Involving patients in do not resuscitate (DNR) decisions: an old issue raising its ugly head.

A recent paper in this journal (1) suggests that involving terminally ill patients in choices concerned with Cardio-Pulmonary Resuscitation (CPR) produces 'psychological pain' and therefore is ill-advised. Such a claim rests on anecdotal observations made by the authors. In this paper I suggest that drawing conclusions in ethics, no less than in science, requires a rigorous framework and cannot be relegated to personal observation of a few cases. The paper concludes by suggesting that patients, if we acknowledge their valid interest in making their own choices, must themselves be allowed to make a prior choice about choosing. Those who may not wish to choose may properly be relieved of this burden and may allow another to choose for them. Routinely allowing others to make choices for competent adults, however, is likely to decrease communication with the dying patient and to introduce an atmosphere of suspicion and fear and to exclude the competent patient from his/her rightful place in the community.     

Comparative analysis of oncological morbidity in the population of an industrial city and workers of a metallurgical plant

Analytical epidemiology techniques were used to study the malignant neoplasms prevalence in the population of Magnitogorsk (400,000), and among the workers engaged in the Magnitogorsk metallurgical plant (64,000 workers). Revealed was that the malignant neoplasms related morbidity rate was 1.6 higher in men and 3.2 higher in women among the plant workers as compared with the city population in general. The cancer risk factors were predominantly occupational ones, e. i. the major industrial carcinogens--benzopyrene in tars and carbon-black; benzol, chromium and nickel in the dust; the carcinogenesis modifying substances--nitrogen oxide, sulfur dioxide, phenols, iron oxides, lead and its non-organic compounds, high temperatures. The data received can be used in further studies and elaboration of primary preventive measures.     

Indoor 222Rn levels in New York State, North Carolina, and South Carolina

Results are presented from approximately 9000 Rn measurements made in New York state, North Carolina, and South Carolina. The estimated statewide geometric mean concentrations were 28.1 Bq m-3 and 55.8 Bq m-3 for basements in New York state, 27.5 Bq m-3 for living rooms and 108.9 Bq m-3 for basements in North Carolina, and 25.0 Bq m-3 for living rooms in South Carolina.     

Chick nutritional encephalomalacia and prostanoid formation

Nutritional encephalomalacia (NE) was induced in young chicks using a diet low in vitamin E and containing 8% ethyl esters derived from safflower oil fatty acids (S-E group). The same diet with added alpha-tocopheryl acetate (S+E) failed to produce the pathology, and chicks receiving aerated linseed oil--high in alpha-linolenic acid and low in alpha-tocopherol (L-E)--did not develop symptoms. Formation of metabolites from labeled arachidonic acid (AA) by thrombocytes was similar in the S+E and S-E groups, yielding thromboxane B2 (TXB2) and hydroxy fatty acids as the major products. Collagen-induced thrombocyte aggregation and TXB2 production were not significantly different in the S-E and S+E groups, but aggregation values and TXB2 synthesis were significantly less in the L-E group than in the ataxic S-E chicks. Prostaglandin E2 production by aortal rings was significantly influenced by the diet; S-E yielded the highest value and L-E the lowest. These results show that alpha-linolenic acid causes alterations in the AA metabolism and thrombocyte function in young chicks.     

Lymphocyte subpopulations in the thymus, lymph nodes and spleen of iron-deficient and rehabilitated mice

Three groups of weanling female mice were fed one of two iron-deficient diets (5 and 12 mg Fe/kg diet) or a normal diet (30 mg Fe/kg diet) for 6 wk. A control pair-fed group was included. Seven mice received the 5 mg Fe/kg diet for 6 wk, then were rehabilitated using the 30 mg Fe/kg diet for 10 d. Mice fed the 5 mg Fe/kg diet were moderately iron-deficient, as shown by indices of iron status. No significant differences were observed in thymus weight or in the proportion and number of thymocyte subsets in thymuses of anemic, moderately iron-deficient and control mice. Thymus weight was decreased in pair-fed mice. No significant difference was found in lymph node subsets. In the spleen of anemic mice, the proportions and total number of Thy-1+ splenocytes, CD4-8+ and CD4+8- cells were very low compared with control (P less than 0.01) and iron-deficient (P less than 0.02) mice. The decrease was not only observed for the percentage of subsets but also for the absolute number of cell subtypes per spleen. Thy-1+ splenocyte subpopulations were normalized after rehabilitation. These quantitative modifications could explain alterations in the blastogenic response of splenic lymphocytes described by other authors.     

Thiamin status of incarcerated and nonincarcerated adolescent males: dietary intake and thiamin pyrophosphate response

We measured thiamin status in 137 incarcerated and 42 nonincarcerated adolescent males by use of both dietary intake data and a standard biochemical assay, thiamin pyrophosphate (TPP) response. Average thiamin intake of the total group was greater than 120% of the age-specific recommended dietary allowance (RDA). Ninety-two percent of incarcerated subjects and 93% of nonincarcerated subjects were consuming greater than or equal to 70% of RDA. Although average daily thiamin intake of nonincarcerated subjects was significantly higher than that of incarcerated subjects, both groups appeared to be at minimal risk for marginal thiamin status. Comparison of TPP response values indicated that there was no significant difference between groups. However, approximately 24% of the total population appeared to have less than adequate RBC thiamin on the basis of current standards for TPP response. Neither dietary intake nor reported previous alcohol intake was correlated with TPP response. These discrepant findings raise questions about the usefulness of the TPP response as the sole indicator of marginal thiamin status.