Selection in the social network: Effects of chronic diseases

Background: This article deals with the consequences of diseasefor someone's personal social network. It is hypothesized thatthe duration of a socially severe disease will affect the socialnetwork in such a way that the proportions of women, kin, long-standingrelationships and people living nearby are higher for peoplesuffering from a disease longer. Contacts with colleagues willdecline. Methods: These hypotheses were tested on the data ofa representative sample of the Dutch, gathered by means of ahealth interview (N = 10, 110). The presence and duration ofdiseases were measured by a checklist of 23 chronic diseases.The social severity of a disease was determined by its visibility,threat to others and functional disablement. The network characteristicsin this study were church membership, membership of voluntaryorganizations, number of dose friends, number of supportgivers,proportions of kin, women, colleagues, long-standing relationshipsand people living nearby. Gender, education, life-cyde stageand work status were taken Into account in all analyses. Results:Logistic and linear regression analyses showed that the durationof a disease, whatever the degree of social severity, does notaffect the network strongly. People suffering longer from sociallysevere chronic diseases reported fewer friends and supportgivers.People suffering longer from moderately severe chronic diseasesreported fewer supportgivers for health-related support. Theresults on socially mild chronic diseases were not in line withthe expectations: people who are ill longer reported more friendsand fewer women in their network. Conclusion: We conclude thatin a general population the duration of diseases hardly hasany effect on social network characteristics.     

A Multicenter Experience with a Bipolar Tined Polyurethane Ventricular Lead

A multicenter study was undertaken to determine the failure rate of a specific polyurethane bipolar tined pacing lead, the Medtronic 4012 pacing lead. Six centers in the United States and Canada implanted 1,190 Medtronic 4012 pacing leads. The study was designed to determine the probability and clinical manifestations of lead failure. Only failures compatible with an insulation problem were included. The probability of a 4012 lead failure by Kaplan-Meier analysis was 20.9% at 6 years after implantation. Failures were manifested as sensing abnormalities, failure to capture, early battery depletion, and significant decrease in measured impedance compared with the previous impedance measurements. Of the 95 definite lead failures, 16 (16.8%) were associated with symptoms similar to those experienced before pacemaker placement. The observed failure rate is unacceptable, and strong consideration should be given to replacing the 4012 pacing lead in pacemaker-dependent patients and closely monitoring nondependent patients.     

Syphilis prevention in pregnancy: an opportunity to improve reproductive and child health in Kenya

Infection with maternal syphilis during pregnancy is a seriouscondition with dramatic impact on pregnancy outcome, includingperinatal wastage and congenital syphilis. Primary preventionof congenital syphilis by antenatal case-detection and treatmentof infected mothers is feasible and cost-effective. Yet theimplementation of syphilis prevention activities is not effectivein many third world countries, due to logistic and managerialobstacles. This paper describes the achievements and the constraints ofthe antenatal syphilis prevention programme in Nairobi, Kenya.The structural and technical problems and alternative strategiesfor the realization of an effective congenital syphilis preventionprogramme in an urban third world setting are discussed.     

Persistence of residual tumour cells after cytokine-mediated ex vivo expansion of mobilized CD34+ blood cells in multiple myeloma

Mobilized CD34⁺ blood cells were immunomagnetically enriched from leukapheresis products in five multiple myeloma (MM) patients. Thawed samples of selected CD34⁺ cells were cultured for up to 21 d in a liquid and stroma-free culture system with different combinations of recombinant cytokines. The most successful cell expansion was obtained when a combination of rh-IL-1β, rh-IL-3, rh-IL-6, rh-SCF, rh-G-CSF and rh-GM-CSF was used. After 14 d this mixture gave a 120–187-fold overall increase of total nuclear cells and a 4–8-fold overall increase of early CFU-GM numbers. In four patients a very sensitive patient-specific PCR analysis showed the presence of monoclonal cells in the initial leukapheresis products. After immunomagnetic separation a tumour cell depletion of 2–4 logs was observed, although all samples still contained malignant cells. Cell suspensions that were cultured with the most potent cytokine combination showed tumour contamination in two-thirds of evaluable cases at the moment of maximal CFU-GM output. Serial cDNA dilution experiments indicated that the positive PCR results at day 14 reflected the persistence of pre-culture tumour cells rather than in vitro expansion of tumour cells in two cases. This study demonstrates that ex vivo expansion of myeloid precursor cells from mobilized CD34⁺ cells in MM patients does not always result in an effective purging of residual tumour cells. On the other hand, our culture conditions do not seem to favour in vitro expansion of malignant cells, despite the use of a cytokine cocktail that includes potential myeloma growth factors.     

