Oregon Head and Spinal Cord Injury Prevention Program and evaluation.

Head and spinal cord injuries are the leading causes of death and disability in the age group from 15 to 24. The Oregon Head and Spinal Cord Injury Prevention Program study sought to determine whether an educational assembly program would affect students' knowledge, attitude, and behavior. An observation study on shoulder belt use showed no increase in usage following the program. Seven Portland high schools (4 experimental, 3 control) participated in a questionnaire evaluation. Two weeks before and after the educational assemblies, 1,331 student surveys were distributed nonrandomly in classrooms. Presurveys were matched to postsurveys by student name, resulting in 626 matches. Survey items are grouped into three categories: knowledge, attitude, and behavior. The experimental schools demonstrated a statistically significant increase in knowledge (two-tailed t test, p less than 0.01), suggesting that knowledge had been imparted. No change was found in attitude or behavior. To produce changes in attitude and behavior a reinforcement program might be necessary. Evaluation of the impact of the program on incidence may be premature.

5-Methyltetrahydrofolate level in the serum of depressed subjects and its relationship to the outcome of ECT.

Serum 5-MeTHF levels are reported in 26 subjects, before and after completing a course of ECT, and compared to 21 healthy volunteers. 5-MeTHF levels of depressed subjects were significantly lower than controls before and after ECT. There was no difference in 5-MeTHF levels between ECT responders and non-responders but folate deficiency was related to severity of depression before ECT. Serum 5-MeTHF was not related to treatment response and values remained markedly low even after a good response to treatment.

Poor participation of nulliparous women in a low dose aspirin study to prevent preeclampsia.

Only four of 39 nulliparous women agreed to participate in a placebo controlled study of low dose aspirin therapy to prevent preeclampsia. The major reason for nonparticipation was fear the aspirin would harm the fetus (30 of 35 women). Twenty-four women felt public promotion of a healthy lifestyle influenced their nonparticipation. No woman felt any practical problems related to the study impeded their recruitment and all but one woman felt the study was important and worthwhile. Eleven women considered any drug therapy or research in pregnancy was anathema. As a result of the low response rate a multicentered study was not feasible. Unless new approaches to research are developed, scientific advances in obstetric practice in New Zealand may depend only on research conducted overseas.

Quality end of life care: the case for a MediCaring demonstration.

People in the last phase of life often need a very different care system than the one currently available. MediCaring extends the hospice model to a larger population with a wider array of services over a longer period of time with an emphasis on symptom management, maintenance of function, comfort and family counseling. This model requires simultaneous efforts to secure longer life and to make the patient and family ready for dying. Services range from psychological and spiritual counseling for the patient and family, to emergency care access, to inpatient respite care. MediCaring would accomplish these goals without increasing costs, primarily by diminishing the use of acute care interventions that may no longer serve the patient.

Does age predict the long-term outcome of depression treated with ECT? (a prospective study of the long-term outcome of ECT-treated depression with respect to age).

Sixty-three subjects with DSM-III-R major depression with melancholia or psychosis were followed up 2-4 years after index treatment with electroconvulsive therapy. There was a twofold increase in likelihood of improved outcome with an additional 20 years of age.

Recovery from depression after electroconvulsive therapy is accompanied by evidence of increased tetrahydrobiopterin-dependent hydroxylation.

Serum phenylalanine and tyrosine levels were measured in 26 patients with severe depression before and after receiving electroconvulsive therapy. The phenylalanine:tyrosine [P:T] ratio declined significantly for those responding to treatment but not for nonresponders. These findings are discussed in relation to tetrahydrobiopterin, the essential cofactor for the formation of noradrenaline, dopamine and serotonin and the hydroxylation of phenylalanine to tyrosine.

New endeavors and innovative programs in end of life care.

This paper presents summaries of initiatives and demonstration programs developed by professional and patient care organizations to improve care at the end of life.