Prevention of child-to-mother transmission of cytomegalovirus among pregnant women

OBJECTIVE: To determine if protective behavior prevents child-to-mother transmission of cytomegalovirus (CMV) during pregnancy. STUDY DESIGN: We studied 166 seronegative mothers (94% white women; mean age, 33 years) with a child <36 months of age attending a day care facility. Mothers, either pregnant or attempting pregnancy, were randomly assigned by day care center to either a control or intervention group. Mothers in the intervention group received instructions for hand washing, glove use, and for avoiding types of intimate contact with their child. The control group received no instructions or information about their serologic status or whether their child was shedding CMV. RESULTS: In the intervention group, 7.8% of women (9 of 115) seroconverted, as did 7.8% of women (4 of 51) in the control group. Two independent predictors of maternal infection were (1) a child shedding and (2) a mother attempting pregnancy at enrollment. For 41 women attempting pregnancy at enrollment with a child shedding CMV, 10 of 24 became infected compared with only 1 of 17 women who were already pregnant at enrollment ( P = .008). CONCLUSIONS: For seronegative women who already know they are pregnant, intervention may be highly effective for preventing CMV acquisition.     

VA Practice Patterns and Practice Guidelines for Treating Posttraumatic Stress Disorder

Little is known about how recent ISTSS practice guidelines (E. B. Foa, T. M. Keane, & M. J. Friedman, 2000) compare with prevailing PTSD treatment practices for veterans. Prior to guideline dissemination, clinicians in 6 VA medical centers were surveyed in 1999 (n = 321) and in 2001 (n = 271) regarding their use of various assessment and treatment procedures. Practices most consistent with guideline recommendations included psychoeducation, coping skills training, attention to trust issues, depression and substance use screening, and prescribing of SSRIs, anticonvulsants, and trazodone. PTSD and trauma assessment, anger management, and sleep hygiene practices were provided less consistently. Exposure therapy was rarely used. Additional research is needed on training, clinical resources, and organizational factors that may influence VA implementation of guideline recommendations.     

Visual contrast sensitivity in deaf versus hearing populations: exploring the perceptual consequences of auditory deprivation and experience with a visual language

Early deafness in humans provides a unique opportunity to examine the perceptual consequences of altered sensory experience. In particular, visual perception in the deaf may be altered as a result of their auditory deprivation and/or because the deaf rely heavily upon a visual language (American Sign Language, or ASL, in the US). Recently, we found that deaf, but not hearing, subjects exhibit a right visual field/left hemisphere advantage on a low-level direction of motion task, a finding that has been attributed to the deaf's experience with ASL [Psychol. Sci. 10 (1999) 256; Brain Res. 405 (1987) 268]. In order to determine whether this visual field asymmetry generalizes to other low-level visual functions, in this study we measured contrast sensitivity in deaf and hearing subjects to moving stimuli over a range of speeds (0.125-64 degrees /s). We hypothesized that if ASL use drives differences between hearing and deaf subjects, such differences may occur over a restricted range of speeds most commonly found in ASL. In addition, we tested a third group, hearing native signers who learned ASL early from their deaf parents, to further assess whether potential differences between groups results from ASL use. These experiments reveal no overall differences in contrast sensitivity, nor differences in visual field asymmetries, across subject groups at any speed tested. Thus, differences previously observed between deaf and hearing subjects for discriminating the direction of moving stimuli do not generalize to contrast sensitivity for moving stimuli, a result that has implications for the neural level at which plastic changes occur in the visual system of deaf subjects.     

A comparative evaluation of substance abuse treatment: I. Treatment orientation, amount of care, and 1-year outcomes

This article first explains the conceptual framework and plan of a naturalistic, multisite evaluation of Department of Veterans Affairs (VA) substance abuse treatment programs. It then examines the effectiveness of an index episode of inpatient treatment and the effectiveness of continuing outpatient care and participation in self-help groups. The study was conducted among 3018 patients from 15 VA programs that emphasized 12-Step, cognitive-behavioral (CB), or eclectic treatment. Casemix-adjusted 1-year outcomes showed that patients in 12-Step programs were the most likely to be abstinent, free of substance abuse problems, and employed at the 1-year follow-up. Patients who obtained more regular and more intensive outpatient mental health care, and those who participated more in 12-Step self-help groups, were more likely to be abstinent and free of substance use problems at the 1-year follow-up. These findings support the effectiveness of 12-Step treatment and show that patients with substance use disorders who become more involved in outpatient care and self-help groups tend to experience better short-term substance use outcomes. Subsequent papers in this section focus on the proximal outcomes of treatment, patients with psychiatric as well as substance use disorders, patient-treatment matching effects, and the link between program treatment orientation and patients' involvement in and the influence of 12-Step self-help groups.     

