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Ernst AA, Houry D, Weiss SJ, Szerlip H. Domestic violence awareness in a medical school class: 2-year follow-up. South Med J 2000; 93:772-6. [PMID: 10963507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
BACKGROUND [corrected] Previous studies have examined short-term effectiveness of domestic violence instruction. We studied the long-term effectiveness (LTE) and long-term retention (LTR) of formal instruction about domestic violence. METHODS A general knowledge survey on domestic violence was given before, 1 month after, and 2 years after 3 hours of instruction to medical students. Good LTE was defined as significant improvement in responses between the first and third surveys. Good LTR was defined as lack of a significant decrease in results between the second and third surveys. RESULTS Two years after the instruction, 104 of 148 (70%) participated. Knowledge of rates of domestic violence against women showed neither good LTE nor good LTR. Responses showed good LTE and LTR concerning domestic violence incidence among men, ethnic and socioeconomic groups being equally represented, victims not being personally responsible for the abuse, and physicians not being required to report domestic violence in the survey state. Responses showed poor LTR and LTE regarding rates of domestic violence in women and abused persons being unable to simply leave their situation. CONCLUSIONS Some improvement in domestic violence awareness was seen 2 years after instruction. However, some information was not retained. Domestic violence instruction should be reemphasized throughout medical school.
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Weiss SJ, Muniz A, Ernst AA, Lippton HL, Nick TG. The effect of prior hypothermia on the physiological response to norepinephrine. Resuscitation 2000; 45:201-7. [PMID: 10959020 DOI: 10.1016/s0300-9572(00)00185-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE this study determines the effect of prior hypothermia on the cardiovascular responses to norepinephrine (NE) after rewarming. METHODS the experiment was a 2x2 controlled design with four groups of feline animals. The two variables were the presence or absence of previous cooling, and the use or non-use of NE after rewarming. During the 'cooling' phase, animals were either cooled using an external arterial-venous femoral shunt to 30 degrees C or maintained at 37 degrees C. After 'rewarming' animals were stratified to receive either NE at rates to deliver 0.2, 1.0 or 5 microg/kg per h or normal saline infusions. Animals were instrumented to measure mean arterial pressure (MAP) and cardiac output (CO) and systemic vascular resistance (SVR) was calculated. RESULTS there were no differences between groups at baseline and low dose NE (0.2 microg/kg per min). At 1.0 microg/kg per min, NE caused a significant increase in CO (P<0.01) and no effect of MAP or SVR in the rewarmed animals when compared with normothermic controls. In rewarmed animals 5.0 microg/kg per min NE caused a significant increase in CO (P<0.01) and no effect on MAP or SVR. In normothermic controls there was a significant increase in SVR (P=0.02) and MAP (P=0.05) and no effect on CO. CONCLUSION this study shows that the effect of prior hypothermia on cardiovascular responses to moderate and high doses of NE is an improved CO with no affect on SVR and MAP. This could alter the clinical utility of NE in this situation.
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Yana I, Weiss SJ. Regulation of membrane type-1 matrix metalloproteinase activation by proprotein convertases. Mol Biol Cell 2000; 11:2387-401. [PMID: 10888676 PMCID: PMC14927 DOI: 10.1091/mbc.11.7.2387] [Citation(s) in RCA: 239] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Membrane type-1 matrix metalloproteinase (MT1-MMP) is the prototypical member of a subgroup of membrane-anchored proteinases that belong to the matrix metalloproteinase family. Although synthesized as a zymogen, MT1-MMP plays an essential role in extracellular matrix remodeling after an undefined process that unmasks its catalytic domain. We now report the existence of a proprotein convertase-MT1-MMP axis that regulates the processing and functional activity of the metalloproteinase. Two sets of basic motifs in the propeptide region of MT1-MMP are identified that potentially can be recognized by the proprotein convertase family of subtilisin-like proteases. Processing of proMT1-MMP as well as the expression of its proteolytic activity were blocked by mutating these recognition motifs or by inhibiting the proprotein convertases furin and PC6 with the serpin-based inhibitor alpha(1) antitrypsin Portland. Furthermore, both furin-dependent and furin-independent MT1-MMP processing pathways are identified that require tethering of the metalloproteinase to the cell surface. These findings demonstrate the existence of a proprotein convertase-MT1-MMP axis that can regulate extracellular matrix remodeling.
