High Ammonia and Low pH in the Urine of the Ghost Crab, Ocypode quadrata.

Nitrogen excreted into the urine (<1 mM) has generally been considered a negligible component of total nitrogen output of crustaceans. But concentrations of ammonia >100 mM were found in the urine of laboratory-held Ocypode quadrata, suggesting that this notion might not be applicable to all crustaceans. To address this issue, hemolymph and urine were removed from freshly captured O. quadrata and analyzed for nitrogenous catabolites and major ions. Hemolymph composition was similar to that of other crustaceans, but the urine was acidic ({Xbar} pH = 5.50) and contained ammonia, often at >100 mM. Other nitrogenous catabolites in the urine (urea, amino acids, and uric acid) were much less concentrated: totaling <12 mM on average. The ionic composition of the urine was similar to that of other crustaceans, with the exception that Na was much less concentrated than Cl-. Total osmolality of hemolymph and urine was similar. The Na+/K+ ATPase activity was greater in the antennal glands than in the posterior gills of O. quadrata, suggesting that this enzyme is important for ammonia concentration and Na resorption. This pattern of enzyme activity was not present in two terrestrial brachyurans whose urine contains little ammonia. The evolutionary significance of high ammonia concentrations in the urine of ghost crabs is unclear.

The Transplant Evaluation Rating Scale. A revision of the psychosocial levels system for evaluating organ transplant candidates.

Psychosocial criteria play an important role in evaluating organ transplant candidates. The Transplant Evaluation Rating Scale (TERS) classifies patients' level of adjustment in 10 aspects of psychosocial functioning that are thought to be important in adjusting to transplantation. On the basis of pretransplant psychiatric consultations, 35 liver transplant recipients received retrospective TERS ratings. Results showed significant correlations between TERS scores and visual analogue scale ratings of five outcome variables at 1-3 years posttransplant. Significant interrater reliability was also found. The TERS represents a promising instrument for transplant candidate selection as well as a valuable tool for further research.

Recombinant human erythropoietin and renal anemia: molecular biology, clinical efficacy, and nervous system effects.

Anemia (hematocrit less than 25%) predictably accompanies chronic renal failure and is present in over 90% of patients on chronic dialysis. Relative erythropoietin deficiency is the proximate cause. Recombinant human erythropoietin recently became available for research and clinical use. Erythropoietin production is regulated by a single copy gene located on chromosome 7; its expression has been shown in the kidney, liver, and macrophages. It is glycosylated protein of 166 amino acids with a molecular weight of 34,000 D. When given to patients with the anemia of renal failure, erythropoietin causes a dose-dependent rise in hematocrit to the normal range within 8 to 14 weeks. Complications of this response are minimal except for a significant incidence of hypertension. When the anemia is corrected, the patient's quality of life, cognitive function, and brain electrophysiology improve dramatically. Recombinant human erythropoietin represents a major breakthrough in the treatment of patients with chronic renal failure. Current reimbursement constraints limit its full application.

Longitudinal change in HIV transmission risk behaviors by gay male physicians.

Gay male physicians were surveyed in 1984 and 1985 about their knowledge and attitudes regarding HIV transmission and AIDS and changes they had made in social, health-related, and sexual activities since the onset of the AIDS epidemic. Most of the 37 subjects who participated in both surveys progressively lessened their participation in HIV transmission risk behaviors over time. Health belief, AIDS knowledge, health coping, social support, mood state, and age factors all contributed to changes in sexual behavior. The modeling of sexual-behavior changes showed general stability over time. This study provides further evidence that multiple psychosocial factors are associated with changes in sexual behavior, even in gay male physicians.

Recombinant human erythropoietin treatment may improve quality of life and cognitive function in chronic hemodialysis patients.

Medical, psychological, and social adaptation (quality of life) as well as cognitive function were studied in 15 chronic stable hemodialysis patients before the onset of treatment with recombinant human erythropoietin (r-HuEPO), 1 month after stabilization of normal hematocrit levels, and 10 to 15 months after treatment onset. After r-HuEPO treatment, subjects had significantly higher hematocrits, markedly improved energy levels, and marginally improved global health. r-HuEPO treatment was also associated with progressively decreased levels of subject mood disturbance and dialysis-related stresses. Subjects had no increased participation in paid employment and only minimally increased participation in social and leisure activities at posttreatment data points. There was no significant improvement in cognitive function after treatment. r-HuEPO treatment appears to be associated with higher energy levels, significant psychological benefits, and minimal improvements in social adaptation. The effects on cognitive function merit further study.

