Hemodynamic effects of amrinone in children after Fontan surgery

After Fontan repair in children, we performed a prospective, open-label study to evaluate the effect of amrinone on pulmonary vascular resistance (PVRI). Eight patients who underwent the Fontan repair had baseline arterial pressure, left atrial pressure, central venous pressure, and cardiac output measured postoperatively. Hemodynamic measurements were repeated after amrinone 4.5 mg/kg. The PVRI tended to decrease, but the change was not statistically significant. Although the systemic vascular resistance decreased to 802 +/- 222 from 941 +/- 191 dynes.s.cm-5.m-2 (P < 0.05), mean arterial blood pressure was unchanged. Cardiac index (3.8 +/- 1.2 to 4.7 +/- 1.6 L.min-1.m-2) and stroke volume index (23.6 +/- 6.7 to 30.5 +/- 8.1 mL.beat-1.m-2) increased, and heart rate decreased (160 +/- 21 to 151 +/- 24 bpm) (P < 0.05). Colloid transfusion during amrinone bolus administration was 13.9 mL/kg. The mean serum amrinone concentration was 4.2 micrograms/mL at the end of bolus and clearance was 2.24 mL.kg-1.min-1. Arrhythmias and thrombocytopenia were not noted. We conclude that amrinone administration is effective in increasing cardiac output in children who have undergone a Fontan repair.

Trends in heterosexual tertiary students' knowledge of HIV and intentions to avoid people who might have HIV

This study investigated trends in HIV knowledge and endorsement of social avoidance of people who might be infected with HIV. The respondents (n = 7387) were self-identified heterosexual students. Most of them (n = 6500) were first-year behavioural or biological sciences students from annual surveys (1988-1995) at Macquarie University. The others (n = 887) were from four biennial (1987-1993) random samples of all students below 30 years of age at the University of Sydney. Students at both campuses completed self-administered questionnaires. Nine items were used to compute Partner Distinction Scale scores which indicated whether students had accurate knowledge that HIV may be transmitted through specific sexual practices with either casual or regular partners. Eleven items contributed to a Social Avoidance Scale. At Macquarie, male students had more accurate knowledge than female students, [F(1, 6024) = 9.20, p < 0.003], but at Sydney there were no significant sex differences in knowledge. Male students endorsed greater social avoidance at both Macquarie, [F(1, 6421) = 195.57, p < 0.00005], and Sydney, [F(1, 881) = 32.41, p < 0.00005]. Multiple linear regression on social avoidance revealed a significant reduction in social avoidance over time, with more rapid decrease among male students. Whereas less social avoidance was partly attributable to better knowledge over time, it is concluded that the improved social climate towards those most affected by HIV is mainly due to a shift in cultural norms.

Network integration: the impact of integrated delivery systems. Roundtable discussion

One of the hottest, most competitive segments of the healthcare IS industry encompasses integration tools and systems for linking divergent, best-of-breed systems. As firms such as Healthcare Communications, HUBLink, Oacis, Software Technologies Corp., Century Analysis and Eagle Innovations vie for new contracts, CIOs and IS directors wonder about the strategic advantages of single-vendor solutions vs. the best-of-breed approach. This dynamic has driven system acquisitions for several years. More recently, 33 percent of respondents to the 1995 HIMSS/HP Survey cited integration across separate facilities as their No. 1 priority for the next two years. Clearly the emergence of integrated delivery systems and providers of continuums of care--where the cost to replace the information technologies of acquired or partnered entities remains prohibitive--will cause the market for interface engines and other integration tools to continue expanding. Following are the perceptions of a few experts on the topic. They were asked to answer two questions: 1) What are the toughest challenges faced when integrating an integrated delivery system? and 2) What are the current best practices to solving this challenge?

Circadian rhythm desynchronosis in military deployments: a review of current strategies

The combined problems of changing work schedules and work places are not uncommon in military operations. For example, during the Persian Gulf War, many military units underwent short notice transmeridian deployment with immediate commencement of 24-h operations upon arrival. Some of these individuals likely suffered from circadian desynchronosis, blunting their effectiveness. The United States Air Force approved limited use of one short acting hypnotic medication to assist aircrew sleep disorders in the operational theater and, until recently, one stimulant medication to enhance alertness. Multiple theoretical strategies for circadian rhythm management are available. However, many U.S. Air Force flight surgeons are not trained on how best to use medications in combination with other circadian rhythm strategies. We present a condensed review of current human circadian rhythm coping strategies pertinent to military operations.

