A randomized, controlled trial of nurse home visiting to vulnerable families with newborns

OBJECTIVE: This project aimed to evaluate the impact of a home visiting programme that targeted families where the child, for environmental reasons, was at great risk of poor health and developmental outcomes. METHODOLOGY: Women in the immediate postpartum period were recruited to a randomized double-blind controlled trial on the basis of self-reported vulnerability factors and were randomly assigned to receive either a structured programme of nurse home visiting, supported by a social worker and paediatrician (n = 90), or assigned to a comparison group receiving standard community child health services (n = 91). Parenting stress and maternal depression were measured at enrollment and at 6 weeks. Preventive health behaviour, service satisfaction and home environment outcomes were tested at 6 weeks, as were child health outcomes. RESULTS: At six weeks, women receiving the home-based programme had significant reductions in postnatal depression screening scores as well as improvements in their experience of the parental role and improvement in the ability to maintain their own identity. Maternal-infant interactions were more likely to be positive, with significantly higher (better) scores in aspects of the home environment related to optimal development in children, particularly maternal-infant secure attachment. Intervention group mothers were significantly more satisfied with the community child health service. CONCLUSIONS: This form of intervention for families is effective in promoting secure maternal-infant attachment, preventing maternal mood disorder and is welcomed by the families receiving it. These findings may predict long-term benefits for the healthy development of children otherwise at risk of a range of poor health and development outcomes.     

Dual marker one day pancreolauryl test

There is a pressing need for a simple non-invasive test of exocrine pancreatic function for use in children. The pancreolauryl test has been modified by the addition of a second marker (mannitol) to achieve a single day test without the need for two timed urine collections. Six healthy subjects and nine patients with cystic fibrosis were studied. Fluorescein, fluorescein dilaurate, and mannitol were taken by mouth, alone or in combinations, followed by 10 hour urine collections in two hourly aliquots to study the comparative pharmacokinetics of these markers. Urinary fluorescein was determined spectrophotometrically and urinary mannitol enzymatically. When fluorescein dilaurate and mannitol were taken together and the results expressed as ratios of percentage fluorescein to percentage mannitol recovery (F:M ratio) (mean (SD)) there was clear discrimination between healthy subjects and those with cystic fibrosis regardless of enzyme replacement treatment (57.3 (18.2) v 3.4 (1.4) v 3.2 (1.6) respectively). The differences in F:M ratios reached statistical significance in urinary aliquots collected between two and eight hours after marker ingestion. This single day tubeless test will greatly simplify the investigation of the child with suspected exocrine pancreatic dysfunction.     

Diet and the risk of vulvar cancer.

In this case-control study, 201 case patients with vulvar cancer and 342 community control subjects responded to a 61-item food frequency questionnaire. Risk was unrelated to intake of dark green vegetables, citrus fruits, legumes, and vitamins A and C and folate. Risk increased modestly with decreased intake of dark yellow-orange vegetables; the relative risk for the lowest versus the highest quartile was 1.6. Analyses using preliminary determinations of the major carotenoids in common fruits and vegetables suggested that alpha carotene might be the protective constituent in dark yellow-orange vegetables. Intake of beta carotene and provitamin A carotenoids was unrelated to risk. Multivitamin users were at lower risk, compared to nonusers, but no trend was observed with increasing years of use, suggesting that this association was due to unmeasured differences in life-style factors. Risk increased irregularly with the number of cups of coffee consumed per week whereas consumption of alcohol was unrelated to risk.     

Abdominal venous system: assessment using MR

Twenty-five patients with known or suspected evidence of venous disease based on results of computed tomography, angiography, or ultrasound were imaged with magnetic resonance (MR) to determine the MR characterization of venous abnormalities. MR findings were proved by laparotomy or autopsy in 18 of 25 cases. In seven of 25 patients in whom only biopsy was performed, the MR findings were correlated with findings from other radiologic tests. On MR, the inferior vena cava (IVC), portal vein, and their major tributaries were seen in all but two cases. In those two, identification of collaterals led to the correct diagnosis of splenic vein thrombosis in one case and left renal vein thrombosis in another. MR imaging helped identify intraluminal thrombi in the IVC (12 of 12 cases), portal vein (two of two cases), renal veins (seven of seven cases), superior mesenteric vein (one case), and iliac veins (seven of seven cases). Intraluminal signal intensity secondary to slow blood flow seen in five patients was always differentiated from the thrombus. MR imaging helped identify correctly the nature of the thrombus in 11 of 16 patients. In five patients, the differentiation between tumor thrombus and blood clot thrombus was not possible. Involvement of the IVC wall by tumor was seen in four cases. MR imaging also accurately depicted slow flow in obstructed or constricted veins; encasement, compression, or displacement of veins without intraluminal occlusions; and the presence of venous collaterals. The MR imaging evaluation of venous abnormalities is accurate, easily performed, and will probably become an important application.     

间硝地平对高血压心肌肥厚老龄鼠肾和肺细胞膜二氢吡啶受体的影响

间硝地平对高血压心肌肥厚老龄鼠肾和肺细胞膜二氢吡啶受体的影响徐毅，奚涛，饶曼人（南京医科大学心血管药理研究室２１００２９）间硝地平（ｍ－ｎｉｆｅｄｉｐｉｎｅ，ｍ－Ｎｉｆ）系我国研制的二氢吡啶（ＤＨＰ）类钙拮抗剂，有扩张血管、降低血压和逆转高血压心肌肥...     

前胡丙素对培养乳鼠心肌细胞自发性收缩及动作电位的影响

用倒置显微镜闭路电视系统及细胞内标准微电极法,记录培养心肌细胞的自发性收缩及动作电位,结果发现:应用Pra-C5min后,心肌细胞收缩频率及细胞边缘运动的速度同时下降。Pra-C10,30和100μmol·L^-1剂量依赖性的方式抑制心肌细胞的收缩速度,分别抑制24%,43%和50%。pra-C(10和30μmol·L^-1)显示了抑制心肌细胞收缩频率的作用,分别抑制13%和19%。Nif3μmol.L^-1分别缩短APD₅₀和APD₉₀14%及17%,但同样浓度的verapatmil则抑制APA27%,缩短APD₅₀8%,分别延长APD90及SCL10%和43%。Pra-C10,30和100μmol·L^-1缩短APD₅₀7%,14%和18%。Pra-C100μmol·L^-1有抑制APA及延长SCL的作用。结果提示,Pra-C对心肌细胞收缩及动作电位的作用可能与其阻滞Ca²⁺通道有关。