Folate and the prevention of neural tube defects: evaluation of a health promotion project in Western Australia

The objectives of this study were: to inform health professionalsand women of childbearing age about the prevention of neuraltube defects by folate; to recommend that all women of childbearingage increase their intake of folate; and to evaluate the effectivenessof the strategies used to achieve these aims. The study tookplace in Western Australia. The Folate and Neural Tube DefectsPrevention Project is a health promotion project using writtenmaterial, presentations and unpaid media. Surveys were carriedout of general practitioners, child health nurses and womenof childbearing age before the project began and 12 months later.The main outcome measures were: knowledge of folate and preventionof neural tube defects and exposure to and effectiveness ofpromotional material. Knowledge of folate and the preventionof neural tube defects increased amongst general practitionersand child health nurses, and most displayed the promotionalmaterial and made changes in their practice to promote an increasedfolate intake for women planning a pregnancy. In women of childbearingage, the knowledge of folate, of spina bifida, and of the associationbetween the two, increased over the study period. Women whohad seen the promotional pamphlet were over seven times morelikely to know that increased folate helps prevent spina bifida.The Project has been effective in raising awareness amongsthealth professionals and women of the prevention of neural tubedefects by folate. Further evaluation is needed to determinethe extent to which folate intake has increased, and its effectivenessin reducing the birth prevalence of neutral tube defects.     

INEFFICIENT URETHRAL MILKING SECONDARY TO URETHRAL DYSFUNCTION AS AN ADDITIONAL RISK FACTOR FOR INCONTINENCE AFTER RADICAL PROSTATECTOMY

PURPOSE: Continence after radical prostatectomy is thought to depend completely on the striated urethral sphincter. However, some patients complain only of occasional post-void dribbling. Therefore, we determined whether urethral dysfunction may be another cause of incontinence. MATERIALS AND METHODS: The sensory threshold of electric stimulation was measured by double ring electrodes in the membranous urethra and 2.5 cm. distal in 29 men before and in 29 after radical retropubic prostatectomy. In addition, voiding cystourethrography was performed in 66 patients before and in 49 after surgery to determine complete post-void urethral emptying or milking. RESULTS: The mean sensory threshold of the membranous urethra was 15 +/- 3 mA. preoperatively versus 38 +/- 17 postoperatively (p <0.0001). The sensory threshold 2.5 cm. further distal was 12 +/- 5 mA. before and 10 +/- 4 after radical prostatectomy, which was not statistically significant. Postoperatively in completely continent patients and in those with dribbling the mean threshold was 32 +/- 12 and 43 +/- 18 mA. in the membranous urethra (p = 0.09), and 11 +/- 4 and 9 +/- 4 mA. in the bulbar urethra, respectively, which was not statistically significant. Of the 66 patients 36 (55%) showed post-void urethral milking before surgery but only 8 of 49 (16%) showed it postoperatively (chi-square test p <0.0001), including 7 who were completely continent and 1 who complained of occasional post-void dribbling. CONCLUSIONS: After radical prostatectomy sensitivity of the membranous but not of the bulbar urethra is affected, correlating with postoperative continence. In addition, post-void dribbling seems to be associated with the loss of urethral milking. We conclude that preserving urethral function is another important continence factor after radical prostatectomy.     

THE ISOLATED BLOOD AND PERFUSION FLUID PERFUSED HEART

The isolated heart is deservedly one of the most popular experimental models in cardiovascular research, both in terms of cost and the quality and quantity of data it provides. However, it is a deceptively simple model, capable of throwing many problems in the path of the inexperienced or unwary perfuser. The following article discusses the advantages and disadvantages of the various types of isolated heart perfusion (Langendorff and working; blood and buffer perfused). We attempt to give an insight into the many factors which must be taken into consideration when first establishing these preparations, we identify the range of indices that can be measured and the potential pitfalls which, with a little care, can be readily avoided.     

A MONOCLONAL ANTIBODY POOL FOR ROUTINE IMMUNOHISTOCHEMICAL DETECTION OF HUMAN RESPIRATORY SYNCYTIAL VIRUS ANTIGENS IN FORMALIN-FIXED,PARAFFIN-EMBEDDED TISSUE

Four monoclonal antibodies (MAbs) with specificities for epitopes on human respiratory syncytial virus (RSV) proteins preserved after formalin fixation and paraffin embedding were identified in fixed and embedded virus-infected HEp-2 cell pellets. The MAbs bound epitopes on the fusion protein, the nucleoprotein, the phosphoprotein, and the M2 protein of the virus. Following high-temperature antigen unmasking, immunohistochemical staining revealed RSV antigens in the lungs of five of seven children who died with confirmed RSV infection and in none of nine children who died for other reasons, with no evidence of RSV infection. Staining was cytoplasmic, granular, and confined to epithelial cells. Intense staining was seen at the apex of ciliated bronchial and bronchiolar epithelial cells in all five positive cases. In one case, of pneumonitis, infected pneumocytes were present in the alveoli and in several cases, CD68-positive, cytokeratin-negative alveolar macrophages stained for viral antigens. These antibodies may prove useful in studies of the pathogenesis of RSV infection. © 1997 John Wiley & Sons, Ltd.     

