Impact of maternal work outside the home during pregnancy on neonatal outcome.

The impact of mothers' work during pregnancy upon neonatal outcome has not been fully elucidated. A study of maternal health habits and neonatal outcome conducted from 1977 to 1979 at Boston City Hospital assessed the effects of paid work outside the home during pregnancy, particularly third trimester work in a standing position, upon duration of gestation and intrauterine growth, while controlling for potentially confounding variables. Postpartum, 1,690 low-income women were interviewed to provide detailed information on their sociodemographic and health characteristics. Of the 1,507 women whose work status during pregnancy could be classified, 55% did not perform paid work outside the home or attend school, 7% worked into the third trimester in a standing position, and 38% had other work histories or attended school. Infants were examined according to a standard protocol by pediatricians blind to mothers' work history. There was no significant relationship between the mothers' work history during pregnancy and the infants' length of gestation, weight, or head circumference at birth, when confounding variables were controlled statistically by multiple regression analyses. However, women who worked in a standing position into the third trimester delivered infants who were longer than infants born either to mothers with other work histories or to mothers who did not work or attend school. Healthy women with uncomplicated low-risk pregnancies who feel well enough to attend school or work during pregnancy, even in a job requiring some standing, may do so without fear that their infant will suffer shortened gestation or impaired intrauterine growth.

B complex vitamin patterns in geriatric and young adult inpatients with major depression.

This study compared the B complex vitamin status at time of admission of 20 geriatric and 16 young adult non-alcoholic inpatients with major depression. Twenty-eight percent of all subjects were deficient in B2 (riboflavin), B6 (pyridoxine), and/or B12 (cobalamin), but none in B1 (thiamine) or folate. The geriatric sample had significantly higher serum folate levels. Psychotic depressives had lower B12 than did non-psychotic depressives. Poorer blood vitamin status was not associated with higher scores on the Hamilton Depression Rating Scale or lower scores on the Mini-Mental State Examination in either age group. The data support the hypothesis that poorer status in certain B vitamins is present in major depression, but blood measures may not reflect central nervous system vitamin function or severity of affective syndromes as measured by the assays and scales in the present study.

Survival of infants born at 24 to 28 weeks' gestation.

Factors affecting the survival of 136 consecutive live-born infants delivered at 24 to 28 weeks' gestation during a 4-year period were analyzed. After careful assessment of gestational age, perinatal care for the fetus of at least 26 weeks' gestation was aggressive. Survival at 26 weeks was 45% and at 28 weeks, 92%. Multivariate analysis showed that the set of variables that best predicts neonatal outcome is gestational age, antepartum glucocorticoid administration, and resuscitation at birth.

Head and neck cancer manpower study.

1. Approximately 40,000 cases of cancer of the head and neck (excluding skin) are diagnosed each year. 2. Approximately 20,000 of these cases and 30,000 cases of skin cancer are treated by 366 head and neck cancer surgeons. 3. Ninety per cent of the cases are treated by 63 per cent of the surgeons. 4. Fifty-eight per cent of the surgeons care for between 50 and 300 cases per year. 5. While 2,759 new board-certified surgeons of all specialties are recruited annually to maintain a work force of 46,000 board-certified surgeons (3), apparently 730 potential head and neck cancer surgeons are being prepared to maintain a work force of approximately 450 head and neck cancer surgeons. 6. These findings indicate the need for in-depth study of the manpower needs in head and neck cancer surgery by all who are responsible for the training of surgeons in this field.

A randomized trial of preoperative radiotherapy in cancer of the oropharynx and hypopharynx.

One hundred patients with stage II and stage III cancer of the oropharynx and hypopharynx were treated under a protocol in which they were randomly selected for treatment by surgery alone or by combined preoperative radiotherapy and surgery. The schedule of preoperative radiation therapy chosen was 2,000 rads from a cobalt 60 machine delivered in five days. Eighty-six of the patients were evaluable at three years; there was no difference in the outcome of the treatment of the two groups. A similar study is urgently needed to determine the value of postoperative radiotherapy in the management of similar cancers.

