The impact of postnatal depression and associated adversity on early mother-infant interactions and later infant outcome

The impact of maternal depression and adversity on mother-infant face-to-face interactions at 2 months, and on subsequent infant cognitive development and attachment, was examined in a low-risk sample of primiparous women and their infants. The severe disturbances in mother-infant engagement characteristic of depressed groups in disadvantaged populations were not evident in the context of postpartum mood disorder in the present study. However, compared to well women, depressed mothers were less sensitively attuned to their infants, and were less affirming and more negating of infant experience. Similar difficulties in maternal interactions were also evident in the context of social and personal adversity. Disturbances in early mother-infant interactions were found to be predictive of poorer infant cognitive outcome at 18 months. Infant attachment, by contrast, was not related to the quality of 2-month interactions, but was significantly associated with the occurrence of adversity, as well as postpartum depression.

Pitfalls in interpreting prostate specific antigen velocity

PURPOSE

The concept of prostate specific antigen (PSA) velocity as an improved marker for prostate cancer detection is intriguing. However, before this concept is applied to individual patients several confounding parameters must be addressed. We determined the variability of serum PSA levels in men without prostate cancer.

MATERIALS AND METHODS

We reviewed data from a prostate cancer screening program, and determined inter-assay and individual variability of the serum PSA values for a 2-year followup period in 265 men clinically free of prostate cancer.

RESULTS

Our average inter-assay coefficient of variation was 7.5%. Therefore, we considered only PSA changes exceeding +/- 15% as significant. Fluctuations in serum PSA occurred in 78% of the men during the observation period, and 12.5% had at least a single PSA increase exceeding 0.75 ng/ml. per year. Fluctuations were noted throughout the entire range of serum PSA levels but became progressively larger with an increasing mean PSA.

CONCLUSIONS

The inter-assay variability must be considered when interpreting PSA velocity. Individual fluctuations in serum PSA dictate an observation period of at least 2 years before PSA velocity is considered abnormal.

Infant growth in the context of maternal eating disorders and maternal depression: a comparative study

There is evidence of growth faltering in infants of mothers with eating disorders. The aim of the current study was to examine whether this is a specific relationship. Thus, the infants of mothers with eating disorders were compared with infants of mothers with post-natal depression and a large comparison group. This study also aimed to explore possible mechanisms whereby growth disturbance comes about. It was found that the infants of mothers with eating disorders were smaller, both in terms of weight for length and weight for age, than either comparison group infants or infants of mothers with post-natal depression. There was little evidence, however, that mothers with eating disorders preferred smaller children or were dissatisfied with their children's shape or that they misperceived their children's size. On the contrary these mothers seemed highly sensitive to their children's shape and, compared with the other two groups, were more likely to judge their children's size accurately. None of these maternal measures significantly predicted the child's growth. The mechanism whereby growth disturbance arises in the context of eating disorders does not appear to be by means of a direct extension of the maternal psychopathology to the infant.

Nebulized budesonide is as effective as nebulized adrenaline in moderately severe croup

OBJECTIVE

Nebulized budesonide and nebulized adrenaline have been shown to be effective in the treatment of moderately severe croup. However, there has been no direct comparison of these therapies. We undertook a multicenter, randomized, double-blind, parallel group study in 66 hospitalized children with viral or spasmodic croup.

METHODS

Children 0.5 to 6 years of age were assessed using a validated croup symptom score (stridor, 0 through 4; cough, 0 through 3; retractions, 0 through 3; dyspnea, 0 through 3; and color, 0 through 4) at 0.5, 1, 1.5, 2, 12, and 24 hours after nebulization. Patients received either budesonide (2 mg/4 mL) or L-adrenaline (4 mg/4 mL) via nebulization. The primary outcome measure was change in the total croup symptom score.

