Guillain-Barré syndrome after vaccination with purified tetanus toxoid

A 47-year-old patient had Guillain-Barré syndrome after the injection of pure tetanus toxoid. He demonstrated a hypersensitive lymphoblastic transformation to purified tetanus antigen, and typing for disease-associated antigens showed him to be homozygous for HLA-B8. This is the first reported case of nonrelapsing Guillain-Barré syndrome after tetanus toxoid vaccination.

Frequency and presentation of depressive symptoms in patients with primary degenerative dementia

The authors examined the frequency and severity of depressive symptoms in elderly patients with presumed primary degenerative dementia and identified the signs and symptoms that provide a reliable basis for diagnosing depression. Forty-four patients and 42 control subjects were interviewed and rated on the Hamilton Rating Scale for Depression and the Sandoz Clinical Assessment-Geriatric Scale. Nine of the patients demonstrated symptoms suggestive of mild, four of moderate, and five of severe depression. Patients had significantly higher scores than control subjects on items that assess intrapsychic rather than vegetative symptoms of depression. These findings underline the importance of maintaining a high index of suspicion for concomitant depressive symptoms in patients with primary degenerative dementia.

Sexuality in aging: a study of 106 cultures

Human Relations Area Files data relating to sexual activity among older individuals in 106 traditional societies were studied to identify cross-cultural patterns of variability in sexual behavior occurring with age. In 70% of the societies for which data were available relating to the sexual behavior of older males, a continuation of sexual activity of various kinds was found to occur with aging. These groups were seen to have expectations for continued sexual activity for older men that implied little, if any, loss of their sexual powers until very late in life. Among females, reports of continued sexual activity and interest were found to occur in 84% of the files containing data on the sexual behavior of this age group. Reports of expressions of strong sexual interest by older women were common in these societies. In addition, 50% of the references to sexual activity of older females were found to relate to changes in the women's role as procreant. A lessening of inhibition in regard to sexual conversation, sexual humor, and sexual gestures was noted in 22% of these 106 societies. This diminution of restraint in regard to sexual conversation was reported more frequently among older women, 74% of the reports of such behavior referring to females. The continuance of sexuality in many societies during aging and the limitation of sexuality in other societies suggests that cultural as well as biological factors may be key determinants in sexual behavior in the later part of life.

Cultural aspects of coping. Illustrated with examples from a changing Hawaiian culture

Recent studies relating to stress and coping have tended to ignore possible cultural differences in coping strategies. A review of the literature reveals that the Hawaiian culture, by virtue of its geographical isolation, has evolved culturally distinct value systems giving rise to unique patterns of coping. Furthermore, despite the high degree of Westernization following the arrival of Captain James Cook in 1778, coping strategies in Hawaii today have continued to reflect culturally distinct value systems. This demonstrates the necessity of considering cultural differences in coping strategies which may result from differences in cultural value systems both between and within geopolitical units.

Activity and work during pregnancy and the postpartum period: a cross-cultural study of 202 societies

Cross-cultural information on 202 traditional societies was perused for data on customs surrounding the expected work load of pregnant and postpartum women. The most common single pattern of work activity during pregnancy was that of continuing full duties until the onset of labor. A bare majority of societies did encourage a lightening of work at some time during pregnancy. Postnatally, most societies did restrict maternal work activity; however, few suspended usual work duties for prolonged periods of time. About one half of societies expected a return to full duties within 2 weeks. Results suggest that the current American trend toward increased participation of women of childbearing age in the work force may be in keeping with the work loads of women in traditional societies.

Reactions to hysterectomy: fact or fiction?

Elective hysterectomy has become culturally patterned as a normal part of the life cycle with more than half of all American women destined for hysterectomy if current rates continue. In keeping with this widespread acceptance, both women and their doctors frequently express satisfaction with the operation. The sequelae that do occur appear to be serious in only a few women, though more minor disturbances do appear in a sizable number. Repeated or controlled studies indicate that hysterectomy may yield problems for some women in the following areas: rejection by male partners, hot flushes after conservation of ovarian tissue, severe hot flushes after ovariectomy, long-term psychourinary problems, weight changes, lingering fatigue and prolonged convalescence, painful intercourse, depression, sleep disturbances, and other psychiatric symptoms. Prospective studies using matched control groups are needed which follow patients at least 2 years postoperatively, as repeated studies have shown "sleeper effect" after hysterectomy with sequelae developing after the first 6 months or even after 1 year. The impact of varying surgical techniques and the long-term endocrine impact of hysterectomy need to be detailed as well as further study undertaken on the psychosomatic sequelae.