Relationship of normal serum vitamin B12 and folate levels to cognitive test performance in subtypes of geriatric major depression.

This retrospective study evaluated the relationships between normal serum vitamin B12 and folate levels and neuropsychologic measures in a sample of 60 geriatric inpatients with psychotic depression, nonpsychotic depression, bipolar disorder, and dementia--all consecutively referred for cognitive testing. The psychotic depression subgroup demonstrated numerous significant positive correlations between B12 and cognitive subtests not seen in other diagnostic subgroups, especially those of IQ, and verbal and visual memory. Metabolic factors including vitamin B12 may play specific roles in the cognitive dysfunctions of different geropsychiatric disorders.

The relationship of behavioral cues to assaultive behavior.

The purpose of this 2-year, case control study was to determine whether differentiation between assaultive and nonassaultive patients can be made based on behavioral assessments and/or sociodemographic variables. For each assault incident, the chart of the patient who assaulted and a randomly chosen patient who did not assault on that day were reviewed (N = 72 subjects or 26 pairs). Various scales were used to evaluate the subjects retrospectively (the day prior to the assault), and patients who assaulted staff were interviewed when possible. An analysis found no differences between patients who assaulted and controls on sociodemographic variables. Those who assaulted had significantly more prior assaults (p = .04) and more difficulty verbalizing angry feelings appropriately on their units (p < .01). Prior to the assault, assaultive patients were more verbally hostile (p = .037) and showed more increased motor activity (p = .001) than controls.

Statistical methods in rehabilitation research.

Of 128 articles in Volume 63 (1982) of the Archives of Physical Medicine and Rehabilitation 48 (37.5%) utilized some form of statistical methodology. The most commonly encountered methods were: mean (with or without standard deviation or standard error); analysis of variance (ANOVA); t-tests; simple correlation/linear regression; and chi-square analysis. A critical review of the analytic statistics used in 40 of these articles revealed that only 23 (57.5%) were considered satisfactory in descriptive and methodologic terms. The most frequently encountered deficiencies were: inadequate description of methods; misuse of t-tests; absence of appropriately complex statistical analysis. A greater understanding of and familiarity with biostatistics is essential for all readers of the Archives to allow critical evaluation of the rehabilitation literature.

Patient assault: a comparison of patient and staff perceptions.

The purpose of this study was to compare the perceptions of assaultive patients and staff victims regarding assault incidents. The hypotheses were as follows: (1) There will be congruence between patients' and victims' reports of objective or factual information regarding the assaults and (2) there will not be congruence between patients' and victims' reports of subjective information about the assaults. Monahan's (1981) framework was used for assessing violence on the assaultive patient and the assaulted staff member. Patients who assaulted a nursing staff member and nursing staff members who were assaulted were interviewed, and the congruence of responses between each pair (patient and staff member) on each question was assessed. For 10 items designated as objective, there was agreement between patients and victims in 6 cases and disagreement in 4 cases. For 8 subjective items, in all cases patients and victims gave different perceptions.

A report on graduates of the Boston University six-year combined liberal-arts--medical program.

Graduates of a six-year combined Liberal-Arts-Medicine Program and their medical school classmates (traditional "eight-year" students) are compared as to their medical school performance and their professional postgraduate activities. On standardized examinations (Medical College Admission Test and examinations of the National Board of Medical Examiners) the six-year group was somewhat better than the eight-year group. In other aspects, such as class ranking, honors at graduation, and medicine clerkship grades, the six- and eight-year groups were similar. The two groups were remarkably similar in their postgraduate professional career choices and in achieving board certification. The data for the first three classes indicate that qualified high school students can succeed academically in an accelerated collegiate-degree program, do well in medical school, achieve postgraduate certification, and begin the practice of medicine at a younger age.

The Accelerated Medical Program and the Liberal Arts at Boston University.

