Clinical features predictive of exercise-induced asthma in children

Exercise-induced asthma (EIA) is a common symptom among young asthmatics. The hypothesis that asymptomatic day-to-day wide fluctuations in lung function and asymptomatic persistent airflow obstruction are risk factors for the development of EIA was studied. The study population was a cohort of known asthmatic children aged 9-14 years attending a residential asthma camp. The method involved the observation of baseline expiratory peak flow recordings (PEFR) for 5 days while the children were receiving their usual maintenance therapy. The method also included the determination of FEV1 pre- and post- 15 min of continuous aerobic exercise. Exercise-induced asthma was expressed as the Lability index (LI). The findings were that LI was significantly correlated (P < 0.01) with the mean PEFR as a per cent of each child's predicted PEFR. The lability index also correlated (P < 0.01) with the degree of day-to-day variability in PEFR expressed as the coefficient of variance (CV). It is concluded that there is a significant correlation between baseline asthma control and the development of EIA. In addition to recommending pre-exercise prophylaxis, practitioners should investigate overall asthma control in children reporting EIA.

Science and early development of mental health nursing

Until very recently, the history of mental health care received little critical investigation. This paper seeks to explore how the western scientific tradition shaped mental health nursing and investigates the pivotal influences which affected its early development, emphasising the role played by mid-19th century asylum care.

Effects of positive airway pressure on upper airway dilator muscle activity and ventilatory timing

To determine upper airway (UA) and ventilatory responses to nasal continuous positive airway pressure (CPAP) and expiratory positive airway pressure (EPAP), we quantitated changes in alae nasi (AN) and genioglossus (GG) electromyographic (EMG) activity, ventilatory timing, and end-expiratory lung volume (EELV) at various levels of CPAP and EPAP in six normal subjects during wakefulness and in seven during sleep. The same measurements were also made before and after UA anesthesia in six normal subjects during wakefulness. During both wakefulness and sleep, CPAP application significantly increased EELV and decreased AN and GG EMG activities. In contrast, EPAP significantly increased EMG activities of both muscles while also increasing EELV during wakefulness. The EMG responses were less marked during sleep. Anesthesia of the UA abolished the EMG responses to CPAP but not to EPAP. These results suggest that, in normal subjects, CPAP application causes a reflex reduction in UA dilator muscle activity mediated by UA sensory receptors. In contrast, EPAP increases UA dilator muscle activity, with the response mediated by conscious influences or reflexes arising outside of the UA.

Utilization of a personal health record in a general medicine clinic

To determine the baseline use of personal medical records maintained by patients, to initiate utilization of a personal health record (PHR), and to assess outcomes associated with its use, a survey, intervention, and outcome study was conducted with follow-up at 2, 7, and 14 months. One hundred randomly selected adult patients of the General Medicine Clinic at The University of Iowa Hospitals and Clinics were evaluated. At onset, 44% maintained no records. At 14-month follow-up, 69% maintained the PHR. The change in documentation was statistically significant (p = .013 x 10(-8), McNemar's Test for Paired Data; 95% confidence interval 0.065, 0.54). The baseline use of personal medical records was poor, but it was improved following introduction of the PHR, and most patients continued using the record 14 months later.

Development of a stress scale for mental health professionals

This paper describes the development of the Mental Health Professionals Stress Scale (MHPSS): a self-report method of identifying sources of stress for mental health professionals. The 42-item scale, which includes seven subscales, was administered to 154 clinical psychologists and 111 mental health nurses. The MHPSS was found to have good internal consistency (alpha = .87 for clinical psychologists; alpha = .94 for mental health nurses). The preliminary evidence suggests that the concurrent validity of the MHPSS is good. The expected relationships between the scale and between the criterion measures--General Health Questionnaire, a symptom check list, job satisfaction, self-reported stress level and quality of social support--were demonstrated. The results also provide evidence for the discriminant validity of the subscales to measure different aspects of the stress experience. The MHPSS was shown to discriminate between two groups of health professionals who might be expected to differ in their sources of stress. For clinical psychologists the most important source of stress was 'professional self-doubt' whereas the major source of stress for mental health nurses was found to be the difficulty of handling potentially violent or difficult patients in the context of scarce staff resources. For both groups, however, 'home-work conflict' was the subscale most strongly and consistently associated with mental health outcome. It is concluded that the preliminary evidence regarding the utility of the MHPSS is encouraging, although further data are clearly needed.

