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Patient attitudes to sternotomy and thoracotomy scars.

BACKGROUND: There are no data comparing patient attitudes to sternotomy and thoracotomy scars following surgery for congenital heart disease (CHD). METHODS: Two hundred and one patients with a scar from CHD surgery (105 sternotomy, 36 thoracotomy, and 60 both scars) had a structured interview to explore attitudes to their scar. RESULTS: Comparable proportions of each group reported that they did not like or hated their scar (23/105 [22 %] sternotomy, 9/36 [25 %] thoracotomy, 17/60 [28 %] both scars). Significantly more patients stated that they where embarrassed by and/or their choice of clothing was affected by a thoracotomy scar (20/36, 56 %) than those with a sternotomy scar (36/105, 34 %), p = 0.04. This was also seen when comparing sternotomy alone with both scars (36/105 [34 %] vs. 34/60 [57 %], p = 0.008). CONCLUSIONS: Adults who have undergone surgery for CHD are more likely to have a negative attitude to a thoracotomy than a sternotomy scar. Before a change in surgical approach is considered based on patient preferences, the acceptability and psychological impact of the different scars following surgery needs formal study.

Adult↗

A Kleinian approach to group psychotherapy.

This article presents clinical material from a group that is now in its seventh year. The clinical material illustrates an aspect of the working through of depressive anxieties. The theoretical framework for understanding the material and my interventions is Bion's application of Klein's ideas. The clinical vignettes show how a group struggles with the split between good and bad characteristic of the paranoid-schizoid position (Ps) and the more integrated view of objects as both good and bad, characteristic of the depressive position (D). This more integrated view carries with it the capacity for both love and hate. One member's early memory of cruelty mobilizes other members' guilt toward their objects as well as their reparative wishes.

Adult↗

How do lesbian women develop serenity?

This article considers how lesbian women recover from alcoholism and develop serenity in the context of a homophobic society. We review what is known about the incidence and lethality of alcoholism in lesbian women. We critique Finnegan and McNally's (1987) five-stage conceptual framework of lesbian and alcoholic identity development, which is based on the disease model of recovery. We present our own model, based on our own recovery experiences. The Deevey-Wall model describes factors that may determine how shaming social environments may affect drinking behavior and recovery in lesbian women. In conclusion, we explain Wall's theory of self-hate as a survival mechanism in traumatically hostile environments.

Adaptation, Psychological↗

Challenging heterosexism in college health service delivery.

The empowerment and affirmation of lesbian, bisexual, and gay students is long overdue. This article explores how human immunodeficiency virus and acquired immune deficiency syndrome (HIV/AIDS), substance abuse, violence and hate-related crimes, suicide, and heterosexism all adversely affect the physical and emotional health of nonheterosexual college students. College health services must expand their current scope and practice and assume a leadership role in combating all forms of oppression by actively incorporating and addressing the unique health issues and needs of the lesbian, bisexual, and gay population. This article provides a brief overview of the relevant healthcare issues for lesbians, bisexuals, and gays; examples of heterosexism in college health services; and recommendations for institutional and personal and professional change.

Bisexuality↗

Overview of dietary sodium effects on and interactions with cardiovascular and neuroendocrine functions.

The battle over salt has changed over the centuries from one of where to find salt sources to one of how much salt to use in a healthful manner. Many questions were answered by the INTERSALT Study across numerous countries and, yet, many questions persist. It is a love-hate relationship, an approach-avoidance paradigm. We need it but in excess it may cause harm. Questions that still remain are, Who is salt sensitive? What are the most appropriate and relevant models to study? What are the functional differences of the many salt effects? Can the data support a single public policy on dietary sodium recommendations? The following review examines some of these questions and the interaction of neural, neuroendocrine, renal, and social factors in the great salt debate. Dietary sodium can alter peripheral and central neurotransmitter concentrations, receptor density, and sensitivity. Low-sodium diets can produce acute neuroendocrine and neural compensations that are different from the chronic effects of low dietary sodium. Chronic high- or low-sodium diets may also cause trophic hormonal changes that can influence resistance vessel structure and, consequently, blood pressure. Both human and animal studies suggest a genetic basis for salt sensitivity. In some cases stress unmasks the salt sensitivity. For instance, the social context can modulate blood pressure responses to a high-sodium diet. Therefore, 24-h monitoring of blood pressure becomes important, especially in salt-sensitive persons.

