Integrating family work into the treatment of young people with severe and complex depression: a developmentally focused model

AIM

Although models of family intervention are clearly articulated in the child and early adolescent literature, there is less clarity regarding family intervention approaches in later adolescence and emerging adulthood.

METHODS

This study provides the rationale and intervention framework for a developmentally sensitive model of time-limited family work in the outpatient treatment of complex youth depression (15-25 years).

RESULTS

Derived from current practice in the Youth Mood Clinic (YMC) at Orygen Youth Health, Melbourne, a stepped model of family intervention is discussed. YMC aims to provide comprehensive orientation, assessment and education to all families. For some, a family-based intervention, delivered either by the treating team or through the integration of a specialist family worker, offers an important adjunct in supporting the recovery of the young person. Developmental phases and challenges experienced by the young person with respect to family/caregiver involvement are discussed in the context of two case studies.

CONCLUSIONS

A developmentally sensitive model is presented with particular attention to the developmental needs and preferences of young people. Formal evaluation of this model is required. Evaluation perspectives should include young people, caregivers, the broader family system (i.e. siblings) and the treating team (i.e. case manager, doctor and family worker) incorporating outcome measurement. Such work determines how best to apply a time-limited family-based intervention approach in strengthening family/caregiver relationships as part of the young person's recovery from severe and complex depression.

Placement Instability Among Young People Removed from Their Original Family and the Likely Mental Health Implications

Background

Young people in out-of-home care are more likely to experience poorer mental and physical health outcomes related to their peers. Stable care environments are essential for ameliorating impacts of disruptive early childhood experiences, including exposure to psychological trauma, abuse and neglect. At present there are very few high quality data regarding the placement stability history of young people in out-of-home care in Australia or other countries.

Objectives

To undertake the first systematic census of background, care type and placement stability characteristics of young people living in the out-of-home care sector in Australia.

Methods

Data was collected from four non-government child and adolescent community service organisations located across metropolitan Melbourne in 2014. The sample comprised 322 young people (females 52.8%), aged between 12 – 17 years (mean age=14.86 [SD=1.63] years).

Results

Most young people (64.3%) were in home-based care settings (i.e., foster care, therapeutic foster care, adolescent care program, kinship care, and lead tenant care), relative to residential care (35.7%). However, the proportion in residential care is very high in this age group when compared with all children in out-of-home care (5%). Mean age of first removal was 9 years (SD=4.54). No gender differences were observed for care type characteristics. Three quarters of the sample (76.9%) had a lifetime history of more than one placement in the out-of-home care system, with more than a third (36.5%) having experienced ≥5 lifetime placements. Relative to home-based care, young people in residential care experienced significantly greater placement instability (χ²=63.018, p<0.001).

Conclusions

Placement instability is common in the out-of-home care sector. Given stable care environments are required to ameliorate psychological trauma and health impacts associated with childhood maltreatment, well-designed intervention-based research is required to enable greater placement stability, including strengthening the therapeutic capacities of out-of-home carers of young people.

A controlled trial of implementing a complex mental health intervention for carers of vulnerable young people living in out-of-home care: the ripple project

BACKGROUND

Out-of-home care (OoHC) refers to young people removed from their families by the state because of abuse, neglect or other adversities. Many of the young people experience poor mental health and social function before, during and after leaving care. Rigorously evaluated interventions are urgently required. This publication describes the protocol for the Ripple project and notes early findings from a controlled trial demonstrating the feasibility of the work. The Ripple project is implementing and evaluating a complex mental health intervention that aims to strengthen the therapeutic capacities of carers and case managers of young people (12-17 years) in OoHC.

METHODS

The study is conducted in partnership with mental health, substance abuse and social services in Melbourne, with young people as participants. It has three parts: 1. Needs assessment and implementation of a complex mental health intervention; 2. A 3-year controlled trial of the mental health, social and economic outcomes; and 3. Nested process evaluation of the intervention.

RESULTS

Early findings characterising the young people, their carers and case managers and implementing the intervention are available. The trial Wave 1 includes interviews with 176 young people, 52% of those eligible in the study population, 104 carers and 79 case managers.