Pseudoseizures in the era of video-electroencephalogram monitoring

Psychogenic seizures may be difficult to distinguish from epileptic seizures lacking electrographic correlate. The presence of concomitant epilepsy or Munchausen syndrome by proxy may increase diagnostic difficulty. Clinical seizure characteristic, suggestion, prolactin levels, and continued recording after medication withdrawal may be useful in reaching a diagnosis. Dissociative disorders may be very common in psychogenic seizure patients.

Thermal study of anti-G ensembles aboard F-16 aircraft in hot weather

Continuing advances in the performance of new fighter aircraft have engendered requirements for more sophisticated protective clothing and life support systems. A major goal is prevention of acceleration-induced loss of consciousness. The USAF's Advanced Technology Enhanced Design G-Ensemble (COMBAT EDGE) increases acceleration tolerance by providing positive pressure to the oxygen mask; the work of pressure breathing is reduced by adding a counter-pressure bladder over the chest. However, the addition of impermeable layers over the chest reduces the area available for evaporation of sweat. This study was designed to determine whether COMBAT EDGE (CE) was demonstrably hotter than standard summer flight clothing (ST) during F-16 sorties in hot weather. Eight male pilots served as volunteer subjects, each flying missions at 1430 and 1745 h on two consecutive days, one day with CE and the other with ST. Data were logged at 1-min intervals for rectal temperature (Tre), skin temperatures at the chest and thigh (Tch and Tth) and air temperatures outside the clothing at the same two sites (Tach and Tath). The weather was stable over the 4 d of data collection with highs of 34-36 degrees C and simultaneous dewpoints of 19-23 degrees C (relative humidity 35-45%). The mean Tach was stable at 28 degrees C in flight, while individual means for Tath ranged from 22 to 25 degrees C. The lower value and greater variability at the thigh reflect its proximity to the air conditioning vent. Despite the differences in air temperature, Tch and Tth remained in the range 34-36 degrees C throughout the flights.(ABSTRACT TRUNCATED AT 250 WORDS)

Comparison of gastrointestinal symptoms in colorectal carcinoma patients and community controls with respect to age

Early diagnosis of colorectal cancer may be delayed by the wide prevalence of gastrointestinal symptoms in the general population. This study assessed, with respect to age, the frequency of gastro-intestinal symptoms in patients with colorectal carcinoma in comparison with community controls and also compared the frequency of such symptoms between 'young' (under 70 years) and 'old' (70 year or over) subjects. Two hundred and seventy three consecutive unselected colorectal cancer patients and 273 age and sex matched community controls were interviewed in a structured manner. Among controls, the 'old' group compared with the 'young' reported abdominal pain (p < 0.05), mucous discharge (p < 0.01), faecal incontinence (p < 0.05), change in flatus production (p < 0.05) significantly more often. There were no significant differences in regularity and frequency of bowel habit by age group. All the symptoms considered were significantly more common in colorectal cancer cases than controls (except abdominal bloating), but the association was less strong in the 'old' group. This study confirms that symptoms attributable to the lower gastrointestinal tract are reported by a clinically important number of community subjects and by a significantly higher proportion of elderly people.

Subjective fatigue of C-141 aircrews during Operation Desert Storm

Airlift crews were exposed to extended work periods, reduced sleep periods, night work, and circadian dysrhythmia caused by shift work and time-zone crossings during Operations Desert Shield and Desert Storm. This research reveals the extent to which severe subjective fatigue was experienced by the crews during Operation Desert Storm. In addition, through the evaluation of long-term and short-term work and sleep histories, this research shows that recent sleep and flight histories are correlated with high fatigue levels. Furthermore, we found a tendency for fatigue to correspond with pilot error. We recommend that the training of personnel involved in long-duration operations include fatigue management strategies and, further, that work policies and environments be designed to take into account the importance of regular and restorative sleep when unusual duty hours are required.

Relationship between plasma insulin and triglyceride concentrations in hypertriglyceridaemic donkeys

Hyperinsulinaemia is a commonly-observed characteristic of insulin resistance, and a reduction in insulin sensitivity is thought to be either a causative and/or symptomatic feature of equine hyperlipaemia. A positive correlation (r = 0.545, P = 0.0015) existed between plasma insulin and triglyceride concentrations determined in 31 donkeys with naturally occurring hyperlipidaemia/hyperlipaemia. Greater insulin values tended to occur in the animals with an overweight body score. Inter-animal variation in insulin concentrations, however, prevented the identification of any differences either within hypertriglyceridaemic donkeys (when classified by clinical condition, date of arrival to a sanctuary and eventual outcome after treatment) or between groups of normotriglyceridaemic (n = 6) and experimentally fasted hypertriglyceridaemic (n = 5) donkeys. Determination of basal plasma insulin concentrations may not provide an accurate assessment of underlying insulin sensitivity. Alternatively, hyperinsulinaemia may be evident only in animals with established insulin resistance.

