Valuation of life: a concept and a scale

OBJECTIVES

The objective was to derive and test the psychometric characteristics of a scale to measure Valuation of Life (VOL).

METHODS

Four samples were used in successive phases of exploratory factor analysis, confirmatory factor analysis, reliability and validity testing, and exploration of response-error effects. Estimates of Years of Desired Life were obtained under a variety of hypothetical quality-of-life (QOL)-compromising conditions of poor health.

RESULTS

Confirmed 13-item (Positive VOL) and 6-item (Negative VOL) factors were obtained. A significant relationship between VOL and most Years of Desired Life estimates remained when demographic, health, quality of life, and mental health measures were controlled. Analysis of Negative VOL revealed that some respondents misunderstand the meaning of an agree response to negatively phrased items.

DISCUSSION

VOL is a cognitive-affective schema whose function as a mediator and moderator between health and end-of-life decisions deserves further research.

The relationship between external events and affect states in older people

Long-term and moderately short-term effects of bereavement and marriage on psychological well-being (PWB) among older people were investigated. The aspect of PWB that was examined was the prevalence of six affects, rated in terms of their frequency during the past year. Affect frequency of four groups was tested: Recently widowed, recently married, and widowed and married elders unselected for length of time in those marital statuses. As predicted, both length of time in the marital status and congruence between the positive event (marriage) and positive affect and between congruence of the negative event (bereavement and negative affect) were associated with group differences. Depressive affect was greatest among the recently bereaved but the recently-married, long-married, and longer-bereaved groups did not differ in depression. Positive affect was greatest among the recently married and other groups did not differ in this respect. Hostility, anxiety, shyness, and contentment were not predicted to differ among groups; in fact, contentment was least in the bereaved; shyness was least among the recently-married, and hostility was lowest among the long-widowed. Results are discussed in terms of the joint influences of time since a life event and the differential relevance of positive and negative affect states to positive and negative events. Continued research attention to the covariation of these factors in relation to the affective aspects of PWB is needed to understand the conditions of stability and change.

Olfactory hallucinations during migraine in an adolescent with an MRI temporal lobe lesion

OBJECTIVE

To report the first example of an abnormal magnetic resonance imaging (MRI) test in a patient with migraine and olfactory hallucinations and to provide additional evidence for a possible role of the temporal lobe in migraine.

BACKGROUND

The relationship between the temporal lobe and migraine with or without hallucinations is unclear and continues to evolve. Clinical and functional neuroimaging studies (positron emission tomography/single photon emission computed tomography) have lent support to the possibility of a relationship. Anatomical neuroimaging with computed tomography has previously been normal.

METHODS

The history and findings of an adolescent with migraine and olfactory hallucinations is reported.

RESULTS

Brain MRI demonstrated a mass in the temporal lobe.

CONCLUSIONS

Magnetic resonance imaging should be considered in patients with olfactory hallucinations and migraine. In addition, the role of the temporal lobe in migraine warrants further study.

Effect of risperidone on QT interval and QT dispersion in the elderly

Risperidone, a relatively new antipsychotic medication, is widely used in elderly adults and is reported to have fewer side effects than existing antipsychotic drugs. Recent studies, however, have reported prolongation of QT interval and corrected QT interval, both with the prescribed dose of risperidone and with overdose. Because QT dispersion measured on the surface electrocardiogram (ECG) recently has been shown to be a marker of future arrhythmic events and to predict mortality in elderly patients in a variety of clinical situations, this study was conducted to investigate the effect of risperidone on QT dispersion and corrected QT dispersion in a group of elderly patients. These patients also were evaluated for occurrence of sudden death and/or symptoms suggestive of ventricular arrhythmia. Although risperidone prolonged QT interval, it had no significant effect on QT dispersion. Further, during the follow-up period there were no incidences of sudden death or symptoms suggestive of ventricular arrhythmia. These results indicate that risperidone can be used safely in elderly patients, who are often taking several medications, without risk of increased QT dispersion.

