Parents Expectations and Child Rearing Practices in Hong Kong

This paper reports on some aspects of interactions of parents with their children in Hong Kong. In particular some of the child rearing practices and their educational implications are presented. The study is an interview based research project in which 130 parents of children between the ages of birth-12 years gave their views about a range of issues including what they want for their child (expectations), how they discipline their child, who the parent goes to for advice on child rearing, how much homework the child does each day. The paper sheds some light on the difficult task of rearing children in a situation where traditional family practices are changing and where pre-schools and schools work in very formal ways.     

Anaesthesia for Treacher Collins and Pierre Robin syndromes: A report of three cases

We present three patients with Treacher Collins or Pierre Robin syndromes who had historical and physical evidence of airway obstruction, difficulty feeding, and sleep disturbances. These preoperative findings correlated with difficult airway management intraoperatively. Based on this experience, we recommend that children with obstructive symptoms have laryngoscopy prior to anaesthetic induction. If the glottic opening is visualized, inhalational induction can proceed. If the glottic structures cannot be visualized, then the anaesthetist must choose between awake oral or nasal intubation, elective tracheostomy, or fiberoptic intubation. In all cases, a tracheostomy tray should be ready and a surgeon experienced in paediatric tracheostomy should be in attendance. After intubation, anaesthesia is best maintained with oxygen and a potent inhalational agent. Extubation should only be done with the patient fully awake and with emergency airway equipment immediately available. Postoperatively, these patients should be transferred to an intermediate care area or intensive care unit where they can be observed closely since delayed complications of airway obstruction are common in this group of patients.     

A phase I trial of combination therapy with continuous-infusion PALA and continuous-infusion 5-FU

Summary Thirty-four patients were treated with N-(phosphonacetyl)-l-aspartate (PALA) at a dose of 850 mg/m²/dayx5 by continuous intravenous infusion (days 1–5) and 5-fluorouracil (5-FU) on an escalating dose schedule of 300–630 mg/m²/dayx5 by continuous intravenous infusion (days 2–6). Dose-limiting oral mucositis occurred at a 5-FU dose of 560 mg/m²/day; other toxicities included nausea, vomiting, diarrhea, skin rash, and superficial venous phlebitis. Myelosuppression was rare. One partial response was observed in a patient with metastatic colorectal carcinoma. Plasma PALA levels were monitored in seven patients. Steady-state levels were achieved by the 2nd day of drug infusion and ranged between 10 and 20 g/ml.     

Obesity and Excess Protein and Carbohydrate Consumption Are Risk Factors for Thyroid Cancer

Conflicting data concerning the association between obesity and differentiated thyroid cancer (DTC) may be attributed to the lack of records showing dietary intake and inadequate evaluation of nutrient composition. We evaluated 115 DTC patients carefully paired with 103 healthy control individuals by using a structured questionnaire, including a 24-h recordatory during 3 days, to investigate calorie intake and macronutrient (proteins, carbohydrates, and lipids) composition of the diet. We observed that excess weight (body mass index > 25 kg/m²) increased individual susceptibility to DTC [odds ratio (OR) = 3.787; 95% confidence interval (CI) = 1.115–6.814; P < 0.0001). This augmented risk was evident in women (OR = 1.925; 95% CI = 1.110–3.338; P = 0.0259) but not in men (P = 0.3498). Excess calorie intake was more frequent in patients with DTC than in controls (OR = 5.890; 95% CI = 3.124–11.103; P < 0.0001), and both excess protein (OR = 4.601; 95% CI = 1.634–12.954; P = 0.0039) and carbohydrate (OR = 4.905; 95% CI = 2.593–9.278; P < 0.0001) consumption were associated with an increased risk of DTC, contrarily to lipid/fiber intake and physical activity (P = 0.894 and 0.5932, respectively). In conclusion, our data indicate that overweight and risk of DTC are associated with higher protein and carbohydrate consumption than the rates recommended by the World Health Organization. The nutritional orientation should be part of preventive strategy targets designed to combat the increasing incidence of both obesity and DTC.     

