Teenage sex. Teenagers can be helped to behave responsibly.
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Adolescent↗
Biomedical subjects
P Graham
Publications and source records attributed to P Graham.
Psychiatric problems in children with hemiplegia: cross sectional epidemiological survey.
OBJECTIVE: To examine the prevalence and predictors of psychiatric problems in children with hemiplegia. DESIGN: Cross sectional questionnaire survey of an epidemiological sample with individual assessments of a representative subgroup. The questionnaire survey was repeated on school age subjects four years later. SUBJECTS: 428 hemiplegic children age 2 1/2-16 years, of whom 149 (aged 6-10 years) were individually assessed. MAIN OUTCOME MEASURES: Psychiatric symptom scores and the occurrence of psychiatric disorder. RESULTS: Psychiatric disorders affected 61% (95% confidence interval 53% to 69%) of subjects as judged by individual assessments and 54% (49% to 59%) and 42% (37% to 47%) as judged from parent and teacher questionnaires, respectively. Few affected children had been in contact with child mental health services. The strongest consistent predictor of psychiatric problems was intelligence quotient (IQ), which was highly correlated with an index of neurological severity; age, sex, and laterality of lesion had little or no predictive power. CONCLUSION: Though most hemiplegic children have considerable emotional or behavioural difficulties, these psychological complications commonly go unrecognised or untreated. Comprehensive health provision for children with chronic neurodevelopmental disorders such as hemiplegia should be psychologically as well as physically oriented.
Child↗
Development and characterization of a monoclonal antibody 369.2B specific for the carboxyl-terminus of the beta A4 peptide.
The beta-amyloid deposits in Alzheimer's diseased (AD) brain are made up mainly of beta A4 peptides which show both N- and C-terminal heterogeneity. The predominant C-terminal species, identified by peptide sequencing of purified beta-amyloid, end either at position 40 or 42 of the beta A4 peptide. The distribution of these two beta A4 species in postmortem tissue as well as their generation in vitro could not be addressed previously due to the lack of specific antibodies that could differentiate them. This report describes the generation of a highly specific monoclonal antibody, MAb 369.2B which was raised against a synthetic peptide consisting of the C-terminus of the 1-42 beta A4 species. MAb 369.2B does not recognize the shorter beta A4 species 1-40 in solution or in solid phase. Furthermore, both beta A4 1-40 and 1-43 were unable to absorb out the antibody when used immunocytochemically. The regional distribution of MAb 369.2B immunoreactivity in AD and non-AD brain samples were compared to MAb 286.8A, an antibody raised against the N-terminal region of beta A4. Overall, the staining patterns were very similar. In AD cases with extreme vascular involvement, the N-terminal (MAb 286.8A) antibody was more likely to label the vascular basement membrane of affected vessels, and to label them more uniformly. In addition, preliminary quantitative analyses revealed that the C-terminal antibody labeled fewer, larger plaques than the N-terminal antibody. Qualitative analyses revealed that these smaller plaques were typically subregions of the larger plaques. The data corroborate the biochemical findings of N-terminal raggedness in beta A4 plaques. Further studies are required to explain this differential pattern of deposition.
Aged↗
Pressure-limited ventilation with permissive hypercapnia and minimum PEEP in saline-lavaged rabbits allows progressive improvement in oxygenation, but does not avoid ventilator-induced lung injury.
OBJECTIVE: To determine whether pressure-limited intermittent mandatory ventilation with permissive hypercapnia and positive end-expiratory pressure (PEEP) titrated to arterial oxygen tension (PaO2) prevents or reduces acute lung injury, compared to conventional ventilation, in saline-lavaged rabbits. DESIGN: Prospective randomised trial. SETTING: University animal laboratory. SUBJECTS: 18 New Zealand White rabbits. INTERVENTIONS: Following five sequential saline lung lavages, anaesthetised rabbits were randomly allocated in pairs to receive either of two ventilation protocols using intermittent mandatory ventilation. The study group had peak inspiratory pressure limited to 15 cm H2O and arterial partial pressure of carbon dioxide (PaCO2) was allowed to rise. The control group received 12 ml/kg tidal volume with rate adjusted for normocarbia. PEEP and fractional inspired oxygen (FIO2) were adjusted to maintain, PaO2 between 8 and 13.3 kPa (60 and 100 mm Hg) using a predetermined protocol. At 10 h or following death, lung lavage was repeated and lung histology evaluated. MEASUREMENTS AND MAIN RESULTS: The mean increase in lavage cell counts and protein concentration and hyaline membrane scores were not significantly different between the groups. Oxygenation progressively improved more in the study group (p = 0.01 vs control for PaO2/FIO2 ratio and alveolar-arterial oxygen tension gradient (AaDO2)). PEEP was similar and the mean airway pressure higher in the control group, suggesting that this probably resulted from less ventilator-induced injury in the study group. Four deaths occurred in the control group (three due to pneumothorax and one to hypoxaemia) and none in the study group (p = 0.08). CONCLUSIONS: This ventilatory protocol may have failed to prevent lung overdistension or it may have provided insufficient PEEP to prevent injury in this model; PEEP greater than the lower inflection point of the pressure-volume curve has been shown to prevent injury almost entirely.