Since September 1961, fifteen classes have matriculated in Boston University's Six- Year College of Liberal Arts--Medical Education Combined Degree Program. The applicant pool is approximately three to four times larger now than in the earlier years, with classes averaging 50 students. Academic qualifications (high-school class rank and Scholastic Aptitude Test and College Board Achievement Test results) of the entering classes have been at a consistently high level. Fifty percent or more of the graduates receive the BA degree with honors; 10% or more receive the MD degree with honors. The degree of flexibility in the liberal arts component of the program has increased and currently exceeds that of the traditional four-year premedical curriculum. These data, together with additional information concerning postgraduate professional activities, indicate that the combined accelerated program has been successful.

A metaanalysis of home uterine activity monitoring.

OBJECTIVE: Our purpose was to assess by metaanalysis the evidence from randomized clinical trials regarding home uterine activity monitoring. STUDY DESIGN: Six randomized controlled trials of home uterine activity monitoring, the same six trials reviewed by the U.S. Preventive Services Task Force on home uterine activity monitoring, were studied. Data were extracted from published reports of the six trials. In addition, unpublished data were obtained by personal communication from the trials' principal investigators. Insofar as possible, the principle of intention-to-treat was maintained. Data regarding twins were handled by use of numbers of pregnancies rather than numbers of infants as sample sizes. Stratified metaanalyses were conducted according to whether the trial did or did not control in study design for the nursing contact factor that accompanies home uterine activity monitoring. In addition, stratified metaanalyses were conducted for singleton and twin pregnancies. The four outcomes investigated were incidence of preterm birth, incidence of preterm labor combined with cervical dilatation > 2 cm, infant referral to the intensive care unit, and mean birth weight. RESULTS: Overall, for all pregnancies home uterine activity monitoring was associated with a statistically significant reduction of 52% in risk of preterm labor combined with cervical dilatation > 2 cm (relative risk = 0.48, p = 0.001) and a statistically significant increase of 86 gm in mean birth weight (p = 0.038). When stratified by singleton or twin pregnancy, the pooled results generally differed by strata. Among singleton pregnancies, home uterine activity monitoring was associated with a statistically significant reduction of 24% in risk of preterm birth (relative risk 0.76, p = 0.037) and a statistically significant increase of 126 gm in mean birth weight (p = 0.009). Among twin pregnancies, there was a statistically significant effect of home uterine activity monitoring with a reduction of 56% in risk of preterm labor combined with cervical dilatation > 2 cm (relative risk 0.44, p = 0.005). There were no statistically significant effects found overall and in any stratum with regard to infant referral to the intensive care unit. Metaanalyses of studies that controlled in design for the nursing contact factor that accompanies home uterine activity monitoring showed either no difference or stronger pooled effects compared with metaanalyses of those studies that did not control for nursing contact. This suggests that the potential bias attributed to the nursing contact feature that accompanies home uterine activity monitoring is not as appreciable as home uterine activity monitoring critics have suggested. CONCLUSIONS: Metaanalysis of existing clinical trial evidence regarding home uterine activity monitoring reveals statistically significant benefits of home uterine activity monitoring. Of the outcomes investigated, home uterine activity monitoring is associated with reductions in risks of preterm birth (in singleton pregnancies only) and preterm labor combined with cervical dilatation > 2 cm, as well as with increased mean birth weight (in singleton pregnancies only).

Nursing staff characteristics related to patient assault.

There is an underlying belief that there is something special about the victims of patient assault, that they possess certain characteristics or behave in a different way from those staff who are not assaulted. Is this a case of blaming the victims, or are there some actual differences between those staff members who are assaulted and those who are not? This study undertook this question. Its specific purpose was to (1) characterize staff victims and compare them to nonassaulted staff and (2) document outcomes on staff who were assaulted. The design included a prospective and retrospective phase. Nursing staff on two acute and four long-term psychiatric units were asked sociodemographic and job-related information at the beginning of the study. The frequency with which each staff member was assaulted was recorded. At the end of 1 year, staff who had been assaulted were compared with staff who had not been assaulted. Any staff members who were assaulated were interviewed to assess the physical and emotional effect of the assault on the victim. Findings indicated no difference between assaulted versus nonassaulted staff on sociodemographic factors, with the exception of marital status. Assessment of job-related factors suggested differences on position in the administrative hierarchy, type of activities involved in direct patient care such as medication administration, and education about handling the aggressive patient. Victim outcomes supported the existing literature. The most frequent site of injury was the head. Staff either did not take leave time or returned to work before they recovered, and many reported emotional stress.

