Pressor reactivity, ethnicity, and 24-hour ambulatory monitoring in children from hypertensive families

We assessed blood pressure responses of a multiethnic (Black and White) sample of 120 children of hypertensive families to orthostasis, video game, forehead cold, and dynamic exercise, and monitored the children's ambulatory pressure 24 hours later. Thirteen children were studied twice (1-year stability). The Black children exhibited higher 24-hour ambulatory systolic and diastolic pressures than the White children. Regardless of ethnicity, peak and mean systolic pressures during each task were generally positively correlated with mean systolic pressure while the children were awake and asleep. Associations between diastolic pressor responses and ambulatory measurements were somewhat dependent upon ethnicity and task. Relatively few reactivity-ambulatory correlations were significant, using pressor reactivity change scores. The children who participated twice exhibited significant 1-year stability for most ambulatory and pressor measurements. Children's pressor responses to laboratory tasks may generalize to the natural environment.

Ethnic differences in the myocardial and vascular reactivity to stress in normotensive girls

Cardiovascular reactivity to stress has been proposed as a mechanism partially responsible for the increased prevalence of essential hypertension in African-Americans compared with whites. However, few studies have examined ethnic differences in cardiovascular reactivity among women. The present study evaluated potential ethnic differences in the cardiovascular reactivity to three laboratory stressors (postural change, video game challenge, forehead cold stimulation). The sample consisted of 171 normotensive girls (74 whites, 97 African-Americans) with a mean age of 11.1 +/- 2.7 years, all with positive family histories of essential hypertension. African-American girls showed higher resting diastolic blood pressures and higher resting total peripheral resistance compared with white girls. African-American girls also exhibited higher peak responses in systolic and diastolic blood pressure and total peripheral resistance and lower cardiac index responses during video game challenge and forehead cold stressor. The findings extend previous observations of ethnic differences in blood pressure reactivity to stress and indicate that concomitant increases in total peripheral resistance appear to account for the greater blood pressure reactivity in African-American girls.

Accuracy of fourth- and fifth-grade students' food records compared with school-lunch observations

Fourth- and fifth-grade students' food records completed by using a labor-intensive approach (with daily monitoring) or a less labor-intensive approach (with weekly monitoring) were compared with school-lunch observations. Records were completed at three elementary schools for 14-23 d by students in 26 classes. Record pages were printed forms with areas for recording items consumed, number of servings, and locations of meals. Students were randomly selected for lunch observation. Kappa coefficients and percent of agreement for interobserver reliability for both approaches combined ranged from 0.43 to 0.91 and 72.6% to 95.5%, respectively, on 24 observations. Pearson correlations for 117 record/observation matches were significant for eight and three of nine meal items for the daily and weekly monitoring approaches, respectively. Thus, students were reasonably accurate in keeping records and more accurate with the more labor-intensive approach. Researchers need to select an approach based on the degree of accuracy desired and available finances.

Evaluation of the Children's Activity Rating Scale (CARS) in young children

We describe the daily activity patterns and the between-day and -year reliabilities of the Children's Activity Rating Scale (CARS) measured in 180 Anglo-, African-, and Mexican-American children aged 3 or 4 yr. Reliabilities were assessed at up to 11 measurement periods over 3 yr. CARS scores were measured by two trained observers (alternating 2-h shifts) up to 12 working hours. There were no significant ethnic or day of week differences in the activity levels. Males had higher mean activity levels than females and higher activity was performed in the summer and fall than the spring or winter. The all-measurements reliability for a mean of 5.34 d of observation over the 3 yr of measurement was 0.57. The reliability across all days and years of measurement was 0.73. The highest level of reliability (0.75) was found for the percent of minutes spent at CARS levels 3, 4, or 5 followed by an intraclass correlation of 0.74 for percent of minutes spent at CARS levels 4 or 5. These data support the utility of using the CARS as a measure of physical activity in younger children from different ethnic groups.

