With the advent of on-site urine testing and other initiatives designed to reduce substance abuse at the workplace, employees who are found to have used alcohol and/or drugs have been coerced into substance abuse treatments under threat of job loss. This widespread practice has produced three questions relative to these practices. First, do these employees have significant substance abuse problems or are they merely "recreational users" who have gotten caught? Second, will these employees participate in standard treatments or will they resist them? Finally, will standard substance abuse treatments provide any benefits to these coerced patients relative to other self-referred patients in treatment? We compared the pretreatment problems, during treatment performance and posttreatment outcomes of 96 employed, insured participants who were coerced into treatment at four private treatment programs due to detection of drug use on the job, to the same measures collected on a comparison group of 161 patients from the same job sites who were self-referred admissions to the same four treatment programs. Results showed that the coerced group had significant substance abuse and other life problems at the start of treatment, but that these problems were generally less severe or chronic than those of the self-referred group. Coerced participants were significantly more likely to remain in treatment (either inpatient or outpatient) than the self-referred participants. Posttreatment follow-up of coerced patients indicated marked improvements in alcohol and drug use, employment, medical, family, and psychiatric problems. These levels of improvement were comparable to those shown by the self-referred patients. We conclude that workplace urine surveillance was successful in detecting employees with significant substance abuse related problems, and that referral to standard treatment was associated with substantial improvements in those problems.

Adult↗

PubMed1996

Type 1 diabetes gets the genomics treatment.

Explore the source record for details and available documents.

Autoimmunity↗

PubMed1996

Encapsulated xenogeneic cells: delivering CNTF to motor neurons.

Explore the source record for details and available documents.

Amyotrophic Lateral Sclerosis↗

PubMed1996

Colour Doppler imaging in giant cell (temporal) arteritis: serial examination and comparison with non-arteritic anterior ischaemic optic neuropathy.

The ophthalmological manifestations of giant cell arteritis (GCA) present a difficult diagnostic and management problem to the ophthalmologist. The orbital circulation is frequently involved in the disease process. The effects of GCA on orbital blood flow assessed by colour Doppler imaging (CDI) were investigated in this study. Serial CDI examinations of the orbital blood vessels were performed (at presentation, 2 days, 1 week and at 1 month) on 7 patients with GCA. CDI examination at presentation was also performed on 4 patients with non-arteritic anterior ischaemic optic neuropathy (AION) for comparison. Blood flow could not be detected in up to three arteries in the affected (ipsilateral) orbit of 6 GCA patients at presentation. Five of these patients were also found to have undetectable blood flow in the posterior ciliary arteries of the contralateral orbit. Serial CDI examination revealed blood flow alterations in arteritic patients despite treatment. Return of blood flow to normal was slow, and related to the clinical features. By contrast, only 1 of the patients with non-arteritic AION showed undetectable blood flow in a posterior ciliary artery. GCA leads to widespread and prolonged alterations in orbital blood flow. CDI allows the detection and monitoring of such alterations in orbital blood flow, which correlate with the clinical features of GCA. Serial CDI examinations in GCA may be used to aid management decisions.

Aged↗

PubMed1996

Inhibition of melatonin secretion onset by low levels of illumination.

Melatonin is a hormone released during darkness under the control of the hypothalamic circadian pacemaker. It has been shown that melatonin is suppressed by light as a function of intensity, with low levels of illumination producing small effects and more intense light greater, but not complete inhibition. The studies which lead to these conclusions administered light subsequent to the secretion pattern being well established. Light as low as 250 lux administered during the normal onset of secretion can reduce melatonin to below detectable levels. The onset of melatonin secretion was delayed for at least an hour during 250 lux exposure and did not rise until termination of light exposure (two hours after control melatonin onset) with higher illumination (500, 1000 and 2500 lux). This tentatively indicates that duration of the inhibition is intensity dependent. It is suggested that the experimental paradigm used in the present study may be a more realistic representation of the effect of normal light exposure (both natural and artificial) on the circadian system, and that findings may be pertinent to the aetiology of certain sleep onset insomnias, which would include delayed sleep phase syndrome (DSPS) and adaptation to shift work.

Adolescent↗

PubMed1996

Embolic stroke in a pregnant patient with a mechanical heart valve on optimal heparin therapy.

