Agents and spectres: Life-space on a medium secure forensic psychiatric unit.

Medium secure forensic psychiatric units are unique environments within the broader 'post asylum' landscape of mental health services. Length of stay is much greater, a recovery-focused care system is much more difficult to implement, and there is a paucity of suitable "step-down" services. The aim of this study was to examine how forensic psychiatric environments contribute to the shaping of recovery, by examining key features such as social interactions and agency. Here, we report on the findings from patients participating in a qualitative-visual study. This analysis forms part of larger study on staff and patient experiences of secure hospital space. In this paper, the analytical focus is directed towards two key elements of recovery - agency and relationality, using the concept of 'topology' and 'life-space', developed by the social psychologist Kurt Lewin. First, we explore how patients have relative freedom to move within institutional spaces, yet lack relational space. Secondly, we explore how life-space is expanded or compressed by the manner in which the patient's present life in hospital is connected or disconnected from their past or pending future. Finally, we discuss the implications of these findings for a recovery model within secure forensic settings, focused on personalisation and expanded life-space.

[Abdominal morbidity following TRAM flap breast reconstruction--patient-reported outcome measures]. / Die subjektive Wahrnehmung abdomineller Symptome nach Brustrekonstruktion mit gestielter und freier TRAM Lappenplastik.

PURPOSE/BACKGROUND: Excellent aesthetic outcomes have been demonstrated with TRAM flap breast reconstruction. However, abdominal wall morbidity after TRAM flap breast reconstruction has not been accurately evaluated in terms of patient symptoms or patient quality of life. To further examine this issue, we performed a cross-sectional survey of TRAM flap breast reconstruction patients utilising questions from a patient-related outcome measure questionnaire. PATIENTS AND METHOD: The questions were posed to post-mastectomy breast reconstruction patients. Items pertaining to abdominal wall symptoms and satisfaction with the outcome were reported on a 5-point Linkert Scale (1=very satisfied/no symptoms to 5=very dissatisfied/frequent symptoms). RESULTS: The study population consisted of 270 patients who underwent pedicled (n=183) or free (n=87) TRAM flap procedures. The frequency of abdominal wall symptoms reported on abdomen-specific questionnaire items was increased in the pedicled TRAM group relative to the free TRAM group. This included "tightness or pulling in abdomen" (2.34 vs. 2.01); "abdominal pain, bloating, or discomfort" (2.11 vs. 1.69); "difficulty doing everyday activities requiring the use of your abdominal muscles" (2.11 vs. 1.67); and "abdominal weakness" (2.36 vs. 1.8). CONCLUSION: We found a relatively low frequency of abdominal symptoms in the TRAM flap patients as a whole. However, there was a tendency towards increased abdominal symptoms in the pedicled TRAM patients compared to the free TRAM patients. As the population sizes in this study are somewhat limited, future studies with increased patient numbers may find greater differences between pedicled and free TRAM patients. In addition, studies evaluating the patients' abdominal wall symptoms pre- and postoperatively may allow for a detailed analysis of abdominal wall morbidity in post-mastectomy TRAM patients.

Parental accounts regarding the physical punishment of children: discourses of dis/empowerment.

OBJECTIVE: In the light of the psychological literature (e.g., Bettleheim, 1987) which indicates various contradictions surrounding the talk about and practice of the physical punishment of children (PPC), the main aim of the present study is to identify and examine the rationale(s) used by parents which bolster(s) PPC. METHODOLOGY: Data collection--semistructured interviews carried out with 10 parents (nine female, one male). Data analysis--discourse analysis (e.g., Potter & Wetherall, 1987), a form of qualitative data analysis which is sensitive to the range and complexity of accounts (or discourses) presented by participants. Hence, we explore the various (often conflicting) discourses deployed by parents while talking about PPC, an approach which has not been used before in the study of parental discipline. RESULTS: Various oppositional discourses were used by the parents, each of which implies diverse justifications and consequences. Four in particular were identified--PPC as (1) pedagogic (educational). (2) cathartic (need relief); (3) individualistic (power assertion); (4) cyclical (reproduction)--and five instances of contradiction explicated with reference to the particular discursive context. CONCLUSION: Much confusion and complexity regarding PPC is evident from parental talk which is marked by discursive variation and contradiction. These discursive collisions notwithstanding, the participant's discourse generally implies the oppressive positioning of children and, consequently, offers support for physical punishment. The study also highlights the utility of discourse analysis as a method for interrogating PPC--and indeed other phenomena related to child abuse and neglect.

