Quantitative assessment of chronic lung disease of infancy using computed tomography.

The aims of this study were to determine whether infants and toddlers with chronic lung disease of infancy (CLDI) have smaller airways and lower lung density compared with full-term healthy controls. Multi-slice computed tomography (CT) chest scans were obtained at elevated lung volumes during a brief respiratory pause in sedated infants and toddlers; 38 CLDI were compared with 39 full-term controls. For CLDI subjects, gestational age at birth ranged from 25 to 29 weeks. Airway size was measured for the trachea and the next three to four generations into the right lower lobe; lung volumes and tissue density were also measured. The relationship between airway size and airway generation differed between the CLDI and full-term groups; the sizes of the first and second airway generations were larger in the shorter CLDI than in the shorter full-term subjects. The increased size in the airways in the CLDI subjects was associated with increasing mechanical ventilation time in the neonatal period. CLDI subjects had a greater heterogeneity of lung density compared with full-term subjects. Our results indicate that quantitative analysis of multi-slice CT scans at elevated volumes provides important insights into the pulmonary pathology of infants and toddlers with CLDI.

Computed tomography score and pulmonary function in infants with chronic lung disease of infancy.

Chronic lung disease of infancy (CLDI) remains a common outcome among infants born extremely prematurely. In older children and adults with lung disease, pulmonary function and computed tomography (CT) scores are used to follow up respiratory disease and assess disease severity. For infants and toddlers, however, these outcomes have been used very infrequently and most often, a dichotomous respiratory outcome (presence or absence of CLDI) is employed. We evaluated the performance of CT score and pulmonary function to differentiate infants and toddlers with CLDI from a control group. CT scans, forced expiratory flows and pulmonary diffusing capacity were obtained in 39 CLDI patients and 41 controls (aged 4-33 months). CT scans were quantified using a scoring system, while pulmonary function was expressed as Z-scores. CT score outperformed pulmonary function in identifying those with CLDI. There were no significant correlations between CT score and pulmonary function. CT score had a better performance than pulmonary function in differentiating individuals with CLDI; however, these outcomes may reflect differing components of the pulmonary pathophysiology of CLDI. This new information on pulmonary outcomes can assist in designing studies with these parameters. Future studies will be required to evaluate which of the outcomes can better detect improvement with therapeutic intervention and/or lung growth.

Lung structure and function of infants with recurrent wheeze when asymptomatic.

Infants with recurrent wheeze have repeated episodes of airways obstruction; however, relatively little is known about the structure and function of their lungs when not symptomatic. The current authors evaluated whether infants with recurrent wheeze have smaller airway lumens or thickened airway walls, as well as decreased airway function. High-resolution computed tomography images 1 mm thick were obtained at three anatomic locations at an elevated lung volume and at functional residual capacity. Forced expiratory flows were also measured in subjects with recurrent wheeze. Airway lumen, wall areas and lung tissue density were not significantly different for recurrent wheeze (n = 17) and control (n = 14) subjects; however, subjects with recurrent wheeze had lower forced expiratory flows than predicted. Similar findings were obtained when subjects were grouped by exposure to tobacco smoke. These findings indicate that infants with recurrent wheeze, as well as exposure to tobacco smoke, have lower airway function when not symptomatic. The lower forced expiratory flows may result from a degree of airway narrowing that could not be resolved with the methodology employed or from other mechanisms, such as more collapsible airways or decreased pulmonary elastic recoil.

Stress, pre-term labour and birth outcomes.

Stress, pre-term labour and birth outcomes Preliminary studies have suggested that stress may be associated with the onset, treatment and outcomes of pre-term labour; however, a systematic comparison of the stress of women with and without pre-term labour has not been reported. Therefore, the purpose of this exploratory study was to compare the stress (daily hassles and mood states) and birth outcomes of black and white women who experienced pre-term labour (PTL) during pregnancy with those who did not. The convenience sample consisted of 35 pregnant women hospitalized in 1996-1997 for the treatment of PTL (24-35 weeks gestation) and 35 controls matched on age, race, parity, gestational age and method of hospital payment. Women in the PTL group had significantly higher tension-anxiety and depression-dejection on the Profile of Mood States (POMS), lower mean birthweight and mean gestational age, and a higher percentage of babies born <37 weeks and weighing 2500 g or less. Black women in the PTL group and white women in the control group had significantly higher scores on the fatigue sub-scale of the POMS and the work and future security sub-scales of the Daily Hassles Scale. Women in the PTL group whose babies weighed 2500 g or less had significantly higher scores on the health, inner concern and financial responsibility sub-scales of the Daily Hassles Scale. The findings from this study indicate the need for further exploration of the interaction of race and stress in understanding and preventing PTL and low birthweight and the need to examine the role of social support in preventing pre-term birth after an episode of PTL.

