Clinical Knowledge and Skill Priorities in Substance Abuse Education: A Nursing Faculty Longitudinal Survey

The aims of this study were to: 1) determine which of 16 substance abuse content areas nursing faculty fellows considered important for their professional growth; 2) determine content areas in which faculty fellows planned to obtain knowledge and skill development during the coming year; and 3) to identify content areas faculty fellows thought undergraduate and/or graduate students should be taught. Questionnaires were mailed to the 43 nursing faculty fellows who were recipients of substance abuse federal training during the 1989-1994 academic years. The response rate was 81%. One and a half years later, 66% responded to the same items on a follow-up survey. The results showed that faculty ratings of knowledge and skill development needs for themselves and their students in nursing were stable over time. Findings can be used to guide faculty and curriculum development in alcohol and other substance abuse.

Parents' evaluation of a preventive intervention following the sudden, violent deaths of their children

A preventive intervention for 156 bereaved parents whose 12- to 28-year-old children died by accident, homicide, or suicide was tested using a multisite longitudinal cohort pretest/posttest experimental design. Reported here are bereaved parents' evaluations of the two-dimensional support program. Problem-focused support was rated by parents' perceptions of readiness, relevance, timing, and understanding of the information and skills presented. Emotion-focused support was rated by the identification of I. Yalom's (1985) therapeutic group factors and group leader/clinician support. Over 70% of all the person/session responses showed that both support dimensions were rated at 6 or 7 on a 7-point scale (e.g., 0 = not at all relevant, 7 = very relevant.) Additional exploratory analyses examined the extent to which 5 participant and treatment characteristics influenced parents' evaluations. Clinical implications and future research directions are suggested.

Parent bereavement stress and preventive intervention following the violent deaths of adolescent or young adult children

It is currently believed that effective intervention programs can reduce the negative consequences of stressful life events. The purpose of this paper is to describe a three-step process used to develop a theory-based preventive intervention for parents whose 12- to 28-year-old children had died 2 to 7 months previously by accident, homicide, or suicide. Assumptive world, family life cycle, victimization, and social support theories form the basis for "matching" parent bereavement stress with selected intervention strategies.

Hyponatraemia and dehydration in severe malaria

The prevalence and likely cause of hyponatraemia in severe childhood malaria were investigated. One hundred and thirty two children, 47 of whom had cerebral malaria, were prospectively recruited and serial simple indices of fluid and electrolyte balance and renal function monitored during admission. In 55%, hyponatraemia (sodium < 135 mmol/l) was present on admission. Hyponatraemia was pronounced (sodium < or = 130 mmol/l) in 21%, and these children gained less weight during admission (mean weight gain 2.4% v 4.3%) than children with a normal sodium (135-145 mmol/l). Overall, 31% of survivors were at least moderately dehydrated on admission (5% weight gain by discharge). These children had higher plasma urea concentrations on admission (6.1 v 4.5 mmol/l) and were more acidotic (mean base excess -12.1 v -8.0) than children who were not dehydrated. There were changes in simple indices of renal function between admission and discharge in children who survived (creatinine 65.7 v 37.9 mumol/l and urea 5.5 v 1.9 mmol/l). The results suggest that dehydration is common in severe childhood malaria, that it may contribute to mild impairment in renal function, and that hyponatraemic children are less water depleted, showing appropriate rather than inappropriate secretion of antidiuretic hormone.

Reliability, construct validity, and subscale norms of the Brief Symptom Inventory when administered to bereaved parents

The Brief Symptom Inventory (BSI) was administered to parents (N = 260; 171 mothers and 89 fathers) whose adolescent and young adult children died unexpectedly and violently by accident, homicide, or suicide. Summary statistics and reliability coefficients (Cronbach's alpha) for the nine subscales and the Global Severity Index were calculated. A comparison of means and standard deviations confirmed the expectation that this sample is dramatically different from the normative American community standard. Raw scores for the subscales were transformed into standardized T scores and critical values for a screening heuristic presented. An attempt to obtain construct validity using factor analysis suggested that a five-factor solution provided a description of this population of bereaved parents that is more insightful than the nine standard subscales of the BSI. Implications for both clinicians and future research are discussed.

