The politics of normalization.

The concept of normalization is an influential paradigm in mental health. However, little attention has been paid to how the psychiatrically disabled fare in the competition for generic services. Four psychiatric aftercare areas were examined: income maintenance, housing, vocational-educational, social-recreational. Results indicate that generic services do not successfully support the chronic patient in three of the four areas examined. Only in the field of vocational-educational support have generic agencies made a serious effort, and even here the most seriously disabled patients still rely on specialized services. The authors suggest that the theory of normalization is constructed on fundamentally erroneous assumptions and discuss alternative rather than normative programs for the long-term mentally ill.     

Hemagglutination inhibition of Cromer blood group antibodies with soluble recombinant decay-accelerating factor

BACKGROUND: Cromer blood group antigens are located on decay- accelerating factor (DAF, CD55), which contains four short consensus repeats (SCRs). Cromer system antibodies may be of clinical significance in blood transfusion. STUDY DESIGN AND METHODS: Soluble recombinant DAF (srDAF) constructs, consisting of all four SCRs or of only two SCRs, were expressed in the yeast Pichia pastoris. They are used in hemagglutination-inhibition tests with Cromer system antibodies and with DAF-specific monoclonal antibodies. RESULTS: The srDAF inhibited hemagglutination by all Cromer system alloantibodies in undiluted serum. Antibodies to antigens of other blood group systems were not inhibited by the srDAF. Hemagglutination-inhibition tests with domain-deleted srDAF showed that UMC is on SCR-4 and confirmed that Tca, TcaTcb, and WESb are on SCR-1; Dra is on SCR-3; and Cra is on SCR- 4. CONCLUSIONS: Hemagglutination inhibition with srDAF is useful in the recognition of antibodies that belong to the Cromer blood group system and facilitates pretransfusion testing. This use of domain-deleted srDAF provides an easy method of determining epitope location on DAF and is an aid to more precise identification of Cromer system antibodies.     

Superior mesenteric artery blood flow velocity and estimated volume flow: duplex Doppler US study of preterm and term neonates

To obtain information about intestinal hemodynamics of healthy neonates, the authors assessed velocity and volume of blood flow with duplex Doppler sonography in the superior mesenteric artery (SMA) in 91 stable preterm and term neonates. Blood flow velocity in the SMA and estimated volume blood flow increased linearly with gestational age and increasing body weight. The mean estimated volume blood flow (+/- standard deviation) was 43 mL/kg/min +/- 13 and did not depend on differences in body weight. The authors also assessed blood flow velocity in the SMA and volume blood flow in 18 infants with conditions that may affect blood supply to the bowel. Twelve infants who were small for gestational age appeared to have an abnormally low resistance of the vascular bed of the SMA during the 1st days of life, as compared with stable appropriate-for-gestational-age infants matched for gestational age. Three of six term neonates with cardiovascular abnormalities had left ventricular outflow obstruction and an abnormal blood flow velocity waveform of the SMA, suggesting a decrease in blood supply to the bowel. The results of this study may help in evaluations of intestinal perfusion in infants with abnormal conditions.     

Acceptance of ostomy and the visitor role in a self-help group for ostomy patients

The helper therapy principle, which underscores the benefits from helping another person, has been relatively unexplored in the self-help movement. This study examined whether persons enrolled in the United Ostomy Association, a self-help group for ostomates, who functioned in a helping role as visitors demonstrated a greater level of acceptance of their ostomy than those persons enrolled in the same group who have not served in the visitor role. Results indicated that visitors' acceptance of their own ostomies was significantly higher than nonvisitors'. The length of time since visitors and nonvisitors had their first ostomy surgery was not a significant factor in the person's acceptance of ostomy. There was a significant relationship between the person's level of acceptance of ostomy and the length of time the individual had served in the visitor role. Serving in the visitor role contributed significantly to predicting a higher level of acceptance of the ostomy. The length of time since surgery was a significant predictor to serving in the visitor role. Factors of age, sex, type of ostomy, and length of time since surgery did not contribute significantly to predicting a higher level of acceptance of the ostomy.     

A Controlled Trial of Androgen Therapy in Experimental Chronic Hypoplastic Marrow Failure

A controlled trial of an androgen, 17-nortestosterone decanoate, was carried out to test its effect as therapy in an experimental model of chronic hypoplastic marrow failure. No effect was detected.     

Preliminary validation of a prediction model for the short-term growth response to growth hormone therapy in children with idiopathic short stature

A discriminant scoring system, using multivariate analysis, has been developed for pretreatment prediction of responsiveness to a 6-month trial of growth hormone (GH) treatment in short children with subnormal growth velocity, but without GH deficiency. Inclusion criteria included a birth weight above 2.5 kg, height below the 3rd centile for chronological age, height velocity below the 25th centile for bone age, no signs of puberty, a maximal GH response to pharmacological stimulation of above 10 μg/l and treatment with GH at a dose of 12–16 IU/m²/week. Children with an increase in height velocity greater than 2.5 cm/year after therapy were considered to be responders. Pretreatment clinical data from 67 patients were employed in a discriminant analysis in order to establish the model. The scoring system developed was as follows: score = -0.4 + 0.92X₁– 0.87X₂, where X₁ is the height velocity SD score (SDS) for chronological age, and X₂ is the bone age SDS for chronological age. This model had a specificity of 96.3% and a sensitivity of 92.5% in predicting the responsiveness to GH. The model has subsequently been applied to a group of 14 patients in order to establish its validity; in this group its sensitivity was 83.3% and its specificity 100%. These preliminary data suggest that the model can be used as a guideline for selecting short, slowly growing, non-GH-deficient children who will respond to short-term GH therapy.