A study of 96 high-risk, but uneventful pregnancies was performed. Overt hyperglycemia was excluded after 24 weeks of gestation by fasting serum glucose >110 mg, serum glucose of >140 mg two hours after a large breakfast (group 1, 44 subjects) or >140 mg two hours after a standard glucose load (group 2, 52 subjects). A significant linear correlation between the two-hour postprandial serum glucose and birth weight was found in group 1 (r = 0.29, p > 0.05). There was a random correlation (r = -0.002, p < 0.4) in group 2. It is suggested that the dietary habits were an important variable.

Birth Weight↗

PubMedDate not supplied

Analysis of a multicomponent smoking cessation project: what worked and why.

BACKGROUND: Health promotion interventions often contain several, conceptually diverse elements. As a result, it is often difficult to determine why interventions succeed or fail as well as which components should be retained or eliminated. One method to examine the effectiveness of individual intervention elements is process analysis. METHODS: Kick It! is a multicomponent smoking cessation intervention developed for lower socioeconomic African Americans. The intervention includes several components, including a 24-page printed cessation manual, a staged-cessation video, a quit contract, two "Quit and Win" contests, and a single telephone booster call. Using data from a randomized intervention trial designed to test the efficacy of the Kick It! intervention, this article examines the use, impact, and interaction of the intervention's subcomponents as well as possible mediating variables related to successful quitting among intervention participants (n = 650). RESULTS: In univariate as well as multivariate analyses adjusting for age and stage of change, two of the five elements, watching the video and entering a Quit and Win contest, were significantly associated with 6-month point prevalence abstinence. Submitting a quit contract and receiving the booster call were significantly associated with quitting in univariate analyses, while reading the Kick It! guide was not significantly associated with quitting in either analysis. CONCLUSIONS: Despite the positive effects observed for individual elements, quitting was not significantly greater among intervention relative to comparison subjects. The primary reason for this appears to be the overall lack of intervention use. Additional research examining strategies to increase use of the Kick It! intervention components as well as the optimal sequencing and combination of components may be warranted.

Adult↗

PubMedDate not supplied

Cholesterol screening in the emergency department.

OBJECTIVE: To determine the feasibility of providing cholesterol screening in the emergency department (ED) and to determine compliance with follow-up recommendations. DESIGN: A prospective observational study. SETTING: The Ambulatory Care and Treatment Section of the George Washington University Medical Center ED. PATIENTS/PARTICIPANTS: All patients seen in the Ambulatory Care and Treatment Section of the ED who were 18 years of age or older and who were residents of the metropolitan Washington, D.C., area were eligible to participate. During the six-month study period, 660 patients were asked to participate and 539 (82%) agreed. INTERVENTIONS: Fingerstick cholesterol measurements were performed on all participants. Participants who had elevated cholesterol levels, as determined by the National Cholesterol Education Program guidelines, were scheduled for a six-week follow-up visit in the Lipid Research Clinic, where repeat fingerstick cholesterol measurements were performed. Those participants with elevated cholesterol levels were instructed to follow up with their primary care physicians. Compliance with follow-up was assessed by a telephone contact four months after the initial ED visit. MEASUREMENTS AND MAIN RESULTS: Of the 539 participants, 100 (19%) were found to have elevated cholesterol levels. Fifty-three (53%) returned for the six-week follow-up visit. Of the 53 who returned, 7 (13%) had normal and 46 (87%) had elevated cholesterol levels. Of the 46 participants with elevated cholesterol levels, 15 (33%) reported four months after their ED visit that they had received further follow-up care. CONCLUSIONS: Cholesterol screening in the ED is feasible, but compliance with follow-up is less than desirable.

Adult↗

PubMedDate not supplied

Chronic ulcerative colitis with pseudopolyposis.

Explore the source record for details and available documents.

Adult↗

PubMedDate not supplied

Ethical approval for national studies in Ireland: an illustration of current challenges.

BACKGROUND: Ethical approval of research projects is, appropriately, an essential prerequisite in health settings. AIMS: This paper outlines difficulties encountered with procedures for gaining ethical approval for two multicentre surveys in Ireland. METHODS: The experiences of two national surveys were documented. RESULTS: Delays in processing ethics applications led to substantial delays in both surveys. Research ethics committees (RECs) assessed applications in an idiosyncratic manner. CONCLUSION: In Ireland, there is currently no accepted mechanism for single location ethical approval for multicentre studies. Instead, they require separate approval from all participating centres. The challenges of this system of application to multiple committees are outlined in this paper, and possible solutions presented.

