Parish nursing: renewing a long tradition of caring.

Parish nurses are experienced registered nurses committed to helping people meet the health needs of their body, mind, and spirit. To fulfill this goal, parish nurses must be health educators and counselors, referral sources, facilitators, patient advocates, healthcare plan interpreters, and multitalented coordinators. The parish nurse uses the skill of nursing assessment of individual and congregational needs and matches the assessment findings to available resources. The parish nurse also advocates increased awareness of health-related issues that lead to earlier and more effective treatment and care. All ages benefit within a context of personal caring and attention offered by a parish nursing model that is often lacking from healthcare delivery systems. Congregations of all sizes, both urban and rural, have successfully started parish nurse programs. Parish nursing programs are a religious response to help bring wholeness and healing to the faith community. The purpose of this article is to explore parish nursing as it has evolved into a model of health care delivery contributing to the empowerment and health of both the individual and the community.     

Canine pancreas and kidney transplantation following total-lymphoid irradiation

The effect of total-lymphoid irradiation on survival of canine pancreas and kidney allografts was studied. TLI had a marked immunosuppressive effect as measured by in vitro immune responses and reduced circulating leukocytes. Despite the changes, median graft survival times for animals treated with 800 cGy (9 days) or 1800 cGy (9.5 days) were not significantly different from untreated control animals (7 days). The addition of low-dose antithymocyte globulin (10 mg/kg/day) on post-transplant days 0, 2, 4, 6, 8, and 10 had no measurable synergistic effect. Similarly, median segmental pancreas allograft survival times after 1700-2200 cGy of TLI treatment (16.5 days) were only marginally longer than those of untreated controls (9 days). The only animal to maintain a graft for greater than 200 days was matched to the donor in mixed lymphocyte culture (MLC). This animal was able to reject a third-party skin graft after 8 days while a graft from the original donor was still surviving after 21 days when the pancreas graft failed from a chronic-type rejection. These results indicate that TLI alone or in combination with ATG will not be predictably effective as a method of prolonging allograft survival. The role of matching major histocompatibility complex antigens in TLI treatment requires clarification.     

Compatibility of cisplatin and fluorouracil in 0.9% sodium chloride injection

The effect of drug concentration and light on the compatibility and stability of cisplatin and fluorouracil in i.v. admixtures was studied. Two sets of admixtures were prepared in 0.9% sodium chloride injection in polyvinyl chloride bags--(1) cisplatin 200 micrograms/mL and fluorouracil 1,000 micrograms/mL and (2) cisplatin 500 micrograms/mL and fluorouracil 10,000 micrograms/mL. Half of the admixtures were protected from light. All admixtures were stored at room temperature (24-26 degrees C), and those admixtures not protected from light were stored under room fluorescent light. After visual inspection, the pH of each admixture was determined, and an aliquot was assayed for drug concentration using a stability-indicating high-performance liquid chromatographic assay. Over a four-hour period, no visual changes were observed and the pH changes observed were negligible. In admixtures containing the lower concentrations of cisplatin and fluorouracil, it took approximately 1.5 hours for the concentration of cisplatin to reach 90% of the initial concentration. By four hours (lower concentration range) and three hours (higher concentration range) after the admixtures were prepared, less than 75% of the initial cisplatin concentration remained. There was less than a 5% decrease measured in the fluorouracil concentrations over the observation time. Admixtures of cisplatin and fluorouracil in 0.9% sodium chloride injection at the concentrations evaluated in this study must be used within one hour of preparation, whether or not they are protected from light. Intravenous administration of fluorouracil and cisplatin by continuous infusion will require alternative approaches to mixing the two drugs in the same container.     

Residential mobility during pregnancy: implications for environmental teratogenesis

Although most teratogens are suspected to act early in the first trimester of pregnancy, birth defects monitoring programs and etiologic studies usually use residence at birth as a proxy measure for residence in the first trimester in searching for environmental teratogens. Because of the high mobility of the U.S. population, residence misclassification can potentially alter inferences concerning environmental teratogens. To evaluate this potential bias, data from the population-based Maryland Birth Defects Reporting and Information System were analyzed. In 1984, the system ascertained 295 infants with one or more of 12 sentinel defects. Of these cases, 59 (20%) mothers reported they have changed address between the time of conception and the time of birth, and 22 have moved to a different county. The residential mobility rate varied by demographic variables and was highest among white women, in the age group 20-24 years. If residence at birth is used as a screening test for residence at conception, it can be shown that in the presence of an environmental teratogenic exposure, misclassification of exposure increases with increasing mobility rate, and population exposure frequency. Such misclassification tends to weaken associations between residence and birth defects and may lead to missing environmental teratogens. This analysis emphasizes the need to use residence information early in pregnancy rather than exclusively at birth.     