Animals↗

Using the FoodEx-LTC to assess institutional food service practices through nursing home residents' perspectives on nutrition care.

Background. Undernutrition occurs in approximately 2 of every 5 nursing home residents, negatively influencing their health and quality of life. The purposes of this study were to collect data about institutional meal preparation and food service practices that promote or retard adequate nutritional intake and to evaluate residents' food and food service satisfaction. Methods. The FoodEx-LTC, a simple, 44-item, 5-subscale questionnaire that measures food and food service satisfaction, was administered to 61 residents. Serum albumin and body mass index gauged the nutritional status of each resident. SPSS for Windows, version 10, was used for analyses. Results. Overall, 89% of residents were satisfied or somewhat satisfied with the food service. Of those who ate in the dining room, 44% had to wait to go back to their rooms, presenting a quality of life issue. Fifty-two percent received food they hated, 56% often received the same food, and 59% received food always cooked the same way. Most residents (75%) felt comfortable refusing food they did not like, but 65% did not complain. Most (79%) wanted to choose what to eat, but only 54% believed that choosing when to eat was important. Conclusions. The FoodEx-LTC, used to monitor nutrition care in nursing homes, incorporates residents' views into service delivery and responds to the Health Care Finance Administration's Nutritional and Hydration Awareness Campaign, part of the federal Nursing Home Initiative. Using the FoodEx-LTC to identify residents' perspectives may promote resident satisfaction and dietary intake through adaptation of nursing home food and food service practices.

Aged↗

Knowledge, risk perception of AIDS and reported sexual behaviour among students in secondary schools and colleges in Tanzania.

A questionnaire survey was carried out among 1041 students in secondary schools and colleges in Dar-es-Salaam, Tanzania to evaluate the relationship between HIV-risky sexual behaviour and anti-condom bias, as well as with AIDS-related information, knowledge, perceptions and attitudes. Self-reportedly, 54% of students (75% of the boys and 40% of the girls) were sexually active, 39% had a regular sexual partner and 13% had multiple partners in the previous year. The condom use rate was higher than previous reports. However, 30% of sexually active respondents did not always use condoms (Risk-1 behaviour) and 35% of those with multiple partners in the previous year did not always use condoms (Risk-2 behaviour). Multiple logistic regression analyses indicated that 'sex partner hates condom' had association with both Risk-1 behaviour (OR 2.47; 95% CI 1.58-3.85) and Risk-2 behaviour (OR 2.47; 95% CI 1.10-5.48). 'Use of condom prevents HIV infection' also had association with both Risk-1 behaviour (OR 2.09; 95% CI 1.19-3.67) and Risk-2 behaviour (OR 3.73; 95% CI 1.28-11.03). Students engaging in risky behaviour were aware of the risk, even though they failed to change their behaviour. Reasons for the AIDS epidemic among Tanzanian students and the importance of more effective AIDS education are also discussed.

Adolescent↗

Liposome-medicated gene transfer and expression via the skin.

A beta-galactosidase gene expression construct was used to investigate the effectiveness of gene delivery and expression when DNA/liposome complexes were topically applied to mouse skin in vivo. DNA was complexed with commercial preparation of N-[1-(2,3-dioleoyloxy)propyl]-N,N,N-trimethyl-ammonium-methyl-sulp hate (DOTAP) in a ratio of 1:1.6 (w/w). The DNA rapidly penetrated the skin and was expressed in the epidermis, dermis and hair follicles. A DNA concentration of 267 microgram/ml DNA was found to be optimal for efficient transfection. Expression was seen as early as 6 h post-application, persisted at high levels 24 and 48 h post-treatment, but was markedly reduced by 7 days after application. In conclusion, utilising a commercially available liposome preparation, topically-applied DNA/liposome complexes can be efficiently delivered and expressed in several cell types within the skin. This simple, non-invasive technique may have implications for a number of gene therapy applications.

