A new method for investigating the relationship between diet and mortality: hazard analysis using dietary isotopes.

Background: The population of Roman Britain are renowned for having elevated nitrogen (δ15) stable isotope values, which have been interpreted as evidence for the increased consumption of marine products. However, such results are now understood to also reflect episodes of stress and disease, suggesting that new interpretations are warranted.Aim: To test a novel approach which combines hazard mortality analysis and stable isotope data to determine whether there is a relationship between age-at-death, elevated δ15N values and mortality risk.Subjects and methods: This study used published osteological and dietary stable isotope data for nitrogen (δ15N) and carbon (δ13C) of 659 1st-5th century AD individuals aged >12 years old excavated from Roman cemeteries in Britain. The relationship between diet and mortality risk was assessed using the Gompertz hazard model, and differences in median reported isotope values between the sexes was determined using a Mann Whitney test.Results: It was discovered that higher δ15N levels are associated with elevated risks of mortality, whereas the opposite pattern was observed for δ13C, and males had higher median δ13C and δ15N values.Conclusion: This study successfully demonstrated that stable isotope data can be integrated into hazard models, allowing one to connect diet and mortality in past populations. It supports the findings of other isotope studies which have established that individuals with childhood stress/trauma will have different isotope patterns.

Relationship of numbing to alexithymia, apathy, and depression.

The present study assessed the relationship between numbing and three associated conditions of alexithymia, apathy, and depression, utilizing data collected on 353 Vietnam combat veterans diagnosed with Posttraumatic Stress Disorder from in- and out-patient settings and an outreach center at various Department of Veterans Affairs Medical centers. All subjects completed four self-report measures: the Glover Numbing Scale, the Beck Depression Inventory, the Apathy Evaluation Scale, and the Toronto Alexithymia Scale-20. The correlation matrix indicated that scores on the four measures were moderately to highly correlated. Principal components analysis with a varimax rotation indicated a five-factor solution that provided evidence for the factorial validity of each of the constructs assessed. Results of the factor analysis of items from the four measures were consistent with numbing being a separate and distinct construct from alexithymia, apathy, and depression. In general, results indicated that all constructs measured were separate and distinct from one another.

Prostate cancer and other xenografts from cells in peripheral blood of patients.

Good models for the investigation of human prostate cancer are few. Cells from approximately 9.2-21 ml of peripheral blood from patients with metastatic prostate cancer or metastatic colon cancer were injected s.c. into nude mice. Prostate cancer from 2 of 11 patients and colon cancer from 1 of 3 patients were found to be growing as metastases in the lungs of the nude mice. To our knowledge, this is the first report of the formation of xenografts from carcinoma cells taken directly from the peripheral blood of patients. Expanding circulating cancer cells with this approach may have important translational applications including: (a) development of models of human cancers; and (b) sampling of cancers from specific patients for novel molecular and therapeutic approaches.

Randomised controlled effectiveness trial of a needs-based psychosocial intervention service for carers of people with schizophrenia.

BACKGROUND: Family interventions are effective in reducing relapse in patients with schizophrenia, but there is little work demonstrating the effectiveness of the interventions in routine service settings. AIMS: To test the effectiveness of a needs-based family intervention service for patients recruited as out-patients and their carers, including those of low expressed emotion status. METHOD: Carers of out-patient schizophrenia sufferers selected only on illness history factors were randomly allocated to receive either family support alone or in combination with systematic psychosocial interventions based on an assessment of need. Delivery of family interventions attempted to involve the clinical team. RESULTS: Relapse outcomes were superior for family-treated patients at six-month follow-up, although most of the clinical and symptom patient variables assessed remained stable, as did measures of carer burden. CONCLUSIONS: The study demonstrated the effectiveness of family interventions in routine service settings. Problems with staff, patient and carer engagement and participation were identified.

Flexor carpi ulnaris tendon transfers in cerebral palsy.

Flexor carpi ulnaris tendon transfer to either the extensor carpi radialis longus or extensor carpi radialis brevis has become a standard procedure to improve function in patients with cerebral palsy. In this retrospective study of the procedure, we have compared preoperative and postoperative wrist position, analysed potential outcome predictors and assessed function by objective and subjective measures. Sixteen children, with flexor carpi ulnaris transfer to extensor carpi radialis longus or brevis or extensor digitorum, were tested at an average follow-up of 4 years (range, 1-9). General resting position improved and the centre of the arc of motion averaged 6 degrees pronation and 9 degrees extension. Subjectively, 14 of 16 parents felt there was an improvement in function, 16 of 16 felt that cosmesis was improved, 14 of 16 would recommend the procedure to others, and 15 of 16 were satisfied overall.

Creating a healthy work environment in the midst of organizational change and transition.

In the midst of organizational change and transition, the need for a healthy work environment is greater than ever. Leaders may be in a position of leading staff on a journey they would rather not be on. Although there may not be a choice of destination, there are many decisions to be made along the way that will impact the health and quality of the journey. Creation of a healthy work environment does not occur overnight. It requires acknowledgment of the reality of the present environment, clear behavioral expectations and standards, systems, and structures to ensure the organizational changes are enduring and a means to assess continually the health of the work environment. Leaders have an opportunity and a responsibility to structure organizations in such a way that dignity, integrity, honesty, and compassion are preserved.

