The psychosocial outcome of pregnancy in women with psychotic disorders

OBJECTIVE: To investigate the psychosocial outcome of pregnancies in women with a history of psychotic disorder in an epidemiologically representative sample and to determine the predictors of having a baby looked after by social services in the first year of life. METHOD: Historical matched controlled cohort study and nested case control study using the General Practice Research Database (GPRD), an anonymised primary care database, in women with a history of psychotic disorders who gave birth in 1996-1998 (199 cases and 787 controls). RESULTS: Twenty-seven percent of cases had a psychotic episode and a further 38% had nonpsychotic depression in the first year after birth. Women with nonaffective psychoses were at a significantly higher risk of postnatal depression compared with controls (adjusted rate ratio 2.07, 95% CI 1.45-2.96, p<0.001). Cases were well supported with 72% in a cohabiting relationship and only 38% on benefits. The only significant predictor of parenting difficulties was recent contact with psychiatric services. CONCLUSIONS: Women with a history of psychotic disorder are at high risk of psychiatric illness postpartum, particularly a twofold risk of postnatal depression, even if they have not been in contact with psychiatric services during pregnancy. However, this epidemiologically representative sample has better parenting outcomes than has been previously reported for specialist treated cases. Liaison between all professionals involved in the care of mothers with psychotic disorders during and after pregnancy is essential to optimise care for them and their families.     

Polyploidisation of metastatic colon carcinoma cells by microtubule and tubulin interacting drugs: effect on proteolytic activity and invasiveness

When SW620 colon cancer-derived metastatic cells were exposed to nanomolar concentrations of Taxol, colchicine or (Z)-3,5,4'-trimethoxystilbene (R3), huge aneuploid, polynuclear cells survived the treatment. These cells released considerable amounts of the matrix metalloproteinase matrilysin (MMP-7), and tissue-type plasminogen activator (tPA) into the surrounding culture medium. MMP-7, and other proteolytic enzymes were highly expressed by these cells. In spite of their enormous size, the polyploid cells exhibited a considerable migratory capacity, as was demonstrated by their migration through an artificial basement membrane. While colchicine and R3-treated cells showed an inverse relationship between drug concentration and invasiveness, treatment with Taxol increased the capacity of the SW620 cells to penetrate through the membrane. The invasive capacity was not correlated with the induction and release of proteolytic enzymes. The idea that expression and release of proteolytic enzymes is a fundamental prerequisite of tumour cell invasiveness is generally accepted. The ability of the cells to respond to chemotactic signalling, and the filamentous structures of the cells, together with several cell adhesion factors, which are the basis of cell migration, are prerequisites of invasiveness. These factors are presumably different in the aneuploid cells produced by Taxol, colchicine and R3, and await scrutiny.     

Improved survival among young patients with cystic fibrosis

OBJECTIVE: To investigate age-specific trends in survival among US patients with cystic fibrosis between 1985 and 1999 and to assess whether survival in female patients with cystic fibrosis has improved relative to survival in male patients. STUDY DESIGN: A retrospective cohort study of 31,012 subjects in the US Cystic Fibrosis Foundation National Patient Registry. Trends in survival outcome were evaluated by the Cox model. RESULTS: Between 1985 and 1999, mortality fell 61% (95% CI, 36-76) for patients age 2 to 5 years, 70% (60-88) for patients age 6 to 10 years, and 45% (32-66) for patients age 11 to 15 years. Improvements in mortality rates among patients older than 15 years were smaller. Female patients had poorer survival rates than male patients in the age range 2 to 20 years, and this gender gap did not narrow throughout time. CONCLUSIONS: Survival rates of US patients with cystic fibrosis have improved remarkably since 1985. However, most of the improvement was limited to patients 2 to 15 years old. Although both genders benefitted from this trend, female patients have had consistently poorer survival rates than male patients in the age range 2 to 20 years. Further studies are needed to clarify why adult patients with cystic fibrosis had little improvement in survival rates.     

