Systematic review and meta-analysis of human milk intake and retinopathy of prematurity: a significant update.

OBJECTIVE: Two recent meta-analyses have studied the association of exclusive or mainly human milk intake (HMI) on retinopathy of prematurity (ROP). One of these meta-analysis found a protective effect of only or mainly HMI on Severe ROP but not on any stage ROP. However, both these meta-analyses did not find protection from any stage ROP or Severe ROP with any amount of HMI. The objective of this study was to study the association between any amount of HMI and the development of All ROP and Severe ROP in very-low birth weight infants (VLBWI) and extremely low birth weight infants (ELBWI) by systematic review using PRISMA-P guidelines and meta-analysis. STUDY DESIGN: Exposure, controls and outcomes studied were any amount of HMI vs no HMI and All ROP/Severe ROP in VLBWI/ELBWI. All ROP was defined as all stages of ROP pooled together, and Severe ROP as ⩾stage 3 ROP and ROP requiring intervention. Results and effect sizes are expressed as odds ratio (OR), relative risk (RR), risk difference (RD) and number needed to treat (NNT) with 95% confidence intervals (95% CI). Data sources used were PubMed, MEDLINE, EMBASE, Cochrane Central Register of Clinical Trials, Scopus and CINAHL until 24 April 2015. Extracted data were pooled using a fixed effects model. Heterogeneity was assessed. Sensitivity analysis was performed. RESULTS: Five hundred nine of 1701 infants who received any amount of HMI developed All ROP vs 310 of 760 infants without HMI developed All ROP with a pooled OR 0.63* (0.51,0.78), RR 0.76* (0.67,0.86) and RD -0.09* (-0.13,-0.05). The NNT with any amount of HMI was 11* (8,20) (*P<0.0001) to prevent one case of All ROP. 204 of 2465 infants who received any amount of HMI developed Severe ROP vs 85 of 764 infants without HMI developed Severe ROP with a pooled OR 0.74* (0.56,0.98), RR 0.77* (0.60,0.98) and RD -0.03* (-0.05,-0.00). The NNT with any amount of HMI was 33* (*P=0.04) to prevent one case of Severe ROP. CONCLUSION: Any amount of HMI is strongly associated with the protection from All ROP and Severe ROP.

Long term diurnal variations in contaminant removal in high rate ponds treating urban wastewater.

In this investigation, diurnal variations in contaminant removal in high rate ponds (HRP) treating urban wastewater were evaluated. Two experimental HRPs (surface area 1.54 m2 and depth 0.3 m), each with a clarifier in series (surface area 0.025 m2), were operated in parallel with different hydraulic retention times (3-10 days) but with the same environmental conditions over a period of one year. The operating strategies adopted only yielded a significant overall difference in removal between the two HRPs for nutrients. Effluent total suspended solids and chemical oxygen demand were slightly higher at midday than at dawn, while for total nitrogen and total phosphorous the concentrations were slightly higher at dawn. All these differences were related to the diurnal changes of DO and pH. The main conclusion of this work is that the diurnal variations of the contaminant concentrations in HRPs do not seriously affect their reliability in treating wastewater.

Student nurse satisfaction: implications for the common foundation programme.

This decade has seen a major restructuring of pre-registration nurse education within the higher education system that was costly and initially largely unpopular with qualified nurses and students. Major flaws have been identified in the common foundation programme (CFP) and student attrition rates remain too high. Our detailed survey of student satisfaction within the CFP shows that clinical placement is the most popular course component and that poor organization remains the worst aspect of the course. Teaching was more highly regarded than the organizational component of the course, although students found room for improvement. Core teaching modules such as bioscience and nursing interventions achieved better ratings than supporting modules, for example social policy or research and reflection on practice. The establishment of contact between personal tutors and students appeared to be slow. The described deficiencies have since been addressed in curriculum planning and the development of new course structure.

Discontinuation, leaving reasons and course evaluation comments of students on the common foundation programme.