Administration, Cutaneous↗

Is chronicity a function of the relationship between the person and the auditory hallucination?

Thirty psychiatric inpatients each rated their relationship with their auditory hallucination using the Structural Analysis of Social Behavior questionnaires which assess partnerships in terms of interpersonal focus, love-hate, and enmeshment-differentiation. Results showed that all subjects had integrated, interpersonally coherent relationships with their voice. Qualitative differences in the nature of the relationships related meaningfully to diagnosis. Selected clinical excerpts suggested that the relationship with the hallucination may serve an adaptive function. Chronicity may be dependent on the nature of that adaptation.

Chronic Disease↗

Managing 'civilian deaths due to war operations': Yorkshire experiences during world war II.

Air raid precautions prior to and during the Second World War included guidance on the burial of civilians who had been killed by enemy bombardment. The Ministry of Health Circular 1779 was published before the start of the war, on the understanding that 'scheme-making' authorities would need time to prepare for the interment of mass fatalities. As the Blitz got underway, tensions emerged between the state's pragmatic concerns to restrict the cost and resources afforded to burial, and the wish of many local authorities to secure decent burial for their citizens. Key issues on which there was disagreement included the state-proposed use of shrouds instead of coffins, and mass interment. These practices carried overtones of the much-hated pauper funeral and ran counter to the political imperative to present civilian death as 'heroic'. This local study is placed in the wider context of the history of death and burial, and provides an indicator of the strength of attachment to customary funerary ritual during the middle of the twentieth century.

Death↗

What should we do about Eduard Pernkopf's atlas?

Eduard Pernkopf created a classic anatomy atlas during World War II. He was also an ardent Nazi. Questions have been raised recently about the propriety of using an atlas created by a Nazi and illustrated by dissections of cadavers whose identities are unknown, but who could have been victims of Nazi political terror. To examine the ethical issues involved, the author first reviews recently published work regarding Pernkopf and his atlas, with the caution that facts are few in a debate where emotions run high and opinions abound. He then considers what has been written by bioethicists on the use of scientific data from the Nazi era and how those arguments might apply to Pernkopf and his atlas. Important questions remain, however. For example, are scientific data tainted by their associations with Nazism, or should such data (including the atlas) be assessed on their own merits, separate from the persons and ideologies involved in their creation? Finally, the author offers his own perspective as a young gross anatomist and physician. He argues that rejecting the hateful beliefs of Pernkopf and his fellow Nazis does not necessitate rejecting the elegant anatomic images they produced. The author further suggests that use of the atlas is itself the most fitting tribute to those who died for it, whether they were victims of Nazi repression or not. Those cadavers not only teach anatomy, they "can remind us of suffering not only in the past but in the present, that we may be more compassionate physicians, more compassionate citizens of the world."

Anatomy, Artistic↗

Iranian kidney donors: motivations and relations with recipients.

PURPOSE: The motivations of Iranian kidney donors and donor-recipient relationships are clarified. MATERIALS AND METHODS: A 13-page 69-item questionnaire was completed by 100 donors and interviews were videotaped. RESULTS: Of the donors 90% did not knew the recipients preoperatively and only 13% had any information on recipient fate postoperatively. In 87% of cases there was no postoperative relationship. Because of recipient failure to appreciate the donors and refusal to realize preoperative promises 51% of donors hated the recipients and 82% were unsatisfied with their behavior. Motivations for donating were purely financial in 43% of cases and mainly financial with a minor altruistic component in another 40%. Of the donors 76% agreed that kidney sale should be banned and if there was another chance they would prefer to beg (39%) or obtain a loan from usurers (60%) instead of vending a kidney. All 6 related donors were paid. The goals of vending were achieved not at all by 75% of donors. CONCLUSIONS: None of the donors studied fulfilled the criteria of compensated donation or donation with an incentive and 97% were vendors. All evidence shows that the donor-recipient relationship in Iran is pathological with no similarity to the emotionally related category of transplantation. Reports by the reformist Iranian press, which have all been banned, show that our sample is a good representative of other Iranian donors. Almost none of the criteria of an acceptable living unrelated renal donor transplant program is met in Iran. The opinion of kidney donors should be regarded as the final arbiter when labeling the act as a sale or donation and it should be considered in discussions of living unrelated donor transplantation.