Crew fatigue during simulated, long duration B-1B bomber missions

Crew fatigue associated with successive and unaugmented 36 h missions was evaluated in B-1B simulators. Data were obtained from 32 operationally qualified crewmembers. All crew-members completed three consecutive, long duration missions, each preceded by 33 to 35 h of crew rest. Oral temperature, salivary melatonin and cortisol, as well as actigraph and subjective measures, were collected during all missions. Temperature and melatonin data indicate that crews maintained their local home base circadian cycles. Elevated cortisol and subjective fatigue during the first mission indicate that it was the most difficult of the three. Furthermore, quality and duration of sleep were lowest during the first mission. These findings emphasize the need for realistic training in long duration fatigue management to improve the safety and effectiveness of the first and subsequent missions.

The long-term therapeutic management of epilepsy

OBJECTIVE

To provide a rational strategy for the evaluation and long-term management of epilepsy.

DATA SOURCES

Articles written between 1964 and 1993, obtained from a MEDLINE search on epilepsy-related topics as well as from the author's personal files, major reference books on antiepileptic drugs, and references identified from these books.

STUDY SELECTION

Articles were selected if they contained well-documented information comparing anti-epileptic drugs, represented controlled clinical trials, or were considered "key" articles of clinical relevance.

DATA SYNTHESIS

Epilepsy is a chronic condition requiring careful long-term management. The treatment is complex, involving classification and diagnosis, selection and monitoring of the appropriate antiepileptic agent, and evaluation of the chosen drug's side effects and drug interactions. Because these side effects increase when drugs are combined, monotherapy is recommended. Long-term management issues and optimal drug selection differ from patient to patient. If seizures are not controlled by medication, the patient may have been misdiagnosed or misclassified. Noncompliance, a major cause of apparent unresponsiveness to treatment, should also be ruled out. Recognizing that current therapy is not ideal for many patients, new pharmacologic and surgical therapies are briefly discussed.

CONCLUSIONS

Physicians can pursue a rational strategy for the management of epilepsy if they understand the risks and benefits of various pharmacologic and therapeutic options and if they maintain open lines of communication with the patient.

Autoantibody production in Kawasaki syndrome

Although a variety of autoantibodies are produced in patients with Kawasaki syndrome (KS), their specificities in many instances are controversial and their role in disease pathogenesis is undetermined. Autoantibody production was studied in 14 patients with Kawasaki syndrome (KS). Antibodies to myeloperoxidase (MPO), the dominant antigen responsible for perinuclear antineutrophil cytoplasmic antibody (pANCA) reactivity, were detected by ELISA in 73% of acute phase and 89% of convalescent phase KS specimens, in contrast to 4% of normal adult control subjects (p < 0.002 and p < 0.001, respectively). MPO and cytoplasmic antineutrophil antibody (cANCA) levels measured by ELISA were significantly elevated above levels for adult normal control subjects (p < 0.005 and p < 0.01, respectively), but not above recently ill childhood controls. Among patients who developed a positive ANCA, antibody titers tended to rise in serial specimens despite clinical improvement. Antibodies to myocardial muscle, cardiac perimysial connective tissue, nuclear antigens (ANA), and smooth muscle were also detected in some KS patients, but titers did not differ significantly from control patients. Autoantibody results were not predictive of patients with echocardiographic abnormalities.

An additional marker for familial hypertrophic cardiomyopathy?

BACKGROUND

Family screening for hypertrophic cardiomyopathy using conventional techniques yields some equivocal cases. Although mutations in the beta-cardiac myosin heavy-chain gene (MYH7) have been demonstrated in some patients, additional diagnostic methods are desirable to clarify the equivocal cases until the full genetic spectrum is characterized. Because coronary flow reserve is reduced in patients with typical hypertrophic cardiomyopathy independent of the severity of left ventricular hypertrophy, this measurement may help to identify patients with equivocal features of the disease.