Cardiology Service, Hospital↗

PubMedDate not supplied

Methadone maintenance in general practice: impact on staff attitudes.

BACKGROUND: The evaluation of a structured protocol for the discharge of stabilised patients on methadone maintenance to general practice provided an opportunity to evaluate the impact on the attitudes of general practitioners (GPs) and practice staff. AIM: To assess attitudes, expectations and experience among GPs and practice staff before the introduction of structured methadone maintenance and six months after its introduction. METHODS: A postal questionnaire was sent to 31 GPs and 23 receptionists in 23 Dublin general practices before the patient's first visit and six months later at the end of the study period. Outcome measures were staff attitudes, incidence of disruption, perceived difficulties in providing care and in prescribing methadone, and stress levels. RESULTS: There was a generally positive attitude to provision of methadone in general practice for stabilised patients, although it was not anticipated to be problem free. Following six months involvement attitudes were similar; stress levels were unchanged, but fewer GPs anticipated problems in delivering the service. All continued to participate in the scheme. CONCLUSION: GPs and receptionists in this sample had mixed views about methadone maintenance which were unchanged by six months experience of the service. The study illustrates important issues in the recruitment and support of general practice in meeting this need.

Adult↗

PubMedDate not supplied

Genomic organisation of the human chordin gene and mutation screening of candidate Cornelia de Lange syndrome genes.

We have determined the genomic organisation of the human chordin gene, CHRD, and have shown that it maps within a gene cluster at 3q27 containing THPO (thrombopoietin), CLCN2 (a voltage-gated chloride-channel gene) and EIF4G1 (a eukaryotic translation-initiation-factor-gamma gene). The CHRD and THPO genes are very close neighbours and are transcribed from opposing DNA strands from promoters that are spaced less than 2 kb apart. We considered that the CHRD gene and the chordin-regulating GSC (goosecoid) gene could be candidate genes for Cornelia de Lange syndrome (CDLS), a developmental malformation syndrome which is primarily characterised by mental handicap, growth retardation, distinctive facial features and limb-reduction defects. CDLS patients typically occur as sporadic cases, but several reports have suggested dominant inheritance. The candidacy of the CHRD and GSC genes was supported by several lines of evidence: prior evidence for a CDLS gene at 3q26.3-q27; a report suggesting a significant association between CDLS and thrombocytopenia; suspected genetic heterogeneity in CDLS; location of the GSC gene in close proximity to a 14q32 breakpoint detected in a CDLS patient with a balanced de novo translocation; known regulation of chordin expression by goosecoid; and the pattern of embryonic expression of the mouse GSC gene. Another candidate gene at 3q27, SOX2, was also considered because of its suspected role as a transcription factor in early development and because of known examples of SOX genes that are loci for dominantly inherited developmental disorders. However, mutation screening failed to identify CDLS patient-specific mutations in CHRD, GSC or SOX2.

Amino Acid Sequence↗

PubMedDate not supplied

Mineral and nitrogen balance study: results of metabolic observations on Skylab II 28-day orbital mission.

Prediction that the various stresses of flight, particularly weightlessness, would bring about significant derangements in the metabolism of the musculoskeletal system has been based on various observations of long-term immobilized or inactive bed rest. The only attempt at controlled measurement of metabolic changes in space prior to Skylab, a study during the 14-day Gemini VII flight, revealed rather modest losses of important elements. The three astronauts of Skylab II consumed a planned day-by-day, quite constant, dietary intake of major metabolic elements in mixed foods and beverages and provided virtually complete collections of excreta for 31 days preflight, during the 28 days inflight, and for 17 days postflight. Analyses showed that, in varying degree among the crewmen, urinary calcium increased gradually during flight in a pattern similar to that observed in bed-rest studies: the mean plateau peak of urinary calcium excretion in the latter part of flight was double preflight levels. Fecal calcium excretion did not change significantly, but calcium balance, owing to the urinary calcium rise, became either negative or less positive than in preflight measurement. Increased excretion and negative balance of nitrogen and phosphorus indicated appreciable loss of muscle tissue in all three crewmen. Significant losses also occurred inflight in potassium, sodium, and magnesium. Based on the similarity in pattern and degree between these observations and those in bed rest of the losses in calcium, phosphorus, and nitrogen, musculoskeletal integrity would not be threatened in space flights of up to at least 3 months. However, if similar changes occur, indicative of continuing losses of these elements, in the planned Skylab flights for considerably more than 28 days, concern for capable musculoskeletal function should be serious for flights of very many months' duration, and greater research attention will need to be given to development of protective counter-measures.

