MATERNAL USE OF ALCOHOL AND OTHER DRUGS DURING PREGNANCY AND BIRTH ABNORMALITIES: FURTHER RESULTS FROM A PROSPECTIVE STUDY

This paper presents an extended analysis of data produced duringa prospective study of the possible association between maternalalcohol use during pregnancy and fetal harm. This new analysisexamines the possible links between not only maternal alcoholconsumption, but also the use of tobacco, prescribed and illicitdrugs and birth abnormalities. There was no general associationbetween birth abnormalities and maternal psychoactive drug useand misuse. Even so, women who neither smoked nor consumed alcoholduring the first trimester produced offspring with significantlyfewer birth abnormalities than did those who drank heavily andsmoked cigarettes.     

Influence of Age, Lead Axis, Frequency of Arrhythmic Episodes, and Atrial Dimensions on P Wave Triggered SAECG in Patients with Lone Paroxysmal Atrial Fibrillation

Signal-averaged P wave of 42 patients with lone paroxysmal atrial fibrillation (PAF) and 29 normal subjects (N) were recorded, using three orthogonal leads and analyzed in the time and frequency (entire P wave or a 100-ms segment ranging from 75 ms before to 25 ms after the end of P wave) domains. PAFs were divided into a group of 12 having ≥ 2 attacks a month (HF) and a group of 30 having ≤ 2 attacks a year (LF). Statistically significant differences were absent with regard to ages of PAF and N; ages of HF, LF, and N at the time of signal-averaged ECG; ages of HF and LF at the time of the first arrhythmic episode; and elapsed times from the first episode. Length of P wave and some frequency-domain parameters were found to be significantly correlated with age. PAF showed a significantly longer duration of P wave in the frontal plane using the time-domain analysis. Frequency analysis was found to be useful in evaluating the influence of attack frequency. HF showed significantly higher values of some frequency-domain parameters than LF and N, while the three groups did not differ for time-domain analysis. P wave duration and frequency content of the three orthogonal leads proved to be significantly different in PAF and N. Right and left atrial echocardiographic dimensions proved to be higher (even if within normal limits) in HF than in LF and N. Results suggest that frequency analysis should be performed on the entire P wave.     

ETHICS, FUNDING AND ALCOHOL RESEARCH

The field of alcohol research is a multidisciphnary area ofinquiry. Moreover the debate about alcohol issues is highlypoliticized, involving not only researchers but also ‘advocates’and those with strong ideological orientations or who representpowerful vested interests. Researchers may easily be caughtin the crossfire in polemics involving such people. From timeto time ethical malpractice is evident, yet there are oftenneither clear guidelines to delineate which behaviours are unacceptablenor how ethical violations are to be handled. This paper considersa number of key issues currently topical in the field. Theseare specifically concerned with the relationships between fundersor sponsors and policy makers and researchers. Such issues includethe ownership of data, sponsor control and the divergent culturesand outlooks of researchers and sponsors/funders. It is concludedthat the field of alcohol research requires a code of ethicsto regulate the relationship between researchers and funders.This should provide protection for subjects, patients, clients,researchers and those who pay for research. Some tentative suggestionsare put forward for discussion.     

Patient-controlled analgesia in children. A comparison of two infusion techniques

The effectiveness of patient-controlled intravenous morphine with and without a supplementary fixed rate infusion was studied in 40 children after orthopaedic surgery and 40 children after abdominal surgery. The use of a background infusion after orthopaedic surgery, where the majority of children received intra-operative regional blockade, resulted in a higher total dose of morphine (P < 0.05) without evidence of improved analgesia, compared to PCA alone. Children receiving a background infusion after abdominal surgery showed evidence of improved sleeping patterns post-operatively compared with those receiving PCA alone, despite similar overall morphine consumption. There were no episodes of excessive sedation, or respiratory depression with the use of either regimen, and over 90% of the children studied were assessed as experiencing either no pain or mild pain. The suitability and efficacy of patient controlled analgesia for management of post-operative pain for children aged between 5 and 17 years appears to be confirmed. The use of a supplementary background infusion may be of value in children.