CONCLUSIONS

Implementing and researching an affordable service system intervention appears feasible and likely to be applicable in other places and countries. Success of the intervention will potentially contribute to reducing mental ill-health among these young people, including suicide attempts, self-harm and substance abuse, as well as reducing homelessness, social isolation and contact with the criminal justice system.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ACTRN12615000501549 . Retrospectively registered 19 May 2015.

Meeting the primary care needs of young people in residential care

BACKGROUND

Young people in out-of-home care, especially those with a history of multiple placements, typically have numerous and complex health needs, and worse health outcomes than their peers who grow up within a family of origin. A significant proportion of this can be attributed to policy failures and poor interagency communication.

OBJECTIVE

The objective of this article is to describe the factors that contribute to the health needs of young people in out-of-home care and the tools available to support general practitioners (GPs) to provide care.

DISCUSSION

GPs are crucial in the early detection of health problems and intervention for this vulnerable population. Marked social and relational problems make the high-priority task of creating a safe and trusting environment a challenge. GPs must also work within the statutory requirements of each state and territory, and navigate the complex out-of-home care system. Using recommended frameworks and maintaining effective communication and support will improve outcomes for these young people, their families and the community.

Decreases in Rotavirus Hospitalizations: Impact Data Pre- and 3 Years Post- First Publically Funded Programs

BACKGROUND: Since January 2012, almost all Canadian provinces have implemented publically funded rotavirus immunization programs. IMPACT had been doing routine active surveillance for rotavirus hospital-izations at pediatric hospitals in 7 provinces since 2005.

OBJECTIVES: Determine changes in hospitalization for rotavirus infection pre and post vacination programs.

DESIGN/METHODS: Active, surveillance of patients hospitalized for rotavirus infections was conducted by IMPACT from January 1 2010 to December 2015 at 12 paediatric hospitals. Rotavirus hospitalization data was compared for periods pre (2010-2011) and post (2012-2014) implementation of publically funded immunization programs. Six sites were located in jurisdictions that had publically funded programs as of January 2012.

RESULTS: Initiation of rotavirus vaccine programs have resulted in a 43% overall reduction in hospitalizations for rotavirus infection in pediat-ric hospitals in Canada with the greatest decreases seen in provinces with programs that were established as of January 2012 where there was a 66% reduction in hospitalizations. Overall, the average yearly number of hospi-talizations for 2012-2014 was 279, compared to 490 in 2010-2011. Six sites with publically funded programs since 2012 had a yearly average of 121.3 cases identified in 2012-2014 compared to an average of 360 cases in 2010-2011. The average yearly number of hospital acquired cases decreased from 78 to 24.7 in sites with vaccine programs whereas sites without increased (26.5 to 33.7 average cases yearly). The proportion of cases occurring in children &lt;2 years was significantly lower in sites with programs (51.6% vs. 72.5%; p&lt;0.0001). In 2012-2014, 63.4% of children were &lt;2 years compared to the period 2010-2011 where 67.7% were &lt;2 years. The seasonal peak in infections has decreased over time, especially in the age groups 6-11 months and 12 to 24 months.

CONCLUSION: Publically funded rotavirus vaccine programs have resulted in important reductions in hospitalizations due to community acquired and hospital acquired rotavirus infections in pediatric hospitals in Canada with the greatest decreases seen in provinces with programs that were established as of January 2012. The proportion of children &lt; 2 years hospitalized with rotavirus infection is decreasing at sites with established programs. Given the &gt;85% efficacy of rotavirus vaccine, increasing uptake and delivery throughout Canada could potentially decrease admissions further.

Invasive Pneumococcal Disease in Canadian Children, 2000-2014: The Canadian Immunization Monitoring Program, Active

BACKGROUND: Before implementation of the first conjugate IPD vaccine program in 2002, invasive pneumococcal disease (IPD) accounted for most severe, invasive bacterial infections in Canadian children. Conjugate vaccine programs in children were implemented with the expectation that the burden of disease from IPD would improve.

OBJECTIVES: To describe the changes in Canadian epidemiology of pediatric IPD before and after the implementation of conjugate pneumo-coccal vaccine programs.