COPING WITH THE OCCUPATIONAL STRESSORS OF POLICE WORK: A STUDY OF SCOTTISH OFFICERS

The Coping Scale of the Occupational Stress Indicator (OSI)¹⁶ was administered to a group of serving Scottish police officers (N=699) in order to examine the coping skills they might employ in dealing with routine police work. Differences in coping style according to age, gender and rank were observed. Overall, a preference for more problem-focused, direct action coping strategies was apparent. In particular, officers displayed a preference for balancing the demands of work and home as a means of coping with the self-perceived stressors of routine police work. No significant correlation was found between the OSI coping scales and psychological distress as measured by the GHQ-28; however, some small effects were apparent in relation to rank, gender and age. © 1997 by John Wiley & Sons, Ltd.     

THE EARLY ONSET DEMENTIAS: A STUDY OF CLINICAL CHARACTERISTICS AND SERVICE USE

The clinical characteristics and the level of service use were studied in a cohort of 200 patients referred for the investigation of presenile dementia, having had the onset of symptoms before the age of 65. The most common diagnoses given were Alzheimer's disease, vascular dementia and depressive pseudodementia. The level of psychiatric morbidity was high, depression insomnia, anxiety and aggression being the most common symptoms. As regards rate of service use, 22% of the Liverpool patients were in residential care after 1 year of follow-up, in contrast to 8% initially. We conclude that there is a need for specialized multidisciplinary services for this group of patients, both diagnostic and supportive.     

THE EFFECTS OF TRANSURETHRAL NEEDLE ABLATION AND RESECTION OF THE PROSTATE ON PRESSURE FLOW URODYNAMIC PARAMETERS: ANALYSIS OF THE UNITED STATES RANDOMIZED STUDY

PURPOSE: We evaluated the effects of transurethral needle ablation and prostate resection on pressure flow urodynamic parameters in men with benign prostatic hyperplasia (BPH), compared symptomatic and objective parameters of efficacy 6 months after initial treatment, and determined whether urodynamic assessment may predict symptomatic improvement. MATERIALS AND METHODS: We enrolled 121 patients with clinical BPH, American Urological Association symptom index of 13 or greater and maximum urinary flow of 12 ml. per second or less in a randomized study comparing transurethral needle ablation to prostate resection at 7 institutions in the United States. Patients underwent baseline and followup assessments at 6 months, including pressure flow studies. RESULTS: Patients who underwent each procedure had statistically and clinically significant improvement in symptom index, BPH impact index and quality of life score. After needle ablation and prostate resection maximum flow improved from 8.8 to 13.5 (p<0.0001) and 8.8 to 20.8 ml. per second (p<0.0001), detrusor pressure at maximum flow decreased from 78.7 to 64.5 (p = 0.036) and 75.8 to 54.9 cm. water (p<0.001), and the Abrams-Griffiths number decreased from 61.2 to 37.2 (p<0.001) and 58.3 to 10.9 (p<0.001), respectively. At 6 months the differences in transurethral needle ablation and prostate resection were significant in terms of maximum flow (p<0.001) and the Abrams-Griffiths number (p<0.001) but not detrusor pressure at maximum flow or symptom assessment tools. The presence or absence of urinary obstruction at baseline did not predict the degree of symptomatic improvement in either treatment group. CONCLUSIONS: Transurethral needle ablation and prostate resection induce statistically and clinically significant improvement in various quantitative symptom assessment questionnaires at 6 months. The parameters of free flow rates and invasive pressure flow studies also significantly improve after each treatment. However, transurethral prostate resection induces a significantly greater decrease in the parameters of obstruction. Baseline urodynamic parameters do not predict the degree of symptomatic improvement and they may not be helpful in patient selection for transurethral needle ablation.     

EFFECTIVENESS OF GROUP ANXIETY MANAGEMENT WITH ELDERLY CLIENTS OF A COMMUNITY PSYCHOGERIATRIC TEAM

This study examined the feasibility and efficacy of group cognitive-behavioural treatment of anxiety in elderly patients referred to a community mental health team for the elderly. The referral of elderly anxious patients by GPs to the team was low over the study period. In a small within-subjects controlled trial, treatment was associated with a significant reduction in anxiety symptoms on two of the three primary outcome measures. Change was greatest for cognitive symptoms of anxiety. The impact of the treatment was less in patients with significant physical ill-health and those with chronic anxiety; different management strategies may be needed for these groups. © 1997 by John Wiley & Sons, Ltd.