An analysis for menstrual data with time-varying covariates

This paper concerns the analysis of menstrual data; in particular, methodology to identify variables that contribute to the variability of menstrual cycles both within and between women. The basis for the proposed methodology is a parameterization of the mean length of a menstrual cycle conditional upon the past cycles and covariates. This approach accommodates the length-bias and censoring commonly found in menstrual data. Data from a longitudinal study of menstrual patterns and other variables among Lese women of the Ituri Forest, Zaire, illustrate the methodology. A small simulation illustrates the bias caused by incorrectly deleting the censored cycles.

Psychological assessment of postdisaster class action and personal injury litigants: a case study

The case study method is used to describe psychological assessments undertaken with victims of a combined natural/technological disaster for litigation purposes. A class action suit was filed in which the authors determined levels of traumatic stress in 27 plaintiffs as a group and relative to each other. The process was effective--the case was settled out of court in favor of the litigants. Individual litigants were satisfied with monetary awards received.

Halofantrine pharmacokinetics in Kenyan children with non-severe and severe malaria

1. Kenyan children with uncomplicated malaria given oral halofantrine (HF; non-micronised suspension; 8 mg base kg-1 body weight 6 hourly for three doses) showed wide variation in the disposition of HF and desbutylhalofantrine (HFm). 2. Eight Kenyan children with severe (prostrate) falciparum malaria who were receiving intravenous quinine, were given the same HF regimen by nasogastric tube. One patient had undetectable HF and two had undetectable HFm at all times after drug administration. 3. The mean AUC(0,24 h) of HF in prostrate children was half (7.54 compared with 13.10 micrograms ml-1 h) (P = 0.06), and that for HFm one-third (0.84 compared with 2.51 micrograms ml-1 h) (P < 0.05) of the value in children with uncomplicated malaria. 4. Oral HF may be appropriate for some cases of uncomplicated falciparum malaria in Africa, but in patients with severe malaria, the bioavailability of HF and HFm may be inadequate.

Gender differences in fire fighter job stressors and symptoms of stress

This study described gender differences in fire fighter appraisal of job stressors and symptoms of stress. A sample of 670 male and 41 female fire fighters responded to an anonymous mail survey consisting of three standardized and investigator-developed questionnaires. Male and female fire fighter respondents were more similar than different on both job stressor and symptoms of stress measures. Five job stressors were ranked the most "bothersome" by both males and females during the last 10 shifts worked. These were: sleep disturbance, wage/benefit concerns, job skill concerns, substandard equipment, and safety concerns. Of these five job stress factors, only one gender difference was noted. Female fire fighters reported significantly higher scores than males on job skill concerns. Job discrimination reported by female respondents was significantly higher than for males (t = 3.51, p < .0001) even though it was not ranked among the five most stressful factors. Partial correlations computed between job stressors and symptoms of stress, while controlling for the number of years as a fire fighter, were of moderately high magnitude for both genders and similar to simple correlations computed. These results suggest that the number of years of service did not account for gender differences reported.

Evaluating students' substance abuse assessment skills

Graduating nursing students' abilities to assess clients for substance use were evaluated using two standardized patient (SP) cases. In the comprehensive health history case (unprompted), 55% of the study participants assessed alcohol use and 20% assessed drug use. When prompted to conduct a substance use history, at least 90% of the subjects asked about the quantity and frequency of alcohol use and 80% asked about drug use. However, in the prompted case, fewer than 10% of the subjects linked current alcohol and drug (AOD) use with risks and consequences, nor did they ask the SP if he had considered decreasing substance use. The mean score for communication skills used in the two assessment interviews were 3.65 and 3.56 on a 1 to 6 Likert scale. These data point out the need for additional emphasis on instructing students to include AOD questions as part of routine assessments, what questions to ask in a substance use assessment, and how to act on the information received. The use of SPs is one way to obtain valid information about students' assessment competencies.

