Advanced disease at enrollment in HIV care in four sub-Saharan African countries: change from 2006 to 2011 and multilevel predictors in 2011.

Objectives: To examine changes between 2006 and 2011 in the proportion of HIV-positive patients newly enrolled in HIV care with advanced disease and the median CD4 cell count at enrollment; and identify patient, facility, and contextual-level factors associated with late enrollment in care in 2011.

Design: Cross-sectional over time.

Methods: For time-trends analyses, routinely collected patient-level data (307 110 adults newly enrolled in 138 HIV clinical care facilities) in Kenya, Mozambique, Rwanda and Tanzania; and for analyses of correlates, patient-level data (46 201 in 195 facilities), and facility and population-level survey data were used.

The multilingual nature of dopamine neurons.

The ability of dopamine (DA) neurons to release other transmitters in addition to DA itself has been increasingly recognized, hence the concept of their multilingual nature. A subset of DA neurons, mainly found in the ventral tegmental area, express VGLUT2, allowing them to package and release glutamate onto striatal spiny projection neurons and cholinergic interneurons. Some dopaminergic axon terminals release GABA.

Dopamine neurons control striatal cholinergic neurons via regionally heterogeneous dopamine and glutamate signaling.

Midbrain dopamine neurons fire in bursts conveying salient information. Bursts are associated with pauses in tonic firing of striatal cholinergic interneurons. Although the reciprocal balance of dopamine and acetylcholine in the striatum is well known, how dopamine neurons control cholinergic neurons has not been elucidated.

Factors impacting the decision to participate in and satisfaction with public/community psychiatry fellowship training.

During yearly meetings of the recently developed network of 15 public/community psychiatry fellowships, it has been noted that programs are having varying degrees of success with regard to recruitment. To understand factors that impact recruitment, a quality improvement survey of fellows and alumni was conducted. Respondents were asked to rate overall satisfaction with their fellowship training as well as perceived benefits and obstacles to participating in a fellowship program, and impact on their careers.

Neuronal generators of posterior EEG alpha reflect individual differences in prioritizing personal spirituality.

Prominent posterior EEG alpha is associated with depression and clinical response to antidepressants. Given that religious belief was protective against depression in a longitudinal study of familial risk, we hypothesized that individuals who differed by strength of spiritual beliefs might also differ in EEG alpha. Clinical evaluations and self-reports of the importance of religion or spirituality (R/S) were obtained from 52 participants, and again at 10-y followup when EEG was measured.

Psychiatry residents' perception of public/community psychiatry fellowship training.

In order to improve recruitment into public/community psychiatry fellowships, a survey was administered to understand psychiatry residents' perception of benefits and obstacles to fellowship training. Using standard statistical methods, the responses of those residents who indicated interest in public/community psychiatry training were compared to those who were not. Residents who were interested in public/community psychiatry fellowships were earlier in their training.

Reducing medical students' stigmatization of people with chronic mental illness: a field intervention at the "living museum" state hospital art studio.

Objective: The authors designed an intervention to reduce beginning medical students' stigmatization of people with chronic mental illness (CMI).

Methods: Pre-clinical medical students visited a state psychiatric facility's "Living Museum," a combination patient art studio/display space, as the intervention. During the visit, students interacted with artist-guides who showed their work and discussed their experiences creating art.

Cognitive outcome of offspring from dexamethasone-treated pregnancies at risk for congenital adrenal hyperplasia due to 21-hydroxylase deficiency.

Objectives: To test whether dexamethasone (DEX) treatment in pregnancies at risk for congenital adrenal hyperplasia (CAH) impairs cognitive functioning in the offspring.

Design: Observational follow-up of prenatally DEX-exposed offspring and controls.

Methods: Study 1 included 140 children aged 512 years: 67 DEX-exposed (long-term: eight CAH girls) and 73 unexposed (with 15 CAH girls).

Brain development and cognitive, psychosocial, and psychiatric functioning in classical 21-hydroxylase deficiency.

The disturbance of the hypothalamic-pituitary- adrenal axis characteristic of congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency (21-OHD) is likely to affect brain development, yet neuroanatomic work is only beginning. Fetal hyperandrogenemia in 46, XX 21-OHD leads to masculinized brain organization and, consequently, at later stages of development, to masculinized gender-related behavior and cognitive function, including, although relatively uncommonly, gender identity. Genital masculinization as well as its surgical treatment has implications for social stigmatization and sexual functioning.

Imaging neurotransmitter release by drugs of abuse.

Previous studies have shown that imaging with positron emission tomography (PET) and single photon emission computed tomography (SPECT) radiotracers that are specific for brain dopamine receptors can be used to indirectly image the change in the levels of neurotransmitters within the brain. Most of the studies in addiction have focused on dopamine, since the dopamine neurons that project to the striatum have been shown to play a critical role in mediating addictive behavior. These imaging studies have shown that increased extracellular dopamine produced by psychostimulants can be measured with PET and SPECT.

The origins of 12-month attachment: a microanalysis of 4-month mother-infant interaction.

