Right hepatic lobe donation for living donor liver transplantation: impact on donor quality of life.

Adult right hepatic lobe living donor liver transplantation (LDLT) has rapidly gained widespread acceptance as an effective procedure for selected patients with end-stage liver disease. However, there are currently no published data on the effect of this procedure on the quality of life of donors. We report the results of a survey of our living liver transplant donors to determine the effect of right hepatic lobe donation on quality of life. We have performed 30 LDLTs since 1997; 24 of these have a follow-up of 4 months or longer. In August 2000, these patients were sent a questionnaire (including a Medical Outcomes Study 36-Item Short-Form Survey) regarding psychosocial outcomes and symptoms after surgery. Major complications occurred in 4 of 24 patients (16%), and minor complications, in 4 of 24 patients (16%). Complete recovery occurred in 75% of patients at a mean time of 3.4 months. Ninety-six percent of patients returned to the same predonation job after a mean time of 2.4 months, and 66% of patients required a period of light-duty work for a mean of 2.8 months before returning to full-duty work. A change in body image was reported in 42% of patients, and 71% reported mild ongoing symptoms (primarily abdominal discomfort) that they related to the donor surgery for which 29% sought evaluation by a physician. The donor's relationship with the recipient was the same or better in 96% of donors, and the relationship with the donor's significant other was the same or better in 88% of donors. Mean out-of-pocket expenses incurred by donors were $3,660. Sixty-three percent of donors reported experiencing more pain than anticipated. All patients would donate again if necessary, and 96% benefited from the donor experience. In conclusion, (1) all our donors are alive and well after donation; (2) almost all donors were able to return to predonation employment status within a few months; (3) most donors have mild persistent abdominal symptoms, and some donors had a change in body image that they attribute to the donor surgery; and (4) this information should be provided to potential donors so they may better understand the impact of donor surgery.

A comparison of persons with early-versus late-onset panic attacks.

BACKGROUND: Although some evidence suggests a bimodal age at onset of panic attacks, the literature comparing subjects with early versus late onset is limited. Previous work suggests that people with late-onset panic attacks may have fewer panic symptoms and exhibit less avoidance. This study sought to compare late-onset panic attacks and early-onset panic attacks with regard to (I) comorbidity, (2) health care utilization, and (3) illness behaviors and coping. METHOD: This community-based study involved interviewing randomly selected adults for the presence of DSM-III-R panic attacks. If panic attacks were confirmed, subjects were asked questions concerning panic characteristics, psychiatric comorbidity, symptom perceptions, illness attitudes, coping, and family characteristics. Subjects reporting early-onset panic (panic onset < 50 years of age) were compared with those reporting late onset (onset > or = 50 years of age). Significant univariate analyses were controlled for differences in age, panic duration, and socioeconomic status by using analysis of covariance and logistic regression. RESULTS: Subjects with late-onset panic attacks (N = 9) utilized the mental health sector less, but were more likely to present to family physicians for their worst panic. Patients with late-onset panic felt that choking and numbness more strongly disrupted function, but felt less strongly that either depersonalization or sweating disrupted function. Subjects with late-onset had fewer comorbid conditions and lower Symptom Checklist-90 scores. Late-onset subjects also had less hypochondriasis and thanatophobia while coping less through avoidance or wishful thinking. CONCLUSION: Late-onset panic attacks are associated with less mental health utilization, lower levels of comorbidity, less hypochondriasis, and a greater number of positive coping behaviors.

[Impact of a community network of psychosocial support in perinatal health]. / Impacto de una red comunitaria de apoyo psicosocial en la salud perinatal.

OBJECTIVE: Determine the impact of a community intervention in perinatal health in, cities of the State of Chihuahua, Mexico. PATIENTS, MATERIAL AND METHODOLOGY: A community intervention was designed including pregnant women (n = 1233), and finally 1148 (6.74% of loss) group intervention (n = 261) control group (n = 887). Intervention consisted of five visits prior to delivery during the 22nd, 26th, 30th, 34th and 38th weeks, as well as a visit during the first 8 days in puerperium, providing social and educational support. In regards to the control group, they were visited in two different occasions, week 22 and purperium, indicating them to continue with their regular care. The outcome variables were perinatal mortality, premature birth (< 37 weeks), low weight at birth (< 2500 grams) and perinatal morbidity. RESULTS: Perinatal mortality rate was smaller in the intervention group 3.8 per 1000 born alive; perinatal mortality in the control group was 13.1. No statistically considerable difference was found in premature birth, in low weight at birth and in perinatal morbidity. CONCLUSION: Community intervention provides a support to pregnant women under psychosocial risk factors; nevertheless, it does not contribute to considerably decrease premature birth, low weight at birth or perinatal complications.