Animals↗
Histamine forming capacity (HFC) and its modulation by H3 receptor ligands in a model of bronchial hyper-responsiveness.
The histamine forming capacity (HFC) of acutely challenged airways from sensitised guinea pigs was investigated. After exposure to nebulised bovine serum albumin (BSA) or normal saline, animals were sacrificed, the pulmonary HFC determined and concurrent in vitro histamine log concentration response curves were constructed for parenchymal strips and tracheal muscle, the latter was field stimulated to record neurogenic responses. Exposure to BSA increased the HFC above controls for 24 hours (p < 0.001) and log concentration response curves for the parenchymal strips were shifted slightly to the left with an increased maximum response. This change appeared 3 hours after exposure and remained elevated at 24 hours. Similar changes did not occur with the trachea. Pre-treatment with thioperamide augmented (p < 0.02) HFC and this increase was inhibited by alpha-methylhistamine (p < 0.05). A possible relationship may exist between increased responsiveness of lower airways to exogenous histamine and a raised endogenous formation, regulated by the H3 receptor.
Animals↗
Tolerance of nicotinamide and carbogen with radiation therapy for glioblastoma.
Nineteen patients with glioblastoma were treated with nicotinamide and carbogen and radiotherapy. Eight patients did not complete the protocol because of hepatic toxicity from phenytoin/nicotinamide drug interactions, persistent nausea or vomiting with nicotinamide, intolerance of the carbogen breathing apparatus, or other reason. In addition, early radiation neurotoxicity appeared increased.
Administration, Inhalation↗
Blindness and trachoma in South Australia.
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Blindness↗
The correlation of elevated levels of an index of lipid peroxidation (MDA-TBA) with adverse outcome in the very low birthweight infant.
The objective of this study was to examine the relationship between malondialdehyde-thiobarbituric acid (MDA-TBA) levels, as a measure of lipid peroxidation, in very low birthweight (VLBW) infants and outcome measures. A prospective observational longitudinal study was carried out in two level III neonatal units in the South Island of New Zealand measuring MDA-TBA levels in 61 VLBW infants in 1993. MDA-TBA levels were measured in (i) maternal plasma within 48 h of parturition, (ii) cord plasma, and (iii) infants' plasma at 2, 7, 14 and 28 days of age and correlated with antenatal and postnatal factors. Elevated levels of plasma MDA-TBA at 7 days were associated with adverse respiratory and ophthalmological outcome in the VLBW infants. Elevated MDA-TBA levels were measured at sample times close to the time of death in the infants who died. These results substantiate previously reported preliminary observations and support the hypothesis that oxidative injury, particularly within the first 7 days of life, is associated with the development of the long-term complications of the pre-term infant. MDA-TBA levels appear to be a useful measure to continue to explore the role of free radical mediated disease in the VLBW infant.
Fat Emulsions, Intravenous↗
Violence in children: the scope for prevention.
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Child↗
Quaker belief and child psychiatry.
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Child↗
Sigmoidoscopy.
The use of a rigid sigmoidoscope, a skill any GP can easily acquire, may save a patient the inconvenience and expense of the more complex procedures of flexible colonoscopy or barium enema. Most colonic pathology occurs within reach of a 25 cm sigmoidoscope. Rigid sigmoidoscopy can be quickly and safely performed in most cases without bowel preparation and in the GP's office.
