Changing incidence of sinus infection in children

This study presents the results of a 20 year review of maxillary sinus wash-outs performed on children. The results show a decreasing incidence of purulent sinusitis over the study period. Only 17 per cent of antral wash-outs undertaken yielded pus, indicating that surgical practice has failed to adequately take account of the changing disease incidence.     

An unsuccessful cotinine-assisted intervention strategy to reduce environmental tobacco smoke exposure during infancy.

OBJECTIVE--To test a low-intensity physician's office-based intervention strategy using infant urine cotinine measurements, aimed at reducing infant exposure to environmental tobacco smoke. DESIGN--A randomized intervention trial. SETTING--Offices of 28 physicians (pediatricians and family practitioners) and two hospital-based clinics in the Greater Portland, Me, area. PARTICIPANTS--Infants brought to the physician by a parent (usually the mother) for an initial well-child visit. A total of 518 of these infants and their mothers consented to provide information about household smoking habits and to provide a sample of the infant's urine for biochemical analysis. SELECTION PROCEDURE--From among the consecutive sample of 518 enrolled mother/infant pairs, 103 mothers reported that they smoked 10 or more cigarettes per day, and these were randomized on an individual basis for intervention (52 pairs) or control (51 pairs). Randomization took place at the study center when the infant's urine sample and information about household smoking habits were received. INTERVENTION--The physician telephoned the mother to report the urine cotinine result and to explain its meaning. The physician then signed and sent an individualized form letter to the mother, providing specific recommendations for changing household smoking habits. RESULTS--Follow-up urine cotinine measurements were obtained in 27 (52%) of 52 infants from the intervention group and in 29 (57%) of the 51 controls 2 months later. The mean log ratio of the follow-up to initial urine cotinine measurements was 6% lower in the intervention group than in the control group. This difference was not statistically significant. CONCLUSION--The low-intensity intervention strategy did not significantly influence infant exposure to environmental tobacco smoke in the household.     

Prospective intervention trial of a screening protocol to identify fetal trisomy 18 using maternal serum alpha-fetoprotein, unconjugated oestriol, and human chorionic gonadotropin.

Two prenatal centres in New England, routinely using a screening protocol for fetal Down syndrome that included maternal serum alpha-fetoprotein (AFP), unconjugated oestriol (uE3), and human chorionic gonadotropin (hCG) measurements in combination with maternal age, adopted a separate screening protocol for trisomy 18. That protocol identified a pregnancy as being at high risk when AFP, uE3, and hCG measurements all fell at or below specified cut-offs (0.75, 0.60, and 0.55 multiples of the median, respectively), regardless of maternal age. Among the first 19,491 women screened, 98 (0.5 per cent) were found to have values which placed them in the high-risk category. Four of these women were subsequently found not to be pregnant. In two others, samples from non-pregnant individuals were found to have been incorrectly submitted for analysis in place of the samples from the pregnant women. All of the remaining 92 women were counselled and offered amniocentesis and fetal karyotyping. Eighty-eight (96 per cent) accepted. Karyotypes or birth outcomes were available on all 92 pregnancies. Six cases of trisomy 18 and one case of Turner syndrome were identified by karyotype. One case of trisomy 18 was identified for every 14 unaffected pregnancies offered amniocentesis. In the present prospective study, an estimated 85 per cent of the cases of trisomy 18 were identified. However, given the small number of cases (six), the 95 per cent confidence interval for the detection rate is broad (40-95 per cent).     

Second-trimester levels of maternal serum unconjugated oestriol and human chorionic gonadotropin in pregnancies affected by fetal anencephaly and open spina bifida

Unconjugated oestriol (uE3) and human chorionic gonadotropin (hCG) levels were determined in second-trimester maternal serum (MS) samples from 21 pregnancies associated with fetal anencephaly and 15 pregnancies associated with fetal open spina bifida. Each measurement was expressed as a multiple of the median (MoM) for unaffected pregnancies for each completed week of gestation. In pregnancies associated with anencephaly, the median value for MSuE3 was very low (0.17 MoM, range less than 0.12-0.33 MoM), suggesting a functional defect in the fetal adrenal prior to 20 weeks' gestation; the median value for MShCG was also low (0.73 MoM), although not to the same extent as for MSuE3. A biological explanation for the hCG result is not apparent. In pregnancies associated with open spina bifida, the MSuE3 and MShCG values were unremarkable, consistent with a lack of involvement of these open fetal defects in the synthesis and secretion of uE3 and hCG.     

