Germline mutations in the ribonuclease L gene in families showing linkage with HPC1

Although prostate cancer is the most common non-cutaneous malignancy diagnosed in men in the United States, little is known about inherited factors that influence its genetic predisposition. Here we report that germline mutations in the gene encoding 2'-5'-oligoadenylate(2-5A)-dependent RNase L (RNASEL) segregate in prostate cancer families that show linkage to the HPC1 (hereditary prostate cancer 1) region at 1q24-25 (ref. 9). We identified RNASEL by a positional cloning/candidate gene method, and show that a nonsense mutation and a mutation in an initiation codon of RNASEL segregate independently in two HPC1-linked families. Inactive RNASEL alleles are present at a low frequency in the general population. RNASEL regulates cell proliferation and apoptosis through the interferon-regulated 2-5A pathway and has been suggested to be a candidate tumor suppressor gene. We found that microdissected tumors with a germline mutation showed loss of heterozygosity and loss of RNase L protein, and that RNASEL activity was reduced in lymphoblasts from heterozyogous individuals compared with family members who were homozygous with respect to the wildtype allele. Thus, germline mutations in RNASEL may be of diagnostic value, and the 2-5A pathway might provide opportunities for developing therapies for those with prostate cancer.

Erotomania revisited: clinical course and treatment

Erotomania is a rare disorder in which an individual has a delusional belief that a person of higher social status falls in love and makes amorous advances towards him/her. Little is known about the background, classification, treatment, or outcome of individuals with this disorder. The purpose of this study was to evaluate current criteria for diagnosing and classifying primary and secondary erotomania in addition to examining course, outcome, and impact on victims of erotomania. Semistructured interviews covering personal and family details in addition to treatment and outcome to date were performed on a series of erotomanic patients identified in a defined area. Evaluation of diagnosis used DSM-IV and other criteria. Fifteen erotomanic subjects (11 female, four male) were identified. Most were isolated, without a partner or full-time occupation. Forty percent had a first-degree relative with a psychiatric history and of those half had a first-degree relative with a mono-delusional disorder. Less than half of the objects of their affection, mainly noncelebrities, were subject to harassment. Subjects with primary erotomania and erotomania secondary to other psychiatric diagnoses were identified using DSM-IV criteria. Ellis and Mellsop's criteria were found to be useful in assessing erotomania but we could not replicate Seeman's fixed and recurrent groups. Treatment and outcome was better than expected particularly for those with primary erotomania and erotomanics with a diagnosis of bipolar affective disorder. In this series, erotomanic symptoms largely occurred in the context of other psychiatric disorders, although subjects with pure erotomanic symptoms were seen. Subjects were less dangerous and engaged in less harassment of victims than the literature suggests. Subjects were often isolated, unemployed, and with few social contacts. Strong family psychiatric histories were seen particularly with regard to mono-delusional disorders raising the possibility of genetic inheritance. An adaptation of Ellis and Mellsop's criteria was suggested for the diagnosis of primary and secondary erotomania. Response to treatment and prognosis was good, particularly for primary erotomania and erotomania secondary to bipolar affective disorder.

Insurance reimbursement for risk-reducing mastectomy and oophorectomy in women with BRCA1 or BRCA2 mutations

PURPOSE

Risk-reducing surgery is an important option for women with BRCA1 and BRCA2 mutations. There are reports in the literature that insurance reimbursement for these procedures varies greatly. Because health insurance coverage significantly affects medical decision-making, current information regarding reimbursement practices of third-party payers is needed.

METHODS

Retrospective study of hospital billing records of 38 women with documented BRCA1 or BRCA2 mutations who underwent either a risk-reducing mastectomy or a risk-reducing oophorectomy between March 1, 1997, and July 30, 2000.

RESULTS

Complete billing and reimbursement information was available for 35 women undergoing a total of 39 risk-reducing surgeries. A total of 38 of 39 (97%) risk-reducing surgeries were covered in full, less applicable coinsurance and deductibles. The rate of insurance reimbursement did not vary with type of insurance, personal history of cancer, or type of procedure.