Adult↗

The future of analysis.

The aim of analysis is to enable our patients to differentiate themselves from their past. The question we face as analysts is whether we are in fact neurotically bound to repeat the past. This paper addresses this question by considering some of the reasons that there is a 'crisis in analysis'. Two central problems within the practice of analysis are identified as contributing to this 'crisis': 1) a view of the patient as 'enemy', or as innately destructive; and 2) a trend towards here-and-now interpretations within the transference which disregards history and the role of external reality. The danger of such an approach is that it does not allow patients to separate from their hateful primal scenes and to become free of neurotic guilt. When we are anxious about our own destructiveness and aggression and do not link this to a failure to form a loving relation, we run the risk of fostering compliance and conformity within our patients and within our own professional societies. In contrast, it is the recognition of the past and its influence on the present that makes analysis a tool for revolution.

Adult↗

Strategic alternative responses to risks of terrorism.

The terrorist acts of September 11, 2001 were a wake-up call for changing our traditional response to risks of terrorism. Given that government and worldwide think-tank organizations maintain that risks of terrorism will continue for the indefinite future, the following questions deserve strategic answers. How long can we respond to terrorism with tactical measures only, sustain current curtailments of some of our freedoms, travel, and quality of life, and absorb losses in human life and properties? Should not underlying strategic motivation lead to the tactical measures? Why do so many groups and individuals in some developing countries hate us? Is it because they fear that the ideas we export through television, movies, literature, and music have a corrupting influence on their cultures? Is it because of past operations that we conducted in such countries as Iran, Nicaragua, El Salvador, and Granada? Can the genesis of the risks of terrorism to the homeland be traced to the unfavorable socioeconomic conditions in less-privileged and developing countries, where civil and religious freedoms are close to nonexistent, and sanitary conditions, health and education, and critical infrastructures of essential utilities are almost at the same level that existed in the United States almost a century ago? If we could make progress at improving the quality of life of the billions of people in the developing countries and become more sensitive to their needs, cultures, and heritage, would their hatred subside? What other measures can we take to reduce their hatred, without compromising our basic cultural and democratic principles or their cultural and social heritage?

Journal Article↗

Studies on sensitivity to racemization of activated residues in couplings of N-benzyloxycarbonyldipeptides.

A series of 24 peptides Z-Gly-Xaa(R)-OH where Xaa = 15 different residues and R = H, NH2, tBu, Bzl, Trt, Mtr, and StBu were coupled with valine benzyl ester in dimethylformamide or dichloromethane at +5 degrees. The accompanying racemization was determined by analysis of the epimeric products by normal phase high-performance liquid chromatography (HPLC) for Xaa(R) = Met, Cys(StBu) and Lys(Z) and by reversed-phase HPLC after removal of benzyl-based protecting groups for Xaa(R) = Ser(tBu), Thr(tBu) and Arg(Mtr). The coupling methods examined included mixed anhydride (MxAn) at -5 degrees, and N,N'-dicyclohexylcarbodiimide (DCC), benzotriazol-1-yl-tris(dimethylamino)phosphonium hexafluorophosphate (BOP) and O-benzotriazol-1-yl-N,N,N',N'-tetramethyluroniumhexafluorophosp hate (HBTU) in the presence of 1-hydroxybenzotriazole (HOBt). Very few couplings gave stereochemically pure products. The order of sensitivity to racemization of residues depended on the method of coupling and the solvent. It varied most when comparing MxAn to HOBt-assisted reactions; it varied moderately when comparing HOBt-assisted reactions. There was less variation in comparing BOP and HBTU reactions that are initiated by the same mechanism. Leu, Nle, Phe, Asn, Lys(Z) and Asp(OBzl) are identified as the residues least sensitive to racemization. DCC-HOBt generally led to less epimerization than the other methods.