RESULTS

Thirty-five children received budesonide and 31 received adrenaline. There was no significant difference in baseline features, including croup score (mean [95% confidence interval]: budesonide, 7.1 [6.7-7.5]; adrenaline, 7.7 [7.3-8.1]). All patients had significant improvement from baseline, and there was not significant difference between the two treatments, as measured by change in croup scores, change in oxygen saturation, duration of hospitalization, number of subsequent treatments with systemic steroids or adrenaline, and adverse events. No child required intubation.

CONCLUSION

This study does not show any difference in efficacy and safety between nebulized budesonide and nebulized adrenaline in the treatment of acute upper airway obstruction in patients with moderately severe croup.

Bartonellosis in Zamora Chinchipe province in Ecuador

Human bartonellosis was investigated in the Ecuadorian province of Zamora Chinchipe; 17 cases were identified retrospectively from hospital records over the period 1984-1995, mostly from 6 communities in the provincial district of Zumba. A questionnaire concerning risk factors for disease transmission was administered in these 6 communities. Blood samples were taken from individuals with current febrile illnesses or skin lesions suggestive of bartonellosis. Samples for detection of Bartonella bacilliformis were also taken from all school-age children in communities where historical cases had been identified by questionnaire. No bacteriologically positive case was identified and no evidence of asymptomatic infection was detected. Risk factors for disease transmission, identified by the questionnaire, included the presence of sick or dying chickens and guinea-pigs. It was suggested that bartonellosis is a zoonosis with wild animals, probably rodents, as the reservoir. The widespread use of residual insecticides and the easy availability of antibiotics is likely to have modified the epidemiology of this disease over the last decade.

Demographic, psychosocial, and objective risk factors related to perceived risk of skin cancer

BACKGROUND AND METHODS

The present study examined the ways in which demographic, psychosocial, and objective risk factors were related to perceived risk of skin cancer among 384 hospital employees who participated in a screening program. It was hypothesized that pyschosocial risk factors would account for a significant portion of the variance in risk perception beyond that accounted for by the other risk factors.

RESULTS

The risk factors accounted for approximately 44% of the variance in risk perception. Psychosocial risk factors accounted for a statistically significant portion of the variance in risk perception beyond that accounted for by other risk factors. Worry, family history of skin cancer, and race/ethnicity were most strongly related to perceived risk.

CONCLUSIONS

Results are discussed in terms of the need for educational programs that emphasize the relationship between level of risk and skin cancer and provide specific information regarding steps that can be taken to prevent skin cancer.

Mutations revealed by sequencing the 5' half of the gene for ataxia telangiectasia

Ataxia telangiectasia is a recessive disorder in which patients show a progressive cerebellar degeneration leading to ataxia, abnormal eye movements and deterioration of speech. Other features include ocular telangiectasia, high serum AFP levels, immunodeficiency, growth retardation and an increased predisposition to some tumours, particularly T cell leukaemia and lymphoma. We report the 1348 amino acid sequence of the N-terminal half of the A-T gene product which, together with the previously published C-terminal half, completes the sequence of the A-T protein. No homologies with other genes have been found within the N-terminal half of the A-T protein. We have also identified six mutations affecting the N-terminal half of the protein. One of these mutations was found to be associated with a haplotype that is common to four apparently unrelated families of Irish descent. All the patients so far examined for both A-T alleles were shown to be compound heterozygotes. None of these mutations affected a putative promoter region which may direct divergent transcription of both the A-T gene and a novel gene E14. The ability to recognise mutations across the entire coding sequence of the A-T gene provides a practical advantage to A-T families since a DNA based prenatal diagnosis will be possible in families where the mutations are identified irrespective of the level of radiosensitivity in these families.

A New Method for Routine Isolation of Oral Treponemes using U-Tubes and Pectin Medium

Determination of the composition of the oral microflora has traditionally been based on cultivation. Treponemes are prevalent in many oral infections but, unfortunately, are not regularly cultured. In this study a new method was established for routine isolation of oral treponemes from clinical samples. Bacterial samples from 47 periodontal pockets and 4 endodontic infections were incubated anaerobically under nitrogen atmosphere at 37 degrees C in U-tubes containing pectin medium. In the U-tube a 'bacterial sample side' and a 'sterile medium side' were established on separate sides of a membrane filter and an agar plug. Using this method we were able to isolate viable treponemes from all bacterial samples. This was in contrast to previously established methods such as the agar dilution technique, the technique involving the membrane filter placed on the surface of solid agar media and the well in agar plate technique. We believe that the 'U-tube method' is a valuable supplement to previously described techniques in routine isolation of treponemes from clinical samples.

