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Toxoplasma gondii , a prevalent neurotropic parasite, induces immunological reactions that have the potential to affect brain and behavior. One possible connection between molecular mediators of inflammation (cytokines) and brain function and behavior is the activation of the enzyme indole-amine 2,3-dioxygenase, a mechanism implicated in containing T. gondii in the immunocompetent host, resulting in relative tryptophan depletion and kynurenine production. This could potentially lead to mood and behavioral dysregulation in latent toxoplasmosis.

This study employed a mixed-method design to test sex-specific parent-child pain associations. Subjects were 179 chronic pain patients aged 11–19 years (mean=14.34; 72% female) presenting for treatment at a multidisciplinary, tertiary clinic. Mothers and children completed questionnaires before their clinic visit, including measures of children's pain, functioning and psychological characteristics. Mothers also reported on their own pain and psychological functioning. Interviews were conducted with a sub-sample of 34 mothers and children before the clinic visit and analyzed using a grounded theory approach. The quantitative data suggest stronger mother-daughter than mother-son pain relationships. The qualitative data suggest that girls' pain and pain-related disability is related to an overly enmeshed mother-daughter relationship and the presence of maternal models of pain, whereas boys' pain and disability is linked to male pain models and criticism and to maternal worry and solicitousness. Boys and girls appear to have developmentally incongruous levels of autonomy and conformity to maternal expectations. The mixed-method data suggest distinct trajectories through which mother and father involvement might be linked to chronic pain in adolescent boys and girls.

Background: This study investigated the patterns of health service utilization among patients with major depressive disorder (MDD) and significant somatic symptoms, who visited psychiatrists in a tertiary care setting. Methods: A total of 211 patients (51 males and 160 females) were recruited from a convenience sampling and assessed for severity of depressive and somatic symptoms. A structured questionnaire was employed to assess their pattern of healthcare service utilization, specifically, type of treatment first sought, out-of-pocket medical expenses, and time from onset of depressive symptoms to first treatment. Results: MDD patients with significant somatic symptoms tended to visit a non-psychiatrist physician first. Those with milder somatic symptoms who first visited non-physician practitioners spent a significantly greater amount on out-of-pocket medical expenses than did those who first visited physicians to get treatment. The patients with chief complaints of psychological and emotional symptoms were more likely to visit a psychiatrist first; however, a longer time interval lapsed before these patients received treatment. Conclusions: Patients with MDD experiencing significant symptoms are unlikely to access appropriate services in a timely manner. The results have implications for improving health care delivery for this population.

Persons with Down syndrome (DS) are comparatively physically inactive, which could accelerate the onset of disease, resulting in symptoms associated with aging that are detrimental to health. The aim was to evaluate movement abilities across the life span in persons with DS. Eleven persons with DS (>50 years, mean age 58 years), and 10 younger persons with DS (<49 years, mean age 28 years) who resided in a residential living center were included in the study. Age- and gender-matched people without DS (n=22) served as control group (CG). Five sensory-motor tasks that involved the integration of hand movements with visual information were used, as well as the posture scale analyzer system to examine postural stability. Results showed that the older persons with DS had more medical problems than the young persons with and without DS. The hand coordination and postural stability of the older adults with DS were more impaired in comparison with the young group and both CGs. It is postulated that their poor motor function and slower responses might be explained by a less active lifestyle, that could accelerate the onset of disease, resulting in symptoms associated with aging that are detrimental to health. Our observations could have significant implications for understanding the mechanisms underlying movement dysfunction in older adults with DS and might offer new approaches for possible prevention.

The WHO Health Promoting School (HPS) approach embraces a comprehensive, integrated construct of a health promotion strategy aimed at the specific participation of the local school, health services and other stakeholders. The objective of this study was to initiate the development of a community-specific health promotion plan for the primary school in Llano Largo to reduce hygiene- and sanitation-related health problems among children. Participatory Rural Appraisal (PRA) techniques and Argumentative Policy Analysis (APA) were applied to assess the underlying causes of health-related problems and to initiate the process of social learning among stakeholders, including parents, teachers, the village committee and representatives from the local hospital, local NGO, local government, and the village church. Stakeholders defined five core problems: 1) serious lack of hygiene; 2) no doctor and a lack of medicines; 3) hunger and malnutrition; 4) absence in school as a result of child labor; and 5) no discipline in school. Lack of communication, organization and education seem to be the underlying causes of these problems. In line with the HPS concept, a community-specific health promotion plan was constructed. A “Social Communication Work Group” was elected to execute the plan. In conclusion, PRA and APA techniques were successful to implement a HPS plan in Llano Largo. Follow-up studies should determine the long-term efficacy of the plan.

Background: Gonadal steroids interact with immune function and mood regulation: their levels during pregnancy, and their subsequent drop during the postpartum period, have been hypothesized to contribute to prepartum depressive symptoms. The objective was to estimate if a previously reported interaction between C-reactive protein (CRP) and peripartum depressive symptoms is at least partially mediated or modified by levels of gonadal steroids. The study group comprised 29 women at high-risk for developing postpartum depression. Methods: We conducted a preliminary longitudinal study with 29 women who were at high-risk of developing depressive symptoms during pregnancy and after delivery. Typical and atypical depression scores were measured at 35–38 weeks' gestation, 1–5 days postpartum, and 5–6 weeks postpartum. Estradiol, progesterone, testosterone, CRP, and interleukin-6 were measured at each time point. Results: Prepartum CRP and atypical depression scores remained significantly correlated after adjusting for gonadal steroid levels. Conclusions: In future larger studies that address the role of potential inflammatory markers in prepartum depression, adjustment for gonadal steroids might not be necessary. However, future studies investigating interactions between prolactin, HPA axis and gonadal steroids and molecular and cellular mediators of inflammation, and their downstream effects could lead to new understanding and therapeutic targeting of peripartum depression.

