A developmental psychopathology framework of the psychosocial needs of children orphaned by HIV

In addition to the obstacles to a successful resolution of grief normally faced by children whose parents have died, children orphaned by AIDS may face additional psychological and social challenges. However, limited attention has been paid to psychosocial and developmental needs of children orphaned by HIV/AIDS, particularly in resource-poor countries or regions. In this article the authors review the global literature on child bereavement and AIDS orphan care experiences in developing countries and present a developmental psychopathology model of the psychosocial issues facing AIDS orphans. The authors identify gaps in the literature and provide suggestions for future research on AIDS orphans in resource-poor countries and regions. They emphasize that future studies need to assess the status of behaviors and mental health of children orphaned by AIDS within a developmental framework, identify those individual and social factors associated with grief, and examine the long-term impact of quality of care, developmental maturation, and attachment with caregivers on the psychosocial well-being of AIDS orphans.     

Should accident and emergency nurses request radiographs? Results of a multicentre evaluation.

OBJECTIVE--To evaluate whether waiting time in accident and emergency (A&E) departments is shortened when experienced nurses request peripheral limb radiographs before a patient is assessed by a doctor. DESIGN--Simultaneous prospective trial in four A&E departments in the United Kingdom with doctors and nurses requesting radiographs; 2000 patients were randomly allocated to either a "Nurse First" or "Doctor First" category. SUBJECTS--Patients older than 5 years presenting with recent peripheral limb injuries. MAIN OUTCOME MEASURES--Timing of the various stages of a patient's passage through the A&E department comparing the orthodox route with a group of patients in whom an experienced A&E nurse had the option of requesting a radiograph before a medical assessment. RESULTS--There was a significant reduction in the time spent in A&E when no radiograph was requested (P << 0.001). The mean time saved in the "Doctor First" (DF) group was 51 min, and in the "Nurse First" (NF) group 36 min. For those who were sent for an x ray 14 min was saved by getting the patient to see the nurse first. However, because the overall referral rate for x rays was greater in the NF group, (78% of patients compared with 74% of the DF group, a significant 4% increase (P = 0.05) this potential benefit was largely lost. Overall the average waiting time in the DF group of 92.5 min (95% confidence interval: 89.2 to 96.1 min) was reduced to 88.5 min (95% CI:85.2 to 91.8 min) in the NF group, a non-significant saving of 4 min. There was no overall difference between the proportion of relevant abnormalities reported by the radiologists for the DF or NF groups (G2 = 0.739, 1df, P = 0.30); however, there was a significant association between the number of relevant abnormalities reported by the radiologists and the different hospitals (G2 = 9.7626, 3df, P = 0.02). Hospital C had the highest abnormality rate reported by the radiologists in both the DF (45%) and the NF (51%) groups. The most time saved in A&E was in the DF category when comparing those who did not have an x ray [58 (CI 54-63) min] with those who did [109 (CI 104-114) min], a saving of 51 min. The corresponding time saved in the NF category between those who did not have an x ray [59 (CI 53-65) min] and those who did [95 (CI 91-99) min] was 36 min. CONCLUSIONS--14 min can be saved by getting the patient to see the nurse first; however, because nurses in three out of four hospitals requested more radiological examinations than doctors, overall only 4 min waiting time was saved when peripheral limb radiographs were requested by nurses. The findings are somewhat against expectations but do identify that specific training and constant monitoring is essential if nurses are to request peripheral limb radiographs, as reflected in hospital C results.     

Tropomodulin expression in developing hearts of normal and Cardiac mutant mexican axolotl

In the axolotl, Ambystoma mexicanum, a simple, recessive cardiac-lethal mutation in gene “c” results in the hearts of c/c homozygous animals being deficient in sarcomeric tropomyosin (TM) and failing to form mature myofibrils. Subsequently, the mutant hearts do not beat. A three-step model of myofibril assembly recently developed in cell culture prompted a reassessment of the myofibril assembly process in mutant hearts using a relatively new late marker for thin filament assembly, tropomodulin (Tmod). This is, to the best of our knowledge, the first report of tropomodulin in an amphibian system. Tropomodulin antibodies were immunolocalized to the ends of the thin filaments. Tropomodulin was also found in discrete punctate spots in normal and mutant hearts, often in linear arrays suggestive of early myofibril formation. The tropomodulin spots assessed in stage 41/42 mutant hearts co-localized with antibodies to other myofibrillar proteins indicative of nascent myofibril formation. This suggests a failure of elongation/maturation of nascent myofibrils, which could be a consequence of decreased TM levels or increased Tmod/TM ratio. Unlike tropomyosin, there is no apparent decrease in the level of Tmod expression in mutant hearts.     

Commentary: ethical issues in the use of computerized databases for epidemiologic and other health research

Computerization of databases has increased apprehension about loss of privacy. The intent of this paper is to facilitate health research that gives proper respect to ethical principles, thereby increasing public comfort and reducing demands for restrictive legislation concerning access to databases. We review how computerization has increased the saliency of concerns and discuss examples of the application of ethical analysis in published database research. Extreme positions notwithstanding, there is general agreement among researchers that research curiosity and the convenience of database research cannot justify the suspension of moral concerns about privacy and confidentiality. Public and professional concerns may affect policy development; therefore, the methods of ensuring privacy and protecting confidentiality must be routinely described in research proposals and published reports along with the benefits of the research. An important issue requiring further attention is that the moral responsibility to respect privacy increases with the sensitivity of information.     