There is considerable financial incentive, at all levels, to reduce student nurse wastage and maintain recruitment to a workforce of professional nurses. This strategy is being pursued in a period following major educational change, when the attrition levels and leaving reasons of students need to be reassessed. Previous reports have identified a high voluntary loss of students on the common foundation programme (CFP) of the pre-registration nursing course. In order to achieve a better understanding of the basic problems faced by student nurses who consider leaving the CFP, questionnaires were distributed to three groups of students: current CFP students; students who had completed the CFP; and students who had discontinued training. The questionnaire responses show that course-based problems, identified as prime leaving reasons by the current and completed student groups, differ from the actual leaving reasons of discontinued students obtained by exit questionnaire. The attitudes of participating and discontinued students to theory, clinical and pastoral components of the CFP are not dissimilar. Some trends in attrition rate relate significantly to student category. Our results have implications for the management of student nurse attrition.

A taxonomy of adolescent health: development of the adolescent health profile-types.

OBJECTIVES: The aim of this study was to develop a taxonomy of health profile-types that describe adolescents' patterns of health as self-reported on a health status questionnaire. The intent was to be able to assign individuals to mutually exclusive and exhaustive groups that characterize the important aspects of their health and need for health services. METHODS: Cluster analytic empirical methods and clinically based conceptual methods were used to identify patterns of health in samples of adolescents from schools and from clinics that serve adolescents with chronic conditions and acute illnesses. Individuals with similar patterns of scores across multiple domains were assigned to the same profile-type. Results from the empirical and conceptually based methods were integrated to produce a practical system for assigning youths to profile-types. RESULTS: Four domains of health (Satisfaction, Discomfort, Risks and Resilience) were used to group individuals into 13 distinct profile-types. The profile-types were characterized primarily by the number of domains in which health is poor, identifying the unique combinations of problems that characterize different subgroups of adolescents. CONCLUSIONS: This method of reporting the information available on health status surveys is potentially a more informative way of identifying and classifying the health needs of subgroups in the population than is available from global scores or multiple scale scores. The reliability and validity of this taxonomy of health profile-types for the purposes of planning and evaluating health services must be demonstrated. That is the purpose of the accompanying study.

Health status of well vs ill adolescents.

BACKGROUND: Accountability of health services in meeting needs and assessing outcomes is hampered by the absence of tools to assess health, especially in children and youth. Because it is no longer adequate to assess health by a narrow focus on biological and physiological measures, instruments that assess functional status, person-focused general health status, and overall well-being in a more comprehensive way are needed. OBJECTIVE: To examine whether a health status instrument we have developed discriminates between teenagers in schools and teenagers attending clinics for acute or chronic conditions. METHODS: Teenagers (aged 11-17 years) in schools and in general medical and specialty clinics completed a questionnaire The Child Health and Illness Profile-Adolescent Edition (CHIP-AE), comprehensively covering aspects of health in 6 domains: discomfort, satisfaction with health, disorders, achievement of social expectations, risks, and resilience. RESULTS: Acutely ill teenagers reported more physical discomfort, minor illnesses, and lower physical fitness; chronically ill teenagers reported more limitations of activity, long-term medical disorders, dissatisfaction with their health, and less physical fitness than teenagers in the school samples. Age, sex, and social class did not explain the differences. Teenagers within the acutely and chronically ill clinic populations differed substantially in their health status. IMPLICATIONS: Availability of a comprehensive instrument (CHIP-AE) to assess adolescent health provides a means of documenting health needs and outcomes in populations of teenagers with acute or chronic illness. The heterogeneity within these groups provides support for a person-focused (rather than a disease-focused) approach to assessing both needs for care and the influence of care on promoting health.

The adolescent child health and illness profile. A population-based measure of health.

This study was designed to test the reliability and validity of an instrument to assess adolescent health status. Reliability and validity were examined by administration to adolescents (ages 11-17 years) in eight schools in two urban areas, one area in Appalachia, and one area in the rural South. Integrity of the domains and subdomains and construct validity were tested in all areas. Test/retest stability, criterion validity, and convergent and discriminant validity were tested in the two urban areas. Iterative testing has resulted in the final form of the CHIP-AE (Child Health and Illness Profile-Adolescent Edition) having 6 domains with 20 subdomains. The domains are Discomfort, Disorders, Satisfaction with Health, Achievement (of age-appropriate social roles), Risks, and Resilience. Tested aspects of reliability and validity have achieved acceptable levels for all retained subdomains. The CHIP-AE in its current form is suitable for assessing the health status of populations and subpopulations of adolescents. Evidence from test-retest stability analyses suggests that the CHIP-AE also can be used to assess changes occurring over time or in response to health services interventions targeted at groups of adolescents.

