Social Connectedness Between Family Caregivers and Older Adults Living in Long-Term Care Homes in the Context of COVID-19

The coronavirus disease (COVID-19) pandemic and resulting restrictions on physical access to long-term care homes culminated in health declines for older adults living there and their families. Knowledge gaps exist regarding maintaining social connectedness when physically separated. The study aimed to explore family members' perceptions of the impact that restrictions on physical access to long-term care homes had on the experience of social connectedness between family members and older adults living in long-term care. The method used was a qualitative description, using in-depth semi-structured interviews. Themes arising from inductive qualitative content analysis of 21 interviews with family members included: (a) lack of connection threatening mental, emotional health, and physical health; (b) navigating trust in the unknown; (c) feelings of stress and anxiety for family members; and (d) technology - an asset, but not for everyone. Study findings suggest more emphasis should be placed on supporting social connections between older adults and their families in the context of long-term care beyond COVID-19.

Health Provider Experiences in Supporting Social Connectedness Between Families and Older Adults Living in Long-Term Care Homes

Introduction

Many people, often older adults, living in long-term care homes (OA-LTCH) became socially isolated during the COVID-19 pandemic due to variable restrictions on in-person visits and challenges associated with using technology for social connectivity. Health providers were key to supporting these OA by providing additional care and facilitating their connections with family using technology such as smartphones and iPads. It is important to learn from these experiences to move forwards from the COVID-19 pandemic with evidence-informed strategies that will better position health providers to foster social engagement for OA-LTCH across a range of contextual situations.

Objective

This exploratory qualitative description study sought to explore health provider experiences in supporting social connectedness between family members and OA-LTCH within the COVID-19 context.

Methods

Qualitative, in-depth semistructured interviews were conducted with 11 health providers.

Results

Using inductive qualitative content analysis study findings were represented by the following themes: (a) changes in provider roles and responsibilities while challenging for health providers did not impact their commitment to supporting OA-LTCH social and emotional health, (b) a predominant focus on OA-LTCH physical well-being with resultant neglect for emotional well-being resulted in collective trauma, and (c) health providers faced multiple challenges in using technology to support social connectivity.

Conclusion

Study findings suggest the need for increased funding for LTC to support activities and initiatives that promote the well-being of health providers and OA living in LTC, the need to prioritize social well-being during outbreak contexts, and more formalized approaches to guide the appropriate use of technology within LTC.

Social Networks May Shape Visually Impaired Older Adults' Occupational Engagement: A Narrative Inquiry

Age-related vision loss (ARVL) has been shown to interfere with older adults' occupational engagement. The primary purpose was to examine the role social networks play in facilitating/constraining engagement in desired occupations for older adults with ARVL. This study adopted a constructivist narrative methodology. Five older adults, ≥ 60 years of age with ARVL, participated in three virtual interviews, which were coded using thematic analysis. Three overarching themes were identified: (a) Diverse Social Networks Fulfill Different Occupational and Psychosocial Needs, (b) Retaining a Sense of Independence through Seeking Reciprocity in Social Relationships, and (c) Community Mobility and Technology Support as Essential for Preserving Social Relationships. Findings broaden understandings of how informal/formal social networks are involved in shaping visually-impaired older adults' adaptation to ARVL and related occupational changes. Findings may help improve the quality and delivery of low-vision rehabilitation services to optimize their contribution to occupational engagement.

Taking Refuge in Religion: Buddhist-Oriented Coping following Late-Life Immigration

Despite a recognition of religion as a resource for coping in later life, few studies have examined how religion is summoned to cope with the stressors of late-life immigration. Drawing upon data generated in a phenomenological study of the aging-out-place experience, this article presents a hermeneutic analysis of textual extracts addressing 10 Sri Lankan-born late-life immigrants' Buddhist beliefs and practices, and how these beliefs and practices contributed to coping with immigration stressors. Four shared experiences facilitated through religious engagement were revealed: religious engagement as a source of purpose, making meaning of suffering and experiencing hope, non-attachment, and connecting to the past and the ethnoreligious community. Late-life immigrants drew on religious engagement to remain resolute amidst adversities, thus reinforcing the importance of culturally responsive milieus and services to support religion-focused coping. Findings are interpreted in relation to Pargament's (1997) theory of religious coping.

