Biomedical subjects
Publications and source records attributed to C McClain.
The effects of chronic alcohol administration and acute maternal oral alcohol intake on fetal development in rats were investigated, both regimens causing substantial increase in fetal mortality. Decrease body, brain, heart, kidney, and liver weight did not appear to be due to zinc deficiency.
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This article describes the setting, policies, practices, and outcomes of the nurse-managed in-hospital birth center at Los Angeles County + University of Southern California Women's Hospital, where women are selected upon admission for birth center care. A retrospective review of available data was made; when compared with hospital records, the primary data source was found to be 96% accurate. Results of the review indicated that from 1981 to 1992, there were 36,410 birth center admissions and 30,311 births, all attended by nurse-midwives; no intrapartum maternal or fetal deaths occurred among all admissions. The intrapartum transfer rate averaged 17%, and declined steadily from a high of 28% in 1982 to a low of 7% in 1990. More in-depth review showed an overall primary cesarean birthrate of 1.8% and an operative birthrate of 4% among the 25,890 admissions and 22,490 births from 1985 to 1992. Detailed postpartum and newborn outcomes from 1982 to 1986 showed a neonatal intensive care unit admission rate of 1.5% and a one-week newborn readmission rate of 1.3% among newborns discharged within 12 to 24 hours; 85% of all newborns returned for follow-up care. This large longitudinal experience demonstrates excellent outcomes that can be achieved when nurse-midwives, working cooperatively with a multidisciplinary health care team, provide in-hospital birth center care to a predominately low-income Hispanic population using a variety of less-traditional intrapartum management techniques. Broader implications for making alternative maternity care services available for low-income women with nurse-midwives and nurses playing a central role are discussed.
Every year several million people sustain brain injury. The development of an optimal metabolic and nutritional support program for brain-injured patients relies on an understanding of the metabolic response and nutritional complications that occur with brain injury. Severely brain injured patients have increased serum and urine levels of norepinephrine, epinephrine, and cortisol. These patients also have increased oxygen consumption and urinary nitrogen excretion. This group has observed hypozincemia, hyperzincuria, increased serum C-reactive protein and copper concentrations, and hypoalbuminemia in nonsteroid-treated severely brain-injured patients. Experimental head injury produces interleukin-1 (IL-1) of brain origin. This cytokine mediates many of the aspects of the acute phase response, including all of the metabolic abnormalities reported by our group. IL-1, when administered intracerebroventricularly to experimental animals, appears to have enhanced biological activity compared to that administered systemically. Interleukin-1 activity has been found in significant amounts in the intraventricular fluid of head-injured patients. We suggest that IL-1 acts in concert with traditional stress hormones such as epinephrine, norepinephrine, and cortisol to produce the profound metabolic disturbances observed in the head-injured patient.
OBJECTIVE: Native American children have not been widely represented in the normative samples of standardized tests assessing motor development. This study investigated the cultural relevance of the Peabody Developmental Motor Scales (PDMS) in 2-year-old Native American children who are typically developing. METHOD: The PDMS was administered to a sample of 44 Pueblo children who were 24 months through 35 months of age and typically developing. Each child's family also completed a parent questionnaire addressing the child's development and family demographics. Participant scores were compared with those of the normative sample. RESULTS: The sample scored significantly lower than the normative sample (p < or = .001) on the Fine Motor Scale, and, when gender was taken into consideration, all but the older girls (30 months-35 months of age) had significantly lower scores. All but the younger girls (24 months-29 months of age) scored within the normal range on the Gross Motor Scale. CONCLUSION: Our results with this small sample suggest that caution be used when comparing motor performance (especially fine motor abilities) of 2-year-old Native American children against the PDMS normative data.
Patients with severe brain injuries have increased energy expenditures and urinary nitrogen excretion. Hypozincemia, hypoferremia, increased levels of acute phase proteins, depressed levels of negative acute phase proteins, and weight loss are common in these patients. The specific mediators of these responses are not known. Nutritional support may beneficially affect outcome in these patients, but enteral feedings are often not tolerated in the acute phase of injury. Animal investigations suggest that total parenteral nutrition and hyperglycemia may increase neuronal injury and worsen outcome. We review the current literature on nutritional support of brain-injured patients and examine the premises on which nutrition supplementation are based. More work is needed to define the metabolic responses and nutritional requirements of patients who sustain central nervous system injury.
Zinc (Zn), an essential trace element, has antioxidant functions, stabilizes membranes, and plays a role in the activity of a host of Zn metalloenzymes. Zn deficiency has been shown to increase erythrocyte fragility, decrease the Zn content of the erythrocyte membrane, and alter erythrocyte membrane fluidity. Recent studies have shown that Zn deficiency induced by various mechanisms disrupts endothelial barrier cell function in vitro, and this was corrected with Zn supplementation. Moreover, physiological amounts of Zn attenuated the barrier dysfunction produced by the inflammatory cytokine tumor necrosis factor. These data have important implications for acute vascular processes, e.g., adult respiratory distress syndrome, and chronic vascular processes, e.g., atherosclerosis. The mechanisms by which Zn may affect endothelial cell function and attenuate cytokine-induced endothelial cell dysfunction are important areas of continuing investigation.
Children who are hospitalized frequently or who have lengthy admissions often require a large number of caregivers to meet their complex health care needs. Even the most organized of teams may experience confusion in their attempt to stay abreast of each other's care of the child. This can be particularly confusing to parents who are trying to cope with the stress of hospitalization, learning to navigate new financial and social service systems, attempting to remember the names and faces of the numerous specialists and their specific recommendations, and caring for their child. The University of New Mexico Children's Hospital in Albuquerque, New Mexico has developed and used a care conference model that includes families, medical staff, social workers, nutritionists, child life specialists, and specialized therapy provides in the process of integrating developmentally appropriate practices within the scope of necessary medical care.