FINDING MEANING IN A CHILD'S VIOLENT DEATH: A FIVE-YEAR PROSPECTIVE ANALYSIS OF PARENTS' PERSONAL NARRATIVES AND EMPIRICAL DATA

Finding meaning in the death of a loved one is thought to be extremely traumatic when the circumstances surrounding the death is perceived to be due to negligence, is intentional, and when the deceased suffered extreme pain and bodily harm immediately prior to death. We addressed this assumption by obtaining personal narratives and empirical data from 138 parents 4, 12, 24, and 60 months after an adolescent's or young adult child's death by accident, suicide, or homicide. Using the Janoff-Bulman and Frantz's(1997) framework ofmeaning-as-comprehensibility and meaning-as-significance, the purposes were to identify the time course to find meaning, present parents' personal narratives describing finding meaning in their experiences, identify predictors of finding meaning, and compare parents who found meaning versus those who did not on five health and adjustment outcomes. The results showed that by 12 months postdeath, only 12% of the study sample had found meaning in a child's death. By 60 months postdeath, 57% of the parents had found meaning but 43% had not. Significant predictors of finding meaning 5 years postdeath were the use of religious coping and support group attendance. Parents who attended abereavement support group were 4 times more likely to find meaning than parents who did not attend. Parents who found meaning in the deaths of their children reported significantly lower scores on mental distress, higher marital satisfaction, and better physical health than parents who were unable to find meaning. Recommendations for future research are made.     

The prevalence of disability from chronic conditions due to injury among adults ages 18-69 years: United States, 1994

Purpose: To describe the causes and determine the prevalence of disability from chronic conditions due to injury among US civilian non-institutionalized persons aged 18-69 years. Methods: Data from the National Health Interview Survey Disability (NHIS-D) Supplement Phase I, United States 1994 were analysed and six disability categories were examined: activities of daily living (ADL), instrumental activities of daily living (IADL), functional activities (FA), sight, hearing, and communication. Results: In 1994, 5.6 million persons aged 18-69 years reported a disability because of a chronic condition that was caused by injury. The prevalence of ADL disability due to chronic conditions caused by injury was 370 per 100000 population; IADL disability was 1256; FA disability was 2512; sight was 231; hearing was 339; and communication was 91 per 100000 population. Fifty per cent of ADL, IADL, and FA disabilities were attributed to motor vehicle crashes and falls, as were 31% of sight, 19% of hearing, and 23% of communication disabilities. Conclusions: Though these estimates may be conservative, this study indicates that injury is a major cause of disability in addition to a leading cause of death in the US.     

Antibodies Reactive to Trypanosoma cruzi Epimastigotes or Amastigotes Express Different Idiotypic Patterns if from Patients with Different Clinical Forms of Chagas' Disease

Antibodies (Abs) were purified from pooled sera of patients with either indeterminate (IND or I) or cardiac (CARD or C) Chagas' disease, on either epimastigote (EPI or E) or amastigote-enriched (AMAST or A) antigen (Ag) columns and their idiotypic (Id) expression examined. Anti-Id rabbit Abs were raised to the different preparations (E-IdI, E-IdC, A-IdI and A-IdC). Competitive ELISAs using anti-Ids were able to discriminate between IdI and IdC, disregarding Ag reactivity. E-IdI and A-IdI present different inhibitory abilities, as do E-IdC and A-IdC, but IdC always competes with IdI for anti-IdI comparably. In contrast, a 4–8-fold increase of IdI is required to compete in parallel with IdC for anti-IdC. Therefore, Ids from IND patients share only low levels of the Ids that are most characteristic of CARD patients. While some CARD Abs also express Ids in common with IND patients, these studies reveal that CARD Abs express some Ids that are characteristic to only CARD patients, and these Ids are present on Abs purified with either EPI or AMAST.     

RESTORATION OF BAROREFLEX CONTROL OF HEART RATE DURING RECOVERY FROM ANAESTHESIA

The effects on baroreflex control of heart rate of halothaneor methohexitone used to supplement 67% nitrous oxide in oxygenhave been studied in 21 patients. Stable anaesthesia with eitheragent caused depression of baroreflex sensitivity by more than50%. The set point of the reflex was also changed by both agents,but in opposite directions. Halothane administration resultedin slower heart rates at lower arterial pressures, whereas theinfusion of methohexitone caused faster heart rates at lowerarterial pressure. During recovery from anaesthesia, there wasa rapid return of baroreflex sensitivity to normal and thiswas achieved before the patients regained consciousness, withno difference between the two groups. The reflex was reset rapidlyand repeatedly during the recovery phase.     