Identification and engagement of naturally occurring retirement communities to support healthy aging in Canada: A set of methods for replication

Background

Naturally occurring retirement communities (NORCs), unplanned communities with a high proportion of older adult residents, offer a model to support older adults to age well in place. The aim of this paper is to provide a comprehensive description of the methods used to identify and engage NORCs appropriate for the development of supportive service programming in Canada.

Methods

Three steps were used to identify and select NORCs in which to develop supportive service programming including: 1) identification of potential NORCs using Canadian Census Dissemination Areas, the Ontario Marginalization Index and Google Maps, 2) engagement of property owner/manager to determine the availability of common space for communal programming and willingness of the owner to support programming and, 3) engagement of older adult residents within the NORC to co-design programming.

Results

Four cities in the south-east, south-central, and south-west of Ontario, Canada were identified to develop NORCs with supportive service programming. Using the methods described, six NORCs were identified, landlords and older adult residents were engaged, and programs initiated between April 2018 and March 2019. The sites included two private high-rise apartments, a city-owned low-rise subsidized apartment complex, two multi-building private high-rise complexes and a mobile home community. An average of 35 (min 20, max 78) older adult members were engaged in an average of 20.5 unique activity sessions at each site per month. On average, social (54%) and physical activities (30%) were more common than nutritional (10%) and knowledge-sharing (8%).

Conclusions

The increased prevalence of unplanned, geographically-bound NORCs creates an opportunity for governments, social and health service providers and policy makers to support healthy aging in their communities. Our experience with the creation of six new NORCs with supportive service programming provides a tested set of methods that can be applied in other communities.

Examining utility and feasibility of implementing patient-reported outcome measures in occupational therapy primary care practice

Introduction

Occupational therapists are increasingly part of interprofessional primary care teams, helping to expand primary care to meet client needs. Effectiveness of occupational therapy services is difficult to determine with currently collected data, and little is known about the best tools to use or how to integrate tools into practice. We explored the utility and feasibility of implementing patient-reported outcome measures (PROMs) within occupational therapy primary care practice.

Method

We integrated pre-test/post-test and exploratory qualitative designs. Over 7 months, nine occupational therapists administered two PROMs to clients receiving falls prevention services, addressing falls efficacy and participation in daily occupations. Subsequent interviews with therapists explored the utility and feasibility of using the tools. We assessed pre-to-post change in PROM scores and thematically analyzed interview data.

Results

The occupational therapists valued measuring function and participation in daily occupations to inform practice, communicate with team members, and demonstrate effectiveness. The falls efficacy scale appeared to capture change over time and was feasible to implement at pre-test.

Conclusion

PROMs appear useful within occupational therapy primary care falls prevention services and can be feasible with attention to administration processes. Further development and testing of PROMs is needed to support occupational therapy primary care practice.

Social Connectivity in the Context of COVID-19 and Long-Term Care

The COVID-19 pandemic has disproportionately impacted older adults, particularly those residing in long-term care homes (LTCHs), causing immense loss of life and resulting in overall health declines in LTCH residents. These vulnerable older adults have also experienced extreme loneliness, anxiety and depression. Social connectedness is an important contributor to well-being and quality of life of older adults in LTCHs and family members are an essential component to this. However, restrictions driven by policies to protect resident safety, have constrained family members’ access to long-term care homes and limited in-person contact between residents and their families. In their absence, health providers have been integral to supporting connections between residents and their families within LTCHs. This study aimed to understand the experiences of social connectedness between residents and family members who have been physically separated due to the current pandemic and, to examine LTCH health providers’ experiences and responses to support social connectedness. Using a qualitative descriptive design, in-depth semi-structured interviews were conducted with 21 family members and 11 healthcare providers. Emergent themes from qualitative content analysis are: (a) all-encompassing impacts of separation; (b) advocacy became my life; (c) the emotional toll of the unknown; 4) the burden of information translation; 5) precarious balance between safety and mistrust for the healthcare system; and (d) a formulaic approach impedes connectivity. A more comprehensive understanding of the experiences and support needs of LTCH residents and their family members within the context of a pandemic can inform practice approaches to support social connections going forwards.