Regional and urban Victorian diabetic youth: clinical and quality-of-life outcomes

OBJECTIVES: To compare groups of urban and regional Victorian diabetic children and assess their quality of life, diabetes knowledge, access to services and metabolic control. METHODS: Forty-seven children from three regional Victorian communities (Horsham, Warrnambool and Sale; n = 16, 18 and 13, respectively) were compared with 120 age-, sex- and duration of diabetes-matched children attending the Royal Children's Hospital (RCH) diabetes clinic in Melbourne. Quality of life, diabetes knowledge, use of services, and metabolic control were assessed using the child health questionnaire (CHQ PF-50/CF-80); a diabetes-knowledge questionnaire; access to a diabetes nurse educator (DNE), dietitian and complication screening; and indices of mean HbA1C (values are taken every 3 months in the 'yearly HbA1C'), respectively. RESULTS: Comparisons of CHQ data showed that regional diabetic youth scored significantly lower on most subscales. The greatest deficits were seen in areas of mental health, self-esteem, parent impact (emotional) and family cohesion. Diabetes knowledge and median yearly HbA1C for patients were not significantly different between the regional and urban centres (8.1%, 8.9%, 8.4% and 8.6% at RCH, Horsham, Warrnambool and Sale, respectively). Patients in regional centres had reportedly less access to team-based diabetes care. CONCLUSIONS: Regional youth in Victoria, with similar levels of metabolic control and diabetes knowledge as their urban counterparts, have a markedly lower quality of life, implying a negative synergy between diabetes and the demands of regional lifestyles.     

The politics of grief and continuing bonds with the dead: the cases of Maoist China and Wahhabi Islam

The article is a contribution to a cross-cultural theory of grief. It examines the relationship between individual/family continuing bonds with the dead and cultural narratives that legitimize political power. The dead are collective representations (Dirkheim) that mediate the larger culture to individuals and to smaller communities and that reinforce social solidarity and identity. The political question is which collective--family, community, church, party, nation--owns the dead and controls the rituals by which bonds with the dead are maintained or relinquished? The article discusses one historical condition: times of rapid change in power arrangements. Bonds with the dead have a power in individual, family, or tribal life that can threaten the narrative that legitimizes the new political power holders. Ancestor rituals that support identity as a family or tribal member are surpressed and replaced by allegiance to collective representations of the new political order. Two historical examples are given: China under Chairman Mao and the Wahhabi reform in Arabic Islam.     

Politics,religions, and grief: the cases of American spiritualism and the Deuteronomic reform in Israel

The article is a contribution to the task of developing a cross-cultural model of grief. It shows that grief narratives can be complexly interwoven with the religious and political narratives of the culture. Two political reforms in which religious narratives figured prominently are given as case examples: 19th-century Spiritualism in North America and the Deuteronomic reform in 7th-century BCE Israel. Similarities and differences between the two are discussed. The article concludes that an adequate cross-cultural model of grief must be capable of explaining how a particular grief narrative relates to the politics and religious narratives in which it is set.     

Die Arthrodese des Glenohumeralgelenks mit einer 4,5-mm-Rekonstruktionsplatte

Objective Arthrodesis of the glenohumeral joint while preserving scapulothoracic motion; elimination of pain. Indications Brachial plexus lesions with preserved function of elbow and hand. Paralysis of deltoid and rotator cuff after poliomyelitis. Neurogenic arthropathy. Infectious arthritis resistant to therapy. Severe, painful glenohumeral arthritis resistant to conservative therapy. Unsuccessful attempts to treat glenohumeral instability. Infected, painful loosened total shoulder replacement. Rotator cuff tears beyond repair. Contraindications Complete upper and lower plexus paralysis (no elbow and hand function). Incomplete recovery after neurosurgical interventions at the upper plexus (nerve transplantation, neurolysis). Insufficient strength of the scapular muscles. Inadequate soft tissue coverage at planned site of plate such as after burns, excessive previous surgery and radiotherapy. Surgical Technique Arthrodesis of the glenohumeral joint in 20° of abduction, 30° of flexion, and 40° of internal rotation using transarticular lag screws. To compensate for moments of tension that are generated by the weight of the arm and that act on the site of arthrodesis, a 4.5-mm pelvic reconstruction plate is inserted from the scapular spine to the anterolateral humeral shaft, thus acting as a tension band while at the same time increasing the interfragmentary compression. Results Between 1994 and 1998, a glenohumeral arthrodesis with a reconstruction plate was performed in 14 patients (twelve men, two women, average age 35.4 [17–56] years). After an average of 14 months postoperatively, active abduction had improved from 10° to 59° and flexion from 11° to 51°. Three patients considered their result excellent (21.4%), eight (57.1%) good, two (14.3%) fair, and one poor (7.1%).     

