Results of a hepatitis C general transfusion lookback program for patients who received blood products before July 1992

BACKGROUND: The Centers for Disease Control and Prevention recommend hepatitis C virus (HCV) antibody (anti-HCV) screening for persons who received blood products before July 1992. A general transfusion lookback program was implemented to identify, counsel, and screen persons who received transfusions at the Alaska Native Medical Center between January 1980 and July 1992. STUDY DESIGN AND METHODS: Hard-copy transfusion records data were entered, and available databases were queried to identify deceased patients and the mailing address of those living. Patients were notified by letter of their HCV risk and encouraged to seek counseling and testing. Serum samples were screened for anti-HCV and HCV RNA, and program costs were estimated. RESULTS: Overall, 3169 transfusion recipients were identified, with 1356 (43%) living and targeted for notification. Of 764 patients notified and screened by this program, 41 (5%) were anti-HCV-positive and 19 (2%) were HCV RNA-positive. There was a higher probability of detecting anti-HCV with each subsequent increase of a transfusion event. Among 298 lookback patients, 33 percent were unaware of having received a blood transfusion. The estimated cost per person sent notification was US$57 and to detect an anti-HCV-positive case it was US$3146. CONCLUSION: This general transfusion lookback program successfully notified and screened patients at a reasonable cost. Further investigation would be helpful in determining the role these programs or other measures could play in promoting HCV screening in persons receiving transfusions before July 1992, especially among those who are unaware of their transfusion history.     

Self-monitoring of progress in weight-reduction: A preliminary report

This paper reports a weight-graphing technique which combines feedback with goal-setting and thus makes progress toward goal weight salient. The technique was used by 11 individuals who lost a mean of 9.6 lb in a mean of 39 days. These results are within the range of those obtained with more comprehensive treatments, suggesting that well-chosen feedback as to progress toward naturally-occurring rewards may be an effective change influence.     

Cicatricial Pemphigoid in a 6-Year-Old Child: Report of a Case and Review of the Literature

Cicatricial pemphigoid has been documented previously in only four patients under the age of 20 years. We report a 6-year-old male who had erosions of the oral and genital mucosa, conjunctivitis, hoarseness, dysphagia, recurrent vomiting, and weight loss. Upper airway obstruction due to a chronically inflamed and scarred epiglottis necessitated tracheostomy. Biopsy of tissue from a solitary cutaneous lesion demonstrated a subepidermal bulla. Direct and indirect immunofluorescence confirmed a diagnosis of cicatricial pemphigoid. Therapy was begun consisting of prednisone, 2 mg per kg per day, in combination with dapsone, 2 mg per kg per day. He did not improve until the prednisone dosage was increased to 4 mg per kg per day.     

Hemispheric asymmetry: the effect of orientation on same different comparison

In a same-different comparison task, orientation affected “same” reaction times for left but not right visual-field presentations. This provided evidence that the “orientation effect” was due to spatial coding of memory representations in the right hemisphere, and that left hemisphere processing involves attention to orientationally invariant features.     

Lung mechanics in relation to radiographic category of coalworkers'' simple pneumoconiosis

ABSTRACT The maximal expiratory flow/static transpulmonary pressure relationship and the maximal expiratory flow response to breathing oxyhelium were used to distinguish between loss of elastic recoil and narrowing of small airways in 36 lifelong non-smoking non-bronchitic South Wales coalminers. On average the miners showed significantly (p < 0·05) reduced lung elastic recoil when compared with 10 healthy similarly aged non-miners. The mean forced expiratory volume in one second and the forced expiratory flow response to oxyhelium at 50% of the vital capacity were significantly (p < 0·05) lower in 12 miners with radiographic categories 2 or 3 when compared with 24 similarly aged miners with radiographic categories 0 or 1. The miners with categories 2 or 3 coalworkers' simple pneumoconiosis (CWP) had worked underground for 10 years longer, and their mean residual volume, residual volume/total lung capacity ratio, volume of isoflow and critical transmural pressure were significantly higher (p < 0·05). The results indicate that in the prodromal and early stages of simple CWP (categories 0 and 1), the dominant pathophysiological abnormality is loss of elastic recoil suggesting the presence of “focal emphysema.” As simple CWP progresses to categories 2 and 3, the loss of recoil is maintained, and the small airways become narrower. These findings are consistent with the hypothesis that progression of simple CWP is associated with the development of both centrilobular emphysema and intrinsic narrowing of small airways.     

Secular Trends and Individual Differences in Toilet-Training Progress

Longitudinal data were obtained for a group of 71 children between18 and 33 months old for the age of onset and completion ofmature toileting behavior, physiological maturity, and maternalpressure for toilet training. The first appearance of toiletingskills and the acquisition of mature toilet-training behavioroccurred later in 1975 than in a comparable 1947 cohort: Onsetoccurred between 18 and 26 months and completion was between26 and 33 months, with girls finishing sooner than boys. Motherswho press for training have children whose skills emerge sooner.Girls who start sooner finish sooner. Mature boys (as measuredby sleep patterns) finish sooner. Partial support was foundfor the hypothesis that onset of toileting skills depends moreon socialization, while completion depends more on maturation.The unexpected sex difference may be due to differences in therelationship of sleep maturity to overall maturation for boysand girls.     

Death, American style

Since the turn of the present century death in America has moved out of homes and into institutions. This paper focuses on the various ways in which dying people and those close to them rebel against dying and grieving in what doctors, nurses, and hospitals consider to be the correct and most therapeutic style.     

Neoplastic angioendotheliosis: Ultrastructural study and review of the literature

Neoplastic angioendotheliosis is a rare disorder characterized by progressive multifocal neurological deficit and dementia. The principal pathological findings are multiple infarcts in the brain and spinal cord and the microscopical demonstration of proliferated neoplastic cells, primarily within the lumens of arteries, arterioles, and capillaries. Vessels of the central nervous system are the most severely affected and appear to be the primary site of neoplastic proliferation. Systemic intravascular and focal extravascular proliferation can also be identified. The endothelial origin of the neoplastic cell with a gradation of changes from normal to neoplastic is demonstrated by the electron microscopical study of involved meningeal vessels. Our patient and those reported in the literature all demonstrate involvement of the central nervous system. In addition, an elevated cerebrospinal fluid protein level is present in all patients for whom that information is available, and fever and renal involvement are frequently present. Steroid therapy is generally ineffective. If the disease is suspected clinically, our studies suggest that meningeal biopsy is the diagnostic procedure of choice to help determine whether chemotherapy should be instituted.