An examination of driving records in a dementia clinic

The driving records of 249 persons referred to an outpatient dementia clinic were examined retrospectively to assess the specificity of the association between diagnosed dementia and increased traffic accidents. The clinic patients were divided into two groups: those who met criteria for dementia and those who did not. For each group, control subjects matched on age, gender, and location of residence were randomly selected from the records of all drivers in the province. The dementia sample had approximately 2.5 times the traffic crash rate of their matched control sample. The not-demented sample had approximately 2.2 times the traffic crash rate of their matched control sample. These individuals exhibited a variety of psychiatric, neurological, and medical conditions which could have affected their driving, and multiple medical problems were often present. Further clarification of the characteristics of "high risk" drivers is required if effective strategies for maximizing independence while minimizing the risk of traffic crashes are to be realized.

Long-term stability studies on the WHO IRP for thromboplastin (human plain BCT/253)

Long-term stability studies on the WHO second primary International Reference Preparation (IRP) for thromboplastin (human plain BCT/253) stored at -20 degrees C have been conducted for ten years. Three centres took part in the exercise using frozen normal and coumarinised plasma samples which were tested throughout. There has been no measurable change in the prothrombin time performance of the human plain IRP over the ten-year period. It can therefore be concluded that new IRP may continue to be calibrated against this preparation in accord with WHO recommendations.

Protein C, antithrombin III and plasminogen: effect of age, sex and blood group

We conducted a cross-sectional study of antithrombin III (ATIII), protein C (PC) and plasminogen (Plg) concentrations in a population of healthy plasma donors in the Trent Region. The distribution of values for protein C was log normal whereas for ATIII and Plg the distributions were positively skewed and differed significantly from normal and log normal. Males had higher antithrombin III concentrations (mean 1.10 iu/ml, range 0.72-1.65) than females (mean 1.07 iu/ml, range 0.75-1.69) (P = 0.001) and levels increased with age in women. Younger women aged 25-34 had significantly lower plasma concentrations of ATIII compared to males of similar age. For protein C, concentrations were higher in males (mean 1.07 u/ml, range 0.37-2.11) than in females (mean 1.01 u/ml, range 0.59-1.61) (P < 0.001) and levels increased with age in both sexes P < 0.001). In women, a novel difference in protein C concentration between ABO blood groups was noted. There was no significant difference in plasminogen concentration between males and females, and in women plasminogen decreased with age (r = -0.205, P < 0.001). We conclude that these variations in ATIII and protein C with age and sex are important considerations in the determination of reference ranges for these proteins.

Preferred meal patterns in non-insulin-dependent diabetes

Current advice on the across-the-day distribution of energy and carbohydrate intakes in non-insulin-dependent diabetes (NIDD) is based on inadequate evidence. We have addressed this by a comparison of an even as opposed to a main evening meal pattern in 11 subjects with NIDD. Contributions of macronutrients to energy intake were fat 29%, protein 20% and carbohydrate 51% with each meal pattern. The peak glycaemic response in the morning was not as good as the response in the evening (P<0.01), where an even energy and carbohydrate spread was used; this contrasts with previous reports in healthy subjects where the morning response to glucose is better than that later in the day. This difference between peak morning and peak evening glycaemic response was not seen with a main evening meal. There was a lower overall glycaemic response with a main evening meal compared with an even meal pattern (P<0.01, by area comparison). The overall insulin response was not significantly different between the two meal patterns, although the sensitivity for insulin appeared better in the evening where there was an evening main meal.