Prognostic value of negative transesophageal dobutamine stress echocardiography in men at high risk for coronary artery disease

Recently published reviews have called into question the sensitvity of transthoracic stress echocardiography to predict cardiac events, especially when the test is negative, compared with myocardial perfusion imaging studies. To our knowledge there are a lack of data assessing the prognostic value of transesophageal echocardiography-dobutamine stress echocardiography (TEE-DSE) in predicting cardiac events. Because TEE-DSE has been reported to be highly accurate for detecting ischemia in patients with suspected coronary artery disease, we tested the hypothesis that a negative TEE-DSE can identify a low-risk group in a population with a high likelihood of coronary artery disease. Between October 1996 and December 1997, 46 high-risk patients with negative TEE-DSE were identified. Annualized pretest risk for all cardiac events using the Framingham model was 4% based on risk factors. Mean age was 64 years. Mean follow-up time was 16.2 months. There were no cardiac deaths. There were 6 soft and 1 hard cardiac event. The annualized combined ischemic cardiac event rate was 3.8%, and for hard cardiac events it was 1.1%. By Kaplan-Meier analysis, 97% of the population remained free of any ischemic event at the end of 1 year and 93% were free at 22 months. We conclude that optimal image quality and enhanced endocardial definition for assessing wall motion changes with TEE translates into better prognostication and approaches that of myocardial perfusion imaging for negative studies. Advances in ultrasound medicine such as contrast enhancement of myocardial definition, which improve diagnostic accuracy of DSE, should translate into better prognostication.

Alterations in taste thresholds in men with chronic obstructive pulmonary disease

OBJECTIVE

Weight loss is a common occurrence in chronic obstructive pulmonary disease (COPD), and efforts to increase energy intake are often unsuccessful. The objectives of this study were to determine if there were any taste threshold differences between normal-weight and underweight men with COPD, and to determine if there was any association between absolute and recognition taste thresholds and biochemical data associated with COPD.

DESIGN

Cross-sectional comparative.

SUBJECTS/SETTING

Potential subjects were identified by their physicians. Forty-six men were willing and eligible to participate. Subjects were given sets of triangle taste tests for 4 tastants: sweet, salty, bitter, and sour. Additional information collected included health history data and biochemical data. Subjects were classified as underweight or normal weight for comparison.

STATISTICAL ANALYSES PERFORMED

Independent t tests and one-way analysis of variance were used to determine differences between persons in the underweight (n = 17) and normal-weight (n = 29) groups, and the influence of confounding variables. Bivariate correlations were used to determine associations between tastant thresholds and biochemical indexes for the entire group (N = 46). Stepwise regression analysis was used to determine significant variables in prediction of thresholds of the 4 tastants for the entire group (N = 46).

RESULTS

Underweight subjects had a significantly higher bitter taste threshold than normal-weight subjects (5.76 vs 5.10, P = .016). A significant negative correlation was found between absolute bitter and bicarbonate (r = -.39, P = .01) and PCO2 (r = -.34, P = .02). A significant regression equation for absolute bitter taste threshold was determined (P = .011) on the basis of bicarbonate values; and upon body mass index for bitter taste recognition threshold (P = .031).

APPLICATIONS

Recognition that patients with COPD may have alterations in taste that are associated with weight status and/or biochemical status can guide dietitians in their recommendations for meal plans targeting individual weight goals.

Affect and quality of life: objective and subjective

OBJECTIVES

The objective of this article is to determine direct and indirect contributions of objective and subjective quality of life (QOL) to positive and negative indicators of mental health. Specifically, the dual-channel hypothesis predicted that objective and subjective social engagement would enhance positive affect (PA) but be unrelated to depression.

METHODS

Older people from senior centers and several housing environments volunteered to complete a questionnaire or interview about a number of aspects of their everyday lives (N = 602). Objective and subjective were related to one another.

RESULTS

Objective activity participation and subjective time use and friend quality were associated with PA. Only time use was related to depression.

DISCUSSION

The importance of assessing both amount of behavior (objective) and its quality (subjective) when measuring QOL was demonstrated. Although external engagement bears a closer relationship to PA than to negative, the dual-channel model relating locus of stimulation differentially to PA and depression requires modification.

