Diabetes mellitus and comorbid depression in Zambia.

AIMS: To replicate, in Zambia, a recent global study by the WHO, which reported that the odds of depression were not increased in African people with diabetes, and to explore the sociodemographic and clinical factors associated with depression. METHODS: A total of 773 control subjects and 157 Zambian patients with diabetes completed the Major Depression Inventory and a list of demographic indicators. RESULTS: Compared with control subjects (mean ± sd Major Depression Inventory score 15.10 ± 9.19), depressive symptoms were significantly more common in patients with diabetes (mean ± sd Major Depression Inventory score 19.12 ± 8.95; P < 0.001). ancova showed that having diabetes [F(1,698) = 16.50, P < 0.001], being female [F(1,698) = 7.35, P < 0.01] and having low socio-economic status (F(1,698) = 13.35, P < 0.001) were positive predictors of depression. CONCLUSIONS: Contrary to the WHO study, we found that depression was a common comorbid health problem among Zambian people with diabetes. Clinicians should consider patients' health status, sex and socio-economic status as potential factors predicting depression.

Developmental monitoring using caregiver reports in a resource-limited setting: the case of Kilifi, Kenya.

AIM: The main aim of the current study was to evaluate the reliability, validity and acceptability of developmental monitoring using caregiver reports among mothers in a rural African setting. METHODS: A structured interview for parents of children aged 24 months and less was developed through both participant consultation and a review of literature. The reliability and validity of the schedule was evaluated through a 10-month monitoring programme of 95 children, aged 2-10 months. The acceptability of the process was evaluated by studying retention rates and by organizing focus group discussions with participating mothers. RESULTS: The structured interview 'Developmental Milestones Checklist' consisted of 66 items covering three broad domains of child functioning: motor, language and personal-social development. The interview yielded scores of developmental achievements that showed high internal consistency and excellent test-retest reliability. The results were sensitive to maturational changes and nutritional deficiencies. In addition, acceptable retention rates of approximately 80% were found. Participating mothers reported that they found the procedures both acceptable and beneficial. CONCLUSION: Developmental monitoring using caregiver report is a viable method to identify and monitor at-risk children in Sub-Saharan Africa.

Monitoring psychomotor development in a resource-limited setting: an evaluation of the Kilifi Developmental Inventory.

BACKGROUND: Modifications made to the Kilifi Developmental Checklist and the psychometric characteristics of the new measure (The Kilifi Developmental Inventory) which assess the psychomotor functioning of children aged 6-35 months are described. METHODS: Two groups of community children (319 rural and 104 urban dwellers) and nine children with neurodevelopmental disorders were recruited for a cross-sectional study. RESULTS: In both a rural and urban reference population, the inventory showed excellent internal consistency, interobserver agreement, test-retest reliability and sensitivity to maturational changes. Children with neurodevelopmental impairment and those who were underweight had significantly lower scores than the community sample, attesting to the sensitivity of the measure. Mothers found the assessment procedures acceptable and informative. CONCLUSIONS: The Kilifi Developmental Inventory is a culturally appropriate measure that can be used to monitor and describe the development of at-risk children in resource-limited settings in Kenya.

Personality in cultural context: methodological issues.

Methodological issues in cultural and cross-cultural personality research are described. A taxonomy of these studies is presented, based on whether a study is exploratory or tests hypotheses, and whether or not contextual information is measured. Core methodological issues are bias and equivalence: a taxonomy and a brief overview of statistical procedures to examine equivalence are presented, with a focus on procedures for assessing structural equivalence (i.e., similarity of meaning of an instrument across cultures). Examples are given of studies in which cultural and cross-cultural approaches, often seen as antithetical, have been fruitfully integrated. Finally, multilevel models are described in which personality characteristics are examined at individual and cultural level.

Improved iodine status is associated with improved mental performance of schoolchildren in Benin.

BACKGROUND: An adequate iodine supply in utero and shortly after birth is known to be crucial to an individual's physical and mental development. The question of whether iodine supplementation later in life can exert a favorable influence on the mental performance of iodine-deficient populations was addressed in various studies, but with contradictory results. OBJECTIVE: The aim of this study was to examine the effect of an improvement in iodine status on mental and psychomotor performance of schoolchildren (7-11 y) who were moderately to severely iodine deficient. DESIGN: The study, which was originally planned as a double-blind, randomized, placebo-controlled intervention, was carried out in an iodine-deficient population of schoolchildren (n = 196) in northern Benin. As the population began to have access to iodized salt during the 1-y intervention period, the study population was split post hoc-on the basis of urinary iodine concentrations-into a group with improved iodine status and a group with unchanged iodine status. Changes in mental and psychomotor performance over the intervention period were compared. RESULTS: Children with increased urinary iodine concentrations had a significantly greater increase in performance on the combination of mental tests than did the group with no change in urinary iodine concentrations. CONCLUSIONS: An improvement in iodine status, rather than iodine status itself, determined mental performance in this population, which was initially iodine deficient. These findings suggest a "catch-up" effect in terms of mental performance.

Signs of impaired cognitive function in adolescents with marginal cobalamin status.

