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Objectives: Little attention has been given to the prevalence rate of mental illness among elderly adults in Latin America. The prevalence rates for psychiatric disorders in Chile among those 65 and older compared with younger individuals, and the prevalence rate of psychiatric disorders among those age 75 and older are presented. Design: A stratified random sample of 2,659 individuals. Setting: Four provinces representative of the Chile's population were surveyed. Participants: Adults age 15 and older were interviewed; however, the analysis is limited to those over age 20. Measurements: The Composite International Diagnostic Interview was administered to obtain Diagnostic and Statistical Manual of Mental Disorders, Third Edition-R diagnoses. Lifetime and 12-month prevalence rates were estimated. Results: Of the 2,659 interviewed 352 were over age 64. Overall, elderly adults had lower prevalence rates of lifetime disorders than the younger population, 20% in comparison with 34%. Dysthymia, agoraphobia, simple phobia, and alcohol dependence disorders were noted to be less common among elderly subjects. Those over the age of 64 in comparison with those over the age of 74 had higher prevalence rates of disorders. A sizable proportion of the disorders among older adults began after the age of 59. One third of elderly respondents with major depression had a late onset disorder. Service utilization was similar between elderly individuals and younger respondents, except for use of specialized psychiatric services, which was lower among elderly adults. Conclusions: Both lifetime and 1-year prevalence of mental disorders were less common in older than in younger persons; however, among elderly adults late onset disorders were not uncommon. Additional studies of the prevalence rates of disorders among older individuals in Latin America are needed for public health planning. [ABSTRACT FROM AUTHOR]

Background. In this study we examined the prevalence rates of post-traumatic stress disorder (PTSD), types of trauma most often associated with PTSD, the co-morbidity of PTSD with other lifetime psychiatric disorders, which disorders preceded PTSD, and gender differences in PTSD and trauma exposure in a representative sample of Chileans.Method. The DSM-III-R PTSD and antisocial personality disorder modules from the Diagnostic Interview Schedule (DIS) and modules for a range of DSM-III-R diagnoses from the Composite International Diagnostic Interview (CIDI) were administered to a representative sample of 2390 persons aged 15 to over 64 years in three cities in Chile.Results. The lifetime prevalence of PTSD was 4.4% (2.5% for men and 6.2% for women). Among persons exposed to trauma, rape was most strongly associated with PTSD. Onset of PTSD significantly increased the risk of developing each of the 10 other tested disorders. Among those exposed to trauma, women were significantly more likely to develop PTSD, after controlling for assaultive violence.Conclusions. This study highlights the importance of investigating the prevalence of PTSD, patterns of co-morbidity of PTSD, and gender differences in PTSD in non-English-speaking countries. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Although several epidemiological studies of the prevalence of psychiatric disorders have been conducted in Latin America, few of them were national studies that could be used to develop region-wide estimates. Data are presented on the prevalence of DSM-III-R disorders, demographic correlates, comorbidity, and service utilization in a nationally representative adult sample from Chile. METHOD: The Composite International Diagnostic Interview was administered to a stratified random sample of 2,978 individuals from four provinces representative of the country's population age 15 and older. Lifetime and 12-month prevalence rates were estimated. RESULTS: Approximately one-third (31.5%) of the population had a lifetime psychiatric disorder, and 22.2% had a disorder in the past 12 months. The most common lifetime psychiatric disorders were agoraphobia (11.1%), social phobia (10.2%), simple phobia (9.8%), major depressive disorder (9.2%), and alcohol dependence (6.4%). Of those with a 12-month prevalence diagnosis, 30.1% had a comorbid psychiatric disorder. The majority of those with comorbidity had sought out mental health services, in contrast to one-quarter of those with a single disorder. CONCLUSIONS: The prevalence rates in Chile are similar to those obtained in other studies conducted in Latin America and Spanish-speaking North American groups. Comorbidity and alcohol use disorders, however, were not as prevalent as in North America. [ABSTRACT FROM AUTHOR]

