Family processes and child risk for injury

Although injuries are the leading health threat to children, behavioral interventions within the family to prevent injuries remain relatively unexplored. In this paper, the parenting literature relevant to maltreatment injuries is reviewed in order to offer a broader picture of the potential influence of the family on all kinds of injuries. Factors that influence parental supervision of risky child behavior, relationship issues that may potentiate risky behavior, and the role of behavioral rules in reducing risky responding are considered. Suggestions for future research on family processes in injury socialization and intervention options are advanced.

Influence of fibrin sealant (Tisseel) on osteochondral defect repair in the rabbit knee

Fibrin adhesives have been shown to improve the natural repair of musculoskeletal tissues. Growth hormone (GH) has a chondrogenic effect on immature cartilage. To test if a fibrin adhesive with and without GH could improve the natural repair of a joint surface lesion, we made a 9 x 4 mm2 osteochondral defect in the femoral groove of adult New Zealand rabbits. The defect in one of the knees was filled with the fibrin adhesive Tisseel, while the defect in the other knee was left untreated as a control. Another group of rabbits was treated in both knees with fibrin adhesive with local addition of GH during 1 week on one side. The experiments showed that the fibrin treatment impaired the natural repair of the osteochondral defect and that GH addition had no effect on the healing process. In a second in vitro experiment, chondrocyte migration into the fibrin adhesive Tisseel was compared to migration into rabbit and human blood clots. No cell migration was seen into the fibrin adhesive, while there was migration into the blood clots. We conclude that a fibrin adhesive like Tisseel is not suitable as a scaffold to promote repair of osteochondral defects in the rabbit knee.

Genetic control of giant perivascular space formation in the thymus of NOD mice

The immune system of NOD mice exhibits several anomalies, one being the intrathymic formation of giant perivascular spaces (PVSs) filled with mature thymocytes and some B-cells, intermingled within a network of extracellular matrix. The abnormal retention of thymocytes on their way to the periphery could have a profound impact on the nature of the exported cells and the regulation of autoimmune events. In the present study, we evaluated the appearance of this defect into F1 hybrids, the association with some of the known diabetes susceptibility loci (Idd genes) in a panel of NOD and reciprocal C57BL congenic strains, and the relative contribution of epithelial versus hematopoietic stroma. The analysis of F1 hybrid thymuses reveals a dominant expression of thymic giant PVS that is only marginally influenced by the outcross strain. Moreover, giant PVS expression in major histocompatibility complex (MHC) and Idd congenic mice is determined by the genetic background. All of the NOD congenics express the anomaly, irrespective of the Idd resistance alleles that have been introgressed, whereas none of the C57BL congenic mice present abnormal PVS. Finally, the expression of giant PVS in parental --> F1 bone marrow chimeras is predominantly controlled by the thymic NOD-derived hematopoietic microenvironment. In conclusion, the giant PVS formation in the NOD mouse thymus is a dominantly inherited anomaly associated with hematopoietic-derived tissue and with non-MHC genes. The exact contribution of PVS to the autoimmune process remains to be definitively established.

Treatment of maternal addiction to prevent child abuse and neglect

Substance abusing mothers are a population neglected by the broader fields of substance abuse research and treatment. They are also at special risk for child abuse and neglect. This paper proposes a treatment model, drawn from the child maltreatment literature, that is also strongly supported by substance abuse research. Barriers within the substance abuse field to the adoption of treatment methods suggested by this model are considered and methods of surmounting those barriers are described. Finally, the need for scientists in the child maltreatment field to draw from the expertise of substance abuse researchers and clinicians is illustrated by data from an ongoing project; these data document the strong link between risk for maltreatment and a history of substance abuse. The need for future collaboration between the two fields is indicated by both literatures and strongly urged here.

Methodological considerations in participant event monitoring of low-base-rate events in health psychology: children's injuries as a model

The present article outlines the advantages of the participant event monitoring methodology for the investigation of unpredictable, low-base-rate events in children. Several methods for assessing the quality of participant event monitoring data are advanced with a data set showing participant event monitoring of children's minor injuries by 61 children and their mothers. Child-mother correspondence and debriefing data suggest good accuracy for frequency estimates. Home- and laboratory-based simulations illustrate the participant event monitors' accuracy for major details. Traditional measures of data quality show good overall coder and test-retest reliability, and cross-observer reports show acceptable estimates of validity for objective aspects of the events and the expected lower estimates for the more subjective aspects. Conceptual and pragmatic difficulties of the method are considered, and suggestions for future research are advanced.