Posterior urethral valves in patients with Down syndrome

Renal and urological anomalies in Down syndrome (DS) have received little attention compared with the nephrourological findings described in other chromosomal abnormalities. Renal hypoplasia, hydroureteronephrosis, ureterovesical and ureteropelvic junction obstruction, and vesicoureteral reflux, but not posterior urethral valves, have been associated with DS. We report the occurrence of posterior urethral valves in three male infants with DS at a single institution. All had multiple urological procedures for correction or palliation of obstruction. Children with DS may have an increased risk for developing posterior urethral valves and obstructive uropathy. Furthermore, they may also develop chronic renal failure secondary to posterior urethral valves. Therefore, we suggests that infants with DS be screened with ultrasonography for renal and urological abnormalities early in life and, if abnormal, a contrast voiding cystourethrogram be performed to rule out posterior urethral valves or other bladder or urethral abnormalities. A review of the renal and urological anomalies in DS reported in the literature since 1960 is presented.     

Coronary heart disease among Pacific Island people in New Zealand

Coronary heart disease is the leading cause of death in New Zealand. Death rates are higher among the Maori than the European population but rates have been declining in both groups over recent years. The occurrence of coronary heart disease among the Pacific Island population in New Zealand is unknown. Data from the National Health Statistics Centre (NHSC) and the Auckland coronary or stroke (ARCOS) study were used to describe the occurrence of coronary heart diseases among Pacific Island people. Age standardised mortality rates show that coronary heart disease is an important cause of death among Pacific Island men. Death rates have declined between 1973-77 and 1978-82 but this trend did not continue among men in the 1983-86 period. Age standardised mortality rates from coronary heart disease from the ARCOS data are 175/100,000 and 52/100,000 for Pacific Island men and women compared with 325/100,000 and 141/100,000 for Maori men and women. Age standardised rates for European men and women are 154/100,000 and 36/100,000 respectively.     

Distribution of neurons and glia in the visual cortex (area 17) of the adult albino rat: a quantitative description

The neuronal and glial cell composition of the rat visual cortex (area 17) has been determined quantitatively using stereological techniques. The volume numerical densities (number of cells per mm3 of cortex) of neurons and of the principal glial cell types (astroglia, oligodendroglia, and microglia) were calculated from tangential semithin resin sections spaced at regular intervals 50 micron apart throughout the entire depth of the visual cortex. From measurements of cortical and laminar thickness the separate volume numerical densities of neurons and glial cells were derived for each lamina in the cortex. In addition, the absolute numbers of cells in each lamina under 1 mm2 of cortical surface were calculated. The mean cortical volume numerical density of neurons was 60,020 +/- 3840/mm3 (mean +/- SEM; n = 8), and 49,040 +/- 2610/mm3 for the combined glial cell types. Astroglia, oligodendroglia, and microglia were present in a ratio of 6:3:1 respectively. It was determined from neuronal and glial somatic volume estimates that the somata of these cells occupied approximately 13.5% of unit cortical volume, with 81.3% of the unit volume being occupied by cortical neuropil. Using previously published reports that described the laminar composition of neurons in terms of the relative proportions of pyramidal and non-pyramidal cells, the laminar volume numerical densities for these neuronal categories have been derived. In addition, it has been estimated that under 1 mm2 of cortical surface there are 79,500 pyramidal and 7790 non-pyramidal neurons distributed throughout layers 1-6 of the rat visual cortex.     

Effects of antidepressant medication on sexual function: a controlled study

There has been little systematic study of the types of sexual dysfunction produced by antidepressant medication or of the frequency with which this type of adverse effect occurs. The authors report results of a double-blind study in which the effects of imipramine, phenelzine, and placebo on specific aspects of sexual function were assessed in depressed outpatients before and after 6 weeks of treatment. Both active treatments were associated with a high incidence of adverse changes in sexual function and produced significantly more adverse effects on sexual function than placebo. Orgasm and ejaculation were impaired to a greater extent than erection. Adverse sexual function changes secondary to antidepressant medication occurred frequently in both men and women, although men reported a higher incidence. Antidepressant-related sexual dysfunction may be of clinical importance for medication compliance in view of current recommendations that antidepressants be administered for longer periods as maintenance therapy or for prophylaxis.