A microanalysis of 4-month mother-infant face-to-face communication revealed a fine-grained specification of communication processes that predicted 12-month insecure attachment outcomes, particularly resistant and disorganized classifications. An urban community sample of 84 dyads were videotaped at 4 months during a face-to-face interaction, and at 12 months during the Ainsworth Strange Situation. Four-month mother and infant communication modalities of attention, affect, touch, and spatial orientation were coded from split-screen videotape on a 1 s time base; mother and infant facial-visual "engagement" variables were constructed.

Post-traumatic stress reactions among Rwandan children and adolescents in the early aftermath of genocide.

Background: Epidemiological investigations of post-traumatic stress reactions in Sub-Saharan Africa, where atrocious violence against civilians is endemic, are rare. This article is the first complete report of the key community-based findings of a 1995 psychiatric epidemiological survey of young survivors of the 1994 Rwandan Genocide.

Methods: The National Trauma Survey (NTS) of Rwandans aged 8-19 measured traumatic exposures using an inventory of possible war time experiences and post-traumatic stress reactions with a checklist of symptoms of Post-traumatic stress disorder (PTSD).

Treatment of depressed bipolar patients with alcohol use disorders: plenty of room for improvement.

Background: We aimed to examine the adequacy of antidepressant treatment and compliance with treatment in bipolar patients with and without alcohol use disorders (AUD). We hypothesize that the adequacy of antidepressant treatment and the compliance with treatment for those with AUD are lower than for those without AUD.

Methods: Subjects were 97 patients with current bipolar major depressive episode, 39 (40.

Discerning patterns of human immunodeficiency virus risk in healthy young adults.

Previous research has questioned the effectiveness of existing methods to identify individuals at high risk for contracting and transmitting human immunodeficiency virus and other sexually transmitted diseases. Thus, new approaches are needed to provide these individuals with risk-reduction strategies. We review our research on young adults' sexual decision making by using theories and methods from social and cognitive sciences.

Distressed mothers and their infants use a less efficient timing mechanism in creating expectancies of each other's looking patterns.

The prediction of events and the creation of expectancies about their time course is a crucial aspect of an infant's mental life, but temporal mechanisms underlying these predictions are obscure. Scalar timing, in which the ratio of mean durations to their standard deviations is held constant, enables a person to use an estimate of the mean for its standard deviation. It is one efficient mechanism that may facilitate predictability and the creation of expectancies in mother-infant interaction.

Age-related ERP differences at retrieval persist despite age-invariant performance and left-frontal negativity during encoding.

Although it has been reported repeatedly that retrieval-related processes decline with aging, the influence of well-documented age-related encoding deficiencies on the observed changes at retrieval have not been ruled out as a contributing factor. Here, we disentangle this confound by using a serendipitous finding reported by Nessler et al. [D.

Does repetition engender the same retrieval processes in young and older adults?

Aging differentially affects retrieval processes underlying recognition memory: familiarity is maintained, whereas recollection declines. We determined whether word repetition across two study-test phases enhanced older adults' use of recollection. During Test 1, frontal episodic memory effects, suggestive of familiarity-based processes, were age invariant, whereas only the young showed a parietal episodic memory effect, suggestive of recollection.

Gender development in women with congenital adrenal hyperplasia as a function of disorder severity.

Prenatal-onset classical congenital adrenal hyperplasia (CAH) in 46,XX individuals is associated with variable masculinization/defeminization of the genitalia and of behavior, presumably both due to excess prenatal androgen production. The purpose of the current study was threefold: (1) to extend the gender-behavioral investigation to the mildest subtype of 46,XX CAH, the non-classical (NC) variant, (2) to replicate previous findings on moderate and severe variants of 46,XX CAH using a battery of diversely constructed assessment instruments, and (3) to evaluate the utility of the chosen assessment instruments for this area of work. We studied 63 women with classical CAH (42 with the salt wasting [SW] and 21 with the simple virilizing [SV] variant), 82 women with the NC variant, and 24 related non-CAH sisters and female cousins as controls (COS).

The promises and limitations of female-initiated methods of HIV/STI protection.

New methods are now available, and others are being developed, that could enable women to take the initiative in preventing sexually transmitted infections. However, attempts to capitalize on "female-controlled" preventive methods thus far have met with limited success. Female-initiated methods were introduced to intervene in the state of gender relations and assist women who are disempowered vis-à-vis their male partners.

Dopamine presynaptically and heterogeneously modulates nucleus accumbens medium-spiny neuron GABA synapses in vitro.

Background: The striatal complex is the major target of dopamine action in the CNS. There, medium-spiny GABAergic neurons, which constitute about 95% of the neurons in the area, form a mutually inhibitory synaptic network that is modulated by dopamine. When put in culture, the neurons reestablish this network.

Brain potentials to sexually suggestive whistles show meaning modulates the mismatch negativity.

Electroencephalographic data suggest that spoken words produce an enhanced output of the brain's automatic deviance detection system, as reflected by the mismatch negativity. Using meaningful and nonmeaningful whistles, we sought to distinguish the effect of semantic content on the brain's deviance detection system from language-specific stimulus features. In the meaningful condition, study participants heard a human 'wolf whistle', which is commonly interpreted as an unsolicited expression of sexual attention.