[Neurosurgical shunt treatment of children with hydrocephalus]. / Nevrokirurgisk shuntbehandling av barn med hydrocephalus.

BACKGROUND: The aims of this study were to determine the ten-year outcome of hydrocephalic children, both in terms of academic results, social skills, physical functioning and surgical morbidity and mortality. MATERIAL AND METHODS: A cohort of 128 children shunted for hydrocephalus at the National Hospital in Oslo between 1985 and 1988 were retrospectively analysed by registering their medical records and in a questionnaire survey. RESULTS: We found that 23 (18%) children died during the ten-year observation period. Six patients died from shunt system failure, ten died from their malignant tumour, six died of their complex cerebral malformations and one died of unknown cause. Of the 105 (82%) children still alive, 104 returned our questionnaire. 92 (88%) reported to be attending a normal school, while 77 (74%) are in the same grade as children of similar age. Of those children at same grade level, 39 (51%) needed extra tutoring, while 35 (45%) reported speech and writing difficulties. Among children not in their adequate grade level, 25 (93%) (p < 0.01) needed extra tutoring, and 23 (85%) (p < 0.01) reported speech and writing difficulties. 50 (48%) participate in physical exercise along with the other children, while 53 (51%) report having normal social relations with children of the same age. 34 (33%) has suffered from epileptogenic seizures, while 24 (23%) daily use prescribed antiepileptic drugs. During the ten-year follow-up period, 108 (84%) patients had a total of 342 shunt revisions. We found no correlation between high incidence of revisions and negative long-term outlook. 99 out of the 105 children alive are considered to be life-long dependent of their shunt system. INTERPRETATION: The vast majority of the children shunted for hydrocephalus that are still alive, have a good or satisfactory level of functioning ten years after their first shunt insertion. This view seems to be shared by the parents of these children, of whom 50 (48%) state that the development of their child has been "very good" compared to what they initially feared.

Future realities in nursing: partnerships, practice, and economics.

Health care reform, innovations in technology, and the need to make health care cost-effective have affected all aspects of health care practice and education. Critical thinking skills, interpersonal and communication skills, leadership and motivation skills, computer literacy, and cultural sensitivity are all capabilities nursing graduates must now possess if they are to practice effectively in the complex and competitive contexts that today define the health care marketplace. Partnerships with community agencies are essential if faculty are to prepare a new generation of nurses who will be proficient in the skills that 21st-century nursing practice will demand. Although academic institutions have made some changes to meet marketplace demands, nursing educators, practitioners, and researchers must thoroughly reconceptualize their philosophies and retool their curricula in response to these changes.

Writing for publication in an RN to Baccalaureate program: an exercise in critical thinking.

More than 35,700 registered nurses are currently enrolled in an RN to Baccalaureate completion program (I). The demand for these graduates is expected to continue, along with an increased demand for community-based educational programs. Many of these students have significant clinical experience and expertise. Nursing faculty are challenged to develop learning experiences and program outcomes that enhance their professional skills and add to their expertise.

Patterns of mental health care among Mexican Americans.

1. Extending cultural care beyond language enhances the use of mental health services and fosters a mutually agreed-on plan of care. 2. Understanding cultural characteristics facilitates an understanding of behavior, family and social dynamics, and adaptation patterns to stress that can empower clients to work toward their goals and validate the impact of emotions and behaviors on others. 3. Culturally appropriate mental health care reflects a synthesis among communication, space, social organization, time, environmental control, and biological variables.

Adolescents' description and management of pregnancy and preterm labor.

OBJECTIVE: To describe adolescents' experiences with pregnancy and preterm labor. DESIGN: Naturalistic inquiry, a qualitative study using intensive, open-ended, tape-recorded interviews and constant comparative data analysis. SETTING: Antepartum units of two hospitals in the southeastern section of the United States. PARTICIPANTS: Eight African American and five white adolescents, ages 14-19 years, hospitalized for preterm labor. RESULTS: The findings are broadly conceptualized as (a) describing pregnancy and preterm labor and (b) managing pregnancy and preterm labor. "Responding to Pregnancy" consisted of descriptions of the adolescents' reactions to pregnancy (initial concern and dislike) and pathophysiologic responses that put the adolescents at risk for preterm labor. "Responding to Preterm Labor" included the various ways that adolescents became aware of preterm labor and their various understandings of the causes and consequences of preterm labor. Vignettes illustrate how adolescents managed pregnancy and preterm labor with ease or with difficulty. Adolescents who received support from others, especially their mothers, tended to deliver near or at full-term. CONCLUSIONS: Nurses can use the findings from this study as a guide for assessing and monitoring adolescents throughout pregnancy. Advanced practice nurses may have the educational background and philosophy of care to provide the most appropriate prenatal care to pregnant adolescents. Research is needed to further explore stressful experiences and support in adolescents' lives and how these are related to preterm labor and birth.

