Role of spirituality in patients with sickle cell disease.

BACKGROUND: Patients with sickle cell disease cope with their disease in various ways, such as psychological counseling, hypnosis, medication, and prayer. Spirituality is a coping mechanism in a variety of diseases. This study evaluates the role of spirituality in patients coping with the pain of sickle cell disease. METHODS: Seventy-one patients from the Georgia Sickle Cell Clinic completed a questionnaire addressing their ability to cope with the pain of sickle cell disease and their degree of spirituality. A descriptive cross-sectional design was used. Correlation and multiple regression analyses were calculated for the relation between coping with the pain of sickle cell disease and spirituality. RESULTS: The questionnaire provided several scales with high internal consistency for measuring spiritual well-being and its two components, existential well-being and religious well-being, that show a correlation between high levels of spirituality and life control. The study population exhibited high levels of spirituality and religiosity, but the influence of these feelings on coping with sickle cell disease was variable. Spiritual well-being was correlated with life-control but not with perceived pain severity. CONCLUSIONS: Existential well-being was associated with general coping ability. Spiritual well-being is important for some patients who must cope with the pain of sickle cell disease.

Is interruption in residency training associated with a change in in-training examination scores?

BACKGROUND: Many military physicians interrupt their training to serve in the position of general medical officer (GMO) after completing their first year of postgraduate medical education. This study compares American Board of Family Practice In-training Examination (ITE) scores of military family practice residents who received continuous training (CFP residents) with those who did GMO tours (GMO residents). METHODS: Historical cohorts of CFP and GMO residents from Army and Navy family practice residencies were compared. The dependent measures were their ITE scores in each year of training. Paired data were analyzed using the Student's test. RESULTS: There were no significant differences in composite or clinical problem set scores between GMO and CFP resident groups. Power to detect a true difference between the groups was 74. CONCLUSIONS: Interruption in residency training is not associated with a significant change in the returning resident's ITE scores.

Orbital lymphoma associated with acquired immune deficiency syndrome (AIDS).

A new case of AIDS-associated, small noncleaved cell (Burkitt's) lymphoma that presented as an orbital mass is described. Extraocular muscle involvement was documented by computed tomography and confirmed by orbital biopsy. Extensive abdominal involvement was subsequently diagnosed and this caused the patient's death only 15 days after the initial consultation and orbital biopsy. A literature review discloses only eight previous case reports of AIDS-associated non-Hodgkin's lymphoma (NHL) involving the orbit: two cases of Burkitt's type and six cases of large cell immunoblastic type. Three additional cases of orbital NHL can be found among larger series of AIDS cases. Affected patients are uniformly young adult males with a history of homosexuality and/or IV drug abuse. Variations in clinical presentation are discussed. Although the morphology of the histopathologic specimen in our case was consistent with a high-grade, small noncleaved cell NHL, flow cytometry revealed an atypical immunophenotype for Burkitt's lymphoma in that CD20 and immunoglobulin light chain antigens were not expressed. Morphologic classification and immunophenotypic characteristics of AIDS-associated NHLs are discussed.

The impact of the daily lottery on the numbers game: Does legalization make a difference?

There has been a profusion of state run legal lotteries over the last two decades. One justification for them has been their supposed diversion of funds from illegal games known as numbers, policy and bolita. Records obtained in a police raid in south Florida provided an opportunity to analyze the impact of Florida' legal lottery on its illegal counterpart. The records ranged over a 13 week period encompassing five weeks prior to the inception of Florida's legal daily numbers and lotto games and seven weeks afterward. While there was a 17 percent decline in monies wagered on the illegal games during the first week of the legal games, illegal wagers quickly rebounded to prelegalization levels.

Perceived environmental drug use risk and the correlates of early drug use or nonuse among inner-city youths: the motivated actor.

