Complicated grief in Bosnian refugees: associations with posttraumatic stress disorder and depression

Complicated grief is likely to be common among refugee populations exposed to war trauma. However, there have been few studies investigating the traumatic antecedents and correlates of complicated grief in refugees, and the relationship of that symptom pattern with other common disorders such as posttraumatic stress disorder (PTSD) and depression. We studied Bosnian refugees recruited from a community center in Sydney, Australia, with the sample being supplemented by a snowball method (N = 126; response rate, 86%). Measures included a trauma inventory, the Clinician Administered PTSD Scale (CAPS), the depression module of the Structured Clinical Interview (SCID), and the Core Bereavement Items (CBI). A dimension of traumatic loss derived from the trauma inventory was a specific predictor of complicated grief, with exposure to human rights violations being associated with images of the traumatic events surrounding the lost person. There was no link between PTSD and grief other than for a low-order association with the PTSD intrusion dimension. In contrast, depression was strongly associated with grief and its subscales. Only the subgroup with comorbid grief and depression reported higher levels of traumatic loss. The results suggest that complicated grief in refugees can become persistent and associated with depression. While PTSD and grief share common symptoms of intrusion, the two symptom domains are sufficiently distinct to warrant independent assessment of grief in refugee populations.     

A randomized controlled study of the use of transscleral diode laser and cryotherapy in the management of rhegmatogenous retinal detachment

PURPOSE: Cryotherapy, the most common modality used to create a chorioretinal adhesion during retinal reattachment surgery, is associated with the dispersion of viable pigment epithelial cells and breakdown of the blood-ocular barrier, which are thought to be causative in a number of postoperative events, including macular pucker, proliferative vitreoretinopathy (PVR), and cystoid macular edema. Transscleral diode laser has been used successfully to create a chorioretinal adhesion in retinal reattachment surgery (diopexy) and experimentally has been shown to cause less pigment dispersion and blood-ocular barrier breakdown than cryotherapy. The authors carried out a prospective randomized study to compare the results and complication rates of transscleral diopexy with those of cryopexy during surgery for rhegmatogenous retinal detachment (RRD). METHODS: Data from 120 patients with recent onset RRD without significant PVR who were suitable for scleral buckling surgery and randomized to treatment using diode laser or cryotherapy were analyzed. The primary outcome measure was reattachment at 6 months with one operation. Secondary outcome measures were pain and swelling on the first postoperative day, cystoid macular edema as assessed angiographically at 6 weeks, and visual acuity, macular epiretinal membrane, and pigment migration under the fovea at 3 months. RESULTS: There was no significant difference between the primary and secondary outcome measures between the two treatment groups, with a primary success rate of 83% in the diode group and 92% in the cryotherapy group. Pain and postoperative swelling on the first postoperative day were equivalent. Cystoid macular edema was angiographically present in 12% in the diode group and 14% in the cryotherapy group. Visual acuity of at least 20/40 was achieved in 54% of patients in both groups. The rate of PVR was 5% in the diode group and 3% in the cryotherapy group. CONCLUSION: In this study of patients with uncomplicated RD without significant preoperative PVR, the experimentally shown benefits of transscleral diode laser did not result in significant improvement in the results of reattachment surgery compared with cryotherapy.     

The results of surgery on macular holes associated with rhegmatogenous retinal detachment

PURPOSE: Macular holes can occur as a secondary phenomenon with or after otherwise successful repair of uncomplicated macula-off rhegmatogenous retinal detachments with peripheral breaks. The purpose of this study was to evaluate the anatomical and visual outcomes of vitrectomy surgery to close the macular holes in these situations. METHODS: A retrospective record review was completed for patients with a retinal detachment with peripheral breaks and a macular hole or those patients developing macular holes within 2 weeks of successful primary external buckling surgery for macula-off retinal detachment. In those patients with a concurrent macular hole and retinal detachment, a primary vitrectomy was carried out to close the macular hole and reattach the retina. In those patients who developed a macular hole after successful primary external buckling surgery, a secondary vitrectomy was then carried out to close the macular hole. RESULTS: The authors reviewed the records of 10 patients. All had a preoperative visual acuity of 20/400 or worse. After surgery, one patient achieved a best-corrected visual acuity of 20/40; six patients achieved a best-corrected visual acuity of 20/80; and three patients achieved a best-corrected visual acuity of 20/120. CONCLUSION: These results suggest that macular hole surgery is worthwhile for these patients and can provide satisfactory results in terms of visual improvement.     