DESIGN/METHODS: The Canadian Immunization Monitoring Program, Active (IMPACT) captures all in- and out-patient lab-confirmed IPD cases presenting at its 12 tertiary care pediatric hospitals across Canada. Nurses abstract case details from the hospital chart onto a standardized report form. Case isolates are serotyped at a central reference laboratory. All participating centers have local ethics and/or administrative approvals.

RESULTS: From 2000-2014 IMPACT centers identified 3,328 IPD cases. Annual case numbers decreased by 48% (323 to 168) over this time period. Annually, vaccine preventable serotypes accounted for on average 89% (n=288) of cases in the pre-conjugate vaccine era (2000-2003) and 34% (n=56) in the post-13-valent conjugate vaccine era (2011-2014), with 73% (n=41/56) due to serotypes 19A, 3 and 6a. The age distribution of cases shifted upward over the time period with 16% (n=204) of cases occurring in children 5 years of age and older in the pre-vaccine era compared to 32% (n=217) in the post 13-valent vaccine era. This shift was due to decreases in cases occurring in children 0-4 years of age, rather than a significant increase in the number of cases occurring in older children. The most frequent presentation of IPD was radiologic-confirmed pneumonia (n=1119), with complicated pneumonia (pneumonia with empyema or pleural effusion) accounting for 36% (405/1119) of cases, followed by bacteremia only (n=919) and meningitis (n=532). The proportion of cases presenting with complicated pneumonia increased significantly (from 6% -24%; p&lt;0.0001) between the pre-conjugate and post 13-valent conjugate eras. The proportion of cases presenting with meningitis did not change over the time periods (15% pre-conjugate era vs. 16% post-13-valent conjugate era; p=0.46). However, the proportion of meningitis caused by vaccine preventable serotypes decreased significantly (from 85%-26%; p&lt;0.0001).

CONCLUSION: The epidemiology of pediatric IPD has changed with the introduction of conjugate vaccine programs. IPD has been reduced by almost 50% in the post-13-valent conjugate vaccine era and vaccine sero-types account for just one-third of cases. However, complicated pneumonia is seen more frequently in the post-13-valent conjugate vaccine era.

Interim estimates of 2013/14 influenza clinical severity and vaccine effectiveness in the prevention of laboratory-confirmed influenza-related hospitalisation, Canada, February 2014

Binary file ES_Abstracts_Final_ECDC.txt matches

Seroprevalence of HSV-1 and HSV-2 antibodies in Canadian women screened for enrolment in a herpes simplex virus vaccine trial

Herpes simplex virus 1 and 2 (HSV-1 and HSV-2) infections continue to be among the most common and unrecognized sexually transmitted infections in the world. Although treatable, HSV-1 and HSV-2 infections remain incurable. Hence, there is interest in the development of a vaccine to prevent genital herpes. As part of a multicentre, randomized, placebo-controlled trial to test such a vaccine, healthy women 18-30 years were enrolled as volunteers in several Canadian centres between 2005 and 2007. This study reports the seroprevalence of HSV-1 and HSV-2 antibodies in this group. A total of 2694 adult female volunteers in Canada with no known history of herpes simplex were screened for HSV antibodies using Western blot assay (the gold standard for diagnosis of HSV) for potential participation in a randomized, double-blind efficacy field trial of a herpes simplex vaccine. This trial provides a unique opportunity to examine the prevalence of antibodies to HSV-1 and of antibodies to HSV-2 in women with no known history of herpes simplex infection. The prevalence of antibodies to HSV-1 and to HSV-2 is compared with that found in previous Canadian studies that focused on a more general population. The overall seroprevalence of antibody to HSV-1 was 43%; that of HSV-2 was 2.5% and seropositivity to both was 2%. The prevalence of antibody to both HSV-1 and to HSV-2 increased with age. Seronegativity to both HSV-1 and HSV-2 was 56% in participating centres with populations under 250,000 and 46% in participating centres with populations over 250,000. Significant racial differences in seropositivity to HSV-1 and to HSV-2 were noted. The likelihood of participants being seropositive to HSV-1 and to HSV-2 was found to increase with age and to positively correlate with the population of the city in which they resided. Hypotheses are proposed to account for differences in racial seropositivity to HSV-1 and to HSV-2.