METHODS

Coronary flow reserve was measured in two subjects: one with a MYH7 mutation but without typical diagnostic features of hypertrophic cardiomyopathy, and one with borderline left ventricular hypertrophy but no mutation in the MYH7 gene. Both subjects underwent screening for hypertrophic cardiomyopathy because of a family history of the disease. Positron-emission tomography was performed to measure myocardial blood flow (MBF) with oxygen-15 labeled water. MBF was measured at baseline and during coronary vasodilatation obtained by intravenous dipyridamole (0.56 mg/kg body weight infused over 4 minutes). Coronary flow reserve was expressed as the ratio MBF-dipyridamole/MBF-baseline.

RESULTS

Coronary flow reserve was 1.69 and 1.12 in the two subjects. Both of these values are 2 SD below that (3.87 +/- 1.08) measured in 17 normal subjects using the same method.

CONCLUSIONS

Noninvasive quantification of coronary flow reserve by positron-emission tomography may have a role in identifying patients with equivocal hypertrophic cardiomyopathy and should be further explored.

Third-trimester maternal psychosocial factors and infants' home stimulation. A prospective study

OBJECTIVE

To examine prospectively the association between mothers' third trimester maternal social support, depression, and satisfaction with a male support figure and their infants' home stimulation 4 months after birth.

DESIGN

Prospective cohort.

SETTING

Prenatal clinics in three private obstetric offices and two public clinics in western Michigan, a postpartum ward in a community hospital, and subjects' homes at follow-up.

PATIENTS OR OTHER PARTICIPANTS

Nulliparous mothers who made at least one visit to a participating prenatal clinic during the third trimester who experienced vaginal deliveries, and whose infants were discharged from normal newborn nurseries between July 1988 and September 1989. One hundred thirty-five mothers agreed to participate, and 101 were available for follow-up home visits.

MAIN OUTCOME MEASURES

Home Observation for Measurement of the Environment, a measure of home stimulation.

RESULTS

Mothers' third-trimester social support explained 20% of the variance (P = .0001) in infants' home stimulation scores at age 4 months. Third-trimester social support was a stronger predictor of postnatal home stimulation than socioeconomic status, race, depressive symptoms, and satisfaction with a male support figure. Third-trimester social support continued to explain a significant amount of variance in home stimulation scores (R2 = .06, P = .01) even after marital status was included in the model.

CONCLUSIONS

Mothers who report higher levels of social support during the third trimester of pregnancy provide higher levels of home stimulation for their infants. These findings suggest that primary care health providers may facilitate early child development by encouraging pregnant mothers to identify and make use of their social resources.

Dysphagia and expiratory air flow

Expiratory air flow preserves the freedom of the upper airway from foodway contamination in patients with dysphagia. Valving the tracheostomy cannula, "quad coughing," the Heimlich maneuver, the "supraglottic swallow," and coupling to a ventilator each has a place among the measures used for treating aspiration.

Detection of Trichomonas vaginalis in pregnant women with the InPouch TV culture system

Trichomonas vaginalis causes a common genitourinary infection which is frequently asymptomatic. At present, pregnant women are not usually screened for the infection unless they are symptomatic. In the present study, we screened and obtained samples for culture from all pregnant women attending a prenatal clinic with the InPouch TV culture system and compared results with those of standard culture in Diamond's medium and slide wet mount examination. The InPouch TV culture system was as reliable as Diamond's medium in detecting T. vaginalis and may be useful and effective in a pregnancy clinic setting.

Occult Kawasaki syndrome with giant coronary artery aneurysms

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Identification of a mutation in the beta cardiac myosin heavy chain gene in a family with hypertrophic cardiomyopathy

OBJECTIVE

To investigate the molecular genetic basis of the cause of disease in a family with hypertrophic cardiomyopathy.

BACKGROUND

Mutation within the beta cardiac myosin heavy chain gene has been shown to be the pathogenetic mechanism underlying the disease in several families, though clear evidence of heterogeneity has been reported.

PATIENTS

A family with a history of hypertrophic cardiomyopathy.

RESULTS AND CONCLUSION

This paper reports a mutation at aminoacid position 908 within exon 23 of the beta cardiac myosin heavy chain gene, resulting in a conversion of a leucine to valine. This base substitution was identified in an individual with a confirmed family history but with equivocal symptoms of the disease. Inheritance of the mutation by his symptom free juvenile offspring demonstrates the application of the technique to presymptomatic diagnosis.

How much do health care providers know about AIDS?