The effect of oxytocin infusion on uterine activity levels in slow labour

Summary. Uterine activity was studied in 31 women who were progressing slowly in spontaneous labour. In 75%, levels of uterine activity were below the tenth centile for normal spontaneous labour (mean uterine activity integral, UAI, 593 kPas/15 min; SD 296). Following oxytocin infusion, there was a significant increase in uterine activity to a mean of 1124 kPas/15 min (SD 276), which was t h e same as in normal spontaneous labour. The response t o oxytocin was dependent upon the pre-existing level of uterine activity, and sensitivity to oxytocin, rather than the dose rate; 84% responded t o infusion rates of < 8 mU/min. The response t o oxytocin was best expressed in terms of active contraction area (uterine activity integral, UAI) or Montevideo units, rather than the frequency or active pressure of contractions. The rate of cervical dilatation following oxytocin augmentation could not be predicted either by t h e increase in uterine activity or by the actual level of activity achieved.     

Long-term performance of Tec vaporizers

We reviewed the maintenance records of Tec vaporizers which had been in clinical use for up to 4 years. Tec 4s and Enfluratec 3s were found to be extremely reliable, but Fluotec 3s suffered progressively from mechanical and calibration problems. Their most recurrent fault was sticking valves caused probably by thymol crystallizing on the valve faces. This fault did not occur with Fluotec 4s, which are designed to prevent liquid agent reaching the valve surfaces. We found, in a study of the effects of thymol accumulation, that only occasional draining of a Fluotec vaporizer is required to keep thymol concentration below the level at which its output is reduced. We conclude that, if regular field calibration checks are carried out as a safety measure, the service interval for Tec vaporizers could be extended beyond Ohmeda's present recommendation of one year.     

Selenium, rubidium and zinc in human semen and semen fractions

The levels of selenium, rubidium and zinc were determined in samples of semen, seminal plasma and spermatozoa from men with suspected infertility, together with several parameters of semen quality. The proportion of whole semen selenium present in sperm increased with increasing sperm count from 0 to 40%. For rubidium 98 +/- 4% and for zinc 95 +/- 8% of the total amount in semen was contained in seminal plasma. In seminal plasma a positive correlation was found between the levels of zinc and selenium, and between the levels of zinc and rubidium, indicating that, like zinc, selenium and rubidium in seminal plasma also derive mainly from the prostate gland. Semen quality parameters, such as sperm motility, vitality, speed and morphology, were not correlated with the contents of the three elements in either whole semen or seminal plasma. As the seminal content of selenium is dependent on the proportion of prostatic secretion in seminal plasma and on the sperm count, and both factors can vary considerably, the selenium level of whole semen does not appear to be a suitable parameter for investigation of the relationship between selenium and semen quality. Provisional measurements suggest lower sperm selenium levels at abnormally low or high sperm counts.     

Ookinete antigens of Plasmodium berghei. Appearance on the zygote surface of an Mr 21 kD determinant identified by transmission-blocking monoclonal antibodies

Zygotes and ookinetes of the rodent malaria Plasmodium berghei can be enriched 50-fold, from whole blood cultures by ammonium chloride lysis. Three monoclonal antibodies (MoAbs) raised against such enriched preparations specifically bind to a determinant of Mr 21 kD as assessed by 125I-labelled goat anti-mouse IgG probed immunoblots of Western transfers of SDS-PAGE gels. Indirect immunofluorescence indicates that the 21 kD determinant bound by specific MoAbs, whilst not detectable on gametocytes or gametes, appears on the parasite surface within 2 h of exflagellation/fertilization and increases thereafter. The three MoAbs specifically binding the 21 kD determinant block oocyst development in mosquitoes by at least 90%, as assessed either by in-vitro membrane feeds or by live feeds on passively immunized mice. These MoAbs reduce ookinete formation in vitro by between 52 and 100%. Possible mechanisms of action of these MoAbs are discussed.