Clinical and ultrasonographic weight estimation in large for gestational age fetus

OBJECTIVE: To examine prospectively the effect on pregnancy outcome of a management protocol, that adds ultrasonographic weight estimation in fetuses suspected clinically as large. STUDY DESIGN: Prospective follow up study of all singleton deliveries during a 1 year period. All patients underwent routine clinical estimation of fetal weight. When clinical estimation of fetal weight was > or = 3700 g, patients were referred for ultrasonographic estimation of fetal weight. When the latter was > or = 4000 g the patient was informed about the risks of birth trauma. Cesarean section was recommended only when > or = 4500 g. Ultrasonography was repeated every 4 days when possible. Predictive values of clinical and ultrasonographic estimations of fetal weight for diagnosing macrosomia, defined for the purpose of this study as 4000 g or more, and their effect on the rate of cesarean sections. RESULTS: Five hundred fifty-five (14.4%) out of 3844 singletons were estimated as 3700 g or more. Only 315 fetuses had ultrasonographic estimation of weight within 3 days of delivery. The sensitivity of clinical and ultrasonographic prediction of macrosomia was 68 and 58%, respectively. Cesarean section rate in newborns weighing 4000 g or more was 22% when macrosomia was clinically suspected compared to 11% when it was not (P<0.05). In fetuses estimated ultrasonographically as 4000 g or larger the cesarean section rate was doubled (50.7% versus 24.9%, P<0.05) compared to those estimated as smaller than 4000 g, although actual weight of 4500 g or more was recorded in 10.6 and 8.5% of these groups, respectively. There were no cases of shoulder dystocia in macrosomic babies when macrosomia was not detected by ultrasound compared to two cases of shoulder dystocia (2.7%) when macrosomia was detected by ultrasound. CONCLUSION: Antenatal suspicion of macrosomia increased the cesarean section rate while the associated improvement in pregnancy outcome remains questionable. The contribution of ultrasound, added to routine clinical estimation of fetal weight, was clinically insignificant apart from a further increase in cesarean section rate.     

Predictors of bereaved parents' satisfaction with group support: an Israeli perspective

This study evaluates various aspects of groupwork with bereaved parents who lost a child during military service. More specifically, it assesses the unique and cumulative contributions of various features of groupwork to the participants' satisfaction with the group support. One hundred and thirty-eight bereaved parents, who participated in 16 support groups, answered a battery of questionnaires tapping 3 aspects of the groupwork: their motives for joining the group, the interpersonal relations among the group members, and the group leadership style. In addition, the participants were asked to evaluate the contribution of the intervention to their adjustment. The findings indicate that the supportive elements of the intervention were associated with the groups' perceived contribution. The clinical implications of these results are discussed.     

Seroepidemiology of hepatitis A antibodies among children's hospital staff

BACKGROUND: With improved socioeconomic conditions, adults are more frequently seronegative for hepatitis A virus (HAV) and therefore susceptible to infection. A safe and efficacious active HAV vaccine has been developed and licensed. The general recommendation is to vaccinate populations at increased occupational exposure to HAV. AIM: To determine the seroprevalence of HAV antibodies among children's hospital employees and to correlate seropositivity with demographic and occupational variables as a basis for formulating vaccine recommendations. METHODS: The staff of a tertiary pediatric medical center participated by answering a structured questionnaire on demographic and occupational data and by donating venous blood for determining HAV antibodies by an enzyme immunoassay. Univariate and multivariate analyses were conducted to identify variables associated with HAV seropositivity. RESULTS: HAV antibodies were found in 48.3% of the 499 employees studied, being lowest in pediatricians (38.7%), and increased with years of work at the hospital, job percentage and contact with pediatric patients. However, multivariate analysis showed that only the sociodemographic variables (age and crowding during childhood) were independently and significantly associated with seropositivity. CONCLUSIONS: HAV seropositivity was associated mainly with sociodemographic variables. Most children's hospital employees, especially pediatricians and other young (<40 years) employees, are seronegative and therefore susceptible to HAV. Vaccination of the high risk groups should be considered.     

Identification of feigned shoulder flexion weakness in normal subjects

OBJECTIVE: The purpose of this study was to compare the effect of three related test protocols on the power of a specific index relating to the difference between the eccentric to concentric strength ratios (DEC) to identify feigned shoulder flexion effort. DESIGN: Seventeen normal subjects were instructed to exert maximal concentric and eccentric shoulder flexion effort and then to feign weakness, pretending the presence of a shoulder injury. RESULTS: For both range of motions (ROMs), the DEC scores in the feigned effort were significantly greater than their maximal counterparts. A case by case analysis revealed that the DEC correctly identified 100% of the feigned efforts when derived from the 40 and 160 degrees/sec combination. CONCLUSIONS: The findings indicate that the DEC retains its efficiency even under very short muscle length variation as long as adequate velocity gradients are applied. Consequently, maximality of effort may be tested outside compromised ROMs, particularly where pain or instability denies the performance of a standard full ROM protocol.     