BACKGROUND: Lack of cobalamin may lead to neurologic disorders, which have been reported in strict vegetarians. OBJECTIVE: The objective of this study was to investigate whether cognitive functioning is affected in adolescents (aged 10-16 y) with marginal cobalamin status as a result of being fed a macrobiotic diet up to an average age of 6 y. DESIGN: Data on dietary intake, psychological test performance, and biochemical variables of cobalamin status were collected from 48 adolescents who consumed macrobiotic (vegan type) diets up to the age of 6 y, subsequently followed by lactovegetarian or omnivorous diets, and from 24 subjects (aged 10-18 y) who were fed omnivorous diets from birth onward. Thirty-one subjects from the previously macrobiotic group were cobalamin deficient according to their plasma methylmalonic acid concentrations. Seventeen previously macrobiotic subjects and all control subjects had normal cobalamin status. RESULTS: The control subjects performed better on most psychological tests than did macrobiotic subjects with low or normal cobalamin status. A significant relation between test score and cobalamin deficiency (P: = 0.01) was observed for a test measuring fluid intelligence (correlation coefficient: -0.28; 95% CI: -0.48, -0.08). This effect became more pronounced (P: = 0.003) within the subgroup of macrobiotic subjects (correlation coefficient: -0.38; 95% CI: -0.62, - 0.14). CONCLUSION: Our data suggest that cobalamin deficiency, in the absence of hematologic signs, may lead to impaired cognitive performance in adolescents.

Dealing with extreme environmental degradation: stress and marginalization of Sahel dwellers.

BACKGROUND: Psychological aspects of environmental degradation are hardly investigated. In the present study these aspects were examined among Sahel dwellers, who live in environments with different states of degradation. The degradation was assessed in terms of vegetation cover, erosion, and loss of organic matter. METHOD: Subjects came from three cultural groups: Dogon (agriculturalists, n = 225), Mossi (agriculturalists, n = 914), and Fulani (pastoralists, n = 844). Questionnaires addressing marginalization, locus of control, and coping were administered. RESULTS: Environmental degradation was associated with higher levels of stress, marginalization, passive coping (avoidance), a more external locus of control, and lower levels of active coping (problem solving and support seeking). Compared to agriculturalists, pastoralists showed a stronger variation in all psychological variables across all regions, from the least to the most environmentally degraded. Women showed higher scores of stress, (external) locus of control, problem solving, and support seeking than men. The interaction of gender and region was significant for several variables. CONCLUSION: It was concluded that environmental degradation has various psychological correlates: people are likely to display an active approach to environmental degradation as long as the level of degradation is not beyond their control.

Assessment of cognitive deterioration in individual patients following cardiac surgery: correcting for measurement error and practice effects.

Assessment of cognitive change in individual patients may be confounded by unreliability of test scores and effects of repeated testing. An index correcting for both problems is proposed and compared with change indices that do not or do not adequately deal with measurement error and practice effects. These indices were used to examine cognitive deterioration in a sample of 63 patients undergoing cardiac surgery. It was demonstrated that for test measures with a low reliability, failure to correct for measurement error resulted in overestimation of deterioration rates. For test measures with a high reliability, but showing substantial practice effects, failure to correct for practice effects resulted in underestimation of deterioration rates. With the proposed index, cognitive deterioration shortly after cardiac surgery was most frequently observed for attention and psychomotor speed, less frequently for verbal fluency, and only occasionally for learning and memory.

Psychological consequences of environmental degradation.

Psychological aspects of environmental degradation in Burkina Faso are studied among two groups of Sahel dwellers, namely the Mossi (agriculturalists, n = 402) and the Fulani (pastoralists, n = 160). Compared to pastoralists, agriculturalists were more stressed and marginalized, the psychological consequences of degradation studied here. Men in both groups scored higher on marginalization and lower on stress than women did. Modem attitudes led to more stress and marginalization. Status in the community was unrelated to stress and marginalization. Locus of control and problem- focused coping were related to marginalization but not to stress. A MIMIC (M ultiple Indicators, MultIple Causes) model was fitted to the data postulating the relationship among four input variables (culture, environmental degradation, cattle and modernity), a latent variable (called carrying capacity) and two output variables (stress and marginalization ). For both men and women an adequate fit was found, with slightly different parameter values for the two sexes.

Psychosocial group intervention and the rate of decline of immunological parameters in asymptomatic HIV-infected homosexual men.

The aim of the study was to determine changes in the rate of decline of immunological parameters after psychosocial group intervention. Subjects were 26 asymptomatic HIV-infected homosexual men who participated in a cognitive-behavioral group therapy (CBT; n = 14), or an experiential group therapy program (ET; n = 12), both of 15 weeks duration. The outcome measures were changes in the decline of CD4 cell counts, and T cell proliferative responses to anti-CD3 monoclonal antibodies from preintervention to 24 months postintervention. No differences in the rate of decline of CD4 cells or T cell responses between the CBT and ET condition were found, and there were no significant changes in CD4 cell count from pre- to postintervention. However, those subjects who showed larger decreases in distress showed a smaller decline in CD4 cell counts. While the rate of decline in T cell responses was significantly less after both interventions, a similar positive change in T cell responses was found in a comparison group of 149 HIV-infected men with similar demographic, psychosocial and immunological characteristics who did not participate in one of the interventions. We conclude that the psychosocial intervention programs tested here did not cause changes in CD4 cell decline or T cell responses and that decreases in distress were related to increases in CD4 cell counts.

A simple test of the Law of Initial Values.

The conceptualization and testing of the Law of Initial Values remains a controversial issue. We critically review common procedures to test the Law, and a simple test of the Law is described and illustrated. The reduction of variance from the pretest to the posttest is crucial in this test.

[Dialysis encephalopathy and aluminum poisoning? Correlated clinical, pathologic-anatomic and spectrometric findings]. / Dialyseencephalopathie und Aluminiumtoxikation? Klinisch, pathologisch-anatomisch und spektrometrisch korrelierte Befunde.

A case of severe dialysis encephalopathy is reported, in which the autopsy finding of an extensive spongiform change in areas of the cortex directly corresponded to high aluminium-concentration in these areas, supporting the theory of an aetiological role for aluminium. A therapeutic approach combining low aluminium intake and removal of aluminium by a chelating agent (desferrioxamine) is promising, but more precise guidelines are needed.