Stress-point intervention for parents of repeatedly hospitalized children with chronic conditions

Little is known about how to assist children with chronic conditions and their families cope with repeated hospitalizations. A two-group, pretest-posttest study was done to determine whether a community-based, stress-point nursing intervention for parents could decrease distress and improve child and family functioning. Fifty participants were randomly assigned to intervention or usual care control groups. The intervention focused on specific, parent-verified child and family issues. Three months after hospitalization, intervention parents had better coping and family functioning than those in the usual care group. Intervention parents' anxiety was initially higher and then lower. There were no child behavior differences between the groups after hospitalization. Intervention children had no developmental regression at 2 weeks and better developmental gains 3 months after discharge than the usual care children. Stress-point intervention for families and their children with chronic conditions improved family coping and functioning, and eliminated hospitalization-induced developmental regression.

Neurochemical mechanisms in brain injury and treatment: a review

This article reviews cellular energy transformation processes and neurochemical events that take place at the time of brain injury and shortly thereafter emphasizing hypoxia-ischemia, cerebrovascular accident, and traumatic brain injury. New interpretations of established concepts, such as diffuse axonal injury, are discussed; specific events, such as free radical production, excess production of excitatory amino acids, and disruption of calcium homeostasis, are reviewed. Neurochemically-based interventions are also presented: calcium channel blockers, excitatory amino acid antagonists, free radical scavengers, and hypothermia treatment. Concluding remarks focus on the role of clinical neuropsychologists in validation of treatment interventions.

Cryptosporidiosis in children who visited an open farm

In the summer of 1995, cryptosporidiosis was diagnosed in a child in hospital. This child had taken part in a summer activity project involving 161 children and nine adults. Reports of a similar illness among a number of other participants prompted an outbreak investigation. A cohort study was conducted in two phases. Thirteen children (aged 6 to 15 years) out of 161 respondents to the first questionnaire met the case definition for illness and cryptosporidium was detected in stools from seven of the 13. Illness was significantly associated with child participants who had visited an open farm (p < .000005). Nine of the cases sought medical attention, and two were admitted to hospital. The second phase of the cohort study was conducted among 52 of the 55 people who had visited the open farm. Illness was significantly associated with playing in sand to which animals had access, at the edge of a stream beside a picnic area (p < .005). Contact with various animals was not associated with illness. This outbreak emphasises the risk for children of visiting open farms. Managers of open farms need to be aware of the potential for transmission of infectious diseases to visiting children. Strict implementation of hygiene measures is essential to minimise risk.

Patterns of kinship in groups of free-living sperm whales (Physeter macrocephalus) revealed by multiple molecular genetic analyses

Mature female sperm whales (Physeter macrocephalus) live in socially cohesive groups of 10-30, which include immature animals of both sexes, and within which there is communal care of the young. We examined kinship in such groups using analyses of microsatellite DNA, mitochondrial DNA sequence, and sex-linked markers on samples of sloughed skin collected noninvasively from animals in three groups off the coast of Ecuador. Social groups were defined through photographic identification of individuals. Each group contained about 26 members, mostly female (79%). Relatedness was greater within groups, as compared to between groups. Particular mitochondrial haplotypes were characteristic of groups, but all groups contained more than one haplotype. The data are generally consistent with each group being comprised of several matrillines from which males disperse at about the age of 6 years. There are indications of paternal relatedness among grouped individuals with different mitochondrial haplotypes, suggesting long-term associations between different matrilines.

Profuse bleeding in epiphrenic diverticula: an unusual finding

Profuse bleeding is an unusual and previously unreported finding in epiphrenic diverticula. The present case describes a man with a history of significant alcohol and tobacco abuse who presented to an emergency room expectorating blood and was then admitted. Further evaluation revealed a large bleeding ulcer crater in the distal esophagus. Findings consistent with candida esophagitis were noted on biopsy. Radiographic examination revealed two large, wide-mouthed diverticula. While hypertensive lower esophageal pressure was noted on manometric evaluation, surgery was not performed on the patient, and he subsequently curtailed his alcohol and tobacco intake. A follow-up examination at 90 days' postdischarge revealed no further bleeding episodes with continued decreased alcohol and tobacco intake.

Nucleotide sequence of the D-loop region of the sperm whale (Physeter macrocephalus) mitochondrial genome

We have amplified, by the polymerase chain reaction, and have sequenced the D-loop region of the mitochondrial DNA from the sperm whale (Physeter macrocephalus). The sperm whale D-loop was aligned with D-loop sequences from four other cetaceans (Commerson's dolphin, orca, fin whale, and minke whale) and an out-group (cow). This alignment showed the sperm whale sequence to be larger than that of other cetaceans. In addition, some sequence blocks were highly conserved among all six species, suggesting roles in the functioning of mitochondrial DNA. Other blocks that were previously reported to be well conserved among cetaceans showed little sequence conservation with the sperm whale D-loop, which argues against the functional importance of these sequence blocks in cetaceans.

Hazardous secrets and reluctantly taking charge: parenting a child with repeated hospitalizations

This study developed a grounded theory of the stresses and coping responses of parents to the repeated hospitalization of chronically ill and disabled children. The theoretical sampling spanned four years and included 30 mothers of children who have a chronic illness or disability and 30 mothers of healthy children; 100 parents of disabled children who attended a weekend retreat: six community health nurses; nine mothers of chronically ill and disabled children before, during and after a hospitalization. The resulting mid-range theory identifies the most stressful aspect as "hazardous secrets" which force the parent to "reluctantly take charge" of the situation. "Vigilance", "calling a halt", "exhaustion" and "taking a break" are key constructs in the process. "Trusting parent and professional relationships" emerged only when a professional assisted in revealing secrets.

Diagnostic problem in acute myocardial infarction: CK-MB in the absence of abnormally elevated total creatine kinase levels

Seven hundred twenty-four consecutive patients admitted to a coronary care unit for chest pain underwent comparative evaluation of ECG and lactic dehydrogenase (LDH) and creatine kinase (CK) enzyme and isoenzyme patterns. Of the 724 patients, 419 (58%) had the myocardial component (MB) of CK detected; however, 69 (16%) of the latter had no abnormal elevation of total CK levels. This group with CK-MB but persistently normal total CK levels demonstrated fewer diagnostic QRS changes on ECG (17% vs 54%) and a lower incidence of LDH 1:2 inversion (28% vs 79%) than did the group with CK-MB and abnormally elevated total CK levels. However, no specific level of either total CK or CK-MB could segregate the patients with QRS or LDH level changes, which suggests that persistently normal levels of CK do not exclude the diagnosis of myocardial infarction. Evidence that myocardial necrosis can occur in the absence of an abnormal elevation of total CK levels is confirmed histologically in one patient.