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Hotary K, Allen E, Punturieri A, Yana I, Weiss SJ. Regulation of cell invasion and morphogenesis in a three-dimensional type I collagen matrix by membrane-type matrix metalloproteinases 1, 2, and 3. J Cell Biol 2000; 149:1309-23. [PMID: 10851027 PMCID: PMC2175112 DOI: 10.1083/jcb.149.6.1309] [Citation(s) in RCA: 489] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
During tissue-invasive events, migrating cells penetrate type I collagen-rich interstitial tissues by mobilizing undefined proteolytic enzymes. To screen for members of the matrix metalloproteinase (MMP) family that mediate collagen-invasive activity, an in vitro model system was developed wherein MDCK cells were stably transfected to overexpress each of ten different MMPs that have been linked to matrix remodeling states. MDCK cells were then stimulated with scatter factor/hepatocyte growth factor (SF/HGF) to initiate invasion and tubulogenesis atop either type I collagen or interstitial stroma to determine the ability of MMPs to accelerate, modify, or disrupt morphogenic responses. Neither secreted collagenases (MMP-1 and MMP-13), gelatinases (gelatinase A or B), stromelysins (MMP-3 and MMP-11), or matrilysin (MMP-7) affected SF/HGF-induced responses. By contrast, the membrane-anchored metalloproteinases, membrane-type 1 MMP, membrane-type 2 MMP, and membrane-type 3 MMP (MT1-, MT2-, and MT3-MMP) each modified the morphogenic program. Of the three MT-MMPs tested, only MT1-MMP and MT2-MMP were able to directly confer invasion-incompetent cells with the ability to penetrate type I collagen matrices. MT-MMP-dependent invasion proceeded independently of proMMP-2 activation, but required the enzymes to be membrane-anchored to the cell surface. These findings demonstrate that MT-MMP-expressing cells can penetrate and remodel type I collagen-rich tissues by using membrane-anchored metalloproteinases as pericellular collagenases.
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Panlilio LV, Weiss SJ, Schindler CW. Stimulus compounding enhances conditioned suppression produced by cocaine-paired stimuli. Exp Clin Psychopharmacol 2000. [PMID: 10743900 DOI: 10.1037//1064-1297.8.1.6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
When 2 stimuli that occasion cocaine self-administration are presented in compound, their ability to increase cocaine-reinforced operant responding is substantially enhanced. The goal of the present experiment was to determine whether stimulus compounding could produce analogous enhancements of a classically conditioned drug effect. Food-maintained responding in rats was suppressed by a tone and a light that were individually paired with response-independent cocaine (3 mg/kg iv). This conditioned suppression was significantly enhanced when the stimuli were presented together in a stimulus-compounding test. The magnitude of this enhancement was similar to that in previous studies in which responding was suppressed by shock-paired stimuli. These results demonstrate that multiple drug-related cues interact in a predictable manner to influence both operant and classically conditioned behavior.
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106
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Ernst AA, Weiss SJ, Johnson WD, Takakuwa KM. Blood pressure in acute vaso-occlusive crises of sickle cell disease. South Med J 2000; 93:590-2. [PMID: 10881775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
OBJECTIVE We compared blood pressure (BP) in patients with sickle cell disease (SCD)-related crises and black patients without SCD. METHODS We retrospectively reviewed charts of emergency department (ED) patients with SCD crises in a 2-year period, recording BPs and demographic and SCD data. A cohort of consecutive black patients without SCD was compared. RESULTS Included were 459 SCD-related visits, 187 by men and 272 by women, representing 106 patients. Women had significantly lower BP than men, diastolic BP was significantly lower in patients with hemoglobin SS disease than in those with hemoglobin SC disease, and systolic BP was significantly lower in patients with bilateral versus unilateral pain. One SCD patient had a history of hypertension. The 125 non-SCD patients, excluding 25 with a history of hypertension, had significantly higher systolic and diastolic BP than patients in SCD crisis. CONCLUSION No patients seen in SCD crisis were hypertensive. Patients who were female, had SS disease, or had bilateral pain had lower BP. Significantly higher BP and more hypertension occurred in black patients without SCD.
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Weiss SJ, Smith T, Laurin E, Wisner DH. Spontaneous splenic rupture due to subcutaneous heparin therapy. J Emerg Med 2000; 18:421-6. [PMID: 10802418 DOI: 10.1016/s0736-4679(00)00157-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
We report a case of spontaneous splenic rupture in a 59-year-old woman who was receiving 15,000 units of heparin subcutaneously (s.c. ) twice a day for deep venous thrombosis (DVT) prophylaxis. Her past medical history included multiple DVT, pulmonary emboli, and ovarian cancer stage III-C with known ascites. The diagnosis of splenic rupture was initially missed because of the ascites. This case illustrates both a previously undescribed complication of s.c. heparin therapy and a failure of ultrasound diagnosis. We emphasize the unique presentation, difficulty in diagnosis, and need for early surgical involvement to ensure the most favorable outcome.