Background. In order to improve care for people with depressive disorders and to reduce the increasing burden of depression, the American Regional Office of the World Health Organization has launched a major region-wide initiative. A central part of this effort was directed to the primary care system where the diagnosis and treatment of depression are deficient in many countries. This study evaluated the materials developed by the World Psychiatric Association in a training program on depression among primary care physicians by measuring changes in their knowledge, attitudes, and practice (KAP).Method. One hundred and seven physicians and 6174 patients from five Latin American countries participated in the trial. KAP were assessed 1 month before and 1 month following the training program. In addition, the presence of depressive symptoms was measured in patients who visited the clinic during a typical week at both times using the Zung Depression Scale and a DSM-IV/ICD-10 major depression checklist.Results. The program slightly improved knowledge about depression and modified some attitudes, but had limited impact on actual practice. There was no evidence that the diagnosis of depression was made more frequently, nor was there an improvement in psychopharmacological management. The post-training agreement between physician diagnosis and that based on patient self-report remained low. The physicians, however, seemed more confident in treating depressed patients after training, and referred fewer patients to psychiatrists.Conclusions. Traditional means of training primary care physicians in depression have little impact on clinical practice regardless of the quality of the teaching materials. [ABSTRACT FROM AUTHOR]

Mental disorders are highly prevalent and cause considerable suffering and disease burden. To compound this public health problem, many individuals with psychiatric disorders remain untreated although effective treatments exist. We examine the extent of this treatment gap. We reviewed community-based psychiatric epidemiology studies that used standardized diagnostic instruments and included data on the percentage of individuals receiving care for schizophrenia and other non-affective psychotic disorders, major depression, dysthymia, bipolar disorder, generalized anxiety disorder (GAD), panic disorder, obsessive-compulsive disorder (OCD), and alcohol abuse or dependence. The median rates of untreated cases of these disorders were calculated across the studies. Examples of the estimation of the treatment gap for WHO regions are also presented. Thirty-seven studies had information on service utilization. The median treatment gap for schizophrenia, including other non-affective psychosis, was 32.2%. For other disorders the gap was: depression, 56.3%; dysthymia, 56.0%; bipolar disorder, 50.2%; panic disorder, 55.9%; GAD, 57.5%; and OCD, 57.3%. Alcohol abuse and dependence had the widest treatment gap at 78.1%. The treatment gap for mental disorders is universally large, though it varies across regions. It is likely that the gap reported here is an underestimate due to the unavailability of community-based data from developing countries where services are scarcer. To address this major public health challenge, WHO has adopted in 2002 a global action programme that has been endorsed by the Member States. [ABSTRACT FROM AUTHOR]

The objective of this study was to compare the instruments and laboratories that are currently used for analysis of milk urea nitrogen (MUN) for bulk-tank milk samples. Two replicate samples from each bulk tank on 10 different dairy farms were sent to 12 Dairy Herd Improvement Association (DHIA) laboratories throughout the US for MUN analysis. Two laboratories used 2 different methods for MUN analysis for a total of 14 analyses on 20 samples (n = 280). Values of MUN were analyzed using a random effects model with farm, laboratory, and farm x laboratory variance components. Greater than 98% of the variance in measured MUN was attributed to farm-to-farm variance for analysis of MUN by the Bentley, CL 10, Foss 6000, and Skalar instruments. However, for the laboratories using the Foss 4000 system, <60% of the variance in MUN was attributed to farm-to-farm variance. Laboratories using the Bentley, CL 10, Foss 6000, and Skalar instruments provided slightly different results for MUN analysis, but >95% of sample measurements fell within 1.75 mg/ dL of each other. The laboratories using Foss 4000 differed from each other, and 95% of samples fell within 5 mg/dL of the CL 10 measurement. Laboratories using the Foss 4000 instrument did not consistently provide measurements of MUN that were similar to each other or to the measurements of the other instruments. [ABSTRACT FROM AUTHOR]

In-home psychiatric services for the elderly are a necessary alternative to traditional forms of mental health care delivery for the comorbid medically ill, the psychiatrically homebound, and those noncompliant with standard outpatient care. This article discusses the different models of in-home psychiatric services. The current Medicare guidelines defining eligibility exclude a sizable proportion of individuals in need of these services. Randomized clinical trials demonstrating the efficacy of in-home psychiatric care in the elderly have not yet been conducted. [ABSTRACT FROM AUTHOR]

