Postoperative Apnea in Former Preterm Infants after Inguinal Herniorrhaphy: A Combined Analysis

Background: Controversy exists as to the risk for postoperative apnea in former preterm infants. The conclusions of published studies are limited by the small number of patients.

Methods: The original data from eight prospective studies were subject to a combined analysis. Only patients having inguinal herniorrhaphy under general anesthesia were included; patients receiving caffeine, regional anesthesia, or undergoing other surgical procedures were excluded. A uniform definition for apnea was used for all patients. Eleven risk factors were examined: gestational age, postconceptual age, birth weight, history of respiratory distress syndrome, bronchopulmonary dysplasia, neonatal apnea, necrotizing enterocolitis, ongoing apnea, anemia, and use of opioids or nondepolarizing muscle relaxants.

Results: Two hundred fifty-five of 384 patients from eight studies at four institutions fulfilled study criteria. There was significant variation in apnea rates and the location of apnea (recovery room and postrecovery room) between institutions (P < 0.001). There was considerable variation in the duration and type of monitoring, definitions of apnea, and availability of historical information. The incidence of detected apnea was greater when continuous recording devices were used compared to standard impedance pneumography with alarms or nursing observations. Despite these limitations, it was determined that: (1) apnea was strongly and inversely related to both gestational age (P = 0.0005) and postconceptual age (P < 0.0001); (2) an associated risk factor was continuing apnea at home; (3) small-for-gestational-age infants seemed to be somewhat protected from apnea compared to appropriate- and large-for-gestational-age infants; (4) anemia was a significant risk factor, particularly for patients > 43 weeks' postconceptual age; (5) a relationship to apnea with history of necrotizing enterocolitis, neonatal apnea, respiratory distress syndrome, bronchopulmonary dysplasia, or operative use of opioids and/or muscle relaxants could not be demonstrated.     

Validity in hermeneutic phenomenological inquiry: towards an ethics of evaluation.

This article explores the relationship of ethics to validity in hermeneutic phenomenological inquiry. First, the authors present a brief overview of the various discourses on validity in qualitative research that have been variously applied to hermeneutic phenomenological inquiry. Next, they examine how relational ethics is a presence to bear within this form of inquiry. Finally, they offer a set of ethical reflections to help the researcher engage in a process of ethical questioning during each step of the research process.     

Becoming a mother — an analysis of women's experience of early motherhood

This paper presents the results of a qualitative study conducted by midwife researchers into women's experience of new motherhood. Data were collected using focus groups involving 55 first-time mothers and analysed using grounded theory method. The analysis produced six categories: 'realizing', 'unready', 'drained', 'aloneness', 'loss' and 'working it out'. The core category, 'becoming a mother', integrates all other categories and encapsulates the process of change experienced by women. Also explained are factors mediating the often distressing experience of becoming a mother. The analysis provides a conceptualization of early motherhood enabling the development of strategies for midwives, nurses and others helping women negotiate this challenge.     

Nutritional considerations in intravenous drug misusers: a review of the literature and current issues for dietitians

Poor nutritional status and inadequate dietary intake in intravenous drug misusers (IVDMs) is a well-recognized problem among those involved in their care. However, there are very few published studies to substantiate these observations. This paper provides a review of the current literature and outlines the aims of dietary advice for IVDMs.     

Promotion of mouthguards among amateur football players in Victoria

Abstract: Wearing mouthguards while playing contact sports reduces the prevalence and severity of orofacial injuries. We report on a 1991–92 promotion of mouthguard use among amateur football players in Melbourne. Four questionnaires were completed by players (1991 season: middle: n =638, 49 per cent response; late: n =770, 51 per cent; 1992: early: n =505, 26 per cent; late: n =698, 54 per cent), in four age groups (16–19, 20–23, 24–29, 30–44 years), about perceived mouthguard value and usage, injury experience, and awareness of a promotional message. Over the two seasons, mouthguard ownership and consistent wear increased and dental injuries decreased. Ownership of mouthguards increased among: 20–23 year olds and 30–44 year olds (13 and 16 per cent); managers, tradespersons, salespersons, labourers and the unemployed (14–19 per cent); residents of northern and western regions (12 and 13 per cent); those with 6 to 10 years of education (29 per cent); players in old boys' networks (13 per cent); and those with English as a first language (8 per cent). Consistent wear was high at matches (89 per cent) but low at training (13 per cent), owing to perceived lack of physical contact. Of dental injuries reported by 25–31 per cent, fractures predominated over luxations and avulsions. Fractures and avulsions were more common at matches than training; luxations predominated at training. When a mouthguard was not worn, the likelihood of a fractured or avulsed tooth was at least twice that when a mouthguard was worn. Some injuries occurred despite the wearing of mouthguards. The promotional message appeared effective in increasing mouthguard use; newspapers and football journals provided effective message locations for players, and ground signs and the electronic scoreboard for spectators.     