The extent to which youth perceive their neighborhood to be at risk was found to be directly related to a series of life-style and drug use context variables. Further, the extent of drug use (nonuse, only alcohol, both alcohol and marijuana) was directly related to two of these variables, but inversely related to the extent their friends used "hard" drugs. These results indicate the critical importance of incorporating a measure of perceived risk into drug studies of adolescents, and highlight the need to view youth as motivated actors, guiding their own behavior in an attempt to actualize self-defined values. This is in direct contrast to most theoretical perspectives which regard this age group as merely responding to powerful external influences.

The effect of perceived neighborhood setting on self-reported tobacco, alcohol, and marijuana use among inner-city minority junior high school youth.

The relationship between neighborhood setting and drug use appears to be drug specific. For alcohol and tobacco a knowledge of peer (friends') use was highly predictive of personal use, independent of how tough or drug involved the neighborhood was thought to be, but quite dependent on neighborhood perceptions for personal marijuana use, becoming more predictive as the neighborhood was perceived as tougher and more drug involved. Knowledge of spare-time activities was predictive of tobacco and marijuana use (independent of neighborhood) but not predictive for alcohol use. The data suggest that because the relationships are complex, intervention/prevention strategies must not only be drug specific but must proceed on many fronts simultaneously. Some suggestions are offered, along with a discussion of findings which may help identify non-users and users in the same population.

The effect of pregnancy on idiopathic scoliosis.

To study the effect of pregnancy on idiopathic scoliosis, ten patients were followed through nineteen pregnancies. Three patients lost 2, 6, and 18 degrees of correction during their initial pregnancies, but the curves remained the same or improved with later pregnancies. The curves of the remaining seven patients, which had stabilized before conception, did not progress. The stability of the scoliosis was not related to the age of the patient. Stable scoliotic curves did not progress with pregnancy in patients in the second decade of life, while unstable scolioses progressed in patients as old as the third decade. The amount that the curve increased was not associated with the initial size of the curve. We hope that our experience will aid orthopaedists in counseling their patients regarding the effect of pregnancy on the magnitude of scoliosis.

Acute myocardial infarction after fluorescein angiography.

A 68-year-old man with a history of previous myocardial infarction and peripheral vascular disease had an acute myocardial infarction 30 minutes after the injection of intravenous fluorescein for fundus angiography. The situational stress or phenylephrine dilating drops could have contributed to the complication.

Epiphyseal stapling for angular deformity at the knee.

Fifty six patients with angular deformities of eighty-two knees were treated with epiphyseal stapling between 1954 and 1973 and followed until maturity. There were sixty-four knock-knees and eighteen bowlegs. In twelve patients with concurrent leg-length discrepancies, long legs were stapled asymmetrically. The deformities were allowed to overcorrect before the staples were removed, but the rebound phenomenon occurred in twenty-two patients with thirty-five deformities. In older children the staples were taken out when the legs looked straight. Exaggerated physiological deformities may correct spontaneously. They should not be stapled before the skeletal age of eleven in girls and twelve in boys. Secondary deformities are corrected earlier. There were no significant complications. Ten revisions of staples were necessary because of extrusion or shifting. The results were satisfactory or improved in 87 per cent of the deformities. When it is indicated epiphyseal stapling is a safe and effective method of correcting angular deformity at the knee in growing children.

Milwaukee brace treatment of idiopathic scoliosis: late results.

Forty-seven patients returned for examination, X-ray and statistical analysis of the results more than 5 years after Milwaukee braces had been discontinued. The mean curves showed a characteristic pattern of rapid improvement after the brace was applied and then gradual loss of correction during the follow-up. There was no statistically significant variation when the results were analyzed according to initial age, initial curve size, or curve pattern. One-third of the patients lost 5 degrees or less after their braces were discontinued at skeletal age 18. The other two-thirds progressed, with the loss of a degree or two a year until their improvement stabilized in the mid or late twenties. More flexible curves stabilized later and lost more correction. Although the mean overall improvement was only slightly more than 3 degrees there was a range from a gain of 40 degrees to a loss of 26 degrees. The 2 most important findings were the tremendous variation in the age at which stabilization or correction occurred and the variability of end results.