We sent a survey to more than 8,000 New Jersey health professionals to collect information on their knowledge level, attitudes, and prevention practices relating to the human immunodeficiency virus (HIV) and the acquired immunodeficiency syndrome (AIDS). The surveys were distributed through the mail in three separate waves with a postcard reminder. A total of 2,725 individuals provided completed questionnaires (34% response rate). We assessed the AIDS and HIV-related knowledge level of these health professionals, compared their knowledge levels, and identified variables that predict a high level of knowledge. The overall test scores indicate a definite need for AIDS education among these health professionals; on average, doctors answered 71% of the knowledge items correctly; dentists, 66%; and nurses, 65%. Doctors scored higher than the other health professionals on almost all of the 38 items relating to the epidemiological aspects of HIV, transmission, identification and reporting of HIV disease and AIDS, and assessment of HIV-associated risks. The multivariate regression model explained 24% of the variability in knowledge score (P = .0001) and identified the following independent variables as significant predictors of knowledge score: age, race, marital status, religious beliefs, political orientation, professional group, average number of hours worked each week, experience with HIV+/AIDS patients, knowledge self-assessment, and sources of AIDS information.

Is bed rest useful after diagnostic lumbar puncture?

A randomized study of 110 patients undergoing their first diagnostic lumbar puncture was performed to compare the effect of immediate mobilization with 4 hours bed rest on the incidence of post lumbar puncture headache. There was no difference between the mobile (n = 54) and bed rest (n = 56) groups in the incidence of post lumbar puncture headache (32% versus 31%, respectively). We conclude that bed rest following lumbar puncture may be an unnecessary imposition on the patient, as well as on nursing staff.

Sexual practices in the transmission of hepatitis B virus and prevalence of hepatitis delta virus infection in female prostitutes in the United States

OBJECTIVE

To evaluate heterosexual transmission of hepatitis B virus (HBV) and the prevalence of hepatitis delta virus (HDV) infection in female prostitutes.

DESIGN

Survey.

SETTING

Sexually transmitted disease clinics, drug treatment programs, detention centers, and/or outreach efforts in eight areas in the United States.

PARTICIPANTS

A total of 1368 female prostitutes 18 years of age or older.

OUTCOME MEASURES

Seropositivity for HBV and HDV infection.

RESULTS

The overall prevalence of past or present HBV infection was 56%: 74% in women who were injecting-drug users (IDUs), 38% in women reporting no history of injecting-drug use (non-IDUs), 51% in whites, 55% in blacks, and 67% in Hispanics. Of 21 HBV carrier IDUs, 21% had HDV infection; of 18 HBV carrier non-IDUs, 6% had HDV infection. In non-IDUs (49%), risk factors for HBV infection were a history of having penile-anal intercourse (odds ratio [OR], 3.1; 95% confidence limits [CL], 1.3, 7.3) and seropositivity for syphilis and human immunodeficiency virus (HIV) infection. In IDUs, factors associated with an increased risk of infection, in addition to behaviors related to injecting-drug use, were the number of lifetime sexual partners, having sexual partners from groups at high risk for HBV infection, and seropositivity for syphilis and HIV infection; spermicide and/or diaphragm use was associated with a markedly decreased risk of HBV infection among blacks (OR, 0.1; 95% CL, 0.03, 0.4) and Hispanics (OR, 0.2; 95% CL, 0.06, 0.9).

CONCLUSION

This is the first study to suggest that having anal intercourse and failing to use vaginal contraceptives may facilitate transmission of HBV to women. Our data support guidelines that recommend hepatitis B vaccination for prostitutes and persons with a history of sexually transmitted diseases or multiple sexual partners.

Prerequisites for oral immunization of free-ranging raccoons (Procyon lotor) with a recombinant rabies virus vaccine: study site ecology and bait system development

A model baiting system suitable for the delivery of an oral rabies vaccine to free-ranging raccoons (Procyon lotor) was developed and tested on barrier islands in South Carolina (USA). Features of barrier island physiography and ecology were studied relative to selective bait deployment and site biosecurity. Capture-mark-recapture data were obtained from 228 raccoons. Raccoon density estimates, using a modified census assessment technique, were one raccoon per 1.8 to 2.7 ha. Mean (+/- SE) and range home area estimates of radio-collared raccoons were 84 (+/- 15.6) ha (27 to 176 ha) by a minimum convex polygon method and 138 (+/- 22.8) ha (43 to 241 ha), by a harmonic mean transformation method. Habitat utilization determinations of radio-collared raccoons were conducted to identify study areas to potentially maximize selectivity of bait towards raccoons and to reduce the absolute number of baits deployed. Island raccoons showed a habitat preference for maritime forest, maritime shrub and marsh areas. Additionally, there was no evidence of inter-island or mainland exchange of ear-tagged or radio-collared raccoons. A disease and mortality survey was conducted to identify baseline pathology and incidental lesions in the target raccoon population, prior to actual vaccination initiation. Thirty-eight percent of 30 clinically suspect raccoons sampled had intracytoplasmic eosinophilic inclusions diagnostic of canine distemper; no other lesions suggestive of viral etiologies were found. Serological surveys for raccoon poxvirus and rabies virus antibodies were negative. Antibody titers to canine adenovirus 1 and 2 indicated a moderate level of exposure (approximately 10 to 16%) in the raccoon population. Overall, 93 to 100% of placebo baits were consistently disturbed by 7 days post-bait deployment, and bait acceptance rates by raccoons ranged from 49 to 85%, by using a modular systems approach to select the optimum combination of bait attractant, biomarker, matrix, density, and distribution. These results suggest that a large proportion (up to 85%) of a free-ranging island raccoon population can be selectively and safely targeted, marked and monitored utilizing a proposed oral bait delivery system for recombinant or other rabies vaccines.

