A partially self-instructional system that any teacher can develop and implement

Some authors have suggested that the teacher has two basic choices of style which can be used to influence learning: he/she can manage learning resources or he/she can function as such a resource. Part of the appeal for the authors of the course format described here is the blurring of that distinction. Functioning both as a manager and a resource appears to us a near optimal role for the teacher.     

Energy Intake and Glycemia in Lactating Women with Type 1 Diabetes

Objective To describe glycemia and insulin administration in lactating women with type 1 diabetes and compare their energy intake, lactation onset, and postpartum weight to lactating women without diabetes.Design A prospective observational study conducted at 2, 3, 6, 14, 42, and 84 days postpartum. Insulin dosage and glucose levels after fasting and at 80 and 110 minutes after eating (by measuring capillary blood glucose concentrations and glycated hemoglobin [HbA_1c] values) are described for women with type 1 diabetes. Dietary intake, weight, and lactation onset for women with type 1 diabetes are compared with those without the disease.Subjects/setting Fourteen lactating women with type 1 diabetes and 25 women without diabetes (control subjects) were recruited from private obstetrician offices and high-risk prenatal clinics at 3 major medical centers.Statistical analyses A repeated-measures 2-factor analysis of variance was used to determine group, time, and interaction effects between women with type 1 diabetes and the control group at 2, 3, 7, 14, 42, and 84 days postpartum.Results Seven women with type 1 diabetes breast-fed through 84 days postpartum, although they perceived later onset of milk and had fasting and postprandial hyperglycemia. Their HbA_1c levels increased by 20%, confirming relative hyperglycemia. After adjustment for prepregnancy weight, women with type 1 diabetes consumed 7 kcal fewer per kilogram per day than control subjects. Average insulin dose was returned to prepregnancy levels of 45.3±3.6 U/d (least square means±standard error of the mean) by 1 week.Application Achieving desired metabolic control during the establishment of lactation is difficult. A better understanding of energy and insulin needs and their relationship to lactation in women with type 1 diabetes is needed. J Am Diet Assoc. 1998; 98: 642–648.     

The spermatocytic seminoma: views on pathogenesis

The spermatocytic seminoma has clinical and histological characteristics which differ from those of other germ cell tumours of the testis. Classical seminomas and teratomas are believed to originate from intratubular carcinoma-in-situ (CIS), which is almost invariably found adjacent to these neoplasms. In addition, DNA analysis of these tumours and the surrounding CIS has shown both to have an aneuploid distribution. In order to throw light on the origin of the spermatocytic seminoma, we have examined the testicular tissue adjacent to fifteen spermatocytic seminomas for the presence of CIS and assessed the DNA content of the tumour cells densitometrically. In twelve specimens seminiferous tubules were present adjacent to the tumour, and in none of these cases was CIS seen. Nuclear DNA measurements were possible in eleven tumours and in five cases the distribution was diploid, in three cases tetraploid, and only in three cases aneuploid. Therefore, we suggest that the spermatocytic seminoma has a different cell of origin from that of other germ cell tumours of the testis.     

Cerebral damage in paraquat poisoning

This is the first report on cerebral changes in eight patients who died of paraquat poisoning. These included generalized oedema, haemorrhages (both subependymal and subarachnoid), glial reactions (microglial activity and astrocytic response) and meningeal inflammation. Oedema and haemorrhage were the most consistent and significant findings: they suggest that paraquat may damage the cerebral blood vessels. The distribution of haemorrhages was unusual and resembled that seen in thiamine deficiency.     

Among Young Adults, College Students and Graduates Practiced more Healthful Habits and made more Healthful Food Choices than did Nonstudents

Objectives Health-related characteristics and habits and food choices of young adults were compared for three groups: college students, college graduates, and nonstudents.Design Subjects completed a mailed survey that included questions about demographics, attitudes, and behaviors and a food frequency questionnaire. Main outcome measures were health-related characteristics and habits and food choices.Subjects Female (n=758) and male (n=580) 18- to 24-year-olds in nine states who were selected randomly by zip code in each state. The response rate averaged 43% for all states.Statistical analyses performed Analysis of variance or χ² tests were applied to health-related personal characteristic variables and the Kruskal-Wallis analysis of variance was applied to food consumption variables for women and men separately.Results According to self-reported heights and weights, female nonstudents were more often overweight than female students or graduates. Nonstudents of both genders reported smoking more often than students or graduates. College students and graduates ate more grain foods high in dietary fiber, more fruits and dark-green vegetables, and more lower-fat milk and meats than non students.Conclusions/applications Non students were at greater health risk for some chronic illnesses, because of poorer health habits and food choices, than were college students and graduates. The behavior of nonstudents implies weaker response to messages promoting weight control, smoking cessation, and observance of the Dietary Guidelines for Americans than behavior exhibited by students or college graduates. Health promotion efforts could be enhanced by identifying demographic, educational, situational, and formative influences on positive health and dietary behaviors of young adults.     

Assessing bias in community-based prevalence estimates: towards an unduplicated count of problem drinkers and drug users

General population survey estimates of the overall prevalence of problem drinking and drug use in a community are biased by the exclusion of non-household populations. Estimates based on compiling prevalences in community institutions may also be biased due to over-counting of users of more than one institution. This paper examines prevalence estimates derived from probability samples of problem drinkers in the general population and within alcohol treatment, drug treatment, mental health, criminal justice and welfare agencies in a single US county. Data sets are merged and weighted to reflect a community sample of institutions, and a 1 7% subset of cases is identified within the institutional samples that are not living in housing units typically included in general population sampling frames. The difference in prevalences of problem drinking in the household and non-household populations is found to be large: 11% and 48%, respectively. Even greater differences are found between estimates of unprescribed weekly drug use (6% and 47%, respectively) and combined problem drinking and weekly drug use (2% and 27%, respectively). This suggests that confining samples to the household population can systematically under-represent the prevalence of problem drinking and drug use. A second source of bias in prevalences is characteristic of studies using records from multiple institutions. When duplication of service use in the five agency samples is considered, it becomes apparent that prevalences may be biased upward due to over-counting of multiple service users.