Firefighters and paramedics: years of service, job aspirations, and burnout

1. Data were collected from an anonymous mail survey of over 2,000 paramedics and firefighters to determine the relationships among years of service and four occupational outcomes, including burnout. 2. Paramedics had poorer outcomes than firefighters. Job title, not percent of emergency service runs per se, significantly differentiated the groups with respect to burnout and job aspiration variables. 3. After adjusting for age, years of service correlated negatively with three measures of job aspirations: job satisfaction, work related morale, and career goal attainment in both groups. 4. If signs and symptoms of burnout occur throughout the worker's life cycle rather than with increasing years of experience, the findings have implications for both prevention and intervention strategies.

Towards optimal regimens of parenteral quinine for young African children with cerebral malaria: unbound quinine concentrations following a simple loading dose regimen

Nine children with severe falciparum malaria were treated with an intravenous quinine regimen which did not require burettes or infusion pumps, to determine its practicability and to ensure that therapeutic drug concentrations were achieved and maintained throughout the dose interval. The regimen comprised quinine dihydrochloride (15 mg/kg; 12.5 mg/kg of the free base), which was added to a bag of intravenous fluid (after wastage of all but 100 mL), and given via standard giving sets over 2 h. Blood was drawn sequentially during the infusion, and for 12 h thereafter; plasma water was obtained by ultrafiltration of samples at the bedside, and quinine concentration was measured, in plasma and plasma water, by high performance liquid chromatography. Drug administration was practicable without burettes or infusion pumps; unbound drug concentrations exceeded the 99% inhibitory concentration for local parasites within 0.5 h, and remained within the therapeutic range for the entire dose interval. This loading dose regimen can now be recommended for young children in African hospitals; maintenance doses of 10 mg/kg should be given at 12 h intervals until oral antimalarial drugs are possible. These recommendations will need to be modified if susceptibility to quinine declines.

A study of the comparative bioavailability of pyrimethamine-sulfadoxine obtained from two oral preparations

The bioavailability of two oral preparations of pyrimethamine-sulfadoxine are compared in a randomised cross-over study. Pyrimethamine(PM)-sulfadoxine(SD) was given orally in a single dose to healthy male adults (SD 12 mgkg-1; PM 0.64 mgkg-1). For Fansidar(Hoffman-LaRoche) the mean AUC for PM and SD were; 0.47 mghl-1 and 45.4 mghl-1, and for Falcidin(Cosmos), the mean AUC for PM and SD were; 0.49 mg hl-1 and 42.9 mghl-1 respectively. There was no significant difference in bioavailability of PM or SD between the two preparations.

An outbreak of intravenous cannulae associated nosocomial septicaemia due to multidrug-resistant Klebsiella pneumoniae

We present the clinical course of four children involved in an outbreak of intravenous cannulae associated nosocomial septicaemia due to multidrug-resistant Klebsiella pneumoniae. The patients involved, two of whom died became bacteraemic within a three week period, and evidence for an environmental source of the organism was obtained.

Brain swelling and ischaemia in Kenyans with cerebral malaria

Computed tomography was performed on 14 unconscious Kenyan children recovering from cerebral malaria (seven of whom had another scan 12-120 days later) to elucidate the cause of intracranial hypertension and neurological sequelae. Brain swelling, defined as a loss of cerebrospinal fluid spaces, was documented in six children, while a further two had conspicuously small ventricles only. There was severe intracranial hypertension in the two children with definite brain swelling in whom intracranial pressure was monitored. There was no evidence of acute hydrocephalus or vasogenic oedema. Four children with brain swelling also had widespread low density areas suggestive of ischaemic damage. The patterns of damage were not uniform but were consistent with a critical reduction in cerebral perfusion pressure (which was documented in the two in whom this was monitored), hypoglycaemia, or status epilepticus. All four had serious neurological sequelae. These data suggest that brain injury in cerebral malaria may be due in part to secondary systemic and intracranial factors as well as to the direct effect of intravascular sequestration.