Naturally occurring atriocaval mesotheliomas in rats

Atriocaval mesotheliomas were observed in two control Sprague-Dawley rats out of a total of 2889 rats examined. Both neoplasms were located at the base of the interventricular septum. Microscopically, the neoplasms consisted of varying proportions of glandular structures and a fibrous tissue stroma. Glandular structures were lined by a single layer of cuboidal to low columnar epithelium with cells containing a moderate amount of eosinophilic fibrillar to granular cytoplasm and a pleomorphic vesicular round nucleus with coarsely clumped chromatin and often a single eccentric prominent nucleolus. Epithelial cells were stained with antibodies raised against both vimentin and cytokeratin. Electron microscopical features included the presence of microvilli, terminal bars composed of modified tight junctions and desmosomes at the lateral and apical borders, and numerous tonofilaments associated with desmosomes.

Measuring fruit and vegetable preferences among 4th- and 5th-grade students

BACKGROUND

Achievement of the nation's Year 2000 fruit and vegetable goal of five or more daily servings may relate to children's preferences for fruits and vegetables. There are, however, no easily administered instruments for measuring preferences for fruits and vegetables among children.

METHODS

An initial questionnaire systematically varied preparation methods after focus group discussions had indicated that this had an impact on fruit and vegetable preferences. The three-part questionnaire (fruits, vegetables, fruit and/or vegetable snacks) was classroom administered. Internal consistencies and test-retest reliabilities were acceptable. Principal components analyses, however, revealed food-specific rather than preparation factors; thus, preparation was eliminated from a revised questionnaire.

RESULTS

Repeat classroom administration of the revised questionnaire yielded acceptable internal consistencies and test-retest reliabilities. Preferences were higher for fruits than vegetables. Principal components analyses indicated single fruit and vegetable factors and a two-factor solution for snacks (vegetables, fruits). Pearson correlations between preferences and consumption were significant, but accounted for only a small fraction of the variance. Correlations between fruit exposure and preferences, and between vegetable exposure and preferences were 0.55 and 0.51, respectively.

CONCLUSION

The revised questionnaire provides a reliable, valid, and simple tool for assessing fruit and vegetable preferences of 4th- and 5th-grade students. The relationship between these preferences and actual consumption is weak; however, making fruits and vegetables more available may enhance preferences.

Determinants of left ventricular mass in normotensive children

Left ventricular hypertrophy has been shown to be an independent predictor of cardiovascular morbidity and mortality. Few studies have examined the determinants of left ventricular mass (LVM) in normotensive children. Eight-four healthy children, blacks and whites, girls and boys, between 6 and 18 years of age, all with positive family histories of essential hypertension, participated in the study. Demographic and anthropometric characteristics, physical activity, and hemodynamic responses at rest and in response to the stress of forehead cold stimulation and a challenging video game were related to M-mode echocardiographic determined LVM indexed by two indices of body habitus. Hierarchical stepwise multiple regression analysis indicated that the significant independent correlates of LVM per body surface area were gender (boys were greater), baseline systolic blood pressure and heart rate, a physical activity index (sweat episodes per week) and peak systolic blood pressure responses to the forehead cold stressor (final model r2 = 0.49). For LVM/height2.7 significant independent correlates were adiposity index (weight z score--height z score), gender (boys were greater), age, resting systolic pressure, and systemic vascular resistance reactivity to forehead cold stimulation (final model r2 = 0.42). These findings with normotensive children corroborate other findings that have typically involved hypertensive children, indicating that resting heart rate and systolic pressure, gender, and adiposity are early determinants of LVM indices in children. In addition, the current findings indicate that hemodynamic responses to stress also appear to play a role in the early development of LVM.(ABSTRACT TRUNCATED AT 250 WORDS)

Ethnicity, gender, family history of myocardial infarction, and hemodynamic responses to laboratory stressors in children

Relationship among ethnicity, gender, grandparents' histories of early myocardial infarction, and hemodynamic responses to forehead cold and treadmill exercise were examined in 87 6-to-8-year-olds (57 White, 30 Black). Boys had greater increases in systemic vascular resistance and decreases in cardiac index to forehead cold. Girls had greater increases and quicker recovery in heart rate to dynamic exercise. Blacks had greater increases and slower recovery in diastolic pressure to exercise and forehead cold. Blacks showed greater increases and slower recovery in systemic vascular resistance to forehead cold. Positive-family-history children had greater increases in diastolic pressure and systemic vascular resistance to forehead cold and greater diastolic pressure increases to exercise. Positive-family-history Blacks had greater increases in systolic pressure to exercise and slower recovery than all other groups.

