Testing the potential therapeutic effects of an online creative arts-based intervention for people with anxiety.

BACKGROUND: Creative arts-based interventions are a relatively new addition to the toolkit of psychological treatments for mental afflictions. As such, the therapeutic efficacy of these therapies when conducted remotely via digital media has been under-researched. To address this gap, this study tested the effects of an online creative arts-based intervention to alleviate anxiety. METHOD: A repeated measures quasi-experimental design was employed on a sample of British adults (N = 41). Data were collected using pre- and post-intervention scores on the General Anxiety Disorder (GAD-7) and Warwick-Edinburgh Mental Wellbeing (WEMWBS) scales. RESULTS: Inferential analysis procedures consisting of multiple tests for within-subjects effects all showed significantly lower levels of anxiety and higher levels of mental wellbeing post-intervention. CONCLUSION: Whilst additional confirmatory and longitudinal research is needed, the results of this exploratory study tentatively indicate that creative arts-based "interventions" delivered through digital media may be effective in substantively reducing common symptoms of anxiety.

Surrogacy and Adoption: An Empirical Investigation of Public Moral Attitudes.

Surrogacy and adoption are both family-making measures subject to extensive domestic and international regulation. In this nationally representative survey study (N = 1552), we explore public attitudes to various forms of surrogacy and adoption in the United Kingdom, in response to an early proposal to allow "double donor" surrogacy as part of the ongoing legal reform project. We sought to both gauge public moral support for adoption and surrogacy generally, the effect that prospective parents' fertility had on this support, and the extent to which the public would find equivalencies between "double donor" surrogacy (DDS) and planned private adoption (PPA) to be morally significant. Our findings indicate that whilst there is broad baseline support for all forms of adoption and surrogacy, this support increases significantly when one or both prospective parents are infertile. These findings also suggest that the language in which a family-making arrangement is characterized has a greater influence on moral support for the arrangement than practical features such as the biological relationship (or absence thereof) between one/both parents and the child.

Selective method for identification and quantification of Bifidobacterium animalis subspecies lactis BB-12 (BB-12) from the gastrointestinal tract of healthy volunteers ingesting a combination probiotic of BB-12 and Lactobacillus rhamnosus GG.

AIM: To develop a novel validated method for the isolation of Bifidobacterium animalis ssp. lactis BB-12 (BB-12) from faecal specimens and apply it to studies of BB-12 and Lactobacillus rhamnosus GG (LGG) recovered from the healthy human gastrointestinal (GI) tract. METHODS AND RESULTS: A novel method for isolating and enumerating BB-12 was developed based on its morphologic features of growth on tetracycline-containing agar. The method identified BB-12 correctly from spiked stool close to 100% of the time as validated by PCR confirmation of identity, and resulted in 97-104% recovery of BB-12. The method was then applied in a study of the recovery of BB-12 and LGG from the GI tract of healthy humans consuming ProNutrients® Probiotic powder sachet containing BB-12 and LGG. Viable BB-12 and LGG were recovered from stool after 21 days of probiotic ingestion compared to baseline. In contrast, no organisms were recovered 21 days after baseline in the nonsupplemented control group. CONCLUSIONS: We demonstrated recovery of viable BB-12, using a validated novel method specific for the isolation of BB-12, and LGG from the GI tract of healthy humans who consumed the probiotic supplement. SIGNIFICANCE AND IMPACT OF THE STUDY: This method will enable more detailed and specific studies of BB-12 in probiotic supplements, including when in combination with LGG.

Estimación del peso fetal mediante ultrasonido / Estimate of fetal weight by ultrasonography

El presente trabajo consiste en la comparación de dos métodos para la estimación del peso fetal mediante el diagnóstico por ultrasonido, uno de ellos utilizado en algunas maternidades, se realiza manualmente utilizando tres tablas de peso fetal, luego promedian los valores de peso fetal de éstas, este promedio se compara con los percentiles de Uscher y el CLAP.Una de las tablas utiliza el diámetro biparietal y la circunferencia abdominal. como parámetros, la otra, la longitud del fémur y circunferencia abdominal. La última solo utiliza la circunferencia abdominal. El segundo procedimiento se basa en el método de Hadlock, incorporado en los equipos de ultrasonido. Este método además de los mencionados parámetros, utiliza la circunferencia cefálica. Los resultados demuestran que el peso fetal en uno y otro método son similares, pero como el método de Hadlock utiliza la computadora del equipo elimina cualquier error humano en la determinación del peso, por lo que se considera más confiable(AU)

Risk factors associated with house infestation by the Chagas disease vector Triatoma pallidipennis in Cuernavaca metropolitan area, Mexico.

