Participants' perception of impact of a workshop on their preventive practices

A 90-minute interactive workshop, offered to small groups on request, was developed to help physicians include evidence-based preventive interventions in their practices. Between 25 September 1996 and 10 December 1997, 593 family physicians throughout the Province of Quebec (Canada) participated in one of the 40 workshops presented in all the regions of Quebec. Almost all participants (98%) completed the self-administered questionnaire. Their opinion of the achievement of three workshop objectives were evaluated using a seven-point Likert scale (-3 to +3)as their perception of the direct impact of the workshop on their practice. The workshop objectives were reached to a high degree: 2.1 (sd 0.90) for prescribing a proper check-up for adults; 1.83(sd 1.02) for explaining to the patient the reasons motivating his/her choice to include or exclude certain tests; 2.09 (sd 0.93)for using concrete and useful tool facilitating the integration of preventive measures in his/her professional practice. Female physicians and those under 40 perceived that the objectives were reached to a greater degree. Participants indicate their intention to modify their practice according to the clinical practice guidelines presented in the workshop.     

Adaptation to a standardized training program and changes in fitness in a large, heterogeneous population: the HERITAGE Family Study

PURPOSE: This paper describes the variations in response to a standardized, computer-controlled training program. METHODS: Steady-state heart rate (HR) and oxygen intake (VO2) of 614 healthy, sedentary men and women aged 16-65 yr were measured during three cycle ergometer exercise tests. The HR associated with 55, 65, 70, and 75% of each subject's pretraining VO2max was used to prescribe exercise intensity. Subjects exercised three times a week, beginning at a HR associated with 55% VO2max for 30 min. Duration and intensity was gradually increased over 20 wk of training. The duration and HR of each training session were controlled by a computer. RESULTS: Using the linear relationship between HR, VO2 and power output (PO), PO were predicted for each of 60 training sessions at the respective programmed HR. The average ratio of the actual training HR to programmed HR was 0.99. It was hypothesized that participants whose actual training PO exceeded their predicted PO would improve VO2max more than those whose actual PO was less than their predicted PO. Using the ratio of actual/predicted PO determined after the training was over, participants were arbitrarily assigned to three groups: 128 participants had low (LO) ratios (0.65-0.84), 408 had average (AV) ratios (0.85-1.14), and 78 had high (HI) ratios (1.15-1.34). Secondary analysis showed that the training program significantly increased mean VO2max of all three groups. Those who had a smaller increase in training PO (LO) had significantly less increase in VO2max than those with larger increases in PO (HI). CONCLUSION: People who exercise at a HR associated with the same %VO2max can vary substantially in their training PO, in their rate of increase in PO over a 20-wk training program, and in improvement of their VO2max.     

The cost of family-oriented communication before air medical interfacility transport

INTRODUCTION: Family-oriented communication with parents by transport teams eases the stress associated with transferring children to tertiary care. This study was conducted to determine the duration of family-oriented visits and whether the visit contributed significant cost to the mission. METHOD: Data collection was prospective and double-blind; questions were incorporated into another study. Subjects were infants or children requiring assisted ventilation and air transport to tertiary care. Time from completion of stabilization to departure and reasons for any delay were recorded. Cost of contact time longer than 20 minutes (total acceptable time for family visit and transfer to vehicle) was calculated at paramedic overtime at $0.82/minute and aircraft wait time at $200/hour if incurred. RESULTS: Forty-six patients were enrolled. In 16 cases (35%), time between completing stabilization and hospital departure exceeded 20 minutes, with "family visit" listed as the explanation. Nine of these visits incurred overtime, and two incurred aircraft wait costs. Total costs for providing communication visits more than 10 minutes long were $607 or approximately $13 per patient. CONCLUSION: The costs for visit time longer than 10 minutes are small compared with the documented benefits of family-oriented communication. However, transport personnel must be mindful of the potential to incur additional cost through overtime, aircraft wait time, or pilot replacement.     

Pulmonary hemorrhage in neonates of early and late gestation

Our objectives in this study of pulmonary hemorrhage (PH) were to define common characteristics of infants who develop PH, identify factors associated with PH and report the outcome. Neonates (42/2980 admissions) with PH and matched controls were identified. Early gestation (< or = 35 weeks) infants with PH [EGPH] (n = 34; 12 survived) had occurrence of PH at 3.6 +/- 1.1 (mean +/- sem) days and were significantly associated with multiple births (p = 0.03), RDS (p < 0.01) and use of Survanta (p < 0.02). Among EGPH, small for gestational age (SGA) infants (n = 7) had a 100% mortality rate. Late gestation (> or = 36 weeks) infants with PH [LGPH] (n = 8; 6 survived) had occurrence of PH at 0.7 +/- 0.3 days and were significantly associated with low 1 minute (p = 0.04) and 5 minutes (p = 0.01) Apgar scores. All infants were managed with increases in mean airway pressure (MAP) and/or use of cocaine/epinephrine through the endotracheal tube. We have identified 2 groups of neonates with distinct factors associated with PH; use of 1:10,000 epinephrine (0.1 ml/kg) and/or 4% cocaine (4 mg/kg) may be useful adjuncts to increases in MAP for management of PH.     