Linguistic entrapment: medico-nursing biographies as fictions

This paper argues that in their trainings health professionals are encouraged to use language naively as if it were a transparent medium of scientific communication. We contend that language use, particularly in the field of mental health care, should be studied in terms of its social functions and attention should be paid to the inevitably constructive nature of language in patients' records, in order that a 'fictional distance' opens up between patients and their records. Recent developments in literary theory and narrative analysis can be deployed as theoretical frameworks to understand this process, and we suggest that more attention to the use of language should be included in the educational programmes for health care professionals to counteract the risk of 'linguistic entrapment' or 'incarceration'.

A measurement tool for assessing stress among mental health nurses

There is growing evidence that nursing is a stressful occupation, particularly mental health nursing. However, the lack of an appropriate measurement tool has meant it has been difficult to investigate the nature of this stress. The aim of this study was to assess the efficacy of one such scale for measuring stress in mental health nurses, the Mental Health Professional Stress Scale. A total of six questionnaires was sent to a sample of 210 community and hospital mental health nurses. The findings suggested that the scale was a useful measure and predictor of stress. The most consistent predictor of poor mental health outcomes for nurses was home/work conflict, outweighing the significance of client/patient-related difficulties.

Survey of the social networks of people with severe mental health problems

The social functioning of people with severe mental health problems is an indicator of general physical and emotional well-being. There exists a wealth of literature on the topic from the professional carer's perspective but relatively little from the perspective of the clients themselves. Thirty clients were interviewed in order to explore their understanding of the nature and value of the social networks in which they were currently involved. Despite having participated in a variety of rehabilitation interventions, these clients remained insecure and lacking in confidence. They had few friends beyond members of their immediate family and were generally leading lonely, friendless existences without the capacity to establish new relationships. Although this study suggests that clients often have grandiose plans for the future, mental health nurses may best meet their needs by helping to sustain existing relationships and using them at all levels of therapeutic intervention, rather than attempting to nurture new relationships for which clients are unready and the failure of which may result in a relapse in clients' mental health status.

The effects of oesophageal distension on diaphragm and laryngeal muscle activity in the anaesthetized cat

The electromyographic (EMG) activities of diaphragm and laryngeal muscles were recorded during oesophageal distension in anesthetized cats. The responses to distension of the thoracic oesophagus differed from those evoked by distension of the cervical oesophagus. The crural component of the diaphragm (CD) was inhibited by distension of the thoracic oesophagus; distension of the cervical oesophagus did not affect CD EMG. Thyroarytenoid (TA) muscle EMG increased markedly and consistently in response to distension of the cervical oesophagus. Distension of the thoracic oesophagus only produced statistically significant increases in TA EMG with high distending volume (10 ml) at the level of the gastro-oesophageal junction. The main abductor of the vocal cords, the posterior cricoarytenoid (PCA) was either unchanged or decreased by oesophageal distension. The electrical activities of left paratendinous diaphragm, left costal diaphragm, internal intercostal and external intercostal muscles remained unchanged. The entire pattern would appear to constitute a means to aid passage of a bolus into the stomach, and simultaneously guard the respiratory tract from reflux or aspiration.