Reliability and variability of indicators of heart-rate monitoring in children

We describe the daily heart-rate patterns and the between-day and within-day reliabilities of several heart rate indicators measured in 131 Anglo-, African-, and Mexican-American children aged 5-7 yr. Heart rates were measured over 12 waking hours with a Quantum XL Telemetry heart rate monitor. The percent of heart rates 25% above resting heart rate, an index of physical activity heart rate (PAHR-25 index), was found to have the highest within-day (0.92) and between-day (0.81) reliabilities. The Spearman-Brown prophecy formula indicated that only 9.3 h of observation would be needed to maintain a within-day reliability of 0.90. The percentage of heart rates 50% above resting heart rate (PAHR-50) was found to have slightly lower within-day (0.88) and between-day (0.56) reliability. Principal components analysis revealed that the PAHR-25 and PAHR-50 indicies only had one component throughout the day. The PAHR-25 and PAHR-50 indicies were weakly correlated with age, suggesting that they may be good indicators of relative PAHR. Male children had higher (P < or = 0.025) PAHR-25 index scores than females. There were no gender or ethnic differences in the PAHR-50 index.

Relationship between family environment and children's hemodynamic responses to stress: a longitudinal evaluation

Because interpersonal relationships may have an impact on the risk of developing cardiovascular disease, the authors examined the prospective relationship of family functioning upon hemodynamic stress responses in 87 6- to 8-year-old children. The parents completed the cohesion, conflict, expressiveness, and control subscales of the Family Environment Scale; 2 years later, the authors assessed the children's hemodynamic responses to postural change, forehead cold stimulation, and treadmill exercise. Maternal reports of greater cohesion and expressiveness were related to less increases in systolic pressure and systemic vascular resistance in response to the forehead cold. Mothers' reports of expressiveness were related to lower systolic pressure and cardiac index reactivity to postural change. Fathers' reports of greater control were associated with greater diastolic pressure and vascular resistance increases to forehead cold and to greater vascular resistance responses to exercise. Paternal reports of greater conflict were associated with greater systemic vascular resistance increases and with lower cardiac index increases to exercise. Results suggest family functioning may predict later hemodynamic reactivity to stress. The findings are discussed in terms of previous research on parent-child interaction patterns and children's cardiovascular health.

Ethnicity, family history of hypertension and patterns of hemodynamic reactivity in boys

This study compared blood pressure, heart rate, stroke volume, vascular resistance, and cardiac output responses to a video game challenge and forehead cold stressor in 6- to 15-year-old males who varied in ethnicity and family history of essential hypertension. Controlling for age, significant baseline differences were obtained with black boys exhibiting higher systolic and diastolic pressures than their white cohorts. Positive family history children were found to have higher cardiac outputs and stroke volumes indexed by body surface area during baseline. Controlling for baseline hemodynamic responses and age, positive family history children exhibited greater increases in systemic vascular resistance and systolic and diastolic pressure and greater decreases in heart rate to the cold stressor. The positive family history children exhibited greater decreases in cardiac index during both the video game and cold stressor phases. Implications of the findings and directions for future research are discussed.

Ethnicity, gender, family history of myocardial infarction, and hemodynamic responses to laboratory stressors in children

Relationship among ethnicity, gender, grandparents' histories of early myocardial infarction, and hemodynamic responses to forehead cold and treadmill exercise were examined in 87 6-to-8-year-olds (57 White, 30 Black). Boys had greater increases in systemic vascular resistance and decreases in cardiac index to forehead cold. Girls had greater increases and quicker recovery in heart rate to dynamic exercise. Blacks had greater increases and slower recovery in diastolic pressure to exercise and forehead cold. Blacks showed greater increases and slower recovery in systemic vascular resistance to forehead cold. Positive-family-history children had greater increases in diastolic pressure and systemic vascular resistance to forehead cold and greater diastolic pressure increases to exercise. Positive-family-history Blacks had greater increases in systolic pressure to exercise and slower recovery than all other groups.

