Changing patterns of neurological mortality in the 10 major developed countries--1979-2010.

OBJECTIVES: To examine whether there is a continued increase in neurological deaths in the major developed countries over the period 1979-2010. STUDY DESIGN: Analyzes changing patterns of neurological deaths and Total Mortality of people aged 55-74 years by sex. METHODS: Baseline WHO 3-year average mortality for 1979-81 were compared with changes in 2008-10, for Total Mortality and the neurological categories Nervous Disease, and Alzheimer & other Dementias deaths in rates per million. To control for different diagnostic practice, the focus is upon Total Neurological Deaths in relation to Total Mortality and Odds ratios are calculated. UK Motor Neuron Disease, Parkinson's disease and variant CJD are explored as possible constituent categories of Nervous Disease for other countries. RESULTS: Total Mortality fell substantially in every country, conversely, Nervous Disease and Alzheimer's rose in seven and six countries respectively. Total Neurological Deaths for males and females increased significantly in Australia, Canada, England & Wales, Italy, the Netherlands and especially the USA. Unlike motor neurone disease, variant CJD' deaths in England and Wales did not contribute substantially to the overall neurological increases found. Odds ratios indicated that neurological deaths differentially increased significantly in every country compared to Total Mortality. CONCLUSIONS: These results pose a major public health problem, as the epigenetic contribution to these changes, rather than longevity, have serious implications indicating earlier onset of neurological morbidity pressurizing families, health and social care services, with resource implications especially for Australia, Canada, Italy, Netherlands, Spain, the UK and the USA.

Extinction of care-induced vocalizations by a desensitization routine on a palliative care unit.

Vocalizations during care occur frequently in patients with dementia, and are not uncommon in the palliative setting. Underlying trigger factors may include pain during movement, fear of being turned, startle reflex, attempts at verbal communication, environmental factors such as cold water, and other possible etiologies. A case of a 92 year old female who screamed and called out during bathing is presented. This patient with comorbid dementia and brain lesions did not respond to pre-event pain medication, and became somnolent due to opioid administration for presumed incident pain. A non-pharmacological approach, with a patient-centered focus rather than task orientation, succeeded in extinguishing the vocalizations after a period of six weeks.

Changing patterns of adult (45-74 years) neurological deaths in the major Western world countries 1979-1997.

OBJECTIVES: To compare changes in 'adult' (45-74 years) 'all-cause deaths' (ACDs) with all neurological death categories by age and gender in the 10 major Western countries between the 1970s (1979-1981) and the 1990s (1995-1997). METHOD: World Health Organization standardized mortality data for age and gender (1979/97) were used to examine changes in adult mortality rates per million based upon ICD-9 categories for ACDs, 'neurological deaths' and the special neurological categories of 'other neurological deaths' (ONDs) and 'mental disorder deaths' (MDDs), which include the dementias. Ratios of ratios were calculated to demonstrate how each individual country's pattern changed over the period by age and gender, resolving the problem of cross-national comparisons. Rates of change across the endpoints and between age groups (45-54, 55-64, 65-74 and 75+ years) were examined using analysis of variance, stepwise regression analysis and cross-tabulation analyses. RESULTS: Meningitis deaths fell substantially, but there was little change in multiple sclerosis or epilepsy deaths. OND rates for the 1990s increased compared with the 1970s rates for males and female, in actual terms and relative to ACDs for almost all countries. Many of the relative rates of increase were substantially higher than 20%. There were significant statistical differences with respect to relative rates of ONDs between the 1970s and the 1990s data, even when the 75+ years age group was excluded. Significant differences were also found between age groups, but only in the 1990s data. MDD rates showed similar trends. Analyses of actual rates of increase in these causes of death showed that males outnumber females in all ages below 74 years. The extent of this difference remained constant across the endpoints. However, in those aged 75 years and over, females outnumbered males at both endpoints, but this disparity widened significantly in the 1990s data. CONCLUSIONS: The 1990s data indicate substantial increases compared with the 1970s data for ONDs (especially amongst 65-74 year olds), and rises in MDDs in 55-64 year olds in five countries, including England and Wales and Germany, and in 65-74 year olds in most countries, suggesting earlier onsets of the underlying conditions. Further country-specific research is required to explain the emerging morbidity and mortality.

