Knowledge of skin test results among parents of asthmatic children.

BACKGROUND: The control of asthma in children depends upon several factors, among which is the ability of parents to minimize the exposure of their children to specific allergens. If parents are ill-informed of the specific allergen sensitivity of their children, they may be unable to take the necessary steps to minimize exposure. OBJECTIVES: This study seeks to determine the ability of parents to recall accurately the skin test results for their children. Parents were low income, multicultural, urban residents. METHODS: One hundred eligible children with persistent asthma, between 6 and 14 years old, who were skin test positive to dust mite or cockroach allergen, were recruited from a mobile asthma clinic in Los Angeles. Caretakers were interviewed in English or Spanish. From skin test results, sensitivity and specificity of parental recall of test results were computed. The sensitivity and specificity were further stratified on demographic and exposure characteristics. RESULTS: The sensitivity was lowest for dogs (65%), but higher for all other allergens: cat 93%, roach 91%, dust mites 88%, and mold 81%. The range of specificity was from 40% to 83%. Thus, parents were more aware of positive than of negative test results. Stratification did not appreciably change the sensitivity or specificity results. CONCLUSIONS: We conclude that the sensitivity and specificity of parental response concerning skin test results is high regardless of cultural, demographic, or exposure levels of the child.     

Maternal mortality in England and Wales 1970–1985: an analysis by country of birth

Objective To determine the risk of maternal mortality in immigrants to England and Wales. Design Analysis of death registrations, 1970–1985, by country of birth. Setting England and Wales.
Population Women dying in England and Wales during regnancy, childbirth or the puerperium, or dying fiom malignant tumour of the placenta.
Main outcome measures The risk of dying in pregnancy, childbirth or the puerperium, adjusted for age and year of death, and the risk of cause-specific death, adjusted for age, in immigrants compared with women born in England and Wales.
Results Women born in West Africa (relative risk 10.3; 95% CI 8.0–13.2) and the Caribbean (4.6; 3.8–5.7) were at very elevated risk of maternal death and of the main causes of death. Women from Southern Asia (1.6; 1.3–2.0) and 'Europe and the USSR' (1.7; 1.2–2.3) were at moderate risk. Adjustment for year of death increased the estimates of risk and women born in the 'Rest of the World' and Scotland were at significantly elevated risk.
Conclusions An increased incidence of obstetric conditions in immigrant groups may account for the elevated risk but it is also possible that differences in care may account for some of the additional risk. The pattern of increased risk does not appear to be explicable by the parity or social class distribution of immigrants as far as data are available on these. Research is required into the aetiology of the differential incidence of obstetric disease. The collection of routine mortality data which include maternal reproductive and social factors would elucidate the significance of such factors to maternal health. Further investigation into possible differences in the process of antenatal care between immigrants and non-immigrants is required, and into whether this affects the risk of maternal mortality.     

Effect of opiates on the release of cholecystokinin from in vitro hypothalamus and frontal cortex of Zucker lean (Fa/−) and obese (fa/fa) rats

Opiates, morphine and [d-Ala²-d-Leu⁵]-enkephalin (DADLE), inhibited the K⁺-stimulated release of cholecystokinin (CCK) from the hypothalamus of both Zucker obese (fa/fa) and lean (Fa/−) rats, in vitro. Morphine and DADLE did not inhibit the K⁺-stimulated release of CCK from frontal cortex from either strain. The opiates did not affect basal efflux of CCK and their effects were all blocked by equimolar concentrations of naloxone. These studies indicate a regional specificity for the effect of opiates on CCK release, and may provide evidence for a cellular mechanism by which endogenous opiates modulate feeding behavior.     

The theory/practice 'gap': taking issue with the issue

Theory/practice issues have a long-standing history in nurse education, and are a chronic source of controversy to which there is no easy or perfect solution We have argued that it is the tension between theory and practice and research which can be usefully exploited in teaching and research Students need to be introduced to the debates surrounding the genesis and generation of nursing knowledge They need to gain an appreciation of what counts as nursing knowledge at different points in time and the politics which drive the legitimation of nursing theory and practice Such an approach has much to offer in helping students deal with reality shock and make sense of their experience as they confront the ambiguities, uncertainties and contradictions that characterize the stock-in-trade of professional life     