Rorschach Depression indices with children and adolescents: concurrent validity findings

Exner (1983, 1986) developed and recently revised (1990b) a Rorschach Depression Index based on scores from variables in the Comprehensive System. This study evaluated both the original and the revised DEPIs for child and adolescent outpatient (n = 67) and inpatient (n = 99) samples in order to assess the diagnostic utility of these indices. There were no significant relationships between the original form and the revised form of the DEPI and clinical elevations on the Depression scale of the Personality Inventory for Children in the outpatient sample or treatment team diagnostic judgments in the inpatient sample. These findings sound a strong cautionary note for using only Rorschach Depression indices to diagnose depression in children and adolescents.

Modafinil: the unique properties of a new stimulant

Modafinil, a novel stimulant which has several remarkable features that distinguish it from other stimulants, has been developed by Lafon, a French pharmaceutical company. Unlike the amphetamines, for example, modafinil is reported to have minimal peripheral side effects at therapeutic doses. It also appears to have a low abuse potential, does not interfere with normal sleep, and does not seem to produce tolerance. It improves vigilance especially in sleep-deprived subjects. It has been used clinically for up to 3 years in the treatment of narcolepsy and idiopathic hypersomnia. It could be an ideal replacement for amphetamine in short-term operations in which fatigue might threaten the successful completion of a mission. We recommend that military laboratories experienced in studying sustained performance include modafinil or perhaps a more selective alpha 1 receptor agonist in their investigations.

Exposure factors for HIV-1 infection among heterosexual drug abusers in New Jersey treatment programs

In a cross-sectional study of 926 subjects from 10 drug treatment programs conducted in 1984 in New Jersey, the seroprevalence of human immunodeficiency virus (HIV) was 35% overall; 30% in whites, 33% in hispanics, and 46% in blacks (p = 0.01 for comparison of blacks to non-blacks). Univariate analysis showed the seroprevalence of HIV was not associated with age or gender, but did correlate with frequency of cocaine or heroin injection (p trend less than 0.001); frequency of needle sharing (p trend = 0.007); and inversely with levels of education (p = 0.05). The prevalence of HIV was also inversely related to the distance of the treatment center from lower Manhattan; being highest for distances of less than 5 miles from lower Manhattan and lowest for distances of 80 miles, with intermediate rates for the intervening distances (p trend less than 0.001). In multivariate analyses, HIV seropositivity was consistently associated with the frequency of needle sharing (p = 0.02) and less than 12 years (high school level) of education (p = 0.02), but not with black race. However, blacks who shared needles less than once a month had a relative risk of 3.2 (95% CI 1.2, 7.7) while non-blacks who shared less than once a month had a relative risk of only 0.9 (95% CI 0.3, 2.4). The risk in non-blacks increased to more than twofold with more frequent needle sharing. When the analysis was stratified by gender and adjusted for needle sharing and geography, a significant twofold increased risk was observed for female (but not male) subjects who had two or more heterosexual partners compared with those who had one partner.(ABSTRACT TRUNCATED AT 250 WORDS)

The reliability and validity of the Maternal Social Support Index for primiparous mothers: a brief report

The Maternal Social Support Index (MSSI) is an 18-item questionnaire designed to quickly assess qualitative and quantitative aspects of a mother's social support. This study examines a sample of primiparous mothers during the first nine months following delivery. Mothers were interviewed within 72 hours after delivery and again at six weeks and nine months. Using Spearman coefficients, the correlation for total MSSI scores between birth and nine months was .75. The correlations for individual items between birth and nine months ranged from .22 to .76. The MSSI at birth was strongly correlated with the Dyadic Adjustment Scale at nine months (r = .41, P = .001). Scores on the Center for Epidemiologic Studies Depression Scale at birth were inversely and significantly associated with the MSSI at six weeks postpartum (r = .50, P = .004). The MSSI assesses important elements of a new mother's environment which are related to her satisfaction with an intimate other, as well as depressive symptoms. These findings are similar to those in earlier reports.