Chagas disease caused by infection with Trypanosoma cruzi Chagas (Kinetoplastida: Trypanosomatidae) is widespread in Mexico, transmitted by various triatomine bugs (Hemiptera: Reduviidae). The only domestic vector in Cuernavaca (population 650 000) is Triatoma pallidipennis (Ståhl) with T. cruzi seroprevalence ranging from 1% to 9% in the resident human population. We surveyed possible risk factors for T. pallidipennis infestation at Cuernavaca (altitude 1200-2200 m) on south-western slopes of the Sierra Madre Occidental. This metropolitan area (with five administrative counties) has rapid urbanization, forested environs and proliferation of 'weekend housing' for visitors from Mexico City, 60 km to the north. To assess factors associated with T. pallidipennis infestation, we first stratified Cuernavaca by altitude and by socio-economic status of population catchment units (PCUs). Within each PCU, one to three blocks were chosen for cluster sampling (three houses/block) and information about Chagas disease was distributed. After obtaining signed consent from householders, representative houses were routinely and opportunistically inspected for T. pallidipennis and surveyed for demographic, economic, physical and other potential risk factors. Of the 1129 houses assessed, T. pallidipennis was found in 4.1% (range 3.0-6.8% per county) and the T. cruzi infection rate was approximately 50% in bugs. Rates of house infestation in poor PCUs were double those in higher socio-economic strata (odds ratio 2.12, confidence interval 1.03-4.3), with >4-fold greater crowding index of T. pallidipennis. The bug density index was inversely correlated with PCU altitude and socio-economic category (altitude of homes being associated with prosperity), while the bug colonization index (presence of nymphs indicating breeding) did not vary significantly across the PCU categories, but did vary according to altitude. Multivariate regression analysis showed that the most significant risk factors associated with T. pallidipennis infestation were lower altitude (linked with lower socio-economic status), garden area >80 m(2), dogs at liberty to enter the house, occurrence of squirrels and opossums around the house, presence of pigs in the surrounding area and having at least one of the adjacent lots empty (unconstructed). Householders who had received information about Chagas disease comprised 33% from infested houses (14/42) but only 15% from non-infested houses (148/984). Hence, the awareness of Chagas disease was significantly associated with having a bug-free house (P < 0.01). When shown specimens of T. pallidipennis, the proportions of householders who recognized them were 78% from infested houses but only 29% of those with uninfested houses. Given the low infestation rates and the high capacity of the population to act appropriately once they have received information regarding this disease and its vector, relevant health education is expected to have a significant impact on triatomine control in this metropolitan area.

CpG-containing ODN has a limited role in the protection against Toxoplasma gondii.

Bacterial DNA containing immunostimulatory motifs (CpG) induces the development of a T(H1) immune response. Since protection against Toxoplasma gondii is correlated with this type of response, the aim of this work was to determine if a synthetic oligodeoxynucleotide (ODN) containing CpG sequences could be useful as adjuvant for the induction of a long-lasting protective immune response against T. gondii. BALB/c mice immunized with a total soluble antigen of T. gondii (TSA2) mixed with ODN-containing CpG sequences developed a typical TH1 response, as determined by antibody isotypes and interferon-gamma (IFN-gamma) and interleukin-4 (IL-4) production by spleen cells. However, they did not resist a challenge with the virulent RH strain of the parasite. Absence of protection paralleled with lower levels of IFN-gamma, when compared with mice vaccinated with the live tachyzoites of the attenuated ts.4 strain of the parasite, which resisted this challenge. Intraperitoneal injection of ODN alone to mice induced a high degree of resistance to a lethal challenge inoculated by the same route. Nevertheless, this nonspecific protection was transient. Thus, the use of ODN containing CpG motifs as adjuvant is of limited value for the induction of a protective immune response against T. gondii.