Effect of glucose on uptake of radiolabeled glucose, 2-DG, and 3-O-MG by the perfused rat liver

In the transition from the fasting to the fed state, plasma glucose levels rise, and the liver converts from an organ producing glucose to one of storage. To determine the effect of glucose on hepatic glucose uptake, radiolabeled glucose, 2-deoxyglucose, and 3-O-methylglucose were injected into perfused rat livers during different nontracer glucose levels, and the concentrations in the outflow were measured. A mathematical model was developed that described the behavior of the injected compounds as they traveled through the liver and was used to simulate and fit the experimental results. The rates of membrane transport, glucokinase, glucose-6-phosphatase, and the consumption of glucose 6-phosphate were estimated. Membrane transport for all of the tracers decreased as nontracer glucose increased, demonstrating competitive inhibition of the glucose transporter. In contrast, the consumption of injected [2-14C]glucose increased when glucose was elevated, demonstrating that glucose caused an activation of enzyme activity that overcame the competitive inhibition of transport and phosphorylation. When glucose was elevated, the rate coefficient of glucokinase did not decrease, indicating that glucokinase was stimulated by glucose. Both changes would lead to the increased glycogen synthesis and decreased glucose production rate observed in vivo during the fasted-to-fed transition.

Accelerating children's risk for injury: mothers' decisions regarding common safety rules

Although safety rules are one of the primary preventative tactics used by parents to avoid childhood injury, very little is known about how rules are applied within families. In this preliminary study in the area of application of family safety rules, we found that mothers tended to impose rules consistently more often than inconsistently, and where they were inconsistent, they tended to regard a risky behavior as unacceptable, even if there was no family rule outlawing the behavior. The number of rules was negatively related to the number of injuries, suggesting that rules may indeed have the preventative properties that parents believe them to have. The importance of understanding how rules may prevent or fail to prevent injuries is underlined and future research challenges are described.

Rabbit articular cartilage defects treated with autologous cultured chondrocytes

Adult New Zealand rabbits were used to transplant autologously harvested and in vitro cultured chondrocytes into patellar chondral lesions that had been made previously and were 3 mm in diameter, extending down to the calcified zone. Healing of the defects was assessed by gross examination, light microscope, and histological-histochemical scoring at 8, 12, and 52 weeks. Chondrocyte transplantation significantly increased the amount of newly formed repair tissue compared to the found in control knees in which the lesion was solely covered by a periosteal flap. In another experiment, carbon fiber pads seeded with chondrocytes were used as scaffolds, and repair significantly increased at both 12 and 52 weeks compared to knees in which scaffolds without chondrocytes were implanted. The histologic quality scores of the repair tissue were significantly better in all knees in which defects were treated with chondrocytes compared to knees treated with periosteum alone and better at 52 weeks compared to knees in which defects were treated with carbon scaffolds seeded with chondrocytes. The repair tissue, however, tended to incomplete the bonding to adjacent cartilage. This study shows that isolated autologous articular chondrocytes that have been expanded for 2 weeks in vitro can stimulate the healing phase of chondral lesions. A gradual maturation of the hyalinelike repair with a more pronounced columnarization was noted as late as 1 year after surgery.

Quantifying tissue damage from childhood injury: the minor injury severity scale

Described an instrument designed to quantify the extent of tissue severity damage following a minor childhood injury event. Few tools exist to allow objective assessment of injury and those which do exist are oriented toward major injuries necessitating medical intervention. The Minor Injury Severity Scale (MISS) does not require specialized medical experience to apply. It yields a 0-7 score which indexes objective parameters such as depth and length of lesion for 22 different kinds of injuries. The data reported here suggest good coder reliability, excellent test-retest stability, and acceptable correspondence between mothers' and children's reports. Data are presented on divergent validity to show that tissue damage is related to but is not the same as injury outcomes such as pain, fear, and disability. Limitations of the scale and challenges to future research are also discussed.

