The immunologic considerations in human head transplantation.

The idea of head transplantation appears at first as unrealistic, unethical, and futile. Here we discuss immunological considerations in human head transplantation. In a separate accompanying article we discuss surgical, ethical, and psychosocial issues concerned in body-to-head transplantation (BHT) [1].

Surgical, ethical, and psychosocial considerations in human head transplantation.

Transplanting a head and brain is perhaps the final frontier of organ transplantation. The goal of body-to-head transplantation (BHT) is to sustain the life of individuals who suffer from terminal disease, but whose head and brain are healthy. Ideally BHT could provide a lifesaving treatment for several conditions where none currently exists.

Facial disfigurement stigma: a study of victims of domestic assaults with fire in India.

In India, the incidence of fire attacks on women has risen dramatically. Although studies and media accounts describe how and why these attacks occur, no research has investigated the lives of survivors. Qualitative analysis of the texts of two focus groups of women scarred by domestic attacks by fire reveals that these women are heavily stigmatized.

Factors associated with non-reimbursable activity on an inpatient pediatric consultation-liaison service.

The aim of this study was to identify factors contributing to clinician time spent in non-reimbursable activity on an inpatient pediatric consultation-liaison (C-L) service. A retrospective study was conducted using inpatient C-L service data on 1,246 consecutive referrals. For this patient population, the strongest predictor of level of non-reimbursable clinical activity was illness chronicity and the number of contacts with C-L service clinicians during their hospital stay.

Factors that affect women's attitudes toward domestic violence in Turkey.

This article examines the attitudes of Turkish women toward justification of intimate partner violence. The data were gathered from the 2003 Turkey Demographic and Health Survey. A random sample of 8,075, aged 15-49, participated in the survey.

Psychosocial considerations in facial transplantation.

The human face and facial transplantation have long captured the interest and imagination of scientists, the media and the lay public. The face is central to our identity, and our communication with the outside world. It is this great importance we attach to our face that makes facial disfigurement such a devastating condition.

Patient expectations in facial transplantation.

Meeting patients' expectations is essential for successful outcomes in reconstructive surgery. In the case of new procedures like facial transplantation that carry with them many unknowns and real, or potential, risk of toxic side effects this becomes especially important. In this study we assessed patient expectations in facial transplantation by surveying individuals with facial disfigurement (n = 34), reconstructive surgeons (n = 45), and controls from the general population (n = 148).

Plastic surgeon's risk acceptance in facial transplantation.

Background: A great deal of ethical debate has accompanied the introduction of facial tissue allotransplantation into the clinical arena. Critics contend that the risks of lifelong immunosuppression do not justify the benefits of this new non-life-saving reconstructive procedure, whereas proponents argue that they do. Absent from this debate are the opinions of individuals with real-life experiences with the risks and benefits associated with this new treatment.

Ethical considerations in human facial tissue allotransplantation.

Background: Human facial tissue allotransplantation is now a clinical reality. Proponents of this new treatment contend that the benefits outweigh the risks, while the critics argue they do not. This debate has been presented in great detail in the bioethics literature but has not been brought to the attention of the plastic surgery community.

Ethical considerations in face transplantation.

Human face transplantation is now a clinical reality. The surgical techniques necessary to perform these procedures have been used routinely in reconstructive microsurgery for many years. From an immunological standpoint since face and hand contain mostly the same tissues it is reasonable to assume that the same immunosuppressive regimen found to be effective in human hand transplants should also work in face transplantation.

Risk assessment of immunosuppressive therapy in facial transplantation.

Background: Immunosuppression-related risks are foremost among ethical concerns regarding facial transplantation. However, previous risk estimates are inaccurate and misleading, because they are based on data from studies using different immunosuppression regimens, health status of the transplant recipients, tissue composition, and antigenicity. This review provides a comprehensive risk assessment for facial transplantation based on comparable data of immunosuppression, recipient health status, and composition and antigenicity of the transplanted tissue.

Psychosocial implications of disfigurement and the future of human face transplantation.

Although the first face transplants have been attempted, the social and psychological debates concerning the ethics and desirability of the procedure continue. Critics contend that these issues have not yet been sufficiently addressed. With this in mind, the present article seeks to elaborate on key psychological and social factors that will be central for addressing the ethical and psychosocial challenges necessary to move face transplantation into mainstream medicine.

Research and events leading to facial transplantation.

Facial transplantation has long captured the interest and imagination of scientists, the media, and the lay public. Facial transplantation could provide an excellent alternative to current treatments for facial disfigurement caused by burns, trauma, cancer extirpation, or congenital birth defects. This article discusses the major technical, immunologic, psychosocial and ethical hurdles that have been overcome to bring facial transplantation from an idea to a clinical reality by providing the reader with a chronologic overview of the research and events that have led this exciting new treatment into the clinical arena.