Sources of occupational stress among firefighter/EMTs and firefighter/paramedics and correlations with job-related outcomes

INTRODUCTION/OBJECTIVE

This paper reports the results of an initial effort to develop and test a measure of the various sources of job-related stress in firefighter and paramedic emergency service workers.

METHODS

A 57-item paper and pencil measure of occupational stressors in firefighter/Emergency Medical Technicians (EMTs) and firefighter/paramedics was developed and administered by anonymous mail survey.

RESULTS

More than 2,000 (50% rate of return) emergency service workers completed and returned the surveys. The responses of 1,730 firefighter/EMTs and 253 firefighter/paramedics were very similar in terms of the degree to which job stressors were bothersome. A factor analysis of replies yielded 14 statistically independent "Occupational Stressor" factors which together accounted for 66.3% of the instrument's variance. These Sources of Occupational Stress (SOOS) factor scale scores essentially did not correlate with a measure of the social desirability test-taking bias. Finally, SOOS factors were identified that correlated with job satisfaction and work-related morale of the respondents. Conflict with administration was the job stressor factor that most strongly correlated with reports of low job satisfaction and poor work morale in both study groups.

CONCLUSION

The findings suggest that firefighter and paramedic job stress is very complicated and multi-faceted. Based on this preliminary investigation, the SOOS instrument appears to have adequate reliability and concurrent validity.

Coping strategies of abstainers from alcohol up to three years post-treatment

This study characterizes the experiences and coping strategies of 23 alcohol-dependent persons who maintained abstinence from alcohol use up to three years post-treatment. Interview, journal, and mail questionnaire data were collected at 12, 18 and 36 months post-treatment. The results support and extend the theoretical model of change proposed by Prochaska and DiClemente (1984). Hallmarks of successful change included factors that can be learned, practiced, perfected and are transferable to other alcohol-dependent persons who decide to break the addictive cycle.

An empirical description of phases of maintenance following treatment for alcohol dependence

This article reports two longitudinal prospective studies conducted sequentially to describe participants' maintenance of abstinence experiences up to 36 months posttreatment. Study 1 reports responses of 102 subjects who maintained alcohol abstinence following treatment and who were assessed for duration and intensity of symptoms associated with postacute withdrawal at baseline, 3, 6, and 12 months. A decreasing linear trend of symptoms was found as time of alcohol abstinence increased. Study 2 obtained interview and survey data from 23 successful abstainers from Study 1 at 12, 18, and 36 months posttreatment to describe coping strategies, perceptions of relapse risk, extent and duration of "aftercare," and substitute addictions as these phenomena developed and changed over time. Multiple occasions of data collection supported the description of three phases of maintenance: symptom stabilization/management accompanied by a cognitive paradigm shift, distancing self from alcohol-dependent behavior, and normalization of life processes.

Validation of addictions nursing diagnoses in a sample of alcohol abstainers 1 year posttreatment

This study examined the fit between 26 Addictions Nursing diagnoses and a sample of clients who had maintained abstinence from alcohol use for 1 year after inpatient treatment for alcohol abuse. Data were obtained from interview transcriptions of 26 successful abstainers. Investigator identification of diagnoses were validated by expert nurse clinicians. Although participants had been abstinent for a year, 73% of the sample showed defining characteristics of 17 of the 26 diagnoses. In addition, the raters identified 3 human responses for which no diagnoses exist, 8 diagnoses that do not have defining characteristics that fit the data, and 13 additional defining characteristics that could be added to the list.