Pars plicata lensectomy/vitrectomy for developmental cataract extraction: surgical results.

Fifty-two cases of developmental cataracts extracted using the pars plicata lensectomy/vitrectomy technique were reviewed. Eyes with additional ocular anomaly other than microphthalmos were not included. No early complications were detected in a postoperative period ranging from 1.5 to 7 years with a median of 4 years, and late complications were limited to secondary membranes occurring in small eyes. Since secondary membranes occurred only in eyes in which the axial length was less than or equal to 17.4 mm and the corneal diameter was less than or equal to 9.5 mm, we suggest that eyes that are small by the absolute dimensions cited here are at greater risk of developing secondary membranes postoperatively. Small eyes by absolute dimensions should be distinguished from microphthalmic eyes, since the relative term microphthalmic is less predictive of risk of complication than are absolute dimensions. Linear Snellen acuity in 15 patients capable of response ranged as follows: 20/20-20/80 with a median of 20/40 in eyes with partial bilateral cataracts; 20/25-20/80 with a median of 20/50 in eyes with complete bilateral cataracts; 20/30-20/400 with a median of 20/200 in eyes with unilateral partial cataracts; and 20/60-CF with a median of 20/400 in eyes with complete unilateral cataracts. Mean patient ages at surgery were 3 months for those with bilateral complete cataracts, 5 months for those with unilateral complete cataracts, 18 months for those with bilateral partial cataracts, and 25 months for those with unilateral partial cataracts. The earliest possible removal of visually significant opacities must be combined with aggressive postoperative visual rehabilitation to obtain the best possible visual outcome.

Intraorbital wood. Detection by magnetic resonance imaging.

The authors present two cases in which intraorbital wooden foreign bodies remained undetected after initial ophthalmologic examination and radiologic investigation which included plain orbital x-rays, orbital computed tomography (CT) scans, and, in one case, orbital ultrasound. In each case, subsequent magnetic resonance imaging (MRI) showed a well-delineated low-intensity lesion suggestive of a retained foreign body. Investigation of a case of suspected wooden foreign body in the orbit should include an MRI scan if there is no contraindication, and no foreign body has been defined on CT scan, ultrasound, or plain orbital films.

Sudden death in childhood in a case of the G syndrome.

We report on the unexpected death at almost 8 years of a boy with the G syndrome who had successfully survived many prior life-threatening complications of the condition. The patient had a characteristic facial appearance, hypertelorism, second-degree hypospadias, stridor and cough on feeding with aspiration of barium, and uncoordinated esophageal swallowing mechanism, but no obvious laryngotracheobranchial defect on endoscopy (or coroner's autopsy). He had a prior cardiac arrest and had outgrown need for a tracheostomy. Aspiration is presumed to be the cause of death.

Changes in conjunctival oxygen tension and temperature with advancing age.

The conjunctival oxygen monitor reflects oxygen tension of the internal carotid artery without introducing the heating artifact characteristic of transcutaneous monitors. It is now being used in the ICU and the operating room to measure accurately and continuously Po2 and temperature of conjunctival tissue. We examined the effect of aging on these values in 101 healthy adult subjects. Mean conjunctival oxygen tension (58 +/- 14 torr) and temperature (34.9 +/- 0.6 degrees C) decreased significantly (p less than .01) with advancing age. Monitoring the conjunctival capillaries may prove to be a useful adjunct to patient care, but the effect of aging must be considered in any such measurement.

Effect of phenylephrine hydrochloride on conjunctival PO2.

Phenylephrine hydrochloride eyedrops induce vasoconstriction through alpha-adrenergic mechanisms. Ten subjects underwent a 46% reduction in conjunctival PO2 when 2.5% phenylephrine eyedrops were administered. Compared with a control group, this reduction was significant. The induced conjunctival hypoxia lasted about 80 minutes. These findings suggest a number of clinical implications.

Parameter Sensitivity In Multivariate Methods.

Multivariate analyses are descriptive models of data. Interpreting the parameters of such models requires knowing how much the fit of the model to the data is impaired by changes in the parameters. The relation of parameter change to loss of goodness of fit can be called parameter sensitivity. Formulas are presented for assessing the sensitivity of multiple regression weights and principal component weights.