The relationship between medical and psychological status in newly diagnosed gay men with AIDS.

We assessed current medical and psychological status in 50 homosexual/bisexual males who were within 3 months of the diagnosis of AIDS. Subjects had typically impaired cellular immunity, relatively well-maintained physical performance capacity, and reported surprisingly good current health status, in spite of significant numbers of medical symptoms. While as a group they reported moderate levels of psychological distress, intact self-esteem, and a high quality of life, a significant minority reported high psychological distress, low self-esteem, and low quality of life. Psychological distress was correlated with subjective, but not objective, measures of current health status.

Structured group intervention model for AIDS patients.

We have gathered and analyzed data on 50 gay men with AIDS before and after a ten-week structured group intervention aimed at reducing psychological distress and improving coping skills. Among the major findings have been information relating coping strategies to depression and anxiety, information about the support networks of people with AIDS, and the relationships between coping strategies, support networks and psychological mood states. We have also found that structured group interventions comprised of problem solving techniques, health education, relaxation training and emotional support are helpful in reducing anxiety and depression and in teaching people more positive ways of coping with their illness.

Relationship of dialysis modality and other factors to cognitive function in chronic dialysis patients.

To determine if dialysis modality may be an independent factor in the level of cognitive function in chronic dialysis patients, cognitive function was studied in 17 pairs of continuous ambulatory peritoneal dialysis (CAPD) and center hemodialysis (CHD) subjects matched for sex, age, diabetic status, and interval since dialysis onset. Data on current metabolic, medical, psychological, and vocational function status were obtained. Neuropsychological (NP) measures included the Number Cancellation Protocol (NCP), Trailmaking test forms A and B (TMT A, TMT B), Symbol Digit Modalities (SDM), and the Rey Auditory Verbal Learning Test (RAVLT). The CAPD subject group had consistently more efficient cognitive function than the CHD subject group. Regardless of modality, the groups of subjects under age 51 and those who were vocationally active had significantly better NP performance. No cognitive function differences were found in groups categorized by sex or duration of dialysis. Creatinine levels were more highly correlated with NP scores than were BUN levels, with higher creatinine levels associated with better cognitive function. Serum calcium, CO2, total protein, albumin, and SGOT levels also were correlated with NP scores. CAPD may be more effective than HD in reversing uremic encephalopathy by mechanisms mostly unrelated to serum creatinine and BUN levels. Longitudinal studies will be needed to determine if dialysis modality is an independent factor in the degree of reversal of uremic encephalopathy.

Quality of life in chronic dialysis patients. Factors unrelated to dialysis modality.

The quality of life (medical, psychological, and social adaptation) of 66 chronic dialysis patients was studied cross-sectionally. The participants had similar levels of medical, psychological, and social adaptation to those found in previous studies of chronic dialysis patients. Medical, psychological, and social adaptation are independent dimensions that are only weakly intercorrelated. When categorized by specific individual or treatment characteristics, men and those over age 51 had poorer medical and psychological adaptation than did women and younger dialysis patients. Duration of dialysis was not related to quality of life. Vocationally active as compared to vocationally inactive subjects had generally superior medical, psychological, and social adaptation. Male sex, age over 51, and vocational inactivity are all associated with poorer dialysis patient adaptation. The development of profiles of groups of dialysis patients at increased risk for poor adaptation may help in targetting scarce psychosocial intervention resources. Studies of the psychosocial efficacy of differing treatment modalities need to consider non--treatment-related factors that may affect patient psychosocial outcomes.

Quality of life in chronic dialysis patients: a critical comparison of continuous ambulatory peritoneal dialysis (CAPD) and hemodialysis.