The management of acute bronchiolitis. Thoracic Society of Australia and New Zealand

The management of acute bronchiolitis is mainly supportive, but infants require minimal handling. Of those who are hospitalized, less than 3% require intensive care and ventilation but in these children the condition is life threatening. Oxygen, fluid replacement and careful observation remain the cornerstones of management. Bronchodilators should be avoided in young infants and antiviral therapy should only be considered in critically ill infants who have an underlying cardiopulmonary condition.

Reduced tissue type plasminogen activator activity of the gastroduodenal mucosa in peptic ulcer disease

The gastroduodenal mucosa has a rich blood supply. An active fibrinolytic system is presumably required to maintain vascular patency, and impairment may result in reduced blood flow, focal tissue necrosis, and peptic ulcerogenesis. Tissue type and urokinase type plasminogen activator activity (expressed as mIU/mg protein) and plasminogen activator inhibitor type-1 antigen were assayed in homogenates of gastric and duodenal biopsy specimens taken from patients with: normal endoscopy (controls) (n = 14); active duodenal ulcer (n = 21); healed duodenal ulcer (n = 12); and active benign gastric ulcer (n = 15). In controls mean duodenal tissue type plasminogen activator activity was 4110 and urokinase type plasminogen activator activity 150; gastric tissue type plasminogen activator was 2760 and urokinase type plasminogen activator 170; plasminogen activator inhibitor type-1 was generally undetectable. At the edge of active duodenal ulcers tissue type plasminogen activator was considerably reduced, 2220 (p < 0.001) whereas urokinase type plasminogen activator was raised, 290 (p < 0.01). At the edge of active benign gastric ulcers tissue type plasminogen activator was substantially reduced, 1160 (p < 0.001) but urokinase type plasminogen activator was unchanged. At the scar of healed duodenal ulcers tissue type plasminogen activator was slightly reduced, 3290, but urokinase type plasminogen activator was increased, 308 (p < 0.05). H2 receptor antagonist treatment had little effect on tissue type or urokinase type plasminogen activator activity. Plasminogen activator inhibitor type-1 was increased at the edge of active ulcers (p < 0.05) especially when tissue type plasminogen activity was low (r = -0.61, p < 0.05). These findings are consistent with the hypothesis that impaired fibrinolytic activity may be implicated in peptic ulcerogenesis.

Vaginal squamous cells in follicular aspirates following transvaginal puncture

Squamous cells are common findings on cytological examination of fluid obtained following transvaginal aspiration of simple ovarian cysts. This prospective study confirms the hypothesis that these cells are commonly introduced as contaminants during puncture of the vaginal wall. The occasional finding of bacteria also suggests a possible mechanism for post-operative pelvic infection.

Cutaneous IgE-mediated inflammatory lesion size is inhibited by an H1 antagonist (terfenadine) while mediator release is unaffected in vivo and in vitro

We are interested in understanding the pathogenesis of the cutaneous IgE-mediated late phase reaction. A double-blind, placebo-controlled, randomized cross-over study with 10 subjects of the effect of the non-sedating antihistamine, terfenadine (Selddane), on the cutaneous reaction to antigen (ragweed or mixed grass) administered intradermally and over denuded blister bases was performed. The activity of terfenadine on anti-IgE-induced mediator release from the skin mast cell, lung mast cell and basophil was also examined in vitro. Terfenadine significantly inhibited the size of the cutaneous reaction at every hour between hours 1 and 9 (hr 9, control 2250 +/- 500 mm2 vs drug 1250 +/- 250 mm2, P < 0.01, n = 10) and showed some inhibitory effect at hours 10-12. While terfenadine blocks histamine release after nasal antigen challenge the release of mediators at skin blister sites was unaffected. The infiltration of leucocytes into the blister supernatant was unaffected by terfenadine although previous studies have shown significant inhibition with another antihistamine, cetirizine. In vitro, terfenadine, like other antihistamines, was found to have inhibitory activity on anti-IgE-induced mediator release at concentrations of 10(-4)-10(-5) M in lung and skin mast cells and basophils. We conclude that the effects of the newer antihistamines on cellular movement into the skin may be diverse, that terfenadine may show organ specificity in vivo and that terfenadine significantly decreases both the early and late gross inflammatory response of the skin to antigen. We cannot, as yet, explain the mechanism(s) by which this occurs.