What about healthy networks? An analysis of the national networks of healthy cities in Europe

The World Health Organization (WHO)/Euro Healthy Cities Projecthas received much attention since the first project cities wereselected in 1987 in fact many more cities than can participateshowed (and still show) their interest. Thus initiatives havebeen taken to establish activities similar to the Healthy CitiesProject, not only in Europe but all over the worl4 ‘nationalnetworks of Healthy Cities’ have developed The nationalnetworks in Europe call themselves ‘EURONET’, aEuropean network of national Healthy Cities networks. EURONETis not a formal association; how this initiative will developin the near future is under discussion. A national network is an example of a social network but becauseof its complexity and different leveLs of ‘networking’,is difficult to analyse. However analysis, and evaluation, isneeded to review the functioning and impact of the healthy citiesidea. To study and analyse the networks in Europe, which areas a whole rather large, a selection has been made to reducethe number of participants (n=14), number of resources (n=4)and (categories of) activities (n=9) which were examined Theanalysis provided information about the development of the network;among other things it looked at why they started who took theinitiative, what changes occurred during the period of development,who were the participants at a national level, what activitieswere undertaken, and the relationship between activities andparticipants. As expected the findings did not provide a uniformpicture of ‘what a national Healthy Cities network shouldlook like’ nor did they give the recipe of ‘howto become a Healthy Cities network’. However, the strengthof national networks is that they have the potential to continuethe Healthy Cities project aims and objectives, even if theWHO project ever ceases.     

The Aicardi Syndrome in a 47, XXY Male

Hopkins, I. J., Humphrey, I., Keith, C. G., Susman, M., Webb, G. C. and Turner, E. K. (1979). Aust. Paediatr. J. , 278–280. the Aicardi syndrome in a 47, XXY male. The Aicardi syndrome is reported for the first time in a male child. His chromosomal analysis revealed a 47, XXY karyotype. This finding supports the suggestion that this condition is due to a newly mutated X-chromosomal dominant gene. The existence of a 47, XXY chromosomal constitution in this male allows heterozygous expressions of the gene as in the female.     

NASPE Expert Consensus Document: Use of IV (Conscious) Sedation/Analgesia by Nonanesthesia Personnel in Patients Undergoing Arrhythmia Specific Diagnostic, Therapeutic, and Surgical Procedures

Use of IV (Conscious) Sedation/Analgesia by Nonanesthesia Personnel in Patients Undergoing Arrhythmia Specific Diagnostic, Therapeutic, and Surgical Procedures. This article is intended to inform practitioners, payers, and other interested parties of the opinion of the North American Society of Pacing and Electrophysiology (NASPE) concerning evolving areas of clinical practice or technologies or both, that are widely available or are new to the practice community. Expert, consensus documents are so designated because the evidence base and experience with the technology or clinical practice are not yet sufficiently well developed, or rigorously controlled trials are not yet available that would support a more definitive statement. This article has been endorsed by the American College of Cardiology, October 1997.     

DDI Pacing: Indications, Expectations, and Follow-Up

The DDI mode of pacing that permits noncompetitive atrioventricular sequential bradycardia support was chosen in 65 of 480 (14%) patients selected for dual chamber pacing between February 1985 and March 1990. All patients were implanted with Pacesetter 283 or 285 pulse generators and programmed to DDI. The indications for pacing were sick sinus syndrome (n = 52), combined sinus node dysfunction and AV block (n = 13). Forty-two of these patients had a history of paroxysmal atrial arrhythmias. All patients received passive fixation atrial and ventricular leads. Follow-up thereafter was performed predischarge, and at 6 weeks, 3 and 6 months after discharge. The duration of follow-up ranged from 1-61 months (mean 31 months). Fifty-four of 65 (83%) patients chosen for DDI remain programmed in the DDI mode. Three patients were reprogrammed to VVI and eight to DDD. During the course of follow-up, six patients presented with effective VVI pacing with consistent ventriculoatrial conduction that was appropriately sensed by the atrial circuit with atrial output inhibition. A further four patients presented with "functional undersensing" due to ventricular blanking period (VBP) characteristics in these pulse generators and in this mode. Functional undersensing was eliminated in all but one patient by reprogramming the VBP to 13 msec with no subsequent episodes of provoked crosstalk inhibition. Effective VVI pacing was observed in patients with AV block during times of sinus acceleration. While DDI mode is an effective form of pacing, permitting non-competitive atrioventricular sequential pacing, potential limitations include: effective VVI pacing during intact ventriculoatrial conduction, functional undersensing when long VBP are programmed, and effective VI pacing with sinus node acceleration during AV block.