Thirty-three matched pairs of chronic continuous ambulatory peritoneal dialysis (CAPD) and center hemodialysis (CHD) patients from three dialysis programs were studied cross-sectionally to assess their current medical, psychological, and social status. The CAPD and CHD groups were similar on matching and medical status variables. The CAPD subject group had a higher quality of life, lower illness and modality related stress scores, and nonsignificantly lower mood disturbance scores. The groups did not differ in self-esteem or health locus of control. CAPD subjects reported higher frequency of participation in community activities, better relationships with dialysis physicians and patients, and were more likely to be currently vocationally active. Dialysis modality likely exerts an independent effect on the quality of life of chronic dialysis patients, and CAPD is likely superior to CHD in this regard. Longitudinal studies are needed to determine the relative role of patient-selection and modality-related factors in determining the psychological and social adaptation (quality of life) of chronic dialysis patients.

Changes in AIDS risk behaviors among homosexual male physicians and university students.

Two samples of homosexual men, 64 physicians and 58 university students, reported profound decreases in several sexual practices linked to transmission of acquired immune deficiency syndrome (AIDS). The physicians showed the greater reduction. When sociodemographic variables, health beliefs, feeling of control over outcome, mood, sexual interest before the AIDS epidemic, and medical care utilization were correlated with decrease and/or increase in AIDS risk behaviors, the clusters of variables most strongly correlated with change in risk behaviors differed between the physicians and students. Interventions designed to change behaviors in AIDS high-risk groups should be tailored for specific subgroups.

Illness concerns, attitudes towards homosexuality, and social support in gay men with AIDS.

High levels of illness-related psychologic distress, marked social stigmatization and loss of social support, and negative internalized feelings towards homosexuality have previously been reported in homosexual men with the diagnosis of acquired immune deficiency syndrome (AIDS). We assessed 50 homosexual or bisexual men who were within 3 months of their AIDS diagnosis with respect to medical status, illness concerns, attitudes towards homosexuality, and social support. Subjects reported levels of illness-related concerns comparable to previously studied cancer patients. Their attitudes towards homosexuality were similar to previously studied healthy homosexual males. Their social support needs were variable, as was their satisfaction with specific types of social support. Their social networks were moderately small. In this AIDS subject group, illness concerns, attitudes toward homosexuality, and social support satisfaction were significantly correlated with each other, and with previously reported levels of psychologic distress and subjective (but not objective) measures of health status.

Psychosocial aspects of acquired immune deficiency syndrome and the primary care physician.

Acquired immune deficiency syndrome is now an epidemic in the United States. Multiple factors contribute to the high degree of psychosocial stress experienced by those with HTLV-III infection, regardless of their current clinical status. Family members, friends, and health care professionals all often experience significant stresses associated with HTLV-III infection or AIDS-spectrum illness in the patient. Knowledge about the psychosocial consequences of cancer, of the unique psychosocial stresses experienced by individuals with AIDS-spectrum illness, and of the functional psychiatric syndromes and organic mental disorders common to AIDS can assist the primary care physician as he cares for individuals with HTLV-III infection and AIDS-spectrum illness.

Adaptation of adult bone marrow transplant recipient long-term survivors.

Although there is a small literature on psychosocial and psychiatric aspects of bone marrow transplants (BMT) in adult recipients during the BMT hospitalization phase, adaptation of long-term adult BMT recipient survivors has received little study. This study surveyed the adaptation of BMT recipient survivors over age 17 who were an average of 42 months posttransplant. Study variables included the recipients' current self-reported health status, mood state, social role function, self esteem, life satisfaction, and relationships with their BMT donors and other family members. A companion study of those who donated BMT to the recipients eligible for this study was also performed. The study participants were preponderantly young adults who currently were in an intimate relationship and vocationally active. About 1/4 of the subjects reported ongoing medical problems. Also, 15-25% reported significant emotional distress, low self-esteem, and less-than-optimal life satisfaction. The subjects' current quality of relationship with their donors was highly correlated with many measures of their psychosocial status. The findings indicate that about 75% of BMT recipient long-term survivors are doing well from a psychosocial as well as a medical standpoint, that the recipient-donor relationship may be sensitive to any changes in the recipient's status, and that 15-20% of BMT recipient survivors report a degree of psychological distress that might benefit from specific psychological/psychiatric intervention.