Background: Doppler echocardiography is a valuable tool for the non-invasive evaluation of diastolic function. This study aimed to correlate the pulmonary capillary wedge pressure (PCWP) estimated by Doppler echocardiography. Methods: Fifty patients with coronary artery disease (unstable angina, acute and previous myocardial infarction) subjected to diagnostic cardiac catheterization for evaluations were studied during the period of January 2002 to December 2002 in the Department of Cardiology at the National Institute of Cardiovascular Diseases, Dhaka, Bangladesh. Results: For the 2D and M mode echocardiographic indices, the ejection fraction was significantly lower and maximal left atrial volume was significantly higher in patients having PCWP ≥18 mm Hg (p<0.05). For Doppler-derived mitral flow, the deceleration rate was significantly higher (p<0.05) in patients having PCWP ≥18 mm Hg. Statistically significant negative correlation of deceleration time (r=–0.483; p=0.001) and ejection fraction (r=–0.334; p=0.01) and statistically significant positive correlation of peak E wave (r=0.345; p=0.01) and deceleration rate (r=0.651; p=0.001) was found with catheter-derived PCWP. Conclusions: Doppler echocardiography is a simple, repeatable, readily available, non-invasive tool which could reduce the need for right heart catheterization and might provide us with a bedside method of estimating and monitoring PCWP.

In Israel, the Office of the Medical Director of the Ministry of Social Affairs is responsible for the medical service in residential care centers for persons with intellectual disability (ID). A standard annual questionnaire was developed during 1997–1998, and the first national survey study conducted in 1998. This present paper presents the findings of the 11th national survey in 2008, for which the following information was gathered via questionnaires: age, gender, and level of ID of persons served at the residential care center in question, status of the population served, functional profile, nursing, medical, and allied professional staff, number of annual examinations, preventive medicine aspects, medications, number of annual cases of infectious disease, annual unintentional injuries, number of deaths, number of hospitalizations, internal residential center hospitalization, ambulatory out-patient use, use of outside laboratory examinations, and dental care. In 2008, 6988 persons were served in nine government, 41 private, and 13 public centers. The average number of persons served per center was 110.92 (range 16–332). The survey in 2008 showed that 78% of the population with ID in residential care in Israel was between the ages of 20 and 60 years old, 45% with severe or profound ID, 41% with moderate and 14% with mild ID. Twenty-four percent were nursing patients, 19% were confined to a wheelchair, 33% had epilepsy, 87% were found to be receiving medication daily for chronic illness, and 55% received psychotropic medication for psychiatric illness.

This paper addresses the relation between poverty and the presence of a child with a disability in the family, using longitudinal data from a secondary source. Two main issues are considered. First, to assess the degree to which explanatory variables influence poverty, an adequate statistical model must handle the possibility that substantial variation between respondents will be owing to omitted variables, multicollinearity and past behaviour. Second, research often compares “no poverty” with “presence of poverty”. We acknowledge that there could be differences between those in moderate poverty and those in severe poverty which might provide additional insights into the relation between “child disability in the family” and “poverty”. A multinomial random effects model is fitted to the data. The results suggest that the distinction between moderate and severe poverty appears to improve the results. Further improvement could be achieved by a clear definition of poverty and disability and of observed variables included in the analysis.

The presentation of malignant spinal cord compression (SCC) can be non-specific, however, benign processes are less frequently suspected in patients with known bony meta-stases presenting with symptoms of SCC. The present report describes the case of a 78-year-old woman with known multi-level vertebral column metastases from non-small cell lung cancer (NSCLC) who presented with symptoms and signs consistent with a malignant cervical SCC. Magnetic resonance imaging surprisingly revealed that the only area of spinal cord compromise was a discrete segment of myelomalacia at the C5/C6 levels adjacent to some chronic posterior longitudinal ligament hypertrophy that had not been appreciated on computed tomography or fluorodeoxyglucose positron-emission tomography-computed tomography. The patient later disclosed a remote history of neck injury sustained during a motor vehicle accident that explained the new finding. This report highlights the importance of thorough work-up for patients with suspected malignant SCC and the need to consider both benign and malignant etiologic processes in its differential diagnosis. This is the first reported case of benign myelomalacia mimicking malignant SCC in a patient with metastatic NSCLC.

Syndromes of delusional misidentification and delusional reduplication are among the many neuropsychiatric conditions that affect both brain and behavior and pose challenges to mental health professionals. Fregoli syndrome is the delusional belief that one or more familiar persons, usually persecutors following the patient, repeatedly transform their appearance. There is a growing body of evidence that delusional misidentification syndromes (DMS), including Fregoli syndrome, have identifiable brain lesions largely related to the right hemisphere. In this article we describe a case report of Fregoli syndrome and discuss the relevant literature. Clinicians encountering DMS can frequently find mismatch with the current Diagnostic and Statistical Manual of Mental Disorders-4th edition-text revision (DSM-IV-TR) categories. It is not clear whether or not these syndromes should be regarded as separate disorders.