Options in education for advanced trainees in isolated general practice

BACKGROUND

Only a small number of remote solo doctors are needed each year to provide health care to remote communities. However, despite advances in the provision of appropriate training for intending rural doctors, the preparation of graduates for this kind of medical practice has received little attention.

OBJECTIVE

To develop and evaluate an optional training unit within the Royal Australian College of General Practitioners Training Program, which provides trainee GPs with an opportunity to learn about remote medicine during training with the distant support of an experienced rural doctor.

METHOD

A program of intensive educational support was developed and piloted with a group of nine GP in solo rural practices and compared to that provided to four GP trainees in standard advanced GP terms. Comparison was based on data collected in trainee logbooks and in questionnaires completed by trainees and supervisors.

RESULTS

The solo trainees received equivalent duration of educational support through the use of communications technology and other distance education methods. The training unit will be trialed further and may remain an option within the Training Program.

Methodological considerations in participant event monitoring of low-base-rate events in health psychology: children's injuries as a model

The present article outlines the advantages of the participant event monitoring methodology for the investigation of unpredictable, low-base-rate events in children. Several methods for assessing the quality of participant event monitoring data are advanced with a data set showing participant event monitoring of children's minor injuries by 61 children and their mothers. Child-mother correspondence and debriefing data suggest good accuracy for frequency estimates. Home- and laboratory-based simulations illustrate the participant event monitors' accuracy for major details. Traditional measures of data quality show good overall coder and test-retest reliability, and cross-observer reports show acceptable estimates of validity for objective aspects of the events and the expected lower estimates for the more subjective aspects. Conceptual and pragmatic difficulties of the method are considered, and suggestions for future research are advanced.

Minimal residual disease may predict bone marrow relapse in patients with hairy cell leukemia treated with 2-chlorodeoxyadenosine

Minimal residual disease (MRD) can be detected in bone marrow core biopsies of patients with hairy cell leukemia (HCL) after treatment with 2-chlorodeoxyadenosine (2-CdA) using immunohistochemical (IHC) techniques. The purpose of this study was to determine whether the presence of MRD predicts bone marrow relapse. We studied paraffin-embedded bone marrow core biopsies from 39 patients with HCL in complete remission (CR) 3 months after a single cycle of 2-CdA. Biopsies performed 3 months posttherapy and annually thereafter were examined by routine hematoxylin and eosin (H&E) staining and IHC using the monoclonal antibodies (MoAbs) anti-CD45RO, anti-CD20, and DBA.44. At 3 months after therapy, 5 of 39 (13%) patients had MRD detectable by IHC that was not evident by routine H&E staining. Two of the five patients (40%) with MRD at 3 months have relapsed, whereas only 2 of 27 (7%) patients with no MRD and at least 1 year of follow up relapsed (P = .11). Over the 3-year follow-up period, two additional patients developed MRD. Overall, three of six (50%) patients with MRD detected at any time after therapy have relapsed, whereas only 1 of 25 (4%) patients without MRD has relapsed (P = .016). These data suggest that the presence of MRD after treatment with 2-CdA may predict relapse.

A new educational approach for supporting the professional development of third-year medical students

This paper describes a new course designed to support the professional development of third-year medical students. The course runs through the clinical clerkships, and has several additional features: it includes a multidisciplinary faculty; it is centrally based in the medical school; it addresses students' values and attitudes in addition to their knowledge and skills; and it makes use of small-group learning methods, and faculty, student, and group continuity during the year. The curriculum, which addresses ethical, social, and communicative issues in medicine, plus the evaluation of students and of the course, are described.

Stereoselectivity and isotope effects associated with cytochrome P450-catalyzed oxidation of (S)-nicotine. The possibility of initial hydrogen atom abstraction in the formation of the delta 1', 5-nicotinium ion