Contributions to the design and statistical analysis of in vivo SCE experiments

Two issues that arise in the design and statistical analysis of in vivo SCE and similar experiments are considered. First, with regard to analysis, the merits of various methods of data transformation are explored in depth. The conclusion drawn is that common transformations of the type studied here seemingly offer little advantage in the assessment of whether a test agent induces SCE in a dose-related manner. Second, a proposal is made for a method to determine, subject to budgetary constraints, the desired numbers of animals/dose group and cells scored/animal. The approach advocated also lends itself to discussions weighing the gains and losses from possible reductions in the number of animals below the 'desired' levels.

Faculty development and curriculum change in substance abuse

What approaches can be used to upgrade nursing education and clinical skills in alcohol and drug abuse? The authors discuss the development of faculty and curricula in three schools of nursing. The programs described are part of a national initiative to ensure that health care professionals have basic knowledge and clinical skills in screening, assessment, intervention, and the appropriate use of referral systems for clients with substance abuse problems.

An Empirically Based Substance Abuse Course for Graduate Students in Nursing

Currently, no texts or compilations of readings offer a comprehensive graduate-level nursing foundation in addictive behaviors. This article describes the development of a theory- and research-based collection of readings and a course designed to meet this need.

Marrow antioxidant enzyme activity in tumor-bearing and non-tumor-bearing mice following vincristine treatment

Pretreatment or "priming" with vincristine (VcR) has been documented to radioprotect animals from whole body irradiation by accelerating recovery of hematopoietic marrow. The mechanisms underlying this phenomenon are unclear, but the marked similarities between priming with VcR and with immune stimulants such as endotoxin and glucan have led to speculation that VcR may be inducing such radioprotective immunoregulators as interleukin 1 (IL-1) and tumor necrosis factor (TNF). The radioprotective ability of these cytokines, in turn, has been linked to an induction of the antioxidant enzyme manganese superoxide dismutase (Mn SOD). To establish whether priming with VcR is associated with induction of antioxidant enzymes, the activities of Mn SOD, copper-zinc (Cu-Zn) SOD, catalase (CAT), and glutathione peroxidase (GPX) were measured in the marrow of both LLca tumor-bearing and non-tumor-bearing mice given a priming dose of VcR. Results in non-tumor-bearing mice indicate that, similar to IL-1 and TNF administration, VcR treatment increases Mn-SOD activity, but not Cu-Zn SOD, CAT, or GPX activity. Furthermore, this increase occurs at the time VcR priming has been demonstrated previously to exhibit maximal radioprotection, suggesting that it may be contributing factor. However, VcR priming has been demonstrated to radioprotect both tumor-bearing and non-tumor-bearing animals, and no increase in Mn SOD activity (or the other enzymes monitored) was found in the tumor-bearing group. Rather, the presence of tumor significantly suppressed antioxidant enzyme activity. Collectively, the present data suggest that it is unlikely that increased antioxidant enzyme activity is directly involved in the VcR priming response.

Preventive intervention following accidental death of a child

This paper describes the development and pilot testing of an empirically and theoretically based preventive intervention program for bereaved parents whose adolescent and young adult children died suddenly following an accident. The parents were assigned to either an early (2-6 months postloss) or a later (7-13 months postloss) transition group (N = 15) in which they received two-dimensional preventive intervention: informational support and emotional support. A comparison group (N = 19) received no intervention. Weekly and summative evaluations completed by bereaved parents and group leaders showed the therapeutic benefits of the preventive intervention for both treated groups. However, the two groups responded differently to the interventions, suggesting that timing and type of support might both be important factors to consider.

