Distribution of HLA DQA.1 alleles in New Zealand Caucasian, Maori and Pacific Islander populations. Comparison with other population studies.

Allele and genotype frequencies for the HLA DQA.1 locus were determined for 127 unrelated Caucasians, 177 unrelated Maori and 98 unrelated Pacific Islanders from the New Zealand population. DNA from blood cells was analysed by polymerase chain reaction amplification of DNA followed by hybridization to allele specific oligonucleotide probes in a reverse dot-blot test. Allele frequencies at the HLA DQA.1 locus for New Zealand Caucasians, Maori and Pacific Islanders were compared with published data for other populations. The distribution of HLA DQA.1 genotype frequencies did not deviate from Hardy Weinberg expectations for the Caucasian and Maori populations. The power of discrimination was 0.93 for Caucasians and 0.86 for Maori. The total Pacific Islander population tested was analysed as was data obtained from Western Polynesians contained within that larger group. Both the total Pacific Islander group analysed, and the Western Polynesians contained within that larger group, failed Hardy Weinberg expectations for the distribution of HLA DQA.1 genotypes. This significant deviation was due to excess homozygotes. The power of discrimination for the total Pacific Islander group and for Western Polynesians was 0.86 and 0.85 respectively. Comparison of Caucasian population studies from New Zealand, the United Kingdom, South Australia, Norway, the United States and Sweden showed these populations have similar HLA DQA.1 allele frequency distributions. Maori and Pacific Islanders have HLA DQA.1 allele frequency distributions that are more similar to each other than any of the other populations studied.

Child abuse as an antecedent of multiple personality disorder.

Until recently, few cases of multiple personality disorder were diagnosed in children. Today, the number of cases is increasing at an alarming rate and appears to be most closely associated with repeated sexual and physical abuse. This paper focuses on reports of childhood multiple personality disorder in the literature, the etiology of this disorder, family dynamics, the differences between childhood and adult multiple personality disorder, credibility problems in children, reasons for failure to diagnose multiple personality disorder in children, treatment, and signs and symptoms to look for in the clinical setting.

A method for evaluating field triage criteria.

The primary goal of triage is to identify the majority of field trauma victims at risk for life-threatening injuries. When triage criteria are made sufficiently sensitive to accomplish this goal, high rates of overtriage occur. Orange County's original physiologic criteria were associated with an overtriage rate of 18-40% depending on the definition of a major trauma victim. During the first year's experience with the original physiologic criteria, 21% of non-CNS motor vehicle trauma deaths occurred in nondesignated hospitals. When the criteria were made more sensitive by adding non-time dependent triage criteria such as anatomic and mechanism of injury criteria, deaths in nondesignated hospitals dropped to 4.4%, but the rate of overtriage doubled. Despite this apparent high rate of overtriage, only 5.5% of all paramedic transports were for patients judged to have met field triage criteria. Based on this experience, an approach is suggested for evaluating the balance between over- and undertriage that occurs for a given set of triage criteria. Once this balance has been defined, triage guidelines can be modified to meet regional triage objectives.