Use of APTIMA Combo 2: the experience of a child advocacy center.

The Centers for Disease Control and Prevention recommends nucleic acid amplification testing for chlamydia and gonorrhea in sexually abused girls. No studies describe performance of APTIMA Combo 2 Assay with second target confirmation on the same testing platform. This nucleic acid amplification testing is evaluated within a large child advocacy center. Girls 3 to 18 years, 35% of whom reported consensual sexual activity, were prospectively tested by APTIMA Combo 2 on urine/vaginal swabs and by vaginal culture. A case of infection was defined as positive culture or positive urine or vaginal swab nucleic acid amplification testing with second target confirmation. Sensitivity of APTIMA Combo 2 on urine was found to be superior to vaginal culture and comparable to APTIMA Combo 2 on vaginal swabs for both infections. APTIMA Combo 2 on urine is less invasive, and its use may be preferred in this traumatized population.

Observational pain assessment versus self-report in paediatric triage.

OBJECTIVE: To examine if observational pain assessment can be used for purposes of triage in children aged >3 years. METHODS: A prospective, single blind, controlled trial was undertaken in children who presented to the emergency department (ED) with pain. Pain was assessed in the waiting room and again at triage before any treatment was administered using the Alder Hey Triage Pain Score (AHTPS), an observational tool designed for triage, and a self-report tool, either the Wong-Baker Faces Pain Rating Scale (WBS) for 3-7-year-old children or a visual analogue scale (VAS) for 8-15-year-old children. Scores were compared by instrument (observational and self-report) and ED location (waiting room and triage room). RESULTS: 75 children (29 aged 3-7 years and 46 aged 8-15 years) were enrolled in the study. The AHTPS scores were significantly lower than the scores measured by the WBS/VAS (p<0.001). The level of pain measured by both methods (self-report, observational) was lower in the triage room. Compared with the AHTPS, the WBS and VAS scored significantly lower in the triage room than in the waiting room (p<0.042 and p<0.006, respectively). CONCLUSIONS: Observational pain assessment underestimates children's perception of pain and should not be recommended in children aged >3 years. Triage has a calming effect on children.

Precepting genital exams: challenges in implementing a complex educational intervention in the continuity clinic.

BACKGROUND: The female genital exam is often omitted from the routine physical. This limits familiarity with normal findings and represents a missed opportunity to evaluate girls for urogenital abnormalities. Continuity clinic offers an opportunity to develop and test a teaching intervention to address this problem. OBJECTIVE: To describe the effect of precepted genital exams on resident confidence and comfort with the exam as well as knowledge and documentation of genital anatomy. METHODS: A controlled trial was conducted in 10 continuity clinics at Children's Hospital, Columbus, Ohio. Residents in 5 clinics reviewed genital anatomy, exam positions, and documentation examples. They were asked to complete 6 precepted exams of girls aged 1-6 years during well-child care over a 6-month period. Residents were given pre- and posttests assessing knowledge of, confidence, and comfort with the genital exam. Pre- and poststudy genital exam documentation was reviewed. RESULTS: Ninety-seven percent of the intervention group, compared to 73% of the control group, answered 4 or 5 on a 5-point scale of confidence with regard to recognizing a normal exam (5 = highest) following the intervention (P = .01). Ninety-four percent of the intervention group and 64% of the control group answered 4 or 5 with regard to how comfortable they were performing genital exams (P = .01). Knowledge scores and documentation of genital anatomy did not differ between groups. Thirty-two percent of residents had the full intervention. CONCLUSIONS: Resident confidence and comfort increase with precepting. Precepting did not improve knowledge or documentation of genital anatomy. We advocate use of this preliminary data to design and test future educational interventions.

[Effects of bacterial extract IRS-19 on the concentration of hydrogen peroxide and myeloperoxidase activity in nasal washings of patients with chronic bronchitis]. / Deistvie bakterial'nogo ékstrakta IRS-19 na kontsentratsiiu perekisi vodoroda i aktivnost' mieloperoksidazy v smyvakh iz polosti nosa u bol'nykh khronicheskim bronkhitom.

