The financial and psychological impacts on mothers of children with chronic fatigue syndrome (CFS/ME).

BACKGROUND: Paediatric chronic fatigue syndrome or myalgic encephalopathy (CFS/ME) is relatively common and children can be severely affected attending little or no school for extended periods. There are no studies quantifying the financial impact of having a child with CFS/ME and there is little information of the impact on parental mood. METHODS: Forty mothers of children with CFS/ME from a regional specialist CFS/ME service completed inventories to assess their psychological well-being (Hospital Anxiety and Depression Scale, General Health Questionnaire-12) loss of earnings and increased expenditure. In addition, eight mothers took part in a semi-structured qualitative interview. RESULTS: Most parents of children with CFS/ME experience loss of monthly income (mean = £247) and increase in monthly expenditure (mean = £206). Twenty-eight (72%) mothers were above the cut-off for the General Health Questionnaire-12 compared with 20% in the healthy population (95% CI 55, 85, P < 0.001) suggesting they probably have a mental health problem. This may be explained by the qualitative interviews where mothers described five areas contributing to poor parental health: lack of understanding from others; marital tension; concern about their child's distress; concern about the impact on siblings and emotional distress causing physical symptoms. CONCLUSIONS: The majority of families of children with CFS/ME experience decreased income and increased expenditure with a marked impact on maternal psychological health. Clinicians need to be aware of this to provide appropriate support to families who care for children with CFS/ME.

The relative efficiency of drug extraction procedures for enzyme digested livers.

Three different extraction procedures were used to determine drug levels in liver samples subjected to alcalase digestions. A micro-scale 1-chlorobutane extraction produced the most consistent results for a wide range of drug types.

Diazepam, alcohol and drivers.

Fifteen hundred drivers' blood samples have been analysed for the drug diazepam (Valium) over a three-year period. Of 1000 hospitalised drivers whose blood samples were forwarded to DSIR for alcohol analysis, diazepam was detected in 2.0% and alcohol in over 90%. Diazepam was found to a lesser extent in blood samples from 370 fatally injured drivers, and from 130 apprehended drivers who returned low blood alcohol levels. The significance of the levels of diazepam and its major metabolite in blood are discussed in relation to the blood alcohol level and consequent driving impairment.

A survey of mothers' impressions of seizure precipitants in children with epilepsy.

In a survey of 446 children with epilepsy attending a regional EEG unit, mothers of nearly 90% of the children reported factors that appeared to act as precipitants of their children's seizures. The relationship between these factors and the seizures ranged from consistent triggers to an occasional association. There were no differences in incidence according to sex, site of focus, or type of epilepsy. Associations between environmental events or internal states are so commonly perceived by mothers that routine inquiry would appear warranted. If the event can be corroborated as a seizure precipitant, application of psychological methods of seizure control may be appropriate; if the event cannot be corroborated, needless anxiety about particular situations for a child may be avoided.

Unusual causes of calf swelling--1. Unusual presentation of a tibial artery false aneurysm.

Peripheral aneurysms of the leg are rare, and nearly always involve the popliteal artery. We describe the unusual presentation of a swollen leg caused by a large false aneurysm of a branch of the posterior tibial artery. This developed in the absence of either a history of trauma, local infection or infective endocarditis.

Oxidative hemoglobin breakdown induced by a rubber additive.

An antioxidant commonly present in black rubber, N-isopropyl-N'-phenyl-p-phenylenediamine (IPPD) caused very rapid oxidation and denaturation of purified hemoglobin. In the red cells, the reaction resulted in the formation of Heinz bodies, a decrease in reduced glutathione concentration, and stimulation of the hexose monophosphate shunt. IPPD appears therefore to have the potential to induce hemolysis in glucose-6-phosphate dehydrogenase deficiency. It would be expected to be more potent than most redox reagents of this type. It does not require further metabolism to be reactive, and its reactivity is similar to that of phenylhydrazine. But in particular since both IPPD and its oxidized form can oxidize hemoglobin it can act catalytically, and at low concentrations is much more effective than phenylhydrazine. Oxidation of blood stored in contact with rubber seals containing IPPD has been observed. It is also possible that prolonged contact of susceptible individuals either with rubber containing IPPD or to IPPD itself during rubber manufacture could result in hemolysis.