Cost-effectiveness analysis when the WTA is greater than the WTP.

The incremental cost effectiveness ratio has long been the standard parameter of interest in the assessment of the cost-effectiveness of a new treatment. However, due to concerns with interpretability and statistical inference, authors have suggested using the willingness-to-pay for a unit of health benefit to define the incremental net benefit as an alternative. The incremental net benefit has a more consistent interpretation and is amenable to routine statistical procedures. These procedures rely on the fact that the willingness-to-accept compensation for a loss of a unit of health benefit (at some cost saving) is the same as the willingness-to-pay for it. Theoretical and empirical evidence suggest, however, that in health care the willingness-to-accept is about twice as much as the willingness-to-pay. We use Bayesian methods to provide a statistical procedure for the cost-effectiveness comparison of two arms of a randomized clinical trial that allows the willingness-to-pay and the willingness-to-accept to have different values. An example is provided.

Mycobacterial di-O-acyl-trehalose inhibits mitogen- and antigen-induced proliferation of murine T cells in vitro.

2,3-Di-O-acyl-trehalose (DAT) is a glycolipid located on the outer layer of the Mycobacterium tuberculosis cell envelope. Due to its noncovalent linkage to the mycobacterial peptidoglycan, DAT could easily interact with host cells located in the focus of infection. The aim of the present work was to study the effects of DAT on the proliferation of murine spleen cells. DAT was purified from reference strains of M. tuberculosis, or M. fortuitum as a surrogate source of the compound, by various chromatography and solvent extraction procedures and then chemically identified. Incubation of mouse spleen cells with DAT inhibited in a dose-dependent manner concanavalin A-stimulated proliferation of the cells. Experiments, including the propidium iodide exclusion test, showed that these effects were not due to death of the cells. Tracking of cell division by labeling with 5,6-carboxyfluorescein diacetate succinimidyl ester revealed that DAT reduces the rounds of cell division. Immunofluorescence with an anti-CD3 monoclonal antibody indicated that T lymphocytes were the population affected in our model. Our experiments also suggest that the extent of the suppressive activity is strongly dependent on the structural composition of the acyl moieties in DATs. Finally, the inhibitory effect was also observed on antigen-induced proliferation of mouse spleen cells specific for Toxoplasma gondii. All of these data suggest that DAT could have a role in the T-cell hyporesponsiveness observed in chronic tuberculosis.

Genetic immunization with plasmid DNA coding for the ROP2 protein of Toxoplasma gondii.

The ROP2 protein of Toxoplasma gondii has previously been proposed as a vaccine candidate against toxoplasmosis. In this work we characterize the immune response induced by injection of plasmid DNA coding for this protein in three strains of mice (BALB/c, C57BL/6, and CBA/J) displaying different levels of susceptibility to toxoplasmosis and compare it with that obtained by vaccination with the live attenuated ts-4 strain of T. gondii. The ROP2 gene was cloned in the eukaryotic expression vector pcDNA3 and the resulting plasmid, named pcDNA3/ROP2, was used to immunize mice. After three immunizations with the plasmid, mice developed antibodies that could be detected by ELISA using a recombinant truncated form of ROP2; and these antibodies also recognized the natural protein by Western blot. Plasmid immunization generated antibodies against the ROP2 of both of the IgG1 and IgG2a isotypes in CBA/J and BALB/c mice and both of the IgG1 and IgG2c isotypes in C57BL/6 mice. However, animals vaccinated with the ts-4 strain generated only IgG2a (in CBA/J and BALB/c mice) or IgG2c (in C57BL/6 mice) against ROP2. Kinetic studies of the generation of isotypes indicated that both isotypes were generated at the same time. Mice immunized with the plasmid DNA did not resist a challenge with the virulent RH strain of T. gondii, while mice vaccinated with the ts-4 strain resisted the same challenge. However, in pcDNA3/ROP2-immunized BALB/c mice, death was significantly delayed with respect to the pcDNA3-immunized control group. These results suggest that plasmid immunization using the ROP2 gene generates a mixed T(H1)/T(H2) response against ROP2, which is different from that obtained by vaccination with live tachyzoites of the ts-4 strain (T(H1) response) and is not protective against the highly virulent RH strain of the parasite.