Environmental legislation has made it necessary for livestock producers to be able to quantify and adjust the N balance on their farms. Whole-farm N balance and efficiencies were computed for 41 commercial dairies in Utah and Idaho using the University of Maryland Nutrient Balancer. The average N balance, or unaccounted for N, was 81 tonnes per year for the average herd size of 466 cows with 35.8% of the inputs accounted for in the outputs. The major inputs for farms that grew crops (n = 23, herd size = 284 total cows) were imported feed (57.4% of all inputs) and nitrogen fixation (30% of inputs). The major outputs were animal products (primarily milk and some meat, 80% of outputs). For farms that grew no crops (n = 18, herd size = 700 total cows), 98% of the inputs were from imported feed. Of the outputs, 57% of the N was in animal products and 42.9% in manure and compost. Whole-farm balance per product for those farms that grew crops was most affected by herd N utilization efficiency (kg feed N per kg product N), crop N utilization efficiency, and availability of manure N applied to crops, while manure N storage efficiency was of lesser importance. For farms that grew no crops, whole-farm N balance per product was most affected by herd N utilization efficiency and manure N storage efficiency. Maximizing conversion of feed N to product N was the best way to reduce whole-farm N balance. [ABSTRACT FROM AUTHOR]

OBJECTIVES: This study investigated the effect of parental bereavement on cancer incidence and survival. METHODS: A cohort of 6284 Jewish Israelis who lost an adult son in the Yom Kippur War or in an accident between 1970 and 1977 was followed for 20 years. We compared the incidence of cancer in this cohort with that among nonbereaved members of the population by logistic regression analysis. The survival of bereaved parents with cancer was compared with that of matched controls with cancer. RESULTS: Increased incidence was found for lymphatic and hematopoietic malignancies among the parents of accident victims (odds ratio [OR] = 2.01; 95% confidence interval [CI] = 1.30, 3.11) and among war-bereaved parents (OR = 1.47; 95% CI = 1.13, 1.92), as well as for melanomas (OR = 4.62 [95% CI = 1.93, 11.06] and 1.71 [95% CI = 1.06, 2.76], respectively). Accident-bereaved parents also had an increased risk of respiratory cancer (OR = 1.50; 95% CI = 1.07, 2.11). The survival study showed that the risk of death was increased by bereavement if the cancer had been diagnosed before the loss, but not after. CONCLUSIONS: This study showed an effect of stress on the incidence of malignancies for selected sites and accelerated demise among parents bereaved following a diagnosis of cancer, but not among those bereaved before such a diagnosis. [ABSTRACT FROM AUTHOR]

The aim of this study was to conduct a quasi-experimental comparison of two employee assistance program (EAP) assessment approaches with substance abusers: confrontational interviewing (CI) and motivational interviewing (MI). A total of 176 EAP clients from 14 study sites met the study criteria, and 89 (51%) agreed to participate in the study. At three and nine months postassessment, both the MI and CI groups showed similar changes in readiness for change, completion of initial treatment plans, and subsequent treatment. Most important, both the MI and CI participants showed significant and comparable improvement on all of the substance abuse baseline measures as well as measures of family-social well-being and effects of drinking/drugging on work performance. The results open the door for EAP counselors to use an empirically supported assessment style that is at least as effective as the traditional confrontational approach. [ABSTRACT FROM AUTHOR]

Details the findings of several analyses which indicate increases in unsafe sexual behavior and increases in rates of rectal gonorrhea among men who have sex with men (MSM) from 1994 to 1997. How the study was conducted; Limitations of the findings.

