Attitudes of Finnish doctors towards euthanasia in 1993 and 2003

Questionnaire studies on the attitudes of Finnish doctors towards euthanasia were conducted in 1993 and 2003, and the results show that they have not become more positive.The attitudes of doctors towards active euthanasia are, in general, more negative than the attitudes of the general public. The interpretations of surveys are, however, highly dependent on the formulation of the questions and, although the questions posed to these groups are similar, it is probable that the interpretations of doctors differ from those of the general public.According to most studies, most doctors, except those from The Netherlands, are against legalisation on active euthanasia. Considerable variation exists in the percentage of doctors opposing the practice. The variation is, of course, partly because of the variation in opinion, but several methodological issues also explain it. Some studies have asked direct questions about the legalisation of euthanasia—for example, in others, the questions have been about the ethical acceptance of the practice. Some studies have used case vignettes, whereas others have used general questionnaires. The knowledge and availability of palliative care may also affect the answers.¹The definition of euthanasia is of particular importance in the studies. The distinction between passive euthanasia (ie, withholding or withdrawing life‐saving treatment) and active euthanasia (ie, deliberately terminating the life of the patient with a lethal drug, for example,) has not always been clear.Although numerous studies with different methods have focused on the attitudes of doctors towards euthanasia and other practices at the end of life, we lack knowledge on possible changes in these attitudes. Legal changes in The Netherlands and Belgium, and open public discussion on these issues, most recently in the Council of Europe (http://assembly.coe.int/Documents/WorkingDocs/Doc03/EDOC9898.htm), may lead us to think that the attitudes of doctors have also become more positive. This study determined whether such a change had taken place in Finland.     

The WHO collaborative study on strategies for extending mental health care, III: Evaluative design and illustrative results

Teams in seven developing countries have adopted a common research design to evaluate new community mental health care services. The nature of the intervention programs varied considerably according to the characteristics of each area. Observations made before the intervention and 18 to 24 months after showed significant changes in the attitudes, knowledge, and diagnostic accuracy of health staff and in community attitudes and reactions. A considerable number of individuals with serious mental disorders received effective care for the first time.     

Exhaustive genotyping of the CEM15 (APOBEC3G) gene and absence of association with AIDS progression in a French cohort

CEM15 (or APOBEC3G) has recently been identified as an inhibitor of human immunodeficiency virus type 1 (HIV-1) replication in vitro. To evaluate the impact of its genetic variations on the progression of acquired immunodeficiency syndrome (AIDS), we have performed an extensive genetic analysis of CEM15. We have sequenced CEM15 in a cohort of 327 HIV-1-seropositive patients with extreme disease progression phenotypes--either slow progression or rapid progression--and in 446 healthy control subjects, all of white descent. We have identified 29 polymorphisms with allele frequencies >1%, 14 of which were newly characterized. There were no significant associations between the polymorphisms or haplotypes of CEM15 and a disease progression phenotype in our cohort.     

The azygos lobe: an unusual anatomical observation with pathological and surgical implications

The azygos lobe is a rare anomaly in broncho-pulmonary segmentation due to an unusual course of the azygos vein. Its radiological aspects are well known but there are few anatomical reports about its bronchial and vascular components. The authors describe the characteristic features in a particular case of the azygos lobe observed in the right lung after studying a fresh specimen and doing a casting of said specimen. This azygos lobe was in a position medial to the right upper lobe and above the hilum. It had the shape of an egg and was 5 cm high, 4 cm wide and 2 cm thick. The azygos fissure was of a vertical form. The lobe was ventilated by the posterior branch of the apical segmental bronchus (B1a). This latter was accompanied by two apical sub-segmental arteries (A1ai, A1aii) and the apical intersubsegmental vein (V1a). The new findings were that: first, the azygos lobe bronchus supplied a part of the right upper lobe; second, the passage of the azygos vein deformed the bronchus of the right upper lobe, and not that of the azygos lobe. This means that it was the right upper lobe, rather than the azygos lobe that was predisposed to the pathology. So, in excising this type of azygos lobe, particular precautions have to be taken to spare the bronchus of the azygos lobe that supplies the right upper lobe.     

Calorimetric determination of the absorbed dose to water for medium-energy x-rays with generating voltages from 70 to 280 kV

For medium energy x-rays produced with tube voltages from 70 to 280?kV, the absorbed dose to water, D(w), has been determined by means of water calorimetry with relative standard uncertainties ranging from 0.45% to 0.98% at 280 and 70?kV. The results were confirmed by Monte Carlo calculations, in which the ratios of D(w) at 5?cm depth in a reference water phantom to the air kerma free in air, K(a), at the same point in space were compared to the corresponding ratios determined experimentally. The general agreement between measurement and calculation was better than 1%. These results confirm earlier investigations in which the absorbed dose to graphite was determined by means of a graphite extrapolation chamber. For the Monte Carlo calculations, an attempt was made to present a complete uncertainty budget, taking into account type B contributions also.     

Dépistage de l’ischémie myocardique par l’échocardiographie de stress à la dobutamine chez le diabétique de type 2 à haut risque cardiovasculaire au Sénégal

Introduction

Diabetes is a major risk factor for coronary artery disease witch may develop insidiously. Several non-invasive methods are used to detect silent myocardial ischaemia, especially in diabetic patients at high cardiovascular risk. We project to screen, by dobutamine stress echocardiography, silent myocardial ischaemia in type 2 diabetics in Senegal.

Methodology

We randomly recruited in hospital in Senegal type 2 diabetics aged at least 40 years and a dobutamine stress echocardiography was performed in those selected according to the French Society of Cardiology and the French Language Association for the Study of Diabetes and Metabolic Diseases.

Results

Dobutamine stress echocardiography was performed in 79 diabetics at high cardiovascular risk, including 56 women. The average age was 58.8 ± 11.8 years. The exam was positive in 67.1% of cases (53/79), with a predominance of motion abnormalities in anterior territory (83%). Cardiovascular risk factors associated with positivity of test were microalbuminuria (p = 0.0001), inactivity (p = 0.0001), dyslipidemia (p = 0.0002), arterial hypertension (p = 0.001), smoking (0.003) and male sex (p = 0.004).

Conclusion

In Africa, dobutamine stress echocardiography has the advantage of its accessibility and its feasibility. Early detection of silent myocardial ischaemia in diabetics at high risk could optimize their care.     

Irreversible inflammation is associated with decreased levels of the alpha1-, beta1-, and alpha2-subunits of sGC in human odontoblasts

The nitric oxide (NO) receptor enzyme soluble guanylate cyclase (sGC) contains one prosthetic heme group as an αβ heterodimer, and two heterodimer isoforms (α(1)β(1), α(2)β(1)) were characterized to have enzyme activity. To test the irreversible inflammation-dependent regulation of sGC in odontoblasts, we incubated decalcified frozen sections of healthy and inflamed human third molars with antibodies against β-actin, nitrotyrosine, inducible nitric oxide synthase (iNOS), α(1)-, β(1)-, and α(2)-subunits of sGC and analyzed them at protein levels by quantitative immunohistochemistry. The irreversible inflammation induced an increase in the signal intensities for nitrotyrosine and iNOS and a decrease for the α(1)-, β(1)-, and α(2)-subunits of sGC in odontoblasts. Inflammatory mediators, reactive oxygen, and nitrogen species may impair the expression of the α(1)-, β(1)-, and α(2)-subunits in odontoblasts. The decrease of sGC at the protein level in inflamed odontoblasts is compatible with a critical role for sGC to mediate biological effects of NO in health.