Drug abuse, AIDS, and the coming crisis in long-term care

As the 21st century approaches and the proportion of the US population over 65 years of age increases, it is expected that the demand for long-term care will expand dramatically. This expectation has been widely discussed. Less widely discussed is a potential for increase in the demand for long-term care resulting, not from the geriatric conditions with which the industry is already familiar, but from chronic and debilitating substance abuse-related diseases. In the United States, the incidence of severe cardiovascular and hepatological deterioration in younger patients has begun to increase, partly due to the increased scope of drug use and the increased variety of drugs used by individuals under the age of 35. HIV disease progression resembles these degenerative conditions in some important ways, and HIV infection is now often accompanied by substance abuse disorders. Thus, the care of HIV-infected patients can serve as a model for the impact on the long-term care industry that this new type of patient is likely to make. Using HIV as a particularly dramatic example, this paper discusses those changes in detail, and concludes with recommendations for successfully adapting to them.     

Increased urinary excretion of human cytomegalovirus in children with malignancy: Detection by polymerase chain reaction

Human cytomegalovirus (HCMV) is one of the most important agents causing opportunistic infections in immunocompromised hosts. In this study, we examined the urinary excretion of HCMV in children with malignancy using polymerase chain reaction (PCR). Urine samples were collected from on-therapy, off-therapy patients with malignancy, and healthy controls. A simple DNA extraction method using glass powder was employed, and inhibitory effect of urine on PCR was prevented. For PCR, a pair of primers from the HCMV major immediate early gene sequence was used. Among patients who received intensive chemotherapy, 52.0% had urinary HCMV excretion after the chemotherapy course. In contrast, off-therapy patients and healthy controls showed a lower incidence of urinary HCMV excretion (20.4 and 8.7%, respectively). The incidence of HCMV urinary excretion in the on-therapy group was significantly higher than healthy controls (P < 0.05). In the on-therapy group, the total white blood cell count of the virus excreters was lower than that of non-excreters. The incidence of HCMV excretion was high in on-therapy patients. Most of the virus excreters were seropositive, so their viruria was thought to be caused by reactivation. Repeated monitoring of virus excretion by this rapid and simple method may be useful to detect HCMV infection early and to control it in such patients.     

An anecdote in the dawn of Japanese psychiatry: The tragedy of Dr. Noboru Ishida

Abstract This is a historical review of the tragic life of a psychiatrist in the dawn of Japanese psychiatry, who was sentenced to life imprisonment for first-degree murder by an American court and imprisoned in America. The purpose of this article is firstly to clarify the strange circumstances under which he was sentenced guilty in spite of his psychosis. In the author's opinion there appeared to be an incorrectness and injustice of the judicial decision in the American court from consideration of the documents of his trial. Secondly, the author would like to acknowledge Dr. Ishida's pioneering contributions to the Japanese psychiatry which, because of the circumstances, have been long buried in the history of Japanese psychiatry.     

Patients' Opinions on Respiratory Care: Do Doctors Fulfill Their Needs?

To date, guidelines and consensus reports on quality care for asthma and chronic obstructive pulmonary disease (COPD) are mainly based on research and opinions of care providers. Patients' viewpoints on good medical care have rarely been studied. We designed a postal questionnaire to study the needs of patients with asthma or COPD for medical care provided by general practitioners and lung physicians. A total of 121 patients filled out the questionnaire, which included 111 items about needs. Although generally satisfied, patients reported several unfulfilled needs. Main topics were the need for information about diagnostic tests, prognosis, and long-term use of medication. In addition, patients wanted more written information about the nature of their disease. One-third of patients wanted more participation in decisions about their treatment. These results suggest the quality of medical care for patients with asthma or COPD can be improved by adjusting provided care to needs expressed by patients.     

