Food security: what the community wants. Learning through focus groups

We used focus groups to learn the range of issues threatening food security of low income residents in our community. Five major themes emerged from the discussions: literacy, money, time, mental health and self-esteem, suggesting several approaches that could help ensure food security: 1) education, 2) sharing of resources, 3) coalition building, and 4) advocacy. Education programs have to be practical, allowing for demonstrations and hands-on learning while emphasizing skill building and problem solving. Incorporating a social aspect into learning may compensate for the social isolation and would capitalize on the impressive mutual support we witnessed. Strategies based on self-help and peer assistance may counteract low self-esteem and overcome suspicion of health professionals. A community-wide effort is needed to address the factors contributing to food insecurity. We envision the formation of a coalition of professionals, agencies, and low income people to develop a comprehensive strategy for achieving food security.

Clinical pharmacology and tissue disposition studies of 131I-labeled anticolorectal carcinoma human monoclonal antibody LiCO 16.88

Antibody LiCO 16.88 is a human IgM recognizing a 30- to 45-kDa intracytoplasmic antigen present in human adenocarcinoma cells. An 8-mg sample of antibody labeled with 5 mCi 131I was co-administered i.v. with 120 mg (three patients), 240 mg (three patients) or 480 mg (four patients) unlabeled antibody as a 4-h infusion. The plasma half-life was 24 +/- 1.2 h and the immediate apparent volume of distribution was 5.2 +/- 0.2 l at the 28-mg dose level. The plasma half-lives and the cumulative urinary excretion of radiolabel did not seem to vary significantly with increasing doses of unlabeled antibody. However, both the volume of distribution and the clearance rate from plasma increased significantly with increasing antibody dose. Uptake of antibody into tumor tissues obtained during laparotomy 8-9 days after administration varied between 0.00002% ID/g and 0.00127% ID/g. In five of seven patients, the tumor content of antibody was higher than that in adjacent normal tissue. Tumor-to-normal tissue ratios ranged from 0.8 to 10 (mean = 3.8 +/- 1.0). In general, the higher radioactivity(cpm)/g tumor was confirmed by both immunoperoxidase and autoradiography. Antibody 16.88 localizes in tumors after administration and may be considered for use in radioimmunotherapy trials.

Diversity of ethnic and racial VNTR RFLP fixed-bin frequency distributions

To examine the impact that intra- and interracial genetic diversities have on VNTR RFLP-fragment-size distributions, a multiracial (East Asian, African American, U.S. Southwest Hispanic, and European Caucasian) and multiethnic (Chinese, Japanese, Korean, and Vietnamese) database has been constructed for the following loci: D1S7, D2S44, D4S139, and D10S28. Homogeneity between samples was examined using the Komologorov-Smirnov two-sample test for RFLP fragment sizes and a log-likelihood test for fixed-bin frequencies with theoretical and Monte Carlo empirical significance levels. Small but significant differences between theoretical and empirical significance-level distributions were observed with both procedures, particularly with the latter. The significance levels of the two types of tests were poorly correlated. Statistically significant differences in fragment-size and fixed-bin distributions were found within and between races, with greater differences occurring between races. Cluster analysis and principal components analysis, using different similarity measures, did not support the hypothesis of greater intra- than interracial diversity, which suggests that ethnic variation can be conservatively estimated by racial variation.

[Neurosyphilis and human immunodeficiency virus (HIV-1)infection. Experience with 6 cases]

HIV infected population has a higher incidence of syphilis, being this an independent risk factor for HIV infection. We report 88 HIV infected patients seen during the last three years. Fourteen (16%) had reactive serum VDRL and FTA-ABS and neurosyphilis was diagnosed in six (6.8%). Three had a treponemal uveitis-retinitis, one a meningovascular syphilis and one a secondary syphilis with meningeal and otological involvement. Patients were treated with penicillin 20 million UI/day for 14 days with good clinical and laboratory response and CSF normalization in those subjected to a second lumbar puncture. It is concluded that neurosyphilis must be considered in the differential diagnosis of neurological complications of HIV infections.

[Isolation of several species of the genus Aspergillus from soil of intrahospital ornamental plants]

The earth of ornamental plants is one of the main reservoirs of Aspergillus type of fungi in hospital areas. We studied 174 ornamental interior plants from a hospital at Santiago. Samples were obtained from the soil surface and sowed in Sabouraud-glucose agar, adding streptomycin and G-penicillin. After 72 h of culture, at least one strain of Aspergillus was isolated from 140 samples (80.5%). The most frequently isolated strain was A fumigatus (129 samples), followed by A niger (75 samples). A fumigatus and A niger were the only isolated strains in 65 and 11 samples respectively. These findings confirm that ornamental plants can be important reservoirs of Aspergillus strains, a potential infectious agent for immunocompromised patients, in hospital areas.

