Relationship between pancreatitis and lung diseases

Patients with acute pancreatitis may develop acute lung injury, manifest clinically as the adult respiratory distress syndrome. Most patients who die during the early stages of severe acute pancreatitis die either with or as a result of this lung injury. To explore the events which couple acute pancreatitis to lung injury, a number of recent studies have been performed in the author's laboratory using a variety of experimental models and interventions including gene-targeted deletion of chemokines, cytokines, specific receptors, and adhesion molecules. These studies have indicated that adhesion molecules such as intracellular adhesion molecule-1 (ICAM-1), neutrophils, platelet activating factor (PAF), substance P, and chemokines acting via the CCR-1 chemokine receptor play a pro-inflammatory role while complement factor C5a plays an anti-inflammatory role in pancreatitis and lung injury. Future studies will build on these observations to expand the list of pro- and anti-inflammatory coupling factors and explore the mechanisms by which they act to cause or prevent lung injury in acute pancreatitis.     

Infant feeding in the second 6 months of life related to iron status: an observational study.

OBJECTIVE: To investigate the relationship between iron status in infancy and type of milk and weaning solids consumed. DESIGN: An observational cohort study. SETTING: 928 term infants from the Avon Longitudinal Study of Parents and Children in 1993-94. METHODS: Haemoglobin and ferritin concentrations at 8 and 12 months were assessed in relation to type and quantity of milk intake at 8 months. RESULTS: By WHO criteria, 22.7% of the infants were anaemic at 8 months and 18.1% at 12 months. More breast--than formula-fed infants were anaemic at 8 and 12 months. Cows' milk as the main drink was associated with increased anaemia at 12 months and low ferritin at 8 and 12 months. No association was found between any nutrients and haemoglobin concentrations. Protein and non-haem iron intakes were positively associated with ferritin concentrations and calcium intake negatively. This effect was more marked in infants being fed cows' milk. More than 25% of infants in the breast milk and cows' milk groups and 41% of infants having >6 breast feeds per day had iron intakes below the lower reference nutrient intake. Feeding cows' milk or formula above 600 ml or >6 breast feeds per day was associated with lower intakes of solids. CONCLUSIONS: Both breast and cows' milk feeding were associated with higher levels of anaemia. Satisfactory iron intake from solids in later infancy is more likely if formula intake is <600 ml per day and breast feeds are limited to <6 feeds per day. Cows' milk should be strongly discouraged as a main drink before 12 months.     

Reliability of DSM-III diagnoses for major depression and generalized anxiety disorder using the structured clinical interview for DSM-III

This study examined the interrater reliability of generalized anxiety disorder (GAD) and major depressive disorder (MDD) diagnoses derived from the Structured Clinical Interview for DSM-III (SCID). Using videotaped interviews, paired raters made independent diagnoses of 75 psychiatric outpatients. The percent agreement of the raters was 82% for MDD and 86% for GAD; the respective kappa values were .72 and .79. The results indicated that the SCID can be employed reliably to differentiate MDD from GAD. The SCID is recommended for further research with these disorders.     

Attempted suicide in those with personality disorders

Summary From a sample of 499 patients admitted to hospitals for suicide attempts, a subsample of 182 suicide attempters who described histories of illicit activities or who were diagnosed with DSM-II antisocial, drug or alcohol personality disorders were compared with another sample of 109 suicide attempters diagnosed as having depressive disorders. The former group of unsocialized attempters obtained similar depression inventory scores as the diagnosed depressive attempters. However, the index attempts of the unsocialized group were made with less suicidal intent than those of the diagnosed depressive patients, and they made more prior suicide attempts than the diagnosed depressive patients.     

A randomized control study of oxytocin augmentation of labour. 2. Uterine activity

Uterine activity was measured in 60 women whose first labour was progressing slowly in the active phase. The mean level of active contraction area (uterine activity integral, UAI) before oxytocin augmentation was 898 (SD 458) kPas/15 min. UAI increased significantly with time, even in women not given oxytocin. UAI increased logarithmically with increasing oxytocin infusion rate. Levels of uterine activity before and after oxytocin infusion are correlated positively such that the higher the initial level of UAI the higher the UAI in response to oxytocin. However, the regression line approaches the line of identity such that even with high doses of oxytocin UAI would not be likely to exceed 2500 kPas/15 min. There is a positive correlation between uterine activity and cervical dilatation rate in unstimulated labour; however, this is less evident following oxytocin infusion. Increases in uterine activity below 1200 kPas/15 min result from both higher frequency and active pressure, whereas above 1200 kPas/15 min any increase is due mainly to a rise in frequency.     

An evaluation of a rural community pharmacy‐based smoking‐cessation counselling and nicotine replacement therapy initiative

Objective To evaluate the efficiency and the effectiveness of a rural community pharmacy‐based smoking‐cessation counselling and nicotine replacement therapy (NRT) initiative. Setting Community pharmacies in NHS Highland in the north of Scotland. Key findings Most clients (77%) smoked cigarettes for an average of 34 pack‐years ranging from 1 to 174 pack‐years. Almost three‐quarters (73%) of the NRT prescribed was in the form of patches. Most respondents (91%) claimed pharmacists' advice was useful, and most (65%) thought that the pharmacist was their preferred healthcare professional for smoking‐cessation advice because of ease of access. At the end of week four, 45% of clients reported that they had stopped smoking, this fell to 35% at the end of week 12, and at 44 weeks the point prevalent abstinence rate was 15.8%. Of those that did not stop, 19% reduced their smoking level. This initiative cost £525 for each quitter. Thirteen quality criteria were defined in the assessment framework of which six were achieved. Conclusions There are no established criteria for evaluating community pharmacy‐based smoking‐cessation initiatives currently available, neither are reductions in smoking levels reported. Enhancing the role of the community pharmacist to include health improvement improves the interface between healthcare and the consumer, and helps to meet the national recommendations. Community pharmacy‐based smoking‐cessation initiatives impact on smoking‐cessation targets, allow for the variety of services relevant to the needs of the population and are part of the key to making a difference. Methods A review of the literature on community pharmacy‐based smoking‐cessation initiatives informed a performance assessment framework. Data for evaluation were collected through client records, questionnaires and semi‐structured interviews of the stakeholders, and a cost‐effectiveness analysis was undertaken.