Prevention of Staphylococcus aureus biofilm on dialysis catheters and adherence to human cells

BACKGROUND: Dialysis patients, often carriers of Staphylococcus aureus in their nares, are at high risk of S. aureus infections. METHODS: We examined whether RNAIII inhibiting peptide (RIP), which interferes with quorum sensing mechanisms, reduces adherence of S. aureus to host cells and to dialysis catheter polymers in vitro. Adherence was tested by spectroscopy using safranin staining, by confocal scanning laser microscopy and by atomic force microscopy. RESULTS: RIP inhibited bacterial adherence to HaCat and HEp-2 cells and reduced adherence and biofilm formation not only on polystyrene, but also on both polyurethane- and silicone-made dialysis catheters, with a preponderant effect on silicone, to which bacteria were more adherent. CONCLUSION: RIP opens a new perspective in anti-S. aureus prophylaxis, particularly in dialysis patients.     

The sequence of vessel interruption during lobectomy for non-small cell lung cancer: is it indeed important?

OBJECTIVE: During pulmonary resections for non-small cell lung cancer, the pulmonary vein is traditionally interrupted first to prevent seeding of malignant cells and consequently decrease metastatic implantation. This hypothesis was never confirmed scientifically. The aim of the present study was to determine whether the sequence of vessel interruption during lobectomy (lobar vein or lobar artery first) affects disease recurrence. METHODS: A historical prospective study was performed of 279 consecutive patients with complete follow-up, who survived lobectomy for non-small cell lung cancer during 1992 to 1998, in a single center. Pre-, intra-, and postoperative variables were collected from the medical records; recurrence and vital status were obtained from follow-up files, central population registry, and personal confirmation, updated to December 2000. Comparison of recurrence rates by sequence of ligation and other independent variables was assessed by univariate and multivariate logistic regression analyses. RESULTS: A total of 133 patients (48%) had vein interruption before the artery (V-first) and 146 (52%) had artery interruption first (A-first). The distribution of demographic, clinical, and other characteristics was similar between the 2 groups, except for the operated side and performing surgeons. The morbidity, blood requirement, and length of stay were equal for both groups. The total recurrence rate (A-first, 53%; V-first, 51%) was similar. Multivariate analysis (controlling for the effect of the performing surgeon) revealed elevated risk for recurrence among patients with high disease stage (odds ratio = 2.54), male gender (odds ratio = 1.59), intraoperative lung manipulation (odds ratio = 2.72), and blood transfusion (odds ratio = 1.49). Sequence of vessel interruption was not found as a risk factor for recurrence (odds ratio = 1.29; 95% 0.73 to 2.29, P =.4). CONCLUSIONS: Our results did not show that sequence of vessel interruption during lobectomy plays a role in tumor recurrence. A prospective study with randomization in selection of method as well as surgeons for each patient is needed to confirm these results.     

Elderly people's ratings of the importance of health-related factors to their self-assessments of health

Identifying the bases for self-assessed health (SAH) has interested researchers in their attempts to understand its validity as a predictor of future health outcomes. Quantitative approaches typically used statistical methods to identify correlates of SAH while qualitative approaches asked people to elaborate on the reasons underlying their rating of health. The current study used a quantitative methodology, asking 487 elderly people to rate the importance of 42 health-related factors as bases for their SAH judgment. Factors indicating overall functioning/vitality were rated highly by all participants. Factors indicating current disease were rated highly by people reporting poor/fair SAH while risk factors and positive indicators were rated highly by those reporting good, very good, or excellent health. Thus, there seems to be a clear distinction between poor and fair SAH that reflect levels of illness, and higher levels of SAH that reflect levels of health.     

Speed of performance of children with developmental right hemisphere syndrome and with attention-deficit hyperactivity disorder

Slowness is a common complaint in children with attention-deficit hyperactivity disorder (ADHD) and with developmental right hemisphere syndrome. However, it was our clinical impression that slowness in developmental right hemisphere syndrome was more prominent than in ADHD. Our objective was to assess slowness as operationalized by speed of performance in children with developmental right hemisphere syndrome, children with ADHD, and controls. The research sample comprised 19 children in each group, matched for age, gender, socioeconomic status, IQ, and handedness. The subjects were administered a reaction time battery assessing speed of performance. Overall, the average performance differed among the three study groups (F(2,53) = 2.40, P < .01). Children with developmental right hemisphere syndrome were slower than their peers with ADHD (t(35) = 1.99, P < .05) and slower than controls (t(35) = 4.55, P < .001). Children with ADHD performed more slowly than controls, although for the majority of tasks, this was nonsignificant. We conclude that slowness is an integral and consistent component of developmental right hemisphere syndrome and cannot be attributed only to the ADHD symptomatology.