Carriage of Haemophilus influenzae and Streptococcus pneumoniae in healthy Chinese and Vietnamese children in Hong Kong

Nasopharyngeal carriage of Haemophilus influenzae and Streptococcus pneumoniae was studied in 621 healthy Chinese children and 300 healthy Vietnamese children aged from 2 months to 5 years in Hong Kong. The carriage rate of H, influenzae type b in Vietnamese children was 1.3% (CI 0.04-2.63%); it was zero in Chinese. The carriage rate of non-typable H. influenzae was 5.8% (CI 1.4-7.6%) in Chinese and 65.4% (CI 58.9-69.8%) in Vietnamese. The carriage rates of S. pneumoniae were 10.8% (CI 8.3-13.2%) and 55.7% (CI 50.1-61.3%) in Chinese and Vietnamese children, respectively. Univariate and multivariate logistic regression analyses were performed to search for factors associated with differences in carriage rates of both H. influenzae and S. pneumoniae between Chinese and Vietnamese children. Although older age, smaller living area and parental smoking were associated with higher carriage rates, these could not explain the remarkably low carriage rates of both bacteria in Chinese children.     

Histopathological studies of the temporal bones in Hurler's disease [mucopolysaccharidosis (MPS) IH]

The structural basis of the combined conductive and sensorineural deafness has been described in two patients with Hurler's disease. All parts of the ear contained numerous large vacuolated Hurler cells, the vacuoles being distended lysosomes from which accumulated glycosaminoglycans had been dissolved during fixation of the tissue. The external and middle ears also showed chronic inflammation. There was resorption of the bone in the mastoid process by masses of Hurler cells and abnormal new bone with prominent cement lines. The blood vessels were surrounded by a 'blue mantle' of osteoid tissue similar to that which is usually associated with otosclerosis. The stapes appeared deformed and was covered by thickened mucosa and granulation tissue. The bone structure of the ossicles resembled that of the mastoid process. The organ of Corti was degenerate and the Reissner's and tectorial membranes were adherent to one another and covered by haemorrhagic material near the vascular striae. The blood vessels in the striae were congested and the scalae media and tympani contained some blood. The neurons in the basal coil of the spiral ganglion were replaced by Hurler cells. The vestibulo-cochlear nerves were disrupted by numerous Hurler cells. These pathological findings adequately explain the combined conductive and sensorineural deafness in these cases. They are also discussed in relation to some other clinical and pathological aspects of these two specific patients.     

Genetic Engineering and Medical Ethics

In the introduction I express the need of introducing the point of view of Ethics when we are dealing with problems of science, technology, and especially medicine. In the first part of my presentation I deal with the problem of the value of human life, coming to the conclusion that human life might not be completely absolute, but is extremely important and “ceteris paribus” should be respected, and the problem of when it starts. Some of the main arguments are discussed. In this connection the question of abortion is briefly discussed. In the second part I deal with some problems related to human reproduction. Most people will be willing to support programmes for treating individuals with genetic disease; but at the same time the dangers of increasing depersonalization of the reproductive process are pointed out. In the third part I take up the problem of In Vitro Fertilisation. IVF has certainly brought benefits to some couples suffering from infertility, but at the same time it has raised quite a few human and moral problems. Is it permissible to fertilise an egg with a donor sperm, replacing the embryo in the womb? What about fertilising a donor egg with the husband's sperm? Is it acceptable to store or freeze embryos for future use? Is it moral to implant such an embryo in a woman who has no genetic relationship with the embryo? Is it moral to use surrogate mothers? Is it moral for ‘spare’ embryos to be killed or used as tissue for research? At the end I stress the need of dialogue between life sciences and ethics.     

Organizational culture: its impact on employee relations and discipline in health care organizations

Organizations need to examine their cultures at the level of the "shop floor"--in health care, the point where health care workers deal with patients--to determine if the culture is consistent with management policies and will permit an effective program of reward and discipline. This article describes a case where organizational culture was a major imperative in the outcome of an arbitration case. Discussed is a shop-floor situation in manufacturing holding implications for health care, a setting in which management, by countenancing counterproductive aspects of the culture, made it impossible to apply discipline as needed. The conclusion is that health care organizations that neglect the detrimental elements of their culture may find themselves not only at risk of poor employee relations, but also unable to apply discipline effectively.     

Low medial and lateral right pulvinar volumes in schizophrenia: a postmortem study

OBJECTIVE: In this study, the volume and neuronal number of the pulvinar thalamic nucleus in schizophrenia patients were measured. METHOD: The authors examined medial and lateral pulvinar nuclei bilaterally in 27 patients with schizophrenia and 28 normal comparison subjects. RESULTS: In the comparison subjects, the medial pulvinar was larger on the right. The right but not left pulvinar nuclei were smaller in the schizophrenia patients than in the comparison subjects. The number of neurons showed similar trends. CONCLUSIONS: These findings confirm low pulvinar volume in schizophrenia and show that it affects both medial and lateral nuclei. The lateralized findings may reflect pulvinar connections with asymmetrical neocortical regions and their asymmetrical involvement in schizophrenia.     

The etiology of schizophrenia and the origin of language: overview of a theory

Schizophrenia is present in all human populations with approximately the same incidence. Why does such illness persist given that it is associated with a reproductive disadvantage? What is the balancing advantage? A possible explanation is linked to human language. According to this hypothesis schizophrenia occurs as a manifestation of genetic diversity associated with language--the function by which Homo sapiens has separated from other primate species. Language originated by a genetic mutation that allowed the cerebral hemispheres to develop with a degree of specialization (or lateralization) reflected in cerebral asymmetries. Individuals with schizophrenia show lesser structural and functional brain asymmetries than the population as a whole, and this finding can be interpreted as a delay, or failure in, establishing hemispheric dominance for language. We review recent evidence supporting this theory.     

