Financial Support to Medicaid-Eligible Mothers Increases Caregiving for Preterm Infants

Maternal and Child Health Journal - To assess the impact of financial support on maternal caregiving activities for preterm infants. We conducted a small randomized controlled trial (RCT) in two...     

Prospective follow-up and pulmonary functions from a placebo-controlled randomized trial of ribavirin therapy in respiratory syncytial virus bronchiolitis. Ribavirin Study Group.

OBJECTIVE: To determine any long-term differences in adverse effects and pulmonary function between infants with respiratory syncytial virus and lower respiratory tract infection who were treated with ribavirin and a control group. STUDY DESIGN: Long-term follow-up included enumeration of episodes of respiratory illness, wheezing, and pneumonia and, ultimately, administration of pulmonary function tests (PFTs). Pulse oximetry was done at each visit. During the first 3 years we conducted follow-up in the fall and spring. In years 4 and 5 we conducted 1 visit per year. During years 5 through 7 we conducted PFTs, and starting with year 7 a methacholine chloride challenge was done if forced expiratory volume in 1 second (FEV1) was greater than 70% of predicted value. RESULTS: We prospectively enrolled (December 1983 to February 1985) in a randomized trial of ribavirin vs placebo children who were previously healthy, were premature, or had chronic pulmonary disease. One pulmonologist (R.F.; blinded) scored and interpreted the results of the PFTs. We studied 42 patients aged 1 to 33 months; 2 patients died (1 receiving ribavirin and 1 receiving placebo) and 5 patients receiving placebo were lost to follow-up; 35 patients (24 taking ribavirin and 11 taking placebo) attended 212 visits. Four patients were premature (3 in the ribavirin and 1 in the placebo group), and 3 of these had bronchopulmonary dysplasia (2 in the ribavirin and 1 in the placebo group). From years 1 to 3, there was more reactive airway disease, wheezing, and pneumonia in the placebo than in the ribavirin group (mean score, 22.3 for 12 placebo-treated patients vs. 15.8 for 23 ribavirin-treated patients; P = .07 by Kruskal-Wallis test); for all years, it was 22.0 for 11 placebo-treated patients vs. 16.0 for 22 ribavirin-treated patients (P = .10). After informed consent was given, 19 patients completed PFTs (13 receiving ribavirin and 6 receiving placebo); 7 of 13 ribavirin-treated patients (53%) had normal or mild PFT results vs. 0 of 6 placebo-treated patients (P = .04 by Fisher exact test). On methacholine challenge (7 ribavirin-treated patients and 5 placebo-treated patients), there was more reactivity in the placebo vs. the ribavirin group (exact P = .07). Scoring done by weighting for severity for 19 patients (13 ribavirin-treated patients and 6 placebo-treated patients) (even after correcting for asthma) showed a significant difference in favor of previously ribavirin-treated patients (exact P = .02). CONCLUSIONS: No outward effects were identified from ribavirin exposure. We observed no increase in reactive airway disease, wheezing, and pneumonia in the ribavirin compared with the placebo group. Weighted severity scores suggest long-term beneficial effect of ribavirin therapy; however, larger numbers should be evaluated.     

Antibody response to low-molecular-weight antigens of Aspergillus fumigatus in allergic bronchopulmonary aspergillosis.

Sera from patients with allergic bronchopulmonary aspergillosis (ABPA) or aspergilloma and normal sera were analyzed for specific antibodies by Western (immuno-) blotting with Aspergillus fumigatus antigens transferred electrophoretically onto polyvinylidene difluoride membranes. Western blot analysis demonstrated consistent reactivity of low-molecular-weight A. fumigatus antigens against ABPA sera but not against uncomplicated aspergilloma or normal sera. None of these low-molecular-weight components had any lectin-binding activity. Sera from patients with aspergilloma, however, frequently reacted with high-molecular-weight components of A. fumigatus. The majority of these high-molecular-weight antigenic components demonstrated concanavalin A-binding activity. The low-molecular-weight bands were discernible in Western blots with sera from all ABPA patients irrespective of disease activities, such as relapse, flare, or treatment. Antibodies detected by methods such as immunodiffusion or enzyme-linked immunosorbent assays demonstrated total antibody responses to most or all antigenic components, while Western blots demonstrated the reactivities of the individual components with the specific antibodies. Western blot analysis thus provided more information for immunodiagnosis of ABPA than other methods, especially when only crude antigens were available.     

The connections between the suprachiasmatic, ventrolateral geniculate and raphe nuclei studied by uptake of [14C]2-deoxyglucose

The [14C]2-deoxyglucose method was used to investigate the role of the ventrolateral geniculate and raphe nuclei in the control of the metabolism of the suprachiasmatic nuclei in adult female Wistar rats anaesthetized with alphaxalone. Three to seven days before the [14C]2-deoxyglucose studies a stimulating electrode was implanted or a lesion was made in the ventrolateral geniculate nucleus, or the ascending projection from the raphe nuclei was severed. Stimulation of the ventrolateral geniculate nucleus (biphasic rectangular pulses, 30 s on and 30 s off, 50 Hz, 500 microA pulse amplitude and 1 ms pulse duration) led to a significant increase in the relative metabolic activity of the ipsilateral suprachiasmatic nucleus and a smaller increase in the relative metabolic activity of the contralateral suprachiasmatic nucleus. The stimulus also increased significantly the relative metabolic activities of mainly the ipsilateral hypothalamus, midbrain central gray and reticular formation, all of which are too remote from the ventrolateral geniculate nucleus to be affected by current spread. In animals in which the ventrolateral geniculate nucleus had been lesioned, the relative metabolic activity of the suprachiasmatic nuclei was not significantly different from normal. In animals in which the ascending projection from the raphe nuclei had been severed, there was a slight, though significant increase in the relative metabolic activity of the suprachiasmatic nucleus of one side. These results, together with the effects of stimulating the suprachiasmatic nuclei [R. C. Maxwell and G. Fink, Neuroscience 23, 241-263 (1987)], show that the connections between the ventrolateral geniculate, raphe nuclei and suprachiasmatic nuclei are "metabolically functional", but that the integrity of the ventrolateral geniculate nucleus is not essential for maintaining the relative metabolic activity of the suprachiasmatic nuclei. The raphe nuclei may reduce the relative metabolic activity of the suprachiasmatic nucleus.