Inhaled bronchodilator use for infants with bronchopulmonary dysplasia.

OBJECTIVE: To identify factors associated with bronchodilator administration to infants with bronchopulmonary dysplasia (BPD) and evaluate inter-institutional prescribing patterns. STUDY DESIGN: A retrospective cohort study of <29-week-gestation infants with evolving BPD defined at age 28 days within the Pediatric Health Information System database. Controlling for observed confounding with random-effects logistic regression, we determined demographic and clinical variables associated with bronchodilator use and evaluated between-hospital variation. RESULT: During the study period, 33% (N=469) of 1429 infants with BPD received bronchodilators. Lengthening mechanical ventilation duration increased the odds of receiving a bronchodilator (odds ratio 19.6 (11 to 34.8) at ⩾ 54 days). There was profound between-hospital variation in use, ranging from 0 to 81%.C ONCLUSION: Bronchodilators are frequently administered to infants with BPD at US children's hospitals with increasing use during the first hospital month. Increasing positive pressure exposure best predicts bronchodilator use. Frequency and treatment duration vary markedly by institution even after adjustment for confounding variables.

Soil is an important pathway of human lead exposure.

This review shows the equal or greater importance of leaded gasoline-contaminated dust compared to lead-based paint to the child lead problem, and that soil lead, resulting from leaded gasoline and pulverized lead-based paint, is at least or more important than lead-based paint (intact and not pulverized) as a pathway of human lead exposure. Because lead-based paint is a high-dose source, the biologically relevant dosage is similar to lead in soil. Both lead-based paint and soil lead are associated with severe lead poisoning. Leaded gasoline and lead in food, but not lead-based paint, are strongly associated with population blood lead levels in both young children and adults. Soil lead and house dust, but not lead-based paint, are associated with population blood lead levels in children. Most soil lead and house dust are associated with leaded gasoline. Lead-based paint dust is associated with cases of renovation of either exterior or interior environments in which the paint was pulverized. Based upon the limited data to date, abatement of soil lead is more effective than abatement of lead-based paint in reducing blood lead levels of young children. About equal numbers of children under 7 years of age are exposed to soil lead and lead-based paint. Seasonality studies point to soil lead as the main source of population blood lead levels. Soil lead is a greater risk factor than lead-based paint to children engaged in hand-to-mouth and pica behavior. In summary, soil lead is important for addressing the population of children at risk of lead poisoning. When soil lead is acknowledged by regulators and the public health community as an important pathway of human lead exposure, then more effective opportunities for improving primary lead prevention can become a reality.

Colchicine reversibly inhibits electrical activity in arthropod mechanoreceptors.

Colchicine and some other microtubule-active agents inhibit the electrical responses of cockroach tibial spine mechanoreceptors. Lumicolchicine, a colchicine analog which does not bind to microtubule protein, does not inhibit mechanoreceptive responses. Colchicine inhibition of peripheral mechanoreceptive responses is fully reversible and dose dependent, but colchicine has no effect on conduction in leg nerve axons. Colchicine inhibition is therefore an effect on the sensory dendrites or soma. The inhibition produced by colchicine could be produced by several effects. Colchicine may inhibit because it (1) disrupts the numerous intracellular microtubules which are a part of this sensory receptor's dendrite, (2) blocks axoplasmic transport of essential materials to the sensory dendrite, or (3) binds to tubulin or other proteins in the dendritic membrane.

An historical look at a contemporary question: the cervical cap.

PIP: The cervical cap was most likely invented during the 19th century and was rediscovered in 1908 by a Viennese physician. The cap was always more popular in Europe than in the US, and the introduction of oral contraceptives and the IUD in the 1960s led to a declining interest in barrier methods. In 1977, the US Food and Drug Administration banned distribution of the cervical cap, presumably in reaction to outbreaks of toxic shock syndrome and despite rising interest in the device on the part of the woman's health movement. It is important for health educators to be informed about empirical research about the cervical cap so that they can counsel consumers in the event that the device is reclassified for general use. Acceptor studies have identified convenience, safety, spontaneity, and comfort as reasons for selecting the cervical cap, while difficult insertion and removal, odor, partner discomfort, and uncertainty about contraceptive effectiveness are cited as reasons for disliking this device. Dislodgement has been a major problem, experienced by almost half of cap acceptors at some point. Discontinuation rates after 6 months of use have been in the 25-40% range. No cases of pelvic inflammatory disease or significant cervical pathology have been recorded. The unplanned pregnancy rate associated with the cervical cap has been estimated to be about 8%. Omission of spermicide, dislodgement, faulty technique, and irregular usage account for most of these failures. There is a need for additional research addressing the issues and documenting the limits of safe cervical cap use.^ieng

You can go home again: evidence from longitudinal data.

In this paper we analyze the economic and demographic factors that influence return migration, focusing on generation 1.5 immigrants. Using longitudinal data from the 1979 youth cohort of the National Longitudinal Surveys (NLSY79), we track residential histories of young immigrants to the United States and analyze the covariates associated with return migration to their home country. Overall, return migration appears to respond to economic incentives, as well as to cultural and linguistic ties to the United States and the home country. We find no role for welfare magnets in the decision to return, but we learn that welfare participation leads to lower probability of return migration. Finally, we see no evidence of a skill bias in return migration, where skill is measured by performance on the Armed Forces Qualifying Test.

'Common sense and a thick hide'. Physicians providing care to their own family members.

OBJECTIVE: To determine how frequently physicians treat their relatives in 17 categories of care, their reasons for deciding to treat, and their level of comfort with this practice. DESIGN: Mailed survey. SETTING: Rural, suburban, and urban practices in Oregon. SUBJECTS: Two thousand fourteen physicians in the following specialties: general practice, family practice, general internal medicine, general surgery, orthopedic surgery, obstetrics/gynecology, and pediatric medicine. RESULTS: One thousand two hundred ninety-two questionnaires (64%) were returned. Minor prescribing was done most frequently, followed by routine pediatric care, physical examinations, and minor surgery. All other forms of care occurred rarely, and there appears to be a gradient based on the level of complexity, seriousness, and potential for conflict with privacy. In general, older, male, and rural physicians provided more services to family members than their younger, female, and urban counterparts. General and family practitioners performed the most family care; general internists, the least. The most important reasons for providing care were convenience for the patient and request from relatives. Providers were most comfortable providing care to their children and least comfortable providing care to their grandparents. CONCLUSIONS: There is a wide range of practice, depending on the nature of the care and provider characteristics. Physicians report treating their own family members rarely and face significant dilemmas when doing so.