Pertussis of adults and infants

Bordetella pertussis continues to circulate even in populations where a high vaccine coverage of infants and children is achieved. Cases in adolescents and adults are reported with increasing frequency in many countries. Adults are a reservoir for infections in very young infants, in whom pertussis may be severe and life-threatening. The salient clinical feature of pertussis in adolescents and adults is prolonged coughing, and recognising that pertussis does occur in these age groups is the most important step in its diagnosis. A laboratory diagnosis can be made by bordetella-PCR from nasopharyngeal swabs or secretions and by detection of antibodies, mainly to pertussis toxin; laboratory diagnosis is, however, not well standardised. Vaccination of adolescents and adults is now possible with acellular pertussis vaccines, which are well tolerated, immunogenic, and effective. Adolescent boosters and the vaccination of health-care workers are already included in vaccination calendars in some countries. Vaccine-recommending bodies and national health-care organisations must have locally relevant information on the transmission of pertussis from adults to infants to be able to make decisions on the advisability, feasibility, and priority for booster immunisation against pertussis.

Recommendations are needed for adolescent and adult pertussis immunisation: rationale and strategies for consideration

Pertussis vaccination of infants has dramatically reduced disease, complications and deaths in infancy and early childhood. But there is still a major public health challenge--to deal with the morbidity and economic burden of illness in older children, adolescents and adults. Furthermore, it is these groups that form a major source of infection for non-immunised and partially immunised infants who are at high risk of severe complications. Adult-type acellular pertussis vaccine confers safe and effective protection against pertussis. There are several strategies to consider for immunising older individuals. Universal vaccination of all age groups would be the best available strategy for protecting individuals. It would also reduce the potential for transmitting the disease to other susceptibles, particularly infants. However, such a policy may be difficult both logistically and economically at this time. More easily achievable as a first step would be a strategy of universal adolescent booster vaccination combined with a programme targeted at adults most likely to have contact with very young babies including healthcare and childcare workers, parents and close family contacts. There is also potential for offering vaccination to adults (and their carers and close contacts) whose medical conditions or advanced age may place them at increased risk of more severe pertussis disease. Specific details of immunisation programmes must be made on a country by country basis depending on local circumstances.

The Immunization Monitoring Program Active (IMPACT) prospective five year study of Canadian children hospitalized for chickenpox or an associated complication

BACKGROUND

Varicella vaccine was approved for use in Canada in 1998. A major goal of universal varicella vaccine programs is to reduce severe infection and associated complications. Baseline data are essential against which to judge the effectiveness of routine childhood immunization.

OBJECTIVE

To describe morbidity and mortality among children hospitalized for chickenpox. Methods. From January 1, 1991, to March 31, 1996, chickenpox admissions to 11 pediatric referral centers were actively identified. Patient and illness characteristics were compared for 3 subgroups defined by prior health: healthy; unhealthy but immunocompetent; immunocompromised.

RESULTS

Of 861 cases 488 (56.7%) were healthy, 75(8.7%) were unhealthy and 298 (34.6%) were immunocompromised. The immunocompromised children differed from healthy/unhealthy cases in mean age (6.4 vs. 4.0/4.6 years, respectively, P < 0.0001); median interval from rash onset to admission (2 vs. 5/5 days, P < 0.0001); complication rate (20% vs. 90%/79%; P = 0.001); and rate of acyclovir therapy (98% vs. 24%/39%; P = 0.001). Unhealthy vs. healthy cases had a higher frequency (P < 0.01) of intensive care (13.3% vs. 4.7%), ventilation (9.3% vs. 2.0%) and death (4% vs. 0.2%).

CONCLUSION

These data provide a baseline for morbidity/mortality resulting from chickenpox before varicella vaccine use in Canada.

A cognitive-behavioural, group-based intervention for social anxiety in schizophrenia

OBJECTIVE

The objective of this study was to investigate the efficacy of group-based cognitive-behavioural therapy (CBT) for social anxiety in schizophrenia.

METHOD

Patients with schizophrenia (20) with comorbid social anxiety were randomly assigned to the group-based CBT or wait-list control condition. Pre-, post- and 6-week follow-up ratings included measures of social anxiety and avoidance, mood and quality of life.

RESULTS

The intervention group improved on all outcome measures and the control group showed no change in symptomatology.

CONCLUSIONS

Group-based CBT is effective in treating social anxiety in schizophrenia.

