What You Know, What You Do, and How You Feel: Cultural Competence, Cultural Consonance, and Psychological Distress.

Describing the link between culture (as a phenomenon pertaining to social aggregates) and the beliefs and behaviors of individuals has eluded satisfactory resolution; however, contemporary cognitive culture theory offers hope. In this theory, culture is conceptualized as cognitive models describing specific domains of life that are shared by members of a social group. It is sharing that gives culture its aggregate properties. There are two aspects to these cultural models at the level of the individual. Persons have their own representations of the world that correspond incompletely to the shared model-this is their 'cultural competence.' Persons are also variable in the degree to which they can put cultural models into practice in their own lives-this is their 'cultural consonance.' Low cultural consonance is a stressful experience and has been linked to higher psychological distress. The relationship of cultural competence per se and psychological distress is less clear. In the research reported here, cultural competence and cultural consonance are measured on the same sample and their associations with psychological distress are examined using multiple regression analysis. Results indicate that, with respect to psychological distress, while it is good to know the cultural model, it is better to put it into practice.

The Ala55Val and -866G>A polymorphisms of the UCP2 gene could be biomarkers for weight loss in patients who had Roux-en-Y gastric bypass.

OBJECTIVE: The aim of this study was to investigate whether the Ala55Val and -866G>A polymorphisms of the UCP2 gene are related to weight loss and changes in body composition after bariatric surgery performed by Roux-en-Y gastric bypass (RYGB). METHODS: This longitudinal study enrolled obese patients submitted to RYGB. Data regarding weight (kg), body mass index (kg/m2), fat-free mass (FFM; kg), fat mass (kg), weight loss (kg and %), and percent excess weight loss were collected from both preoperative and 1-y postoperative medical records. Polymorphisms were genotyped by allelic discrimination using real-time polymerase chain reaction and TaqMan-predesigned single nucleotide polymorphism Genotyping Assay kits (Applied Biosystems, Foster City, CA, USA). The t test was used to compare variables between genotypes of each polymorphism to analyze the dominant and recessive models. Linear regression models were used to adjust the effects of initial weight, age, and sex on the variation of weight and body composition (P < 0.05). RESULTS: We analyzed 150 severely obese individuals (age 47.2 ± 10.5 y; 80% women). Genotype analysis showed a greater prevalence of heterozygous GA (41.3%) for -866G>A polymorphism and CT (39.3%) for Ala55Val polymorphism. Individuals who carried the T (CT+TT) and A (GA+AA) mutated alleles for Ala55Val and -866G>A, respectively, showed a higher weight and FFM loss. CONCLUSION: The mutated alleles T for Ala55Val and A for -866G>A polymorphism could be biomarkers of weight loss 1 y after RYGB.

Morphological characteristics of the digestive tract of Schizodon knerii (Steindachner, 1875), (Characiformes: Anostomidae): An anatomical, histological and histochemical study.

The digestive tracts of 44 specimens of Schizodon knerii were studied using anatomical, histological and histochemical techniques. The mouth has terminal position, the lip epithelium is squamous stratified with mucous, claviform cells and taste buds, teeth have an incisive form and the tongue has a stratified squamous epithelium with mucous cells and taste buds. The oropharynx cavity is formed by gill apparatus and pharyngeal teeth. The oesophagus presented pleated mucosa, a stratified squamous epithelium with mucous cells, oesophageal glands and taste buds. The stomach presented cardiac, fundic and pyloric regions, simple prismatic epithelium with tubular glands, with none in the pyloric region. The intestine contains 11-15 pyloric caeca, a simple prismatic epithelium with brush border, goblet cells and lymphocytes. Mucosal cells, oesophageal glands and goblet cells reacted positively to PAS, amylase + PAS, Ab pH 2.5 and Ab pH 0.5. Gastric prismatic cells reacted positively to PAS, amylase + PAS, but only those in the pyloric region reacted positively to Ab pH 2.5 and Ab pH 0.5. The results improve the understanding of the anatomy of S. knerii feeding habits and the presence of mucosubstances in the epithelium, highlights the importance of glycoproteins for passing food through the digestive tract.

