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Recruitment of voluntary non-remunerated apheresis donors: the second five years' experience in Shenzhen.

The voluntary non-remunerated blood donation campaign in Shenzhen, China, was launched in 1993 and the smooth change from paid donors to unpaid took only a decade. In the first half the volunteer donation system and a sufficient blood supply was promoted and this paved the way for further development in the second half during which the non-remunerated donation system became substantial and integral due to recruitment for plateletapheresis and peripheral stem cells donation as well as whole blood donations. Ninety percent of the donors registered for plateletapheresis do donate and none of the twenty-three non-related donors with matched HLA genotypes broke their promise to donate their peripheral stem cells.

Altruism↗

Reported willingness among adolescent nonsmokers to help parents, peers, and others to stop smoking.

BACKGROUND: This study of 1025 adolescent nonsmokers aged 11-19 years examined level of interest and factors associated with reported willingness to help someone stop smoking. METHODS: Data were collected from a survey distributed primarily in the schools at four geographic and ethnically diverse study sites. RESULTS: A total of 692 adolescents identified someone close to them who smokes whom they thought should quit. Of these, 90% reported that they would be willing to help this person stop smoking. Multivariate predictors of willingness to help were female gender, less difficulty reading English, and greater level of comfort with talking to the smoker about their smoking. The smoker that the adolescents were willing to help was most often a parent or same age friend. CONCLUSIONS: If this strong interest among adolescents could be tapped, engaging teens as support persons could be a novel public health approach to reaching parents, adolescents, and other smokers in the population.

Adolescent↗

Lifesavers and Samaritans: emergency use of cellular (mobile) phones in Australia.

BACKGROUND: There has been highly publicised concern about possible radiation health effects from mobile phones and towers, but scant attention has been paid to the use of mobile phones in reducing notification times in emergencies. METHOD: National random telephone survey of Australian mobile phone users (n = 720) and extrapolation to national user population (n = 5.1 million). FINDINGS: Using a cellular phone, 1 in 8 users have reported a traffic accident; 1 in 4 a dangerous situation; 1 in 16 a non-road medical emergency; 1 in 20 a crime; and 1 in 45 being lost in the bush or being in difficulty at sea. INTERPRETATION: Any debate about the net health impact of mobile phone proliferation must balance possible negative effects (cancer, driving incidents) with the benefits from what appears to be their widespread use in rapidly reporting emergencies and in numerous acts of often health-relevant 'cellular Samaritanism'.

Accidents, Traffic↗

Mechanisms of atrioventricular junctional tachycardia. Role of reentry and concealed accessory bypass tracts.

Electrophysiologic investigations with programmed stimulation of the human heart have clearly established the participation of the atrioventricular (A-V) junction in three different types of junctional reciprocating tachycardia: (1) paroxysmal supraventricular tachycardia in the Wolff-Parkinson-White syndrome: (2) the vast proportion of "paroxysmal atrial tachycardia" without evidence of preexcitation during sinus rhythm with antegrade conduction; and (3) the permanent or almost permanent (chronic relapsing) form of supraventricular tachycardia with its characteristic rate-dependent initiating mechanism. The obvious presence of the Wolff-Parkinson-White syndrome during sinus rhythm does not necessarily imply that the accessory pathway will be utilized during supraventricular tachycardia. Conversely, in the absence of preexcitation, the mechanism of A-V junctional reciprocating tachycardia has been traditionally attributed to pure intranodal dissociation, often without definite direct proof. Concealed accessory pathways (with unidirectional block) may be more frequent than realized and should be carefully searched for. Proof that supraventricular tachycardia utilizes an accessory pathway for retrograde conduction to the atrium often requires meticulous electrophysiologic studies- Conslucions based on the absence of various findings may be misleading. Emphasis must be placed on positive viagnostic features. One or more of the following observations may prove or disprove participation of a Kent bundle during supraventricular tachycardia: (1) induction of A-V block during tachycardia: (2) influence of electrically induced ventricular premature beats upon tachycardia; (3) patterns of retrograde atrial activation during tachycardia; or (4) influence of functional bundle branch block on the rate of the tachycardia. Analysis of events at the onset of rather than during the tachycardia is probably less important but may also provide suggestive clues about the mechanism of reentry. Observation of the following variables may be helpful: (1) behavior of antegrade conduction at the onset of tachycardia; (2) relation of atrial and ventricular activation at the onset of tachycardia; (3) presence of retrograde ventriculoatrial (V-A) conduction; (4) prolongation of the H-V interval at the onset of tachycardia; and (5) atrial stimulation at various sites. Precise understanding of the pathophysiology of supraventricular tachycardia is important because specific therapy (pharmacologic, pacemaker or surgical) may ultimately depend on accurate knowledge of the underlying mechanisms.