Seroprevalence and risk factors for HTLV-I/II infection among female prostitutes in the United States

We tested 1305 female prostitutes from eight areas of the United States for antibodies to human T-cell lymphotropic virus type I/II. Overall, 6.7% were human T-cell lymphotropic virus type I/II seropositive (with antibodies to both gag and env gene products). The seroprevalence rates ranged from 0% in southern Nevada to 25.4% in Newark, NJ. Human T-cell lymphotropic virus type I/II seropositivity was independently associated with race (odds ratio, 4.68), intravenous drug use (odds ratio, 2.94), hepatitis B seropositivity (odds ratio, 2.87), recruitment in Newark (odds ratio, 2.34), and more years of sexual activity (odds ratio, 1.08 per year of sexual activity). Groups with high rates included blacks, Hispanics, and American Indians, and the rates in these groups were significantly higher than among whites and Asian Americans for women both with and without a history of intravenous drug use. Among intravenous drug users, the only other independent associations were more years of sexual activity and recruitment in Newark; and in non-intravenous drug users, hepatitis B seropositivity. These data show that human T-cell lymphotropic virus type I/II infection is present among female prostitutes in some areas of the United States. Further studies are needed to evaluate patterns of transmission and long-term health effects.

Development of positive feelings in primiparous mothers toward their normal newborns. A descriptive study

Though mothers' development of positive feelings about their newborns is the first step in maternal attachment, little research has described factors which may influence the process. This descriptive study reports normative data for primiparous mothers with normal newborns. The authors interviewed 100 primiparous mothers on the postpartum ward within 72 hours after delivery at a community hospital to ascertain factors associated with the development of positive feelings. Over one third (39%) of mothers studied reported their first positive feeling during the prenatal period, 42 percent during birthing or the first day and 19 percent on the second or third day. A majority of mothers (70%) described their strong positive feelings toward their newborns (i.e., "love") as a sense of caring, commitment and concern. Several demographic, biological and environmental factors were associated with the development of first positive feelings in primiparous mothers. One half of mothers who planned to become pregnant developed positive feelings prenatally, while 57 percent of mothers who did not plan to become pregnant reported their first positive feelings during birth or the first day. Delay in first positive feelings until after the first day was associated with labor longer than 8 hours, disappointment with the "bonding" experience, breast-feeding, and high depressive symptoms.

Knee orthoses for valgus protection. Experiments on 11 designs with related analyses of orthosis length and rigidity

Recent years have seen the introduction of a great many knee orthosis designs prescribed for protection against ligamentous injury or reinjury of the knee. The configurations and materials incorporated in these designs vary greatly, but all claim to be very effective. A leg model and 11 different commercially available knee orthoses were tested with static loading to obtain objective data on the relative effectiveness of the 11 designs to protect the knee from externally applied valgus moments. From these data, the effectiveness of each orthosis was calculated in terms of the rigidity contributed to the leg/orthosis combination. At a static valgus loading of 78 Nm, there was an eightfold variation in the rigidities contributed by the various knee orthoses, ranging from a low of 0.9 Nm per degree valgus to a maximum of 7.2 Nm per degree. The authors related analyses of two aspects of knee orthosis design (orthosis length and orthosis rigidity) to effectiveness in protecting against knee valgus overload injuries. Correlations were found between design inadequacies noted theoretically and efficacy problems evident from the laboratory tests. Orthosis length and orthosis rigidity must both be adequate, or the orthosis will not be biomechanically effective.

Bolus position at swallow onset in normal adults: preliminary observations

A "delayed swallowing reflex/response" (i.e., when the swallow reflex is not triggered when the bolus passes the back of the tongue at the anterior facial arch) Logemann has been widely accepted as an abnormality. Careful review of the literature supports the premise that a "delayed swallowing reflex/response" may in fact be a variation of normal. This paper describes swallowing in normal adults. We report the videofluoroscopic measurements of bolus position at the onset of swallow. A radiopaque marker was affixed to the anterior facial arch and the distance between the head of the bolus and the anterior facial arch was measured at the onset of swallow. A statistically significant proportion of swallows (22 of 30) occurred after the head of the bolus passed the anterior facial arch. This finding suggests that there may be diverse sites for elicitation of the swallowing response/reflex rather than a single site (i.e., the anterior facial arch). The relevance of this finding to treatment using thermal stimulation is discussed, as is the versatility of the normal pharynx.

