Utilization of Behavioral Health Services among Medicaid-Eligible Women with Pre-Existing Psychiatric Disorders during the Perinatal Period

Objective: Using Behavioral Model of Health Services Use (Andersen, 1995) as a theoretical framework, this study (a) examined the patterns behavioral health service utilization among Medicaid-eligible women with pre-existing psychiatric disorders and established behavioral health treatment, and (b) investigated the individual-level factors associated with behavioral health services pre-pregnancy, during pregnancy, and the postpartum period. Methods: Administrative data from Community Behavioral Health were used in a retrospective cohort study design. The study included 813 women who (a) delivered babies (live births) between January 1, 2008 and December 31, 2008, (b) were residents of Philadelphia County, (c) were Medicaid-eligible during some or all of the study period, between January 1, 2006 to December 31, 2009, (d) had a primary DSM-IV-TR diagnosis of attention-deficit/disruptive behavior disorder, substance-related disorder, schizophrenia/psychotic disorder, mood disorder, anxiety disorder, impulse control disorder, or adjustment disorder, and (e) had an established behavioral health treatment history prior to pregnancy. Generalized estimating equations (GEE) were used to examine associations between predisposing, enabling, and need factors and four types of behavioral health services: (a) outpatient use (use vs. non-use; (b) number of outpatient visits; (c) inpatient use; and (d) number of inpatient days. Results: During pregnancy, rates of outpatient use decreased to 46%, but increased to 71% during the postpartum period. Similarly, rates of inpatient us decreased during pregnancy to 10%, but increased to 18% postpartum. Approximately 24% of the women made 35 or more outpatient visits, and 17% had 10 or more inpatient days. Predisposing (White and Hispanic race/ethnicity and older age), enabling (SSI without Medicare and days of Medicaid enrollment), and evaluated need (a mental health diagnosis) factors were associated with outpatient use. Predisposing (White race) and enabling (SSI without Medicare and days of Medicaid enrollment) factors were associated with the number of outpatient visits. Predisposing (White race) and enabling (days of Medicaid enrollment) factors were associated with inpatient use. The enabling factor, days of Medicaid enrollment, was associated with the number of inpatient days. Conclusion: Health insurance coverage via Medicaid was positively associated with behavioral health service use and intensity of use, but was not robust enough to decrease racial and ethnic disparities in behavioral health service use, suggesting an unmet need for behavioral health services among racial and ethnic minority perinatal women. Policy implications of these findings are discussed.Dr.P.H., Community Health and Prevention -- Drexel University, 201

Epidemiología de la Urgencia Psiquiátrica en el Instituto Psiquiátrico "Dr. José Horwitz": Un nuevo estudio comparativo

Indexación: ScieloUna urgencia psiquiátrica es cualquier alteración del afecto, conducta o pensamiento que puede producir daños a terceros o al consultante. La consulta de urgencia ido en aumento en los últimos años. Objetivos: Determinar laprevalencia de las distintas patologías, describir su distribución según sexo, edad, sector de residencia, estado civil, ocupación, previsión y derivación en las consultas de urgencia psiquiátrica en el Hospital Psiquiátrico "Dr. JoséHorwitz" de Santiago y comparar estos resultados con publicaciones previas de estudios en el mismo centro. Material y Método: Muestra representativa de 1999 casos, escogidos aleatoriamente de las consultas realizadas entre el Io de julio de 2005 y el 30 de junio de 2006. Se agruparon los diagnósticos de acuerdo a la nomenclatura CIÉ-10. Resultados: 48,7% de las consultas fueron realizadas por pacientes de sexo masculino. La media de edad fue 39 años. 76,7% de las consultas fueron realizadas en horario diurno. El 48,3% de los pacientes no tiene ocupación. 48% eran solteros. Abuso de sustancias y alcohol, trastornos esquizoides, afectivos y neuróticos congregan el 73,9% de las consultas. La más prevalente fue la de trastornos asociados al abuso de sustancias y alcohol con un 19,7% del total. Conductas autoagresivas (74%) y trastornos afectivos (74%) se asoció más a mujeres, en cambio el abuso de sustancias y alcohol más con hombres (76%). Discusión: Las consultas por trastornos esquizoides han disminuido a lo largo de los años. En cambio las consultas por el abuso de sustancias y alcohol y los trastornos afectivos han aumentado. Se hacen sugerencias para enfrentar el nuevo perfil epidemiológico.A psychiatric emergency is any alteration of affection, thought or behavior that may cause harm to others or to the same consultant. These consultations have increased over the last years. Objectives: Determine the prevalence of the various pathologies, describing their distribution according to sex, age, area of residence, marital status, occupation, health insurance, and referral in psychiatric emergency consultations at "Dr. José Horwitz" Hospital of Santiago, and to compare these results with previously published studies in the same center. Material and Method: We used a representative sample of 1999 cases, chosen randomly from consultations held between July 1,2005 and June 30,2006. Diagnoses were grouped according to the nomenclature of the ICD-10. Results: 48.7% of the consultations were carried out by male patients and. Average age of consultation was 39. 76.7% of consultations were carried out in daytime. The 48.3% of people who consulted didn't have any occupation. 48% were singles. Abuse of substances and alcohol, schizoid, afective and neurotic disorders congregate 73.9% of total consultations. The most prevalent were the disorders associated with abuse of substances and alcohols with a 19.7% overall. Autoagressive behaviors (74%) and affective disorders (74%) were associated with females, while abuse of substances and alcohol was associated with males (76%). Discussion: Schizoid disorders have proportionally declined in importance over the years. In contrast, abuse of substances and alcohol, and affective disorders have increased their frecuency. Suggestions are made to FACE the new epidemiological profile.http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0717-92272010000400002&nrm=is