Identification of N-myc regulatory regions involved in embryonic expression.

Our knowledge on the regulation of the N-myc proto-oncogene expression comes mostly from in vitro studies. Very few in vivo analyses have been performed to identify the regulatory elements involved in N-myc developmental expression. In the present study, we defined DNA regions required for the regulated expression of N-myc during early embryogenesis. We showed that the expression of N-myc driven by the human N-myc sequences previously described to control N-myc expression in appropriate cell types in vitro cannot rescue the mouse N-myc mutant phenotype, suggesting that regulatory elements necessary for N-myc embryonic expression were missing. To identify the regulatory DNA regions involved in N-myc expression, transgenic mouse lines carrying N-myc/lacZ reporter constructs were generated. Beta-galactosidase staining analysis at different stages of gestation revealed that >16 kb of mouse N-myc genomic sequences are required to recapitulate the entire spatiotemporal expression pattern of the endogenous N-myc gene between embryonic d 8.5 and 11.5. This observation supported the notion that the sequences previously identified by in vitro assays were not sufficient to reproduce the N-myc embryonic expression pattern. However, regulatory elements that can direct specific expression in the visceral arches, the limb buds, the CNS, and the dorsal root ganglia are included into the mouse N-myc genomic sequences tested. Altogether, these findings indicated that the regulation of the spatiotemporal expression pattern of N-myc during development necessitates multiple regulatory DNA elements.     

Decreased amounts of antibodies to 22 and 18 kDa antigens in the peritoneal fluid of patients with endometriosis

Accumulated evidence implicates immunological alterations inendometriosis. The purpose of this study was to look for variationsin antibodies to distinct antigens in peritoneal fluid of womenwith and without endometriosis. Peritoneal fluid was aspiratedfrom 17 women undergoing laparoscopy for tubal ligation and37 patients complaining of symptoms of pain and/or infertility.Peritoneal fluid antibodies to a standard preparation of peritonealfluid antigens were detected by Western blot analysis usingperoxidase-labelled anti-human immunoglobulin G antibodies specificto the Fc region. Antibodies to distinct antigens were quantifiedby estimating the ratio of the relative optical density betweensamples and a standard amount of antibodies. Marked changeswere found in the antibody detection to two antigens havingapparent molecular weights of 22 and 18 kDa. The intensity ofthe antibody signal was significantly weaker in the peritonealfluid from endometriosis patients (0.36 ± 0.06 and 0.46± 0.06) compared with that in women without endometriosis(0.62 ± 0.08 and 0.75 ± 0.06). It was also weakerin patients without endometriosis presenting with infertility(036 ± 0.07 and 0.47 ± 0.08), but only the 18kDa antigen result was significant After adjusting for infertility,the P values for the 18 and 22 kDa bands were 0.03 and 0.28(not significant) respectively in the group of endometriosispatients. These changes were not related to the phase of themenstrual cycle. These data suggest an alteration in the immuneresponse to two distinct antigens in the peritoneal fluid fromwomen with endometriosis and infertility. Further evaluationof these two antigens and their antibodies would be of interestto help understand endometriosis and its associated infertility.     

A case of viral neonatal calf diarrhea in a Quebec dairy herd

This report is concerned with a consistent problem of neonatal calf diarrhea (NCD) in a dairy herd in which, for nearly two years, the morbidity had approached 100% and the mortality had varied from 20% to 45%. Generally, diarrhea appeared at three days of age. By the fluorescent antibody tissue section technique the two Nebraska NCD viruses (reo-like and corona-like) were detected in the cytoplasm of many absorptive cells of the small intestine from a calf submitted for necropsy. Reo-like virus antigen was not detected in the absorptive and crypt cells of the colon but coronavirus-like antigen was. An adenovirus was also isolated from the small intestine of this calf. The disease was reproduced experimentally in a two day old colostrum deprived calf with a bacteria free intestinal homogenate obtained from the naturally infected calf. Both Nebraska NCD viruses were demonstrated in this experimental animal. However, the adenovirus was not re-isolated. Histological lesions observed in the small and large intestines of the naturally and experimentally infected calves were similar and because of their good correlation with the immunofluorescent findings, a combination of the two Nebraska NCD viruses was thought to be a major cause of the neonatal calf diarrhea problem afflicting this dairy herd.