Effect of valproate and carbamazepine on visual evoked potentials in epileptic children

The effects of carbamazepine (CBZ) and sodium valproate (SV) monotherapy on visual evoked potentials (VEP) were studied in 18 epileptic children receiving CBZ and nine epileptic children receiving SV. Pattern reversal VEP were determined before the administration of antiepileptic drugs (AED) and 1 year later during which time the patients had received AED. The VEP amplitude showed no consistent changes after 1 year of CBZ and SV therapy, but VEP P-100 latencies were significantly prolonged after 1 year of CBZ therapy. We conclude that CBZ causes a slowing down of central impulse conduction and that VEP is useful to evaluate the effects of AED within the central nervous system.     

Assessing community support for harm reduction services: Comparing two measures

Introduction and Aims . Previous attitudinal research has found that the way survey questions are asked can influence respondents’ answers regarding their support for sensitive issues. This study aimed to explore whether findings regarding community support for harm reduction services could be manipulated through priming of language and information contained within survey items. Design and Method. A convenience sample of 260 university students from Sydney Australia were surveyed during late 2008 about their attitudes towards harm reduction services. Participants were randomly allocated to two groups: one received a questionnaire that provided factual information about harm reduction services (Survey 1), while a second group received a questionnaire that contained no information about harm reduction services and framed heroin use as problematic (Survey 2). Results. Participants who completed Survey 1 expressed significantly higher levels of support for harm reduction services overall than participants who completed Survey 2 (t₍₂₄₉₎ = ?5.8, P < 0.001). Regression analysis indicated that overall support for harm reduction services was associated with the survey version that participants received and participants’ political affiliations. These two factors accounted for 17.5% of the variance in the data. Discussion and Conclusions. Research findings regarding community support for harm reduction services are influenced by questionnaire design. This has implications for the development and expansion of harm reduction services and policy.[Hopwood M, Brener L, Frankland A, Treloar C. Assessing community support for harm reduction services: Comparing two measures. Drug Alcohol Rev 2010]     

Is point of access to needles and syringes related to needle sharing? Comparing data collected from pharmacies and needle and syringe programs in south‐east Sydney

Introduction and Aims. The comprehensive needle and syringe distribution system in New South Wales is partly based on the premise that different points of access to injecting equipment may attract different groups of injecting drug users. This paper examines patterns of equipment acquisition and risk for blood‐borne virus transmission among injecting drug users who use pharmacies and needle and syringe programs (NSP) in south‐east Sydney. Design and Methods. Clients obtaining injecting equipment from four NSP (n = 147) and eight pharmacies (n = 227) in 2006 voluntarily completed a self‐administered questionnaire. Respondents were grouped into three categories based on their needle and syringe acquisition patterns: exclusive use of NSP, exclusive use of pharmacies and use of both. Results. Although it was common for respondents to report using both pharmacies and NSP to obtain needles and syringes (57%), a proportion reported exclusive use of pharmacies (17%) and NSP (14%). Exclusive pharmacy users were more likely to have never received treatment for their drug use and the least likely to have had a recent test for hepatitis C. Compared with respondents who exclusively used NSP, respondents who exclusively used pharmacies were more likely to report receptive sharing of injecting equipment (adjusted odds ratio 5.9, 95% confidence interval 2.02–17.14), as were respondents who reported using both sources (adjusted odds ratio 5.8, 95% confidence interval 2.35–14.40). Discussion and Conclusions. The high prevalence of receptive equipment sharing among pharmacy clients indicates a need to improve access to needles and syringes and ancillary equipment, possibly by including ancillary equipment at no cost in existing pre‐packaged pharmacy products.[Bryant J, Topp L, Hopwood M, Iversen J, Treloar C, Maher L. Is point of access to needles and syringes related to needle sharing? Comparing data collected from pharmacies and needle and syringe programs in south‐east Sydney. Drug Alcohol Rev 2010]     

Validation of the Functional Status II questionnaire in the assessment of extremely-low-birthweight infants

Aim  The increased survival of infants born at extremely low birthweight (ELBW) has been associated with significant morbidity, including higher rates of neurodevelopmental disability. However, formalized testing to evaluate these problems is both time-consuming and costly. The revised Functional Status questionnaire (FS-II) was designed to assess caregivers' perceptions of the functional status of children with chronic diseases.
Method  We evaluated the reliability and validity of the FS-II for ELBW infants at 18 to 22 months corrected age using data from the US Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Neonatal Research Network (NRN). Exploratory factor analyses were conducted using data from the network's first follow-up study of 1080 children born in 1993 to 1994 (508 males, 572 females [53%]), and results were confirmed using data from the next network follow-up of 4022 children born in 1995 to 2000 (1864 males, 2158 females [54%]).
Results  Results suggest that a two-factor solution comprising measures of general health and independence is most appropriate for ELBW infants. These factors differed from those found among chronically ill children, and new, more appropriate scales are presented for screening ELBW survivors. Both scales demonstrated good internal consistency: Cronbach's α=0.87 for general health and α=0.75 for independence. Construct validity of the scales was assessed by comparing mean scores on the scales according to scores on the Bayley Scales of Infant Development, second edition (BSID-II), and medical conditions.
Interpretation  As hypothesized, infants with greater functional impairments according to their BSID-II scores or medical conditions had lower scores on the general health and independence scales, supporting the validity of the scales.     

A short protocol for muscle MRI in children with muscular dystrophies

The use of muscle magnetic resonance imaging in patients with muscular dystrophies or congenital myopathies has been limited. We describe the development of a short protocol to be used in young patients with neuromuscular disorders. The protocol includes transverse T1-weighted spin echo sequence images of thighs and calves. The total scanning time is less than 30 minutes, and can be easily applied to patients over the age of 4 years without any need for sedation. Although only the leg muscles are imaged, the images obtained can still help to identify specific patterns of muscle involvement and provide additional help in the differential diagnosis of muscle disorders with overlapping clinical features.     