葛根素对高血压患者血浆内皮素和一氧化氮的影响

目的：检测正常人与高血压病（ＥＨ）患者血浆内皮素、一气体氮的变化及葛根素对其的干预效应。方法：ＥＨ对照组口服苯磺酸氨氯地平５ｍｇ／ｄ,或合和盐酸苯那普利１０ｍｇ／ｄ,每日一次,１５ｄ为一疗程。ＥＨ伍用治疗组同时合用５％ＧＮＳ２５０ｍｌ＋葛根素注射液４００ｍｇ静滴,两组治疗前后检测血浆ＥＴ、ＮＯ水平变化。结果：ＥＨ各组血浆ＥＴ较正常人组均显著增高（Ｐ〈０．０１）,血浆ＮＯ水平及ＮＯ／ＥＴ比值除轻度Ｅ     

Long-term outcomes of alcohol use disorders: comparing untreated individuals with those in alcoholics anonymous and formal treatment

OBJECTIVE: The aim of this study was to examine how the type and timing of help received over 8 years by previously untreated problem drinking individuals were linked to drinking and functioning outcomes. METHOD: At the time of the 8-year follow-up, individuals (N= 466, 51% male) had self-selected into four groups: no treatment (n = 78), Alcoholics Anonymous (AA) only (n = 66), formal treatment only (n = 74), or formal treatment plus AA (n = 248). RESULTS: Individuals who received some type of help--AA, formal treatment or both--were more likely to be abstinent at 8 years than were untreated individuals. Although the AA only group was better off than the formal treatment only group at 1 and 3 years, the informally and formally treated groups were equivalent on drinking outcomes at 8 years. Similarly, despite the formal treatment plus AA group having been better off at 1 and 3 years than the formal treatment only group, the two formal treatment groups were comparable on drinking at 8 years. Both helped and untreated individuals improved between baseline and 1 year on drinking outcomes, but only formally treated individuals showed continued improvement over 8 years on drinking indices. Participation in AA or formal treatment during Year 1 of follow-up was associated with better drinking outcomes at 8 years. CONCLUSIONS: Individuals who obtain help for a drinking problem, especially relatively quickly, do somewhat better on drinking outcomes over 8 years than those who do not receive help, but there is little difference between types of help on long-term drinking outcomes.     

Excretory urography with iohexol: evaluation in children

A multicenter clinical study was conducted using iohexol, a second-generation nonionic contrast medium, for excretory urography performed in 130 children. Doses of iohexol (300 mg iodine/ml) ranged between 150 and 660 mgI/kg (0.5 and 2.2 ml/kg). Iohexol was tolerated well, and no significant adverse reactions occurred. Sixty-five iohexol urograms were evaluated to determine the minimum dose for adequate visualization of the kidneys and collecting systems. A dose greater than 300 mgI/kg (1.0 ml/kg) always resulted in a urogram of diagnostic quality, while visualization was insufficient for diagnosis in 10% of studies done with doses of 150-300 mgI/kg (0.5-1.0 ml/kg). Another 65 iohexol urograms were compared in a blinded manner with a similar number of studies performed using iothalamate meglumine at comparable iodine concentration and dose. Visualization of calyces and pelvoinfundibular structures achieved with iohexol was rated better with statistical significance, but there was no difference in visualization of the renal parenchyma or ureters. Use of iohexol in excretory urography may be advantageous in children who are at greatest risk for an adverse reaction to contrast media or in those most likely to benefit from use of a low osmolality contrast agent.     

Scales for the measurement of attitudes toward blood donation

Attitudes toward blood donation are frequently assumed to vary along a single dimension from unfavorable to favorable. In contrast, theories of attitude structure specify three distinct attitude components: affect, cognition, and behavior. This article describes the development of three new scales for the measurement of affective, cognitive, and behavioral components of attitudes toward blood donation. The scales were developed using the method of equal-appearing intervals and were administered to both donors of blood and nondonors. Correlations among the scales were relatively small and supported the three-component distinction. Affect was more strongly correlated with the number of prior donations than was cognition, which suggested an important role for emotional factors in blood donation. Scores on all three scales showed the attitudes of blood donors to be more favorable than those of nondonors.     

Years of potential life lost: Evaluating premature cancer death in men

Cancer is one of the most serious health concerns facing the nation. Health care policy makers who determine cancer research and treatment priorities must analyze death rates as an indicator of public health priorities. Two additional indexes that account for premature death include years of potential life lost (YPLL) and potential years of life lost per death (YPLL/D). Data for ten leading causes of cancer death in men from 1974-1983 were analyzed and the YPLL and YPLL/D corresponding to these cancers was calculated. Each cancer was then ranked from most to least significant according to each index. The analyses show that using YPLL and YPLL/D to evaluate cancer death in men results in rankings that differ from those obtained when using death rates alone. The premature death indexes, when used in combination with traditional mortality indexes, would enhance the data base used by funding agencies who select and evaluate cancer treatment and prevention programs.