Acute scrotum as a complication of Thiersch operation for rectal prolapse in a child

BACKGROUND: We report a case of acute scrotal condition that presented in a four year old male child one year after being treated for an idiopathic rectal prolapse utilizing Thiersch wire. CASE PRESENTATION: The acute scrotum had resulted from spreading perianal infection due to erosion of the circlage wire. The condition was treated with antibiotics and removal of the wire. The child made an uneventful recovery. CONCLUSION: This case highlights that patients with Thiersch wire should be followed until the wire is removed. Awareness of anal lesions as a cause of acute scrotal conditions, and history and physical examination are emphasized

Delineamento macro-agroecológico do Brasil.

O trabalho objetiva dar uma visão global da distribuição espacial das zonas macro-agroecológicas identificadas e sua vocação agroecológica. As fontes de informações foram os trabalhos da EMBRAPA-SNLCS, mapa de solos do Brasil escala 1:5.000.000, levantamentos de solos a nível estadual e regional e experiência dos pesquisadores envolvidos. Outros dados foram obtidos por consulta bibliográfica. As zonas macro-agroecológicas foram identificadas pela conjugação dos dados de vegetação natural, clima, solos, relevo, textura, drenagem e fertilidade natural, levando ao reconhecimento de 55 zonas, agrupadas em 18 classes de aptidão agroecológica. Os resultados são apresentados num mapa escala 1:5.000.000 e num texto explicativo. A pequena escala do mapa é inadequada para indicações a nível local, contudo o produto assume grande importância, por fornecer informações referentes a vocação agroecológica das terras do Brasil, mostrando sua extensão e distribuição, permitindo ao mesmo tempo, o entendimento das relações dos ecossistemas com seu aproveitamento racional. Em termos de aptidão agroecológica do território nacional, encontrou-se 11,71% para pecuária; 27,89% para extrativismo; 29,48% para lavoura; e 30,92% para a preservação da flora e da fauna.bitstream/item/62690/1/CNPS-BOL.-PESQ.-37-91.pdf; bitstream/item/217091/1/Mapa-Delineamento-macro-agroecologico-do-Brasil-1988.pdf; bitstream/item/125762/1/Delineamento-Macro-agroecologico-do-Brasil.pdfAcompanha 1 mapa, color. Escala 1:5.000.000

Calcium Homeostasis in Myogenic Differentiation Factor 1 (MyoD)-Transformed, Virally-Transduced, Skin-Derived Equine Myotubes