A novel stereocilia defect in sensory hair cells of the deaf mouse mutant Tasmanian devil

Stereocilia are specialized actin-filled, finger-like processes arrayed in rows of graded heights to form a crescent or W-shape on the apical surface of sensory hair cells. The stereocilia are deflected by the vibration of sound, which opens transduction channels and allows an influx of ions to depolarize the hair cell, in turn triggering synaptic activity. The specialized morphology and organization of the stereocilia bundle is crucial in the process of sensory transduction in the inner ear. However, we know little about the development of stereocilia in the mouse and few molecules that are involved in stereocilia maturation are known. We describe here a new mouse mutant with abnormal stereocilia development. The Tasmanian devil (tde) mouse mutation arose by insertional mutagenesis and has been mapped to the middle of chromosome 5. Homozygotes show head-tossing and circling and have raised thresholds for cochlear nerve responses to sound. The gross morphology of the inner ear was normal, but the stereocilia of cochlear and vestibular hair cells are abnormally thin, and they become progressively disorganized with increasing age. Ultimately, the hair cells die. This is the first report of a mutant showing thin stereocilia. The association of thin stereocilia with cochlear dysfunction emphasizes the critical role of stereocilia in auditory transduction, and the discovery of the Tasmanian devil mutant provides a resource for the identification of an essential molecule in hair cell function.     

Elongation of hair cell stereocilia is defective in the mouse mutant whirler

The recessive mouse mutant whirler (wi) shows no response to sound and exhibits circling and head-tossing behaviour, indicative of both auditory and vestibular dysfunction. The wi mutation maps genetically to mouse chromosome 4. We examined the organ of Corti of whirler mutants to explore the possibility that the wi mutation affects sensory hair cells. Scanning electron microscopy (SEM) reveals that the specialised microvilli (stereocilia) that are projected by the sensory hair cells and are vital for sound transduction are abnormal in wi homozygotes. Specifically, wi homozygous inner hair cell (IHC) stereocilia are approximately half the length of equivalent stereocilia in heterozygous littermates. They are arranged normally into ranks, but the gradation in height and width of stereocilia in adjacent ranks is less prominent in wi homozygotes. Analysis of IHC stereocilia during the course of their development shows that, by embryonic day 18.5, mutant stereocilia are already significantly shorter than those in controls. Mutant stereocilia elongate at a normal rate, at least until postnatal day 1, but prematurely stop elongating between postnatal days 1 and 4. Stereocilia length then decreases. At postnatal day 15, outer hair cell (OHC) stereocilia in wi homozygotes appear short and are arranged in a rounded, "U" shape rather than the normal "W" or "V" shape. Eventually, both IHCs and OHCs degenerate. We show that the whirler locus encodes a protein(s) required for the elongation and maintenance of IHC and OHC stereocilia.     

Do demographic variables affect the timing of referral to the nephrologist?

The consequences of late referrals for nephrological care include: increased morbidity, poorer quality of life on dialysis and probably increased mortality. Few studies look at the socio-demographic factors which influence referral to the nephrologist. There is good evidence from studies in other areas of health care that socio-demographic and economic factors influence access to health care. It is important that the nephrology community understand whom the individuals are who likely to be referred late so that we can address any inequality in access to services. We studied all of the patients who started renal replacement therapy in our unit over a five-year period, 1st January 1996 to 31st December 2000 (n = 494). We collected data on gender, age at referral, ethnicity, the date that the individual started dialysis as well as the date they were first seen by a nephrologist. We analysed the data to see if age, gender or ethnicity was associated with timing of referral. If an individual had seen a nephrologist more than three months prior to starting dialysis, they were termed 'early referred', if not they were termed 'late referred' Since this was a sociologically driven research project, we set statistical significance at the 10% (0.1) level. Our data showed that gender did not affect the timing of referral (p = ns), ethnicity affected referral in so much as whites were more likely to be referred late than blacks (p = 0.08) but no more so than non-whites (p = ns). People under the age of 30 were statistically more likely to be referred late than people over the age of 30 years (p = 0.027) as were people under the age of 40 (p = 0.047). We interpret these finding as demonstrating that health care professionals are referring older people and people from the black community in good time and that, in contrast to other studies of inequalities in health, these findings demonstrate that the elderly and ethnic minorities are not being disadvantaged.     

现代医院财务管理的若干问题

如何加强现代医院的财务管理,提高经营管理水平,已成为促进现代医院发展的重要课题.本文对市场经济条件下现代医院的财务管理观念、内容、理论和方法、工作机构以及面对机遇与挑战的管理措施等若干问题进行了探讨.