A population-based study of acute medical conditions associated with bullous pemphigoid

Background  Bullous pemphigoid is associated with poorly understood dramatically increased early mortality rates.
Objectives  To assess the incidence of acute events predisposing to early mortality.
Methods  Computerized medical records from the Health Improvement Network, a large population-based U.K. general practice database, were used to conduct a cohort analysis. Outcome measures were incidence rates of myocardial infarction, pulmonary embolism, pneumonia and sepsis compared with a matched control population.
Results  People with bullous pemphigoid were three times as likely to develop pneumonia, adjusted rate ratio 2·94 [95% confidence interval (CI) 2·01–4·31] or pulmonary embolism, adjusted rate ratio 3·12 (95% CI 1·37–7·12) compared with matched controls. No statistically significant increase was seen for myocardial infarction, adjusted rate ratio 1·24 (95% CI 0·66–2·33), or sepsis, adjusted rate ratio 2·02 (95% CI 0·78–5·21).
Conclusions  The risk of pulmonary embolism and pneumonia is increased following a diagnosis of bullous pemphigoid. It may be possible to reduce associated mortality through considering prophylaxis with either antithromboembolic measures or antibiotic therapy and vaccination.     

Changes in and predictors of length of stay in hospital after surgery for breast cancer between 1997/98 and 2004/05 in two regions of England: a population-based study

Background  

Decreases in length of stay (LOS) in hospital after breast cancer surgery can be partly attributed to the change to less radical surgery, but many other factors are operating at the patient, surgeon and hospital levels. This study aimed to describe the changes in and predictors of length of stay (LOS) in hospital after surgery for breast cancer between 1997/98 and 2004/05 in two regions of England.     

Representation of the body by single neurons in the dorsolateral striatum of the awake, unrestrained rat

Single cell recordings in awake monkeys and cats have demonstrated that individual body parts are represented within striatal subregions receiving projections from somatic sensorimotor cortex. Literature indicating that the lateral striatum of the rat receives similar cortical inputs and subserves sensorimotor functions prompted a study of whether this subregion contains similar representations of the body. Single cell recordings were obtained from 923 neurons of 24 awake, unrestrained rats. Of 788 neurons categorized according to body part, 264 (34%) discharged in relation to active movement, passive manipulation, and/or cutaneous stimulation of a particular part of the body; the remainder were related to global, whole body movement (38%) or were unresponsive (28%). Neurons related to individual body parts were recorded throughout the entire anterior-posterior extent of the dorsolateral striatum (+1.60 to -2.12 mm A-P, from bregma), intermingled among each other in all 3 dimensions. Two topographic arrangements were observed. First, neurons that fired rhythmically, in phase with low frequency (5-6 Hz) whisking of the vibrissae were segregated in the caudal striatum (-0.2 to -2.12 mm A-P) from neurons related to other body parts, which were distributed from +1.6 to -0.8 mm A-P. Second, representations of the head and face were located ventral to those of the limbs, despite substantial overlap in their overall distributions. A prominent feature of individual electrode tracks was the clustering together of cells related to the same body part. Neurons related to body parts exhibited substantial diversity, which took several distinct forms. Some neurons fired during movement or sensory stimulation in any direction, whereas others showed selectivity for a particular direction. Certain neurons responded to sensory stimulation of a large unilateral region of the body (e.g., all vibrissae or the entire forelimb), whereas others responded to stimulation of highly restricted regions (e.g., a single vibrissa or a single forepaw digit). Finally, neurons differed in the extent to which they exhibited active and passive properties. Among vibrissae-related neurons, one group fired rhythmically during whisking but did not respond to sensory stimulation of the vibrissae; a second group responded to sensory stimulation of the vibrissae but did not fire rhythmically during whisking; a third group showed both properties. Among limb-related neurons, firing during active movement was a property of every cell; none showed sensory responsiveness without showing a relation to active movement of one limb. Of the limb-related neurons, 89% tested responded to passive manipulation of the limb to which the neuron was actively related, and 71% also responded to cutaneous stimulation.(ABSTRACT TRUNCATED AT 400 WORDS)     

An approach to the delineation of adult attachment. Scale development and reliability

The authors present the results of a project to develop scales to measure the features of adult attachment using a construct-oriented approach. Adult attachment is defined in terms of eight features: proximity seeking, secure base effect, separation protest, feared loss of the attachment figure, reciprocity, availability, responsiveness of the attachment figure, and use of the attachment figure. Each feature was defined and a large item pool to tap all dimensions was derived from item nominations by clinicians, researchers, and lay subjects. The resultant scales were administered to a small sample for preliminary empirical testing. Analyses of internal reliability for each scale resulted in the elimination of items that detracted from reliability. After editing, all scales had satisfactory internal consistency. A discriminant-functions analysis provided suggestive evidence that this method of defining and measuring adult attachment would have relevance for identifying psychopathology.     

Childhood bacterial meningitis in Kuwait

A total of 110 cases of bacterial meningitis were studied over a 7-year period. The attack rate was 3.2/100,000 overall and 13/100,000 in children under 12 years. Haemophilus influenzae was the most common pathogen (44.3%), followed by Streptococcus pneumoniae (20.9%) and Neisseria meningitidis (12.7%). The mean patient age was 2.7 years, but 44/49 cases of H. influenzae meningitis were in children under 2 years, an attack rate of 31/100,000. The mortality was 22.4% for neonates and 6.5% for other children, and was associated with coma at presentation and unusual microorganisms. Neurological sequelae were detected in 19% of surviving children.