Examining Community-Based Housing Models to Support Aging in Place: A Scoping Review

BACKGROUND AND OBJECTIVES

With the global population aging, there is demand for older adults to age in place, that is, to live and age well in their home and community with some level of independence. Community-based housing models exist and may support this process. This scoping review aimed to describe and synthesize the ways in which community-based housing models relate to older adults' aging in place and identify strengths and gaps in the literature.

RESEARCH DESIGN AND METHODS

The housing models explored were: villages; naturally occurring retirement communities; congregate housing and co-housing; sheltered housing; and continuing care retirement communities. This exploratory scoping review examined international peer-reviewed literature published from 2004-2019. Six databases were searched using terms related to housing models and older adults. Forty-six articles met the inclusion criteria. Descriptive numerical summary and thematic analysis were used to synthesize study characteristics and findings.

RESULTS

Our analysis revealed four themes relating to aging in place in the housing models: Social Relations, Health and Well-being, Sense of Self and Autonomy, and Activity Participation. Further analysis identified housing-specific characteristics that appeared to pose barriers to, or enable, aging in place.

DISCUSSION AND IMPLICATIONS

To best support aging in place, the findings of the review suggest multiple characteristics worth considering when developing or relocating to a community-based housing model. Further research is required to understand how facilitating characteristics can promote aging in place for community-dwelling older adults.

Participatory Action Research With Older Adults: A Critical Interpretive Synthesis

Background and Objectives

Given population aging, the meaningful involvement of older adults in influencing policy and programs through participatory action research (PAR) is increasingly vital. PAR holds promise for equitable participation, co-learning, community mobilization, and personal and social transformation, however, little scholarly attention has been given to critically evaluating how PAR has been taken up with older adults. The objective of this review was to critically evaluate the use of PAR with older adults.

Research Design and Methods

A critical interpretive synthesis (CIS) of 40 PAR studies with older adults was conducted. Critical engagement with the articles identified dominant tendencies, limits of these tendencies, and proposed ways forward.

Results

Within the majority of articles reviewed, older adults were not prominent partners in PAR given their often limited involvement in designing the research questions, learning research skills and knowledge, and implementing findings for change. Furthermore, power differentials between researchers and older adults were evident, as older adults were often positioned as participants rather than partners. Finally, this article demonstrates various boundaries on the foci of studies related to inclusivity and sustainability.

Discussion and Implications

This study revealed that the promises PAR holds are often not fully realized in projects with older adults, given that they are rarely positioned as equitable partners, co-learners, or agents for change. The findings have the potential to stimulate further uptake of PAR research with an older adult population, highlighting areas for change in systems and research practices.

Older women's engagement in community occupations: Considerations of lifespan and place

Background: To reach the promise of age-friendly communities, more complete understandings of how participation in community occupations occurs, in place and over time, is needed.Aim: To explore older Canadian women's engagement in community occupations as it occurs over the lifespan and in context.Materials and methods: Data from three selected participants were drawn from an exploration of older adults' social connectedness in neighbourhoods, which involved an ethnographic approach involving narrative interviews, go-along interviews, and activity tracking and follow-up interviews. A transactional lens oriented analysis, considering occupation in place, over time. Analysis involved identifying key storylines and themes and drew on conceptualizations of transition and continuity.Results: The participants' stories revolved around two themes: continuity within leisure over time and social engagement as a work in progress. The participants demonstrated differing patterns of achieving continuity within leisure and worked to maintain social engagement in the face of continually evolving social networks.Conclusions and significance: Findings enhance understandings of transition, continuity and the transactions between person and place that shape leisure and social engagement over time. Occupational therapists can consider community occupations from a transactional lens within services and policy to better support older women's participation and inclusion in neighbourhoods.