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Weiss SJ, Ernst AA, Blanton D, Sewell D, Nick TG. EMT domestic violence knowledge and the results of an educational intervention. Am J Emerg Med 2000; 18:168-71. [PMID: 10750923 DOI: 10.1016/s0735-6757(00)90011-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The objective of this study was to determine levels of knowledge regarding domestic violence (DV), and the effectiveness of formal instruction about DV. A general knowledge survey of DV was given before and approximately 4 to 6 months after 3 hours of instruction given by Emergency Medicine and Law Enforcement faculty. A Emergency medical service (EMS) consisting of 73% paramedic-level providers in a metropolitan urban/suburban area. Differences in DV knowledge before and after the instruction were the main outcome measures. In the preinstruction series, 46 emergency medical technicians (EMTs) participated. After the instruction 19 EMTs participated (42%). Thirty-five percent of EMTs before instruction and 37% after instruction correctly identified the prevalence of DV against women as 15% to 30%. Thirty-five percent of EMTs before instruction and 63% after instruction (P < .05) correctly identified the prevalence of DV against men as 0% to 15%. Before instruction 54% knew that DV is equal among races, and 79% after instruction (P < .05). Before instruction 37% of EMTs knew that DV is equal in different socioeconomic groups and 68% after instruction (P < .05). The percent of EMTs who knew that the victim is not responsible for the abuse was 50% before instruction and 89% after instruction (P < .05). Before instruction, the results on a knowledge questionnaire were 54% correct, after instruction, results improved to 71% correct. Improvement in understanding of DV was shown for 4 of 11 questions after 3 hours of instruction. These results indicate the need for more instruction on DV for EMTs.
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Morewood GH, Weiss SJ. Intra-aortic balloon pump associated with dynamic left ventricular outflow tract obstruction after valve replacement for aortic stenosis. J Am Soc Echocardiogr 2000; 13:229-31. [PMID: 10708472 DOI: 10.1067/mje.2000.102698] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
An unstable patient with critical aortic stenosis had an intra-aortic balloon pump placed preoperatively for hemodynamic support and alleviation of symptoms. After separation from cardiopulmonary bypass following aortic valve replacement, the patient was hypotensive with increased pulmonary artery pressures. Transesophageal echocardiography revealed left ventricular outflow tract obstruction associated with systolic anterior motion of the mitral valve and severe mitral regurgitation. This pathophysiology was present when ventricular systole was preceded by balloon counterpulsation, but was absent during unassisted systole. This case report demonstrates a potentially significant untoward effect of intra-aortic balloon pump augmentation after aortic valve replacement for aortic stenosis. The timely diagnosis of this iatrogenic condition in the operating room permitted the prompt implementation of appropriate management strategies and avoided unnecessary surgical intervention.
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Panlilio LV, Weiss SJ, Schindler CW. Effects of compounding drug-related stimuli: escalation of heroin self-administration. J Exp Anal Behav 2000; 73:211-24. [PMID: 10784010 PMCID: PMC1284772 DOI: 10.1901/jeab.2000.73-211] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Previous experiments have demonstrated that presenting independently established discriminative stimuli in compound can substantially increase operant responding maintained by food reinforcement or shock avoidance. Recently, this phenomenon was also shown to occur with cocaine self-administration. The present study further assessed the generality of these stimulus-compounding effects by systematically replicating them with heroin self-administration. Rats' nose-poke responses produced intravenous heroin (0.025 mg/kg per infusion) on a variable-ratio schedule when either a tone or a light was present. In the absence of these stimuli, responding was not reinforced. Once discriminative control by the tone and light had been established, the stimuli were presented in compound under extinction (with heroin discontinued) or maintenance conditions (with heroin available during test-stimulus presentations). In extinction, the tone-light compound increased responding approximately threefold compared to tone or light alone. Under maintenance conditions, compounding increased heroin intake approximately twofold. These effects closely matched those obtained earlier with cocaine. This consistency across pharmacological classes and across drug and nondrug reinforcers further confirms that (a) self-administered drugs support conditioning and learning in a manner similar to that supported by other reinforcers; and (b) multiple drug-related cues interact in lawful and predictable ways to affect drug seeking and consumption.