A recurrent glycine substitution mutation, G2043R, in the type VII collagen gene (COL7A1) in dominant dystrophic epidermolysis bullosa.

Dystrophic epidermolysis bullosa (DEB) is caused by mutations in the type VII collagen gene (COL7A1). Nearly all cases of dominant DEB are caused by glycine substitution mutations occurring within the triple helical region of type VII collagen, and most of the mutations are unique to individual families. In this study, we identified a patient of Hispanic-Mexican origin with a mild form of DEB, which resulted from a de novo dominant glycine substitution, G2043R, in exon 73 of COL7A1. We also investigated a Scottish family with a three-generation pedigree of dominant DEB, in whom the same glycine to arginine substitution mutation was demonstrated. This particular mutation has also been detected previously in three other families with dominant DEB: one Italian, one Hungarian and one Norwegian. Given the widespread geographical distribution of this mutation and the demonstration of its occurrence as a de novo event, G2043R therefore represents the first example of a mutational hotspot in dominant DEB. Interestingly, although both the Mexican and Scottish families we studied had some clinical features in keeping with the Pasini form of the disorder, there was considerable interfamilial variability as well as intrafamilial diversity in the affected individuals.

SES and ethnic differences in perceived caregiver availability among young-old Mexican Americans and non-Hispanic whites.

Differences in perceived caregiver availability were examined among a random sample of Mexican American (MA) and non-Hispanic white (NHW) young-old residents (58-74 years old) in three socioeconomically distinct neighborhoods in San Antonio, Texas. For MAs across all three socioeconomic status (SES) groups, being female, widowed, and having more chronic illnesses were associated with a lesser likelihood of perceived caregiver availability. SES and number of children were not associated with perceived caregiver availability. Among MAs and NHWs of middle- and upper-SES, being male, married, and of upper-SES were associated with a greater likelihood of perceived caregiver availability. The number of children modified the associations of both SES and ethnic group with perceived caregiver availability.

Hispanic American elders: caregiving norms surrounding dying and the use of hospice services.

The purpose of this review is to (1) provide an overview of health and demographic characteristics common to the Hispanic elder population, (2) address family caregiving issues surrounding the terminal illness of a loved one, (3) understand resource utilization by Hispanic elderly and their family caregivers, and (4) make recommendations for the provision of information and education about hospice services. Case examples will illustrate patterns and themes unique to Hispanic caregiving.

Hispanic elders in Texas: implications for health care.

Hispanic elders are a large, rapidly growing subgroup of the Hispanic population in Texas. This population continues to suffer from a high incidence of non-insulin-dependent diabetes mellitus, with similar or lower rates of cardiovascular disease than non-Hispanic whites have. Barriers that may modify potentially effective diagnostic or appropriate treatment plans include communication problems, access issues, and use of informal health-care services. Knowledge and attention to these issues may improve compliance and decrease morbidity of this cohort. This article summarizes important information affecting the health of Hispanic elders in Texas and alerts practitioners to issues that may affect the care of their older Hispanic patients.

Characterization of cattle of a five-breed diallel: VI. Fat deposition patterns of serially slaughtered bulls.

Dissection and chemical analysis data from 197 bulls of 15 breedtypes were used to examine the distribution of total fat (TOTFAT) among carcass fat (CFAT), viscera fat (VIF), kidney plus pelvic fat (KPF) and blood fat (BLF). The bulls were obtained from a five-breed diallel involving Angus, Brahman, Hereford, Holstein and Jersey; reciprocal crosses were pooled. One or two bulls of each breedtype were slaughtered at each of seven ages: 6, 9, 12, 15, 18, 24 and 30 mo. An allometric equation was utilized to describe growth rate of each fat depot relative to either TOTFAT or carcass side weight (CSW). The pooled within-breedtype differential growth rates obtained from the allometric equation indicated that as TOTFAT or CSW increased, the proportion composed of CFAT and KPF increased (growth coefficients significantly greater than 1), whereas the proportion composed of VIF and BLF decreased (growth coefficients significantly less than 1). Holstein and Jersey tended to have more CFAT than Hereford, Angus and Brahman. Jersey had more KPF than other breeds. Crossbreds exhibited positive heterosis for CFAT and VIF, and negative heterosis for KPF. On a constant CSW basis, there were no significant breedtype differences in TOTFAT: nevertheless, differences in fat distribution among breedtypes persisted. There were different amounts of fat at the depots studied, but fat growth coefficients relative to TOTFAT tended to be homogeneous among breedtypes.