Release planning for inmates with mental illness compared with those who have other chronic illnesses

The authors evaluated the effort of New Jersey jails to plan for the postrelease treatment needs of inmates with mental illness compared with inmates with heart disease and HIV infection or AIDS. Seventy percent of interviewees expressed a belief that release planning for persons with serious mental illness is very or extremely important. However, virtually all the jails reported providing "no real release planning." A majority of the jails provide aftercare plans for fewer than 10 percent of inmates with serious mental illness. A lack of release planning was noted for the other chronic conditions. Release planning for particular chronic problems is most common and complete in facilities with special treatment programs, such as a mental health unit.     

Estrogen and neuroprotection: from clinical observations to molecular mechanisms

We now appreciate that estrogen is a pleiotropic gonadal steroid that exerts profound effects on the plasticity and cell survival of the adult brain. Over the past century, the life span of women has increased, but the age of the menopause remains constant. This means that women may now live over one third of their lives in a hypoestrogenic, postmenopausal state. The impact of prolonged hypoestrogenicity on the brain is now a critical health concern as we realize that these women may suffer an increased risk of cognitive dysfunction and neurodegeneration due to a variety of diseases. Accumulating evidence from both clinical and basic science studies indicates that estrogen exerts critical protective actions against neurodegenerative conditions such as Alzheimer's disease and stroke. Here, we review the discoveries that comprise our current understanding of estrogen action against neurodegeneration. These findings carry far-reaching possibilities for improving the quality of life in our aging population.     

X‐linked dystonia (“Lubag”) presenting predominantly with parkinsonism: A more benign phenotype?

"Lubag," or Filipino X-linked dystonia, typically presents with either pure dystonia (that inexorably becomes generalized) or combined dystonia-parkinsonism. We report on three cases of Lubag presenting with isolated parkinsonism without dystonia or late-onset dystonia and a slower course.     

Thalidomide use in the US : experience with pregnancy testing in the S.T.E.P.S. programme.

INTRODUCTION: In 1998, thalidomide (Thalomid), a known human teratogen, was approved by the US FDA for the treatment of erythema nodosum leprosum. To prevent fetal exposure to thalidomide, a restricted distribution risk management programme, the System for Thalidomide Education and Prescribing Safety (S.T.E.P.S.), was implemented. All clinicians, pharmacists and patients who prescribe, dispense and receive thalidomide, respectively, are required to enroll in S.T.E.P.S. Sexually active females of childbearing potential must use two methods of birth control before, during and after treatment. These patients must also have a negative pregnancy test within 24 hours before beginning therapy and periodically while on therapy. The objective of this report is to summarise the patterns of thalidomide use and to describe the occurrence of positive pregnancy tests in females of childbearing potential while they were using thalidomide in the S.T.E.P.S. programme in the US. STUDY DESIGN/METHODS: A retrospective review of patients receiving thalidomide within the S.T.E.P.S. programme from September 1998 to 31 December 2004 to determine the occurrence of positive pregnancy tests whilst on treatment. RESULTS: Approximately 124,000 (43% female) patients were registered within the S.T.E.P.S. programme between September 1998 and 31 December 2004. Approximately 6,000 patients were females of childbearing potential, representing 5% of all patients and 11% of all female patients. Between 30 July 2001 and 31 December 2004, >88% of thalidomide use was for oncological conditions. There were 72 females of childbearing potential who had positive pregnancy tests. Sixty-nine of these patients had false positive pregnancy tests. Of the remaining three, one woman was pregnant while on thalidomide. This patient had an initial negative test and received thalidomide. Therapy was stopped when she had a positive pregnancy test. This pregnancy resulted in a miscarriage. Two additional patients were determined to be pregnant before receiving thalidomide. CONCLUSIONS: The S.T.E.P.S. programme is critical to managing the risks of thalidomide-associated teratogenicity. Sustained vigilance among health care providers and patients receiving thalidomide is essential to its continued success. Health care providers should be aware of the occurrence of false-positive pregnancy tests in females of childbearing potential receiving thalidomide.     