Nursing case management: affecting quality and cost

North Mississippi Health Services' nursing case management program has been deemed a success by all parties involved, especially the patients. High-risk patients with specific chronic health problems receive an enhanced level of care and experience significant reductions in cost, length of stay, and repeat hospitalizations. Quality of life for many of these patients is also improved. These outcomes are made possible by assigning a registered nurse to case manage or coordinate care for these patients.

Inhibitory effect of polyunsaturated fatty acids on the growth of Helicobacter pylori: a possible explanation of the effect of diet on peptic ulceration

Diets high in polyunsaturated fatty acids may protect against duodenal ulcer, possibly through inhibiting the growth of Helicobacter pylori. This hypothesis was tested in vitro by incubating H pylori microaerophilically with a range of polyunsaturated fatty acids. omega-3 Linolenic acid significantly, but reversibly, inhibited growth at 1.8, 2.5, and 5 x 10(-4) M (p < 0.01), while concentrations of 10(-3) M killed virtually all organisms, with cell lysis observed by electron microscopy. Similar inhibitory effects were seen with other polyunsaturated fatty acids, at concentrations of 2.5 x 10(-4) M the relative inhibitory potencies were oleic (C18:1) < linoleic (C18:2) < arachidonic (C20:4) < omega-3 linolenic (C18:3) = omega-6 linolenic (C18:3) = eicosapentanoic (C20:5) acid. Cell fractionation studies with 14C labelled linolenic acid showed that the linolenic acid was associated with the membrane fraction. Commonly ingested dietary polyunsaturated fatty acids inhibit the growth of H pylori in vitro, an effect which deserves further in vivo study.

The prevalence and correlates of fatigue in patients receiving treatment with chemotherapy and radiotherapy. A comparison with the fatigue experienced by healthy individuals

Fatigue can be a prevalent and serious problem for the individual with cancer and can negatively impact on the individual's quality of life. Little is known about the prevalence of clinical fatigue among patients with cancer and how the fatigue cancer patient's experience compares with the fatigue people experience as a function of their normal daily activities. This study, which utilized a control group, investigated the prevalence of fatigue among patients receiving treatment with radiotherapy (n = 54) and chemotherapy (n =47) over two measurement points. The level of fatigue experienced by cancer patients was compared with the level of fatigue experienced by apparently healthy auxiliary staff (n = 53) working at three cancer treatment facilities. There were no differences in the mean level of fatigue experienced by cancer patients and the mean level experienced by healthy controls before the start of cancer treatment. However, cancer patients experienced a significant increase in fatigue over a 5- or 6-week course of radiotherapy and 14 days after treatment with chemotherapy, and these increases were significantly greater than the fatigue reported by healthy control subjects. The midpoint of the Pearson Byars Fatigue Feeling Checklist was accepted as a crude measure of clinical fatigue and was found to be significantly different from the mean level of fatigue reported by healthy controls. The prevalence of fatigue among patients after undergoing cancer treatment was determined to be 61%. Fatigue in cancer patients was found to covary with weight, symptom distress, mood disturbance, and alterations in usual functional activities. The best predictors of fatigue in the patient sample were their symptom distress and mood disturbance. Symptom distress and fatigue were significant predictors of impairment in functional activities related to illness. Implications for practice and future research are discussed.

Patient satisfaction with an antepartum home-care program

Evaluation of patient satisfaction with alternative health-care delivery models is an important component of program evaluation. Patient satisfaction occurs when there is congruence between expected care and the care received. This descriptive study investigated patient satisfaction with the Antepartum Home Care Program in Winnipeg, Canada. A convenience sample of 66 pregnant women completed the Antepartum Home Care Program Evaluation Questionnaire. Most respondents were very satisfied with the physical and emotional care they received at home, including the information they received. Ninety-eight percent of the women indicated that the care they received from the program met their expectations. Being able to receive care at home, rather than in the hospital, was the most frequently identified benefit of the Antepartum Home Care Program. These results will assist program planners with decisions concerning program improvements and growth.