Comparison of the local tolerability and adhesion of a new matrix system (Menorest) for estradiol delivery with an established transdermal membrane system (Estraderm TTS)

OBJECTIVE

To compare the local tolerability and adhesion of two transdermal systems for estradiol delivery, an established membrane system (Estraderm TTS 50) and a new matrix system (Menorest).

METHODS

275 healthy female subjects participated in this two-centre, open-label, within subject comparative study. Subjects received twice-weekly application of one placebo reservoir to the right abdomen and buttock and one matrix to the left abdomen and buttock for 21 days (wearing 4 patches simultaneously). Skin irritation, pruritus (by direct questioning) and adhesion were assessed at each patch change using rating scales.

RESULTS

Overall the two systems showed comparable local tolerability and adhesion assessed by 1590 readings for each system type on buttocks and abdomen. Skin irritation occurred less frequently with Estraderm TTS than Menorest on both buttocks (11.9% vs. 15.9%) and abdomen (13.7% vs. 15.9%). The incidence of pruritus was low for both systems with over 90% of applications on buttocks and 88% on abdomen being associated with no pruritus at all. Mild pruritus was seen slightly more frequently with Estraderm TTS than Menorest on both buttock (4.8% vs. 3.3%) and abdomen (7.8% vs. 2.8%). Similar adhesion was seen for both systems on the buttocks although the incidence of patches falling off was slightly lower with Estraderm TTS compared to Menorest (8.9% vs. 13.1%). On the abdomen the pattern was reversed with slightly better adhesion for Menorest.

CONCLUSIONS

The results suggest that there are no significant clinically relevant differences between the local tolerability and adhesion of an established membrane system for estradiol delivery (Estraderm TTS) and a newly introduced matrix system (Menorest).

COPD: using nutrition to prevent respiratory function decline

Close to three-fourths of patients with chronic obstructive pulmonary disease (COPD) suffer from weight loss. Identifying a single cause for this is difficult, as several factors-including chronic mouth breathing, dyspnea, aerophagia, certain medications, and depression-often act in concert. Malnutrition can exacerbate symptoms of COPD by decreasing ventilatory muscle strength, exercise tolerance, and immunocompetence, and by increasing the risk of depression and anxiety. Goals of nutrition intervention are to prevent or reverse malnutrition without worsening the disease process and to improve respiratory function, thereby reducing morbidity and delaying mortality. Recommendations for intake of fats, carbohydrates, protein, and water must be individualized.

Circadian oscillations of Lhc mRNAs in a photoautotrophic cell culture of Lycopersicon peruvianum

Fourteen genes encoding proteins of the light harvesting complex (Lhc) are expressed in a photoautotrophic cell culture from the wild species of tomato (Lycopersicon peruvianum). For two genes, Lhca2 (cab7) and Lhcb2(*)1 (cab4), a rhythmic oscillation of the transcript accumulation is observed under light/dark and constant dark conditions indicating that gene expression is controlled by a circadian clock in the tomato cell culture. The circadian expression of the Lhc genes remains present after application of 2,2'-dipyridyl. However, the amplitude of Lhc mRNA oscillations and the photosynthetic capacity (Fmax/Fo) decrease significantly. The transcript accumulations of psbA, rbcS and rbcL are less or not at all affected by 2,2'-dipyridyl.

Selling/buying a dental practice

The times they are a'changing, along with the way dental practices are acquired and offered for sale. It behooves both the dentist who is looking to buy a practice and the dentist who is thinking about disposing of a practice to thoroughly understand the rules of the game.

Effects of prebehavioral cognitive work on adolescents' acceptance of condoms

Two educational strategies designed to promote condom use for sexually transmitted disease protection were tested in a field experiment involving 291 female, adolescent family planning clinic clients. The 1st strategy was designed to enhance attitude-behavior correspondence by increasing direct experience with handling condoms. The 2nd, a contingency-planning exercise, induced clients to generate a mental representation of negotiating condom use with a sexual partner. Both strategies were compared with the standard education. The dependent measures were condom acceptance (operationalized by the number of condoms taken), attitudes, and knowledge. Clients in the contingency-planning condition accepted about 60% more condoms than did other clients. Condom attitudes followed the same pattern, and knowledge did not differ among conditions.

