Estimating the chance of an inadequately immunised child getting pertussis

Before informed advice can be given to parents and health care workers about the need for pertussis immunisation, an estimate of the risk of inadequately immunised children contracting pertussis is needed. The study reported here was conducted because the literature contains no such estimates of risk. Analysis was made of a county's Notification of Disease Reports. Computation was carried out of age-specific annual notification rates of pertussis amongst adequately and inadequately immunised children. It was found that inadequately immunised one-year-old children probably have more than a one in six chance of developing pertussis before age ten.     

Neonatal mortality amongst Scottish preterm singleton births (1985–1994)

Objective To provide a valid estimate of singleton neonatal mortality based on birthweight and gestational age at delivery.
Design Record linkage of maternity data and neonatal mortality data.
Setting Scotland, UK.
Population All singleton preterm deliveries from 24 to 36 weeks inclusive between 1985 and 1994.
Main outcome measure Neonatal death.
Results There were 625,646 liveborn singleton deliveries over the study period, of which 33,912 were preterm (5.4%). The overall neonatal mortality in the preterm group was 41/1000 and the data have been presented by both gestational age and birthweight. The neonatal mortality rate fell with advancing gestation from 795/1000 live births at 24 weeks to 9/1000 live births at 36 weeks and was higher at the extremes of birthweight for a given gestational age. There was a significant increase in the proportion of babies delivered iatrogenically over the study period (χ test for trend   P < 0.001  ).
Conclusion This is the largest recent series to consider neonatal mortality using both birthweight and gestational age. These figures will be of use in obstetric management when elective preterm delivery is considered, and for providing prognostic guidance following preterm delivery.     

The nurse''s decision-making process and the implementation of psychogeriatric nursing in a mental hospital

This study looks at the psychogeriatric nurse's decision-making process and on this basis seeks to describe the implementation of psychogeriatric nursing in a mental hospital. The subjects consist of 26 nurses working on the psychogeriatric wards of one hospital. The data were collected using a questionnaire (n = 26), a 1-week time-usage analysis, content analysis of nursing plans (n = 56), and observation of planning meetings (n = 15). The results for different phases of the decision-making process suggested that nurses had little difficulty with the identification of problems. Data collection tended to concentrate on the physical side of nursing work. The setting of explicit targets for nursing care proved to be difficult. The vast majority of the nurses (85%) felt that decision-making on different nursing alternatives was only moderately or not at all successful. Over half of the nurses felt that their ability to evaluate the outcome of treatment and nursing was either satisfactory or poor. Time-usage analysis indicated that the nurses had frequent interaction with their patients in connection with basic care, although the nurses themselves did not regard this part of their work as active interaction with the patient.     

The change process in alcoholics: client motivation and denial in the treatment of alcoholism within the context of contemporary nursing

Despite being constantly cited as a critical intervening variable in the recovery from alcohol problems, there is a paucity of literature on client motivation. This paper reviews the current literature which impacts on motivation and its importance in treatment and develops in a stepwise manner the revised expectancy/motivation hypothesis, tentatively explaining both motivation and denial as a natural process in behavioural change. Because of the revised expectancy/motivation hypothesis' distinctly defined stages which closely relate to the process of nursing and the qualitative and quantitative measurement it entails which the nursing process demands, it offers a particularly appropriate model for treatment within nurse practice.     

Routine hysteroscopy for patients with a high risk of uterine malignancy

Summary. Seventy patients with abnormal vaginal bleeding were examined with a Storz hysteroscope. The examination took an average of only 5 min. Sixty patients had the examination under general anaesthesia, five under paracervical block and five had no form of anaesthesia. All tolerated the procedure well. There were no complications directly related to the hysteroscopic examination. There was complete correlation between the histology of the endometrium obtained at subsequent curettage and the hysteroscopic findings.     

Systemic necrotizing vasculitis associated with childhood sarcoidosis

Childhood sarcoidosis is a rare disorder with protean manifestations. The case of a child with prolonged fever, hepatosplenomegaly, pancytopenia, and systemic necrotizing vasculitis manifesting as fever, rash and skin infarctions, digital pregangrene, and foot drop is reported. This is the first case of systemic necrotizing vasculitis reported in sarcoidosis. The fulminant course of the disease required treatment with intravenous pulsed cyclophosphamide and high doses of corticosteroids. The spectrum of vasculitis in childhood and adult sarcoidosis is reviewed.     

Detection of subclinical ascorbate deficiency in early Parkinson''s disease

From mid-October 1989 to mid-July 1990 all newly admitted residents to Bury Local Authority Residential Homes were comprehensively medically screened. In a series of 100 residents eight had early Parkinson's disease (six of them hitherto undiagnosed). Seven showed evidence of Vitamin C deficiency. Of the seven showing evidence of deficiency, four suffered from early Parkinson's disease. Of the 93 without evidence of Vitamin C deficiency only four had Parkinson's disease. This indicates a significantly higher prevalence of Parkinson's disease in the group with Vitamin C deficiency (P less than 0.001 using Fisher's exact).