Case study of language and numerical disability: A sequential processing deficit?

We report a case study of Christine, an intelligent 30-year-old woman with a developmental learning disability. Psychometric evaluation and extensive interviews revealed several findings: most notably, evidence of anomia, auditory processing problems, difficulty acquiring reading and spelling skills, and an extremely poor sense of number. In addition, Christine showed all four of the Gerstmann symptoms (left-right confusion, finger agnosia, dysgraphia, and dyscalculia). We suggest that most, if not all, of these impairments may be explained in terms of a sequential processing deficit (e.g., Bakker 1967; Tallal 1980). In Christine's case, difficulty perceiving serial order appears to have resulted in a major conceptual impairment involving number.HD-To me four is a number that comes after three and before five. It means twice two …C-To me four is a picture.

Improving utilization and patient care. A rural hospital reduces length of stay through policy revisions and education

In 1990 Saint Vincent Memorial Hospital, Taylorville, IL, intensified efforts to improve resource utilization. A program of daily case review and medical staff education has helped the hospital reduce average length of stay from between 7 and 8 days to between 5 and 6.8 days. Steps taken to achieve this include: Hiring an outside medical adviser to oversee collection and analysis of data related to length of stay and conduct case reviews Appointing a medical review officer and a physician-specific case manager Establishing a Utilization Management Task Force, which has reformed the policy concerning patients with methicillin-resistant Staphylococcus aureus to ensure discharge in a timely manner; implemented a nonacute-day reporting system; and completed a transitional care study to identify the benefits of transferring medically stable Medicare patients to the Skilled Nursing Facility.

Transitive inference in rats (Rattus norvegicus)

Although Piagetian theory proposes that the ability to make transitive inferences is confined to humans above age 7, recent evidence has suggested that this logical ability may be more broad based. In nonverbal tests, transitive inference has been demonstrated in preschool children and 2 species of nonhuman primates. In these experiments, I demonstrate evidence of transitive inference in rats (Rattus norvegicus). I used an ordered series of 5 olfactory stimuli (A < B < C < D < E) from which correct inferences were made about the novel B versus D pair. Control procedures indicated that performance did not depend on the recency with which the correct answer was rewarded during training and may be disrupted by the addition of logically inconsistent premises (F > E and A > F). The possibility that logical transitivity may reflect a form of spatial paralogic rather than formal deductions from a syllogistic-verbal system is discussed.

Relationship between the Millon Clinical Multiaxial Inventory and the Millon-II: value of scales for Aggressive and Self-defeating personalities in Posttraumatic Stress Disorder

This study addressed two issues, the interrelationship between the Millon Clinical Multiaxial Inventory (MCMI) and the Millon II (MCMI-II) and the value of the new personality scales, Aggressive and Self-defeating, in a sample with diagnoses of combat-related Posttraumatic Stress Disorder. 100 confirmed cases of combat-related Posttraumatic Stress Disorder were given a battery of measures including both Millon inventories and the Minnesota Multiphasic Personality Inventory (basic scales and selected subscales). They were rated on discharge status during a structured treatment program. Basic treatment and background information were also obtained. Analysis showed scores on the MCMI-II scales were higher but generally reflective of MCMI scales and that the Self-defeating personality style tends to be reflective of greater psychopathology, suicidal problems, treatment/disposition difficulties, overreporting of symptoms, and intensity of problems. Discussion encouraged the use of the MCMI-II with special emphasis given to the Self-defeating style in this group with Posttraumatic Stress Disorder.

An encephalomyocarditis virus epizootic in a baboon colony

Approximately 80 baboon deaths were caused by encephalomyocarditis virus (EMCV) infection in a 3060 member research and production colony. The epizootic extended over a 9-month period and occurred in baboons ranging from 1 day to 22 years of age. Acute death was the most common history. When clinical disease was detected, it was characterized by labored respiration associated with acute congestive heart failure. The salient necropsy findings were pulmonary congestion and edema, hydropericardium, hydrothorax, ascites, lymph node and splenic hypertrophy, and pale white-to-tan mottled hearts. The most significant histologic lesion was nonsuppurative necrotizing myocarditis. Placental infection with fetal loss occurred. Diagnosis was confirmed by light microscopy, transmission electron microscopy, virus culture, and serology. Rarely, EMCV-induced antibody persisted in surviving baboons for more than 24 months. EMCV-infected feral rats were the probable source of the virus and their control stopped the epizootic. No EMCV neutralizing antibody was detected in colony support personnel or chimpanzees.