The role of neutrophils and platelet-activating factor in mediating experimental pancreatitis.

BACKGROUND & AIMS: Pancreatitis is characterized by inflammation and death of acinar cells. Death can occur by either necrosis or apoptosis. The initial injury may cause expression of cytokines that mediate activation and infiltration of neutrophils. The aim of this study was to assess the effect of neutrophils and platelet-activating factor (PAF) in cell death responses. METHODS: The effects of neutrophil depletion with antineutrophil serum (ANS) and a PAF antagonist (BN52021) were measured in the cerulein model of pancreatitis. Rats received a 6-hour intravenous infusion of cerulein either alone or after treatment with ANS, BN52021, or both. RESULTS: Cerulein-induced pancreatitis was characterized by neutrophilic infiltration, vacuolization of acinar cells, and foci of necrosis. Treatment with ANS and BN52021 prevented the inflammatory response caused by cerulein and decreased the cell damage. Treatment with ANS increased apoptosis in cerulein-infused animals. When BN52021 was added, apoptosis was abolished. The measurement of PAF in pancreatic tissue showed a ninefold increase with cerulein treatment alone and a 14-fold increase in cerulein-infused, neutrophil-depleted animals. CONCLUSIONS: The results indicate that cerulein stimulates pancreatic production of PAF. PAF mediates both apoptosis and neutrophil chemotaxis in the pancreas. Neutrophils in turn may convert acinar cells undergoing apoptosis into necrotic cells.

Signal transduction and HIV transcriptional activation after exposure to ultraviolet light and other DNA-damaging agents.

Short wavelength (254 nm) ultraviolet light (UVC) radiation was much more potent in activating transcription of human immunodeficiency virus 1 (HIV) reporter genes stably integrated into the genomes of human and monkey cells than ionizing radiation (IR) from a 137Cs source at similarly cytotoxic doses. A similar differential was also observed when c-jun transcription levels were examined. However, these transcription levels do not correlate with activation of nuclear factor (NF)-kappa B and AP-1 measured by band-shift assays, i.e. both types of radiation produce similar increases in NF-kappa B and AP-1 activity, suggesting existence of additional levels of regulation during these responses. Because of the well-established involvement of cytoplasmic signaling pathways in the cellular response to tumor necrosis factor-alpha (TNF-alpha), UVC, and IR using other types of assays, the role of TNF-alpha in the UVC response of HIV and c-jun was investigated in our cell system. We demonstrate that UVC and TNF-alpha activate HIV gene expression in a synergistic fashion, suggesting that it is unlikely that TNF-alpha is involved in UVC activation of HIV transcription in stably transfected HeLa cells. Moreover, maximum TNF-alpha stimulation resulted in one order of magnitude lower levels of HIV expression than that observed after UVC exposure. We also observed an additive effect of UVC and TNF-alpha on c-jun steady-state mRNA levels, suggestive of a partial overlap in activation mechanism of c-jun by UVC and TNF-alpha; yet these responses are distinct to some extent. Our results indicate that the HIV, and to some extent also the c-jun, transcriptional responses to UVC are not the result of TNF-alpha stimulation and subsequent downstream cytoplasmic signaling events in HeLa cells. Additional levels of regulation that do not directly involve the NF-kappa B and AP-1 transcription factors, such as changes in chromatin structure associated with the UV repair process, may also be important for a full transcriptional response of HIV and c-jun to UVC. In addition to the new data, this report also summarizes our current views regarding UVC-induced activations of HIV gene expression in stably transfected cells.

Prevalence of congenital adrenal hyperplasia in Kuwait.

Between 1978 and 1988 congenital adrenal hyperplasia (CAH) was diagnosed in 60 children in Kuwait with an estimated prevalence of 1:9,000 livebirths, which is higher than that reported from Europe and Canada. In addition, there was presumptive evidence of CAH resulting in the death of 20 other children, giving a prevalence figure of 1:7000. There were 41 girls (68%) and 19 boys (32%). Thirty-one of the girls (75.6%) and 11 of the boys (57.9%) were saltlosers. Fifty-four patients (90%) were diagnosed as 21-hydroxylase deficient, 3 patients (5%) had a deficiency of the 3 beta-hydroxy-steroid dehydrogenase enzyme, and 3 patients (5%) showed a deficiency of 11 beta-hydroxylase.

Familial hypophosphataemic rickets: experience with 24 children from Kuwait.

