Heart rate of motor vehicle accident survivors in the emergency department, peritraumatic psychological reactions, ASD, and PTSD severity: a 6-month prospective study

This small-scale study investigates the relationships between the heart rate of motor vehicle accident survivors presenting in the emergency department (ED) and acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) symptom severity. It also examines the relationships between the survivor's heart rate in the ED and peritraumatic dissociation and peritraumatic distress reported 2 weeks posttrauma. Fifty motor vehicle accident (MVA) survivors were assessed 2 weeks, 1 (N = 42), 3 (N = 37), and 6 months (N = 37) post-MVA. The heart rate in the ED predicted self-reported ASD symptom severity and clinician-rated PTSD symptom severity at 6 months but not at 1 or 3 months. Survivors' heart rate in the ED was significantly correlated with peritraumatic dissociation but not peritraumatic distress. These findings support the role of elevated ED heart rate as a predictor of both ASD and chronic PTSD symptom severity and may help to clarify the discrepant findings of previous research.     

Psychopathology of white mentally ill immigrants to Jamaica

Object: To test the hypothesis that white immigrants to a predominantly black country have a different pattern of psychopathology from the native population.Method: The psychopathology (DSM IIIR) of white immigrants to Jamaica seen in the author's private practice between 1979 and 1990 was compared with the psychopathology of a control sample of native Jamaicans matched with the immigrant sample for age, sex, and social class.Results: There was no statistical difference in the major diagnoses mood disoder (35%), anxiety states (27%), and schizophrenia (20%) between the immigrant and control groups. White immigrants to this black country did not develop schizophrenia at higher rates than the native born. White mentally ill immigrants to Jamaica move into social class positions at a significantly higher level (p<0.005) than those of their parents with whom they grew up in their home country. This was significantly different (p<0.005) from their Jamaican controls. Two case studies are presented to illustrate these findings.Conclusions: The political/economic situation which exists in black postcolonial countries like Jamaica provides a protective social environment for white immigrants, which buffers them from the etiological conditions that engender schizophrenia in immigrants to other countries with predominantly white populations.     

Phased-in smoke-free workplace laws: reported impact on bar patronage and smoking, particularly among young adults in South Australia

OBJECTIVES: To measure the reported impact of phased-in smoke-free bar laws on bar patronage and smoking behaviour, particularly among young adults. METHODS: Cross-sectional survey of a representative sample of 2,004 South Australian adults, conducted four months into Phase I of the new laws. A comparable survey was conducted in 2003. RESULTS: Awareness of and support for the smoke-free laws were high. Phase I of the new laws did not reduce patronage. Young adults (18-24 years) reported higher patronage of bars and greater impact of the new laws on patronage, current smoking and future likelihood of quitting. CONCLUSIONS AND IMPLICATIONS: Smoke-free laws are an effective public health measure to protect against second-hand smoke. Evidence is now emerging that they may also reduce smoking among young people, as bars are social settings with potential to alter social norms about smoking and promote reduced consumption and quitting.     

Impact of voluntary folate fortification on plasma homocysteine and serum folate in Australia from 1995 to 2001: a population based cohort study

STUDY OBJECTIVE: To investigate the effect of the voluntary folate fortification policy in Australia on serum folate and total plasma homocysteine (tHcy) concentrations. DESIGN: Population based cohort study. SETTING: Perth, Western Australia. PARTICIPANTS: Men and women aged 27 to 77 years (n = 468), who were originally randomly selected from the Perth electoral roll. The cohort was surveyed in 1995/96 before widespread introduction of folate fortification of a variety of foods, and followed up on two occasions, firstly in 1998/99 and again in 2001, when a moderate number of folate fortified foods were available. Subjects with abnormal serum creatinine concentrations at baseline were excluded from this analysis. MAIN RESULTS: Repeated measures analysis of variance was used to determine changes in serum folate and tHcy over the three surveys and to assess whether time trends were related to age, sex, MTHFR C677T genotype, or consumption of folate fortified foods. An increase (38%) in mean serum folate (p < 0.0005) and a decrease (21%) in mean tHcy (p < 0.0005) were seen after introduction of the voluntary folate fortification policy in Australia. Serum folate was consistently higher (p = 0.032) and tHcy was consistently lower (p = 0.001) in subjects who consumed at least one folate fortified food compared with subjects who did not consume any folate fortified foods in the previous week. The time related changes in serum folate and tHcy were affected only by intake of folate fortified foods (p < 0.0005) and not by any other measured variables including age, sex, or MTHFR genotype. CONCLUSION: Voluntary fortification of foods with folate in Australia has been followed by a substantial increase in serum folate and decrease in tHcy in the general population.     