Existential loneliness: a review of the concept, its psychosocial precipitants and psychotherapeutic implications for HIV-infected women.

While many of the most urgent psychological issues that women with HIV infection are forced to deal with are existential in nature, and therefore shared by humankind, the assault on their physical and psychological being may trigger these issues in large amounts and may overwhelm their defensive structure. Existential loneliness may be an important existential issue that arises for these women and needs to be given equal consideration alongside other forms of loneliness. In this paper, we review the concept of existential loneliness, discuss methods to measure the concept, delineate some central psychosocial precipitants of existential loneliness among HIV-infected women, and discuss psychotherapeutic implications. We conclude that incorporating an existential philosophical perspective into one's particular therapeutic stance may be especially appropriate with this population.

The manifestation and management of staff countertransference on a pediatric AIDS team.

The authors discuss the countertransference reactions that arise in staff who work in a hospital outpatient clinic with children with HIV and AIDS. Countertransference feelings such as guilt, anger, and helplessness can be easily aroused when working with a young, impoverished, dying population. Factors that precipitate these feelings and their manifestations are discussed, as well as the antitherapeutic effects of acting on one's countertransference. Psychodynamic explanations are offered for some of the more salient countertransference reactions. Finally, suggestions are made for management of countertransference, such as strong team leadership, ongoing support groups, and redefinition of therapeutic objectives.

Introducing physicians to case management in psychiatry.

All physicians sooner or later find themselves in contact with a case manager whose job is to help the noninstitutionalized psychiatric patient who is chronically ill. This paper is an attempt to orient the physician about this phase of treatment which started not many years ago. The article gives a short history of the development of case management and demonstrates the various steps the case manager takes in working with a patient. These are, assessment of the problems, plans to meet the problems, linkage with agencies, monitoring the progress, advocacy, and evaluation. These activities may bring about improvement in the kind of patient frequently considered hopeless.

A parental support group in a pediatric AIDS clinic: its usefulness and limitations.

This article describes a support group for parents and caretakers of children being treated for human immunodeficiency virus (HIV) infection in a hospital outpatient clinic. Issues involved in the establishment of the group are discussed, including the population, the setting, the choice of group modality, planning of the group, and recruitment and composition of the group. Predominant group themes included guilt, fear, anger, and loss of control. Specific issues raised included deterioration in the child's condition, myths about HIV transmission, and coping with death. Therapeutic interventions by leaders and group members are described. The need to use alternate models of support groups and to allow departures from standard group techniques in this context is emphasized.

Psychosocial aspects of AIDS in children and adolescents.

The first part of this article addresses the neuropsychiatric aspects of human immunodeficiency virus (HIV) infection in children and adolescents, including developmental delay, depression, and dementia. The specific clinical issues of disclosure of diagnosis and discussion of death with a child are examined. The second part presents aspects of the impact of AIDS on families, approaches to HIV antibody testing, and therapeutic interventions for the family.

Use of photorefractive fiber in optical interconnections and switching.

Various uses of photorefractive fiber in optical interconnections and electrooptical switching in terms of phase conjugate hologram technique are proposed.

Reconfigurable interconnections using photorefractive holograms.

Using coupled wave theory and the law of refraction, diffraction properties of volume holograms are discussed. Reconfigurable interconnections by either wavelength tuning or spatial division techniques are proposed. Reflection type volume holograms can be used for a large number of reconfigurable interconnections in terms of finite wavelength tunability. Transmission volume holograms encoded in pinhole holograms can be easily reconfigured by spatial light modulator. Experimental demonstrations obtained by using these methods are presented.

Phase measurement of a Fourier spectrum by a fringe-scanning phase-conjugate interferometer.

We present a novel method for obtaining the phase distribution of an object spectrum by using a fringe-scanning phase-conjugate interferometer. A detailed analysis of the proposed technique is provided, and experimental demonstrations for validating this technique are also given. The major advantages of this method are its potentially high accuracy and its low space-bandwidth-product requirement for the detection system.