Modulation of secretory processes of phagocytes by IX 207-887

In chronic inflammation, the mediators released by phagocytes are in part responsible for the initiation and perpetuation of the disease. IX 207-887, which is a novel antiarthritic drug, inhibits the release of cytokines from mononuclear cells at concentrations which are achieved therapeutically in human rheumatoid arthritis and in animal models of arthritis. Furthermore, the production of superoxide and release of azurophil and specific granules by N-formyl-Met-Leu-Phe-stimulated neutrophils are significantly reduced. As a consequence, IX 207-887 may break the vicious circle which is manifest in chronic inflammation. In a recent double-blind placebo controlled study IX 207-887 has been shown to be an effective slow-acting drug for use in rheumatoid arthritis.

ION AND FLUID SECRETION BY DIFFERENT SEGMENTS OF THE MALPIGHIAN TUBULES OF THE BLACK FIELD CRICKET TELEOGRYLLUS OCEANICUS

Cricket Malpighian tubules have two morphologically distinct segments, a thin distal segment, which occupies approximately 10 % of the total tubule length, and a main segment. The two segments differ in secretion rates and response to corpora cardiaca extract. The secreted fluids differ in osmotic concentration and elemental composition. The distal segment secretes fluid at a rate (per mm length) which is approximately twice that of the main segment under control conditions. After stimulation by corpora cardiaca extract (Cc) the rate from the main segment approximately doubles whilst the distal segment rate remains unchanged. Fluid from the main segment and the whole tubule is slightly hypo-osmotic to the medium (5–11 mosmol kg-1) under control conditions, whereas that from the distal segment is slightly hyperosmotic (12 mosmol kg-1). On stimulation with Cc, the whole tubule fluid becomes slightly hyperosmotic (12 mosmol kg-1), that from the main segment remains slightly hypo-osmotic (3 mosmol kg-1) but fluid from the distal segment becomes very hyperosmotic (55 mosmol kg-1). Differences between the tubule fluid and the medium osmolality are indicated in parentheses. Fluid from the main segment has high concentrations of K (166 mmol l-1), Cl (111 mmol l-1), Na (41 mmol l-1) and P (83 mmol l-1), whereas that from the distal segment has high concentrations of K (101 mmol l-1) and Cl (137 mmol l-1). On stimulation with Cc, the elemental concentrations in fluids from the main segments and whole tubules do not change significantly but the K and Cl concentrations in distal segment fluid increase (182 and 188 mmol l-1 respectively). The Mg present in whole tubule fluid is derived largely from the distal segment. The ionic composition accounts for the observed osmotic concentrations in fluid from whole tubules, main segments and stimulated distal segments, but not for the concentrations in fluid from unstimulated distal segments. The fluid from unstimulated distal segments contains an unidentified organic solute accounting for approximately 90 mosmol kg-1 of the osmotic concentration. The distal segment contributes 22 % and 11 % of the fluid volume, 26 % Cl, 14 % K and 12 % Cl, 11 % K in control and Cc-stimulated tubules respectively. Considerably higher values are observed in individual tubules. The distal segment makes a significant contribution to the total ion output of the tubule. The cyclic AMP content of tubule segments treated with corpora cardiaca extract was found to increase in both main and distal segments. When expressed in terms of protein content there was no difference between segments. However, in terms of total cell volume, the cells of the distal segment had a tenfold greater cyclic AMP content than those of the main segment. This is consistent with a 10- to 20-fold higher secretion rate of K by the distal segment. It is suggested that the distal segment, whilst having a higher length-specific fluid secretion rate than the main segment, is, nevertheless, concerned primarily with ion and solute secretion since it is unresponsive to diuretic hormone. The prime role of the main segment, which does respond to diuretic hormone, is fluid secretion. There appear to be major differences in hydraulic conductivity between the two segments.