A family in which 6 males have X-linked mental retardation has been studied with polymorphic DNA probes. The males differ from unaffected males only in impaired intellect and in smaller head size. The gene that causes mental retardation in the family appears to be located in band Xq21 on the basis of linkage with 3 markers: DXS250, DXS345 and DXS3 (theta max = 0.00; Zmax = 1.6). A multipoint lod score of 2.36 was obtain with no recombination relative to DXS326 in Xq21. This family is considered to have nonspecific X-linked mental retardation and has been given the designation MRX8.

Adult↗

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Schneiderian symptoms in multiple personality disorder and schizophrenia.

We report structured interview data from a series of 102 cases of multiple personality disorder (MPD) diagnosed in four centers. Schneiderian first-rank symptoms of schizophrenia were equally common in all four centers. The average MPD patient had experienced 6.4 Schneiderian symptoms. When these 102 cases are combined with two previously reported series of MPD cases, an average of 4.9 Schneiderian symptoms in 368 cases of MPD is noted. This compares with an average of 1.3 symptoms acknowledged by 1,739 schizophrenics in 10 published series. Schneiderian symptoms are more characteristic of MPD than of schizophrenia.

Adult↗

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Dissociative experiences and disorders among women who identify themselves as sexual abuse survivors.

The purpose of the study was to identify dissociative experiences and disorders among women who are survivors of sexual abuse. Fifty-one women from two different centers who identified themselves as abuse survivors participated in the research interviews. The Dissociative Experiences Scale (DES) and the Dissociative Disorders Interview Schedule (DDIS) were used to collect data. The results indicated that 88.2% of the 51 women had a dissociative disorder of some type. Twenty-eight (54.9%) of the women had a DDIS diagnosis of multiple personality disorder (MPD). The women had high DES scores, a high number of secondary features of MPD, high rates of depression, borderline personality, substance abuse, somatic symptoms, Schneiderian symptoms, ESP/supernatural experiences, suicide attempts, and conversion symptoms. The vast majority of sexual abuse survivors in this sample have extensive dissociative symptomatology and related features. Therapists working with adult sexual abuse survivors should be knowledgeable about dissociation, should thoroughly assess a client's dissociative abilities, and should incorporate these findings into the therapy process.

Adaptation, Psychological↗

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Comparison of a manual hexadimethrine bromide-antiglobulin test with saline- and albumin-antiglobulin tests for pretransfusion testing.

A prospective double-blind study compared a manual hexadimethrine bromide (Polybrene) antiglobulin antibody detection test (P-AHG) and crossmatch with the albumin-antiglobulin antibody detection test and saline-antiglobulin crossmatch routinely used in our laboratory. A total of 10,084 pretransfusion blood samples from approximately 6000 patients were tested. The P-AHG method detected 153 of 157 alloantibodies for which antigen-negative, crossmatch-compatible blood is routinely provided. All four antibodies not detected were anti-K. The routine techniques detected 147 of the 157 alloantibodies. The P-AHG method detected only 36 percent of the alloantibodies for which crossmatch-compatible blood is routinely provided without determination of the antigen status of the donor unit's red cells (e.g., anti-Lea), whereas the routine method detected 91 percent of such antibodies. Eighty-six percent of the 189 alloantibodies detected by the Polybrene technique were found before the addition of antiglobulin. The manual Polybrene test is a rapid and sensitive technique; it may be used without an antiglobulin phase as a routine crossmatch procedure when accompanied by a sensitive antibody detection test that includes antiglobulin and an additional test to ensure ABO compatibility.

Blood Grouping and Crossmatching↗

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Preparing the nursing profession for participation in a genetic paradigm in health care.

It is critical that nurses be recognized for their ability to deliver genetic services in collaboration with medical geneticists, genetic counselors, physicians, and providers from other disciplines. The purpose of this special communication is to describe progress made by the International Society of Nurses in Genetics toward incorporating genetics into nursing education and practice.

Certification↗

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How others do it: Meridian Park Hospital uses new concepts for flexibility.

Explore the source record for details and available documents.

Equipment and Supplies, Hospital↗

PubMedDate not supplied

Relationship among plasma cortisol, catecholamines, neuropeptide Y, and human performance during exposure to uncontrollable stress.

OBJECTIVE: Although many people are exposed to trauma, only some individuals develop posttraumatic stress disorder; most do not. It is possible that humans differ in the degree to which stress induces neurobiological perturbations of their threat response systems, which may result in a differential capacity to cope with aversive experiences. This study explored the idea that differences in the neurobiological responses of individuals exposed to threat are significantly related to psychological and behavioral indices. METHODS: Individual differences in neurohormonal, psychological, and performance indices among 44 healthy subjects enrolled in US Army survival school were investigated. Subjects were examined before, during, and after exposure to uncontrollable stress. RESULTS: Stress-induced release of cortisol, neuropeptide Y, and norepinephrine were positively correlated; cortisol release during stress accounted for 42% of the variance in neuropeptide Y release during stress. Cortisol also accounted for 22% of the variance in psychological symptoms of dissociation and 31% of the variance in military performance during stress. CONCLUSIONS: Because dissociation, abnormalities in the hypothalamic-pituitary-adrenocortical axis, and catecholamine functioning have all been implicated in the development of stress disorders such as posttraumatic stress disorder, these data suggest that some biological differences may exist before index trauma exposure and before the development of stress-related illness. The data also imply a relationship among specific neurobiological factors and psychological dissociation. In addition, the data provide clues about the way in which individuals' psychobiological responses to threat differ from one another.

