Validation of a telephone-administered geriatric depression scale in a hispanic elderly population.

OBJECTIVE: To develop and validate a Spanish version of the Geriatric Depression Scale (GDS) for telephone administration. DESIGN, SETTING, AND PATIENTS: The original version of the GDS was translated into Spanish. A random sample of 282 ambulatory elderly individuals was contacted by phone. Those completing the phone GDS (GDS-T) were asked to schedule an appointment within two weeks in which we collected data on demographics, physical exam, functional and mental status, and a face-to-face version of the GDS (GDS-P). We estimated question-to-question kappa statistics and the Pearson correlation coefficient between the GDS-T and GDS-P scores. We evaluated reliability of the GDS-T and GDS-P using the Cronbach's alpha coefficient. We estimated the sensitivity, specificity, and criterion validity of the GDS using the DSM IV criteria for depression as our gold standard. RESULTS: Thirty patients (11%) refused to participate. Of the remaining 252 patients, 169 (67%) attended the personal interview. The Cronbach's alpha coefficient was 0.85 for GSD-P and 0.88 for GDS-T. Sensitivity and specificity were 88% and 82% for GDS-P and 84% and 79% for GDS-T. The prevalence of depression in the group completing both scales was 12.8% using the GDS-P and 14.9% using the GDS-T (P >.05). Among those who only completed the GDS-T, the prevalence was 22.7% (P <.05) suggesting that depressed patients kept their appointments less frequently. CONCLUSIONS: The telephone GDS had high internal consistency and was highly correlated with the validated personal administration of the scale, suggesting that it could be a valid instrument for screening of depression among elderly ambulatory Spanish-speaking patients. Because the depression rate was significantly higher among those not presenting to the personal evaluation, the adoption of GDS-T may help detect and plan early interventions in patients who otherwise would not be identified.

[Registry of genetic and malformative diseases in the province of Macerata]. / Registro delle malattie genetiche e malformative della provincia di Macerata.

OBJECTIVES: The aim of this epidemiological research is to evaluate the prevalence of genetic diseases and malformative syndromes in paediatric population living in the Macerata county. MATERIAL AND METHODS: All the data were collected through a careful analysis of a specific questionnaire sent to all the family paediatricians. RESULTS: 23,379 children living in Macerata county, aged 0 to 9 years, were evaluated (93.8% of all this paediatric population). Among those were found N 400 cases of genetic diseases and malformative syndromes: Malformations Tot.N. 255 cases (63.3% of the reported cases); Malformative Syndromes Tot. N. 55 cases (27.8% of the reported cases); Endocrinology and Metabolic Diseases Tot. N. 41 cases (10.3% of the reported cases); Osteochondrodysplasia Tot. N. 22 cases (5.7% of the reported cases); Other Tot. N. 28 cases (7.0% of the reported cases); Male population was found more affected than female: M/F ratio = 1.4. The analysis of the data showed an increasing trend in detecting these pathological conditions, consistent with the increase in geographic altitude (3 areas considered): 0-100 meter = 0.88%; 100-600 m.a.s. = 1.34%; over 600 m.a.s. = 1.88%. CONCLUSION: The knowledge of the number of children affected by genetic and malformative diseases in the Macerata county is relevant in order to establish a Genetic Service with the aim to better support the medical assistance of these patients and counselling service for the families.

[The catarrhal child]. / Il bambino catarrale.

The first seven years of a child's development are often described as the catarrhal stage. This is because of the increased incidence of upper respiratory tract infections. Nasal obstruction in the children is common and symptoms are often distressing. The authors report a rational approach to this problem to produce effective treatment of recurrent nasal obstruction. In particular clinical features, diagnosis, and therapy of recurrent rhinitis, adenoid hypertrophy, and tonsillar obstruction are described. The indications for adenoidectomy, tonsillectomy or adenotonsillectomy has been questioned.

An individualized approach to locating the occlusal plane.