Qualitative-Geospatial Methods of Exploring Person-Place Transactions in Aging Adults: A Scoping Review

Purpose

Research exploring how places shape and interact with the lives of aging adults must be grounded in the places where aging adults live and participate. Combined participatory geospatial and qualitative methods have the potential to illuminate the complex processes enacted between person and place to create much-needed knowledge in this area. The purpose of this scoping review was to identify methods that can be used to study person-place relationships among aging adults and their neighborhoods by determining the extent and nature of research with aging adults that combines qualitative methods with participatory geospatial methods.

Design and Methods

A systematic search of nine databases identified 1,965 articles published from 1995 to late 2015. We extracted data and assessed whether the geospatial and qualitative methods were supported by a specified methodology, the methods of data analysis, and the extent of integration of geospatial and qualitative methods.

Results

Fifteen studies were included and used the photovoice method, global positioning system tracking plus interview, or go-along interviews. Most included articles provided sufficient detail about data collection methods, yet limited detail about methodologies supporting the study designs and/or data analysis.

Implications

Approaches that combine participatory geospatial and qualitative methods are beginning to emerge in the aging literature. By more explicitly grounding studies in a methodology, better integrating different types of data during analysis, and reflecting on methods as they are applied, these methods can be further developed and utilized to provide crucial place-based knowledge that can support aging adults' health, well-being, engagement, and participation.

Understanding Social Isolation Among Urban Aging Adults: Informing Occupation-Based Approaches

Socially isolated aging adults are at risk of poor health and well-being. Occupational therapy can help address this issue; however, information is needed to guide such work. National surveys characterize social isolation in populations of aging adults but fail to provide meaningful information at a community level. The objective of this study is to describe multiple dimensions of social isolation and related factors among aging adults in diverse urban neighborhoods. Community-based participatory research involving a door-to-door survey of adults 50 years and older was used. Participants ( N = 161) reported social isolation in terms of small social networks (24%) and wanting more social engagement (43%). Participants aged 50 to 64 years reported the highest levels of isolation in most dimensions. Low income, poor health, lack of transportation, and infrequent information access appeared linked to social isolation. Occupational therapists can address social isolation in similar urban communities through policy and practice that facilitate social engagement and network building.

Social isolation in older adults who are frequent users of primary care services

OBJECTIVE

To describe older adults who are frequent users of primary care services and to explore associations between the number of primary care visits per year and multiple dimensions that define social isolation.

DESIGN

Mailed, cross-sectional survey.

SETTING

An urban academic primary care practice in Kingston, Ont.

PARTICIPANTS

Forty patients aged 70 years and older who attended 12 or more appointments in the previous year with residents, physicians, nurses, nurse practitioners, or registered practical nurses.

MAIN OUTCOME MEASURES

Social isolation (size of close social network, loneliness, satisfaction with social participation, frequency of social participation), past and future need for health services related to social issues, and health and functional variables.

RESULTS

The participants reported relatively low levels of loneliness, with a mean (SD) score of 4.1 (1.3) out of 9. Overall, 18.9% of participants reported having a small close social network, 45.9% of participants wanted to do more social activities, and 57.5% of participants were isolated according to at least 1 indicator. Some participants (23.1%) had received primary care services related to social issues, and most participants (54.5%) wanted these services in the future, including receiving information about other health services or community resources, or having discussions about loneliness, relationships, or social activities. Number of primary care visits was not associated with any of the 4 indicators of social isolation.

CONCLUSION

Social isolation in older, frequent users of primary care services might be more common than previously thought, particularly the aspect of dissatisfaction with social participation. Expanded primary care services and referrals to other services might help to address this population's desires for services related to social issues. Future research could examine the social needs of older primary care attenders and the feasibility of providing related interventions in primary care settings.

An examination of social support influences on participation for older adults with chronic health conditions

Social support can improve participation in everyday activities among older adults with chronic health conditions, but the specific types of support that are needed are unclear.

PURPOSE

This study examined the types of social support that most strongly predict participation in everyday activities.

METHOD

Two hundred and twenty-seven participants completed a self-administered cross-sectional survey. The sample included adults aged 60 years or more with arthritis, diabetes, chronic obstructive pulmonary disease and/or heart disease. Participation was defined as satisfaction with participation in 11 life areas. Social support was defined as availability of tangible, affectionate, emotional/informational and positive social interaction support.