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Ernst AA, Weiss SJ, Nick TG, Casalletto J, Garza A. Domestic violence in a university emergency department. South Med J 2000; 93:176-81. [PMID: 10701783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
BACKGROUND We attempted to determine the prevalence and demographics of domestic violence (DV) among male and female patients in a university emergency department (ED). METHODS The validated Index of Spouse Abuse (ISA) was used. Patients aged 18 years or older seen during 28 randomly selected 4-hour shifts were eligible. RESULTS Of the 97 participants in the study, 57 were female. One man and 3 women were victims of present physical DV, with 1 male and 2 female victims of present nonphysical abuse. Three of the 40 men and 22 of the 57 women had been victims of past physical violence. One man and 15 women had been victims of past nonphysical abuse. Alcohol use, suicidal ideation, family history, and psychiatric history were all strongly correlated with DV. CONCLUSIONS The prevalence of DV past was significantly higher in the females. Present violence was more rare and less than that reported in other ED studies.
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Cheung AT, Guvakov DV, Weiss SJ, Savino JS, Salgo IS, Meng QC. Nicardipine intravenous bolus dosing for acutely decreasing arterial blood pressure during general anesthesia for cardiac operations: pharmacokinetics, pharmacodynamics, and associated effects on left ventricular function. Anesth Analg 1999; 89:1116-23. [PMID: 10553821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
UNLABELLED The objective of this study was to evaluate the efficacy of nicardipine, a dihydropyridine calcium channel antagonist, administered as an IV bolus dose to acutely decrease arterial pressure in anesthetized cardiac surgical patients. We performed a double-blind, randomized, self-controlled, dose-ranging study in 40 adult cardiac surgical patients to determine the pharmacokinetics and pharmacodynamics of nicardipine 0.25 mg, 0.50 mg, 1.00 mg, and 2.00 mg administered as an IV bolus. Transesophageal echocardiography was used to assess left ventricular preload, afterload, and global systolic function. Plasma nicardipine concentration was measured using high-performance liquid chromatography. Nicardipine selectively decreased arterial pressure in a dose-dependent manner with a maximum response within 100 s and recovery to half the maximum response within 3-7 min without associated changes in heart rate. The decreases in arterial pressure were associated with only small decreases in left ventricular end-systolic wall stress and small increases in global left ventricular systolic function without changes in left ventricular end-diastolic cavity area or cardiac output. The time course for nicardipine bolus was consistent with a two-compartment pharmacokinetic model with rapid redistribution from a small central compartment. IMPLICATIONS Nicardipine was effective for selectively decreasing arterial blood pressure acutely, but had no effects on ventricular preload or cardiac output. The absence of dose-dependent changes in cardiac output, left ventricular systolic performance, and left ventricular afterload despite significant decreases in arterial pressure suggested that nicardipine had a small negative inotropic action.
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Ernst AA, Casaletto JJ, Nick TG, Weiss SJ. Serum glucose levels in elderly trauma victims. Ann Emerg Med 1999. [DOI: 10.1016/s0196-0644(99)80220-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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116
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Diercks DB, Weiss SJ, Derlet RW, Ernst AA. Abscess location and wound culture results: A comparison between intravenous drug users and nonusers with extremity abscesses. Ann Emerg Med 1999. [DOI: 10.1016/s0196-0644(99)80187-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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117
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Ernst AA, Green E, Ferguson MT, Weiss SJ, Green W. Emergency department evaluation of male victims of sexual assault. Ann Emerg Med 1999. [DOI: 10.1016/s0196-0644(99)80236-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Prehospital electrocardiograms (ECGs) have been shown to decrease the time from onset of pain to onset of treatment. They are obtained prior to treatment while the patient is likely to have his/her most intense pain. With paramedics initiating care in the field, patient assessments may be clinically different by the time the patient reaches the hospital. Thus, obtaining an ECG as early as possible during treatment could aid in the access to treatment for the few patients whose ECGs improve with prehospital care. We present a case in which the prehospital presentation was indicative of an acute myocardial infarction (MI), whereas the presentation to the hospital was not as clear-cut. The patient was taken immediately to the catheterization laboratory based on the prehospital findings and was found to have an acute MI that was treated. Laboratory findings indicated that there was a significant improvement in patient outcome based on this early treatment. This case further illustrates the role of a prehospital ECG.