Cardiovascular and thrombophilic risk factors for idiopathic sudden sensorineural hearing loss

BACKGROUND: In recent years there has been a significant increase in the diagnosis of sudden sensorineural hearing loss (SSHL) in western, countries with an incidence of 20 of 100,000 people affected every year. No clear causes for this disease have been found thus far, but cochlear ischemia has been hypothesized in patients in whom an infectious episode or acoustic neurinoma have been excluded. OBJECTIVES: The aim of this case-control study was to investigate a number of acquired and inherited thrombophilic risk factors [antithrombin, protein C and S; factor V (FV) Leiden, FII polymorphism; lupus anticoagulant (LA); anticardiolipin (aCL) antibodies; fasting homocysteine (Hcy); lipoprotein(a) (Lp(a)); plasminogen activator inhibitor-1 (PAI-1)] in addition to cardiovascular risk factors in patients with idiopathic SSHL (ISSHL). PATIENTS AND METHODS: We investigated 155 patients (67 male/88 female; age: 55 (range 19-79 years) with a diagnosis of ISSHL within 30 days from the onset of symptoms, and 155 controls (67 male/88 female; age 54 (range 19-78 years). Fasting Hcy levels were significantly higher in patients than in controls [11.6 (6.7-60) micromol/L vs. 8.7 (5.0-24) micromol/L] as well as PAI-1 levels [19 (2-95) mg/dL vs. 14.5 (4.0-87) mg/dL]. Lupus anticoagulant was present in 13 of 155 (8.4%) patients; 20 patients (12.9%) had positivity of aCL (four IgM and 16 IgG). In no patient was a deficiency of physiological clotting inhibitors antithrombin, protein C and protein S found. No significant differences between patients and controls were observed for Lp(a) plasma levels [111 (1-1146) mg/L vs. 103 (11-695) mg/L] and for the presence of FV Leiden (4.5% vs. 4.5%) and FII variant G20210A (3.8% vs. 3.2%). RESULTS AND CONCLUSIONS: Independent risk factors for ISSHL at the multivariate analysis (adjusted for age, sex and the traditional cardiovascular risk factors) were the positivity of aCL: OR 5.6 (95% CI 2.0-15.3); cholesterol levels within the second and third tertiles (with respect to the first tertile): T2 = OR 4.8 (95% CI 1.9-12.6)/T3 = OR 19 (95% CI 7-50.1); PAI-1 and Hcy levels within the third tertile (with respect to the first tertile): OR 20 (95% CI 7.8-78) and OR 4.0 (95% CI 2.0-8.1), respectively. These preliminary data suggest that hypercholesterolemia, hyperhomocysteinemia, elevated PAI-1 levels and anticardiolipin antibodies are associated with ISSHL, so indirectly supporting the hypothesis of a vascular occlusion in the pathogenesis of the disease.     

Nutrition and Health Status Assessment of Community-residing Elderly in New York City: A Pilot Study

Ninety-five percent of persons over the age of 65 years live in the community and benefit from community-based health and nutrition services. The purpose of this project was to evaluate diet, function, and mental health in 40 men and women aged 65 years and older who were residing in a large metropolitan community. Nutritional status was assessed using two 24-hour recalls, 5 days of food records, a food frequency, and anthropometric measurements. Participants responded to standardized activities of daily living and instrumental activities of daily living instruments and an investigator-developed, performance-based appraisal of food preparation and management. Cognition and mood were assessed using the Folstein Mini-Mental Examination and the Yesavage Depression Scale. The nutrient intakes for individuals were compared with the Recommended Dietary Allowances (RDAs) and the Food Guide Pyramid. Mean energy intake was 1,625 kcal (range=787 to 2,910 kcal); 7 persons consumed more than 2,000 kcal. The mean vitamin and mineral intake for participants met the RDAs except for calcium, vitamin D, zinc, and magnesium intakes. The average percentages of carbohydrate, protein, and fat were 53%, 16%, and 30%, respectively. Nutritional assessments of subjects with and without congregate meals were contrasted. Six of the 13 congregate-meal participants were at nutritional risk, compared with 6 of 27 not receiving congregate meals. The interrelationships of diet, functional status, and mental health factors were examined along with recommendations for future data collection in similar studies. J Am Diet Assoc. 1998;98:554-558.     

Nurses' Judgments of Pain in Term and Preterm Newborns

Objective: To examine neonatal intensive-care unit nurses' Judgments of pain intensity in term and preterm newborns and to describe the cues used to assess the possible presence of pain in newborns.
Design: A combination of quantitative and qualitative approaches that included both parametric and nonparametric statistical procedures and a content analysis.
Setting: A large, university-affiliated, tertiary-care hospital in central Canada.
Participants: Forty-five registered nurses employed in the neonatal intensive-care unit.
Interventions: Nurses viewed videotapes of term and preterm newborns and written vignettes. Visual analogue scales and open-ended questions were used.
Main Outcome Measures: Pain intensity ratings of full-term and preterm newborns and the cues identified as indicative of pain in newborns.
Results: Nurses gave significantly higher pain intensity ratings to the full-term group than to the preterm group of newborns. Some differences were found in the cues identified by the nurses in assessing pain in term versus preterm newborns.
Conclusions: Nurses' judgments of pain intensity in newborns are influenced by the vigor and richness of the newborn's behavior response. Neonatal nurses must be provided with continuing education that focuses upon recognition of the signs and symptoms of pain in newborns.