Factors affecting peritoneal dialysis selection in Taiwanese patients with chronic kidney disease.

BACKGROUND: Taiwan has the highest incidence and prevalence of end-stage renal disease (ESRD) in the world with 55,499 ESRD patients on long-term dialysis. Nevertheless, 90.96% of these patients are managed on maintenance haemodialysis (HD), with only 9.03% enrolled in a peritoneal dialysis (PD) programme. AIM: The study aim was to identify the factors affecting Taiwanese patient's selection of PD in preference to HD for chronic kidney disease. METHODS: A cross-sectional research design was utilized with 130 chronic renal failure (CRF) patients purposively selected from outpatient nephrology clinics at four separate Taiwan hospitals. Logistic regression was used to identify the main factors affecting the patient's choice of dialysis type. RESULTS: Single-factor logistic regression found significant differences in opinion related to age, education level, occupation type, disease characteristics, lifestyle modifications, self-care ability, know-how of dialysis modality, security considerations and findings related to the decisions made by medical personnel (P < 0.05). Moreover, multinomial logistic regression after adjustment for interfering variables found that self-care ability and dialysis modality know-how were the two main factors affecting the person's selection of dialysis type. CONCLUSIONS: Self-care ability and the person's knowledge of the different types of dialysis modality and how they function were the major determinants for selection of dialysis type in Taiwan based on the results from this study. The results indicate that the education of CRF patients about the types of dialysis available is essential to enable them to understand the benefits or limitations of both types of dialysis.

The emancipation of nursing practice: applying anti-psychiatry to the therapeutic community.

This paper raises issues about the process and conduct of clinical relationships with people diagnosed as mentally ill who live in therapeutic communities. This clinical work is of particular importance in the late 1990s due to the changing socio-cultural climate of interaction with people living with mental illness. This climate has a focus of care on recovery in the community and not on long-term hospitalization. The paper takes the position of anti-psychiatry as a preferred model of intervention because it is person and not diagnosis oriented. The nature of the therapeutic community is explored in relation to its importance in the context of destigmatizing mental illness, its structure, and in its ability to empower the person from a philosophically driven and experiential perspective.

Rural families as resources for family members who are mentally ill: a call for nursing involvement.

The concept of Rooming In, developed by country psychiatrist Mike Richardson, is presented as an exemplar of an innovative mental health family nursing concept and provides a context for the further evaluation of the nurse's role in family care. Rooming In involves the 24-hour voluntary care of a mentally ill person by a close friend or relative on the general hospital ward. This article describes a descriptive, qualitative pilot research project conducted in a rural general hospital in New South Wales, Australia. Six family members, their mentally ill relatives, friends, and registered nursing staff were interviewed for the study. Data are presented as categories derived from the analysis of interview transcripts.

Glycated hemoglobin in insulinoma.

OBJECTIVE: To determine whether preoperative levels of glycated hemoglobin (GHb) are lower in patients with functioning insulinoma and, if so, whether a distinct separation of GHb values from those in control subjects might serve for diagnosis. METHODS: We examined preoperative GHb in consecutive patients (who had this measurement done) with surgically confirmed insulinoma for the period 1983 (when the current method became available for routine use) through 1996. Hemoglobin A(1) (HbA(1)) was measured by the Isolab Glyc-Affin Test System (normal range, 4 to 7%). We studied 64 patients with insulinoma (40 women and 24 men; median age, 47.5 years; age range, 21 to 79) and 38 control subjects (25 women and 13 men; median age, 42.5 years; age range, 20 to 83) considered not to have a hypoglycemic disorder on the basis of normal results of a supervised 72-hour fast. RESULTS: HbA(1) was significantly lower in patients with insulinoma (median, 4.7%; range, 2.7 to 6.9%) than in control subjects (median, 5.3%; range, 4.1 to 6.4%) (P<0.001, two-tailed rank sum test). Among 15 patients with insulinoma treated with diazoxide preoperatively, HbA(1) was higher (median, 4.8%; range, 4.2 to 6.9%) than in patients not treated with diazoxide (median, 4.6%; range, 2.7 to 5.7%), although the difference was not statistically significant (P = 0.08). CONCLUSION: Because of considerable overlap in HbA(1) values, no GHb value was diagnostic for insulinoma; however, 16 of 64 patients (25%) with insulinoma had HbA(1) values below the lowest value (4.1%) in control subjects. Thus, HbA(1) values less than 4.1% in patients with possible insulinoma are strongly indicative of that disorder.

Correlation of specific migration (Cf) of plastics additives with their initial concentration in the polymer (Cp).

The first list of plastics additives which may be assigned restrictions in a future amendment to Directive 90/128/ EEC is likely to contain over 200 substances. If food consumption factors are taken into account many compounds on this list could have restrictions removed but there would, without doubt, still be many additives with restrictions. Extensive migration testing of food contact plastics containing restricted additives to ensure compliance would be required. These limits would be difficult to enforce, add significant cost burdens on the packaging industry and, for these reasons, may not provide improved consumer safeguards. An alternative means of control has been proposed based upon polymer composition. However, in order to support such a scheme a reliable correlation between migration of additives to their composition in the polymer must be demonstrated. There has been strong interest in establishing this relationship and a feasibility project to investigate the specific migration of four commonly used additives has been successfully completed. The study was initially funded for 1 year, by the Ministry of Agriculture, Fisheries and Food (MAFF) and industry. Analytical methods to determine the additives in food simulants have been developed and linear correlations have been demonstrated between the concentration of all four additives and their specific migration levels for each polymer studied. Experimental migration data have been compared with those generated by mathematical models.

Haploid and diploid expression of a Brassica campestris anther-specific gene promoter in Arabidopsis and tobacco.

The anther-specific cDNA clone Bcp1 from Brassica campestris is expressed in both the haploid pollen and diploid tapetum, as shown by in situ hybridization. We have isolated Bgp1, a genomic clone homologous to Bcp1. The coding region and extensive 5' flanking sequences of Bgp1 have been sequenced, and the coding region shows 88% identity with Bcp1. RNA gel blot analysis confirmed the expression of Bgp1-specific transcripts in B. campestris pollen. A 767 bp 5' DNA fragment was fused to the reporter gene beta-glucuronidase (gus) and introduced into both Arabidopsis thaliana and Nicotiana tabacum by transformation. This 5' fragment directed high-level expression in the pollen and tapetum of transgenic Arabidopsis. In transgenic tobacco however, the same construct was expressed only in pollen. A series of 5' deletion constructs has been created and used to transform A. thaliana to analyse the 5' region of Bgp1. The results indicate that Bgp1 expression in the tapetum and pollen of Arabidopsis requires the presence of different 5' DNA sequences.