Psychological changes in parents eight months after the loss of an infant from stillbirth, neonatal death, or sudden infant death syndrome--a longitudinal study.

OBJECTIVE: We proposed to measure part of the natural history of grief by determining the changes in the psychological symptoms experienced by bereaved parents over the 8 months after the loss of an infant from sudden infant death syndrome (SIDS), neonatal death (NND), or stillbirth (SB). Parents were interviewed twice, at 2 and 8 months after the loss. METHODOLOGY: A total of 220 bereaved families (45 SIDS, 93 NND, and 82 SB) were compared with 226 control families who had a live born child. Comparison was based on responses to a standardized measure of anxiety and depression (Delusions-Symptoms-States Inventory). RESULTS: For separate cross-sectional comparison at both 2 and 8 months, significant differences were noted in the frequency of maternal symptoms of anxiety and depression between bereaved and control groups (P < .001). Such differences were present for paternal anxiety and depression at 2 months, but not 8 months. A second series of analysis examined longitudinal changes in symptom frequency between 2 and 8 months for each bereaved group. For mothers, the changes were significant for anxiety and depression: SIDS and NND (P < .001), SB (P < .01). For fathers, the changes for anxiety and depression in SIDS were P < .01; NND, P < .05 for anxiety and P < .01 per depression; changes were not significant for SB. At 2 months, relative risks for symptoms of maternal anxiety were significant for all three bereaved groups: SIDS, 22.4; NND, 5.4; and SB, 5.1. Comparable significant figures at 8 months were: SIDS, 5.5; NND, 3.9; and SB, 3.0, respectively. For depression the results for 2 months were: SIDS, 8.6; NND, 5.9; and SB, 6.7 (all significant) while at 8 months the results were: SIDS, 5.1; NND, 3.8; and SB, 2.4 (SB group not significant). For fathers the relevant risks were generally lower. At 2 months, anxiety levels were higher than controls in all three groups, and for depression in the SIDS and SB groups. At 8 months, significant results persisted only in the SB group. CONCLUSION: These data indicate that bereaved parents have a marked reduction in the symptoms of mental illness over the first 8 months after the loss. Although the changes over time are significant for both mothers and fathers, mothers at 8 months still demonstrated higher levels of anxiety and depression when compared with controls. These levels of symptoms are far less evident for fathers at 8 months.

Resection of abdominal aortic aneurysm in the presence of horseshoe kidney.

We report four cases of abdominal aortic aneurysm associated with horseshoe kidney. These cases illustrate the factors that determine the ease of resection in this situation: whether the isthmus of the kidney is parenchymatous or thin and fibrous; the presence or absence of anomalous renal arteries; and the origin of the arterial supply of the renal isthmus. Although the technical challenges involved in aneurysm resection in the presence of horseshoe kidney are significant, these cases illustrate that standard resection and replacement of the aneurysm with a prosthetic graft usually should be possible.

The distribution of polyphosphoinositides in lipid films.

Fluorescence microscopy of Langmuir films is used to determine the effect of polyphosphoinositides (PPIs) on the structure of phosphatidylcholine-containing monolayers. Dramatic alterations in the texture of these films occur as the fraction of PPI in the film is altered. These changes depend on the ionic strength of the underlying subphase and can be accounted for by considering the electrostatic interactions among PPIs. Surface adsorption of a fluorescent peptide derivative based on the PPI binding site of the protein gelsolin co-localizes with PPI-rich domains. Localization of polyphosphoinositides in domains within the inner leaflet of the plasma membrane is proposed to be a key element in some aspects of intracellular signaling, and these data have implications for explaining the cause of restructuring of such domains.

Biodegradable fumarate-based drug-delivery systems for ophthalmic applications.

