Family routines and rituals--The importance of family functioning: Comment on the special section.

This diverse collection of papers highlights routines and rituals in family life. Just as individual family members bring unique styles and perspectives to the family table, to be incorporated into a family framework, so do each of these papers present rich and varied research questions, designs, and measurement strategies that enrich our understanding of family routine behavior patterns and ritual meanings. This series adds to our conceptualization of family routines and rituals within a systems perspective highlighting: 1) families are comprised of multiple levels that operate individually; interact with each other; and as a whole, reveal properties distinct from separate parts; 2) families tend toward stability in meaningful patterns of functioning; and 3) family functioning has meaning for individual outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relevance of axonal swellings and atrophy to gamma-diketone neurotoxicity: a forum position paper

Traditionally, gamma-diketone neuropathy is classified as a distal axonopathy and has been characterized by giant axonal swellings in CNS and PNS tissues. These swellings contain neurofilamentous masses and are associated with thinning and retraction of the myelin sheath. It has been proposed that this axonopathy is caused by direct gamma-diketone modification of neurofilaments (NFs) involving pyrrolation of epsilon-amino groups on NF lysyl residues and possibly secondary autoxidation of the pyrrole rings with creation of covalent NF-NF crosslinks. Neurofilaments are thought to undergo chemical modification as they progress along the axonal axis and, eventually, accumulate at distal nodes of Ranvier where their proximodistal movement is impeded. Development of swelling presumably initiates axonal degeneration and subsequent functional deficits. However, other research suggests that axonal swellings are a non-specific effect related to subchronic gamma-diketone exposure. Such evidence draws into question the mechanistic relevance of these swellings. In contrast, research conducted over the past decade indicates axonal atrophy is a specific morphologic component of gamma-diketone neuropathy which might have both functional and mechanistic importance. In this overview, the potential neurotoxicological significance of both axonal swellings and atrophy are evaluated critically. Based on the evidence to be presented, we propose that axonal atrophy is the morphological consequence of the molecular mechanism of gamma-diketone neuropathy. Accordingly, several mechanistic scenarios related to the development of atrophy will be discussed. It is hoped that this Forum will stimulate scientific debate and initiate laboratory investigations which will either confirm or refute the involvement of axonal atrophy in gamma-diketone neurotoxicity. Investigating gamma-diketone atrophy might provide insight into the mechanism of other toxic axonopathies which are also associated with reduced axon caliber; e.g., acrylamide and carbon disulfide neuropathies.     

The importance of GLU361 position in the reaction catalyzed by cholesterol oxidase

Cholesterol oxidase stereospecifically isomerizes cholest-5-en-3-one to cholest-4-en-3-one. When the base catalyst for isomerization, Glu361, is mutated to Asp, the rate of deprotonation of cholest-5-en-3-one is not affected, but protonation of the dienolic intermediate becomes rate-limiting. This may be a consequence of the large distance between the catalytic base and carbon-6 of the intermediate in the mutant enzyme.     

The position of internal medicine in Europe. Report from a meeting of the presidents of European internal medicine societies

A series of 48 cases of malignant mucosal melanomas treated at the Milan Cancer Institute from 1975 to 1990 is retrospectively reviewed. There were 34 males and 14 females, and their ages ranged from 21 to 79 years (mean, 58). The site of origin of the tumor was the nasal cavity in 26 cases, the oral cavity in 15, larynx in two, lip mucosa in two, pharynx in two and upper esophagus in one. At presentation, the neoplasm was limited to the primary site in 60.4% of the patients. Most patients (34) were treated with surgery alone. Nine were treated with surgery combined with chemo- and/or radiotherapy and five with radiotherapy combined with chemotherapy and/or immunotherapy. Only when surgery was part of the treatment (42 of 48 cases) the patients were rendered disease free, but no further relapse of disease was documented in only five of these patients. The observed 2- and 5-year survival rate of the entire group was 45% and 21%, respectively. The 4-year disease-free survival rate was 7%. The median interval between therapy and the first relapse was 8.5 months (range, 1-66). In 44% of the patients the first recurrence of the tumor was at the primary site.     