Effects of prebehavioral cognitive work on adolescents' acceptance of condoms

Two educational strategies designed to promote condom use for sexually transmitted disease protection were tested in a field experiment involving 291 female, adolescent family planning clinic clients. The 1st strategy was designed to enhance attitude-behavior correspondence by increasing direct experience with handling condoms. The 2nd, a contingency-planning exercise, induced clients to generate a mental representation of negotiating condom use with a sexual partner. Both strategies were compared with the standard education. The dependent measures were condom acceptance (operationalized by the number of condoms taken), attitudes, and knowledge. Clients in the contingency-planning condition accepted about 60% more condoms than did other clients. Condom attitudes followed the same pattern, and knowledge did not differ among conditions.

Management of urinary retention after surgical repair of hip fracture

OBJECTIVE

To compare the use of indwelling catheters and intermittent catheterization in the management of urinary retention after surgical repair of hip fractures.

DESIGN

Randomized open trial.

SETTING

Orthopedic unit in a general hospital.

PATIENTS

Patients 60 years or more admitted to hospital for surgical repair of a hip fracture between November 1986 and December 1987. Of the 76 who were eligible and agreed to participate 5 became medically unstable, 2 died before surgery, and 2 did not have urinary retention after surgery. The remaining 55 women and 12 men were randomly assigned to one of two treatment groups.

INTERVENTION

An indwelling catheter inserted preoperatively was removed 48 hours after surgery (group 1); the procedure was repeated if necessary after 24 hours. Intermittent catheterization was performed every 6 to 8 hours (group 2); the frequency was adjusted to avoid bladder distension.

MAIN OUTCOME MEASURE

Pattern of return to satisfactory voiding within 5 postoperative days.

RESULTS

Of the patients in group 1, 37% resumed voiding within the 5-day postoperative period, as compared with 66% in group 2 (p less than 0.025). The mean numbers of days for return to satisfactory voiding were 9.4 and 5.1 respectively (difference 4.3 days, p less than 0.01, 95% confidence interval 0.7 to 8.0 days). Urinary tract infections developed in 31% of those in group 1 and 38% of those in group 2; the difference was not significant.

CONCLUSION

Satisfactory voiding resumes earlier with the use of intermittent catheterization, if begun at the onset of urinary retention and repeated at regular intervals, than with the use of an indwelling catheter in elderly patients who have undergone surgical repair of hip fractures.

Tailoring family planning services to the special needs of adolescents

Experimental service protocols tailored to the needs of teenage family planning patients were developed that emphasized indepth counseling, education geared to an adolescent's level of development, and the provision of reassurance and social support. These protocols were tested against usual service delivery practices in a study involving 1,261 patients under 18 years of age at six nonmetropolitan family planning clinics. A comparison with teenagers obtaining services at control sites found that six months after their first clinic visit, patients at the experimental sites were more likely to be using a method, were less likely to experience difficulty in dealing with problems, were more likely to continue using their method despite problems and had learned more during the educational session. Teenage patients at the experimental clinics were also less likely to have become pregnant within one year than those who went to control clinics. Attrition during the year following the first study visit was similar among both groups; patient satisfaction was very high, and equivalent at experimental and control sites. The data show that the extra time and effort required to meet the special needs of teenagers is justified by their improved contraceptive use, greater knowledge and lower pregnancy rates.

Prevalence and epidemiologic correlates of Chlamydia trachomatis in rural and urban populations

In two rural and two urban family planning clinics in central Pennsylvania, the authors screened 889 women making routine visits for Chlamydia trachomatis using the Chlamydiazyme immunoassay method (Abbott Laboratories; North Chicago, IL). C. trachomatis antigens were detected in 11.2% of the women; they found no differences in prevalence between rural and urban clinics. Among 21 clinical characteristics and seven risk factors, younger age (younger than 25), oral contraceptive use, gonococcal infection, mucopurulent exudate, abnormal vaginal discharge, and cervical ectropion were associated with chlamydial infection. Logistic regression revealed that age alone was independently associated with infection. The authors found that screening criteria derived from other epidemiologic studies generally did not predict the presence of C. trachomatis in the present sample. In a follow-up study performed at least one year later, 169 patients were re-screened; 47 tested positive and 122 negatives for C. trachomatis. Overall, 11.8% were infected, which was 12.4% of those who originally tested negative and 10.6% of those who originally tested positive.

