Malpractice crisis threatens health care for Detroit's homeless.
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Biomedical subjects
Publications and source records attributed to S Norman.
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A pronounced age predisposition was noticed in a study of 30 goats with the neurologic form of caprine arthritis-encephalitis. Most affected animals were between 2 and 4 months of age, but ages ranged from 1 month to 20 years. Clinically, mild to moderate fever was recorded for approximately half of the patients. Brain involvement (in 16 of 30 goats) was most commonly identified by depression, head tilt, torticollis, and circling. Signs of spinal cord involvement were most frequently those of white matter damage: hypertonia, hyperreflexia, and para- or tetraparesis. In approximately 90% of patients, there were increases in protein content and WBC numbers in the cerebrospinal fluid. Microscopic lesions were most frequent in the brain and cervical portion of the spinal cord and consisted of a nonsuppurative inflammatory response and demyelination with preservation of axons.
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Two cases with allergic contact dermatitis from chromate in green military uniform sweater and pants are described. Chemical analysis showed that water-soluble chromate was released from a uniform even after repeated washings.
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A brush delivered to the biopsy site by a metal introducer and cannula set was tested as an alternative implement for transcervical collection of chorionic villi. This implement was easy to use and readily identified by ultrasound. With only one attempt at sampling, the overall collection rate for 83 patients was 65 per cent. With practice 84 per cent successful collection was achieved. Gestations between 8 and 11 weeks was the best time for collection of chorionic villi. A single sampling can produce adequate material (15 mg wet weight) suitable for diagnostic purposes. No gestation sac was perforated but some slight bleeding followed the procedure. Appreciable success following a single sampling attempt coupled with the low complication rate suggests that this technique may have clinical application and deserves further investigation.
Prior studies of alexithymia in chronic pain patients have used unvalidated alexithymia measures or have not controlled for treatment-seeking status. In this study, we compared 30 patients with chronic pain and patients seeking treatment for two other problems: nicotine dependence (n = 32) or moderate obesity (n = 25). Alexithymia was assessed with the well-validated Toronto Alexithymia Scale (TAS) and also with the Alexithymia Provoked Response Questionnaire (APRQ). On both alexithymia measures, chronic pain patients were more alexithymic than nicotine-dependent and obese patients; the latter two groups did not differ. Chronic pain patients had greater psychopathology on the Minnesota Multiphasic Personality Inventory-2 (MMPI-2), and both alexithymia measures correlated positively with certain types of psychopathology. We conclude that alexithymia is increased among patients with chronic pain, that this relationship is not confounded by a treatment-seeking bias, and that alexithymia may contribute to both chronic pain and psychopathology.
Alexithymia's link with health care utilization is unclear. Alexithymia may be overrepresented among clinical samples because of a proclivity to seek care, or alexithymia may prompt delay or avoidance of care, perhaps exacerbating illness. In 911 young adults, this study examined relationships between alexithymia (Toronto Alexithymia Scale-20; total and three factor scores) and the use of six health services during the past year: outpatient medical treatment, emergency room, hospitalization, psychotherapy, routine dental care, and nonprescription analgesics. Three potential mediators (insurance status, depression, and somatic complaints) were controlled to determine alexithymia's unique relation to utilization. The alexithymic difficulty in identifying feelings was linked to increased use of outpatient treatment, after controlling for potential mediators. Difficulty identifying feelings also was related to the use of psychotherapy and analgesics, but these relationships were accounted for by increased depression and somatic complaints, respectively. The alexithymic preference for externally oriented thinking was independently linked with the decreased use of outpatient treatment, to not having psychotherapy, and to being more likely to obtain preventive dental care. Our results may explain contradictions in the literature; separate alexithymic characteristics have different relationships with different types of health care utilization.
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