Reduced alcohol use in pregnancy and changed attitudes in the population

The objectives of this study were to investigate (1) changes in consumption of alcohol among pregnant women over a period of 5 years (1984/85–1990), (2) changes of attitudes towards drinking during pregnancy in the general population over the same period of time, and (3) possible connections between (1) and (2). The investigation was designed as a cross-sectional study. Our subjects were two representative samples of pregnant women in Oslo, n = 577 and 425, and two representative samples of the Norwegian population, n = 1004 and 1204. The main outcome measures were a self-completed questionnaire for the pregnant women and a personal interview for the general population sample. There was a significant reduction (50% decrease) in alcohol consumption among the second cohort of pregnant women compared with the first. Furthermore, we found an increase during the 5-year period in the number of persons with a restrictive attitude towards alcohol use during pregnancy. There seems to be a connection between these two phenomena, but with our present state of knowledge it is hard to say anything about the causal relationship between them.     

Quality Ratings of a Hospital Foodservice Department by Inpatients and Postdischarge Patients

Objectives To examine quality of food and nutrition services using the ratings of inpatients and patients who had been discharged (postdischarge patients).Design Questionnaires were used to collect perceptions of inpatients and postdischarge patients on the quality of food and nutrition services. A 5-point scale allowed subjects to rate quality from very poor to very good.Subjects Questionnaires were completed by 252 inpatients and 437 postdischarge patients of a midwestern teaching hospital.Statistical analysis Analysis of variance was used to assess differences in quality ratings on the basis of demographic variables. Stepwise regression was used to determine variables that best predicted overall satisfaction. Paired t tests were conducted to compare matched inpatient and postdischarge ratings.Results Ratings of food and nutrition services indicated that patients were satisfied; few differences were found in ratings on the basis of patient demographics. Food quality was the best predictor of overall satisfaction for both inpatients and postdischarge patients. As patient expectations were increasingly met or exceeded, patient ratings of quality increased. The majority of patients in the matched sample gave the same ratings on the inpatient and postdischarge questionnaires.Applications Foodservice managers who desire to improve patient satisfaction should focus attention on meeting or exceeding patient expectations for food quality. J Am Diet Assoc. 1998;98:1303–1307.     

EFFECTS OF ACUTE ALCOHOL ADMINISTRATION ON VERBAL AND SPATIAL LEARNING

The effects of alcohol and placebo on cognitive functioningin male, Asian-American college students were evaluated witha double-blind, placebo-controlled cross-over design using amulti-trial learning test in which verbal and spatial learningwere simultaneously assessed. Verbal recall was impaired consistentlyacross learning trials, while impairment of spatial recall wasevident only on later learning trials. Recall of spatial informationwas influenced by order of presentation and amount of exposuretime of items. Results do not support a theory that spatiallearning is more impaired by alcohol than verbal learning, andthus do not lend support for the hypothesis that alcohol hasa greater effect on right than left hemisphere functioning.Results provide evidence that alcohol increases susceptibilityto interference effects.     

The Use of Cost‐Effectiveness Analysis for Pediatric Immunization in Developing Countries

Context: Developing countries face critical choices for introducing needed, effective, but expensive new vaccines, especially given the accelerated need to decrease the mortality of children under age five and the increased immunization resources available from international donors. Cost‐effectiveness analysis (CEA) is a tool that decision makers can use for efficiently allocating expanding resources. Its use in developing countries, however, lags behind that in industrialized countries. Methods: We explored how CEA could be made more relevant to immunization policymaking in developing countries by identifying the limitations for using CEA in developing countries and the impact of donor funding on the CEA estimation. We conducted a comprehensive literature search using formal search protocols and hand searching indexed and gray literature sources. We then systematically summarized the application of CEA in industrialized and developing countries through thematic analysis, focusing on pediatric immunization and methodological and contextual issues relevant to developing countries. Findings: Industrialized and developing countries use CEA differently. The use of the Disability‐Adjusted Life Year (DALY) outcome measure and an alternative generalized cost‐effectiveness analysis approach is restricted to developing countries. In pediatric CEAs, the paucity of evaluations and the lack of attention to overcoming the methodological limitations pertinent to children's cognitive and development distinctiveness, such as discounting and preference characterization, means that pediatric interventions may be systematically understudied and undervalued. The ability to generate high‐quality CEA evidence in child health is further threatened by an inadequate consideration of the impact of donor funding (such as GAVI immunization funding) on measurement uncertainty and the determination of opportunity cost. Conclusions: Greater attention to pediatric interventions and donor funding in the conduct of CEA could lead to better policies and thus more worthwhile and good‐value programs to benefit children's health in developing countries.     