Colonic Diseases↗
Prevalence of childhood asthma symptoms in an industrial suburb of Christchurch.
AIM: In response to community concern about the possible respiratory effects of emissions from a fertiliser plant, a study was carried out to determine whether the prevalence of asthma symptoms in 5-8 yr old children in an industrial suburb of Christchurch (Hornby) was the same as in the rest of Christchurch. METHODS: A sample of 646 children aged 5-8 years in Hornby was compared with 1183 6-7 year old children randomly selected from schools throughout the Christchurch metropolitan area. The Christchurch sample was part of the International Study of Asthma and Allergies in Childhood (ISAAC) carried out during 1993. ISAAC questionnaires on respiratory symptoms with some additional questions about smoking and pets were answered by the caregivers of the children sampled. RESULTS: Response rates were 97% in Hornby and 94% in Christchurch. Of the sample, 29% (Hornby) and 27% (Christchurch) had 'wheeze in the last 12 months' while 45% of Hornby and 44% of Christchurch children had 'ever wheezed', 28% had 'ever had asthma'. Significantly more children in Hornby (44%) were exposed to passive smoking compared to Christchurch (29%). Indoor pets were present in 73% and 67% of homes, respectively. CONCLUSION: There was no evidence of an increase in asthma symptoms reported in children in the industrial area of Hornby.
Air Pollution↗
Localised prostate cancer: which way forward?
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Humans↗
Modelling covariate effects in observer agreement studies: the case of nominal scale agreement.
Correction for chance-expected agreement has become an accepted technique in the analysis of observer agreement data and may be particularly useful when the level of agreement achieved in different populations is compared. However, formal methods for making comparisons of chance-corrected agreement or, more generally, for studying the effects of covariates on chance-corrected agreement have not received much attention. For nominal scale agreement data we show how Tanner and Young's model for observer agreement can be applied to this problem. The models discussed can be fitted using existing software and certain model parameters have interpretations in terms of positive and negative agreement odds ratios. The proposed methodology facilitates investigation of issues such as confounding of covariate effects and interaction between covariates in their effect on chance-corrected agreement. The methods outlined therefore allow observer agreement data to be analyzed in a manner strongly analogous to the logistic modelling of the association between disease and suspected risk factors. The methods are illustrated using data on the comparability of primary and proxy respondent reports of the primary respondents participation in physically vigorous leisure time activity.
Analysis of Variance↗
Sexually abused and nonabused mothers' discussions about sex and their children's sexual knowledge.
This study investigated the impact of a mother's experience of childhood sexual abuse on her discussion of sex with her child. Two groups of sexually abused and nonabused mothers, drawn from a larger community sample and matched for social class and the sex and age of their index children, were asked about discussion of sexual information within their family. Children were interviewed about their sexual knowledge. Significantly more mothers who reported an incident of sexual abuse during their childhood said that they had detailed discussions with their child about sexual development and contraception than mothers who reported no childhood incidence of abuse. Although there was no difference between the two groups in independent interviewers' ratings of the children's overall sexual knowledge, more children from the abused mothers' group mentioned their parents as a definite source of sexual information, in particular, regarding contraception. There were also differences between the two groups in the children's responses to a set of ambiguous pictures. More children in the abused mothers' group than the nonabused group gave stories related to child abductions and the possibility of sexual abuse in response to two of the pictures. A mothers' willingness to acknowledge childhood sexual abuse is related to more open discussion of sexual information within the family.
Adolescent↗
A community-wide promotion of asthma self-management in New Zealand.
Asthma affects approximately 9% of young adults in New Zealand, with evidence of an increase in prevalence over recent years. Morbidity and mortality from this condition have caused widespread concern. In response to identified deficiencies in asthma management, initiatives to promote self-management using an asthma action plan were promoted throughout the Canterbury region in 1991 as part of a regional pilot study. A resource kit was prepared and self-management principles were promoted to general practitioners in discussion workshops. A community-wide promotion of the action plan was followed by a process and outcome evaluation. The plan and associated resources were well received by doctors and patients. Seventy-seven percent of doctors responding to a questionnaire had used the plan, and of these, 94% indicated that they would continue to use the plan in the future. Patients who obtained a completed plan experienced a greater reduction in nocturnal waking with asthma and improved self-management skills.
Adult↗