AIM: To determine the effect of intranasal treatment with IRS-19, an immunomodulating agent, on the number of polymorphonuclear leukocytes (PMNL), H2O2 concentration and myeloperoxidase (MPO) activity in nasal washings. MATERIAL AND METHODS: 28 adult patients of both sexes with chronic bronchitis participated in an open study of intranasal treatment with IRS-19. RESULTS: The number of PMNL recovered from nasal spaces increased from 4460 +/- 3960 to 10,490 +/- 10,950 cells/ml (p < 0.02) after two month administration of IRS-19. It was accompanied by 2.6- and 1.4-fold increase (p < 0.001) in MPO activity and H2O2 concentration, respectively. However, no correlation was found between increments in these three variables. CONCLUSION: Since PMNL and MPO--H2O2--Cl- system are involved in the first line of defense against invading pathogens it is suggested that the above mentioned changes may represent one among mechanisms leading to enhancement of antibacterial defence in the airways in response to treatment with IRS-19.

Right-sided neglect following a left subcortical lesion.

Unilateral spatial neglect is, in humans, typically consequent to lesions of the right hemisphere and pertains to the left hemispace. Although neglect is maximally frequent after right cortical lesions, it may also ensue from lesions confined to right subcortical structures. By contrast, hemispatial neglect consequent to left hemispheric lesions occurs less frequently. Reports of neglect following lesions to left subcortical structures are even more rare and largely anecdotal. Here we report on a right-handed man who had two successive left-sided brain lesions at an interval of 10 years from one another. The first lesion, centered upon the occipital lobe, induced a contralateral hemianopia, but no signs of hemispatial neglect; by contrast, the second lesion, a capsulo-thalamic hemorrhage, did induce a florid and persistent right-sided neglect. This finding would suggest that left subcortical structures may be important nodes in the network subserving spatial representations.

The peer advisor experience providing social support.

Research shows a link between increased social support and decreased complications after myocardial infarction (MI). In a current randomized controlled trial (RCT), a social support intervention administered by nurse and peer advisors is being examined to determine its influence on the health outcomes of unpartnered, post-MI elders. This qualitative study (as part of the larger RCT) sought a better understanding regarding the experience of the peer advisor. Data sources included peer advisor logs, a focus group, and telephone interviews with peer advisors. Findings revealed that helping, mutual sharing, committing, and benefiting are characteristics of peer experiences. Primarily because of their personal experience of recovery from MI, peer advisors had a remarkable ability to relate to assigned post-MI elders, offering a unique form of social support complementary to current health practices.

Addressing sexual abuse in the primary care setting.

OBJECTIVE: To describe factors that prompt pediatric practitioners to suspect child sexual abuse, the barriers to inquiry, and the approach to management of cases of possible abuse. DESIGN: Qualitative, descriptive, and case-based. METHODS: Six focus group interviews were conducted. Maternal and Child Health Bureau-sponsored collaborative office rounds groups nationwide participated in discussions of five vignettes. Each group interview lasted 1.5 hours and had 7 to 16 participants (n = 65). Audiotaped data were transcribed and analyzed independently for themes by two reviewers. RESULTS: Five themes emerged from the group interviews: anticipatory guidance, red flags, approach to management, terminology used in discussions, and barriers to inquiry. All groups discussed giving anticipatory guidance about sexual abuse. Half (3/6) believed girls were more likely to be victimized, and some (2/6) gave more anticipatory guidance to girls for this reason. Although some groups reported giving anticipatory guidance about sexual abuse, many reported inconsistencies in their practice. All groups identified historical, behavioral, and physical red flags for sexual abuse but believed that they were not trained in residency to recognize these signs. There was no consensus regarding the approach to management of cases of possible sexual abuse, and many participants did not know the types of questions that they should be asking children when they suspect abuse. Members of all groups reported using imprecise terms when they discuss sexual issues with families. Most (4/6) believed that it was a practitioner's responsibility to inquire about abuse but believed that their discomfort with sexual topics was a barrier to inquiry. All believed that the most significant barrier to inquiry was inadequate training in the area of sexual abuse and that cases are missed because of lack of training. CONCLUSIONS: Highly motivated pediatric practitioners reported that they give anticipatory guidance about sexual abuse inconsistently, that they were not trained to recognize red flags for sexual abuse, and that they do not have a consistent approach to cases of suspected abuse. Additionally, they reported that they are not comfortable discussing sexual issues and that they miss cases of sexual abuse primarily because of lack of training. Educational interventions that target these themes are essential to improve the ability of pediatricians to screen children and to intervene when sexual abuse is identified.

