Contribution of PTSD/POW history to behavioral disturbances in dementia.

As many World War II and Korean Conflict veterans suffering from posttraumatic stress disorder (PTSD) grow older, increasing numbers will be diagnosed with dementia. We retrospectively analyzed patients with dementia, comparing the behavioral disturbances of those with PTSD to those without PTSD. We hypothesized that due to the additive effect of the neurobiological and behavioral changes associated with PTSD and dementia, the dementia with PTSD group would show more agitation and disinhibition than the dementia without PTSD group. Sixteen patients with diagnoses of dementia and PTSD were matched on age and Mini-Mental States Examination (MMSE) scores to 16 patients with dementia without PTSD. Demographic characteristics, co-morbid diagnoses, global Assessment of Functioning (GAF), Cohen-Mansfield Agitation Inventory (CMAI), and paranoid items of Brief Psychiatric Rating Scale (BPRS) and Positive and Negative Syndrome Scale for Schizophrenia (PANSS) were assessed. The patients with diagnoses of dementia with PTSD did not differ significantly in their clinical presentation, hospital course, and condition at discharge from patients with dementia without PTSD. Chi-square analysis showed that significantly more subjects in the PTSD group were prescribed anti-depressants compared to the non-PTSD group. Interestingly, within the PTSD group, the subgroup of patients who were former prisoners of war had a significantly higher mean score for paranoia and significantly less verbal agitation. This pilot study reveals that a diagnosis of PTSD alone is not sufficient to influence behavior in veterans with dementia; however, we also present provocative results that patients with more severe trauma (POW) do have changes in their behavior.

Outcomes of decreased length of hospital stay among geriatric patients with dementia.

This study examined the outcomes associated with shortening hospital stays for geriatric inpatients with dementia at a Veterans Administration medical center. Thirty-three patients who were admitted after January 1997, when the hospital decided to reduce patients' lengths of stay, were matched with 33 patients who were admitted before January 1997. Despite significant differences in lengths of stay, no differences were found between the groups on measures of agitation or overall functioning. Despite significantly shorter stays since January 1997, the results of our study indicate that the cognitive and emotional status of patients discharged since that time are equivalent to those of patients discharged after longer hospital stays.

Community-based plan for treating human immunodeficiency virus-infected individuals sponsored by local medical societies and an acquired immunodeficiency syndrome service organization.

Individuals infected with human immunodeficiency virus frequently experience difficulty finding medical care from private physicians. Fear of occupational exposure, prejudice, lack of knowledge, and financial loss have all been cited as reasons for the reluctance of primary care physicians to accept patients with acquired immunodeficiency syndrome into their practices. To meet the medical needs of all patients infected with human immunodeficiency virus, this Virginia community adopted a voluntary rotational referral plan to provide primary care for all such individuals. The program required the cooperation of a voluntary pool of internists and family practitioners and an acquired immunodeficiency syndrome service organization with a volunteer physician advisor to coordinate referrals of unassigned patients. No physician received more than three referrals per year. During the 2 years of operation, 118 referrals were made to 30 physicians. Regular educational seminars were provided with medical updates and consultation support was provided. This locally based program appears to be meeting the acquired immunodeficiency syndrome challenge in this community and may have applicability to other communities as well.

Regiospecific dechlorination of pentachlorophenol by dichlorophenol-adapted microorganisms in freshwater, anaerobic sediment slurries.

The reductive dechlorination of pentachlorophenol (PCP) was investigated in anaerobic sediments that contained nonadapted or 2,4- or 3,4-dichlorophenol (DCP)-adapted microbial communities. Adaptation of sediment communities increased the rate of conversion of 2,4- or 3,4-DCP to monochlorophenols (CPs) and eliminated the lag phase before dechlorination was observed. Both 2,4- and 3,4-DCP-adapted sediment communities dechlorinated the six DCP isomers to CPs. The specificity of chlorine removal from the DCP isomers indicated a preference for ortho-chlorine removal by 2,4-DCP-adapted sediment communities and for para-chlorine removal by 3,4-DCP-adapted sediment communities. Sediment slurries containing nonadapted microbial communities either did not dechlorinate PCP or did so following a lag phase of at least 40 days. Sediment communities adapted to dechlorinate 2,4- or 3,4-DCP dechlorinated PCP without an initial lag phase. The 2,4-DCP-adapted communities initially removed the ortho-chlorine from PCP, whereas the 3,4-DCP-adapted communities initially removed the para-chlorine from PCP. A 1:1 mixture of the adapted sediment communities also dechlorinated PCP without a lag phase. Dechlorination by the mixture was regiospecific, following a para greater than ortho greater than meta order of chlorine removal. Intermediate products of degradation, 2,3,5,6-tetrachlorophenol, 2,3,5-trichlorophenol, 3,5-DCP, 3-CP, and phenol, were identified by a combination of cochromatography (high-pressure liquid chromatography) with standards and gas chromatography-mass spectrometry.

Reductive dechlorination of dichlorophenols by nonadapted and adapted microbial communities in pond sediments.

Fresh and dichlorophenol (DCP)-adapted sediments from two ponds near Athens, Georgia exhibited distinctly different dechlorinating activities. These differences centered on the relative rates of reductive dehlorination in both fresh and adapted sediments and on the substrate specificity of the adapted sediments. Fresh Cherokee Trailer Park Pond sediment dechlorinated 2,3-, 2,4-, and 2,6-DCP to monochlorophenols at a faster rate and after a shorter lag period than fresh Bolton's Pond sediment. Lag periods were not observed in either Cherokee or Bolton's sediments that had been adapted to dechlorinate either 2,3-, 2,4-or 2,6-DCP. Adapted Cherokee sediments exhibited faster dechlorinating rates and a broader substrate specificity than the adapted Bolton's sediments. The broad substrate specificity of each of the adapted Cherokee sediments contrasted sharply with the narrow specificity of the 2,6-DCP-adapted Bolton's sediment. The preference for reductive dechlorination wasortho>meta orpara in sediments from both ponds.