Effects of APOE, APOB and LDLR variants on serum lipids and lack of association with xanthelasma in individuals from Southeastern Brazil.

Xanthelasma might be a clinical manifestation of dyslipidemia, a recognized risk factor for coronary artery disease. We investigated the association of apolipoprotein E (APOE HhaI), apolipoprotein B (APOB XbaI and Ins/Del) and LDL receptor (LDLR AvaII and HincII) gene polymorphisms with lipid profiles in 100 Brazilians with xanthelasma and 100 controls. Allele frequencies were similar in both groups. APOE, APOB and LDLR genotypes were not correlated with differences in the serum lipid profile. In individuals with xanthelasma, the APOB D allele was associated with less chance of having increased LDL-cholesterol (O.R. = 0.16, CI95% = 0.03-0.94, p = 0.042). In the control group, the APOB X+ allele was associated with less chance of having both increased total cholesterol (O.R. = 0.16, CI95% = 0.03-0.78, p = 0.023) and increased LDL-cholesterol (O.R. = 0.10, CI95% = 0.02-0.60, p = 0.012). Moreover, there was a significantly higher frequency of control individuals (68%) with elevated serum triglyceride levels, compared to patients (48%, p = 0.008). On the other hand, triglyceride levels in controls also seemed to be influenced by all other gene polymorphisms studied, an effect that might be enhanced by environmental factors.

A prospective study of cultural consonance and depressive symptoms in urban Brazil.

Cultural consonance refers to the degree to which individuals, in their own beliefs and behaviors, approximate the prototypes for belief and behavior encoded in shared cultural models. In previous cross-sectional studies, lower cultural consonance in several cultural domains was associated with worse health outcomes, including greater psychological distress. The current paper extends these findings in three ways. First, the effect of cultural consonance on depressive symptoms is tested in a prospective study. Second, it is hypothesized that the effect of cultural consonance in a specific cultural domain will depend on the degree of cultural consensus within that domain: the higher the cultural consensus, the greater the effect of change in cultural consonance in that domain on depressive symptoms. Third, it is hypothesized that cultural consonance will have an inverse effect on depressive symptoms independent of the occurrence of stressful life events (a well-known risk factor for depression). We tested these hypotheses in a study conducted in urban Brazil, and found that change in cultural consonance (assessed as a general construct) was associated with depressive symptoms at a 2-year follow-up. Furthermore, cultural consonance in the domains in which there was highest cultural consensus--the domains of family life and lifestyle--was more strongly associated with depressive symptoms at follow-up than cultural consonance in domains with lower cultural consensus. Finally, all of these effects were independent of stressful life events. These results lend further support to the importance of cultural consonance in relation to human health.

Absence of circadian salivary cortisol rhythm in women with anorexia nervosa.

STUDY OBJECTIVE: To compare the cortisol levels and 24 hour salivary cortisol rhythm in patients with anorexia nervosa (AN) and normal controls. DESIGN: Prospective transversal controlled study. SETTING: Tertiary-referral University Hospital. PARTICIPANTS: Twenty-five patients aged 15 to 35 years, 13 of them with regular ovulatory cycles, and 12 with diagnosis of AN. INTERVENTIONS: Salivary and blood collection for cortisol 24-hour rhythm determination. MAIN OUTCOME: Salivary cortisol was determined at 9 am, 5 pm, and 11 pm. Seric follicle-stimulating hormone, luteinizing hormone (LH), prolactin, estradiol (E2), progesterone, dehydroepiandrosterone-S (DHEA-S), and cortisol were sampled together with the 9 am salivary sample. RESULTS: LH, E2, and DHEA-S levels were reduced in patients with AN. A correlation between salivary and serum cortisol levels was observed in the 9 am sample only in controls (r = 0.67, P = 0.01; AN: r = 0.48, P = 0.12). Cortisol rhythm was present in all control subjects, whereas it was absent in one third of AN patients. The area under the curve for the AN group with preserved rhythm was significantly higher than for the control group (Me = 6811 ng/dl/24h vs 3708 ng/dl/24 h; P = 0.034). CONCLUSION: Patients with AN have higher salivary cortisol levels when compared to normal women and some of them do not present circadian rhythm.