The impact on patient satisfaction of the introduction of family medicine residents into a model practice facility

This study examines the effects on patient satisfaction of the introduction of family medicine residents into the staff of an ongoing private practice that joined a Department of Family Medicine. Questionnaires were administered to clinic patients during a four-week period four months prior to when residents began seeing patients at the clinic and again five months after residents joined the clinic staff. Satisfaction at both times was high; however, significant declines from Time 1 to Time 2 were noted on most items. Analysis showed that this decline was not related to dissatisfaction within the residents. A questionnaire was also mailed to a sample of patients who had not visited the clinic more than once during the first year of the resident program there. Three fourths of these individuals still viewed themselves as patients of the clinic. Implications of these findings for family medicine residency training programs are discussed.     

Family systems and alcohol misuse: Research on the effects of alcoholism on family functioning and effective family interventions.

This article reviews the most prominent research at the interface between studies of alcohol addiction and family systems psychology. The review addresses the general effects of alcohol misuse on family functioning as determined in empirical studies comparing healthy families, alcohol afflicted families, and otherwise troubled families. Three factors ("dry" vs "wet" families, family development and the progression of alcoholism, and family structure) are identified as particularly relevant to understanding the treatment needs of families affected by alcohol misuse. Research examining the general efficacy of family interventions in the treatment of alcoholism and specific treatment considerations unique to treating families coping with alcohol misuse are reviewed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Enteral nutrition in intensive care patients: a practical approach. Working Group on Nutrition and Metabolism, ESICM. European Society of Intensive Care Medicine

Severe protein-calorie malnutrition is a major problem in many intensive care (ICU) patients, due to the increased catabolic state often associated with acute severe illness and the frequent presence of prior chronic wasting conditions. Nutritional support is thus an important part of the management of these patients. Over the years, enteral nutrition (EN) has gained considerable popularity, due to its favorable effects on the digestive tract and its lower cost and rate of complications compared to parenteral nutrition. However, clinicians caring for ICU patients are often faced with contradictory data and difficult decisions when having to determine the optimal timing and modalities of EN administration, estimation of patient requirements, and choice of formulas. The purpose of this paper is to provide practical guidelines on these various aspects of enteral nutritional support, based on presently available evidence.     

The effect of a course in family medicine on future career choice: a long-range follow-up of a controlled experiment in medical education

The career choices and professional behavior of three cohorts of students who participated in a family medicine program were studied by mail questionnaire. Cohort I (1957--1960), as part of an educational experiment, had been randomly assigned to the course; unselected classmates were used as controls. Cohort II (1961--1965) and Cohort III (1966--1970) were volunteers; alphabetically adjacent classmates were used as a comparison group. The results suggest that the impact of a given medical school course on future behavior must be evaluated in the context of general medical school orientation and societal trends extraneous to the school itself.     

Value importance as a moderator of the value fulfillment–job satisfaction relationship: Group differences.

Short forms of the Minnesota Satisfaction Questionnaire and the Work Values Inventory were used to measure intrinsic and extrinsic facets of job satisfaction and dimensions of value fulfillment and importance in 264 Ss in 3 groups: state employees, bank employees, and US Navy cadets. Moderated regression techniques did not support a fulfillment–importance interaction effect in 1 organization, found inconsistent effects in another, and obtained strong, consistent effects in the third. Differences among the organizations are discussed, and it is proposed that control over value fulfillment and anticipated impact of fulfillment on future outcomes might be joint moderators, along with value importance, of the fulfillment–satisfaction relationship. (38 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Joint Committee on Aviation Pathology: XII. Sarcoidosis: a review of some features of importance in aviation medicine

Sarcoidosis is defined in terms of its histology and natural history. Emphasis is placed upon its insidious nature and potentially pronounced pathophysiological effects. The use of lung function studies as an index of disability in the three described phases is discussed. Though we have only found the disease coincidentally in aircraft accidents, stress is placed upon the need for careful monitoring of affected aircrew and the necessity for respiratory function tests.