Supportive and nonsupportive family behaviors: relationships to adherence and metabolic control in persons with type I diabetes

The Diabetes Family Behavior Checklist (DFBC) was administered to 54 adults and 18 adolescents (less than 19 yr of age) with insulin-dependent diabetes mellitus (IDDM). Subjects and family members completed parallel forms of the DFBC at initial and 6-mo follow-up home interviews. During each of these periods, adherence was assessed via self-report, 1 wk of self-monitoring, and 24-h dietary recalls. The results showed reliable differences between adolescents and adults. More negative interactions with family members were reported by adolescents and their family members, and adolescents were in poorer metabolic control. For adults but not adolescents, negative DFBC scores were prospectively predictive of poorer regimen adherence over the 6-mo interval for measures of glucose testing, insulin injection, and dietary adherence. In addition, higher negative DFBC scores for adults were marginally associated with higher HbA1 levels (P less than 0.10). We conclude that the DFBC is a promising measure of family interaction related specifically to the IDDM regimen and that, for adults, higher levels of nonsupportive family behaviors may be related to reduced regimen adherence and poor control.     

Radon-smoking synergy: A population-based behavioral risk reduction approach.

BACKGROUND: Radon and cigarette smoking have a synergistic, multiplicative effect on lung cancer rates. Smokers, and perhaps nonsmoking residents, of smoking households are at increased risk for lung cancer even when radon levels are relatively low. A behavioral risk reduction strategy emphasizing smoking cessation is proposed and data are presented from pilot studies and a short-term evaluation of a randomized intervention trial. METHODS: Pilot studies, including radon testing, interviews, questionnaires, and focus groups, led to a three-arm randomized intervention trial comparing two kinds of written materials and telephone counseling. Smoking households were recruited by offering free radon test kits through an electric utility companies billing system. Three-month follow-up data were obtained by mail and phone. RESULTS: Of an estimated 2,600 smoking households in the utility district, 1,220 requested a radon test kit, and 714 were randomized into three treatment conditions. Brief phone counseling (up to two short calls) significantly increased smoking quit rates, compared to written materials only, and was also related to other risk reduction behaviors (e.g., household ban on smoking). CONCLUSIONS: Offering free radon testing through a public utility billing system is an effective recruitment tool for reaching households at risk due to radon-smoking synergy. Brief telephone counseling is superior to written materials in reducing smoking and encouraging indoor smoking bans. Methods are needed to better inform smokers of their additional risk from exposure to even low levels of radon.     

Reye's syndrome: assessment of intracranial monitoring.

Direct measurements of arterial blood pressure and intracranial pressure were recorded in 39 patients aged 3.6 months to 5 years 11 months with Reye's syndrome judged to be stage 2 or beyond. Of 33 patients who survived, 27 made a full recovery and six were severely handicapped. Measurement of cerebral perfusion pressure, which is greatly reduced in the more severe forms of Reye's syndrome, was a better guide to prognosis and management than intracranial pressure alone. The findings emphasise that maintenance of cerebral perfusion pressure is essential if mortality and morbidity are to be reduced. Intracranial monitoring is mandatory in all but the mildest cases of Reye's syndrome.     

Fine-needle aspiration biopsy of orbital and periorbital masses

We present the cytologic findings of 18 fine-needle aspirates performed on orbital and periorbital masses. An accurate specific diagnosis was confirmed by histology in ten cases. In eight cases the diagnostic evaluation and/or therapeutic regimen was significantly altered by the results of the fine-needle biopsy. In three cases the cytologic diagnoses obviated the need for open biopsy. Two specimens were insufficient for diagnosis. No false positive diagnosis of malignancy occurred. Electron microscopy was useful in three cases to confirm the correct cytologic diagnosis. Immunocytochemistry helped to define a lymphoid proliferation as monoclonal. The cytologic findings from an unusual case of sebaceous carcinoma are presented.     

Brain biopsy in the management of focal encephalitis.

The value of a brain biopsy in diagnosis and management of suspected herpes simplex encephalitis was studied in 29 patients (16 prospectively and 13 retrospectively). The biopsy showed herpes simplex encephalitis in eight, culture-negative encephalitis in 14, and was normal in three patients. It provided an alternative diagnosis in four patients, for two of whom curative treatment was available. The biopsy was complicated by a fatal intracranial haemorrhage in one patient. The low yield of alternative diagnoses suggests that a brain biopsy is not justified in the routine investigation of focal encephalitis.     

In vitro and in vivo activity of murine lymphokine-activated killer cells after cryopreservation

The in vitro and in vivo effects of cryopreservation on the cytotoxic activity of murine lymphokine-activated killer (LAK) cells were studied. LAK cells were generated by incubation of spleen lymphocytes of BALB/c mice for 3 days with recombinant interleukin-2 (rIL-2) and subsequent cryopreservation. Cytotoxicity was determined in a 51Cr release assay. After thawing, cytotoxic activity was reduced (40.4% 51Cr release at an effector:target cell ratio of 40:1 as compared to 68.5% 51Cr release before freezing) and could be restored to precryopreserved levels by reincubation with rIL-2 for 2 days after thawing (78.8% 51Cr release). These cells were then tested in BALB/c mice injected with RAW 112 cells, a pre-B-cell lymphoma line. The results demonstrate that the survival rate of mice injected with cryopreserved and restimulated LAK cells (50% survival greater than 180 days after injection) did not differ significantly from that of mice injected with fresh unfrozen LAK cells (60% survival greater than 120 days, 50% survival greater than 180 days). Cryopreserved LAK cells have potential use in adoptive immunotherapy.