CONCLUSION

Insurance carriers reimbursed the vast majority of BRCA mutation carriers undergoing risk-reducing surgery.

Benefits of thickened feeds in previously healthy infants with respiratory syncytial viral bronchiolitis

Infants with respiratory syncytial virus (RSV) bronchiolitis have an increased risk of aspiration. The optimal feeding strategy for these patients has not been described. Fifteen previously healthy and clinically stable infants with RSV bronchiolitis underwent video-fluoroscopy studies to assess swallowing using thin barium. Those with abnormal studies underwent a repeat study, using barium that was thickened with rice cereal. Nine of 15 infants had abnormal studies with thin barium. Laryngeal or tracheal penetration with thin barium was seen in 3 and 2 infants, respectively, but not with thickened barium. Aspiration of thin barium was seen in 4 infants, but it corrected in 3 of these 4 infants with thickened barium. Thickened feeds provide a simple, safe, and cost-effective intervention to improve swallowing dysfunction and prevent aspiration in infants with RSV bronchiolitis.

An oblique effect in aesthetics: homage to Mondrian (1872-1944)

The effect of the orientation of Mondrian's paintings on their aesthetic appeal was examined. Eight paintings, four with horizontal/vertical frames in the original and four with oblique frames, were presented in eight different orientations and rated for aesthetic appeal on a 7-point scale. There was a stronger preference for pictures presented so that their component lines were horizontal and vertical than for pictures presented with their component lines in an oblique orientation. In addition, subjects showed a preference for the original orientation, perhaps because rotation changes the lateral balance of the paintings as well as the orientation of the component lines. There was no overall preference for one frame orientation over another, but there was an interaction between frame orientation and component orientation, resulting in a preference for paintings where the components were parallel to the surrounding frame. It is suggested that the aesthetic oblique effect reported here is related to the oblique effect in orientation perception and the privileged access which horizontal and vertical lines have to the visual system. This offers a possible mechanism for aesthetic judgments of abstract patterns: we find pleasing those stimuli which are closely tuned to the properties of the human visual system.

Measuring psychological adjustment to HIV infection

AIMS

A modified version of the Mental Adjustment to Cancer Scale (The Mental Adjustment to HIV Scale--MAHIVS) was used to evaluate patterns of psychological adjustment in response to HIV infection.

METHODS

A sample of 164 HIV positive homosexual/bisexual men were recruited across three Australian centers (79 asymptomatic (CDC II/III) and 85 symptomatic HIV infection (CDC IV)). Factor analysis of the MAHIVS was conducted and the predictive validity of the MAHIVS was investigated using the General Health Questionnaire, while The Diagnostic Interview Schedule was used to assess current and lifetime psychiatric disorder. Other measures of adjustment/coping were used to investigate the construct validity of the MAHIVS (neuroticism, locus of control, defense style).

RESULTS

Factor analysis of the MAHIVS detected four factors: Hopelessness, Fighting Spirit/Self Efficacy, Personal Control, and Minimization. Hopelessness and Fighting Spirit factors exhibited acceptable levels of internal consistency and validity, with significant correlations detected with psychological symptoms and significant association with other measures of psychological adjustment and personality. Fighting Spirit emerged as a potential indicator of psychological resilience, whereas Hopelessness was significantly associated with psychological symptoms and current major depression (but not past depression).

CONCLUSIONS

The findings indicate the validity of the MAHIVS and support the presence of common themes in the psychological adaptation to life-threatening illness that can be detected across disease categories and groups.