Outcomes in Adolescents with Postural Orthostatic Tachycardia Syndrome Treated with Midodrine and β-Blockers

Background: Postural orthostatic tachycardia syndrome (POTS) is associated with debilitating fatigue, dizziness, and discomfort in previously healthy adolescents. The effects of medical therapy have not been well studied in this patient population. This study assessed the relative efficacy and impact of drug therapy on the functioning and quality of life in adolescents with POTS.
Methods: A retrospective, single center, chart review analysis with a follow-up written survey was conducted on a group of 121 adolescents who had undergone autonomic reflex screening at the Mayo Clinic from 2002 to 2005 as part of an evaluation for possible POTS.
Results: Of 121 surveys sent, 47 adolescents returned a completed survey. In this cohort of patients, the two most commonly prescribed drug therapies were midodrine (n = 13) and β-blockers (n = 14). Patients in the midodrine group were comparable to patients in the β-blocker group in gender, age, pretreatment postural heart rate changes, and months from initial evaluation to survey completion. More patients treated with a β-blocker reported improvement after visiting Mayo Clinic (100% vs 62%, P = 0.016) and more attributed their progress to medication (63.6% vs 36.4%, P = 0.011) than did those treated with midodrine.
Conclusion: Treatment with both midodrine and β-blockers was associated with overall improvement in POTS patients' general health; however, adolescents taking β-blockers were more likely than those taking midodrine to credit the role of medications in their improvement.     

Improved Short-Term Outcomes of Primary Coronary Stenting Compared to Primary Balloon Angioplasty in Acute Myocardial Infarction at Experienced Centers: The PAMI Study Group Experience

To study the additive benefits of routine stent implantation in patients undergoing primary percutaneous transluminal coronary angioplasty (PTCA) at experienced centers, we compared the outcomes of the 982 patients undergoing PTCA for acute myocardial infarction (AMI) in the Primary Angioplasty in Myocardial Infarction-2 (PAMI-2) trial (only 1% of whom were stented) to the 312 patients in the PAMI Stent Pilot Trial (236 [76%] of whom were stented). The inclusion and exclusion criteria, PTCA methodology, and definitions used were prespecified to be identical between the two trials. Compared to the primary PTCA approach in PAMI-2, the strategy of stenting all eligible lesions in the PAMI Stent Pilot Trial was associated with reduced rates of in-hospital death (0.6% vs 2.7%, P = 0.03), reinfarction (1.3% vs 4.6%, P = 0.008), recurrent ischemia (3.5% vs 11.6%, P < 0.0001), target vessel revascularization (7.3% vs 11.4%, P = 0.04), and a shorter hospital stay (6.4 ± 4.4 vs 7.1 ± 6.2 days, P = 0.01). By multiple logistic regression analysis in 1,294 patients, stent implantation versus PTCA only was the strongest predictor of freedom from the composite in-hospital end point of death, reinfarction, or target vessel revascularization (TVR) (8.3% vs 15.0%, multivariate odds ratio = 0.4, P < 0.0001). These data strongly suggest that despite the excellent results achieved when primary PTCA is performed by experienced operators, the short-term outcomes of mechanical reperfusion can be further improved by a primary stent strategy.     

Outbreak of Rash in Children Associated with Recreational Mud Exposure

Abstract: We conducted an investigation of a rash outbreak in children who attended the “Mud Mania Festival.” The mean incubation period of illness was 26 hours, and mean duration was 4.3 days. Time spent in mud was associated with the extent of rash in a dose–response fashion. The cultures from lesions of two unrelated cases yielded Enterobacter cloacae.     

Blastomere Analysis: Issues for Discussion

There has been little professional discussion about the implications of blastomere analysis for genetic screening. In this article, some of the legal, ethical, and practical issues associated with the technology are identified. Issues are categorized as those involving availability and payment, phenotype selection, and imperfect genes. Nurses need to be knowledgeable about these issues to participate in the formation of policies governing the use of blastomere analysis and other genetic screening procedures.