[Evaluation of MTHFR C677T gene polymorphism and homocysteine level in coronary atherosclerotic disease]. / Avaliação da relação entre o polimorfismo C677T no gene para MTHFR e a concentração plasmática de homocisteína na doença arterial coronariana.

OBJECTIVE: The aim of this study is to determine the prevalence of C677T methylenetetrahydrofolate reductase (MTHFR) polymorphism and correlate it with plasma homocysteine levels in coronary artery disease (CAD). METHODS: Ninety-three patients with documented CAD from Hospital Universitário Oswaldo Cruz (Recife, PE, Brazil) and 108 healthy controls were evaluated. Homocysteine and folate levels were determined by HPLC and chemoluminescence, respectively, and lipid profile was considered. Genotyping was done by RFLP/PCR. RESULTS: The groups were homogeneous for the C677T polymorphisms. The homocysteine level in cases (11.7 micromol/L) was statistically different from that observed in controls (8.84 micromol/L, p< 0.05). It was also observed that 72% of the patients had homocysteine values above 12 micromol/L while the control group presented only 32% in this range. There was no relationship between homozygosity for the C677T polymorphism and the homocysteine level (p= 0.634). We noticed statistical differences between folate levels from patients and controls (6.22 and 7.69 ng/dL, p< 0.05, respectively). However, there was no correlation between homocysteine and folate concentrations in the entire group (r= -0.202). Comparing cases and controls, the odds ratio (OR) when homocysteine is high and folate is low was OR= 11.9; CI 95%= 4.16-34.42, p< 0.01. CONCLUSION: A lack of correlation between C677T mutation and homocysteine level suggests that environmental factors and others genetic factors seem to exert more influence on homocysteine level in this population.

The human cholesteryl ester transfer protein I405V polymorphism is associated with plasma cholesterol concentration and its reduction by dietary phytosterol esters.

We examined the relationships of I405V cholesteryl ester transfer protein (CETP), Taq1B CETP and apolipoprotein (apo)E polymorphisms with the pattern of response to dietary plant sterol ester (PSE) by plasma lipids and CETP concentrations as well as lecithin-cholesterol acyltransferase (LCAT) activity. Subjects with moderate primary hypercholesterolemia (20-60 y old; 50 women; 10 men) consumed margarine (20 g/d) without (placebo) or with PSE (2.8 g/d = 1.68 g/d phytosterols) for 4 wk each period, in a crossover, double-blind study. Plasma CETP concentration was measured by ELISA; endogenous LCAT activity was expressed as the percentage of esterification (30 min incubation) of the subjects' (14)C-unesterified cholesterol HDL. PSE reduced concentrations of plasma total cholesterol (TC) (10%) and LDL cholesterol (LDL-C) (12%). In relation to the I405V CETP polymorphism, the percentage reductions in TC with consumption of PSE for the II, IV and VV phenotypes were 7.2, 4.2 and not significant, respectively, whereas LDL-C significant reductions occurred only for II (9.5%). However, the CETP concentration diminished only in the II phenotype.

Comparative research in social epidemiology: measurement issues

The aim of comparative research in soical epidemiology is to determine how risk factors for disease may vary within and between sociocultural and ethnic groups and in relation to outcomes. This aim assumes that measurement equivalence within and between social groups can be established, an assumption usually left untested. A model is presented here for deriving cross-culturally valid measures that are also intraculturally sensitive. Measurements so derived can then be used to compare cross-cultural and intracultural effects in a single analytic model. This approach is illustrated by pooling data on social stressors, social supports, and blood pressure from three studies. (AU)