RESULTS

Multiple regression analyses showed that participants who perceived greater tangible support and positive social interaction support had higher satisfaction with participation than participants with lower levels of these types of support.

CONCLUSIONS

Targeting and developing tangible and social interaction support may help to facilitate satisfaction with participation for older adults with chronic conditions. Creating networks for companionship appears equally as important as providing support for daily living needs. Implications for Rehabilitation Varying types of social support can improve participation in older adults with chronic health conditions. Tangible support and positive social interaction support are the strongest predictors of participation. Creating networks for companionship may be equally as important as providing support for daily living needs.

The effect of the environment on participation of children and youth with disabilities: a scoping review

OBJECTIVE

The study’s purpose was to identify and synthesize research evidence regarding the effect of the environment on community participation of children with disabilities.

METHODS

A scoping review of peer-reviewed studies published from 1990 to 2011 was performed. Two independent reviewers selected studies based on a systematic procedure. Inclusion criteria for studies were: participants with a disability, aged 5–21 years, whose environment was examined in relation to participation in out-of-school activities. Data were organized and synthesized based on environmental domains within the International Classification of Functioning, Disability and Health (ICF): Natural Environment/Products and Technology; Support and Relationships; Attitudes; and Services, Systems and Policies.

RESULTS

Searching identified 1232 articles and 31 met the inclusion criteria. Each domain of the environment within the ICF influenced participation as a facilitator and/or barrier. The most common facilitators involved social support of family and friends and geographic location. The most common barriers included attitudes, physical environment, transportation, policies and the lack of support from staff and service providers.

CONCLUSIONS

Knowledge derived from this review can assist practitioners in addressing the specific environmental domains that influence children's participation. Such awareness can also foster new research questions and assist policy makers in identifying the factors influencing participation.

IMPLICATIONS FOR REHABILITATION

All domains of the environment, suggested by the ICF, have an influence on children’s participation.Evidence regarding the effect of the environment on participation is focused primarily on children with physical disabilities; more studies are needed involving various health conditions and age groups. Practitioners and decision-makers can focus attention on specific aspects of the environment, e.g. attitudinal challenges and social support, in order to foster inclusion and participation-based communities.

Neighbourhood influences on participation in activities among older adults with chronic health conditions

We examined the relationships between perceptions of neighbourhood characteristics and satisfaction with participation in everyday activities among 248 older adults with chronic health conditions in Hamilton, Ontario, Canada. We used a cross-sectional survey to collect data regarding neighbourhood characteristics, social support, social network size, and individual characteristics. Path analysis showed that fewer neighbourhood problems directly predict higher levels of satisfaction with participation. Neighbourhood cohesion indirectly predicts participation by predicting social support, which predicts participation. Neighbourhood safety indirectly predicts participation by predicting increased social cohesion and neighbourhood amenities may influence participation similarly. Changes to neighbourhood characteristics have the potential to facilitate participation in daily activities for older adults with chronic health conditions.

Neighborhood Influences on Participation among Older Adults with Chronic Health Conditions: A Scoping Review

Older adults with chronic health conditions face difficulties participating in everyday occupations but may gain support to do so from neighborhood environments. This article describes research regarding neighborhood influences on participation in this population. A scoping review identified 689 articles, of which 15 met the selection criteria. Findings indicate that neighborhood economic status, services/resources, mobility resources/barriers, physical problems, cohesion, and safety are linked to participation in older adults and older adults with chronic conditions. Most studies measured participation frequency or limitations and did not consider social support as a covariate. These findings can guide research to examine a range of neighborhood characteristics while considering the effects of the individual's characteristics and social support. Longitudinal and qualitative research can also help to understand this complex area of study.

Occupational Therapy Interventions for Chronic Diseases: A Scoping Review

OBJECTIVE. We reviewed the evidence regarding the effectiveness of community occupational therapy interventions, delivered alone or within a multidisciplinary team, in improving occupational outcomes for adults with selected chronic diseases.