Iliac vein approach to permanent pacemaker implantation

Since July 1980, 90 patients have had 95 permanent pacemakers implanted via an iliac vein approach. An incision is made superior to the inguinal ligament and the iliac vein is cannulated with a single lead for the ventricle or two leads for the atrium and ventricle. The pulse generator is placed in the subcutaneous tissue of the abdomen lateral to the umbilicus via a second incision. Overall 28 pacemaker implants were for atrial pacing, 53 for ventricular pacing and 14 were dual chamber. Nine (21%) of the atrial leads displaced and required repositioning and 5 (7%) of the ventricular leads dislodged and required revision. Lead dislodgement, especially in the atrium, remains a major weakness of the approach, and decreases its utility. Eleven percent of the last 19 atrial leads have dislodged. Nevertheless, the method is simple to perform and is presented as an alternative to the usual pectoral implantation site.

Invitation to attend a health check in a general practice setting: comparison of attenders and non-attenders

A sample of 1570 men and women aged 20-45 years registered with an inner-city Cardiff practice were offered the opportunity by their general practitioner to have a health check at the surgery. The demographic characteristics, attitudes, beliefs and preventive health behaviour and past contact with the practice were compared for a sample of 259 non-attenders and 216 attenders. The results showed that attenders were generally better educated, better motivated to look after their health, had fewer ties and commitments, performed more healthapproved practices, had had more recent contact with their own practice and accepted the legitimacy of a general practitioner's interest in his patients' lifestyle. Offering cohorts of patients additional screening services is unlikely to be efficient or effective since it is the low-risk people already known to the doctor who are most likely to attend. The onus lies on primary health care to provide services in a way which permits appropriate screening of the high-risk groups as they attend for other reasons.

Extracellular calcium alters frequency modulation of [3H]acetylcholine release from rat hippocampal slices

The concentration of extracellular Ca2+ has been shown to enhance or attenuate [3H]acetylcholine (ACh) release subsequent to a conditioning stimulus in rat brain hippocampal slices. Slices were incubated in vitro in [3H]choline solution. Subsequently the slices were subjected to two consecutive electrical stimulations separated by 15 or 30 min at 0.25, 1, 4 and 16 Hz and [3H]ACh release was assessed. It was found that a conditioning stimulus may reduce [3H]ACh release during a second stimulation. This phenomenon is frequency related and disappears when the two stimulations are 30 min apart. High extracellular Ca2+ (4.0 mM) further attenuated [3H]ACh release during the second stimulation, whereas low Ca2+ (0.32 mM) abolished the decrease in [3H]ACh release following the second stimulation in all frequencies tested.

The East cumbria community health project

The East Cumbria Health Project is in its second year and aims to encourage and support groups and individuals to explore, identify and action their own health education needs. The project is a unique joint venture between a local health authority, the United Kingdom's Open University and the Manpower Services Commission, who fund the project. The project employs one full-time co-ordinator and fourteen part-time community health facilitators. All facilitators were previously unemployed local residents. The project serves a mixed rural and urban community of approximately 180,000 in the North West of England between the Lake District and the Scottish Border. The project to date has demonstrated that non-professional health workers with appropriate training can work effectively to complement existing professional community health workers. The project has also demonstrated that workers drawn from the local population can be effective in stimulating local communities and groups of people to become more involved with health and health care issues. Finally, the project has demonstrated that community health workers drawn from the local population can act as useful links between the statutory and voluntary health services and local communities.

Situational factors related to rural adolescent alcohol use

Factors and situations associated with alcohol use in a sample of rural junior and senior high school students are examined. Much research has shown that age, gender, grade in school, religiosity, socioeconomic status, and involvement in extracurricular activities are all related to adolescent alcohol use. The present paper looks at the relationship between these factors and situations which might be conducive to drinking (e.g., driving around in a car, before going to a party, etc.) to determine whether the factors make it more likely that an adolescent will drink in such situations. The amount of time spent in social activities was positively related to alcohol use in all situations examined except drinking at home or at dinner. The amount of time spent studying and the frequency of attending religious services were negatively related to alcohol use in the various situations. Females were also less likely to drink in the situations discussed. Policy implications and directions for future research are discussed.