Aerospace Medicine↗

PubMedDate not supplied

Coprescribing of nonsteroidal anti-inflammatory drugs and cytoprotective and antiulcer drugs in Nova Scotia's senior population.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are frequently prescribed for the elderly and are commonly prescribed with cytoprotective or antiulcer drugs to prevent or treat gastrointestinal side effects. The objective of this study was to examine the utilization and drug costs of NSAIDs, and to examine coprescription of cytoprotective and antiulcer drugs with NSAIDs in the Nova Scotia population aged 65 years and older. The study used data from the Nova Scotia Seniors Pharmacare program database, which contains data on claims for all filled prescriptions to persons 65 years of age and older. We examined claims for the period April 1, 1993, to March 31, 1994. Aspirin accounted for the largest percentage of the total days supply of NSAIDs (25.2%), followed by diclofenac (18.8%) and naproxen (12.9%). Diclofenac accounted for the largest share of expenditures for NSAIDs (27.6%). Overall, 17.1% of the total days supply of NSAIDs were coprescribed with a cytoprotective or antiulcer drug. Histamine2 blockers accounted for most coprescribed days supply (83.6%) followed by sucralfate (8.1%), misoprostol (4.5%), and omeprazole (2.3%). The appropriateness and cost-effectiveness of these coprescriptions must be examined.

Aged↗

PubMedDate not supplied

Treatment of premenstrual syndrome. A double-blind trial of dydrogesterone.

A double-blind randomised crossover trial of oral micronised progesterone and placebo had demonstrated that progesterone had beneficial effects over placebo for some mood and physical premenstrual symptoms. A further trial using identical methodology was carried out to assess whether dydrogesterone would have the same beneficial effects. Prospective assessment confirmed the presence of a premenstrual syndrome in 30 women. Of these, six withdrew during the 4 months of the study. Twenty-four women completed the double-blind crossover protocol. All women were interviewed premenstrually before treatment and in each month of treatment. They completed the Moos Menstrual Distress Questionnaire, Beck Depression Inventory, Spielberger State Anxiety Inventory, Mood Adjective Checklist and a Daily Symptom Record. Analysis of data found an overall beneficial effect of being treated for most variables. Further analysis showed that the most major effects occurred in the first 2 treatment months. This study could find no evidence that dydrogesterone was more effective than placebo in treating premenstrual complaints.

Administration, Oral↗

PubMedDate not supplied

Aggression and hostility in substance abusers: the relationship to abuse patterns, coping style, and relapse triggers.

A cohort of 3,367 substance abusers seeking treatment were administered measures of aggression and hostility including the Buss-Durkee Hostility Inventory and the NEO Personality Inventory Hostility Scale. Polysubstance abusers scored significantly higher on all measures of hostility and aggression, regardless of whether they abused cocaine or not. Subjects scoring higher on aggression and hostility utilized escape-avoidance, distancing, and confrontational coping styles more regularly. Subjects scoring higher on measures of aggression and hostility reported more situations that triggered their use of substances and less confidence that they could resist using when faced with such situations in the future. This was especially true for situations involving unpleasant internal states, situations involving rejection, and situations involving conflict with family and friends. The implications of these findings for clinical assessment and treatment planning are discussed.

Adaptation, Psychological↗

PubMedDate not supplied

The man with the round face and left lower quadrant mass.

Explore the source record for details and available documents.

Cognition Disorders↗

PubMedDate not supplied

Toxicity--seizures in an infant caused by (or related to) oral viscous lidocaine use.

A 5-month-old infant with seizures secondary to oral viscous lidocaine toxicity is described. Despite prior reports of this complication in the literature, many practitioners are unaware of the potential adverse effects of topical lidocaine usage in the pediatric patient. Complications of topical lidocaine use and recommendations regarding its use in the pediatric patient are discussed.

Administration, Oral↗