Lacrimal gland inositol trisphosphate isomer and inositol tetrakisphosphate production

In the lacrimal gland, cholinergic agonists stimulate protein and electrolyte/water secretion by producing inositol trisphosphate (IP3) from phosphatidylinositol bisphosphate. To determine which IP3 isomers were produced and whether inositol tetrakisphosphate (IP4) was produced during activation of secretion, rat exorbital gland acini were [3H]inositol-labeled and stimulated by the cholinergic agonist carbachol. Water-soluble inositol phosphates were separated by anion-exchange chromatography using Dowex columns or high-performance liquid chromatography. Intracellular Ca2+ concentration ([Ca2+]i) was measured by fluorescence using the Ca2+ dye fura-2. Carbachol (10(-3) M) produced a time-dependent increase in 1,4,5-IP3, 1,3,4-IP3, and 1,3,4,5-IP4 levels during 0-60 s of stimulation. The 1,4,5-IP3 level increased rapidly and was followed by a slower rise in 1,3,4-IP3 and 1,3,4,5-IP4 levels. A 3-s carbachol (10(-8) to 10(-2) M) stimulation caused a concentration-dependent rise in the 1,4,5-IP3 level. Carbachol (10(-9) to 10(-2) M) increased [Ca2+]i in a concentration-dependent manner. Carbachol (10(-3) M) increased [Ca2+]i to a maximum level by 10 s; by 60 s [Ca2+]i decreased by 38%. The maximum increase in 1,4,5-IP3 levels occurred at a higher carbachol concentration than the increase in [Ca2+]i or protein secretion. We concluded that cholinergic stimulation of the lacrimal gland rapidly increased 1,4,5-IP3 levels, which was responsible for the initial increase in [Ca2+]i and initial rapid phase of protein and fluid secretion. Cholinergic stimulation also increased 1,3,4-IP3 and 1,3,4,5-IP4, but more slowly; either acting alone or with 1,4,5-IP3, they could account for the slower phase of secretion.

The Urgency of Substance Abuse Education in Schools of Nursing

The abuse of alcohol and drugs has become a major health and social problem in the United States. Nurses comprise the largest segment of health-care professionals, yet report their educational experiences offer little to prepare them to develop substance abuse prevention and intervention programs. This article identifies factors that contribute to this educational gap, discusses challenges in planning and implementing substance abuse curricula, and offers specific guidelines for improving educational experiences.

An explanatory model of recovery from disaster loss

The development and testing of an explanatory model of recovery from disaster loss are described. The sample consisted of 155 persons at Time1-1981, 101 persons at Time2-1983, and represented five magnitudes of disaster loss: bereaved of disaster victims presumed dead; bereaved of disaster victims confirmed dead; persons whose permanent homes were destroyed; persons whose recreational property was destroyed; and a no disaster-loss comparison group. Data tested in the model were collected 1 and 3 years following the volcanic eruption of Mt. St. Helens in 1980 on eight variables: magnitude of loss, mass media coverage, negative rating of change, change in income, self-efficacy, social support, satisfaction with financial settlement, and mental distress. Path analysis was selected to estimate the magnitude of hypothesized direct and indirect linkages between variables presumed as causes of variables treated as effects. Results showed an improvement of goodness of fit by testing the model with the 1981 data, respecifying the model, and testing it again with the 1983 data. The greatest explanatory effects on mental distress 3 years postdisaster were mental distress reported 1 year postdisaster and negative ratings of change associated with disaster loss.