Inclusion of equity in economic analyses of public health policies: systematic review and future directions

Objectives : To assess current approaches to inclusion of equity in economic analysis of public health interventions and to recommend best approaches and future directions. Methods : We conducted a systematic review of studies that have used socioeconomic position (SEP) in cost‐effectiveness analyses. Studies were identified using MedLine, EconLit and HEED and were evaluated based on their SEP specific inputs and methods of quantification of the health and financial inequalities. Results : Twenty‐nine relevant studies were identified. The majority of studies comparing two or more interventions left interpretation of the size of the health and financial inequality differences to the reader. Newer approaches include: i) use of health inequality measures to quantify health inequalities; ii) inclusion of financial impacts, such as out‐of‐pocket expenditures; and iii) use of equity weights. The challenge with these approaches is presenting results that policy makers can easily interpret. Conclusions : Using CEA techniques to generate new information about the health equity implications of alternative policy options has not been widely used, but should be considered to inform future decision making. Implications for public health : Inclusion of equity in economic analysis would facilitate a more nuanced comparison of interventions in relation to efficiency, equity and financial impact.     

Advancing the clinical nurse leader model through academic-practice-policy partnership

The nursing profession is tasked with identifying and evaluating models of care with potential to add value to health care delivery. In consideration of this goal, we describe the Clinical Nurse Leader (CNL) initiative and the activities of a national-level CNL research collaborative. The CNL initiative, launched by the American Association of Colleges of Nursing in collaboration with education and healthcare leaders, has delineated CNL education curriculum and practice competencies, and fostered the creation of academic-practice-policy partnerships to pilot CNL integration into frontline nursing care delivery. The partnership has evolved into an Agency for Healthcare Research and Quality affiliate practice-based research network, the CNL Research Collaborative, which links research, policy, education, and practice stakeholders to advance the CNL evidence base. We summarize foundational CNLRC research to explain CNL practice, quantify CNL effectiveness, and bring clarity to how CNLs can be implemented to consistently influence care, quality, and safety.     

Embryonic behavior,hatching and neuromuscular development in the chick following a transient reduction of spontaneous motility and sensory input by neuromuscular blocking agents

Embryos were immobilized with neuromuscular blocking agents for one to four days between days 10 and 15 of incubation. This treatment reduces spontaneous motility, as well as movement-initiated proprioceptive and cutaneous stimulation. Although the major aim of these experiments was to determine the effects of such treatment on subsequent behavioral development, several indices of neuromuscular and general morphological development were also examined. A single injection of curare on day 10 continues to depress spontaneous motility for virtually the entire remaining incubation period. This effect is due to the persistence of unmetabolized curare in the closed system of the egg. When a comparable dose of a rapidly metabolized neuromuscular blocking agent (succinylcholine) is given, this long term behavioral depression is not found. Embryos treated with SC can remain totally immobilized for up to 60 hours with no apparent repercussions on subsequent behavior; spontaneous embryonic motility, reflex sensitivity, hatching, and several general posthatching behaviors, all appeared normal following such treatment. Embryos immobilized for as little as 48 hours developed joint malformations and were retarded in general growth by about one day whereas 24 hours of paralysis was not sufficient to induce these effects. Twenty-four hours of total paralysis from days 10 to 11, plus a 40–50% reduction in motility until days 15 or 16, does not appear to cause any abnormalities in muscle or spinal cord development. Muscle histology, motor endplates, cell number in the spinal cord and choline acetyltransferase and acetylcholinesterase activity in spinal cord and muscle were all comparable to controls. An 80–90% reduction in motility on days 11 through 15, however, induces an apparent alteration of the intensity and distribution of histochemically demonstrable AChE in the anterior and posterior latissimus dorsi muscles. The present findings suggest that the suppression of overt motility for a period comprising ca. 5–12% of the total incubation time (21 days) does not modify subsequent behavioral development or the underlying neurogenetic mechanisms. Though these findings provide some support for the notion that the embryonic nervous system develops in forward reference to and without benefit from function or sensory input, only a more complete reduction of neural function, especially CNS activity, can provide a critical test of this concept.