Factors associated with penile amputation in Thailand.

This report describes factors associated with the act of penile amputation by three female partners in southern Thailand. While gender-specific roles and paternalistic behaviors are normative in Thai society, specific precipitating factors for the three amputations included: (1) an immediate financial crisis that adversely affected one of the children in the family; (2) ingestion of drugs or alcohol by the husband immediately before the event; (3) public humiliation of the wife in the presence of a mia noi (secondary wife) or concubine within the week that preceded the incident. Understanding women's cultural preservation in Thailand may promote culturally sensitive and meaningful nursing care.

Fathers' parenting attitudes during a child's first year.

OBJECTIVE: To determine whether fathers' interactions with their children from prebirth to 1 year of age changed the fathers' parenting attitudes as measured by the Adult-Adolescent Parenting Inventory (AAPI). DESIGN: Nonrandomized, longitudinal, descriptive study. SETTING: Private obstetricians' offices, prenatal clinics, and prenatal classes in a large city in the southeastern United States. PARTICIPANTS: White, well-educated, stable, upper-middle class fathers attending prenatal education classes. At time 1 (prebirth), n = 293 with 228 first-time fathers and 65 experienced fathers. At time 2 (3 months), n = 62 with 46 first-time fathers and 16 experienced fathers. At time 3 (1 year), n = 42 with 30 first-time fathers and 12 experienced fathers. MAIN OUTCOME MEASURES: Parenting attitudes as measured by the AAPI. RESULTS: Repeated measures analysis of variance revealed a significant difference in two of the four constructs measured by the AAPI. When their children were 3 months old, fathers scored significantly lower in the areas of expectations and belief in the use of corporal punishment, and their raw scores did not significantly differ in the areas of empathy and appropriate family roles. CONCLUSION: These fathers need education about appropriate expectations of a 3-month-old child and information regarding alternative methods of discipline.

Assessment of the potential for maladaptive parenting in expectant fathers with the Adult-Adolescent Parenting Inventory (AAPI).

The purpose of this investigation was to determine if expectant fathers could be assessed for potential maladaptive parenting with the Adult-Adolescent Parenting Inventory (AAPI). Image factor analysis with matrix rotation by SPSSx was used to replicate Bavolek's (1984) earlier work. It was concluded that the AAPI was appropriate for use with expectant fathers because their responses were not significantly different than those of other populations. The 232 subjects' scores indicated that although they had appropriate attitudes toward empathy and family roles, they had limited knowledge of child growth and development and had strong beliefs in physical discipline. Recommendations include the need for further studies using the AAPI to validate its effectiveness as a predictive tool in the primary prevention of child abuse and neglect.

Implementing negotiating strategies into teen parenting programs.

New parents need information and support to provide care for an infant. When that new parent is a teenager, teen parenting classes can provide the necessary information and support. In addition to basic infant care information, the inclusion of negotiation skills into teen parenting classes enhances the teenager's ability to communicate effectively with immediate family, successfully access preventive health care, and promote positive interactions with other social systems. Steps for incorporating negotiation strategies into teen parenting programs are offered.

Identification of hydroxymethanesulfonate in fog water.

Previous studies have suggested that hydroxymethanesulfonate ion (HMSA) can be an important species in fog and cloud water. Formation of HMSA explains observed excesses of sulfur in the S(IV) state (+4 oxidation state) and formaldehyde (CH(2)O) in fogs and clouds. HMSA was determined in fog water by a novel ion-pairing chromatographic technique. Concentrations in samples collected in Bakersfield, California, within 5 kilometers of major sources of sulfur dioxide (SO(2)), were as high as 300 micromoles per liter. Total CH(2)O and S(IV) concentrations, which were measured independently, ranged from 10 to 200 and 5 to more than 300 micromoles per liter, respectively. Concentrations of CH(2)O, S(IV), and HMSA at Buttonwillow, California, which is 15 kilometers from the nearest source of SO(2), were less than those at Bakersfield but not absent. These data confirm that HMSA forms in atmospheric water droplets and can reach appreciable concentrations. HMSA represents an important source of acidity for water droplets and may also play a role in long-distance transport and transformation of SO(2).