A 28-year-old woman with a mechanical aortic heart valve experienced an embolic stroke in early pregnancy after her anticoagulation therapy was changed from warfarin to heparin. This occurred despite use of a subcutaneous heparin infusion pump and optimal anticoagulation. Thromboembolism can occur in pregnant patients with mechanical heart valves despite optimal heparin therapy.

Adult↗

PubMed1996

Enhancement of post trabeculectomy bleb formation by laser suture lysis.

AIMS: To study the efficacy of laser suture lysis in the promotion of filtration and bleb formation during the early postoperative period after trabeculectomy. METHODS: This was a prospective study of 20 eyes from 20 patients undergoing trabeculectomy. Patients were entered into the study if, after a trial period of ocular massage, the intraocular pressure (IOP) was greater than 21 mm Hg 48 hours after surgery. Other criteria for inclusion were a deep quiet anterior chamber, no bleb formation, and a patent internal ostium on gonioscopy. Suture lysis was performed using a frequency doubled neodymium YAG (532 nm) laser and a Hoskins lens. The IOP was measured within 5 minutes of lysis and gentle ocular massage was employed if there was no spontaneous bleb formation. A further suture was lysed if at this stage there was still no bleb associated with a high IOP. RESULTS: Suture lysis was successful in all cases in the early postoperative period. The mean IOP before lysis was 33.8 (SD 8.9) mm Hg and the IOP immediately after lysis was 13.2 (7.9) mm Hg. Eighteen (90%) patients had successfully controlled IOP (mean 14.1 (3.6) mm Hg) without medication after a mean follow up of 6 months. CONCLUSION: Laser suture lysis is a safe and effective method of promoting filtration following trabeculectomy. It can avoid surgical manipulation of the scleral flap with its associated risks of bleb failure and thereby contributes to a successful operative outcome.

Aged↗

PubMed1996

Intensive speech treatment for patients with Parkinson's disease: short-and long-term comparison of two techniques.

The purpose of this study was to evaluate the long-term (12 months) effects of two forms of speech treatment on the speech and voice deficits that occur in Parkinson's disease. Thirty-five patients with idiopathic Parkinson's disease were assigned to one of two speech treatment groups: voice and respiration (The Lee Silverman Voice Treatment [LSVT]) or placebo (respiration) treatment. Vocal intensity data from before, immediately after, and at 6 and 12 months after speech treatment revealed statistically significant differences between the treatment groups. Only subjects in the LSVT group improved or maintained vocal intensity above pretreatment levels by 12 months after treatment. The placebo group had statistically significant deterioration of vocal intensity levels from before to 12 months after treatment during conversational monologue. The LSVT group did not deteriorate to levels below pretreatment in vocal intensity over the 12-month period. This study is the first to document the short-and long-term effects of intensive speech treatment (LSVT), which focuses on the voice, for patients with Parkinson's disease compared with a placebo speech treatment group.

Aged↗

PubMed1996

Childhood acute lymphoblastic leukemia: are routine end-of-therapy bone marrow and cerebrospinal fluid examinations necessary?

OBJECTIVE: To ascertain the usefulness of bone marrow and cerebrospinal fluid (CSF) examinations in identifying or predicting relapse in children with acute lymphoblastic leukemia (ALL) before discontinuation of chemotherapy. MATERIAL AND METHODS: We retrospectively reviewed the medical records of 113 children with ALL in first continuous complete remission who had undergone routine end-of-therapy bone marrow aspiration and CSF examinations. RESULTS: One patient had frank bone marrow relapse at the completion of therapy, which was evident by the presence of blasts in the peripheral blood. None of the other 112 patients had morphologic evidence of bone marrow relapse or positive CSF cytologic findings. The seven subsequent relapses could not have been predicted by the results of end-of-therapy bone marrow or CSF studies. CONCLUSION: Routine morphologic examination of the bone marrow and CSF at the completion of therapy for ALL has no diagnostic or prognostic value.

Adolescent↗

PubMed1996

Lymphatic drainage to triangular intermuscular space lymph nodes in melanoma on the back.