"The occlusion of the teeth is the most potent factor in determining the stability in the new position." This was written by Kingsley more than 100 years ago and it is equally true today. Identifying the degree of occlusal change that occurs, either through growth factors or because of treatment, is necessary and important. This article explores the relation that exists between the occlusal plane and the lower-face skeletal pattern in the individual patient. A method is shown to locate the occlusal plane within these various lower-face skeletal patterns. This becomes an important factor in treatment when changes in the occlusal relation are made in patients, especially in maxillofacial surgery, prosthetics, and orthodontics.

The quadrilateral analysis: a differential diagnosis for surgical orthodontics.

The integration of the diagnostic and treatment skills of both the orthodontist and the maxillofacial surgeon has become a standard procedure in the treatment of severe dentofacial dysplasias. Orthognathic surgery, surgery without prior tooth movement, is being replaced by an interdisciplinary approach as the treatment of choice. When a proper tooth-to-denture-base relationship is obtained, an ideal maxillomandibular relationship can be achieved surgically. The quadrilateral analysis enables the practitioner to obtain an individualized skeletal, dental, and soft-tissue assessment of each patient requiring treatment. It determines the direction and extent of the skeletal dysplasia in millimeter measurements and allows the clinician to outline the appropriate surgical orthodontic procedures. The quadrilateral analysis indicates that in a balanced facial pattern a 1:1 ratio exists between the maxillary bony base length (Max.Lth.) and the mandibular bony base length (Mand.Lth.); also that the average of the anterior lower facial height (ALFH) and the posterior lower facial height (PLFH) equals these bony base lengths. Simply stated, the Max.Lth. = Mand.Lth. = (formula; see text) An accurate diagnosis locates the area and quantifies the magnitude of skeletal dysplasia. Then the correct placement of a dentition within the denture bases and the appropriate surgery in the area of dysplasia can produce an individualized, balanced facial pattern.

The quadrilateral analysis: an individualized skeletal assessment.

There must be a change in our approach to orthodontic diagnosis, especially in those cases involving skeletal dysplasias. The orthodontic practice of today requires a more in-depth diagnostic approach before a realistic treatment plan can be developed. An understanding of the problem that exists is emerging as the essential ingredient before appliance therapy can begin. Diagnosis should dictate the direction of treatment for both the orthodontist and the surgeon. A cephalometric analysis should be able not only to detect but to locate the area of the skeletal dysplasia. Surgery, if at all possible, should be performed where the problem exists. In many cases, it becomes rather confusing to determine whether or not surgical orthodontic treatment is indicated, because most of the cephalometric measurements that are used do not reveal whether a skeletal problem exists, its location, or its magnitude. We believe that current cephalometric analyses do not completely recognize the extent of the dysplasia or where it is located within the jaws. Because of this, surgery is performed by repositioning bones to mask the defect rather than to restore a normal balance between the bones of the face. The only recourse the surgeon has is to achieve an acceptable facial profile by relying on cephalometric norms or to make the necessary correction on what appears visually to be an acceptable profile. The quadrilateral analysis offers an individualized cephalometric diagnosis on patients with or without skeletal dysplasias. We believe that it is a reliable and accurate method of assessing whether orthodontic treatment, surgical treatment, or a combination of both is required to achieve a satisfactory result.

Vitamin B6-dependent seizures: pathology and chemical findings in brain.

A 13 1/2-year-old child died with vitamin B6-dependent seizures in progress. Microscopic findings in brain included an abnormally sparse quantity of central myelinated fibers in the cerebral hemispheres. Glutamic acid concentrations were elevated and GABA concentrations reduced in the frontal and occipital cortices but not in the spinal cord. All other amino acid concentrations were normal, except for increased cystathionine in the occipital cortex. Pyridoxal-5-phosphate (PLP) was reduced in the frontal cortex. Glutamic acid decarboxylase activity comparable to that of controls was detected when the PLP concentration was greater than 0.05 mM. These findings suggest that pyridoxine-dependent seizures in man are associated with reduced GABA concentrations in the brain and with diminished central white matter structures.