Anti-Arrhythmia Agents↗

Potentiation of the excitatory action of NMDA in ventrolateral periaqueductal gray by the mu-opioid receptor agonist, DAMGO.

Several lines of evidence have suggested that mu-opioids, generally regarded as inhibitory, also have effects that stimulate neural activity. To look for possible excitatory opioid action in the rat periaqueductal gray (PAG), we first re-examined data from a previous study and found that met-enkephalin could evoke a delayed, sluggish excitation, suggestive of modulation by the opioid on the action of certain excitants. This observation, coupled with other studies that show mu-opioids can modulate NMDA receptor activation, prompted us to perform extracellular recording of the responses of single ventrolateral PAG (vlPAG) neurons in brain slices to DAMGO, a mu-opioid, and to NMDA. When applied alone, DAMGO at nM concentrations, like met-enkephalin, often evoked the delayed excitation and occasionally an inhibition. When applied after a brief exposure to NMDA, DAMGO at doses as low as 0.1 nM potentiated the excitation produced by a subsequent pulse of NMDA. This occurred, depending on cell type, in 23-100% of vlPAG neurons. The potentiating action of DAMGO was blocked by naloxone, suggesting it was mediated by mu-opioid receptors. Characterization of these mu-opioid actions revealed that the potentiation and the delayed excitation, unlike the inhibition, was not blocked by another opioid antagonist, nalmefene, nor by an inhibitor of the G protein of the G(i) class, N-ethylmaleimide. Moreover, the potentiating action was distinct from the inhibition in that it was: (a) enhanced by repeated opioid applications, (b) exhibited low effective doses, (c) had a long time course (minutes to develop and last tens of minutes) and (d) was present in distinct though overlapping cell populations. These data reveal an unconventional action of opioids in PAG neurons, that is, a potentiation of excitation produced by NMDA. This effect appeared mechanistically distinct from opioid inhibition or disinhibition and may be related to established examples of direct opioid excitation. These observations may help understanding behaviorally important mechanisms linked to acute and chronic opioid functions in the vlPAG.

Action Potentials↗

Nurses' experiences of the encounter with elderly patients in acute confusional state in orthopaedic care.

The aim of this study was to illuminate nurses' experiences of the encounter with elderly patients who developed acute confusional state (ACS) in orthopaedic care. Forty-eight nurses with professional background as registered (n=26) or licensed practical nurses (n=22) who took part in the nursing care of acute confused patients were involved. Open-ended unstructured interviews were conducted with regard to the course of events, experiences and interpretation of what had happened during the ACS as well as the nurses' actions and encounter with the confused patient. The texts were analysed using manifest and latent content analysis, revealing that the nurses had difficulties in reaching the patients and their reality, and thus in understanding their experiences. Interpretation of the nurses' experiences showed that the nurses found it difficult to reach the patients' reality because the patients were in a divided and/or different world. They interpreted the patients as seeking solitude or company, keeping a distance or being suspicious of the nurses. The findings indicated that the interaction in the encounter between the acutely confused patients and the nurses indicated insufficient and/or broken reciprocity. The nurses used various strategies to meet the patients, being a companion and/or being a surrogate. They acted in the encounter based on their view of the patient and their ability to enter into and understand the patients' situation. The strategies were more or less successful, sometimes resulting in contact and calming the patients and in other cases increasing the patients' irritation and anger. The results were more successful when the strategies were derived from the nurses' interpretation of the patients' situation and the nurses paid attention to the patients and confirmed them.