[The biological monitoring of ecologic cadmium exposure in the free state of Bavaria]

In 1984/1985 631 blood-donors settled in different regions of Bavaria took part in a "cadmium-campagne". Due to this project a substantial medical anamnesis was made and blood has been investigated to determine the cadmium level, furthermore, urine was taken for the determination of cadmium, total protein, beta 2-microglobulin, creatinine and density. In conformity with recent epidemiological investigations in Europe it was evident that the actual internal cadmium exposure - in relation to the cadmium level in blood - has not increased. Subsequently a not acceptable accumulation was excluded accordingly to the result of the proofed renal excretion of cadmium. In consideration of the established low cadmium level in biological material there was no impairment of the kidneys due to cadmium. This is also obvious in the total protein- and beta 2-microglobulin-excretions in urine which are in the normal range. By dividing the collective according to smoking habits this study confirmed, that higher values have been linked with the smokers. However, as to the age and sex there were no significant influences. The evaluation of a regional subdivision of the received samples in overcrowded regions, rural and areas far from industry did not show notable differences. Furthermore, a differentiated aspect was seen after the classification into domiciles, whereby 8 different cities, small towns and villages, resp., were considered. Despite of various differences it must be pointed out, that the cadmium level in blood as well as in urine is below the normal levels with some exceptions only. This study did not show criteria for a risk caused by cadmium which effects the general population of Bavaria.

[The modification of different element levels in human blood by occupational cadmium exposure]

The influence of occupational cadmium exposure on the electrolyte (Ca, Mg) and trace element (Fe, Cu, Zn, Mn) concentrations in blood, erythrocytes and serum was investigated. The study was performed at 62 cadmium exposed persons and 38 men not occupationally exposed. The cadmium blood levels of the workers from eight factories (cadmium electroplating, cadmium stearate processing and hard soldering) ranged from 1.0 to 23.7 micrograms Cd/l blood (median 4.2 micrograms/l), of the normal persons from 0.3 to 4.1 micrograms Cd/l blood (median 1.6 micrograms/l). Around 90% of the cadmium was found in the erythrocytes. The cadmium levels in serum were much lower and increased negligibly with elevated blood cadmium concentrations. An influence of cadmium on the concentrations of calcium, iron, copper and manganese in the blood compartments could not be found. In the compartments plasma and erythrocytes higher magnesium levels were detected in comparison to the normal group; a correlation to the cadmium levels did not exist. The medians for the zinc levels in blood, erythrocytes and serum in the exposed groups were significantly higher than the normal zinc levels and correlated with the blood cadmium levels. For blood samples with cadmium concentrations exceeding 10 micrograms/l the ratio of zinc to cadmium was reduced against zinc in spite of elevated zinc and increasing cadmium levels. A negative significant correlation was calculated for the relationships of cadmium and zinc in blood and erythrocytes. A significant change of the element concentrations in the sense of a transfer from one compartment to another was not detected.

The role of sexual self-concept in the use of contraceptives

Sexual self-concept--defined as an individual's evaluation of his or her own sexual feelings and actions--is proposed as an important predictor of contraceptive behavior among teenagers, and a scale measuring the concept is described. In exploratory analyses among university students, sexual self-concept is found to be associated with frequency of contraceptive use and use at most recent intercourse. It is also associated with their choice of contraceptive--students who had used prescription methods at last coitus had significantly higher scores on the sexual self-concept scale than did those who had used nonprescription methods or no method. These findings, together with the finding from analysis among high school students that sexual self-concept appears to improve with age, suggest that younger teenagers may be poorer users of contraceptives because of a lower sexual self-concept. Counseling and sex education that address social and psychological issues may help improve adolescent contraceptive practice by addressing teenagers' views of their own sexuality.

Associateships, partnerships, buying, and selling. Strategies for established practitioners and new dentists

Associateships, partnerships, and buying-selling practices are the current trend among new and established practitioners. The method for fulfilling these objectives is addressed in this article.