Structural alterations in retinal tissues from rats deficient in vitamin E and selenium and treated with hyperbaric oxygen

Vitamin E and selenium play key roles in preventing in vitro lipid peroxidation and free radical damage to retinal tissues. In this research, we studied the effects of hyperbaric oxygen on retinal structure in rats fed diets deficient in vitamin E and/or selenium. We also correlated any alterations in retinal structure with previously measured alterations in electroretinograms (ERGs). Age-matched rats were fed a basal diet deficient in both vitamin E and selenium (B diet), a basal diet supplemented with vitamin E alone (B+E diet), or selenium alone (B+Se diet), or with both micronutrients (B+E+Se). Half the rats in each group were treated (+HBO) with hyperbaric oxygen (100% O2 at 3 ATA for 1.5 per hr day, 5 days per week) and half were not (-HBO). We previously found that the rats fed the B diet for 6 weeks and treated with HBO for 4 weeks (B+HBO group) had diminished a-wave ERG amplitudes. At this time point all rats in the B group and half of the rats in the B+E+Se group were killed for the structural studies reported here. Surprisingly, we found no evidence of photoreceptor cell necrosis [i.e. a decreased thickness of the outer nuclear layer (ONL)] in retinas from rats in the B+HBO group despite the diminished amplitude of the a-wave which arises from this retinal layer. Quantitative structural analyses of retinas from rats in the B+HBO, B-HBO, B+E+Se-HBO and B+E+Se+HBO groups also failed to reveal any significant differences in the cell height of the retinal pigmented epithelium (nasal, central or temporal regions) or the number of mitochondria, phagosomas or inclusion bodies in the central retinal pigment epithelium (RPE). The inner nuclear layer (INL) thickness was, however, consistently decreased in all retinal regions for the rats in the B+HBO group. Our previous work also showed that only rats fed the B+Se diet for 17 weeks and treated with HBO for 15 weeks (B+Se+HBO group) showed diminished a-wave and b-wave ERG amplitudes. At this time point rats in the B+E+Se, B+E, and B+Se groups were killed for structural studies reported here. Only rats in the B+Se+HBO group showed a significantly decreased (about 20%) thickness of the central ONL. This evidence of photoreceptor cell necrosis correlated very well with our previous observation of diminished a- and b-wave amplitudes only in the B+Se+HBO group (at week 17).(ABSTRACT TRUNCATED AT 400 WORDS)

A survey of home care aides. A personal and professional profile

How can home health agency managers recruit and retain home care aides effectively? This study reveals the factors that influence aides' work choices, valuable information in battling worker shortage and costly turnover.

Reliability and variability of heart rate monitoring in 3-, 4-, or 5-yr-old children

We describe the daily heart rate patterns and the between day and within day reliabilities of several heart rate variables measured in 159 Anglo-, African-, and Mexican-American children aged 3-5 yr. Heart rates were measured over 12 waking hours with a Quantum XL Telemetry heart rate monitor. There were no significant ethnic, gender, day of week, or season of the year differences in either mean resting heart rate, mean daily heart rate, mean longest duration of the heart rate sustained above 120 bpm for the day, nor percent of minutes of daily heart rate above 120 bpm. The reliabilities for these variables for 2 d of observation separated by 3-6 months ranged from 0.65 to 0.66. At this level of reliability, just over 4 d of recording are necessary to achieve a reliability of 0.80. All within-day across-hour reliabilities were greater than 0.80. However, for mean hourly heart rate and the longest duration of heart rate sustained above 120 bpm each hour, a principal components analysis revealed three distinct time components during the day. This suggests that monitoring heart rate during limited portions of the day will provide a biased estimate of overall heart rate. For the morning component, there were significant ethnic and gender differences in the children's heart rates and younger children had longer durations of heart rate sustained above 120 bpm than older children. Although daily heart rate monitoring is not a perfect indicator of children's physical activity, these data suggest that it may be a reliable measure among younger children from different ethnic and gender groups.