2D and 3D high resolution gradient echo functional imaging of the brain: venous contributions to signal in motor cortex studies

Recent emphasis on high resolution gradient echo studies in functional imaging has led to the conclusion that there are likely three domains of response to the blood circulation in the brain when considering field inhomogeneity effects of the venous blood pre- and during activation. The first is a coherent effect due to large or macroscopic vessels on the order of the size of the voxel (ca 200-500 microns in most studies). These can lead to very large signal changes (up to 100%). The second is at the venule level (ca 50-200 microns) and is associated with smaller parenchymal changes (usually ca 10% or less). The third is at the capillary level and is associated with much smaller signal changes at 1.5 T and even up to 4 T. The actual signal changes depend on field strength and sequence design. In this paper, we present our experience in detecting the first two domains with 2D and 3D gradient echo imaging at 1.5 T. We find that high resolution enables visualization of the larger small veins in motor cortex studies and that, on occasion, it is possible to see the venule effects as well. We suggest a simple model to explain the large signal changes based on susceptibility changes and partial volume effects. Comparisons of the functional imaging data to this model and to MR angiographic studies are also shown as evidence of the venous sources of the susceptibility changes.

Use of community health workers with inner-city children who have asthma

Use of community health workers (CHWs) to obtain health, social, and environmental information from African-American inner-city children with asthma was one component of a larger intervention study designed to reduce morbidity in African-American children with asthma. A subset of 140 school-aged children with asthma was recruited and enrolled in a program to receive home visits by CHWs for the purposes of obtaining medical information and teaching basic asthma education to the families. Data obtained by the CHWs revealed low inhaled steroid use, high beta 2 agonist use, frequent emergency-room visits, decreased primary-care visits, and increased allergen and irritant exposure. Appropriately recruited and trained CHWs are effective in obtaining useful medical information from inner-city families with children with asthma and providing basic asthma education in the home.

Triple-drug immunosuppression for heart transplantation in infants and children

Triple-drug immunosuppression with OKT3 induction is effective rejection prophylaxis in pediatric cardiac allograft recipients. The concerns regarding prevalent lymphoproliferative disease, growth retardation, cytomegalovirus, and other opportunistic infections have not been realized. Since June 1986, 34 pediatric patients, 23 males and 11 females, (age 4 days to 15 years) have undergone orthotopic heart transplantation at our institution. Fifteen patients were less than 6 months old and 13 had type I or II hypoplastic left heart syndrome. There have been four (12%) operative and four (12%) late deaths and a survival rate of 76% after a mean follow-up of 33 months (range, 1 to 82 months). The only deaths attributed to allograft rejection occurred in two newborn recipients (2 and 10 months after surgery) who neither received maintenance steroids nor underwent routine biopsy. The only death from infection (pneumococcus) occurred 6 months after surgery in a 4-year-old patient who was not known to be asplenic. Of the 27 long-term (> 1 year) survivors, 17 (68%) had an average of two rejection episodes during the follow-up period, 10 patients (32%) have been free of graft rejection, and 26 patients (96%) have not experienced a cytomegalovirus infection despite OKT3 induction therapy. Two patients developed lymphoproliferative disease, one of whom was successfully treated by transient reduction of immunosuppression. The other patient died 13 months after transplantation of a lymphoma of the central nervous system. All survivors have demonstrated satisfactory increases in mean height and weight.(ABSTRACT TRUNCATED AT 250 WORDS)

Community-based home-care program for the management of pre-eclampsia: an alternative

OBJECTIVE

To evaluate the safety, acceptability and cost of a community-based home-care program for the management of mild pre-eclampsia.

DESIGN

A descriptive study of outcomes between Apr. 1, 1985, and Dec. 31, 1989.

SETTING

St. Boniface General Hospital, Winnipeg.

PATIENTS

Urban Winnipeg residents between 27 and 40 weeks' gestation with mild pre-eclampsia who demonstrated acceptance and compliance with home-care management; 321 patients of 1330 were enrolled in the program.

INTERVENTIONS

Bed rest at home with daily biochemical and biophysical follow-up protocol and weekly clinic visits; patient education; hospital admission for labour, induction, worsening pre-eclampsia or noncompliance with rest at home.

OUTCOME MEASURES

Patterns of referral to the program; clinical, biochemical and biophysical profiles; incidence of severe complications; reduction in total hospital stay and cost analysis.

RESULTS

As many women were referred from physicians' offices as were referred from the hospital's antepartum unit, the average gestational age at referral being 36 weeks. Most (205 [64%]) of the women were nulliparous. The average length of stay in the program was 11.5 days. The program's availability resulted in a reduction of 2 days (from 5.7 days to 3.7 days) on average in the length of hospital stay when analysed for all 1330 women with pre-eclampsia. Of the 321 patients in the program 137 (43%) were admitted to hospital for worsening pre-eclampsia; severe pre-eclampsia developed 4 days after admission in 9. No patient suffered eclampsia, disseminated intravascular coagulopathy, abruption or fetal loss related to pre-eclampsia while in the program. The estimated cost saving in the management of pre-eclampsia was over $700,000 over the study period.

CONCLUSION

The community-based home-care program is a safe, feasible and less costly alternative to hospital admission in the management of mild pre-eclampsia.