Dysfunctional skeletal muscle calcium homeostasis plays a central role in the pathophysiology of several human and animal skeletal muscle disorders, in particular, genetic disorders associated with ryanodine receptor 1 (RYR1) mutations, such as malignant hyperthermia, central core disease, multiminicore disease and certain centronuclear myopathies. In addition, aberrant skeletal muscle calcium handling is believed to play a pivotal role in the highly prevalent disorder of Thoroughbred racehorses, known as Recurrent Exertional Rhabdomyolysis. Traditionally, such defects were studied in human and equine subjects by examining the contractile responses of biopsied muscle strips exposed to caffeine, a potent RYR1 agonist. However, this test is not widely available and, due to its invasive nature, is potentially less suitable for valuable animals in training or in the human paediatric setting. Furthermore, increasingly, RYR1 gene polymorphisms (of unknown pathogenicity and significance) are being identified through next generation sequencing projects. Consequently, we have investigated a less invasive test that can be used to study calcium homeostasis in cultured, skin-derived fibroblasts that are converted to the muscle lineage by viral transduction with a MyoD (myogenic differentiation 1) transgene. Similar models have been utilised to examine calcium homeostasis in human patient cells, however, to date, there has been no detailed assessment of the cells’ calcium homeostasis, and in particular, the responses to agonists and antagonists of RYR1. Here we describe experiments conducted to assess calcium handling of the cells and examine responses to treatment with dantrolene, a drug commonly used for prophylaxis of recurrent exertional rhabdomyolysis in horses and malignant hyperthermia in humans

Malignant hyperthermia

Malignant hyperthermia (MH) is a pharmacogenetic disorder of skeletal muscle that presents as a hypermetabolic response to potent volatile anesthetic gases such as halothane, sevoflurane, desflurane and the depolarizing muscle relaxant succinylcholine, and rarely, in humans, to stresses such as vigorous exercise and heat. The incidence of MH reactions ranges from 1:5,000 to 1:50,000–100,000 anesthesias. However, the prevalence of the genetic abnormalities may be as great as one in 3,000 individuals. MH affects humans, certain pig breeds, dogs, horses, and probably other animals. The classic signs of MH include hyperthermia to marked degree, tachycardia, tachypnea, increased carbon dioxide production, increased oxygen consumption, acidosis, muscle rigidity, and rhabdomyolysis, all related to a hypermetabolic response. The syndrome is likely to be fatal if untreated. Early recognition of the signs of MH, specifically elevation of end-expired carbon dioxide, provides the clinical diagnostic clues. In humans the syndrome is inherited in autosomal dominant pattern, while in pigs in autosomal recessive. The pathophysiologic changes of MH are due to uncontrolled rise of myoplasmic calcium, which activates biochemical processes related to muscle activation. Due to ATP depletion, the muscle membrane integrity is compromised leading to hyperkalemia and rhabdomyolysis. In most cases, the syndrome is caused by a defect in the ryanodine receptor. Over 90 mutations have been identified in the RYR-1 gene located on chromosome 19q13.1, and at least 25 are causal for MH. Diagnostic testing relies on assessing the in vitro contracture response of biopsied muscle to halothane, caffeine, and other drugs. Elucidation of the genetic changes has led to the introduction, on a limited basis so far, of genetic testing for susceptibility to MH. As the sensitivity of genetic testing increases, molecular genetics will be used for identifying those at risk with greater frequency. Dantrolene sodium is a specific antagonist of the pathophysiologic changes of MH and should be available wherever general anesthesia is administered. Thanks to the dramatic progress in understanding the clinical manifestation and pathophysiology of the syndrome, the mortality from MH has dropped from over 80% thirty years ago to less than 5%

Exome sequencing in suspected monogenic dyslipidemias

Exome sequencing is a promising tool for gene mapping in Mendelian disorders. We used this technique in an attempt to identify novel genes underlying monogenic dyslipidemias

Levantamento de reconhecimento dos solos do Estado do Paraná.

O conhecimento pormenorizado das propriedades morfológicas, físicas, químicas e mineralógicas dos solos, constitui fonte de informação básica para a compreensão e solução dos problemas que afetam a pesquisa agropecuária.bitstream/item/62547/1/CNPS-BOL.-PESQ.-27-84.pdf; bitstream/item/125763/1/Levantamento-de-Reconhecimento-dos-Solos-do-Estado-do-Parana-1parte.pdf; bitstream/item/125765/1/Levantamento-de-Reconhecimento-dos-Solos-do-Estado-do-Parana-2parte.pdfAcompanha 1 mapa, color. Escala 1:600.000

Levantamento semidetalhado de solos do Município de Paty do Alferes e sub-bacias do Córrego do Saco-Rio Ubá, estado do Rio de Janeiro.

Constitui um levantamento de solos a nível semidetalhado, realizado na escala 1:20.000, tendo como objetivos principais atender às metas previstas no projeto "Interações ambientais tendo em vista o desenvolvimento sustentável das microbacias dos afluentes do córrego do Saco-rio Ubá, nos municípios de Paty do Alferes e Miguel Pereira, RJ", com apoio do FINEP-PADCT/CIAMB