The influence of positivistic thought on nineteenth century asylum nursing

The development of positivism, which had a considerable influence on the evolution of psychiatric thought and practice during the second half of the nineteenth century, is outlined. It was within this intellectual framework that figures such as Kraepelin, Bleuler and Schneider developed psychiatric nosologies and diagnostic criteria for certain mental illnesses. While there was little scientific evidence to support the claim that medical treatments had any beneficial effects on pyschiatric disorders, nevertheless psychiatric institutions were established in the mid-nineteenth century based on the medical model. Nurses were expected to observe, collect and report data on mental patients which were then presented to doctors for analysis. The intellectual climate of the asylums was such that nurses were not encouraged to question the scientific principles upon which the therapeutic regime was based, nor were they encouraged to seek a rationale for their daily observations and data collection. The specialized training for asylum nurses which was introduced towards the end of the nineteenth century did not give nurses their own professional identity, but rather reinforced the supremacy of medical knowledge in the care of the mentally ill. Trained nurses enhanced medical credibility, but did not progress care of the mentally ill because their training did not imply or encourage questioning of the positivistic basis of psychiatric treatment.

DiGeorge anomaly with renal agenesis in infants of mothers with diabetes

We report on 2 infants with the DiGeorge anomaly born to diabetic mothers treated with insulin. Both infants had unilateral renal agenesis. One of the mothers has manifestations suggestive of velo-cardio-facial syndrome (VCFS). Cytogenetic studies on both patients and the mother with apparent VCFS were normal. Molecular studies utilizing probes from the DiGeorge critical region did not demonstrate a 22q11 microdeletion in either patient or the mother with apparent VCFS. We conclude that maternal diabetes is a pathogenetic factor in the DiGeorge anomaly, and infants of diabetic mothers who have this anomaly should also be screened for renal agenesis.

Carbon dioxide-sensitive superior laryngeal nerve afferents in the anaesthetized cat

The effects of CO2 on laryngeal receptors were studied in ten anaesthetized, paralysed, artificially ventilated cats using a preparation in which the upper airway was isolated in situ and artificially ventilated. This allowed CO2 to be confined to the upper airway and enabled responses to CO2 to be recorded whilst the larynx was being ventilated under physiological conditions. Single-unit afferent activity was recorded from the superior laryngeal nerve and the pressure and thermal sensitivity of receptors determined. Carbon dioxide responses were tested by switching from upper airway ventilation with room air to mixtures containing 5 and 9% CO2 with 21% O2 in N2. Fibres were classified into two broad groups, tonic and quiescent, depending on their level of activity when the larynx was not being ventilated. All tonic fibres responded to either positive or negative pressure. Quiescent fibres were either positive or negative pressure receptors, cold receptors or had no response to pressure or cold airflow. The majority of all categories of fibres were significantly affected by CO2 in a reversible and usually concentration-dependent manner. Tonic fibres were inhibited, regardless of pressure sensitivity. Quiescent negative and positive pressure receptors were excited and inhibited respectively whilst cold receptors and fibres with no response to occlusion were excited. Laryngeal hypoxia and systemic asphyxia and hypercapnia had no effect on receptor activity. We conclude that the majority of laryngeal receptors are sensitive to CO2 and that this receptivity may be important in the control of ventilation and upper airway muscle activity.

Comparative mapping of 9 human chromosome 22q loci in the laboratory mouse

We present a comparative map of genes on human chromosome 22q and homologous loci in the mouse genome. Gene order in humans was established using a panel of somatic cell hybrids. Genetic maps spanning homologous segments on three mouse chromosomes were generated using an interspecific backcross. The conserved linkage between human chromosome 22 and mouse chromosome 16 includes two closely linked loci, Comt and IgI-1. The second conserved linkage involves human chromosome 22 and mouse chromosome 11 and contains two genetically and physically linked loci, Lif and Nfh. Finally, conserved synteny involving mouse chromosome 15 and human chromosome 22 spans 30 cM and contains five loci (Acr, Bzrp, Dia-1, Il2rb and Pdgfb). Loci within this conserved synteny have been sublocalized to different portions of human chromosome 22. The order of genes on mouse chromosome 15 and human chromosome 22 provides further evidence for chromosomal rearrangements within the conserved synteny that have occurred since the divergence of lineages leading to mice and humans.