Epidemiology of severe influenza outcomes among adult patients with obesity in Detroit,Michigan, 2011

We conducted a retrospective cohort study to evaluate the impact of obesity on influenza disease severity. Individuals with obesity were more likely to have lower pulmonary disease manifestations [OR = 1·97 (95% CI 1·05, 3·69), P = 0·03] and to be admitted to an inpatient ward [OR = 2·93 (95% CI 1·50, 5·71), P = 0·002] when compared with non‐obese individuals. Among admitted individuals, persons with obesity were more likely to require a lengthy hospital stay [OR = 3·86 (95% CI 1·03, 14·42), P = 0·045]. Five of the six deaths in study subjects occurred in persons with obesity.     

Evaluation of an education program for patients with breast cancer receiving radiation therapy

The acquisition of knowledge is presumed to be part of the coping process for women facing increased stress because of a breast cancer diagnosis. The purpose of this study was to evaluate the impact of an education program on the perceived adequacy of knowledge of patients with breast cancer receiving radiation therapy. Second, the intent was to investigate the patients' preferences regarding involvement in decision making, amount and type of information wanted, and preferred information-seeking activities.A priori quota sampling was planned to ensure that at least 20 subjects were recruited to each of 3 age categories, assumed to represent premenopausal, perimenopausal, and postmenopausal patients with breast cancer receiving radiation therapy. Subjects (N = 79) completed questionnaires before and after the evidence-based education program. The education consisted of a 20-minute interactive video (first session); individualized education, including technical procedures and self-care (second session); and a 1-hour class (third session). Individual teaching as required was provided afterward during radiation therapy.Significant increases in perceived adequacy of knowledge scores indicate that the program was effective, especially with information concerning disease and treatment for postmenopausal subjects. Subjects' participation in 7 of the information-seeking strategies suggests that many had actively sought information before undergoing radiation therapy. Preferences for information that may be indicative of individual coping patterns were similar for more than half of the subjects. The majority preferred as many details as possible, as much information as possible (good and bad), and to participate in decision making. However, not all subjects wanted complete information, except for the information on all side effects. Findings from this study suggest that individual patients' information preferences, priority information needs, and preferred information-seeking activities should be identified early and incorporated within educational programs to target resources and maximize the likelihood that positive patient outcomes will result.     

Fourth ventricle rosette-forming glioneuronal tumour in children: an unusual presentation in an 8-year-old patient, discussion and review of the literature

Introduction

Rosette-forming glioneuronal tumour of the fourth ventricle is a rarely described entity. While usually having an indolent course and hence classified as a WHO grade 1 tumour, the precise characteristics and risk of recurrence of this tumour are still unknown. In addition, the preferred treatment modality remains unclear.

Discussion

We present a case of an 8-year old with an early recurrence of 9 months after undergoing a sub-total resection of her tumour. Following further resection, there was no tumour present on the 3-month follow-up. In order to better characterise this tumour entity, we performed a review of the available literature on the subject. We found that it mainly affected young adults and had a female predominance. While initially these tumours were described in the fourth ventricle, the current literature suggests that they may be found in a larger variety of sites within the brain and spinal cord. There are several reports of recurrence occurring between 9 months and 10 years following surgery. There is as yet no feature of the tumour that appears to predict the risk of recurrence.

Conclusion

This phenomenon warrants further examination to discover if there is a sub-section of tumours that is likely to recur, and until this is established, all patients should be followed up at regular intervals.     

Meeting the sexual health care needs of young people: a model that works?

Introduction In the UK, young people have been identified as a specific group who experience poor sexual health and there is scope for improving this if sexual health services are sensitive and relevant to their needs. This paper reports on the work of two services which were set up specifically for young people, exploring whether the model of service provision adopted was successful in engaging this group. Methods Routine monitoring data (anonymous) in relation to all contacts with the services were collected. After the services had become established, short questionnaires were administered to young people using them. Results For service one, 425 contacts were recorded over 34 service sessions. Of these, 149 were new clients: 52% young men (78) and 48% young women (71), with a mean age of 14 years. There were 259 repeat contacts: 74% with young men (191) and 26% with young women (68). For service two, 399 contacts were recorded over 61 service sessions. Of these, 118 were new clients: 32% young men (38) and 68% young women (80), with a mean age of 16.8 years. There were 274 repeat contacts: 40% with young men (108) and 60% (166) with young women. All of the young people were generally very satisfied with the services they received. The youngest young people were less likely to indicate that they would have accessed other sexual health services. Discussion and conclusions This study indicates that young people of both sexes, between the ages of 11 and 19 years, can be engaged by sexual health services, if provision is modelled on ‘best practice’ and what is known about the sexual health service needs of young people. Engagement with such services is a prerequisite for addressing the diversity of sexual health needs young people are likely to have in contemporary society and the findings of this study in relation to gender and age are particularly pertinent.     

Long-term follow-up of children breast-fed by mothers receiving depot-medroxyprogesterone acetate

A long-term follow-up study compared development and health of 128 breast-fed children whose mothers had received depotmedroxyprogesterone acetate (depot-MPA) while lactating and 142 control children whose mothers had used mechanical contraceptives or no contraceptives or had undergone sterilization. The children, who were approximately 4-1/2 years old at follow-up, showed no ill effects on their growth and development and health status from exposure to depot-MPA. Depot-MPA-treated mothers lactated significantly longer than controls and also had greater parity than controls. These factors apparently contributed to a difference in weight at follow-up. Compared with the SempePedron standard, more of the depot-MPA group were underweight and more controls were overweight.