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Rosenthal EL, Hotary K, Bradford C, Weiss SJ. Role of membrane type 1-matrix metalloproteinase and gelatinase A in head and neck squamous cell carcinoma invasion in vitro. Otolaryngol Head Neck Surg 1999; 121:337-43. [PMID: 10504584 DOI: 10.1016/s0194-5998(99)70217-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The proteolytic activity of gelatinase A, a member of the matrix metalloproteinase (MMP) family, is considered to be a critical factor in tumor cell penetration of the extracellular matrix. To express catalytic activity, however, gelatinase A requires activation by another MMP, membrane type 1-matrix metalloproteinase (MT1-MMP). The head and neck squamous cell carcinoma cell line, UM-SCC-1, forms a quiescent monolayer atop collagen unless stimulated with epidermal growth factor (EGF; 3.5 nmol/L), which induces single cell invasion within 48 hours. To determine the role of the MT1-MMP/gelatinase A protease system in an in vitro stromal invasion model, expression vectors for MT1-MMP and gelatinase A were transfected into UM-SCC-1 (SCC-1/MT and SCC-1/gelA, respectively). SCC-1/MT tumor cells were found to invade in the absence of growth factor stimulation. Additionally, these cells displayed shorter onset to invasion and penetrated deeper into the collagen gel with EGF stimulation than did control vector transfectants. SCC-1/gelA cells similarly demonstrated invasion in the absence of EGF and a heightened invasive potential under EGF-stimulated conditions. These results suggest that the MT1-MMP/gelatinase A protease system participates in squamous cell carcinoma invasion of collagenous matrices.
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Weiss SJ, Ernst AA, Phillips J, Hill B. Gender differences in statewide EMS transports. Ann Emerg Med 1999. [DOI: 10.1016/s0196-0644(99)80227-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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121
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Miller P, Weiss SJ, Ernse AA, Russell S. Recidivism in an urban emergency department. Ann Emerg Med 1999. [DOI: 10.1016/s0196-0644(99)80478-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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122
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Takakuwa KM, Ernst AA, Weiss SJ. A breast knowledge survey in an urban emergency medicine department. Ann Emerg Med 1999. [DOI: 10.1016/s0196-0644(99)80208-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ernst AA, Takakuwa KM, Letner C, Weiss SJ. Warmed versus room temperature saline solution for ear irrigation: a randomized clinical trial. Ann Emerg Med 1999; 34:347-50. [PMID: 10459091 DOI: 10.1016/s0196-0644(99)70129-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
STUDY OBJECTIVE To test the hypothesis that ear irrigation with warmed normal saline solution is more comfortable and results in fewer side effects than irrigation with room temperature saline solution in normal volunteers. METHODS The study was a randomized, single-blind, crossover trial in which each subject received 30 mL warmed normal saline solution in 1 ear and 30 mL room temperature saline solution in the opposite ear. The solutions (warmed versus room temperature) and the order of irrigation (right versus left ear) were separately randomized. Investigators obtaining scores were blinded to solution temperature. Subjects rated the discomfort of irrigation, using separate visual analog scales, from 0 (no pain) to 100 mm (worst pain ever). RESULTS Forty volunteers were enrolled in the study. The mean difference in visual analog scale scores favoring warmed over room temperature saline solution was 26 mm (95% confidence interval [CI], 19 to 33 mm; P <.0001). Twenty percent more patients reported dizziness with room temperature irrigation (95% CI, 6% to 34%). There was no gender effect or order effect for the 2 solutions. CONCLUSION Warmed normal saline solution was both clinically and statistically more comfortable than room temperature saline solution as an ear irrigant in normal volunteers. Significantly less dizziness was reported with the warmed solution.
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Weiss SJ, Ernst AA, Blanton D, Sewell D, Nick TG. Domestic violence among emergency medical technicians. Acad Emerg Med 1999; 6:857-9. [PMID: 10463562 DOI: 10.1111/j.1553-2712.1999.tb01222.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Weiss SJ, Goebel P, Page A, Wilson P, Warda M. The impact of cultural and familial context on behavioral and emotional problems of preschool Latino children. Child Psychiatry Hum Dev 1999; 29:287-301. [PMID: 10422353 DOI: 10.1023/a:1021397032359] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This study examined the impact of financial, cultural, and family variables on the incidence of behavioral and emotional problems in a group of two- and three-year-old Latino children. The vulnerability of these children to mental health problems stems from the many challenges faced by their families, especially those associated with acculturation and poverty. Results indicate that most problems experienced by the children were related to depression and social withdrawal. Children were at greatest risk whose parents had immigrated from Central America, whose families relied more extensively on internal coping strategies such as passive resignation, and whose parents were dissatisfied with their family's interactions.
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