Children's help-seeking behaviour

A study of children's help-seeking behaviour with respect to bullying and parental arguing is reported. A number of specific hypotheses and open-ended questions were investigated with boys and girls aged8-17 years. Female helpers were preferred overall, thought a relationship existed between the child's and helper's gender. Parents, friends, and teachers were all chosen, and parent and peer helpers were seen as complementary rather than competitive sources of help. Reasons for choosing helpers were notably varied, but largely related to perceived qualities of the helper rather than the child's own needs. Children depicted helping as an active response on the part of the helper. These findings, are discussed and implications of practice noted.     

Lung eicosanoid metabolism

Eicosanoids are metabolites of the essential fatty acid, arachidonic acid, which is an integral part of all cell membranes. Membrane damage (as in lung injury) and stretching of tissues are recognized stimuli for lung prostaglandin release, indicating a spectrum of possible roles of eicosanoids in the function of the normal and diseased lung. This article reviews the most pertinent issues regarding the roles of arachidonic acid metabolites in the lung.     

Pulmonary lesions due to Dirofilaria immitis (dog heartworm). Report of four cases with radiologic findings.

Chest radiographs of 4 patients with Dirofilaria immitis (dog heartworm) revealed solitary, small, peripheral, noncalcified nodular lesions. The pulmonary lesions were apparently produced secondary to lodging of the parasite in peripheral pulmonary vessels. None of the patients had symptoms referable to the heartworm lesions. Needle aspiration in 2 patients revealed a nonspecific inflammatory lesion.     

Zinc absorption in Guatemalan schoolchildren fed normal or low-phytate maize

BACKGROUND: Poor bioavailability of zinc from high-phytate diets is an important contributory factor to zinc deficiency in low-income populations. OBJECTIVE: The objective of this study was to determine the effect of low-phytate maize consumption on zinc absorption. DESIGN: The participants were apparently healthy children from the Central Highlands of Guatemala. Sixty children (20 per group) were randomly assigned to be fed only the low-phytate maize or 1 of 2 control maizes, the isohybrid wild-type maize or a local maize, for a 10-wk period. During the final week, the fractional absorption of zinc for all meals was measured during 1 d with the use of zinc stable isotopes and a dual isotope ratio technique based on urine enrichment data. RESULTS: Mean (+/-SD) phytate intakes for the low-phytate, wild-type, and local maize groups were 1536 +/- 563, 2056 +/- 517, and 2253 +/- 687 mg/d, respectively. Corresponding zinc intakes were 8.6 +/- 2.5, 8.1 +/- 2.0, and 9.7 +/- 2.6 mg/d, and the dietary phytate:zinc molar ratios were 18 +/- 5, 26 +/- 6, and 23 +/- 5. Corresponding fractional absorptions of zinc were 0.32 +/- 0.07, 0.28 +/- 0.07, and 0.29 +/- 0.06. The respective values for total absorbed zinc were 2.72 +/- 0.88, 2.30 +/- 0.96, and 2.78 +/- 1.04 mg/d. No significant differences in either the fractional absorption of zinc or total absorbed zinc were seen between the maize groups. CONCLUSION: Under the conditions of the present study, zinc absorption was not increased by the long-term use of low-phytate maize in children whose major dietary staple is maize.     

Postpartum outcomes in supine delivery by physicians vs nonsupine delivery by midwives

CONTEXT: Clinically preferred maternal position during childbirth has varied between supine and nonsupine over time and from patient to patient. Preferred maternal birthing position is coming under increasing scrutiny. OBJECTIVE: To compare postpartum maternal and infant outcomes resulting from supine and nonsupine positions maintained during the second stage of labor. DESIGN AND METHODS: Nonrandomized clinical trial comparing low-risk women (N=198) in two separate obstetrics practices. In one practice, parturients (n=100) used only the supine position as their birthing position. In the other practice, parturients (n=98) used any or all of three nonsupine positions (sitting, squatting, or kneeling/hands-and-knees). Data collection took place immediately after birth by provider survey and included: Apgar scores, demographics, estimated blood loss, neonatal weight, perineal integrity, position during second-stage labor and birth, and vulvar edema. RESULTS: Infants born to mothers in nonsupine positions were delivered with significantly less tearing of the perineum (P<.001) and less vulvar edema (P<.001). Although the length of second-stage labor was shorter among the women who were nonsupine, this result lacked statistical significance. There did not appear to be increased risk to the infant from the mother's nonsupine posture. CONCLUSION: Nonsupine positions during labor and delivery were found to have clinical advantages without risk to mother or infant. Enhanced maternal outcomes included improved perineal integrity, less vulvar edema, and less blood loss.     

The length of consultations in general practice

Four characteristics of patients which might affect the length of time spent in consultations in general practice were studied: the sex, diagnosis, age, and social class of the patient. The sex of the patient was not shown to be significantly associated with any difference. The diagnosis of `psychoneurotic'' conditions was significantly associated with long consultations (p < 0·001) and this is discussed.The number of consultations lasting less than the median time for the whole series was significantly more common in the 15 to 29 age group.There have been few reports published on this topic, which seems important, and I hope further work will examine this aspect of the work patterns of established and trainee general practitioners.     

Percutaneous catheter drainage of pleural effusion and empyema

Fluoroscopy-guided percutaneous catheter drainage (PCD) was used in 38 patients to diagnose and/or treat pleural effusions (21), hemothorax (one), symptomatic malignant effusions (four), and empyemas (12). Fluoroscopic guidance combined with the use of a small needle, J-tip guide wire, and pigtail catheter made it possible to safely drain both free and loculated fluid collections, including areas with difficult access. In 11 of the 12 patients with empyema, the pus (or purulent fluid) was successfully drained using PCD. Two or more catheters were used in all but one patient. In four of the empyemas, PCD was used successfully after incomplete or unsuccessful chest tube drainage. In five, PCD was used as the sole means of drainage. In three patients, chest-tube drainage was used to drain residual (one) or recurrent (two) empyemas after PCD. The safety and relative ease of PCD makes it an attractive alternative method for closed drainage of pleural fluid collections.