Acute Disease↗

Evolutionarily stable strategies of mutual help between relatives having unequal fertilities.

The evolutionarily stable strategy of mutual help between relatives having unequal fertilities is studied in a kin selection model, which also takes into account competition between kins and the possibility of reciprocation. It turns out that competition and reciprocation can establish ESSs which are completely different from those expected by Hamilton's basic theory.

Altruism↗

Older women with breast cancer: perceptions of the effectiveness of nurse case managers.

BACKGROUND: There are many challenges that an older woman and her family face when diagnosed with breast cancer. Utilizing community-based nurse case managers may influence the older client and her family to adapt to the many challenges associated with the diagnosis and treatment of breast cancer. PURPOSE: The purpose of this qualitative study is to describe how older breast cancer clients perceive community-based nurse case managers. From findings generated, recommendations were developed to improve the practice of community-based nurse case managers. METHOD: A randomized prospective trial to evaluate the effect of nurse case management on the treatment of 106 older women with breast cancer provided data for this content analysis. Older women (>65 years of age) newly diagnosed with breast cancer cared for by 60 surgeons practicing at 13 community and 2 public hospitals in southeast Texas were invited to participate. DISCUSSION: Community-based nurse case managers made a positive impact on older women with breast cancer by helping in managing coexisting medical conditions, providing support, providing education, giving assistance with activities of daily living (ADLs), and helping to navigate through the health care system. To increase their effectiveness, it was recommended that nurse case managers communicate well, be well educated about breast cancer, have standard gerontology nurse case management training, and integrate multiple support systems when caring for older clients with breast cancer. CONCLUSION: There are unique challenges that an older woman and her family face when diagnosed with breast cancer. Utilizing community-based nurse case managers may influence the client and her family to adapt to the many challenges associated with the diagnosis and treatment of breast cancer. Community-based nurse case managers can make a positive difference on the outcomes of older women with breast cancer.

Activities of Daily Living↗

Adrenal function predicts demoralization after losses.

Stressful experiences can cause disturbances in the hypothalamic-pituitary-adrenocortical axis and the sympathetic-adrenomedullary system. The authors hypothesized that assessments of adrenal function made in the circumstances of stressful losses would predict outcome 1 or 2 years later. The authors collected 24-hour urinary free cortisol, serum cortisol, and 24-hour urinary catecholamines 2 months after intake and used these measures as predictors of depression, anxiety, hopelessness/helplessness, unresolved grief, self-rated health, and help-seeking behavior on follow-up at 13 and 25 months. Adrenal function in the circumstances of a loss predicted only demoralization scores (hopelessness/helplessness) on follow-up.

Adrenal Insufficiency↗

Prosocial behaviours of young adolescents: a focus group study.

This study investigated young adolescents' perceptions of their peers' prosocial behaviours. In eight focus groups, 53 11- to 13-year olds described specific prosocial acts of their peers. Results suggest that traditional research has not addressed the diversity of prosocial behaviours that youth enact, nor emphasized behaviours that are salient to young adolescents. Such behaviours included standing up for others, encouraging others, helping others develop skills, including others who are left out, and being humorous. Facilitating emotional regulation of others emerged as an important component of prosocial behaviour. These data can help guide future research on prosocial development to include a broader array of authentic behaviours of young adolescents.

Adaptation, Psychological↗

Friendship patterns.

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Adaptation, Psychological↗

Depressive disorders and personality variables in HIV positive and negative intravenous drug-users.