Comparable renal graft survival in African-American and Caucasian recipients

In past years, many pediatric transplant centers found African-American renal transplant recipients to have poor graft survival. Since 1991 anti-lymphocyte induction therapy has been routinely used for pediatric cadaveric (CAD) and living-related donor (LRD) renal allograft recipients at the University of Tennessee, Memphis. Sixteen African-American first renal allograft recipients received induction therapy: 11 CAD allografts (10 OKT3, 1 ATGAM) and five LRD (all ATGAM). Sixteen Caucasian recipients received induction therapy; 3 CAD (all OKT3), 1 living-unrelated donor (OKT3), and 12 LRD (9 ATGAM, 3 OKT3). Mean age at renal transplantation was 11.8 and 10.5 years for African-American and Caucasian recipients, respectively. Predicted graft survival (PGS) estimated by the Kaplan-Meier method for the African-American patients was 94% at both 1 and 3 years, and for Caucasian patients was 94% and 85% at 1 and 3 years, respectively. Eleven African-American CAD recipients had a PGS of 91% at 1 and 3 years. Renal allograft survival for African-American and Caucasian pediatric recipients at our center appears to be comparable. This could be due, in part, to the use of anti-lymphocyte induction therapy. However, other factors, such as improved compliance or better immunological and pharmacological monitoring, may also have contributed. Received April 18, 1997; received in revised form January 14, 1998; accepted January 19, 1998     

Oral health status of a long-term-care, veteran population

Abstract – The Department of Veterans Affairs (VA) operates the largest, integrated health care system in the United States of America. The projected need for long-term-care in the VA health care system parallels an expected increase in need for care in the United States, but precedes the need for care in the general population by 25–30 yr. The VA's Office of Dentistry, in an effort to estimate the resource requirements of this swelling group of veterans, initiated in 1986–7 an oral health survey of long-term care patients. The overall goals were to describe the oral health status of VA nursing home care units (NHCU) residents and to develop a methodology for estimating future dental health services utilization. This study describes the oral health status of the study population. Demographic and oral health data were collected for 650 long-term care residents of six VA NHCUs between October 1986 and July 1987. Data were collected on sociodemographic status, medical history, dental caries, periodontal diseases, oral soft tissue pathology, and the presence of dental prostheses. Caries and periodontal disease were evaluated using the United States National Institute of Dental Research Survey of Employed Adults and Seniors protocols. The oral health status of the population is described using DMF and ESI indices, the prevalence of oral lesions, levels of tooth loss, oral hygiene scores, and the status of existing dentures. Findings show moderate levels of untreated dental caries and periodontal disease and significant tooth loss which increased with age. A need for preventive therapy, restorative dentistry, conservative periodontal therapy, and prosthodontic care was evident. Soft tissue oral pathologies were rare and frequently related to prostheses use. The subject's overall willingness for care was high. Subjects were found to have a high number of medical comorbidities, and one third of all subjects had to be excluded from the periodontal examination for medical reasons or non-cooperation.     

BDNF increases monoaminergic activity in rat brain following intracerebroventricular or intraparenchymal administration

We have previously demonstrated alterations in serotonin metabolism within descending pathways following infusion of brain-derived neurotrophic factor (BDNF) into the midbrain, near the periaqueductal gray and dorsal and median raphe nuclei. The aim of the present study was to extend these studies to include a comprehensive regional examination of monoamine (serotonin, dopamine and norepinephrine) and metabolite levels in discrete areas of the intact, adult rat forebrain following direct intraparenchymal midbrain BDNF infusion. We have compared neurochemical changes following midbrain infusion of BDNF to those obtained following intracerebroventricular (i.c.v.) infusion. Significant increases in levels of 5-HIAA and/or the 5-HIAA/5-HT ratio were found in all areas examined including the hippocampus, cortex, striatum, n. accumbens, substantia nigra and hypothalamus following both midbrain and i.c.v. infusion. Changes in dopaminergic activity were also observed, but displayed more regional specificity, i.e. changes were found primarily within the striatum and cortex. The two infusion sites produced similar patterns of neurochemical effects although the magnitude of the changes did vary in some areas. These results suggest that BDNF increased synthesis and/or turnover of serotonin, and to a lesser extent dopamine, in the mature rat forebrain. Furthermore, these data point to possible functional roles for BDNF in neuropsychiatric and neurodegenerative conditions which involve a dysregulation of these monoamine systems.     

Spatial abilities,sex differences and EEG functioning

The relationship of EEG asymmetry to spatial performance was studied for high and low spatial ability males and females. As in previous research for high spatial ability males relatively greater right hemispheric activity was associated with successful spatial performance. For low ability males, a group rarely studied, the opposite relationship was found. Both high and low ability females showed no consistent pattern of relationships.