The haemochromatosis gene: A co-factor for chronic liver diseases?

There is increasing evidence that hepatotoxins, such as alcohol and the hepatitis viruses, act as co-factors in causing hepatic fibrosis and cirrhosis. For example, alcohol aggravates the hepatic damage produced by iron in hereditary haemochromatosis. We present evidence that the reverse is also true, that is, that iron loading of mild to moderate degree due to heterozygosity or homozygosity for the haemochromatosis genetic mutations acts as a significant hepatotoxin aggravating hepatic damage from other causes of liver disease. These include non-alcoholic steatohepatitis, chronic hepatitis C, porphyria cutanea tarda and possibly primary liver cell cancer. However, any additional hepatotoxic effect is due to the hepatic iron concentration and not the mutations in the haemochromatosis genes.     

Sexual dysfunction in couples with learning handicaps

This article describes the sexual dysfunctions experienced by couples in which both partners have learning and/or developmental disabilities. It addresses issues of frequently contributing factors in their development and specific concerns that arise in their treatment. The importance of raising clinicians' awareness and sensitivity about sexual dysfunction among the learning handicapped is discussed.     

Solvent polymeric membrane pH catheter electrode for intraluminal measurements in the upper gastrointestinal tract

A hydrogen ion-selective PVC membrane based on octadecyl isonicotinate (ETH 1778) is used to construct a miniaturised potentiometric pH electrode for intraluminal application. The all-polymeric device includes a reference electrode and is of less than 2 mm overall diameter. The current state of the materials used limits its dynamic range to between pH 0 and 4. The lifetime is at least five months. The inexpensive and easy construction allows its use as a disposable device.     

Physical health nurse consultant role to improve physical health in mental health services: A carer's perspective

The physical health of people diagnosed with a mental illness is significantly poorer in comparison with the general population. Awareness of this health disparity is increasing; however, strategies to address the problem are limited. Carers play an important role in the physical health care of people with mental illness, particularly in facilitating navigation of and advocating in the health care system. A specialist physical health nurse consultant position has been suggested as a way to address the physical health care disparity and limited research available suggests that positive outcomes are possible. In the present study, a qualitative exploratory research project was undertaken, involving in‐depth interviews with people identifying as mental health carers. Two focus groups and one individual interview were conducted involving a total of 13 carers. The resulting data were analyzed thematically. Views and opinions about the proposed physical health nurse consultant (PHNC) position were sought during these interviews and are reported in this paper. Two main sub‐themes were evident relating to characteristics of this role: reliability and consistency; and communication and support. Essentially carers expressed a need for support for themselves and consumers in addressing physical health concerns. Successful implementation of this position would require a consistent and reliable approach. Carers are significant stakeholders in the physical health of consumers of mental health services and their active involvement in identifying and tailoring services, including development of the physical health nurse consultant must be seen as a priority.     

Patient education needs as reported by congestive heart failure patients and their nurses

Patients with congestive heart failure (CHF) need considerable education to enable them to provide effective self-care for their chronic illness. No information has been published about the learning needs of this population. The purpose of this study was to examine hospitalized CHF patients and their nurses' perceptions regarding the importance and realism of typical patient education content. An instrument to assess learning needs was developed and piloted for use in this study. Thirty hospitalized patients and 26 nurses were surveyed. Both nurses and patients rated all information as important to learn and realistic to learn during the patients' hospitalizations. Patients and nurses agreed that medication information was the most important to learn. Generally, patients rated information as more important than nurses rated the same information areas. Suggested nursing interventions and future research endeavours are addressed.     

Prevalence of hepatitis B and C seropositivity among health care workers of the ISSEMYM

"Background: The prevalence of serum markers of viral hepatitis in health-care workers seems to be similar to that described in the general population, even though this group would appear at increased risk because exposure to potentially infectious material. There is scarce information available in Mexico in this regard. Aim: To define the prevalence of serum markers for hepatitis C (anti-HCV antibodies) and hepatitis B (hepatitis B surface antigen, HBsAg) in health-care workers at the Instituto de Seguridad Social del Estado de Mexico y Municipios (ISSEMYM) and to establish the presence of viremia in subjects with positive serum markers. Method: Health-care workers from ISSEMyM with unknown hepatitis serologic status participated voluntarily in this trial. They completed a written questionnaire detailing potential risk factors for viral hepatitis and provided a blood sample. Results: A total of 374 health-care workers were included. Seven subjects (1.8%) were positive, 5 for anti-HCV antibodies (1.3%) and 2 for HBsAg (0.5%). None of these subjects had detectable serum HCV RNA or HBV DNA on further testing. Conclusions: The frequency of positive serum markers for viral hepatitis in this group of healthcare workers is similar to the estimated prevalence among the general population in Mexico. No case of active infection defined by positive viremia was encountered in this group of subjects."     

What do psychiatric emergency patients really want and how do they feel about what they get?

Psychiatric emergency patients range along a continuum from persons who present to the service with specific requests for help, to individuals who are brought to the service in handcuffs against their will for reasons they do not understand. In addition, studies suggest that psychiatric emergency patients' wishes and expectations often fall outside the traditional framework of psychiatric assessment (1), are not straightforward or concrete (2) or are not accurately perceived by the clinicians who see them (3). How these factors impact on patient satisfaction with the treatment they have received is not well-understood, because the manner in which specific patient variables and treatments might relate to patient satisfaction among the psychiatric emergency service population has not been systematically studied (4) (5) (6). In contrast, psychiatric inpatients and outpatients (7) (8) (9) usually express positive attitudes about their mental health care, although this finding may be skewed by a lack of real anonymity (10). Chronic patients tend to express less satisfaction with their treatment programs than do others, and patient satisfaction in some studies has been related to patient demographics, diagnoses, treatment histories (11) and patients' global rating of treatment outcome (12).