Recognition of depression in people of different cultures: a qualitative study

<p>Abstract</p> <p>Background</p> <p>Many minority group patients who attend primary health care are depressed. To identify a depressive state when GPs see patients from other cultures than their own can be difficult because of cultural and gender differences in expressions and problems of communication. The aim of this study was to explore and analyse how GPs think and deliberate when seeing and treating patients from foreign countries who display potential depressive features.</p> <p>Methods</p> <p>The data were collected in focus groups and through individual interviews with GPs in northern Sweden and analysed by qualitative content analysis.</p> <p>Results</p> <p>In the analysis three themes, based on various categories, emerged; "Realizing the background", "Struggling for clarity" and "Optimizing management". Patients' early life events of importance were often unknown which blurred the accuracy. Reactions to trauma, cultural frictions and conflicts between the new and old gender norms made the diagnostic process difficult. The patient-doctor encounter comprised misconceptions, and social roles in the meetings were sometimes confused. GPs based their judgement mainly on clinical intuition and the established classification of depressive disorders was discussed. Tools for management and adequate action were diffuse.</p> <p>Conclusion</p> <p>Dialogue about patients' illness narratives and social context are crucial. There is a need for tools for multicultural, general practice care in the depressive spectrum. It is also essential to be aware of GPs' own conceptions in order to avoid stereotypes and not to under- or overestimate the occurrence of depressive symptoms</p

Chronic canine ehrlichiosis (Ehrlichia canis): A retrospective study of 19 natural cases

Nineteen dogs from Greece with chronic ehrlichiosis were studied. The dogs exhibited bicytopenia or pancytopenia, bone marrow hypoplasia, seroreactivity to Ehrlichia canis ( E. canis) antigens, and had no history of drug or radiation exposure. Anorexia, depression, severe bleeding tendencies, hypoalbuminemia, and increased serum alanine aminotransferase activity were also hallmarks of the disease. All these animals eventually died, irrespective of the treatment applied. Some dogs were also serologically positive for Rickettsia conorii, Leishmania infantum ( L. infantum), and Bartonella vinsonii subspp. berkhoffii. Polymerase chain reaction testing of bone marrow samples revealed E. canis, Anaplasma phagocytophilia, Anaplasma platys, and L. infantum in some dogs. Concurrent infections did not appear to substantially influence the clinical course and final outcome of the chronic canine ehrlichiosis

Seroprevalence of Ehrlichia canis, Ehrlichia chaffeensis and Ehrlichia ewingii in dogs in North America

Background: This study evaluated the exposure of dogs to three different Ehrlichia spp. in the south and central regions of the United States where vector-borne disease prevalence has been previously difficult to ascertain, particularly beyond the metropolitan areas. Methods: Dog blood samples (n = 8,662) were submitted from 14 veterinary colleges, 6 private veterinary practices and 4 diagnostic laboratories across this region. Samples were tested for E. canis, E. chaffeensis and E. ewingii specific antibodies using peptide microtiter ELISAs. Results: Overall, E. canis, E. chaffeensis and E. ewingii seroprevalence was 0.8%, 2.8%, and 5.1%, respectively. The highest E. canis seroprevalence (2.3%) was found in a region encompassing Arkansas, Louisiana, Oklahoma, Tennessee and Texas. E. chaffeensis seroreactivity was 6.6% in the central region (Arkansas, Kansas, Missouri, and Oklahoma) and 4.6% in the southeast region (Georgia, Maryland, North Carolina, South Carolina, Tennessee and Virginia). Seroreactivity to E. ewingii was also highest in the central region (14.6%) followed by the southeast region (5.9%). The geospatial pattern derived from E. chaffeensis and E. ewingii seropositive samples was similar to previous reports based on E. chaffeensis seroreactivity in white-tailed deer and the distribution of human monocytic ehrlichiosis (HME) cases reported by the CDC. Conclusions: The results of this study provide the first large scale regional documentation of exposure to E. canis, E. chaffeensis and E. ewingii in pet dogs, highlighting regional differences in seroprevalence and providing the basis for heightened awareness of these emerging vector-borne pathogens by veterinarians and public health agencies

Conformity, Loyalty and the Jesuit Mission to England of 1580

In Elizabethan England, under the 1559 Act of Uniformity, church attendance was compulsory on Sundays and Holy Days for all those aged 14 or over. The law was enforced ‘upon payne of punishement by the Censures of the Churche, and also upon payne that every p[er]son so offending shall forfeite for every suche offence twelve pens’.2 The 1581 Act imposed a fine of £20 a month on Catholic recusants — a huge leap from the normal 12 pence.3 Obviously the authorities had become uneasy following the arrival in 1580 of the Jesuits Edmund Campion and Robert Persons, who challenged the Elizabethan regime’s legitimacy by urging Catholics not to attend the state Church.4 Reports for nonattendance may have been many, but the number of parishioners not receiving communion was even more significant. Church papistry was a major reason for non-reception. Communion had to be taken at least three times a year, usually at Whitsunday, Easter and Christmas. According to one John Earle as late as 1628, church papists always found a way to avoid receiving this sacrament, which they viewed as an aberration of the true communion: Once a moneth he presents himselfe at the Churche, to keepe off the Church-warden, and brings in his body to save his bayle. He kneels with the Congregation, but prayes by himselfe, and askes God forgivenesse for coming thither. If he be forced to stay out a Sermon, he puls his hat over his eyes, and frownes out the houre, and when hee comes home, thinkes to make amends by abusing the Preacher. His maine policy is to shift off the Communion, for which he is never unfurnish’t of a quarrel, and will be sure to be out of Charity at Easter; and indeed he lies not, for hee has a quarrel to the Sacrament.