[Ambulatory medical care in Mexico: the cost for users]. / Atención médica ambulatoria en México: el costo para los usuarios.

OBJECTIVE: To analyze the results of the National Health Survey (ENSA-II) as to the costs generated by the search and obtainment of ambulatory medical attention in various institutions of the private and public health sector. MATERIAL AND METHODS: Information was raised from the health care cost indicators reported by the study population of the ENSA-II. The dependent variable was the direct expense for the consumer and the independent variables, the condition of being insured and the income. Variation significance levels were identified using the test by Duncan. RESULTS: The costs at national level in US dollar were: transport $2.20, medical visit $7.90, drugs $9.60, diagnostic studies $13.6; average total cost for ambulatory attention was $22.70. Empirical finding suggest a new direct and indirect cost-for-consumer analysis for the health care users. These costs represent an important burden on the family income, which worsens when users are not insured. CONCLUSIONS: Incorporation of the economic perspective to the analysis of public health issues should not be limited to the analysis of the health provider's expenses, particularly if the problems of equity and accessibility must be solved, which are at present characteristic of health care services in Mexico.

[Motives for non-vaccination: critical review of the international literature, 1950-1990]. / Motivos de no vacunación: un análisis crítico de la literatura internacional, 1950-1990.

Many countries have acknowledged that vaccination programs call for a mastery of technical and organizational elements if they are to become accessible to the population. One of these elements has been greatly underestimated: the participation of populations and their motivations. Experiences in several countries are here analysed, on the basis of a bibliographic revision of the period 1950-1990. Results show that existing studies vary in their conceptual and methodological focuses, according to the region in which research was carried out and to the kind of researcher involved. This fact is to be explained by the posture, common among researchers, of believing that they know in depth the subjective determinants of the behavior of the societies to which they belong. Based on this, they only use methodologies that allow them to arrive at a superficial understanding regarding the response of populations to the offer of vaccines.

Adrenal changes in murine pulmonary tuberculosis; a clue to pathogenesis?

When mice were infected with virulent Mycobacterium tuberculosis H37Rv by the intra-tracheal route, there was an early phase of adrenal hyperplasia, histologically resembling the adrenocorticotropic (ACTH)-driven changes seen in Cushing's disease. This was followed at 3 weeks by progressive atrophy until the weight of the adrenals was approximately 50% of that seen in control uninfected mice, in spite of the fact that the adrenals were not infected. All layers of the adrenal cortex were affected, but the medulla was normal. Electron microscope studies revealed apoptosis. The switch from adrenal hyperplasia to adrenal atrophy corresponded to onset of an IgG1 response recognising a wide range of mycobacterial components in Western blots. Delayed type hypersensitivity (DTH) responses were seen throughout, but differed in their sensitivity to TNF alpha. Thus if TNF alpha was injected at 24 h into DTH sites elicited during the phase of adrenal hyperplasia, there was no increment in swelling at 48 h. However similar injections of TNF alpha resulted in a doubling of the swelling in DTH sites elicited during the phase of adrenal atrophy. This may be relevant to the pathogenesis of cytokine-mediated tissue damage in the human disease. If 2 months before mice received the intratracheal infection, they were pre-immunised with 1 x 1097) autoclaved Mycobacterium vaccae, a stimulus previously shown to induce a Th1 pattern of response, the early increase in adrenal weight was attenuated and delayed, and the subsequent atrophy did not occur. In sharp contrast, pre-immunisation with 1 x 10(9) autoclaved M. vaccae, known to prime a mixed pattern of cytokine release (IFN gamma and IL-4), resulted in adrenal atrophy that began within 4 days of infection, and was complete by day 14. These results suggested that the pattern of cytokine release provoked by the infection, modulated the adrenal changes, perhaps in synergy with products derived from the organisms themselves. Since we have already shown that profound adrenal changes also occur in human tuberculosis, we now propose that a change somewhere in the cytokine-hypothalamo-pituitary-adrenal axis may underlie the T cell dysfunction and immunologically-mediated tissue damage in this disease.

