How do nurses deal with their own grief when a patient dies on an intensive care unit, and what help can be given to enable them to overcome their grief effectively?

There is an expectation that nurses are good at caring for relatives on the death of a patient. Who, though, cares for the nurses? Using both a quantitative and a qualitative approach, this study looks at how nurses overcome their own grief when a patient dies on an intensive care unit. Information was first collected using a questionnaire. Personal grief, however, is a very emotive area, so a proportion of the nurses from the initial study were then asked to take part in a semi-structured interview, to explore their feelings in more depth. The quantitative data were analysed using the computer software Statistical Package for the Social Sciences and the results were related to the interview responses. This showed how nurses deal with their grief, and that many, but not all, felt that the informal support network already present was sufficient. Some nurses, however, felt that a support group would also be helpful and some felt the availability of a counsellor would be useful. All nurses felt that more training about how to deal with their own grief was needed.

Evaluation of the double diffusion, enzyme immunoassay and immunoblotting techniques, for the diagnosis of human hydatid disease in tropical areas

Hydatid disease in tropical areas poses a serious diagnostic problem due to the high frequence of cross-reactivity with other endemic helminthic infections. The enzyme-linked-immunosorbent assay (ELISA) and the double diffusion arc 5 showed respectively a sensitivity of 73% and 57% and a specificity of 84-95% and 100%. However, the specificity of ELISA was greatly increased by using ovine serum and phosphorylcholine in the diluent buffer. The hydatic antigen obtained from ovine cyst fluid showed three main protein bands of 64, 58 and 30 KDa using SDS PAGE and immunoblotting. Sera from patients with onchocerciasis, cysticercosis, toxocariasis and Strongyloides infection cross-reacted with the 64 and 58 KDa bands by immunoblotting. However, none of the analyzed sera recognized the 30 KDa band, that seems to be specific in this assay. The immunoblotting showed a sensitivity of 80% and a specificity of 100% when used to recognize the 30 KDa band.

Pre- and post-treatment immunodiagnostic evaluation in human schistosomiasis mansoni

Schistosomiasis control seems to be different in countries were low parasitic burden and asymptomatic clinical patients are the features of majority of cases. Immunological methods must substitute the traditional coprologic techniques used for some decades in the Control Program. Circumoval Precipitin Test (COPT), intradermal test and ELISA with soluble egg antigen (SEA) are evaluated for using as tools for seroepidemiologic studies. COPT and ELISA were performed after treatment to known their utility when impact of chemotherapy must be assessed. One hundred sixty five persons were followed up 3, 6, 9 and 12 months after treatment. The mean sensitivity of COPT studied by age groups was 95.6% which is very important considering that 88.4% of the studied population excreted less than 100 eggs/gr of feces, while sensitivity of intradermal test was 58.2%. Children showed the highest reactivity to COPT. When treatment is effective, COPT reactivity progressively diminish until become negative one year later. In the non cure group, the COPT reactivity diminished but never below 20%. ELISA-SEA did not modify one year after treatment. Effort should be made to isolate fractions of eggs of Schistosoma mansoni whose antibodies disappear after treatment.

Mice immunized with a synthetic peptide construct corresponding to an epitope present on a Plasmodium falciparum antigen are protected against Plasmodium chabaudi challenge

Inhibitory monoclonal antibody (MoAb) 8E7/55 recognizes a parasitophorous vacuole membrane (PVM) antigen in Plasmodium falciparum. Previous studies have identified the epitope, DNNLVSGP, recognized by the MoAb. A synthetic peptide containing this sequence was synthesized and coupled to diphtheria toxoid (DT) and was found capable of generating antibodies when used as an immunogen in mice which recognize the native antigen exp-1. In this study we demonstrate the ability of the MoAb and antisera generated against the peptide construct to recognize a 54 kD PVM antigen in Plasmodium chabaudi. The P. chabaudi antigen is synthesized in trophozoites and released to the surrounding culture media outside the parasitized erythrocyte. Mice immunized with the peptide conjugate are protected when challenged with a lethal strain of P. chabaudi. Protection in the mice correlated with the antibody titre prior to challenge. If the PVM antigen from P. chabaudi is a homologue of exp-1 from P. falciparum, then these experiments may provide a guide to the antibody titres required in human trials before antibody mediated protection could be expected. The discovery that a PVM localized antigen is secreted into the surrounding in vitro culture media provides us with a valuable model system for further investigation of protein trafficking pathways in malaria-infected erythrocytes.

Air quality and respiratory disease in Newcastle, New South Wales

OBJECTIVE

To investigate respiratory illnesses in the Newcastle region, their change over time, and their geographic relationship to industrialised areas.

DESIGN

We analysed admissions to public hospitals by postcode area in the Newcastle region, for all causes and for all the various respiratory causes, for the years 1979-1988. Comparisons were made between the State of New South Wales and the Newcastle area, and between geographic areas within Newcastle. Changes over the 10-year period were noted.

RESULTS

For both all causes and respiratory causes, admission rates to Newcastle hospitals, 1979-1988, were significantly lower than those for the rest of New South Wales in 1986. There was a correlation between living in the industrial part of the city and hospital admission for all causes and respiratory causes. There was also a correlation between mean disposable family income and hospital admissions, with those areas with the higher incomes having lower admission rates. Over the 10 years studied there was a statistically significant decline in admissions for respiratory causes, both in absolute terms and after controlling for changes in admissions for all causes. In children aged 0-14 years a significant increase in admissions for asthma occurred between 1979 and 1988, which could not be explained by diagnostic shift.

CONCLUSIONS

On the basis of hospital statistics, the members of the Newcastle population seem little different from those in the remainder of New South Wales. From 1979-1988, the efforts by industry, with the support of the community, to reduce industrial pollution have been accompanied by a reduction in hospital admission rates for respiratory diseases in general and for chronic obstructive lung disease in older people. Other contributing factors include reduced smoking rates and improved medical management. Correlations between geographic location and respiratory admission rates may be a manifestation of social class rather than poor air quality, although a contribution from the latter cannot be discounted. A concomitant rise in asthma admission rates in children aged 0-14 is likely to be unrelated to any change in air quality.