Effect of phorbol esters on rat lacrimal gland protein secretion

To identify a role for protein kinase C in lacrimal gland protein secretion, we incubated rat exorbital lacrimal gland acini in the ester 4-beta-phorbol 12, 13 dibutyrate (beta-phorbol dibutyrate), its inactive isomer 4-alpha-phorbol 12, 13 dibutyrate (alpha-phorbol dibutyrate), and the diacylglycerol analog 1,2-oleoyl acetylglycerol (OAG). We determined protein secretion by measuring the activity of peroxidase, a protein secreted by lacrimal gland acini. beta-phorbol dibutyrate, but not alpha-phorbol dibutyrate, stimulated peroxidase secretion in a concentration-dependent manner with 3 X 10(-8) M producing maximal secretion. OAG (10(-6) M) also stimulated peroxidase secretion. To determine whether muscarinic and alpha 1-adrenergic agonists activate protein kinase C, we added beta-phorbol dibutyrate (10(-7) M) simultaneously with carbachol (10(-5) M) or phenylephrine (10(-4) M); under both conditions, secretion was less than additive. Protein secretion in the presence of beta-phorbol dibutyrate (10(-7) M) and vasoactive intestinal peptide (VIP) (10(-8) M), the latter that acts through cAMP, was additive, and when the beta-phorbol dibutyrate but not the VIP concentration was decreased to 10(-8) M, secretion was potentiated. We conclude that muscarinic and alpha 1-adrenergic agonists, but not VIP, stimulated lacrimal gland protein secretion by activating protein kinase C.

Role of cyclic AMP and Ca2+ in potentiation of rat lacrimal gland protein secretion

Addition of a cholinergic agonist carbachol and vasoactive intestinal peptide (VIP) to dispersed rat exorbital lacrimal gland acini produces protein secretion, measured by secretion of the enzyme peroxidase, that was statistically significantly greater than additive (potentiated). To determine where in stimulus-secretion coupling these secretagogues interact to potentiate secretion, rat exorbital gland acini were incubated simultaneously with cyclic AMP- and Ca2+-dependent agonists and protein secretion, cyclic AMP level, or Ca2+ concentration measured. As a measure of protein secretion, the supernatant obtained after centrifugation of acini was analyzed for peroxidase, a protein secreted by rat lacrimal glands. Interaction did not occur at the receptor level, because peroxidase secretion also was potentiated by simultaneous addition of carbachol and forskolin, which activates the catalytic subunit of adenyl cyclase. A potentiated increase in the cyclic AMP level did not potentiate protein secretion, because the level was the same with VIP as with carbachol and VIP added together at concentrations that potentiated peroxidase secretion. A potentiated increase in free intracellular [Ca2+] did not potentiate protein secretion, because [Ca2+] was greater with carbachol than with carbachol and VIP added together at concentrations that potentiated peroxidase secretion. We conclude that cholinergic- and VIP-dependent pathways interact to potentiate lacrimal gland protein secretion after the rise of intracellular cyclic AMP or Ca2+.

A statistical analysis for the mouse lymphoma cell forward mutation assay

This paper illustrates the usefulness of solvent control trials and presents a statistical analysis for mouse L5178Y lymphoma data. Examination of solvent control trials establishes that the natural logarithm of mutant frequency is approximately normally distributed and that both the mean and variance of mutant frequency vary by trial. There is little evidence of downturns at higher doses in the dose-response curves studied; therefore, a trend test is proposed for the detection of an increasing dose-response curve. A Monte Carlo investigation confirms that the proposed trend test is better able to detect an increasing dose-response than 4 alternate methods of analysis.

Mental distress and recovery in a high-risk bereavement sample three years after untimely death

Recovery from postdisaster bereavement was the primary concern of this longitudinal study: would levels of mental distress and recovery reported 1 year following a natural disaster be better predictors of mental distress and recovery reported 3 years postdisaster than demographic variables, concurrent life stress, and mediating factors? The 119 bereaved and control participants studied in 1981, one year following the 1980 volcanic eruption of Mount Saint Helens, were recontacted in 1983; of these, 85 consented to follow-up. The 1983 data collection consisted of identical measurement tools and procedures used in 1981. Three regression analyses addressed prediction of mental distress and recovery. The first two analyses compared disaster-bereaved and nondisaster-loss controls; the third pertained only to the bereaved. For the bereaved/control comparisons, 1981 levels of mental distress, age, sex, education, and 1983 levels of negative life stress, self-efficacy, and social support were predictors of the dependent variable, mental distress. For the bereaved group, 1981 mental distress and 1983 self-efficacy scores were the only significant predictors of 1983 mental distress. In the control group, two additional variables, sex and concurrent negative life stress, were also significant predictors of 1983 mental distress. In the final regression analysis, predictors of self-rated recovery, importance of the deceased person rated by the bereaved 1 year postdisaster, and beliefs of preventability of death reported 3 years postdisaster were predictors of 1983 recovery. Only importance of the deceased person was a significant predictor in the latter analysis. Results suggest that recovery is a lengthy process and that much remains to be learned about influencing factors.