[Social and political actors in the formulation of health reform in Spain]. / Los actores políticos y sociales en la formulación de la reforma Sanitaria, en España.

An analysis of the participation of social and political actors in the process of formulating health policy allows one to understand the specific characteristics of the organization and operation of a health system. This study analyzes the drafting process for the General Health Act (LGS) in Spain with the purpose of establishing the relationship between social, political, and economic actors in both the formulation of the Act itself and the organization of the Spanish Health System. A case study was carried out from 1982 through 1986. Documentary parliamentary data, the medical press, national magazines and journals, and press reports by political, social, and public health actors were analyzed. The first version of the General Health Act presented by the Spanish Socialist Workers' Party (PSOE) proposed a health system with funding and public administration aimed at achieving universal health coverage, integrated care, community participation, and health education. This proposal was submitted to a complex negotiating process with business groups, unions, and health professionals. The General Health Act as finally approved excludes the principles of equity and incorporates private interests in health: "free choice of doctor and hospital", public funding and private administration of the health system, and the establishment of Social Security as the core of the entire health system.

[Equity and health: research needs for the development of a social policy]. / Equidad y salud: necesidades de investigación para la formulación de una política social.

This article presents a general view of the evolution of the conceptual approach to equity in health and its current meaning. The analysis of equity from the standpoint of distribution-accesibility, use and outcome of health services is proposed. Every point of view is addressed to an operational and policy-making position. This paper concludes with a proposal of perspectives for research development in this field.

[Spontaneous regression of an aneurysmal bone cyst of the vertebrae after partial excision. Bibliographic review]. / Regresión espontánea de un quiste óseo aneurismático de localización vertebral tras su extirpación parcial. Revisión bibliográfica.

A case of a lumbar aneurysmal bone cyst is presented in a 5 year-9 month old girl. The characteristics of this tumor are described, specifically in the spinal area, with particular reference to the diagnostic and therapeutic difficulties referred, taking into account the existing bibliography. The partial resection has been curative, as it has been frequently written about in publication worldwide and which suggest that surgery does not have to be aggressive in unapproachable cases and that radiotherapy is unnecessary.

Prevalencia de portadores de Salmonella y Shigella en manipuladores de alimentos / Prevalence of Salmonella and Shigella carriers among food handlers

Se realizo un estudio observacional, descriptivo y transversal del 27 de octubre al 20 de noviembre de 1980 cuyo objetivo fue determinar la prevalencia de portadores de Salmonella y Shigella en manipuladores de alimentos de establecimientos comerciales en Puerto Vallarta, Jalisco. Se estudiaron 300 coprocultivos de 150 manipuladores, dos por cada uno de ellos, encontrandose una prevalencia de portadores de Salmonella y Shigella de 12%, con 1,3% de portadores sintomaticos. Hubo una prevalencia de portadores de Salmonella sp.de 9.3%, de Salmonella typhi 1.4% y 1.3% de portadores de Shigella flexneri

Evaluación de un hidrolizado de gelatina como aglutinante para la fabricación de tabletas / Evaluation of a gelatin hydrolysate as agglutinant in tablet elaboration

Se estudian las propiedades de un hidrolizado de gelatina como agente aglutinante para la fabricación de tabletas mediante evaluación comparativa con la gelatina de dos variantes con distinto peso molecular. Se usaron como substrato dos fórmulas de ácido ascórbico, y se discriminaron mediante análisis de varianza los efectos significativos del aglutinante sobre diferentes parámetros de los granulados y tabletas. Se realizaron, además, pruebas adicionales utilizando como material de base, carbón vegetal activado y paracetamol. Se propone la inclusión del producto evaluado en la categoría de aglutinante fuerte y se destaca su amplia versatilidad(AU)