A survey of ethnic foods for microbial quality and aflatoxin content

A range of ethnic foods was examined for their microbiological content in relation to total viable counts (TVC) of aerobic bacteria, counts of presumptive coliforms, yeast and mould counts; presence of Salmonella spp., Listeria monocytogenes, Escherichia coli O157:H7 and Campylobacter spp.; total enumeration of Clostridium perfringens, Staphylococcus aureus and Bacillus spp.; identification of moulds and the presence of total aflatoxins. Samples, which included cereals, nuts, dried fruits, herbs and spices, were obtained from local retail outlets and distributors. It was established that three samples of pistachio nuts contained significant levels of aflatoxins. The concentration of total aflatoxins in these three nut samples ranged from 15 to 259 microg/kg of sample. Only two other samples contained trace amounts of aflatoxins, all other samples analysed were found to be free of any detectable level of aflatoxins. TVCs, coliform counts and yeast and mould counts varied widely depending on the matrix tested. Generally, rice, wheat and peanuts produced low counts whereas other nuts, gram flour and spices produced much higher counts. Cl. perfringens, Staph. aureus, and Bacillus spp. were common in spices, nuts and gram flour, however, Listeria monocytogenes was only detected in four samples and in no sample could Salmonella spp, E. coli O157:H7 or Campylobacter spp. be detected.

A survey of community mental health nurses' perceptions of clinical supervision in Northern Ireland

Since the early 1990s, clinical supervision has been the subject of debate by nurse academics and practitioners. This debate has encouraged the adoption of clinical supervision by the profession throughout the United Kingdom. Search of the literature demonstrates that there has been little published research regarding clinical supervision in Northern Ireland. This study is designed to redress this information deficit. The current position of clinical supervision in relation to community psychiatric nursing in Northern Ireland is explored and evaluated. A survey approach was adopted, collecting data from community psychiatric nurses (CPNs) in Health and Social Services Trusts in Northern Ireland. Data was obtained relating to the practice of clinical supervision and to attitudes of CPNs, their managers and supervisors. Results indicate that there is support for clinical supervision and that it is being implemented within community psychiatric nursing in Northern Ireland, although not in all cases. However, the findings indicate that serious education and training deficits exist, and the importance of the interface between managerial and clinical supervision is emphasized. The issues of providing effective education and training in supervision skills, and the uncertainty that was highlighted regarding fundamental concepts underpinning clinical supervision, have implications for nursing practice, education and management. In addition, based on findings of this study, the difference between management-led supervision and clinical supervision as envisaged by the UKCC, which promotes the personal and professional development of nurses, requires further exploration.

Knowledge and attitudes of hospital staff to occupational exposure to bloodborne viruses

In order to assess awareness of occupational risk of exposure to bloodborne viruses a questionnaire was sent to 245 health care workers, representing a 10% sample of employees with patient contact in a large teaching hospital in Scotland, stratified by occupational group. One hundred and eight questionnaires (44%) were returned. Seventy per cent of respondents in laboratory and clinical areas described themselves as having sufficient knowledge for their own area of practice, but many gave incorrect answers or expressed uncertainty about the infectivity of HIV and hepatitis B and hepatitis C viruses. Ninety-four respondents were unaware that a regimen containing more than one antiretroviral drug is now recommended for post exposure prophylaxis of HIV infection, 37 thought they had been at risk of bloodborne viral infection and had contacted the occupational health department for advice, and 68 respondents disagreed with guidelines from the United Kingdom's General Medical Council on testing of patients for bloodborne viruses. The results indicate a need for educational initiatives for new and existing staff.

Wiskott-Aldrich syndrome: life-threatening haemorrhage from aneurysms within the liver, small bowel mesentery and kidney, requiring both surgical and radiological intervention

Wiskott-Aldrich syndrome (WAS) is a rare, generally X-linked recessive condition, originally described by Wiskott in 1937 as a triad of discharging ears, eczema and thrombocytopoenia. Aldrich included bloody diarrhoea in his report of 1954, with severe immunodeficiency and predisposition to malignancy being recognised subsequently. The incidence currently quoted is approximately 4 per million live male births, although there is some regional variation. We report the case of a long-term survivor who had massive haemorrhage from an intrahepatic aneurysm and, on a separate occasion, the right kidney.