Successful use of a polymerized hemoglobin blood substitute in a critically anemic Jehovah's Witness

A stable, polymerized hemoglobin product has been formulated that overcomes the three traditional hurdles of hemoglobin-based blood substitutes: nephrotoxicity, osmotic diuresis, and blood-borne pathogens. We present a case of a patient with persistent colonic bleeding and a hemoglobin of 2.9 g/100 mL. Since her religious faith prevented her from accepting blood products, we offered a hemoglobin-based substitute and describe the use of this product.     

The relationship between pain and negative affect in older adults: anxiety as a predictor of pain

Although the relationship between pain and negative affect (e.g., depression, anxiety, and anger) has been repeatedly demonstrated in younger populations, the findings have varied widely among studies. Additionally, there has been minimal research on the relationship between negative affect and acute pain in older adults. This is especially disturbing when one considers that the population is at a higher risk for painful conditions than any other age group. The current study investigated the relative contributions of state anxiety, trait anxiety, depression, state anger, and trait anger to acute pain in an elderly, postsurgical population. The participants (n = 100) were all over the age of 65 and were receiving treatment on an inpatient rehabilitation unit following orthopedic surgery (e.g., knee or hip replacement surgery). Data were analyzed by means of multiple regression, regressing the five predictor variables on the single criterion variable. Results indicated that the only significant predictor of pain in this population was state anxiety, and that this variable alone accounted for 27% of the variance in pain. Treatment implications and suggestions for further research were discussed.     

Well-being, appraisal, and coping in African-American and Caucasian dementia caregivers: findings from the REACH study

Although there has been considerable interest in racial differences in family caregiving for persons with dementia, most research to date has either ignored racial diversity or based conclusions on small numbers of caregivers drawn primarily from single site studies. The current study utilized participants from four sites of the REACH (Resources for Enhancing Alzheimer's Caregiver Health) multi-site study to compare well-being, appraisal, and religious coping by race. African-American (n = 295) and Caucasian (n = 425) dementia caregivers from four cities (Birmingham, Memphis, Boston, and Philadelphia) were compared in their demographics, care recipient characteristics, mental and physical health, and psychosocial coping resources including appraisal and religious coping. African-American caregivers reported lower anxiety, better well-being, less use of psychotropic medications, more benign appraisals of stress and perceived benefits of caregiving, and greater religious coping and participation, than Caucasian caregivers. Self-rated health did not differ by race, but African-American caregivers reported more unhealthy behaviors than Caucasian caregivers. Some results were specific to site, possibly due to differences in recruitment strategies, inclusion/exclusion criteria, and regional differences. Adjustment for covariates, including caregiver relationship to the care recipient, gender, age, socioeconomic status, and care recipient behavioral problems, altered few of these differences. Results are discussed in terms of their relevance to psychosocial intervention programs for ethnically diverse caregivers.     

Obstetric adversity and age at first presentation with schizophrenia: evidence of a dose-response relationship

OBJECTIVE: The purpose of the study was to determine if a dose-response relationship exists between obstetric adversity and age at first presentation with schizophrenia. METHOD: The Dublin Psychiatric Case Register was used to identify subjects with schizophrenia. Data on obstetric complications, social class of origin, and family history of psychiatric illness were obtained for those subjects. RESULTS: A total of 409 patients with ICD-9 schizophrenia were identified. Patients with a history of obstetric complications presented earlier to psychiatric services. As the number of complications increased, the mean age at first presentation decreased. This effect was independent of social class of origin and family history of psychiatric illness. CONCLUSIONS: Obstetric adversity exerts an independent influence on the age at first presentation with schizophrenia, in a dose-response manner. This finding supports the existence of a causal relationship between obstetric adversity and age at first presentation with schizophrenia.     

Context-sensitive behavioral supports for young children with TBI: short-term effects and long-term outcome

OBJECTIVE: To investigate the effects of a multicomponent cognitive-behavioral intervention on the challenging behavior of two young children with growing behavioral concerns after traumatic brain injury. DESIGN: Single-subject reversal designs were used to document the effects of the intervention on the specific dependent variables. In addition, qualitative data were collected to determine the children's long-term outcome and staff evaluations of the intervention. PARTICIPANTS: Both children were normally developing before injury at age 5 years. Both experienced increasing behavior problems as expectations in school escalated. MAIN OUTCOME MEASURES: Quantitative data included frequency and intensity of aggression and amount of work completed. Qualitative data included children's general engagement in school work and peer interaction and staff evaluations of the intervention. INTERVENTION: The intervention included components of positive behavior supports, cognitive supports, and an executive function routine. RESULTS: The targeted challenging behaviors were reduced to near zero with decreased intensity. Long-term outcome was positive. CONCLUSIONS: These results illustrate the potential for successfully treating behavior disorders in young children with traumatic brain injury using a support-oriented intervention that combines behavioral and cognitive components.     

Groin tissue necrosis requiring skin graft following parenteral abuse of buprenorphine tablets

In May 2002 Buprenorphine (Subutex®) was listed on the Australian Pharmaceutical Benefits Schedule for treatment in opioid dependence. In addition to broadening treatment options, buprenorphine has the advantage of an improved safety profile. The risk of overdose is lessened but other risks remain due to diversion. French experience reports widespread deviation of buprenorphine sublingual tablets to intravenous injection. We report a case of attempted parenteral administration of buprenorphine tablets. Stringent protocols for dispensing are appropriate. [Feeney GFX, Fairweather P. Groin tissue necrosis requiring skin graft following parenteral abuse of buprenorphine tablets. Drug Alcohol Rev 2003;22:359 - 361]