Atrial natriuretic factor modifies the biosynthesis and turnover of norepinephrine in the rat adrenal medulla.

In the present work we investigate atrial natriuretic factor (ANF) effects on the endogenous content, utilization and turn over of norepinephrine (NE), on tyrosine hydroxilase (TH) activity, on cAMP and cGMP levels, and on phosphatidylinositol hydrolysis in rat adrenal medulla in order to assess the possible mechanisms underlying ANF effects on NE metabolism. Results showed that ANF (5 microg/kg) increased NE endogenous content (44%) and diminished the amine utilization. On the other hand, the atrial factor (10 nM) inhibited both spontaneous and evoked, by 100 mM KCl TH, activity (48% and 59%, respectively). When second messenger systems were studied results showed that 10 nM ANF increased cGMP levels in adrenal medulla (51%), while it modified neither cAMP levels nor phosphatidylinositol hydrolysis. These results suggest that ANF may play an important role in the modulation of the sympathoadrenergic system function, behaving as a putative neuromodulator.

Effect of bacterial extract, IRS-19, on the concentration of hydrogen peroxide and myeloperoxidase activity in nasal washings of patients with chronic bronchitis.

Twenty eight adult patients of both sexes with chronic bronchitis participated in an open study to determine the effect of intranasal treatment with IRS-19, an immunomodulating agent, on the number of polymorphonuclear leukocytes (PMNL), H2O2 concentration and myeloperoxidase (MPO) activity in nasal washings. The number of PMNL recovered from nasal spaces increased from 4460 +/- 3960 to 10,490 +/- 10,950 cells/ml (p < 0.02) after two month administration of IRS-19. It was accompanied by 2.6- and 1.4-fold increase (p < 0.001) in MPO activity and H2O2 concentration, respectively. However, no correlation was found between increments in these three variables. Since PMNL and MPO-H2O2-Cl- system are involved in the first line of defense against invading pathogens it is suggested that above mentioned changes may represent one among mechanisms leading to enhancement of antibacterial defence in the airways in response to treatment with IRS-19.

The newly synthetized pyridobenzoxazocynone inhibits HIV-1 reverse transcriptase activity.

We synthetized pyridobenzoxazocynone that differs in the enlarged eight-membered heterocyclic system from the basic structure of pyridobenzoxazepinones a known class of non-nucleoside HIV-1 reverse transcriptase inhibitors. Pyridobenzoxazocynone hydrochloride was found to inhibit HIV-1 reverse transcriptase activity. At concentration 0.35 microM the enzyme activity decreased by 64 +/- 14%. Higher concentrations of pyridobenzoxazocynone hydrochloride completely abolished the enzyme activity expressed as radioactivity of acid insoluble products. These results suggest that pyridobenzoxazocynones may represent a new class of HIV-1 reverse transcriptase inhibitors.

Sr-90 transfer factors for rye in podzolic soils: dependence on soil parameters.

The transfer factor (TF) for Sr-90 was studied in 10 rye fields with podzolic soils near Bremen. Values between 0.10 and 0.30 were obtained with a mean of 0.18. The TF was correlated with various soil parameters (pH, organic matter, K, Ca and P content). Negative correlations were found between TF and pH-value, Ca and P content. However, the content of organic matter in the soils was positively correlated with soil and grain activity (Bq/kg).