Environmental characteristics related to patient assault.

Environmental factors related to physical assault by patients were examined to identify clinical implications warranting further investigation and to test methodology. The concepts of ward conditions (degree of patients' illness, numbers of patients and staff) and ward climate were the focus of the study. Participants were patients and nursing staff on two acute and four long-term psychiatric units in a large neuropsychiatric hospital. Patients and staff were asked to complete the Ward Atmosphere Scale to assess ward mood and climate. Each assault incident was identified from the daily nursing ward report. With each assault occurrence, the nurse manager was asked to complete a questionnaire about environmental conditions at the time of the assault. Most assaults occurred during meal times and afternoons. The most frequent locations were ward corridors and dayrooms. There appeared to be an inverse relationship between assault frequency and number of staff. Crowding rather than total number of patients per ward was suggested as a factor related to assault. Degree of patient acuity seemed to be inversely related to assault frequency. There were suggested trends between assault frequency and a low score on autonomy and a high score on staff control. Clinical implications, ideas for further research, and improved design measures are suggested. The challenge to understand and control this complex phenomenon remains a critical issue for inpatient nursing care.

Predicting violence: nursing diagnosis versus psychiatric diagnosis.

Predicting violent behavior is a major concern for nurses as well as other mental health professionals. Two diagnostic assessment systems (Nursing Diagnosis-NANDA and Psychiatric Diagnosis-DSM III-R) were compared in their ability to predict assaultive behavior. The nursing diagnosis potential for violence suggested a difference (p = .07) between the assaultive and control subjects. No differences were found between assaultive and control subjects on psychiatric diagnoses. Nursing diagnosis is based upon measurable behaviors and is time specific. Clinical implications and further research endeavors in this area are suggested.

Developing psychodynamic group treatment methods for aggressive male inpatients.

Group psychotherapy is one intervention that can be used for aggressive male inpatients. This paper reports relevant literature and clinical applications for conducting a psychodynamic psychotherapy group designed to help patients (a) identify, understand, and deal with underlying problems resulting in aggressive behavior; (b) improve interpersonal relationships; and (c) find more appropriate ways of expressing feelings, particularly those associated with aggressive behavior. The review of literature focuses on therapeutic approaches for dealing with aggressive feelings in group therapy; men's issues in group psychotherapy, including stages of group development for men and the expression of aggression; and the outcome of aggressive behavior in response to group therapy. Clinical applications discussed are preparation for the group; the group contract, including the "group as a whole" approach; patient selection; modeling authority; and countertransference and projective identification.

Measurement of intestinal absorption in mice by a double-label radioisotope perfusion technic.

The use of the standard chemical technic for measuring intestinal glucose absorption was compared with a new double-label radioisotope technic. Glucose absorption and water flux in the mouse small intestine were measured by both methods. The results indicated that the 2 approaches yield almost identical values. The radioisotope technic utilized [14C] polyethylene glycol to measure water flux and [3H] glucose. The technic was found to be reliable, rapid, and applicable to small samples and other substrates. It is particularly suited to absorption studies in small animals such as the mouse, where sample size is limited. The study also showed that the polyethylene glycol recovery rate from the mouse intestine was 97.8%, indicating that it is a valid absorption marker in this species.

Evidence for mitosis in the adult corneal endothelium.

Intracellular structures probably representative of mitotic figures were seen by specular microscopy in the endothelium of a corneal graft following a rejection reaction. Serial measurements over an eight month period initially showed grossly enlarged cells and apparent mitotic figures. Subsequently, clusters of cells smaller than any cells previously seen were observed. Measurements of endothelial cell area over this period demonstrated a highly significant (P less than 0.0001) decrease in cell area, or increase in cell density, with time. These observations indicate that at least under some circumstances mitosis occurs in the endothelium of the adult human cornea.