Invasive pneumococcal infections in Canadian children, 1991-1998: implications for new vaccination strategies. Canadian Paediatric Society/Laboratory Centre for Disease Control Immunization Monitoring Program, Active (IMPACT)

We reviewed 2040 consecutive cases of invasive pneumococcal infection that were seen at 11 pediatric centers across Canada during 1991-1998 to determine if such infections could be prevented by new conjugate vaccines. Isolates from 1528 cases were serotyped. Most cases (61.5%) occurred in patients aged >2 years. Underlying medical conditions were present in 23.2% of case patients. Serotypes in the 7-valent conjugate vaccine matched isolates as follows: 85.8% of tested isolates from children aged 6 months to 5 years, but significantly fewer isolates in younger and older children; 72.9% of isolates from non-healthy children, but 83.9% of isolates from previously healthy children; and 95.4% of isolates with high-level penicillin resistance, but only 72.7% of those with intermediate-level resistance. Significant natural variation in the proportion of isolates matching 7-valent vaccines occurred from year to year and among centers. New conjugate vaccines have great potential but their effectiveness and limitations require ongoing study.

Cost of chickenpox in Canada: part I. Cost of uncomplicated cases

OBJECTIVE

The purpose of this study was to assess the direct medical costs and productivity losses associated with uncomplicated chickenpox (no hospitalization) in Canada.

METHODS

A total of 179 otherwise healthy 1- to 9-year-old children with active chickenpox were recruited from schools, day care centers, and physician offices in 5 provinces. Direct medical (physician contacts, medication, and diagnostic tests) and nonmedical (personal expenses including child care) resources expended during the illness were determined by caregiver interview. Productivity losses attributable to the disease were determined by assessing caregiver time lost from work and daily activities. Unit costs for all resources were obtained from sources in 2 provinces, and per-patient treatment costs were determined from the patient, Ministry of Health, and societal perspectives.

RESULTS

From a societal perspective, the per-case cost for children from 1 to 4 years of age and from 5 to 9 years of age was $370.2 and $236.5, respectively. Direct medical costs accounted for 10% of the total costs in both groups. The largest cost driver in patient care was caregiver productivity losses, which amounted to $316.5 in the younger age group and to $182.7 in the older age group. Based on an estimated yearly incidence of 344 656 cases of uncomplicated chickenpox in Canada, the total annual societal burden of the disease can be estimated at $109.2 million, with a cost to the Ministry of Health of $11.2 million.

CONCLUSION

Chickenpox is one of the last common childhood diseases prevalent in Canada, and the uncomplicated disease, despite its rather benign course, imparts a large annual economic burden.

Treatment of severe pertussis: a study of the safety and pharmacology of intravenous pertussis immunoglobulin

BACKGROUND

Pertussis in infants is often severe, resulting in complications and prolonged hospitalization. Treatment is limited to supportive care. Antibiotics do not significantly alter the course of the disease. Therapies directed at pertussis toxin, a major virulence factor of Bordetella pertussis, might be beneficial. This study examines the safety and pharmacology of intravenous pertussis immunoglobulin (P-IGIV), which has high levels of pertussis toxin antibodies.

METHODS

P-IGIV was prepared as a 4% IgG solution from the pooled plasma from donors immunized with inactivated pertussis toxoid. The IgG pertussis toxin antibody concentration of 733 microg/ml is >7-fold higher than contained in conventional intravenous immunoglobulin products. Children with presumptive pertussis were allocated to one of three treatment doses of P-IGIV.

RESULTS

Twenty-six of 30 enrolled children had confirmed pertussis. There were no adverse events associated with P-IGIV except one patient who had transient hypotension that responded to an infusion rate decrease. P-IGIV doses of 1500, 750 and 250 mg/kg achieved > or =4-fold, 3-fold and >2-fold rises in peak geometric mean titers of pertussis toxin IgG antibodies, respectively. P-IGIV exhibited a half-life of 38.4 days and a volume of distribution of 87.8 ml/kg. All three treatment groups showed declines in lymphocytosis (P < 0.05) and paroxysmal coughing by the third day after P-IGIV infusion compared with preinfusion values.

CONCLUSION

P-IGIV is safe and achieves high pertussis toxin antibody titers in infants. This study provides data for a prospective, controlled trial of P-IGIV.