Between 1982 and 1988, familial hypophosphataemic rickets (FHR) was diagnosed in 24 children, in nine during screening of the families of index patients. The average annual incidence was 0.2/1000 live births. There were 16 boys and 8 girls in 10 families, of which nine had more than one affected child. Their ages at the onset of the disease ranged between 10 months and 14 years (mean 6.9 yrs). Growth retardation and bowing of the legs were the most prominent features, observed in all index patients and in four of the patients diagnosed by screening. Treatment with 1 alpha-hydroxyvitamin D3 and phosphates was associated with acceleration of growth in all children, healing of rickets in 21, and normalization of the serum phosphate in 22. Two children with late diagnosis are now older than 16 years with a final height below the 3rd centile. Three more pubertal children are also shorter than the 3rd centile. In areas where nutritional rickets is common, FHR is likely to be missed and the treatment delayed with grave consequences; in particular, growth retardation and bone deformity.

Vitamin-D-deficiency rickets in Kuwait: the prevalence of a preventable disease.

Two hundred and fifty children with clinical, biochemical and radiological evidence of vitamin-D-deficiency rickets were studied over a period of 5 years. Their ages ranged from 1 month to 2 years. Breastfed infants formed 63% of total cases. Intramuscular therapy with vitamin D in a dose of 600,000 IU, deep intramuscular, proved to be safe and effective. In contrast, oral vitamin D did not provide such satisfactory results, presumably owing to poor patient/parental compliance. This report reveals that vitamin-D-deficieny rickets is common in Kuwait in spite of abundant sunlight all through the year because children are wrapped up and kept indoors. Insufficient intake of vitamin D is another important factor in the pathogenesis of vitamin-D-deficiency rickets in Kuwait.

Pattern of urolithiasis in a general hospital. A prospective study.

Judging from the abundance of papers published in the medical journals there appears to be a global increase in the incidence of urolithiasis. Urinary excretion of various stone-forming salts in a 24-hour urine specimen is the mainstay of the metabolic workup done in stone-formers. According to the findings patients have been classified into neat categories depending on whether they were hypercalciuric, hyperuricosuric, etc. As a group their excretion of calcium, oxalate, and urate was not different from the controls. However, they excreted significantly more phosphate and had lower 24-hour urine volumes than the controls.

Aminoacidopathies: a review of 3 years experience of investigations in a Kuwait hospital.

We present a summary of the results of quantitative amino acid analysis in 800 subjects over a three-year period in Al-Sabah Hospital, Kuwait. Thirty-five patients with aminoacidopathy were identified, all but two of whom were the offspring of first-degree consanguineous marriages: nine cases of phenylketonuria, one benign hyperphenylalaninaemia, seven non-ketotic hyperglycinaemia, five tyrosinaemia, five homocystinuria, four citrullinaemia, two cystinuria, one hyperprolinaemia, and one maple syrup urine disease. The clinical and biochemical findings in these cases are described.

Acetylator phenotype in spontaneous SLE and rheumatoid arthritis.

Acetylator phenotype was determined in 22 patients with spontaneous systemic lupus erythematosus and the proportion of 'slow' acetylators compared with that obtained in a group of patients with rheumatoid arthritis and a group of healthy controls. 73% of the SLE group were designated 'slow' compared with 72% of the rheumatoid group and 64% of the control group. These differences were not significant.

Interaction of ethanol with amylobarbitone, phenobarbitone and methaqualone.

The presence and mechanism of synergism of action between ethanol and amylobarbitone, phenobarbitone or methaqualone was determined by application of simple pharmacokinetic models to log dose-response curves and plasma concentration-time curves for the hypnotics alone or when ethanol was given concurrently. For all three hypnotics, ethanol was found to increase the duration of hypnosis, but the mechanism of action was different for each. A sub-hypnotic dose of ethanol increased the volume of distribution of amylobarbitone and the consequent reduction in fractional elimination prolonged the half-life of the hypnotic. The distribution and elimination of methaqualone were not affected by ethanol, but there was a sensitisation of the target organ, shown by a reduced minimum effective dose. The minimum effective dose of phenobarbitone was also reduced by ethanol, but in addition, the rate of elimination of phenobarbitone was increased after the period of hypnosis.

Enzyme multiplied immunoassay of phenobarbital by LKB reaction Rate Analyser: a comparison with analysis by gas-liquid chromatography.

A procedure for the enzyme multiplied immunoassay of phenobarbital using the LKB Reaction Rate Analyser is described. The temperature optimum, linearity, specificity, and precision of the assay are reported. A highly significant correlation coefficient is obtained when the technique is compared with gas-liquid chromatography by analysing human sera containing a range of phenobarbital levels.