The stereochemical course of cytochromes P450 [P4501A1, P4502B1, P4502B4, and P450101 (P450cam)] catalyzed alpha-carbon oxidations of the cis-(Z)- and trans-(E)-5'-d1 diastereomers of (S)-nicotine has been examined. All enzyme preparations led to the stereoselective abstraction of the 5'-hydrogen atom trans to the pyridine ring with P450101 and human liver microsomal preparations displaying the highest (90%) and P4502B1 the lowest (67%) degree of stereoselectivity. No isotope effect was detected for any of the enzyme-catalyzed reactions, although the existence of an intrinsic isotope effect was inferred by the observation of an intramolecular isotope effect of 2-2.6 observed for the N-demethylation of (S)-N'-dideuteromethylnornicotine. Evidence for P450101-catalyzed N'-oxidation was sought but could not be found at higher than trace levels. These results, together with those obtained by computational methods, are interpreted in terms of an alpha-carbon oxidative pathway involving hydrogen atom abstraction rather than single electron transfer as the initiating event in the P450-catalyzed oxidation of (S)-nicotine to its delta 1',5'-iminium ion metabolite.

Clinical experience with the Leeds-Keio artificial ligament in anterior cruciate ligament reconstruction. A prospective two-year follow-up study

In this study, 24 consecutive patients with symptomatic chronic anterior cruciate ligament ruptures who had ligament reconstructions with the Leeds-Keio artificial ligament were observed for a minimum of 2 years or until ligament failure, whichever came first. The evaluation included a clinical examination, Lysholm knee score, and testing with a KT-1000 arthrometer. Within 2 years after surgery three patients underwent reoperation because of a rupture of the artificial ligament leading to instability. Another six patients developed significant subjective instability, even during ordinary activity. Only eight patients had a subjectively stable knee. Eleven patients scored 84 points or less on the Lysholm knee score, and 13 patients scored 85 points or more. The mean difference in anterior translation between the reconstructed knee and the opposite knee tested with the KT-1000 arthrometer was 3.7 mm. The high incidence of unstable knees, 9 of 24, due to insufficiency of the artificial ligament in this 2-year follow-up study strongly suggests that the Leeds-Keio artificial ligament is not an effective device for the reconstruction of the anterior cruciate ligament.

A developmental exploration of expectations for and beliefs about preventing bicycle collision injuries

Investigated developmental and gender-related trends in 2nd, 5th, and 8th graders', undergraduates', and adults' reactions to simulated bicycle collisions. Recently, scientists have called for exploration of the developmental mechanisms that underlie childhood injury. Our laboratory has, in three separate studies, demonstrated age-related decreases in beliefs about the negative consequences of bicycle collision. These developmental decreases in the expected seriousness of outcome parallel age-related increases in injury risk. The present study examined two alternative explanations for cognitive differences that might be related to increased risk for bicycle injury with increasing age. Contrary to predictions, however, age and gender were unrelated to subjects' expectations for whether a collision would take place, be actively avoided, or fail to take place. Similarly, age and gender were unrelated to whether subjects believed they could remain safe, that safety equipment (e.g., helmets) would keep them safe, or that different behavior would keep them safe. Results fail to support these expectations and beliefs as alternative explanations to developmental and gender-related trends in bicycle injuries, and indirectly suggest the importance of children's beliefs about the seriousness of injury as a contributer to injury risk behavior.

Sweat gland carcinoma in a human immunodeficiency virus-infected patient

Eccrine (sweat gland) carcinoma is a rare form of skin cancer that may be locally destructive. It is known to recur after resection and can metastasize to regional or distant lymph nodes. There have been two reported cases in association with patients immunocompromised as the result of organ transplantation (I. Penn: Prog Allergy. 37: 259, 1986). We report here the first case of sweat gland carcinoma in a patient infected with the human immunodeficiency virus.

Parents' socialization of children's injury prevention: description and some initial parameters

In a year-long participant observation study of remediative action following actual injury, 61 8- and 9-year-old children and their 27-46-year-old mothers wrote records and reported on more than 1,000 minor injuries in branching biweekly interviews. Mothers reported that 80.1% of injuries received no parent-initiated remediation, 14% received only a lecture, and less than 3% of injuries were followed by parental action. Children reported that 96.1% of their injuries were followed by no remediative action and recalled lectures after only 1.2% of injuries. Remediative action was related to type of child activity (e.g., unstructured play was followed by remediation more often than more purposive behavior) and to mother's affect (e.g., anger) and beliefs (e.g., that injury was the child's fault or due to rule violation). The parameters that influenced remediative consequences, and thus that may influence future injury, are discussed.