings of a preliminary investigation. Not replicated were significant correlations between PM and outcome measures derived from therapists' and an independent rater's evaluations. Initially high PM was significantly related to patients' self-ratings of symptoms and problems after discharge.

Relationships between psychological mindedness and personality traits and ego functioning: validity studies.

Two studies further investigated the psychometric properties of the self-report Psychological Mindedness Scale (PMS), which has been shown to have good internal consistency and evidence of predictive and divergent validity. Its construct validity was investigated by assessing (1) whether total scores on the PMS of a group of medical students attending a personnel clinic in a psychiatric outpatient setting would be related in theoretically expected ways to their scores on a personality test; and (2) whether total scores on the PMS of a group of regular clinic patients would have the expected theoretical relationships to scores on a measure of ego functions. The findings of both studies provided support for the construct validity of the PMS.

Determinants of outpatients' satisfaction with therapists : relation to outcome.

This study investigated outpatients' satisfaction with therapists, as determined by their perceptions of therapists' behaviors and characteristics, and related patient satisfaction to measures of psychotherapy outcome derived from patients themselves, therapists, and an independent rater. After discharge, 138 demographically and diagnostically heterogeneous patients who had been in psychodynamically oriented psychotherapy returned mailed questionnaires. Therapist characteristics and behaviors such as being likeable, accepting, encouraging, and respectful, helping patients to understand themselves better, and not being "too quiet," as well as overall ratings of satisfaction with therapists, were significantly correlated with patients' ratings of improvement and of help received and with therapists' ratings of outcome.

Review of research in supportive psychotherapy: an update.

Supportive psychotherapy techniques are widely practiced not only for hospitalized or chronically ill psychiatric patients, but also, on a relatively short-term basis, for patients in acute crisis situations. It has also been found effective for patients with medical illnesses to help them develop more effective coping mechanisms, thereby providing a more favorable long-term course of illness. In spite of the growing practice of this approach to therapy, it is apparent that to date neither the number nor the quality of controlled studies of supportive psychotherapy has increased substantially since empirical studies of this form of treatment were reviewed in 1986. However, with its growing acceptance in the field as a body of specific goals, strategies and techniques that can be taught, perhaps we may now expect to see an increase in better designed and controlled studies that utilize objective and measurable assessment techniques, and that include a follow-up of sufficient length to enable valid statements to be made concerning efficacy.

Critical incidents in psychotherapy.

The critical-incident technique was used to obtain a list of patient behaviors that create special difficulties for the psychotherapist. The list was prepared by a group of seven clinicians during a series of meetings. Included in the list were such items as: insulting the therapist; coming late to the session; threatening suicide; and offering gifts. The list was given to 21 experienced psychiatrists who were asked to rate both the importance and the frequency of occurrence of each incident in their experience. The critical incidents could be divided into five major categories: threat of harm from the patient; criticism of the therapist or the therapy; occurrence of a major life crisis; attempts by the patient to seek friendship or seduction, and miscellaneous incidents, such as being consistently late. When ratings by the experienced psychiatrists were compared with those of 10 third-year psychiatric residents, it was found that the inexperienced psychiatrists in almost every case rated the incident as less important and more frequent than did the experienced clinicians. In terms of implications, knowledge of critical incidents in psychotherapy may provide a source of material for training purposes, may enable the development of modeling procedures for training in communication skills, and may encourage supervisors to focus attention on important therapeutic issues.

Strategies of therapist interventions : a preliminary empirical study.

Forty-one categories of patient communications just before therapist interventions were identified from a review of psychotherapy transcripts. For each communication type, a set of possible therapist interventions was constructed. Descriptions of these interactions were sent in the form of a questionnaire to 350 experienced clinicians, who were asked to indicate their degree of agreement with each possible response. Ratings from the 141 responding clinicians showed little relation to age, gender, experience level, or orientation but showed marked differences for different response alternatives. A separate group of seven experienced clinicians used these data to develop a new categorization of 15 types of therapist interventions and 5 types of patient communications. A tentative information-processing model of patient-therapist communications is proposed.

Development of a therapist activity rating scale: preliminary findings.

A 61-item scale was constructed of relatively explicit descriptions of behavior in which a psychotherapist might engage. The scale is largely noninferential, is basically atheoretical but applicable to psychodynamically oriented therapy, may be completed by either the therapist or an independent rater with minimal training, and may be used to rate entire therapy sessions or specific segments of sessions. The scale shows high interrater reliability and discriminant validity.

The Suicide and Aggression Survey: a semistructured instrument for the measurement of suicidality and aggression.

Despite the rising concern with the increasing rate of violent and suicidal behaviors in this country and others, we remain relatively limited in our ability to rigorously define, classify, and measure these behaviors. In addition to our previous work in developing self-rating scales assessing aspects of aggressive behaviors, we have developed the Suicide and Aggression Survey (SAS), a new, comprehensive, semistructured interview and research tool, for the purpose of comprehensively evaluating and understanding the multiple constituents of these behaviors, and for assisting in predicting which individuals might be at high risk for suicide or violence. The present report describes the need for such an instrument and the theoretical models that have guided us in constructing it; one of these is a sequential description of the major classes of variables related to aggression and the other is a two-stage model of countervailing forces. Preliminary reliability data and a description of the structure of the interview are included.

Substance abuse among psychiatric inpatients.

The drug use history was obtained for all patients admitted to the inpatient service of a large municipal hospital during a 1-month period. A total of 104 patients were evaluated. An inverse relationship was found between the frequency of drug use and the diagnosis of schizophrenia. Approximately one third of the patients were found to be polydrug users, that is, individuals who used at least two types of drugs weekly (e.g., alcohol plus cocaine, heroin plus cocaine, etc.) during the 3 months prior to hospitalization. Most of the polydrug users were males. Patients who scored high in drug use tended to be younger, had more seclusions while on the ward, and had less of a history of drug or alcohol treatment. The drug having the highest frequency of daily use was found to be cocaine. It appears that drug use in general and polydrug use in particular is increasing among psychiatric patients.

A review of treatment studies of minor depression: 1980-1991.

This article provides a brief overview of the changing nature of the concept of minor depression. It then discusses treatment studies conducted from 1980 to 1991 of patients diagnosed as neurotic depression, depressive neurosis or dysthymia, characterologic depression, "double depression" and minor depression or dysthymia, if there has been a full remission of a major depressive episode lasting at least six months prior to the development of dysthymia. Long-term treatment of chronic depression is also reviewed. Cognitive-behavioral intervention and marital therapy have been reported beneficial for patients diagnosed as having neurotic depression, characterological depression, or dysthymia. All studies of antidepressant drug treatment showed drugs to be efficacious and superior to placebo, with few differences found between drugs. In addition, they all showed the importance of analyzing the interactions between treatment and severity or diagnosis. Patients diagnosed as "double depression" also appear responsive to both psychosocial intervention and drug treatment; in general, however, these patients tend to have a poor long-term outcome and continued treatment is indicated. The most obvious finding to emerge from this review is that the diagnosis of minor depression is ambiguous, in large part because of the lack of defining criteria related to severity and course. The review also revealed that in addition to poorly defined subgroups, many studies lacked controls, had small sample sizes, inadequate and/or inconsistent measures of outcome, and limited follow-up. For these reasons, their findings cannot be considered conclusive. Finally, the literature revealed a dearth of controlled studies of psychosocial treatment for well defined subgroups of neurotic depression.