METHODS: Lymphoscintigraphy with 99mTc-antimony sulphide colloid was performed on patients with cutaneous melanoma of the back to define draining node fields and sentinel nodes before surgery. RESULTS: One patient was found to have drainage from the back to sentinel lymph nodes in the triangular intermuscular spaces bilaterally, above and lateral to the scapula. Subsequently, drainage to this node field has been found in 26% of 42 consecutive patients who have had lymphoscintigraphy performed for melanoma on the back. CONCLUSION: When performing lymphoscintigraphy to locate draining node fields and sentinel nodes in patients with melanoma on the back, it is important to look for drainage to the triangular intermuscular space node field by obtaining posterior and lateral scans. Any sentinel lymph nodes found in this field should be marked prior to surgery in the same way as nodes in other node fields are delineated so that they may be removed at surgery.

Adult↗

PubMed1996

A simple clinical method to measure the optic disc size in glaucoma.

PURPOSE: The cup-to-disc ratio is a widely used clinical measure of optic nerve damage in the management of glaucoma patients and those suspected of having glaucoma. Knowledge of the optic disc size allows for a better assessment of the clinical significance of the cup-to-disc ratio. In this study, two optical methods-slit-lamp biomicroscopy and confocal scanning laser ophthalmoscopy-were used to measure the vertical disc diameter as an indirect measure of optic disc size. The aim was to provide a simple and clinically useful examination technique in the management of glaucoma. METHODS: The vertical optic disc diameter was measured with aspheric lenses (Volk 60, 78, and 90 D, and Nikon 60 and 90 D) using slit-lamp biomicroscopy in 25 emmetropic normal volunteers. The average of three readings was determined for each of the lenses and the measurements were correlated with the magnification-corrected diameter measured with the Heidelberg Retina Tomograph. RESULTS: The mean vertical disc diameter of the group, as measured with the Heidelberg Retina Tomograph, was 1.81 +/- 0.18 mm. Results obtained with the lower-power lenses correlated best with the Heidelberg Retina Tomograph measurements (for example, Volk 60 D: r = 0.80, p = 0.0001, 95% confidence interval 1.76-1.85 mm), whereas the 90-D correlation was the weakest (for example, Volk 90 D: r = 0.59. p = 0.002, 95% confidence interval 1.75-1.87 mm). With the Volk 60-D lens, the "best fit" equation for estimating disc diameter, in millimetres, is Y = 0.85X + 0.06, where Y is the Heidelberg Retina Tomograph value and X is the slit-lamp biomicroscopy measurement. CONCLUSION: Using these formulae, the clinician is able to estimate the optic disc diameter with sufficient accuracy to allow clinical decisions to be made in the evaluation of patients with glaucoma, without recourse to expensive technology.

Adult↗

PubMed1996

Hydration assessment during cold-weather military field training exercises.

To quantify the magnitude of dehydration and to identify predictors of dehydration by utilizing changes in total body water (TBW), 24 male Marines were studied during an 8d moderately cold-weather (1-3 degrees C) training exercise. Training consisted of approximately 12 h/d of moderately intense activity. Variables examined included body composition, TBW, and various blood and urinary parameters indicative of hydration. Dietary food and fluid records were also maintained. Body composition changes were consistently with the high energy expenditure and insufficient energy intake. Despite a decrease in TBW, significant dehydration as assessed by blood and urinary parameters did not occur over the 8d period, therefore no relationships were found between TBW and any of the clinical indicators of dehydration. The change in TBW was reflective of a decrease in lean body mass. These data suggest that during cold-weather military field exercise, despite high activity levels and a negative energy balance, body fluid balance can be maintained when particular attention is paid to fluid intake.

Adult↗

PubMed1996

The influence of early biological risk and the home environment on nine-year outcome of very low birth weight.

The contributions of early medical risk and the early and contemporary home environment on cognitive and academic outcomes of 35 nine-year-old survivors of very low birth weight (VLBW) who were followed prospectively were investigated. There were no significant relationships between the measures of early medical risk and outcome. The quality of the home environment accounted for half of the variance in outcome. Five themes that showed consistent associations over time with positive outcomes were: parental responsivity, parent support for learning, parent involvement with the child, exposure to a variety of experiences, and the presence of a father figure.

Analysis of Variance↗