Status of natural disaster victims' health and recovery 1 and 3 years later

Bereaved, property loss, and control groups (N = 155) studied 11 months following the 1980 volcanic eruption of Mt. St. Helens were recontacted 35 months postdisaster to test the hypotheses that the greater the loss experienced, the higher the stress, and the poorer the health. In general, the hypotheses were supported. Even though mental distress decreased between the two data collection periods, the mental health of the bereaved group remained poorer than both the property loss and control groups. At 3 years postdisaster, only 4% of the study participants reported complete recovery from disaster loss. Findings are compared with those of other recent disasters and clinical and theoretical implications are discussed.

Identification of postdisaster bereavement risk predictors

Investigators have focused primarily on the bereavement experiences of widows and parents of deceased infants. In this study, subjects were 69 bereaved close family members and friends of deceased disaster victims and 50 control subjects. Six variables, not examined before, were entered in a series of hierarchical step-wise regression equations to determine their ability to predict health outcomes. The six variables were gender, age, concurrent life stress, perception of the prior relationship between the bereaved and deceased as central or peripheral, perception of catastrophic death as preventable or unpreventable, and perception of social support. The three health outcomes were depression, somatization, and physical health status. Results indicated that the six selected variables accounted for 48% of the variance in predicting depression, 39% in predicting somatization, and 35% in predicting physical health status in the bereaved group. Concurrent negative life stress was the most important single predictor in all three health outcomes in both groups of subjects.

Neonatal lung neutrophils and elastase/proteinase inhibitor imbalance

Serial bronchoalveolar lavage (BAL) was performed prospectively on 10 normal control subjects, 20 Respiratory Distress Syndrome (RDS), and 11 Bronchopulmonary Dysplasia (BPD) newborn infants to evaluate the role of pulmonary inflammation in neonatal lung disease. Minimal inflammation was found in BAL at less than 24 h of life in all groups, but significant pulmonary polymorphonuclear leukocyte (PMN) influxes were noted at 96 h in RDS and BPD compared with control subjects. By 1 wk of life, BAL PMN counts returned to normal in RDS, but counts remained significantly elevated through 5 wk in BPD. Alveolar macrophage (AM) counts were significantly elevated at 96 h in RDS (p less than 0.05), but were significantly depressed in BPD at 4 and 5 wk (p less than 0.05). The BAL elastase/alpha 1-proteinase inhibitor (alpha 1Pi) ratios in RDS did not differ from those of normal control subjects; however, these ratios were significantly elevated from 1 through 4 wk of life in BPD, placing these infants at risk for proteolytic lung damage. Lavage elastase levels were elevated in both RDS and BPD, associated with a parallel increase in BAL alpha 1Pi in RDS and depressed BAL alpha 1Pi in BPD. These findings suggest that pulmonary inflammation, associated with a prolonged PMN influx and an imbalance between elastase and alpha 1Pi, may contribute to the development of the neonatal chronic lung disease, BPD.

Stress Levels and Health Status of Victims of a Natural Disaster

Bereaved, property loss, and control groups (N = 155) were compared 11 months after the volcanic eruption of Mt. St. Helens using standardized instruments and structured interviews. It was hypothesized that the greater the loss the greater the stress and the poorer the health. Bereaved subjects reported significantly higher levels of stress and lower levels of mental health, but not physical health. Persons who lost their permanent homes reported high rates of stress, but did not report significantly higher levels of depression, somatization, or poorer physical health. Conceptual and methodological implications are discussed.