Recurrent tenosynovitis in Sweet's syndrome

SIR, An uncommon association of inflammatory polyarthritis isacute febrile neutrophilic dermatosis or Sweet's syndrome. Thishas the four cardinal features of fever, peripheral neutrophilicleucocytosis, painful plaque-forming inflammatory papules anda diffuse dermal neutrophilic infiltrate without vasculitis[1, 2]. There may be ocular, central nervous system, pulmonary,hepatic and renal involvement as well as oro-genital ulceration.Up to 62% of cases [3, 4] have musculo-skeletal manifestationsincluding myalgia, arthralgia and arthritis. Of the cases ofarthritis described in the literature [4–6], there noreports of associated tenosynovitis. The cause of Sweet's syndromeis unknown but it has an increased incidence in a number ofconditions, particularly infections, haematological     

Permissive hypercapnia

There has been increasing recognition that mechanical ventilation can cause acute parenchymal lung injury (ventilator-induced lung injury, or VILI) in addition to the more widely recognized forms of barotrauma. Furthermore, in patients with acute lung injury, this type of injury may cause considerable morbidity and mortality. Subsequently, the goals of mechanical ventilation have been altered to avoid this outcome. In patients with relatively normal lungs who are receiving mechanical ventilation because of neuromuscular dysfunction or impaired conscious level or for short-term postoperative support, maintaining normal blood-gas tensions without risk of VILI is usually easy. In patients with acute asthma, chronic obstructive pulmonary disease, or acute lung injury, however, accepting abnormal blood-gas tensions, particularly an elevated PaCO2 (permissive hypercapnia), to improve survival and reduce complications is frequently necessary. Extensive experience has shown that ventilated patients usually tolerate moderate hypercapnia and frequently some degree of hypoxemia in the absence of shock, anemia, severe cardiac disease, or other contraindications.     

What radiation dose for DLA-identical canine marrow grafts? [published erratum appears in Blood 1989 Feb;73(2):624]

In view of reported attempts at marrow grafting after nuclear accidents with a broad range of radiation exposures, the present study explored the total-body irradiation (TBI) conditions needed for engraftment in a canine model by using marrow from DLA-identical littermates. Previous studies have shown that such grafts are consistently successful when recipients are exposed to 920 cGy of TBI delivered at a rate of 7 cGy/min from opposing dual cobalt sources. The present TBI doses were all in the lethal range. Five dogs were administered 450 cGy; seven dogs, 600 cGy; five dogs, 700 cGy; and five dogs, 800 cGy of TBI administered at 7 cGy/min. They received a median of 3.3 x 10(8) marrow cells/kg intravenously after completion of radiation. Results showed transient allogeneic marrow engraftment in all dogs administered the lowest dose of TBI studied (450 cGy). Importantly, transient grafts permitted four of five dogs to live long enough for autologous marrow recovery to occur. At increasing radiation doses, 600, 700, and 800 cGy, the risk of graft failure lessened, with 3 of 7, 2 of 5, and 1 of 5 dogs, respectively, showing graft rejection. Fewer dogs survived with autologous marrow recovery, and more showed sustained allogeneic engraftment (4 of 7, 3 of 5, and 4 of 5 dogs, respectively). We conclude that DLA-identical littermate marrow grafts are beneficial in the setting of otherwise lethal radiation exposures, with most dogs either experiencing sustained allogeneic engraftment or surviving with autologous marrow recovery due to the extended support provided by a transient allogeneic graft.