METHOD. We completed a scoping review of randomized controlled trials published from 1988 through 2008. Studies included participants with heart disease, depression, rheumatoid arthritis, osteoarthritis, chronic obstructive pulmonary disorder, or diabetes.

RESULTS. Sixteen studies met the inclusion criteria. Ten studies found significant differences between intervention and control groups for at least one outcome of function in activities of daily living, functional self-efficacy, social or work function, psychological health, general health, or quality of life. Conflicting evidence exists regarding the impact of intervention on physical function and health.

CONCLUSION. Occupational therapy can improve occupational outcomes in adults with chronic diseases. Using and building on this evidence, occupational therapists can continue to promote their role in helping to meet this population's needs.

Small business employers' views on hiring individuals with mental illness

This study investigated the beliefs of small business employers regarding hiring individuals with mental illness. Fifty-eight participants completed mail-in questionnaires concerning beliefs and willingness to hire persons with mental illness. Employers were most concerned regarding the social and emotional skills of individuals with mental illness. Those employers who reported positive beliefs, had positive interactions with individuals with mental illness, or operated in public/social services, stated greater willingness to hire a person with mental illness. Methods to decrease stigma are discussed.

[Superoxyde dismutase 1 gene abnormalities in familial amyotrophic lateral sclerosis: phenotype/genotype correlations. The French experience and review of the literature]

About 20 p. cent of cases of amyotrophic lateral sclerosis are familial (FALS). Fifteen percent of FALS cases are associated with an abnormality in the superoxide dismutase 1 (SOD1) gene. To date, more than 100 different genetic abnormalities have been reported, all except two are autosomal dominant. The clinical characteristics of patients presenting with FALS associated with an SOD1 abnormality is homogeneous when there is no doubt about the hereditary aspect of the genetic abnormality: mean age at onset 42 years, limb onset, slow evolution. Except when present in the setting of a clearly inherited disease (FALS) (several patients through several generations), the causality of a given SOD1 mutation often remains an open question. Consequently, search for SOD1 mutation is not warranted when atypical features such as young age at onset or slow progression are present. Conversely, a complete family study is justified to determine the precise role of a given SOD1 mutation because of the large number of potential SOD1 mutations, the variability of the transmission mode, and the non-exceptional absence of proven causality for ALS. Specific cases where a frequent SOD1 mutation with a recognized causal effect is recognized (no more than 15 out of more than 90 mutations) would be an exception.

Grounding policy development within an educational setting: an exploration

OBJECTIVE

To explore an approach for informing the development of regional policy by eliciting the considered views of GP participants at an educational event. In particular we discuss the reaction of GP participants to this approach. (In this instance our GP participants were trainers and the evolving policy under discussion was that of 'clinical governance'.)

METHOD

An educational event was planned to facilitate discussion and the recording of the considered views of GP trainer participants. The acceptability of this approach to the participants was evaluated via observation and through feedback forms.

RESULTS

While observation suggested that the participants were involved in many lively and constructive discussions, the feedback generated showed that many participants felt uncomfortable about the use of an educational event to inform development.

DISCUSSION

We recognize the need to inform and facilitate change through the involvement of those who will be participants in the change process. The rapid timescales imposed by change and the 'burden' of additional research involvement on practitioners are issues. Approaches based on action research and participatory research principles may have potential and can throw light on the difficulties we experienced.

CONCLUSION

We need to identify approaches which will allow us to ground development within the views of those to be affected by change. Our own attempt demonstrated difficulties. We would welcome further debate over methods and approaches applicable in this border territory between research, development and education.

The Culture, Sexual and Asexual Reproduction, and Growth of the Sea Anemone Nematostella vectensis