Application of a new image analysis technique to study brain asymmetry in schizophrenia

The hypothesis that normal brain torque (i.e. rightward frontal and leftward occipital asymmetry) is anomalous in schizophrenia (Crow, 1997. Trends in Neuroscience, 20, 339-343) was tested by application of a novel image analysis technique on three-dimensional magnetic resonance images obtained in 26 adult patients with chronic schizophrenia (18 males, 8 females) and 24 controls (14 males, 10 females). Right and left cerebral hemisphere tissue was extracted via non-linear co-registration with a mask image, and maps were computed of inter-hemispheric differences in tissue volume in an array of columns of voxels orthogonal to the mid-plane (2D), and profiles of coronal slice volumes (1D). Furthermore, integration of two-dimensional column maps gave approximate lobar asymmetries, and occipital and frontal asymmetries were combined to give a volumetric measure of brain torque. Significant brain torque was revealed in male and female control and patient groups, and did not correlate with brain size. Frontal and occipital asymmetries were significantly correlated in all groups. Both frontal and occipital components of torque were significantly increased in males than females. Patients tended to have reduced torque, particularly the leftward occipital component. Furthermore, 3/26 patients (but no controls) had reversed torque (leftward frontal and rightward occipital asymmetry). Contrary to Crow's hypothesis, brain torque was not significantly reduced in patients with schizophrenia relative to controls, although reversal of torque was found in three cases. Future studies with larger sample sizes should consider sexual dimorphism and specific symptoms in relation to asymmetry.     

The educational needs of healthcare managers and executives in the key strategic areas of healthcare

Management approaches used by many healthcare organizations lag behind those of similar competitive industries. The authors of this article report findings from an exploratory study of executives' perceptions of training needs in managerial strategy. The authors asked executives to rate the level of knowledge required for each of five key areas in strategic management and then to assess actual levels of knowledge in the field. They found that (a) strategic management is vital in this competitive industry, (b) there is a disconnect between what healthcare managers should know and what they actually know about the tasks of strategic management, and (c) more resources need to be devoted to strategic management training and the development of managers at all levels of healthcare organizations.     

Executive development in healthcare during times of turbulence: top management perceptions and recommendations

In this research we report an analysis of comments from managers and executives in healthcare organizations to provide insights into the strategic management needs of healthcare organizations. The comments were obtained as part of a survey that asked upper-level managers and executives to identify strategic management skill and knowledge needs in healthcare organizations. After completing the survey, the respondents were given the opportunity to comment on any topics of concern to them. A total of 67 comments, many of them extensive and insightful, were obtained. In this paper, we review the literature dealing with educational and developmental needs of healthcare managers. Much of this literature is academic in nature and permits an interesting comparison to the perspective of management and executive practitioners. Emerging from the literature was a concern for environmental turbulence and a recognition that healthcare managers are at risk of falling behind in terms of skill development under such conditions. Respondent comments suggested a recognition of the potential problems. The comments are classified into four major categories: needs and skills in turbulent conditions; program and educational needs; issue clarification; and additional comments. Moreover, the first two categories appeared to break out into a set of six additional themes, which we suggest will be important to those designing programs for executive development in healthcare during turbulent times. While the source of this research is healthcare settings in Canada and the USA, the findings should be applicable to international healthcare organizations that use strategic management concepts and practices.     

A genome-wide scan for linkage to chromosomal regions in 382 sibling pairs with schizophrenia or schizoaffective disorder

OBJECTIVE: Some genome-wide scans and association studies for schizophrenia susceptibility genes have yielded significant positive findings, but there is disagreement between studies on their locations, and no mutation has yet been found in any gene. Since schizophrenia is a complex disorder, a study with sufficient power to detect a locus with a small or moderate gene effect is necessary. METHOD: In a genome-wide scan of 382 sibling pairs with a diagnosis of schizophrenia or schizoaffective disorder, 396 highly polymorphic markers spaced approximately 10 centimorgans apart throughout the genome were genotyped in all individuals. Multipoint nonparametric linkage analysis was performed to evaluate regions of the genome demonstrating increased allele sharing, as measured by a lod score. RESULTS: Two regions with multipoint maximum lod scores suggesting linkage were found. The highest lod scores occurred on chromosome 10p15-p13 (peak lod score of 3.60 at marker D10S189) and the centromeric region of chromosome 2 (peak lod score of 2.99 at marker D2S139). In addition, a maximum lod score of 2.00 was observed with marker D22S283 on chromosome 22q12, which showed evidence of an imprinting effect, whereby an excess sharing of maternal, but not paternal, alleles was present. No evidence of linkage was obtained at several locations identified in previous studies, including chromosomes 1q, 4p, 5p-q, 6p, 8p, 13q, 15p, and 18p. CONCLUSIONS: The findings of this large genome-wide scan emphasize the weakness and fragility of linkage reports on schizophrenia. No linkage appears to be consistently replicable across large studies. Thus, it has to be questioned whether the genetic contribution to this disorder is detectable by these strategies and the possibility raised that it may be epigenetic, i.e., related to gene expression rather than sequence variation. Nevertheless, the positive findings on chromosome 2, 10, and 22 should be pursued further.