Dipeptides↗

Semisynthetic derivatives of inositol 1,4,5-trisphosphate substituted at the 1-phosphate group. Effects on calcium release from permeabilized guinea-pig parotid acinar cells and comparison with binding to aldolase A.

Derivatives of inositol 1,4,5-(tris)phosphate [Ins(1,4,5)P3] substituted at phosphate 1 were compared with respect to their calcium releasing effect in permeabilized guinea pig parotid acinar cells and to their inhibitory action on aldolase A. sn-Glycero(3)-1-phospho-D-myo-inositol-4,5-(bis)phosphate, but also glycolaldehyde(2)-1-phospho-D-myo-inositol-4,5-(bis)phosphate [GcaPIns(4,5)P2] and its derivative N-octyl-aminoethanol(1)-1-phospho-D-myo-inositol-4,5-(bis)phosphate stimulated calcium release and inhibited aldolase A. The relative efficacy of the different derivatives of Ins(1,4,5)P3 was similar for both effects. N-Hydroxyethyl-2-aminoethanol(1)-1-phospho-D-myo-inositol-4,5-(bis)phosp hate [HeAetPIns(4,5)P2], another derivative of GcaPIns(4,5)P2 was considerably less effective on both parameters than the other Ins(1,4,5)P3 derivatives. Although the concentration leading to half-maximal activation of calcium release varied from 1.7 microM for Ins(1,4,5)P3 to 128 microM for HeAetPIns(4,5)P2, the maximal effect was the same for all derivatives. The results indicate that the 1-phosphate group of Ins(1,4,5)P3 can be modified without or with only minor loss of biological activity. This may be utilized for future studies aiming at elucidating the putative Ins(1,4,5)P3 binding site.

Animals↗

Dreams of anorexic and bulimic women. A research study.

The research paradigms used in this study fit with the content analysis paradigms of Hall and Van de Castle (1966) and Dippel et al. (1987), but differ in the use of descriptive scenarios specific to eating disorders. Anorexic and bulimic patients are often able to share their dreams with their therapists, and this process is sometimes the start of building an analytical relationship. This study compared the dreams of twelve eating-disordered women with eleven 'normal' women. A total of 275 dreams was collected over a four-week period and rated on a 91-item scale (Brink 1991) by eight raters. Significant differences were found between the two groups, with eating-disordered women having more dream scenarios depicting themes of: impending doom at the end of the dream, attitudes of 'whatever I do I won't succeed', and images of the dreamer being attacked, and being watched. Significant differences were also found in dream content portraying the psychological traits of: ineffectiveness, self-hate, negative emotions, an inability to self-nourish, obsession with weight, and anger. The discussion centres around the role of 'inordinate oral rage', the nature of ego defences, how these defences manifest themselves in dream images and in daily living, and how they severely impair positive transformative processes. The implications for clinical practice are that dreams are an amenable way of working with eating-disordered women, and that the therapist is more likely to promote positive transformation through focusing on their dreams than trying to change their behaviour.

Adult↗

Forgivingness, vengeful rumination, and affective traits.

Trait forgivingness is the disposition to forgive interpersonal transgressions over time and across situations. We define forgiveness as the replacement of negative unforgiving emotions with positive, other-oriented emotions. Rumination has been suggested as a mediator between forgivingness and emotional outcomes; however, we suggest that different content of rumination leads to different outcomes after transgressions. In four studies of 179, 233, 80, and 66 undergraduate students, trait forgivingness was negatively correlated with trait anger, hostility, neuroticism, fear, and vengeful rumination and was positively correlated with agreeableness, extraversion, and trait empathy. The disposition to ruminate vengefully mediated the relationship between trait forgivingness and (1) anger-related traits and (2) both revenge motivations and state anger following a specific recent transgression, but it did not mediate between forgivingness and (1) fearfulness and (2) avoidance motivations following a specific transgression. Self-hate statements, a proxy for depressive rumination, mediated the relationship between forgivingness and both depression and fearfulness but not the relationship between forgivingness and trait anger. Future research should distinguish the contents of mental rumination following interpersonal transgressions.

Adult↗