Architecture of research in psychiatry, 1953 to 1983

Although there has been one report on the trends in study design in general medicine, we are aware of none for general psychiatry prior to this communication. Accordingly, articles from the American Journal of Psychiatry (N = 194) and the Archives (N = 109) were randomly sampled for the years 1953, 1963, 1973, and 1983. Two raters achieved reliability (kappa = .82) for recognizing the major types of study design (cohort, clinical trial, case control, cross sectional, case report, and review). There was a significant change in study architecture over time, with the percentage of review articles declining and the percentage of case-control and cross-sectional studies increasing. Another major finding was a large increase in use of inclusion and exclusion criteria for diagnosis in non-review article studies. The general trends are for increasingly sophisticated research designs to be used in psychiatry research. The quality of research designs in psychiatry for 1983 also compares favorably with research designs found in a respected medicine journal.     

Concept and practice of international health in the Takemi program

The Takemi Program in International Health was established at the Harvard School of Public Health in 1983 as a research and advanced training program for midcareer health professionals concerned with the allocation of resources for health, especially in developing countries. This essay describes the origins of the Takemi Program and presents seven principles that underlie the concept and practice of international health in the Takemi Program. The principles are: research emphasis, policy orientation, interdisciplinary perspective, mutual respect, individual freedom, community spirit, and individual capacity building. The broader implications of these principles are suggested for current efforts to redefine the concept of international health.     

Phonatory reaction times of rheumatoid arthritic and normal females

This study examined the degree to which rheumatoid arthritis affects a speaker's ability to accomplish rapid vocal fold adjustments. The phonatory initiation, phonatory termination, and manual reaction times of 14 rheumatoid arthritic (RA) and 14 normal (NL) speakers were compared during a morning and an afternoon session. In addition, electroglottographic (EGG) measures (0 Hz-10 kHz bandwidth and 30 Hz-10 kHz bandwidth) allowed us to explore the components of each subject's reaction times. For two speech reaction-time tasks, temporal measures that reflected primarily mechanical adjustments of the vocal folds were significantly longer in the RA group than in the NL group. The two groups also differed significantly on manual response time, phonatory initiation time, and medial movement initiation time. Neither group displayed evidence of laryngeal morning stiffness.     

Technical fixes and other problems in saving lives in the world's poorest countries

4 types of impediments are suggested to the 3 kinds of technology that now promise great advances for health conditions in poor countries, i.e., the classical public health measures, the miracle drugs and machines of modern medicine, and the emerging processes of the new biology. These barriers -- the inherent limitations of technology, economic constraints on implementation, social and cultural obstacles to adoption, and the political processes of the health system -- are reviewed in an effort to clarify the role of technology in saving lives in the world's poorest countries. To start, it is necessary to recognize the inherent limitations of technical innovations in reducing mortality rates. A new drug, such as praziquantel, may be effective in humans in combatting the parasite responsible for schistosomiasis, yet as long as water supplies and snails remain contaminated and poor sanitation and water use habits persist, the cycle of disease transmission also may persist, meaning people can be reinfected. Disease control is affected critically by the interaction of society with the environment. Thus, the effectiveness of certain privately produced drugs in controlling disease depends on implementing the appropriate public health measures. Technology also has shown limited capability to eradicate diseases. The 1st and only successful case of intentional disease elimination is smallpox. Regarding economics, only 0.95% of the gross national product (GNP) in 22 low-income countries in sub-Saharan Africa went for the government's health budget. Government expenditures on health are limited. Poor countries traditionally have depended heavily on foreign assistance to provide health supplies, and recent cutbacks in US foreign aid have cut into the health programs of poor countries. The lack of a strong social infrastructure presents a major obstacle to the application of health technology in poor nations. Social behavior and cultural patterns also can interfere with the appropriate use of technology to improve health. The political forces within a country affect the role of technology in improving health conditions, and the politics of foreign assistance works to shape the health system of poor nations. Politics interferes most directly with health delivery in cases of social instability and open war. In sum, new technology is only 1 element in resolving the health problems of a society. Social as well as technical research needs to be conducted in the poor countries and in the world academies.     

Nitrous oxide does not exacerbate pulmonary hypertension or ventricular dysfunction in patients with mitral valvular disease

Using the rapid-response thermistor pulmonary artery catheter and transoesophageal echocardiography, this study examined the effects of 100 per cent oxygen, 70 per cent nitrous oxide/30 per cent oxygen, and 70 per cent nitrogen/30 per cent oxygen on the pulmonary circulation and ventricular function in ten patients with pulmonary hypertension. In comparison with baseline measurements, nitrous oxide administration resulted in small but statistically significant (P less than 0.05) changes in mean arterial pressure (76 +/- 14 to 67 +/- 12), mean pulmonary arterial pressure (37 +/- 14 to 33 +/- 13 mmHg), and cardiac output (3.7 +/- 1.4 to 3.2 +/- 1.1 L.min-1). Seventy per cent nitrogen resulted in no significant changes from baseline. The repeat 100 per cent oxygen measurements were nearly identical to the nitrous oxide measurements. It is concluded that nitrous oxide does not exacerbate pulmonary hypertension or ventricular dysfunction during high-dose fentanyl anaesthesia in patients with mitral valvular disease.