Grapheme-phoneme correspondence in dyslexic and matched control readers

Snowling (1980) reported that dyslexic children appear to have specific deficits in grapheme-phoneme conversion skills. Using a similar methodology, the present study compared the ability of dyslexic and control readers to make phoneme discriminations between the beginnings and ends of words. Recognition of word pairs as same or different were presented in four conditions: visual presentation-visual recognition (V-V), auditory-auditory (A-A), visual-auditory (V-A) and auditory-visual (A-V). It was found that dyslexic readers had particular difficulty with the mixed-mode conditions (V-A, A-V) which required grapheme-phoneme conversion. Furthermore, dyslexic readers were particularly error-prone in these conditions if words differed on their end-sound rather than their beginning sound.

Ethics consultants' recommendations for life-prolonging treatment of patients in a persistent vegetative state

OBJECTIVE--Surprisingly little is known about the content of ethics consultants' recommendations. We chose to study this issue using hypothetical persistent vegetative state (PVS) cases. We addressed four questions: What recommendations do ethics consultants give regarding life-prolonging treatment (LPT) in PVS cases? To what degree is there consensus? What factors influence recommendations? Do recommendations conform to established guidelines? DESIGN--Questionnaire survey. Our questionnaire asked subjects what they would recommend for seven hypothetical vignettes involving a PVS patient that varied with respect to advance directives and family wishes. We also questioned subjects about demographic characteristics, ethics consultation experience, and personal preference for LPT in PVS. SUBJECTS--Attendees at an annual meeting of the Society for Bioethics Consultation (n = 154). RESULTS--The response rate was 77%. Eighty-one percent of respondents were ethics committee members and 62% were ethics consultants. There was general agreement among respondents for only one of seven vignettes: in the case of a PVS patient whose advance directive and family agree that LPT be stopped, 93% recommended stopping all LPT. Responses to other vignettes varied considerably. Although patient wishes were an important factor influencing recommendations, none of the respondents adhered invariably to the patient's advance directive. Recommendations were also influenced by family wishes, resource allocation considerations, legal constraints, and personal preference for LPT in PVS. Guidelines we examined were generally too equivocal to be useful for evaluating ethics consultants' recommendations. CONCLUSIONS--The finding of wide variability in ethics consultants' recommendations suggests a need to clarify standards for ethics consultation.

HIV infection among STD patients--Kigali, Rwanda, 1988 to 1991

To follow the progression of HIV seropositivity among heterosexual adults at risk for HIV infection in the country of Rwanda prospectively, up to 100 patients with sexually transmitted diseases (STD) were tested each month from 1988 to 1991 at the health centre of Biryogo, which is located in a very crowded sector of the capital city, Kigali. Each patient had a blood sample tested anonymously for the presence of HIV antibodies. HIV seropositivity was defined as a reactive ELISA test combined to a reactive Western blot test. The overall HIV seropositivity among the 2058 subjects tested was 61%. It was higher (73%) among the 688 women tested as compared to the 1362 men tested (55%; P < 0.001). The per cent HIV seropositivity did not increase between 1988 and 1991, neither among the male nor among the female clinic attenders. However, the per cent seropositivity was higher in the older age groups, especially among the males. This exceedingly high proportion of HIV-infected STD patients in Kigali re-emphasizes the urgent need to include STD treatment, prevention and control among the priority actions for decreasing HIV transmission in African towns. Also, as the per cent seropositivities did not show any trend to increase over the 4-year period considered, we propose that our intensive HIV serosurveillance strategy among STD patients in Kigali be modified, since the plateau of HIV infection appears to have been attained in this particular high-risk population.

Attentional bias in anxiety: selective or not?

Under certain circumstances, anxiety has been shown to be associated with a processing bias favouring threatening information. Much of the evidence has come from experiments utilising the modified Stroop colour-naming paradigm. However, the traditional Stroop stimuli does not allow for a good test of selective attention. The present study presented colour, neutral and threatening words in conditions where the distracting (word) and target (colour) information were presented: (i) together; or (ii) separately. High trait-anxious Ss took longer to colour-name threatening words than neutral words, even when the threatening material was presented outside the focus of attention. There were no differential responses to threat and neutral words for low trait-anxious Ss. High trait-anxious Ss were also distracted by separate colour words, which produced no interference for the low-anxious Ss. These results suggest that high-trait anxiety may be associated with a general inability to maintain attentional focus, rather than by an automatic attentional bias towards threatening information.

Trends of human immunodeficiency virus type-1 infection in female prostitutes and males diagnosed with a sexually transmitted disease in Djibouti, east Africa

A cross-sectional serosurvey for human immunodeficiency virus type 1 (HIV-1) was conducted during the first quarter of 1991 among high risk groups in Djibouti, East Africa, and compared with previous surveys in 1987, 1988, and 1990. The survey demonstrated evidence of HIV-1 infection in 36.0% (n = 292) of street prostitutes, 15.3% (n = 360) of prostitutes working as bar hostesses, and 10.4% (n = 193) of males diagnosed with a sexually transmitted disease. By multivariate modeling, HIV-1 seropositivity in prostitutes was associated with Ethiopian nationality, working as a street prostitute, and residing in Djibouti for two years or less. We suggest that prostitution, particularly street prostitution, is a major route of HIV-1 transmission in Djibouti.