Buspirone effect on tobacco withdrawal symptoms: a randomized placebo-controlled trial

BACKGROUND

Withdrawal symptoms hinder smoking cessation in nicotine-dependent smokers. This prospective, double-blind, placebo-controlled clinical trial was conducted to evaluate buspirone for nicotine withdrawal symptoms.

METHODS

Fifty-four heavy smokers (mean 33.1 cigarettes per day for 24 years) were randomly prescribed 30 mg/d of buspirone or placebo beginning 3 weeks before abrupt smoking cessation. Validated nicotine withdrawal and anxiety scales were administered at baseline and serially for 2 weeks after cessation.

RESULTS

Baseline demographic and nicotine-dependence measures were similar for each group. Three smokers (1 on buspirone, 2 on placebo) dropped out of the protocol prior to the quit date. Both groups had significant withdrawal effects over time (analysis of variance [ANOVA] P = 0.0001). There was a significant buspirone effect on any nicotine withdrawal symptoms (ANOVA, alpha = 0.05). Smokers who relapsed, regardless of group, reported significantly worse craving, irritability, anxiety, and difficulty concentrating than abstainers (P less than 0.05). Relapse rates at follow-up visits were not significantly different between groups. Two-week abstinence rates were 52 percent for placebo and 62 percent for buspirone (chi-square, P = 0.760).

CONCLUSIONS

In these heavy smokers, buspirone offered no relief from nicotine withdrawal symptoms. Regardless of treatment, relapsing smokers experienced more intense nicotine withdrawal.

Hostility: relationship to lifestyle behaviors and physical risk factors

The relationship between hostility and coronary artery disease may be partially mediated by unhealthy lifestyle behaviors. This study examined the relationship between hostility, lifestyle behaviors, and physical risk factors in 138 adult men and women. Subjects completed the Cook and Medley Hostility Scale (Ho scale) and self-reports of their dietary habits, consumption of alcohol and cigarettes, and physical activity. Recent findings indicated that a composite hostility score from three rationally derived subscales of the Ho scale tapping the dimensions of cynicism, hostile affect, and aggressiveness was a better predictor of mortality than the total Ho score. Thus, this composite measure of hostility and the total Ho score were used in data analyses. Measures of resting blood pressure, height, weight, and adiposity were also obtained. In men and women, both measures of hostility were positively associated with cholesterol intake and vigorous physical activity. Among women, both hostility measures were positively related to animal fat intake and negatively related to fiber intake. The composite measure was positively related to their resting systolic pressures. Among men, both hostility measures were positively related to cigarette smoking and sugar intake and negatively associated with systolic blood pressure and calcium intake. Findings are discussed in terms of previous research linking hostility to lifestyle behaviors and CAD.

Counselling and communication in health care Counselling and communication in health care Wiley John £ 15.95 358pp 0-471-92965-4 [Formula: see text]

Counselling and Communication in Health Care is depressing, exciting, and definitely relevant reading for nurses. It gives a sobering review of the research evidence that the levels of competent, knowledgeable communication and counselling required by patients and their families are, generally, not being provided.

Family history of myocardial infarction and hemodynamic responses to exercise in young black boys

The influence of family history of coronary artery disease on children's hemodynamic responses to exercise was examined with 25 black boys aged 7 to 10 years. Blood pressure, heart rate, cardiac output, stroke volume, and total peripheral resistance were evaluated during preexercise, peak exercise, and recovery stages. Children with a family history of CAD exhibited greater systolic blood pressure and total peripheral resistance during preexercise and peak exercise stages than did those without a family history of coronary artery disease. After controlling for preexercise differences, the group with a family history of coronary artery disease exhibited greater increases in systolic blood pressure and less attenuation of total peripheral resistance to peak exercise than the group without a family history of coronary artery disease. Cardiac output indexed by body surface area and stroke volumes were higher at all times in the group without a family history compared with the group with a family history of coronary artery disease. Findings are compared with those of adult studies in terms of influence of family history of coronary artery disease on cardiovascular reactivity to stress.