Dissemination of responsible service of alcohol initiatives to rugby league clubs

OBJECTIVES: To determine the acceptability of intervention strategies that increase the responsible service of alcohol by non-metropolitan rugby league clubs. METHOD: Rugby league clubs were provided an information kit and advice by local public health workers, police and a lead agency regarding their responsible service of alcohol practices. Rugby League clubs and public health workers completed an acceptability survey at the conclusion of the study. RESULTS: Data were collected from 160 contactable clubs (100% consent) and 12 of 14 participating public health workers. Almost all clubs reported of contact with the lead agency, public health workers and police to be acceptable. Fifty-nine percent of clubs reported contact with public health workers to be useful. One-third of the public health workers considered that they were not the most suitable professional group to be involved in delivering the intervention. CONCLUSIONS: In spite of a suggested culture of harmful alcohol consumption among rugby league participants and spectators, non-metropolitan rugby league clubs appear receptive to public health strategies that increase their responsible service of alcohol. IMPLICATIONS: The ability of the public health sector to meet this opportunity appears limited, and may require additional strategies to increase the capacity of public health workers to develop/deliver inter-sectorial interventions in this setting.     

Contrast echocardiographic assessment of the neonatal ductus arteriosus.

Contrast echocardiography is a safe and accurate method of diagnosing patent ductus arteriosus (PDA) in newborn infants. In this study the presence of PDA in very low birthweight infants receiving mechanical ventilation was investigated by contrast echocardiography. This was used as a basis for determining the accuracy of clinical signs and M mode echocardiography in the diagnosis of PDA. At the first contrast echocardiographic examination at a mean age of 49 hours PDA was found in 75% of infants. Clinical signs were inconsistent; 42% of the infants with PDA at the first examination had a murmur, no relation being found between PDA and heart rate or cardiothoracic ratio. Left atrial and left ventricular dimensions were significantly raised and left systolic time intervals significantly lower in the group with PDA. There was, however, considerable overlap, with the sensitivity of each measurement varying between 52% and 71%. Left systolic time interval combined with left ventricular:aortic root ratio gives the best differentiation between infants with or without PDA.     

Assessing smoking prevalence amongst school children in a health board region

The objective of the study was to provide baseline data for Tayside in 1995 on the prevalence of smoking cigarettes in school children, aged 11 to 15 years. The design was a cross-sectional survey of 4675 children, obtained using a random cluster sample of 79 schools, stratified by school year and deprivation category. The main outcomes measures using a structured questionnaire, were the prevalence and level of smoking, by age and gender. The prevalence rate of regular smoking was 9% (95% CI 8.2%-9.8%). The rate rises appreciably for boys between 13 and 14 years and for girls between 12 and 13 years. Source of cigarettes was also an outcome measure, most cigarettes were obtained from small shops. Health Boards require a standard method for collecting regional baseline data on the prevalence of smoking among children both for evaluation of targeted health promotion initiatives by age and gender and also for comparison of regional smoking prevalence with national targets.     

Acetaminophen-induced inhibition of Fas receptor-mediated liver cell apoptosis: mitochondrial dysfunction versus glutathione depletion

We reported previously that acetaminophen overdose interrupts the signaling pathway of Fas receptor-mediated apoptosis. The aim of our study was to investigate the mechanism of this effect. Male C3Heb/FeJ mice received a single dose of acetaminophen (300 mg/kg ip) and/or anti-Fas antibody Jo-2 (0.6 mg/kg iv). Some animals were treated with allopurinol (100 mg/kg po) 18 and 1 h before acetaminophen injection. After 90 min of Jo treatment, there was processing of procaspase-3 and a significant increase in liver caspase-3 activity, which is consistent with apoptotic cell death. Treatment with acetaminophen 2.5 h before Jo inhibited the increase in hepatic caspase-3 activity by preventing the processing of the proenzyme. When administered alone, acetaminophen did not induce caspase-3 activation but caused significant liver injury. Acetaminophen treatment alone caused mitochondrial cytochrome c release, depletion of the hepatic ATP content by 55%, and a 10-fold increase in mitochondrial glutathione disulfide levels. Pretreatment with allopurinol prevented the mitochondrial oxidant stress and liver injury due to acetaminophen toxicity but had no effect on Jo-mediated apoptosis. Allopurinol did not affect the initial glutathione depletion after acetaminophen. However, allopurinol restored the sensitivity of hepatocytes to Fas receptor signaling in acetaminophen-treated animals. Histochemical evaluation of DNA fragmentation with the TUNEL assay showed that acetaminophen eliminated Fas receptor-mediated apoptosis in all hepatocytes not just in the damaged cells of the centrilobular area. Our data suggest that acetaminophen-induced mitochondrial dysfunction and not the initial glutathione depletion is responsible for the interruption of Fas receptor-mediated apoptotic signaling in hepatocytes.