Nematostella vectensis, a widely distributed, burrowing sea anemone, was raised through successive sexual generations at room temperature in non-circulating seawater. It has separate sexes and also reproduces asexually by transverse fission. Cultures of animals were fed Artemia sp. nauplii every second day. Every eight days the culture water was changed, and the anemones were fed pieces of Mytilus spp. tissue. This led to regular spawning by both sexes at eight-day intervals. The cultures remained reproductive throughout the year. Upon spawning, adults release either eggs embedded in a gelatinous mucoid mass, or free-swimming sperm. In one experiment, 12 female isolated clonemates and 12 male isolated clonemates were maintained on the 8-day spawning schedule for almost 8 months. Of the female spawnings, 75% occurred on the day following mussel feeding and water change, and 64% of the male spawnings were similarly synchronized under this regime. Fertilization and development occur when gametes from both sexes are combined in vitro. At 20°C, the embryos gastrulate within 12-15 hours. Spherical ciliated planulae emerge from egg massess 36-48 hours post-fertilization. The planulae elongate and form the first mesenteric couple, as well as four tentacle buds, by day five. By day seven, they metamorphose and settle as 250-500 μm long, four-tentacled juvenile anemones. More tentacles and all eight macrocnemes are present at 2-3 weeks. Individuals may become reproductively mature in as few as 69 days. Nematostella vectensis has the potential to become an important model for use in cnidarian developmental research.

Multiple transfer of lysosomal enzymes from normal lymphocytes to I-cell disease fibroblasts

Cells from patients with inherited lysosomal deficiency diseases can acquire the missing lysosomal enzyme by direct cell-to-cell transfer from normal lymphocytes. Cells from I-Cell Disease (Mucolipidosis type II; ICD) patients are simultaneously deficient in many lysosomal enzymes due to an inborn error of glycoprotein processing. In this study we show that such cells acquire high levels of several of the missing lysosomal enzymes when they are cultured in contact with lymphocytes. Moreover, the present results also show that enzyme levels in the donor lymphocytes are not depleted but increase during cell contact with the fibroblasts.

Morphine kinetics and kidney transplantation: morphine removal is influenced by renal ischemia

Morphine plasma concentrations were determined in six patients receiving kidney transplants from living-related donors, and nine patients receiving kidney transplants from cadavers. The total cold ischemic time was about 2 hr for kidneys from living-related donors and 14 hr for those from cadavers. After an intravenous bolus dose of morphine, plasma morphine concentrations decreased to a plateau that lasted for several hours; morphine elimination resumed when the transplanted kidney began to clear creatinine. The duration of the total cold ischemic time was significantly related to both the duration of the plateau in morphine concentration (P = 0.008) and the first postoperative day creatinine clearance (P = 0.021). Morphine elimination half-life after the plateau was related to first postoperative day creatinine clearance (P less than 0.001). It was concluded that morphine elimination depended upon intact renal function.

Effects of mitogenic stimulation of lymphocytes on lysosomal enzyme activity

Changes in the activities of several lysosomal enzymes were studied during transformation of mouse spleen cells in vitro. The activity of beta-glucuronidase increased during culture in the presence of T or B-cell mitogens, and lymphoblasts contained higher levels of activity than did small, non-transformed lymphocytes. Moreover, lymphoblasts in well-transformed cultures had higher activities than those in poorly-transformed cultures. The activities of other lysosomal enzymes (N-acetyl-beta-glucosaminidase, alpha-mannosidase, beta-glucosidase) also increased during mitogenic stimulation, but each at different rates, although aryl sulphatase was unaffected. Such differences may be of importance when lymphocytes are used for diagnosis of inherited lysosomal deficiency diseases.

Analysis of a recent epidemic due to penicillinase-producing Neisseria gonorrhoeae: epidemiologic and medical considerations

In Norfolk, Virginia, two epidemics of disease due to proved penicillinase-producing Neisseria gonorrhoeae were investigated intensively, both epidemiologically and medically. The first epidemic appeared in October 1976 and was controlled in one month; it was followed by a hiatus of four years before the emergence of the second epidemic in October 1980. The latter apparently was brought under control by December 1980, since no more patients with penicillinase-producing N. gonorrhoeae have been discovered to date (March 1982). Certain interesting medical aspects emerged from the investigation. Resistant organisms were cultured from asymptomatic as well as symptomatic patients and from all potentially infected sites. At times, resistant organisms were cultured from only one of several sites in a given patient or both resistant and sensitive organisms were cultured from a single site. It was concluded that this type of gonorrhea can be contained by intensive epidemiologic investigation combined with adequate diagnosis and treatment.