Sleep Problems in Two-Year-Olds

The parents of children aged between 18 and 32 months attendinga south-west London general practice were asked to completea questionnaire and diary about their child's sleep behaviour.Of the 142 parents approached, 116 (82%) responded and 99 completedboth the sleep diary and questionnaire. One-quarter of the respondentswere found to be troubled by their child's sleeping patterns.Analysis showed that the children of these parents had moredisturbed sleeping-waking rhythms, and slept less time bothduring the day and night compared with the children of parentswho had no complaints about the child's sleeping pattern. Nodemographic or social factors were found to be associated withdisturbed sleep patterns. However, children with sleep problemswere less often given an attachment object at bedtime, lessoften cuddled on waking at night and more often taken into theirparents' bed than other children. These findings raise the possibilitythat modification of the way parents handle the child with sleepproblems might effect an improvement in the child's sleep.     

Patient Characteristics Associated with the Labelling of Asthma

Patient characteristics associated with the asthma label wereinvestigated in 262 children, aged 8 years, who reported wheezingillness in the previous 12 months. Children were first identifiedby a screening questionnaire administered to the parents ofall 8 year old schoolchildren in Croydon, south London. Interviewswere conducted with those reported to have had a wheezing illnessin the previous 12 months to obtain details of the child's illness,medical care, demographic and socioeconomic characteristics.Multivariate analysis showed that the likelihood of being labelledasthmatic was increased in those who had a parental historyof hayfever [odds ratio (OR) = 2.24, 95% confidence interval(Cl) = 1.22–4.14] or at least two allergic provoking factors(OR = 3.83, 95% Cl = 1.44–10.15). No significant associationswere found between asthma labelling and children's socioeconomiccharacteristics or use of general practitioner services. Thesefindings suggest that wheeze is likely to be labelled asthmawhen the clinical history suggests an allergic aetiology.     

Intrapartum Care of a Woman With Aortic Aneurysms

Advances in technology and complex care have enabled women with various health problems to become and remain pregnant. Consequently, health-care practitioners are seeing an increasing number of pregnant women who have aortic aneurysms. This case study describes the culturally sensitive intrapartum care of a Middle Eastern woman with ascending and descending aortic aneurysms.     

Hemodynamic Effect of Propafenone and the Experience in Patients with Congestive Heart Failure

The effects of propafenone on left ventricular function and hemodynamics are presented in this study. In one group of 13 patients who underwent electrophysiological testing and subsequent chronic oral therapy with propafenone, eight had left ventricular ejection fractions determined by nuclear study before and during therapy with the drug. Initial measurements ranged from 22% to 39% (mean 30%), while those on chronic therapy showed no statistical difference and ranged from 22% to 48% (mean 30%). In a separate dose titration study of 14 patients, left ventricular ejection fraction showed a modest but significant decrease (52%± 9% to 48%± 11%; p < 0.05). This change was more marked in patients with an initial low ejection fraction. Propafenone appears to be safe in these patients but should be administered with caution in patients with particularly low ejection fractions.     

毒性中药鬼臼质量标准研究

目的:建立毒性中药鬼臼的质量标准。方法:采用显微、液质联用方法进行定性鉴别,以液相色谱法进行含量测定。结果:各方法可用于鬼臼的质量鉴定。结论:建立的显微、LC-MS等方法可对其进行定性定量分析。     

Case report: A patient with primary biliary cirrhosis and autoimmune haemolytic anaemia

Diseases of an autoimmune nature are well recognized in association with primary biliary cirrhosis. Although autoimmune thyroiditis and many rheumatological conditions are well described in primary biliary cirrhosis, autoimmune haematological diseases have been less well reported. We report on a 66 year old North American Indian man with coincident primary biliary cirrhosis and warm antibody haemolytic anaemia. This case report supports the suggestion of an association between autoimmune haemolytic anaemia and primary biliary cirrhosis.     

Saving a dental residency: a joint commitment

The ability of the hospital to financially sustain a quality dental residency program depends on achieving the required increase in the volume of patients and the appropriate payer mix proportions. Although the importance of achieving financial viability places the program at a continuing risk, the dental department and the hospital's administrative staff members have taken a significant step forward to assure viability of the residency program in a financially uncertain health care environment.