The prevalence of disability from chronic conditions due to injury among adults ages 18-69 years: United States, 1994

Purpose: To describe the causes and determine the prevalence of disability from chronic conditions due to injury among US civilian non-institutionalized persons aged 18-69 years. Methods: Data from the National Health Interview Survey Disability (NHIS-D) Supplement Phase I, United States 1994 were analysed and six disability categories were examined: activities of daily living (ADL), instrumental activities of daily living (IADL), functional activities (FA), sight, hearing, and communication. Results: In 1994, 5.6 million persons aged 18-69 years reported a disability because of a chronic condition that was caused by injury. The prevalence of ADL disability due to chronic conditions caused by injury was 370 per 100000 population; IADL disability was 1256; FA disability was 2512; sight was 231; hearing was 339; and communication was 91 per 100000 population. Fifty per cent of ADL, IADL, and FA disabilities were attributed to motor vehicle crashes and falls, as were 31% of sight, 19% of hearing, and 23% of communication disabilities. Conclusions: Though these estimates may be conservative, this study indicates that injury is a major cause of disability in addition to a leading cause of death in the US.     

Patient health outcomes in psychiatric mental health nursing

This integrative literature review examined evidence concerning the relationship between psychiatric mental health nursing interventions and patient-focused outcomes. Empirical studies, published between 1997 and 2007, were identified and gathered by searching relevant databases and specific data sources. Although 156 articles were critically appraised, only 25 of them met the inclusion criteria. Findings from this review showed that the most frequently used outcome instruments assessed psychiatric symptom severity. Most of the instruments targeted two symptom categories: altered thoughts/perceptions and altered mood. Other outcome instruments were categorized in the following domains: self-care, functioning, quality of life and satisfaction. The most important finding of this review is the lack of consistently strong evidence to support decisions concerning which outcome instrument or combination of instruments to recommend for routine use in practice. Based on this review, additional research to conceptualize, measure and examine the feasibility of outcome instruments sensitive to psychiatric mental health nursing interventions is recommended.     

The views of general practitioners on the reuse of patients' own drugs

□ The quality of patient care could potentially improve through patients' own drugs (POD) schemes □ POD schemes need to be promoted to primary care professionals     

Longitudinal stress fracture in the femoral diaphysis

Stress fractures occur in multiple sites but more so in the lower limbs and show a predilection for certain sites. The lower femoral shaft is not a common site and a longitudinal stress fracture is extremely rare. A case is reported of a longitudinal stress fracture in the distal femoral shaft that was not suspected initially despite the patient's athletic activities. Review of the literature did not reveal documentation of any similar case.     

Synthesis and secretion of immunoglobulin by spleen cells from resistant and susceptible mice infected with Trypanosoma brucei brucei GUTat 3.1

By 6 days after infection of susceptible C3H/He and resistant C57BL/6 mice with Trypanosoma brucei brucei GUTat 3.1, splenic plasma cell responses of both strains of mice were similar in terms of plasma cell number, intracellular Ig, Ig secretion, Ig class and Ig specificity for surface-accessible variant surface glycoprotein (VSG) epitopes on the infecting organisms, despite higher parasitaemia in the C3H/He mice. By 7 days after infection, however, although splenic plasma cells from both strains of mice had greatly amplified their Ig responses, those from C57BL/6 mice (which cleared parasites from their bloodstream between 6 and 7 days after infection) contained and secreted 3-5 times more Ig specific for exposed VSG epitopes on the infecting organisms than those from C3H/He mice which did not clear parasites from their bloodstream. In vitro, trypanosomes can absorb significant amounts of VSG-specific antibody produced by splenic plasma cells. However, differences in the detection of VSG-specific antibodies present in, and secreted by, splenic plasma cells of 7-day infected C3H/He and C57BL/6 mice were shown not to result from the presence of parasites in the cultures of C3H/He spleen cells. It is argued that between 6 and 7 days after infection, the C3H/He mice selectively lose the capacity to support development of plasma cells specific for exposed VSG epitopes on the infecting organisms and that this is a consequence rather than a cause of differences in the peak levels of first wave parasitaemia.     

PITUITARY ACTH DEPENDENT CUSHING''S SYNDROME DUE TO ECTOPIC PRODUCTION OF A BOMBESIN-LIKE PEPTIDE BY A MEDULLARY CARCINOMA OF THE THYROID

A 41-year-old man presented with Cushing's syndrome and the biochemical features of ectopic ACTH production. Investigation revealed mediastinal metastases from a medullary carcinoma of the thyroid. The peripheral plasma contained grossly elevated levels of bombesin-like immunoreactivity (irBombesin) as well as calcitonin; blood sampling via a venous catheter confirmed a gradient of irBombesin, but not of ACTH, in the mediastinal vein draining the tumour. On extraction the tumour contained a bombesin-like peptide, but not vasopressin or corticotrophin releasing factor and only very low levels of ACTH; immunohistochemical studies showed positive immunostaining for bombesin and calcitonin but none for ACTH or CRF. No ACTH was released from dispersed tumour cells in vitro. However an extract of the tumour stimulated ACTH release in vitro from perifused dispersed rat anterior pituitary cells. This is the first reported case of Cushing's syndrome due to ectopic production of a bombesin-like peptide, causing excessive pituitary ACTH secretion.