Failure of physicians to consider the diagnosis of pertussis in children

To determine the ability of physicians to make a diagnosis of pertussis and factors associated with improved diagnosis, 8,235 children from 88 child care centers and 14 elementary schools from Quebec City, Quebec, Canada, were evaluated by using a questionnaire completed by parents and a medical record review. Children must have consulted a physician to be included in the evaluation. There were 558 children meeting the surveillance case definition and 416 meeting a modified World Health Organization case definition who consulted a physician. A diagnosis of pertussis was considered in 24%-26% of children meeting either case definition, made in 12%-14%, and reported for 6%. Pertussis diagnosis was significantly associated with having a history of pertussis exposure (P < or = .003), four pertussis-related symptoms (P < .001), and a cough for > or = 5 weeks (P < or = .05) and consulting in a hospital setting (P < or = .03). The proportion of cases of pertussis diagnosed and reported is low even when children present with classical symptoms.

Effectiveness of a whole cell pertussis vaccine in child-care centers and schools

BACKGROUND

Pertussis has substantially increased in Quebec, Canada, since 1990. We estimated pertussis vaccine effectiveness and vaccine coverage in child-care centers and elementary schools.

METHODS

Two retrospective cohort studies were simultaneously conducted. One included 4482 children attending 88 public child-care centers and the other included 3429 pupils in 14 elementary schools. Cough and pertussis symptoms were assessed through a questionnaire and medical records; immunization status was ascertained by examination of written records.

RESULTS

In child-care centers 95% of children had received at least three vaccine doses at the beginning of the follow-up; in schools more than 98% of pupils had received at least 4 doses. With > or = 4 doses of vaccine and a standard case definition used for surveillance (cough > or = 2 weeks, > or = 1 pertussis symptom and no other apparent cause for cough), vaccine effectiveness was estimated at 61% (95% confidence interval, 44 to 72%) in child-care centers and at 60% (95% confidence interval, 10 to 82%) in schools. With the same number of doses but a case definition requiring a cough > or = 5 weeks, vaccine effectiveness increased to 71% (95% confidence interval, 49 to 83) in child-care centers and to 86% (95% confidence interval, 66 to 94%) in schools.

CONCLUSIONS

The increase in pertussis in Quebec is not caused by a low vaccine coverage. A low vaccine effectiveness may contribute to the resurgence of pertussis in the past decade.

Clinical course of pertussis in immunized children

To describe the clinical course of Bordetella pertussis infection in a highly immunized childhood population, we studied prospectively endemic and epidemic pertussis in a metropolitan population with an immunization rate > 90% during an 8-year period from 1987 through 1994. Patients with a possible diagnosis of pertussis were referred by family or emergency room physicians for nasopharyngeal culture. Patients with a culture positive for B. pertussis were contacted by a nurse who completed a detailed questionnaire for the index case and all family members. Repeat home visits were made each week for 4 weeks. Of the 189 patients with pertussis who were evaluated 103 subjects were < 5 years of age. Congestion predated the onset of cough by up to 1 week in 35 (34%) cases. Seventy (68%) subjects < 5 years of age developed a paroxysmal cough within the first week of their illness. Ninety-one (88%) cases < 5 years old had a persistent paroxysmal cough for > 21 days. Coughing in this group lasted from 16 to 91 days (median 48). Erythromycin therapy appeared to shorten the duration of cough; however, patients were not randomized to receive erythromycin at a specific time. Despite adequate immunization some children develop pertussis. The clinical course in these patients is milder than in unimmunized subjects. Nevertheless the symptomatology in these children should still be readily identified by most physicians using classical clinical criteria of pertussis.

Stress and unaided smoking cessation: a prospective investigation

A prospective design was used to determine the outcomes associated with unaided smoking cessation and the influence of stress on cessation. Heavy smokers (N = 308) completed stress-related measures and were then recontacted at 1, 6, and 12 months. At each follow-up, they indicated their smoking status (which was confirmed by collateral report and biochemical tests) and completed several stress-related questionnaires. Results indicated that 33% of subjects smoked continuously throughout the year, 39% quit briefly but subsequently relapsed, and 15% quit (confirmed biochemically). An additional 7% reported that they had quit, but this could not be confirmed, and 6% were lost to follow-up. Compared with nonquiters, quitters reported less perceived stress, greater self-efficacy, greater use of problem solving and cognitive restructuring, and less reliance on wishful thinking, self-criticism, and social withdrawal. A model to forecast quitting was built and cross-validated.

