The atrial switch procedure dramatically improved the prognosis of children with complete transposition of the great arteries (TGA). Overall actuarial survival was approximately 75% after 25 years and was better in patients with simple TGA than in those with complex TGA. Mortality by any cause (16%) and cardiovascular mortality (12% and 13%) were comparable in both centers. Progressive congestive heart failure and sudden death were the principal modes of death. Most of the survivors denied any symptoms or had mild limitations in their daily activities. However, long-term problems in this growing population of adults are challenging and include late arrhythmias (up to two thirds of the patients), systemic ventricular (SV) failure, systemic atrioventricular valve regurgitation and reoperations, such as baffle reconstruction, being the most frequent. Objective assessment of SV function obtained by echocardiography is difficult. It may include fractional area change and tricuspid annular motion. Survivors after an atrial switch procedure are unique and have a good quality of life. However, the definitive and true history of the RV supporting the systemic circulation is not as yet known.
Most of the data on psychological outcome and the mental health treatment available following natural disasters originate from the indigenous population of the region destroyed. Examining tourists returning from the area affected by the 2004 tsunami presents an opportunity of studying the impact of natural disasters on psychological outcome and mental health treatment in their countries of origin. The aim of the present study was to extend the current knowledge on psychiatric morbidity and potential positive outcomes, as well as subsequent mental health treatment following a natural disaster, based on the results from a sample of home-coming Swiss tourists.
Tourists who had been potentially affected by the 2004 tsunami were assessed using the Post-traumatic Diagnostic Scale, the Hospital Anxiety and Depression Scale, and the Post-traumatic Growth Inventory. Outcome variables were related to the degree of tsunami exposure. In addition, mental health treatment before and after the tsunami was assessed.
Of the 342 respondents, 55 (16.8%) fulfilled the criteria of post-traumatic stress disorder (PTSD). Evidence of anxiety or depressive disorder was found in 17.8% and 8.0%, respectively. The tsunami victims who had been directly affected showed significantly more symptoms of anxiety, depression and PTSD, as well as post-traumatic personal growth, than tourists who were indirectly affected or unaffected. A total of 12.3% of untreated respondents fulfilled the criteria for PTSD and 38% of respondents who had received psychiatric treatment were still fulfilling PTSD criteria 2(1/2) years after the tsunami.
A marked percentage of respondents reported symptoms of PTSD but they remained untreated or were treated insufficiently. We recommend that tourists returning from regions affected by natural disasters be informed about PTSD and that careful screening be given to those found to be at risk of PTSD. An open-door policy of mental health services is particularly needed for tourists returning home who have been affected by large-scale disasters.
Data from 12 different European countries show a rapid increase in HIV antibody positivity among drug users or a high degree of contamination already reached wherever studies have been made. Until 31 December 1986, 698 (18%) of AIDS cases were among drug users, of which 600 (15%) of AIDS cases were solely drug users, and 98 (3%) were in addition homosexual or bisexual. A further increase is expected. Because of the epidemiological importance for transmission to the heterosexual population, this problem has become a focus of attention. Drug abusing prostitutes constitute a major source of infection for the heterosexual population and newborns. The increase in the number of AIDS cases in 1986 among male drug abusers was 98 - that is up 61% compared to previous years; among women, the increase was 56%. The 3 main approaches to solution of this problem, i.e. interdiction of the drug trade, availability of sterile needles, and an education program have not proven as successful as anticipated. Relevant indications of the progress of infection in society can only be obtained by systematic observation of conversion rates in differential subgroups, i.e. drug abusers, newly incarcerated drug abusers, male and female prostitutes who use drugs, and individuals newly reporting for treatment. Separation of HIV antibody positives and negatives in therapeutic communities which are not drug free is recommended for epidemiological purposes in view of the developments to date. Nor should forced segregation of the infected from noninfected be dismissed out of hand.
Farmers are known to be at high risk from the development of occupational airway disease. The first stage of the European farmers' study has shown that pig farmers in Denmark and Germany, poultry farmers in Switzerland and greenhouse workers in Spain were at highest risk for work-related respiratory symptoms. Therefore, the aim of this study was to determine exposure levels at relevant farm workplaces. Dust and endotoxin levels as well as microbiological concentrations were determined in 213 crop and animal farming environments by personal sampling. The highest total dust concentrations were found in poultry houses in Switzerland with median concentrations of 7.01 mg/m(3). The median airborne endotoxin concentrations in total dust ranged between 0.36 ng/m(3) in Spanish greenhouses and 257.58 ng/m(3) in poultry houses in Switzerland. Likewise, the highest median concentrations of total (2.0 x (7) cells/m(3)) and active fungi (4.4 x (5) cfu/m(3)) have been found in Swiss poultry houses. The predominant fungus taxa discovered in poultry houses were Eurotium spp. and thermophilic fungi. Cladosporium and Botrytis were mainly detected in greenhouses. The exposure level found in this study might put the farmers at risk from respiratory diseases.
Although many people recover from substance-use associated problems on their own, little is known about this phenomenon. The paper had two objectives: to use a new research method, computer-assisted content analysis, to understand alcohol and drug abusers' perceived reasons for self-change and to undertake a comparative evaluation across substances and cultures to validate previous findings about subjective appraisal processes. Three studies of natural recoveries of alcohol and drug abusers in two countries conducted tape-recorded interviews with 216 respondents. The taped responses were coded based on a content analytic dictionary approach using a computerized content analysis program. All three studies found several processes mediating the decision to change substance use. The computer content analysis confirmed a cognitive appraisal process regardless of the cultural setting or substance. The findings suggest that several procedures might have benefit in clinical interventions.