The function of a photocrosslinked poly(propylene fumarate) (PPF)/poly(N-vinyl pyrrolidone) (PVP) matrix for the sustained release of three ophthalmic model drugs, acetazolamide (AZ), dichlorphenamide (DP), and timolol maleate (TM), was investigated. The drugs differ in molecular weight and degree of dissociation in aqueous environments; both are parameters that significantly influence drug diffusivity. AZ, DP, and TM-loaded cylindrical rods (10 mm length, 0.6 mm diameter) were fabricated by photoinduced cross-copolymerization of PPF and N-vinyl pyrrolidone (NVP) in molds. The released amounts of AZ, DP, TM, and NVP were determined by high-performance liquid chromatography (HPLC). The effects of drug properties and loading on the release kinetics were investigated. The in vitro release of AZ, DP, and TM was well sustained from the polymer matrices over a period of approximately 210, 270, and 250 days, respectively. The release kinetics correlated with the HPLC retention profiles of the different drugs. Following a small initial burst release (<10%), a dual modality release controlled by diffusion and bulk erosion was found for all drugs. Drug release rates of up to 4 microg/day were reached. Matrix drug loading generally affected the extent of the burst release, release kinetics, as well as the matrix water content and matrix degradation that were determined gravimetrically. Microcomputed tomography was used to image structural and dimensional changes of the devices. A preliminary rabbit implantation study revealed promising ocular biocompatibility of drug-free PPF/PVP matrices. All results indicate the potential of photocrosslinked PPF-based matrices as polymeric carriers for long-term ophthalmic drug delivery.

Early parental responses to sudden infant death, stillbirth or neonatal death.

OBJECTIVE: To examine the mental health of parents after stillbirth (SB), neonatal death (NND) or sudden infant death syndrome (SIDS). DESIGN: The sampling frame from southeast Queensland was observed over 2.5 years. Control families were matched for birth date, sex of child, hospital and health insurance status. SETTING: Home interviews, by specially trained social workers, took place two months after the death of the infant. PARTICIPANTS: Results were based on 918 responses from 260 bereaved families (99 SB, 109 NND, 52 SIDS) and 252 control families, with a 63.6% overall participation rate. MAIN OUTCOME MEASURES: Questionnaires included standardised measures of anxiety, depression, biographic and demographic data. It was hypothesised that subject families would show more symptoms of anxiety and depression than control families, with mothers and parents affected by SIDS having the highest levels. RESULTS: Affected parents report significantly more psychological symptoms than controls, mothers more than fathers (P less than 0.001). Parents affected by SIDS showed more symptoms than other affected parents. High levels of anxiety were 14 times more likely in mothers affected by SIDS than controls (95% confidence interval, 5.4-36.6), with depression 12 times more likely (95% confidence interval, 3.8-43.5). Anxiety for groups affected by SB and NND were respectively 3.9 (2.1-10.5) and 6.5 (2.6-16.3) times more likely than for controls, and depression 6.9 (2.1-22.5) and 8.5 (2.7-26.7) times more likely. Differences were less marked for fathers, except for fathers affected by SIDS. CONCLUSIONS: Parents affected by stillbirth, neonatal death or sudden infant death syndrome manifest high levels of anxiety and depression two months after the death. Mothers have more symptoms than fathers, and parents affected by SIDS have the most symptoms of anxiety and depression.

Alcohol and drug usage in parents soon after stillbirth, neonatal death or SIDS.

The behaviour of bereaved parents with respect to their drug and alcohol ingestion was examined 2 months following the loss of an infant from stillbirth (SB) neonatal death (NND) or sudden infant death syndrome (SIDS). Responses from bereaved families (99 SB, 109 NND, 52 SIDS) were compared with 252 control families (who had a liveborn infant). There was no difference in self-medication using aspirin as the example. The use of sedative drugs was significantly higher in all bereaved mothers (but especially the SIDS group). Use of sedatives by fathers was significantly higher only in the SIDS group. There was also a greater frequency of heavy drinking of mothers in all the bereaved groups and fathers in the SIDS group. These results have implications for the understanding and care of families following infant loss.