Characterizing exposures to nonpersistent pesticides during pregnancy and early childhood in the National Children's Study: a review of monitoring and measurement methodologies

The National Children's Study is a proposed longitudinal cohort study to evaluate the relationships between children's health and the environment. Enrollment is estimated to begin in September 2005, and 100,000 children will be followed from preconception or early pregnancy until adulthood. Among multiple health outcomes, the study is proposing to investigate whether pre- and/or postnatal exposures to nonpersistent pesticides increase the risk of poor performance on neurobehavioral and cognitive exams during infancy and early childhood. Characterization of exposures will be challenging. Nonpersistent pesticides include many chemicals with biologic half-lives on the order of hours or days. Exposures can occur through multiple pathways (e.g., food and residential or agriculture pesticide use) and by multiple routes (inhalation, ingestion, dermal). Effects may depend on the developmental stage when exposure occurs. Sequential sampling is likely to be required and may involve a combination of environmental and biologic monitoring as well as collection of questionnaire data. In this article we review measurements that can be used to characterize exposures. These include biologic markers, personal and indoor air sampling techniques, collection of dust, surface and dermal wipe samples, and dietary assessment tools. Criteria for sample selection will necessitate evaluation of the time frame of exposure captured by the measurement in relationship to critical windows of susceptibility, the cost and validity of the measurements, participant burden, and variability in exposure routes across populations and at different age periods.     

Nurses' personalities,nursing-related qualities and work satisfaction: a 10-year perspective

The personalities and qualities of nursing personnel are considered to be of great importance for their interactions and nursing relationships with patients and may also influence work satisfaction. The aim of the study was to explore the extent to which different personal qualities and personality factors, with a possible effect on motivation, professional conduct and coping with stress and anxiety, are represented in a group of assistant nurses (second level nurses), and how these qualities are related to nursing competence and long-range work satisfaction. A group of 51 female nursing students (mean age 31.8 years) participated in the study. The nursing-related qualities were empathy, sensitivity to non-verbal communication, feelings of discomfort in different nursing situations and work satisfaction. The personality factors were psychogenic needs and defence mechanisms. At a follow-up 2 years later, 43 nurses were interviewed, work satisfaction was assessed and nursing competence was appraised. At a follow-up 10 years after completion of nursing school, 33 of the nurses took part in a telephone interview. Work satisfaction was assessed in 23 of those who were still working as nurses. Cluster analysis performed on baseline data resulted in four groups: empathic, discomfort prone, service-minded and dominant. At the first follow-up, the service-minded had the greatest work satisfaction, with many considered to be 'real jewels'. At the second follow-up 8 years later, there appeared to be an overrepresentation of injuries and long-term sick leave in this group, whose members had apparent difficulties in being dominant and asserting own interests. Work satisfaction diminished in all the groups over time. Long-term work satisfaction was found, however, to be related to degree of empathy and a low degree of sensitivity to aggressiveness.     

Aldosterone-Producing Adrenal Cortical Adenoma with Oncocytic Change and Cytoplasmic Eosinophilic Globular Inclusions

We report an interesting morphological alteration in the adrenal of a 72-year-old woman suffering from severe hypertension due to primary hyperaldosteronism. The laparoscopic left adrenalectomy specimen revealed an adrenal cortical adenoma composed of varying proportions of oncocytic and clear cells, predominantly showing central oncocytic change. Oncocytes also exhibited numerous eosinophilic intracytoplasmic globular inclusions, which are not commonly observed in aldosterone-producing adrenal cortical adenomas. Ultrastructural study revealed that the inclusions originated in degenerating mitochondria, explaining their association with the oncocytic phenotype of the tumor.     

Ectopic Growth Hormone-Releasing Hormone Secretion by a Neuroendocrine Tumor Causing Acromegaly: Long-Term Follow-Up Results

Ectopic secretion of growth hormone-releasing-hormone (GHRH) is a rare cause of acromegaly—representing less than 1% of patients. A 25-year-old woman was admitted to the hospital with acromegaly and a 6 × 6 cm infrahepatic mass. Sellar magnetic resonance imaging indicated diffuse pituitary enlargement consistent with hyperplasia. The infrahepatic mass was resected, and the histopathological diagnosis was a well-differentiated invasive neuroendocrine carcinoma of the duodenum with metastases to local lymph nodes. The tumor cells contained cytoplasmic immunoreactivity for GHRH. Because increased IGF-1 concentrations persisted after the operation, the patient was treated with octreotide long-acting repeatable (LAR) injections of 20 mg/month. Growth hormone and IGF-1 levels normalized. After 6 years of surveillance, a left paraaortic mass was detected by uptake of indium¹¹¹ octreotide. Surgical exploration revealed metastatic neuroendocrine carcinoma in a 2.5-cm lymph node. Postoperatively, the IGF-1 concentration was mildly elevated. Octreotide LAR therapy is being continued at 10 mg/month. This case suggests that octreotide treatment may have a beneficial effect on disease course and can be maintained for as long as 7 years in a patient with acromegaly due to a GHRH-secreting neuroendocrine carcinoma.     

Effects of carbon fibre spring orthoses on gait in ambulatory children with motor disorders and plantarflexor weakness

A consecutive series of 17 children (six males, 11 females; mean age 11y 11mo [SD 4y 5mo]; range 3y 11mo-17y 4mo) with plantarflexor weakness was assessed to compare gait differences between a carbon fibre spring orthosis (CFSO) and participants' regular orthoses. Twelve children had myelomeningocele, four children had arthrogryposis, and one child had neuropathy with peripheral muscle pareses. All participants underwent clinical examination and 3D gait analysis. Parents answered a questionnaire to assess subjective perceptions of the orthoses. Results from 3D gait analysis provided evidence that CFSOs enhance gait function in most participants by improving ankle plantarflexion moment (p<0.001), ankle positive work (p<0.001), and stride length (p<0.001). The CFSO did not suit all participants, which emphasizes the importance of analyzing each patient's needs.     

Effects of chronic stress on the immune response to oral human serum albumin-conjugated starch microparticles in rats

Uptake of antigens and bacteria over the follicle-associated epithelium (FAE) is increased after chronic psychological stress. We investigated whether stress affects the immune response to particle-conjugated antigens taken up via the FAE. Rats were submitted to two 10-day periods of water avoidance stress and orally immunized during these periods. Stressed immunized rats displayed altered cell populations and a Th1-skewed immune response within the lymphoid follicles, together with enhanced delayed-type hypersensitivity. We conclude that chronic stress affects the cell-mediated immune response after oral immunization, which may have implications for the understanding of allergic and autoimmune diseases and development of oral vaccines.     

Factors related to alcohol and drug consumption in Swedish widows

The use of alcohol and medications among Swedish widows was analyzed in relation to various background variables. In Total, 1053 widows (640 widows younger than 65 years and 413 widows older than 65 years) answered the questionnaire. Many reported increased fatigue and sleeping problems. Around one-third of the widows reported drinking alcohol for relief of grief and inadequate support. Association existed between grief and increased intake of sedatives and sleeping pills, and between grief and drinking for relief of grief, as well as increase in intake of sedatives. In widows older than 65 years, perception of bad health, negative outlook for the future, and insufficient support seemed to increase the risk of more sedatives and sleeping pills. Negative outlook for the future also tended to lead to a heightened risk for increased intake of alcohol. There seems to be remaining health problems a long time after bereavement, and counseling may be needed especially when drugs and alcohol are extensively used.