Adult↗

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Nonadherence with ACE inhibitors is common and can be detected in clinical practice by routine serum ACE activity.

Our objective was to assess whether serum angiotensin-converting enzyme (ACE) activity during routine clinical practice accurately reflects patient adherence to ACE inhibitor treatment in chronic heart failure (CHF). During 1994-95, ACE was measured in 73 CHF patients who were routinely attending the heart failure clinic at Ninewells Hospital. At the same time, the Medicines Monitoring Unit collected data on whether and when prescriptions for ACE inhibitors were redeemed at community pharmacies, which enabled each patient's adherence over a prolonged period to be assessed. We then correlated whether an elevation in serum ACE was associated with poor adherence with ACE inhibitor treatment. In total, 18% of CHF patients appeared to exhibit less than 70% adherence with their ACE inhibitor treatment, with 34% exhibiting less than 85%adherence and 58% exhibiting less than 100% adherence. A serum ACE activity of more than 12 U/L gave 91% positive predictive accuracy that the patient was less than 100% adherent with his or her ACE inhibitor treatment. At the other extreme, a serum ACE less than 6.5 U/L gave 81% positive predictive accuracy that the patient was more than 85% adherent with ACE inhibitor treatment. Nonadherence with ACE inhibitor treatment, therefore, was found to be common in patients with CHF. The simple, inexpensive test of serum ACE activity can be used in CHF patients to identify many, although not all, nonadherent patients so that adherence-enhancing strategies can be targeted toward them. Further work is clearly required to explore the precise clinical utility of this promising test. (c)2001 by CHF, Inc.

Journal Article↗

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Role of MHC, Mls and TCR in immune tolerance.

MHC class II molecules and self antigens, such as Mls, influence T-cell selection by clonal deletion of potentially self-reactive T cells. In order to examine the role of various class II molecules in the T-cell receptor-self antigen interaction, class II transgenic and recombinant mice were analysed for TCR expression. Our studies indicate that the A alpha and E alpha chains can present Mls gene products for the clonal deletion of V beta 6-bearing T cells, and that the A alpha q chain is defective in this process. We have also shown that E alpha A beta heterodimer in transgenic and recombinant mice is expressed and functions to delete I-E reactive V beta llT cells, demonstrating again the role of the E alpha molecule.

Animals↗

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Healthcare performance measurement in Canada: who's doing what?

Explore the source record for details and available documents.

Canada↗

PubMedDate not supplied

Willingness to pay to shorten waiting time for cataract surgery.

We interviewed persons who had recently been placed on a public waiting list for cataract surgery in Manitoba, Canada; Barcelona, Spain; and Denmark. The majority of the respondents were unwilling to pay higher taxes to reduce the length of the waiting list or to pay more out of pocket to have the surgery performed earlier in the private sector. Less than 2 percent actually had the surgery done in the private sector. We conclude that in spite of expressed public dissatisfaction with waiting lists in all three sites, a majority of the respondents did not support the actions that could have reduced their own wait.

Aged↗

PubMedDate not supplied

Comparing health system performance in OECD countries. Organization for Economic Cooperation and Development.

We present data from the Organization for Economic Cooperation and Development and the World Health Organization on the performance of the health care systems in twenty-nine industrialized countries in 1998. We also compare the performance of the United States with the other industrialized countries for selected indicators in 1960, 1980, and 1998. On most indicators the U.S. relative performance declined since 1960; on none did it improve.

Delivery of Health Care↗

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Are Fortune 100 companies responsive to chronically ill workers?

We conducted a survey of Fortune 100 companies to determine their response to the growing number of employees with chronic conditions. We found that although all companies cover some services that are particularly beneficial to persons with chronic conditions, gaps in coverage remain. We also found large variations in cost-sharing mechanisms, number of covered visits, and lifetime maximum benefit provisions, which are especially important to persons with chronic conditions. In general, for persons with chronic conditions the benefits offered by these Fortune 100 companies are superior to those offered by Medicare.

Chronic Disease↗

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Changing the chronic care system to meet people's needs.

Persons who are likely to be the heaviest users of medical and supportive care services--those with chronic illnesses, disabilities, and functional limitations--are often forced to navigate a system that requires them to perform most of the coordination functions themselves and is generally not organized around their needs. In 1996 an estimated 128 million Americans had at least one of these three conditions, and 9.5 million had all three. This paper examines the current programs designed to assist these persons and suggests changes in eligibility rules, coverage policies, and educational programs to provide a system more oriented to people's chronic care needs.

Chronic Disease↗