Objective: To study the potential usefulness of the 6-minute walk test, a self-paced submaximal exercise test, as a prognostic indicator in patients with left ventricular dysfunction.Design: Data were collected during a prospective cohort study, the Studies of Left Ventricular Dysfunction (SOLVD) Registry Substudy.Setting: Twenty tertiary care hospitals in the United States, Canada, and Belgium.Participants: A stratified random sample of 898 patients from the SOLVD Registry who had either radiological evidence of congestive heart failure and/or an ejection fraction of 0.45 or less were enrolled in the substudy and underwent a detailed clinical evaluation including a 6-minute walk test. Patients were followed up for a mean of 242 days.Outcome Measures: Mortality and hospitalization.Results: During follow-up, 52 walk-test participants (6.2%) died and 252 (30.3%) were hospitalized. Hospitalization for congestive heart failure occurred in 78 participants (9.4%), and the combined endpoint of death or hospitalization for congestive heart failure occurred in 114 walk-test participants (13.7%). Compared with the highest performance level, patients in the lowest performance level had a significantly greater chance of dying (10.23% vs 2.99%; P = .01), of being hospitalized (40.91% vs 19.90%; P = .002), and of being hospitalized for heart failure (22.16% vs 1.99%; P < .0001). In a logistic regression model, ejection fraction and distance walked were equally strong and independent predictors of mortality and heart failure hospitalization rates during follow-up.Conclusion: The 6-minute walk test is a safe and simple clinical tool that strongly and independently predicts morbidity and mortality in patients with left ventricular dysfunction. [ABSTRACT FROM AUTHOR]

The 'illusion of visitors' is a common phenomenon among geriatric patients presenting for psychiatric or neurologic evaluation and treatment. Although these illusory beliefs are etiologically diverse, patients may commonly have visual impairment and functional and/or structural disruption of frontal and right-hemisphere-mediated cognitive functioning. This article outlines eight cases of illusory beliefs among elderly patients, presenting psychiatric, neurologic, neuroimaging, and neuropsychological findings among these patients. Commonalities and differences among these cases are discussed, and a framework is provided for multidisciplinary assessment and treatment of patients presenting with illusory beliefs. (J Geriatr Psychiatry Neurol 1997 ; 10:79-87). [ABSTRACT FROM PUBLISHER]

SUMMARY A Bayesian analysis is given for a state space model with errors that are finite mixtures of normals and with coefficients that can assume a finite number of different values. A sequence of indicator variables determines which components the errors belong to and the values of the coefficients. The computation is carried out using Markov chain Monte Carlo, with the indicator variables generated without conditioning on the states. Previous approaches use the Gibbs sampler to generate the indicator variables conditional on the states. In many problems, however, there is a strong dependence between the indicator variables and the states causing the Gibbs sampler to converge unacceptably slowly, or even not to converge at all. The new sampler is implemented in O(n) operations, where n is the sample size, permitting an exact Bayesian analysis of problems that previously had no computationally tractable solution. We show empirically that the new sampler can be much more efficient than previous approaches, and illustrate its applicability to robust nonparametric regression with discontinuities and to a time series change point problem. [ABSTRACT FROM AUTHOR]

This paper studies coherent, energy-minimizing mixtures of two linearly elastic phases with identical elastic moduli. We derive a formula for the 'relaxed' or 'macroscopic' energy of the system, by identifying microstructures that minimize the total energy when the volume fractions and the average strain are fixed. If the stress-free strains of the two phases are incompatible then the relaxed energy is nonconvex, with 'double-well structure'. An optimal microstructure always exists within the class of layered mixtures. The optimal microstructure is generally not unique, however; we show how to construct a large family of optimal, sequentially laminated microstructures in many circumstances. Our analysis provides a link between the work of Khachaturyan and Roitburd in the metallurgical literature and that of Ball, James, Pipkin, Lurie, and Cherkaev in the recent mathematical literature. We close by explaining why the corresponding problem for three or more phases is fundamentally more difficult. [ABSTRACT FROM AUTHOR]

The intent of this study is to illustrate cultural differences in the amount of perceived burden for primary caregivers of persons with Alzheimer's Disease. Caregivers in Guatemala and Rhode Island were given a questionnaire exploring: caregiver well-being, available supports, traditional ideology, and perceived burden. The data indicate that Guatemalans have less institutional and more informal supports available, as compared with USA caregivers. Guatemalan caregivers brought patients to a doctor sooner after the appearance of their first symptoms (0.9+/-1.0 years versus 1.6+/-1.8 years) and had poorer perceived health than USA subjects, suggesting a higher level of caregiver burden. Cultural response bias however may account for the difference in perceived health. [ABSTRACT FROM AUTHOR]