Predicting surgical outcome for pain relief and return to work.

BACKGROUND: We evaluated a new psychological test (Paindex) for identifying and quantifying psychological factors associated with poor surgical outcome, and predicting the degree of pain relief and return to work. METHOD: This test was administered to 120 randomly selected patients before carpal tunnel and laminectomy surgeries. RESULTS: This test correctly predicted the probability of pain relief and return to work in 46 of the 50 laminectomy patients (92%), and 63 of the 70 carpal tunnel patients (90%). The overall test sensitivity was 86% and the specificity 94%. CONCLUSION: These findings indicate that this can be a useful adjunctive test for identifying psychological problems that could have a bearing on the decision to operate and then problems that could occur after surgery, particularly in cases where the extent and degree of pain and disability are judged to be considerably in excess of the objective medical findings.

Predicting surgical outcome for pain relief and return to work.

BACKGROUND: We evaluated a new psychological test (Paindex) for identifying and quantifying psychological factors associated with poor surgical outcome, and predicting the degree of pain relief and return to work. METHOD: This test was administered to 120 randomly selected patients before carpal tunnel and laminectomy surgeries. RESULTS: This test correctly predicted the probability of pain relief and return to work in 46 of the 50 laminectomy patients (92%), and 63 of the 70 carpal tunnel patients (90%). The overall test sensitivity was 86% and the specificity 94%. CONCLUSION: These findings indicate that this can be a useful adjunctive test for identifying psychological problems that could have a bearing on the decision to operate and then problems that could occur after surgery, particularly in cases where the extent and degree of pain and disability are judged to be considerably in excess of the objective medical findings.

Could you starve to death in England in 1839? The Chadwick-Farr controversy and the loss of the "social" in public health.

The public health field has long been pulled in two directions, either toward a narrower biomedical mission to control infectious disease or toward a broader mission to address the social and economic factors that adversely affect health and wellbeing. This paper explores as an instance of this tension an 1839 controversy between the statistician William Farr and the pioneering sanitary reformer Edwin Chadwick on the role of starvation as a cause of death. Farr thought hunger contribution significantly to many deaths; Chadwick wanted Farr to concentrate on the diseases from which people actually died. The paper then considers what the "constitutional" disease theories, which underlay Farr's concerns, implied for public health using medical testimony on child labor in industrial revolution factories as an illustration. An exploration of this constitutional medicine may help provide a "useable past" for modern public health workers interested in broadening the scope of public health.

Vulnerability Scale: a preliminary report of psychometric properties.

This work describes assessment of the psychometric properties of a self-report instrument, the Glover Vulnerability Scale. This scale was administered to a total of 11 groups (N = 695). Six of the groups were Vietnam combat veterans diagnosed as having Posttraumatic Stress Disorder (n = 531). The estimate of internal consistency was .88; the test-retest correlation over 4 wk. was .81. Convergent and discriminant validations were satisfactory based on the pattern of the scale's correlations with relevant MMPI subscales and demographic data. Scale scores also discriminated levels of functioning within the population diagnosed with Posttraumatic Stress Disorder and discriminated veterans diagnosed with Posttraumatic Stress Disorder from patients with major depressive disorder and anxiety disorder. Principal component factor analysis gave a 4-factor solution: social comfort, vulnerability, paranoia, and family trust. Over-all, the findings strongly support the clinical application of the Vulnerability Scale.

The Numbing Scale: psychometric properties, a preliminary report.

This study explored the psychometric properties of a new self-report instrument, The Glover Numbing Scale. The scale measures a variety of behaviors reported by individuals experiencing an inability to access feelings other than hostility and rage. The scale was administered to inpatient Vietnam combat veterans with post-traumatic stress disorder (PTSD, n = 323), PTSD diagnosed Veterans Affairs (VA) outpatient and veterans' outreach center veterans (n = 208), two Vietnam veteran noncombat groups (n = 45), two psychiatric noncombat controls (anxiety disorder, n = 40; major depressive disorder, n = 31), and a nonpsychiatric never-in-Vietnam veteran control group (n = 48). Reliability information suggested that the scale was internally consistent with good test-retest correlations. Convergent and discriminant validations were assessed based on the pattern of the scale's correlations with relevant Minnesota Multiphasic Personality Inventory (MMPI) scales. The contrasting pattern of correlations provided by a subgroup of veterans who reported always feeling dead or shut down was highlighted. Principal component analysis resulted in a five factor solution that provided evidence for the scale's factorial validity. Numbing Scale scores discriminated levels of psychopathology within the veteran population. PTSD outreach center veterans' sum scores and item scores on the Numbing Scale were more similar to responses of anxiety disorder patients than to major depressive disorder patients. Overall, the findings strongly support the clinical application of the Numbing Scale.