Invalidation: a central process underlying maltreatment of women with disabilities

Recent qualitative studies indicate that maltreatment of women with disabilities by health care providers is a serious quality of care issue. To begin to address this problem, we conducted a secondary analysis of data derived from three qualitative studies of abuse of women with disabilities. Findings identified Invalidation as a central process underlying maltreatment. Invalidation was characterized by health care providers Taking Over care, Discounting, Objectifying, and Hurting women with disabilities during health care encounters. These findings highlight the need to educate health care providers about social and interpersonal aspects of disability and address the problem of Invalidation in health care settings.     

Evaluation of misting controls to reduce respirable silica exposure for brick cutting

It is estimated that more than 1.7 million workers in the United States are potentially exposed to respirable crystalline silica, with a large percentage having been exposed to silica concentrations higher than the limits set by current standards and regulations. The purpose of this study is to characterize the use of water-misting engineering controls to reduce exposure to respirable crystalline silica for construction workers engaged in the task of brick cutting. Since data concerning the efficacy of engineering controls collected at worksites is often confounded by factors such as wind, worker skill level, the experiments were conducted in a laboratory environment. A completely enclosed testing chamber housed the brick-cutting saw. Respirable dust concentrations were measured using the Model 3321 Aerodynamic Particle Sizer. Specifically, the laboratory experiment was designed to compare dust suppression through water misting using conventional freely flowing water techniques. Brass atomizing nozzles with three flow rates were used for making this comparison: low (5.0 ml s(-1) or 4.8 gal h(-1)), medium (9.0 ml s(-1) or 8.6 gal h(-1)) and high (18 ml s(-1) or 17.3 gal h(-1)). The flow rate for freely flowing water, using manufacturer-supplied equipment, was 50 ml s(-1) (48 gal h(-1)). The experiment consisted of five replications of five samples each (low-misting, medium-misting, high-misting, freely flowing water and no control). The order of sampling within each replicate was randomized. Estimates of dust reduction showed that low-misting nozzles reduced the respirable mass fraction of dust by about 63%, medium-misting nozzles by about 67%, high-misting nozzles by about 79% and freely flowing water by about 93%. Based on these results, it may be feasible to use misting to control respirable silica dust instead of freely flowing water. This strategy is of practical interest to the construction industry which must frequently limit the amount of water used on construction sites.     

Unlicensed staff members' experiences with patients' pain on an inpatient oncology unit: implications for redesigning the care delivery system

Although unlicensed staff have routine contact with patients in pain, little research relates to their role with these patients. The purpose of this study was to describe the experiences of unlicensed inpatient hospital staff caring for cancer patients in pain. We sought to understand pain identification and communication practices, describe common practice situations, and identify training needs. We conducted 4 focus groups with unit secretaries, nurses' aides, and housekeepers (N = 24) on 2 inpatient oncology units at an urban, northeastern teaching hospital. Group processes were tape-recorded, transcribed, and analyzed using Atlas/ti software and content analysis. Analysis generated 5 issues related to pain in the daily practice of unlicensed staff: perceived function with pain, building relationships with patients, interpreting patients' pain, system issues, and job challenges and coping strategies. Unlicensed staff reported performing important functions related to pain, including alerting nursing staff to patients' pain, and providing psychosocial support. Participants shared difficulties of working with patients in pain and expressed interest in education on pain identification and course of illness. Findings provide insight into the role of unlicensed staff, and have implications for the educational preparation of this group as well as the nature of their participation in the care delivery system.     

Analysis of SCA-2 and SCA-3 repeats in Parkinsonism: evidence of SCA-2 expansion in a family with autosomal dominant Parkinson's disease

The spinocerebellar ataxias (SCAs) are progressive neurodegenerative disorders linked to more than 20 genetic loci. Most often, these diseases are caused by expansion of triplet repeats encoding polyglutamine (polyQ) tracts. The phenotype is variable and can cause a disease that overlaps clinically with Parkinson's disease (PD). l-Dopa-responsive parkinsonism with minimal cerebellar deficits has been described in SCA2 and SCA3. In order to define if mutation at these loci is a common cause of clinically defined parkinsonism we typed the SCA-2 and SCA-3 repeats for expansion in a series of 280 patients diagnosed with PD or parkinsonism. We identified one pathogenic expansion in SCA-2 in a North American family with autosomal dominant parkinsonism.