Insights from latent partition analysis into categories inherent in wellness-illness

How health–disease is perceived or conceptualized is important for nursing research There is increasing evidence that individual representations are important in constructing the experience of health–disease What is the personal saliency of health–disease for the individual? To explore the patterns of meaning inherent in health–disease, a card sort was undertaken among 15 healthy individuals and 15 individuals with chronic renal disease Both groups were given 28 cards to sort twice once for when they felt ‘well’ and again for when they felt ‘ill’ The theoretical basis underlying the items of the card sort was a model of wellness-illness being developed Latent partition analysis was used to cluster the concepts from each data set followed by multi-dimensional scaling to analyse the structure of the intercategory probability estimates A possible unidimensional pattern of meaning (harmony) emerged for the ‘well’ data and a two-dimensional pattern (disharmony and optimism) for the ‘ill’ data This represents a preliminary step in the development of a theoretical model that would permit assessment of the meaning of health–disease for the individual     

Developing the occupational stress indicator (OSI) for use in Brazil: A report on the reliability and validity of the translated OSI

The Occupational Stress Indicator (OSI) was translated into Brazilian Portuguese and administered to a sample of 84 white-collar workers in Brazil. Five of the six scales of the OSI (job satisfaction, mental and physical health, coping, type A behaviour, sources of stress) showed acceptable reliability. The reliability of the sixth scale (locus of control) was disappointing, in keeping with earlier findings that suggest that this scale requires further development. Alternative measures of the stress outcomes — job satisfaction, mental health and physical health — were taken in order to assess the construct validity of these three scales. These measures included translations of the Hackman-Oldham job satisfaction measure and the Crown–Crisp Experiential Index, as well as subjective measures of health-related behaviours. Correlational and multivariate analyses of these data suggested that the job satisfaction, mental health and physical health scales of the OSI had good validity, with the physical health measure probably including a psychosomatic component. These findings are promising for the development of a new version of the OSI designed for use in South America.     

Chemotherapy of L1210 and L1210/ARA-C leukemia with 5-aza-2′-deoxycytidine and 3-deazauridine

Summary The in vitro and in vivo antineoplastic activity of 5-aza-2-deoxycytidine (5-AZA-dCyd) and 3-deazauridine (3-DU) against L1210 and L1210/ARA-C (resistant to cytosine arabinoside) leukemic cells were investigated. L1210/ARA-C cells were more sensitive to the inhibitory effects of 3-DU than L1210 cells. Deoxycytidine completely reversed the in vitro cytotoxic effects produced by 3-DU on L1210 cells, but not those produced in L1210/ARA-C cells. L1210/ARA-C cells, which are deficient in deoxycytidine kinase, were completely resistant to the antileukemic effects of 5-AZA-dCyd, whereas this analogue produced a very potent antileukemic effect against L1210 cells. To study the in vivo interaction of 5-AZA-dCyd and 3-DU with respect to drug resistance, mice were simultaneously injected i. v. with 10⁴ L1210 cells plus 10² L1210/ARA-C cells. A 9-h i. v. infusion of 5-AZA-dCyd (12.8 mg/kg) or 3-DU (186 mg/kg) produced an increase in life span of 56% and 26%, respectively. However, the sequential administration of 5-AZA-dCyd followed by 3-DU produced a 265% increase in life span and 7/10 longterm survivor, a very potent antileukemic effect. These results suggest that 3-DU is an excellent agent for use in combination chemotherapy to overcome drug resistance to the deoxycytidine analogue, 5-AZA-dCyd.This investigation was supported by grant MA-6356 from the Medical Research Council of Canada and by LEUCAN     

Hyper-recombination and mutator effects of the mms9-1, mms13-1, and mms21-1 mutations in Saccharomyces cerevisiae

Summary Spontaneous mitotic intragenic and intergenic recombination at various sites is enhanced 10 to 100 fold in the methyl methanesulfonate (MMS)-sensitive mutants mms9-1, mms13-1, and mms21-1 of Saccharomyces cerevisiae. All three mutants show elevated rates of spontaneous mutation. Sporulation is reduced in diploids homozygous for any of the three mutations, and a deficiency in meiotic recombination and meiotic chromosome segregation is observed. Pleiotropic effects on cell viability, growth rate, and radiation sensitivity, in combination with the alterations in recombination and mutagenesis displayed by mutant strains, suggest that the MMS9, MMS13, and MMS21 genes play important roles in DNA replication and/or genetic recombination.