Composite tissue allotransplantation of the hand and face: a new frontier in transplant and reconstructive surgery.

Each year an estimated 7-million people in the USA need composite tissue reconstruction because of surgical excision of tumors, accidents and congenital malformations. Limb amputees alone comprise over 1.2 million of these.

Risk acceptance in laryngeal transplantation.

Purpose: Advancements in the fields of head and neck surgery and immunology have paved the way for new quality of life-improving procedures such as larynx transplantation. To quantitatively assess the risks versus benefits in larynx transplantation, we used a questionnaire-based survey (Louisville Instrument For Transplantation [LIFT]) to measure the degree of risk individuals are willing to accept to receive different types of transplantation procedures.

Methods: The LIFT contains 237 standardized questions incorporating standard gamble and time tradeoff outcome measures as well as questions assessing body image perception, depression, self-esteem, optimism, socially desirable responding, and demographics.

Investigation of risk acceptance in facial transplantation.

Background: The surgical techniques necessary to transplant a human face are well established, and the early success of human hand transplants suggests that the immunological hurdles of transplanting human facial tissues have largely been overcome. Therefore, it is the ethical barriers that pose the greatest challenge to performing facial transplantation. At the center of the ethical debate is the question, "Do the risks posed by the life-long immunosuppression that a recipient would have to take justify the benefits of receiving a face transplant?" In this study, the authors answer this question by assessing the degree of risk individuals would be willing to accept to receive a face transplant.

Risk acceptance in composite-tissue allotransplantation reconstructive procedures.

Composite-tissue allotransplantation (CTA) is a new therapeutic modality to reconstruct major tissue defects of the face, larynx, and extremities. Unlike most life-saving organ-transplantation procedures, CTA is considered to improve quality of life. Therefore, the question arises, do the risks posed by the immunosuppression drugs that patients must take to prevent rejection justify the benefits of these procedures? The purpose of this study was to assess the relative risk that individuals are willing to accept in order to receive the benefits of CTA procedures.

On the relationship between cultural values and preferences and affective health in Nepal.

Background: The westernization of developing countries has improved physical health and life expectancy. Modernization, however, is believed to have injurious effects on mental health. Some research suggests that the effects of modernization vary, hurting some but benefiting others.

A comparison of influences on attitudes towards mental health service use in an African-American and White community.

The purpose of this study was to examine the attitudes toward mental health service (MHS) use within a sample of African-American and White adults (N = 739) and to identify correlates associated with those expressed attitudes. African-Americans (n = 132) and Whites (n = 607) were interviewed using the Louisville Metropolitan Survey that included the Attitudes Toward Seeking Professional Psychological Help Scale. Findings from this study indicated that responses regarding seeking mental health services were positively correlated with educational attainment and gender In addition, further findings also suggested that while race was significantly associated with attitudes toward seeking mental health services, it was also associated with prior familiarity with mental health services African-Americans reported both less willingness to seek mental health services and less familiarity with mental health services.

Factors affecting quality of oral care in intensive care units.

Aims: This paper presents a study to assess to nurses' attitudes and practices concerning oral care and to determine predictors of the quality of oral care in intensive care units.

Background: The oropharynx of critically ill patients becomes colonized with potential respiratory pathogens; oral care has been shown to reduce oropharyngeal bacteria and ventilator-associated pneumonia.

Methods: In April 2002, a random and national sample of 420 intensive care unit directors was asked to participate in the survey.

Survey of oral care practices in US intensive care units.

Background: Research has shown that oral care involving toothbrushes and topical antimicrobials improves the oral health of medically compromised patients and may reduce the incidence of nosocomial infections including pneumonia. This survey research was undertaken to determine the type and frequency of oral care in intensive care units (ICUs) in the United States and the attitudes, beliefs, and knowledge of health care workers.

Methods: A randomly selected survey of 102 ICUs within the continental United States participated with 556 respondents; 97% of respondents were registered nurses.

Authoritarianism and attitudes toward mental health services.

Right-wing authoritarians have been shown to resist change and to demonstrate hostility toward out-groups and social movements that may advocate change from traditional and conventional beliefs. Using data from the Louisville Metropolitan Survey, an omnibus survey of 771 adults interviewed by telephone, the authors investigated the relationship between right-wing authoritarianism (RWA) and attitudes toward mental health services. The findings of the bivariate and regression analyses indicated that high scorers on a version of B.