Estimating the seroincidence of HIV-1 in the general adult population in Kigali, Rwanda

OBJECTIVE

To estimate the seroincidence of HIV-1 infection in the general adult population of Kigali, Rwanda.

DESIGN

Repeated standardized cross-sectional studies.

SETTING

Two urban prenatal clinics.

PATIENTS

A total of 4486 consecutive pregnant women consulting in 1989 and 1990.

MAIN OUTCOME MEASURES

Prevalence of HIV-1 antibodies.

RESULTS

HIV seropositivity increased by 3-5% annually over this period, indicating that it has not reached a plateau in this sentinel population. The percentage infection rates, calculated using two complementary methods, were 26.2-30.7% in 1990. Extrapolating these results to the general population of Kigali, we estimate that 2300-3800 new infections in young women and 3600-6100 new infections in young men occur annually among the total population of 350,000 in Kigali.

CONCLUSIONS

A new HIV infection occurred in an adult every 50-90 min, on average, in Kigali during 1989-1990, while every 6-7 h a baby with maternally acquired HIV infection was born. Our HIV surveillance system, which is based on prenatal sentinel posts, is a useful tool for monitoring the progression of the HIV epidemic in Kigali.

Cognitive function and quality of life in end-stage renal failure

The Sickness Impact Profile (SIP) and the Wechsler Memory Scale--Revised (WMS-R) were administered to a small sample of end-stage renal failure patients. The memory test successfully discriminated between patients who were rated by their nurses to be well adjusted or poorly adjusted to dialysis treatment. It is concluded that this instrument may be useful in investigating cognitive function in this patient population.

[Infection by the human immunodeficiency virus in the Republic of Djibouti: literature review and regional data]

The first evidence of HIV infection in Djibouti, East Africa, was found in the spring of 1986; the first case of acquired immunodeficiency syndrome (AIDS) was diagnosed in March 1988; and, as of the end of 1991, 104 cases of AIDS had been reported. HIV-1 infection was predominant. Previously published results of four serosurveys carried out in October 87, June 1998, February 1990, and from January 1991 to April 1991 among high risk groups are presented and compared. The subjects included street girls, bar hostesses, and male STD patients. HIV-1 infection was demonstrated in 1991 among 36.0% of street girls, 15.3% of bar hostesses and 10.4% of male STD patients. Three sera were positive for both HIV-1 and HIV-2 antibodies. The prevalence of HIV-1 infection among street girls in Djibouti did not increase between February 1990 and January 1991 while the prevalence of HIV infection among male STD patients rose almost five-fold during the same period. HIV prevalence in bar hostesses showed a steady growth. Epidemiology of HIV infection among prostitutes is complex as theses populations have a rapid turn-over. HIV prevalence data and predominance of Ethiopian nationality among prostitutes suggest importation of HIV from Ethiopia via the prostitutes and their clients. These results are reviewed and compared with data from Ethiopia and Somalia.

Diagnostic challenges: lymphotropic sero-"questionables"

During a sero-survey for lymphotropic retroviruses, seven screening tests were performed for the three lymphotropic retroviruses of relevance in Djibouti, East Africa (HIV-1, HIV-2 and HTLV-1). Of the 82 subjects whose sera reacted in at least one retroviral screening assay, about one third could be followed, and their sera were re-examined after a 5-month interval, and then after an additional 3-month interval. Six selected individuals are reported here, whose retroviral serologies presented important and often unexplained changes over an eight-month period. The six cases summarize prototypic situations and present serological results in a style appropriate to stimulate thought on the significance and interpretation of lymphotropic viral serologies. Each case study is followed by a set of questions that formulate pertinent serological concepts.

Redefining the emergency physician's role in do-not-resuscitate decision-making

In summary, Wrenn and Brody's [14] study raises important questions about the appropriate role of emergency physicians in discussing DNR decisions in the emergency setting. Their approach to DNR orders expands, appropriately we believe, the traditional role of emergency physicians. We suggest that it is desirable for emergency physicians to give patients and family members the option of DNR status when there is a significant likelihood that the patient will experience cardiopulmonary arrest before the admitting physician can address the DNR issue and the patient is profoundly debilitated or terminally ill. In addition, emergency physicians have a heightened obligation to promptly address DNR status when appropriate decisions about resuscitation have been reached previously, as in the following cases: (1) when a clearly valid portable prehospital DNR order is in effect; (2) when the patient's primary physician clearly indicates to the emergency physician that the patient is DNR; (3) when an incompetent patient has an advance directive that explicitly precludes CPR and unquestionably applies to the current situation; (4) when a clearly competent, informed patient requests that a DNR order be entered. Finally, we advise emergency physicians against using the principle of futility as sole justification for DNR orders except in situations in which cardiopulmonary arrest is expected, and outcome data suggest that survival is virtually unprecedented.