BACKGROUND: Only a few reports investigated the prevalence of depression in intravenous drug-users with HIV infection, including both asymptomatic and symptomatic subjects. In the same group, the association of depression and personality diagnoses was also poorly researched. METHODS: A consecutive sample of intravenous drug-users was collected from patients admitted to an infectious disease clinic, another random sample was taken from out-patients attending a methadone maintenance treatment program. Subjects were first screened with the Hospital Anxiety and Depression Scale, and then all positive subjects were evaluated with the Composite International Diagnostic Interview. Depression was diagnosed according to DSM-IIIR. In-patients were also given a structured personality inventory (Karolinska Psychodynamic Profile). RESULTS: HIV-positive patients had a high rate of depression (major depression 36.2%, dysthymic disorder 7.1%) when compared to HIV-negatives (15.7 and 3.9%, respectively). In-patients had the highest rate of depression, irrespective of HIV clinical staging. A personality disorder was diagnosed in 36% of the sample, but these subjects were no more significantly depressed. LIMITATIONS: Poor detection of depression by the admitting physician may have led to selective hospitalization of patients with both HIV and mood disorder. The composition of the sample may also be biased by the help-seeking behavior of HIV patients who are also depressed. CONCLUSION: Physicians treating AIDS patients should be alerted to the high rate of depression in clinical HIV illness, in order to identify and properly treat depression.

Adult↗

Patterns of cognitive decline in aged rhesus monkeys.

Although cognitive decline has been well established as a consequence of aging in non-human primate models, the prevalence or frequency of impairment for specific age ranges has not been described. The first aim of this study was to estimate prevalence of cognitive impairment on each of the six tests of cognitive performance by comparing the performance of early-aged (19-23 years old), advanced-aged (24-28 years old), and oldest-aged (29+ years old) monkeys to that of young adults (< 15 years old). The second aim was to derive a single overall measure of cognitive performance to help classify behavioral function in our aged monkeys. Accordingly, we obtained performance measures for these age groups on six behavioral measures: (1) acquisition of the delayed non-matching-to-sample task (DNMS); (2) performance of the DNMS with a delay of 120 sec; (3) the spatial condition of the delayed recognition span test (DRST); (4) the color condition of the DRST; (5) spatial reversal learning; and (6) object reversal learning. Early-aged monkeys displayed prevalence rates of impairment significantly greater than zero on all tasks except the DRST-color. The highest prevalence of impairment was observed in this age group in a task measuring spatial memory (DRST). Significant trends toward progressively higher impairment rates in advanced-aged and oldest-aged monkeys were observed for DNMS-acquisition, DRST-color and spatial reversal learning tasks. A linear transformation of standardized scores on the six cognitive tests was derived by means of principal components analysis (PCA). The first PCA (PCA1) included data from 30 monkeys with available data on all six measures, and yielded a composite measure which declined linearly with increasing age (r = -0.74). A second PCA (PCA2) was performed on data from 53 monkeys for which three test scores (DNMS-acquisition, DNMS-120s delay, and DRST-spatial condition) were available. The composite score derived from this analysis was highly correlated (r = 0.93) with the composite score from PCA1, suggesting that a score based on only three tests may provide an adequate classification of global cognitive ability.

Aging↗

Geriatric psychiatry in primary care. A focus on ambulatory settings.

Considering how tightly interwoven are the strands of mental and physical health in the fabric of late life, it would be unwise for psychiatrists and primary care physicians to continue to insist on separately tracing and mending frayed old threads, each in mostly one direction, occasionally irritated by the shortcomings in the others work, and only occasionally seeking or offering assistance. As reflected in their help-seeking behavior and their characterization of suffering, the elderly often do not see, or do not choose to recognize, the theoretical and professional distinctions we hold so dear. Acknowledging the impact of the unmet needs of elderly patients, and respecting the wisdom of their choices, primary care physicians and psychiatrists have an obligation to work together more effectively. Improved mental health in our geriatric patients will require major efforts in the areas of research, public education, health care funding, and community resource development, as well as in individual patient care. Medical disciplines working in isolation or in opposition will not attenuate these obstacles effectively.

Aged↗

Bystanders.

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Accidents, Traffic↗