Chromosome analysis of lymphocytes from radiation workers in tritium-applying industry

Objectives : The frequency of chromosomal aberrations (CA) and micronuclei (MN) in peripheral blood lymphocytes was compared in two groups of persons occupationally exposed to tritium either through the use of luminous paints or in the weapons industry, with the aim of finding a correlation between the CA and MN assays, the extent of radiation hazard, and the duration of occupational exposure to chemical forms of tritium and the ability of the latter to induce hazards in human lymphocytes. Methods : CA analysis and the cytochalasin B micronucleus test were performed. Urinary tritium in both groups was measured using a liquid scintillation method. For purposes of comparison, 2 control groups (40 persons) were examined; 24 exposed individuals were matched to their controls according to age, sex, and smoking habits. Results: Values recorded for the frequency of CA in the group of workers handling tritium in luminous dial painting were 0.015 ± 0.014 dicentrics/cell, 0.023 ± 0.017 total unstable CA/cell, and 0.035 ± 0.019 MN/binucleated cell. Urinary levels of tritium in this group of employees ranged from 1.35 to 9.43 MBq/l. As compared with their matched controls, in these workers the differences in the yield of CA as well as in MN were statistically highly significant (P<0.005 and P<0.003, respectively). The same parameters analyzed in workers employed in the armament industry gave values of 0.001 ± 0.003 dicentrics/cell, 0.010 ± 0.008 total unstable CA/cell, and 0.021 ± 0.029 MN/binucleated cell. No detectable concentration of urinary tritium was found. As compared with their matched controls, in these workers the differences were also statistically significant (P<0.027 and P<0.012, respectively). The yield of CA, particularly the yield of dicentrics, was significantly higher (P<0.005) in the group of luminous dial painters as compared with the weapons industry workers. The difference found in the yield of MN between the two groups of workers was also statistically significant (P<0.084). Intercontrol differences in the yields of spontaneous CA as well as in MN were insignificant (P<0.683 and P<0.735, respectively). The results are discussed with respect to individual variations in the response to low doses of ionizing radiation, disorders in the handling of radionuclides, the duration of occupational exposure, and the chemical properties of the radionuclides used. Conclusion : Tritium in the chemical form of luminous paint is a more powerful clastogenic agent than tritium gas. Statistical analysis demonstrated that lymphocyte effects are due to the concentration of tritium in urine rather than to the duration of occupational exposure. Since the radiation hazard measured by the MN assay did not differ from that determined by the CA assay, the MN test can be recommended as a rapid assay for screening purposes in cases of occupational exposure to low radiation doses. Received: 20 November 1996 / Accepted: 1 August 1997     

Electronic media use and suicidal ideation in Japanese adolescents

The present study found that a lifetime history of suicidal ideation may be significantly associated with a history of searching the Internet for information about suicide or self‐injury, experiences of anxiety or emotional pain related to the use of electronic media, and adolescents' distrust of the people around them. The impact of experiences using electronic media on suicidal ideation among Japanese adolescents is discussed.     

BRNO-I, An Implantable, Diaphragm-Type Total Artificial Heart: Technical Aspects of Design

The technical aspects of artificial heart design for experiments on calves are presented in this paper. The object of the design was to verify the basic anatomic and hemody-namic criteria for the design of more perfect cardiac pros-theses. Each of the ventricles has a 100-ml stroke volume and is dismountable. Rigid parts are made of polymethyl-methacrylate. The inlet valve has the shape of a flap. The outlet valve has two polyurethane reinforcing leaves. The diaphragm is also made of polyurethane. During tests using artificial circulation, a maximum cardiac output of 14.6 L/min was achieved. Typical sensitivity of flow on the atrial pressure is 0.3 L/min/torr at a frequency of 90 pulses per minute.     

Individual flexibility: an essential prerequisite in arranging shift schedules for midwives

The irregular shift system in Finnish hospitals with schedules traditionally planned for short 3-week periods creates problems in the social life of the personnel. Current backward rotation with 'quick returns' and rest periods between the shifts which are too short cause fatigue. The possibilities provided by legislation for individual and functional flexibility in the planning of schedules have not been utilized because of the hierarchical structure of hospital organizations. This study was aimed at finding measures to reduce the strain caused by irregular shift work. It consisted of two parts: a survey of midwives doing a three-shift work in hospitals ( n =366), and an intervention in six maternity wards ( n =45). During the 6-month intervention the influence potential of the personnel increased, and the number of quick returns fell. As a result, the mental strain of the work decreased and the stress levels fell. The positive effects were evident especially among the elderly midwives: their work became less strenuous and their social interaction improved. Despite the positive effects of the intervention, 55% preferred the former system with longer continuous free time. The physiological criteria for a good shift system were outweighed by the demands of social life, emphasizing the importance of individual flexibility and participation in the planning process.