[Plasmodium falciparum travels by train from Ethiopia to Djibouti]

To investigate the role of the Djibouti-Ethiopian railway as a potential vehicle for inter-regional spread of malaria vectors and malaria parasites, we performed a double-sided study, both entomological and parasitological, during November 1989, at the frontier post of Guelile where the trains from Ethiopia enter the Republic of Djibouti. No malaria-transmitting mosquitoes were collected either from the daily passenger train or from the weekly vegetables train. One hundred and five passengers entering Djibouti by train from Ethiopia had a thick film examined for malaria parasites. Five smears were positive for Plasmodium falciparum, among them two showed gametocytes. We conclude that the railway may be an effective route for the propagation of the human malaria parasite between Ethiopia and Djibouti. Indeed, passengers infected abroad could import plasmodia into Djibouti and thus become the index cases for local malaria outbreaks, in case the climatic and entomological prerequisites essential for sustaining malaria transmission are present.

[Dissimilar glucose-6-phosphate dehydrogenase (G-6-PD) deficiency in the Afars and the Somalis of Djibouti]

In order to determine the prevalence of deficient activity of the enzyme glucose-6-phosphate dehydrogenase (G-6-PD) among the inhabitants of the east African Republic of Djibouti, we analyzed by the methaemoglobin reduction test the blood of 170 Djiboutian males, 81 Afars and 89 Somalis. Eight subjects were found to be G-6-PD deficient, 1 Afar and 7 Somalis (1.2% versus 8%; P = 0.02). We conclude that in Djibouti, health care providers should consider the presence of potential G-6-PD deficiency in their patients, especially in males of the Somali ethnic group. Indeed, many medications are contraindicated in the G-6-PD deficient subjects, and primaquine and pyrimethamine-sulfadoxine (FANSIDAR) have to be considered dangerous anti-malarial drugs for Somali males as long as their level of G-6-PD activity has not been determined. Since in Djibouti many acute falciparum cases are presenting with severe icteric anaemia, we hypothesize that some of these haemolytic anaemias might not be caused by the parasitic infection alone, but that some malaria patients might become aggravated through the administration of haemolytic drugs in case they are G-6-PD deficient. Finally, we propose that our study should be expanded to include the systematic determination of the variants of the enzyme in all subjects found G-6-PD deficient, since the clinical manifestations of G-6-PD deficiency are directly related to the type of variant present.

Tryptophan and high-carbohydrate diets as adjuncts to smoking cessation therapy

Treatments that reduce the immediate effects of smoking withdrawal have potential for helping smokers quit. Serotonin-enhancing substances, such as tryptophan and high-carbohydrate diets, have been used in clinical disorders to relieve negative affect, a classic symptom of cigarette withdrawal. This research project investigated the use of tryptophan (50 mg/kg/day) and high-carbohydrate diets, together with more traditional smoking cessation treatment techniques, to ameliorate the smoking withdrawal syndrome and to improve abstinence rates. Subjects were randomly assigned to receive either tryptophan (n = 16) or placebo (n = 15). Standard smoking cessation treatment was identical for the experimental and control groups and consisted of four 2-hr weekly sessions of multicomponent group therapy. Smoking behavior, symptoms of nicotine withdrawal, and negative affect were assessed during a 2-week withdrawal period. Tryptophan-treated subjects who could not fully abstain were able to smoke fewer daily cigarettes. Reported anxiety and other withdrawal symptoms were lower in the tryptophan group compared with control subjects. These data suggest that serotonin-enhancing substances show promise for use as an adjunct to existing smoking cessation programs.

"Quality of life" for patients with end-stage renal failure

The assessment of health status and quality of life among chronically ill patients is an area of current scientific interest. This paper considers the utility of a short but comprehensive instrument to assess the quality of life for end-stage renal failure patients. the Spitzer QL-Index was completed by 8 nurses for all patients in the Wellington region currently being treated with home hemodialysis (n = 58); hospital hemodialysis (n = 13); and continuous ambulatory peritoneal dialysis (n = 37). Results indicated that home hemodialysis patients achieve the highest quality of life in comparison to the other two treatment modalities. It is concluded that the QL-Index has some discriminative validity for this patient population, and its use may contribute to informed decision making by both patients and doctors.

Are tuberculosis wards a risk factor for HIV in Africa?

A twenty-year-old female prostitute had an indeterminant HIV western blot in Djibouti during June 1988. She was hospitalised at the tuberculosis hospital in October and was re-tested for HIV in November. Her western blot result was still indeterminant, despite a progressive profile, and she therefore escaped to the hospital's HIV surveillance system. There were strong indications that while in-hospital, the patient resumed the activities of her previous profession. We conclude that active tuberculosis may develop in African HIV patients prior to the development of a confirmatory HIV western blot profile. Thorough precautionary measures are indicated for preventing HIV from spreading to health care personnel and amongst hospitalised patients in Africa.