[Progressive multifocal leukoencephalopathy in a patient with acquired immunodeficiency syndrome]

We report a 28 year old heterosexual male with AIDS that presented with progressive motor disturbances and malaise. Light and transmission electron microscopy of a stereotaxic brain biopsy demonstrated a progressive multifocal leukoencephalopathy. This is a demyelinating infectious cerebral disease attributed to JC virus and must be considered in the differential diagnosis of central nervous system disturbances in AIDS patients.

Aggressive behaviors among the institutionalized elderly

OBJECTIVE

To describe the incidence and characteristics of aggressive behaviors in a group of institutionalized elderly.

DESIGN

Retrospective survey.

SETTING

350-bed, urban skilled nursing facility.

PATIENTS

All nursing home residents who had an incident report completed after an aggressive behavior.

MEASUREMENTS

Examination of all incident reports of aggressive behavior for 1 year.

RESULTS

There were 94 reports of aggressive behaviors. Twenty-nine residents exhibited one aggressive behavior, 12 residents two, and six residents exhibited three or more aggressive behaviors. These six residents accounted for 44% of all events. The incidence of aggressive behavior was 0.27 per resident per year for the entire facility; on the Alzheimer's unit the incidence was 0.75 per resident per year. Sixty-two percent of the victims of aggressive behavior were other nursing home residents, 37% were employees, and 1% were visitors. The charts of the six residents with three or more aggressive behaviors were reviewed. These residents received trials of multiple scheduled psychotropic medications, often exhibited several additional agitated behaviors around the time of the attack, were at risk for psychiatric hospitalizations during the study period, and often were noted to have underlying acute medical illnesses near the time of the attack.

CONCLUSION

Approximately two aggressive behaviors per week occurred in a large nursing home. Residents and staff of Alzheimer's units have a higher risk of being victims of aggressive behavior. A small number of patients account for nearly half of the behaviors, even on the Alzheimer's unit. Aggressive behaviors may be clinical indicators of underlying acute medical illnesses.

The BULIT-R: its reliability and clinical validity as a screening tool for DSM-III-R bulimia nervosa in a female tertiary education population

The Bulimia Test (BULIT) has been updated to accommodate the DSM-III-R criteria for bulimia nervosa. Therefore, in this study, we evaluated the psychometric properties of the BULIT-R using a sample of young women at a tertiary educational institute. The results showed all 28 BULIT-R items correlated highly with the total test score (average = .59) and the internal reliability was high (.92). In terms of its concurrent validity, the BULIT-R correlated highly (.90) with the Bulimia Investigatory Test Edinburgh (BITE), a screening measure argued to detect bulimia nervosa. In terms of criterion-related validity, the optimal cutoff for the BULIT-R as a screening measure was 98 with this sample, using a semistructured DIS-III R interview administered by experienced clinicians who specialize in eating disorders. At this cutoff, the sensitivity was 100%, the specificity 99.0%, the negative predictive value 100%, and the positive predictive value 71.3%.

Phenotypic and functional analysis of expanded natural killer cell subpopulations in Hodgkin's disease patients treated with lymphoid irradiation

We have evaluated the immunophenotype and function of presumptive NK cells taken from Hodgkin's disease patients before and after mantle/para-aortic lymphoid irradiation. We find that the lymphoid irradiation appears to induce a relatively stable, generalized expansion of the entire NK cell compartment rather than an increase in any specific NK cell subset. Flow cytometric cell sorting and functional NK cell assays based on immunophenotype demonstrate no significant changes in the phenotypic proportions of individual NK cell subsets and no significant changes in the lytic activity or cytotoxicity spectrum of these NK cells. These changes in the NK cell compartment may play a role in the long-term immunosuppression of these patients.

A double-blind trial of melatonin as a treatment for jet lag in international cabin crew

This study investigated the efficacy of oral melatonin in alleviating jet lag in flight crew after a series of international flights. The optimal time for taking melatonin in this group was also investigated. In a double-blind placebo-controlled trial, 52 international cabin crew were randomly assigned to three groups; early melatonin (5 mg started 3 days prior to arrival until 5 days after return home); late melatonin (placebo for 3 days then 5 mg melatonin for 5 days); and placebo. Daily ratings showed a trend in jet lag, mood, and sleepiness measures toward an improved recovery in the late melatonin group and a worse recovery in the early melatonin group as compared to placebo. Retrospective ratings made 6 days after arrival showed the late melatonin group reported significantly less jet lag and sleep disturbance following the flight compared to placebo. The late melatonin group also showed a significantly faster recovery of energy and alertness than the early melatonin group, which reported a worse overall recovery than placebo. These findings show melatonin may have potential benefits for international aircrew.