Stress and unaided smoking cessation: a prospective investigation

A prospective design was used to determine the outcomes associated with unaided smoking cessation and the influence of stress on cessation. Heavy smokers (N = 308) completed stress-related measures and were then recontacted at 1, 6, and 12 months. At each follow-up, they indicated their smoking status (which was confirmed by collateral report and biochemical tests) and completed several stress-related questionnaires. Results indicated that 33% of subjects smoked continuously throughout the year, 39% quit briefly but subsequently relapsed, and 15% quit (confirmed biochemically). An additional 7% reported that they had quit, but this could not be confirmed, and 6% were lost to follow-up. Compared with nonquiters, quitters reported less perceived stress, greater self-efficacy, greater use of problem solving and cognitive restructuring, and less reliance on wishful thinking, self-criticism, and social withdrawal. A model to forecast quitting was built and cross-validated.

Deficient priming activity of newborn cord blood-derived polymorphonuclear neutrophilic granulocytes with lipopolysaccharide and tumor necrosis factor-alpha triggered with formyl-methionyl-leucyl-phenylalanine

Newborn infants are more susceptible to bacterial infections than adults. This susceptibility has been attributed to defects in humoral and cellular activity. Host cellular activity can be modified by factors produced by bacteria or the host in response to infection. We assessed the effect of two factors associated with gram-negative bacterial infection, lipopolysaccharide (LPS) and TNF-alpha, on polymorphonuclear neutrophilic granulocytes (PMN) obtained from adult or newborns (umbilical cord blood). PMN were primed in vitro with LPS (10 micrograms/L) or TNF-alpha (10(-9) M) for 45 min and then assessed, using a chemiluminescence (CL) assay as an indicator of oxidative radical production with formyl-methionyl-leucyl-phenylalanine as the trigger for CL initiation. CL activity of unprimed PMN was similar for adults and newborns (13.3 and 13.7 CL units, respectively). After priming with LPS, CL activity was increased to 43.4 CL units for PMN from adults but to only 17.6 CL units for PMN from newborns (p < 0.001, adults versus newborn increment). Priming of PMN with LPS was most effective when autologous plasma was present. Using FITC-conjugated LPS and a flow cytometry assay, we could demonstrate no difference between the binding affinity of LPS for adult and newborn PMN. However, formyl-methionyl-leucyl-phenylalanine binding studies indicated that adult PMN had a higher number of binding sites. TNF-alpha priming of newborn PMN was also ineffective. Adult PMN increased CL activity by 3.9-fold when primed with TNF-alpha, whereas newborn PMN increased by only 1.75-fold (p < 0.005). This priming deficiency was not attributable to TNF-alpha receptors because phycoerythrin-conjugated TNF-alpha was associated with PMN from adults and newborns equally. Thus, PMN from newborns are not primed effectively in vitro with LPS or TNF-alpha. This defect may contribute to neonatal susceptibility to bacterial infection.

Prolonged survival of Bordetella pertussis in a simple buffer after nasopharyngeal secretion aspiration

A simple method for recovery of Bordetella pertussis is described using phosphate-buffered saline containing a casein hydrolysate for transporting secretions collected by nasopharyngeal aspirate. Bordetella pertussis was reisolated from 92% of clinical specimens held at 4 degrees C for 1 week and from all specimens held at -20 degrees C. This method will facilitate the centralization of laboratory facilities for the diagnosis of pertussis.

Spurious correlations--causes and cures

Although the Pearson Product--Moment Correlation Coefficient is one of the most widely used statistics in the health and behavioral sciences, it is not always appreciated that the critical assumption of bivariate normality underlies its interpretation. When variables have marginal distributions which are skewed or have heavy tails which produce outliers, correlations may be either spuriously large or small. Having diagnosed problems through exploratory data analysis, one must take the appropriate corrective action, such as re-expressing (transforming) variables or selectively discarding discordant observations.