Resveratrol analog (Z)-3,5,4'-trimethoxystilbene is a potent anti-mitotic drug inhibiting tubulin polymerization

Resveratrol (3,5,4'-trihydroxystilbene) a natural polyphenol present in medicinal plants, grapes and wines, has potent chemopreventive properties on intestinal carcinogenesis. A methylated derivative (Z-3,5,4'-trimethoxystilbene: R3) was synthesized. R3 at 0.3 microM exerted a 80% growth inhibition of human colon cancer Caco-2 cells and arrested growth completely at 0.4 microM (R3 was 100-fold more active than resveratrol). The cis conformation of R3 was also 100-fold more potent than the trans isomer. R3 (0.3 microM) caused cell cycle arrest at the G2/M phase transition. The drug inhibited tubulin polymerization in a dose-dependent manner (IC50=4 microM), and it reduced also by 2-fold ornithine decarboxylase and s-adenosylmethionine decarboxylase activities. This caused the depletion of the polyamines, putrescine and spermidine, which are growth factors for cancer cells. R3 inhibited partially colchicine binding to its binding site on tubulin, indicating that R3 either partially overlaps with colchicine binding or that R3 binds to a specific site of tubulin that is not identical with the colchicine binding site modifying colchicine binding by allosteric influences. The resveratrol derivative (Z)-3,5,4'-trimethoxystilbene (R3) is an interesting anti-mitotic drug that exerts cytotoxic effects by depleting the intracellular pool of polyamines and by altering microtubule polymerization. Such a drug may be useful for the treatment of neoplastic diseases.     

Methylenetetrahydrofolate reductase gene C677T and A1298C polymorphisms in patients with small cell and non-small cell lung cancer

Two mutations of methylenetetrahydrofolate reductase (MTHFR) gene (C677T and A1298C) may lead to a decreased activity of the enzyme. These mutations may change a risk of some cancers. We evaluated these two polymorphisms of MTHFR in patients with small cell lung cancer (SCLC) and non-small cell lung cancer (NCSCL). All lung cancer patients had statistically significantly higher percentage of MTHFR 677TT genotype in comparison with non-cancer controls. There were no statistically significant differences in the distribution of MTHFR 1298 genotypes. Neither of the polymorphisms presented any statistically significant differences between SCLC and NSCLC.     

Continuing education: the 1998 Survey of the Royal Australasian College of Dental Surgeons

BACKGROUND: Continuing education (CE) is an essential professional activity. In the last decade, CE has been actively pursued by the medical profession in Australia and abroad. However, the uptake of CE in dentistry has been much slower and there is minimal Australian data on dental CE. METHODS: To determine the level of CE activity, in 1998, postal questionnaires were sent to all fellows of the Royal Australasian College of Dental Surgeons. The responses were analysed. RESULTS: There was a high response rate (90 per cent) but a moderate usable rate (54 per cent). The results show a biphasic distribution between high and low CE activity. The average amount of activity of those involved in CE was 116 hours per year, above the usually accepted minimum of 100 hours/year. Some groups, particularly members of the specialist divisions of oral and maxillofacial surgeons (215 hours) and periodontists (205 hours), have high levels of CE. However, approximately 25 per cent of college fellows reported little or no CE activity. The survey revealed that inactive fellows are more likely to be older and in general practice. Inactive fellows were also tardy in replying to the questionnaire. CONCLUSION: The high activity CE group needs to be recognised and encouraged to continue. Specific plans to help the low CE activity group should be developed. Although these findings relate directly to the Royal Australasian College of Dental Surgeons, they are presented as they have implications for the dental profession at large.